Monoclonal antibody against histiocytosis X cells.

Monoclonal antibody against histiocytosis X cells (HXCs) was established. The antigen was the cell membrane of HXCs from the submandibular lesion of a 63-year-old man who had been diagnosed as an adult type of histiocytosis X (HX) and whose HXCs had numerous Birbeck granules (BGs). The obtained monoclonal antibody, named MI1, reacted with the antigenic cell membrane of HXC. Immunoblotting showed that MI1 bound to the cell membrane of 28500 mw. MI1 also reacted with interdigitating reticulum cells (IDCs) in the tonsil and Langerhans cells (LCs) in the epidermis. MI1 reacted with the BGs which connected to the cell membrane, but not with those located near the nucleus.


Morphometric studies on the development of human thyroid gland in early fetal life.

Histological and morphometric studies were performed on 30 thyroid glands obtained from normal human fetuses. Their crown-rump length (CRL) ranged from 57 to 190 mm, corresponding to the gestational age of 10-20 weeks. The weight of the thyroid gland increased proportionally in relation to CRL, foot length and fetus weight. The first follicles containing PAS-positive colloid were observed in the peripheral part of the thyroid gland of 57 mm CRL fetus. The number of follicles per 1 mm2 of thyroid surface section increased up to 85 mm CRL and thereafter gradually declined for the end of studied period of fetal life. The volumes (in mm3) of thyroid epithelium, colloid and stroma, beginning from 85 mm increased proportionally to the CRL while the height of epithelial cells did not change. The epithelium/colloid ratio decreased notably to 165 mm CRL and thereafter remained constant. Results of the present study suggest that the thyroid gland of human fetus approaches structural maturity in 17.5 week of gestation.


Kupffer cells and PIMs in acute experimental African swine fever.

An ultrastructural study of Kupffer cells and pulmonary intravascular macrophages (PIMs) of healthy and African Swine Fever (ASF)-infected pigs was carried out. A vascular perfusion method was performed in order to obtain an optimal intravascular morphology and tissue fixation. The infection developed acute ASF lesions in both organs. Both Kupffer cells and PIMs were studied at different stages of infection. The differences observed in both macrophagic cells from uninfected and infected tissues are shown and discussed.


Age-related morphometric changes occurring in the somata of astrocytes of the granular layer of rat neocerebellar cortex (Crus I and Crus II).

A quantitative study concerning the age-related changes occurring in the cell body and somatic organelles of neocerebellar astrocytes is carried out, using rats aged 2 to 24 months. Manual stereological techniques are used to determine the following parameters on electron micrographs: the somatic volume, the volume density and the absolute volume of the protoplasmic structures as well as the mean surface of the rough endoplasmic reticulum cisternae per cell. None of the parameters reveals any clear-cut general temporal pattern. The soma and the cell components show statistically significant differences in the parameters with ageing, excepting the dense bodies (relative and absolute volumes) and the Golgi apparatus (relative volume). There are significant positive linear trends between, on the one hand, the somatic volume and, on the other hand, the absolute volume of either of the following structures: nucleus, glial filaments, ground substance and dense bodies. Some linear correlations between the absolute volumes of organelles are also found. Despite the ability for karyokinesis, it is concluded that astrocytes do undergo changes with ageing.


The toxic effects of bis (tributyltin) oxide on the rat thoracic aorta.

The toxic effects of bis (tributyltin) oxide (TBTO) on the ultrastructure and permeability of rat thoracic aorta were studied electron microscopically and the accumulation sites of tin were determined with an X-ray microanalyzer. Male Wistar rats received 0.05ml/kg of TBTO as an emulsion in 1 ml of distilled water through a stomach tube. After time intervals of 2, 4, 6, 8, 10, 12 h after intubation, thoracic aortae were isolated and prepared for electron microscopy. Marked swelling of mitochondria in the aortic endothelial cells appeared at 4 h after TBTO treatment. By x-ray microanalysis, tin L-alpha peaks (3.44 keV) were obtained from these swollen mitochondria. Subendothelial edema progressed between 6 and 8 h after TBTO treatment. By tracer experiment, it was seen that large amounts of peroxidase reaction products filled the expanded subendothelial space. At 12 h after TBTO treatment, degenerative changes of the endothelial cells were prominent. These results indicated that orally administered TBTO accumulated in the mitochondria of the endothelial cells of thoracic aorta. The direct toxic effects of TBTO on mitochondria might induce severe damage to the endothelial cells and cause disturbance of the permeability barrier function of the endothelial layer and subendothelial edema.


Histopathology of the pituitary gland in neonatal little (lit) mutant mice.

The pituitary gland in the little (lit) mutant mouse was analyzed with respect to the cytoarchitecture of the pars distalis and the volumetric density of immunoreactive growth hormone (GH) cell granules in neonatal lit/lit and normal C57BL mice. At 8 days postnatally the volume of GH granules/total tissue was significantly less in the lit/lit pars distalis, and the cells were loosely arranged, as compared with the normal pars distalis. In newborn mice a statistically significant difference could not be detected between normal and lit/lit mice with respect to the volumetric density of GH granules; however, differences occurred in the cytoarchitectural organization of the pars distalis. These differences included prominent vascular channels and well-defined cords and clusters of cells in the normal newborn mice, in contrast to indistinct vascular elements and a more diffuse arrangement of cells in lit/lit.


Transforming growth factor-alpha expression in rat experimental hepatocarcinogenesis.

Growth factors in general and transforming growth factor-alpha in particular have been related to cell proliferation and cell differentiation. This study was designed to clarify the distribution pattern of TGF-alpha in chemically-induced hepatocarcinogenesis. Sprague-Dawley rats were subjected to different non-intensive or intensive carcinogenic treatments using diethylnitrosamine (DEN) as carcinogen and ethinyl estradiol (EE) as promoter. The livers were fixed in 2% paraformaldehyde, dehydrated in a series of ethanol solutions, embedded in paraffin and sectioned. In the preneoplastic lesions no TGF-alpha immunoreactive cells were identified, but in some hepatic tumours cell immunostained with TGF-alpha antibody were observed. These results suggest that the cells capable of expressing TGF-alpha constitutively may be involved in neoplastic development in vivo.


Retinal photoreceptor fine structure in the red-backed salamander (Plethodon cinereus).

The retinal photoreceptors of the red-backed salamander (Plethodon cinerus) have been studied by light and electron microscopy. Rods and single cones are present in this duplex retina in a ratio of about 25:1. The photoreceptors in this amphibian species are much larger than is reported for most vertebrates. In the light-adapted state, rods reach deep into the retinal epithelial (RPE) layer. The rod outer segment is composed of discs of uniform diameter displaying several very deep incisors. The rod inner segment displays a distal elliposid of mitochondria and a short stout myoid region. Rod nuclei are electron dense and often protrude through the external limiting membrane. Rod synaptic spherules are large and display several invaginated synaptic sites as well as superficial synapses. It is felt that the rods do not undergo retinomotor movements. The cone photoreceptors are much smaller than the rods and display a tapering outer segment, an unusual modified ellipsoid and a large parabolid of glycogen in the inner segment. Cone nuclei are less electron dense than rods and are located at all levels within the outer nuclear layer. The synaptic pedicle of the cones is larger, more electron lucent and display more synaptic sites (both invaginated and superficial) than that of rods. It is felt that cone photomechanical responses are minimal.


Retinal pigment epithelial fine structure in the red-backed salamander (Plethodon cinereus).

The retinal pigment epithelium (RPE) of the red-backed salamander (Plethodon cinerus) consists of a single layer of large squamous shaped cells. The RPE cells are but minimally infolded basally (sclerally) but show many large apical (vitreal) processes interdigitating with the rod outer segments. These epithelial cells are joined laterally by prominent tight junctions located in the mid region of the cells. Internally smooth endoplasmic reticulum is very plentiful while rough endoplasmic reticulum is not. Polysomes, small dense mitochondria and small round to oval melanosomes are plentiful. Golgi zones and lysosome-like bodies are also present as are phagosomes of outer segment material and myeloid bodies. The RPE cell nucleus is large and vesicular. It is felt that the melanosomes undergo retinomotor movements but as only light-adapted specimens were examined it is not known how extensive are these movements. Bruch's membrane or complexus basalis shows the typical pentalaminate structure noted for most vertebrates. The choriocapillaris is a single layer of large anastomosing capillaries which are minimally fenestrated facing Bruch's membrane.


Carbohydrate cytochemistry of bonnet monkey (Macaca radiaca) nasal epithelium. Response to ambient levels of ozone.

The main purpose of this study was to determine whether exposures to ambient levels of ozone induced changes in the carbohydrate content in the anterior nasal cavity of bonnet monkey. Monkeys were exposed to 0.00. 0.15, or 0.30 ppm of ozone for 6 or 90 days, 8 hours/day. Monkeys treated for 90 days to 0.15 or 0.30 ppm of ozone displayed damaged ciliated cells and a new cell type in their respiratory nasal epithelium, the "intermediate" cells possessing morphological characteristics of both ciliated and secretory cells. Characterization of the secretory cell carbohydrates with the PA-TCH-SP, HID-TCH-SP and LID-TCH-SP techniques indicated the existence of periodate-reactive sulfated and carboxylated polysaccharides in both treated and control monkeys. Ozone-inhalation, however, induced the appearance of a large number of mucous cells with dilated cisternae of rough endoplasmic reticulum compared to controls, which reacted negatively for sugar presence. In addition, in the respiratory epithelium ozone induced the increase of cells with intracytoplasmic lumina containing material reacted positively for sulfated and carboxylated polysaccharides.


Morphometric study on the interhemispheric asymmetries in the Wistar rat and the effects of early experience.

Sixty male Wistar rats were used for this experiment and assigned at random to the control group or to the stimulation method. Control rats show cerebral asymmetry with right bias at the frontal and occipital lobes. In the case of stimulated rats the differences from the occipital zone increase while those from the frontal lobe disappear.


Expression of HBsAg and HBcAg in liver tissue: correlation with disease activity.

The patterns of Hepatitis B surface antigen (HBsAg) and Hepatitis B core antigen (HBcAg) expression were studied in liver biopsies taken from 41 patients with chronic HBV disease. Immunohistochemical methods were used on deparaffinized sections for the identification of HBsAg and HBcAg in liver tissue. Twenty-one of the 41 cases (51.2%) were classified as inactive liver disease and 20 (48.8%) as active liver disease. In liver biopsies with inactive disease, HBsAg demonstrated varying types of cytoplasmic expression in a rather high number of hepatocytes distributed mainly in clusters, while HBcAg was rarely expressed in liver nuclei. On the other hand, in liver biopsies with active disease HBsAg was characterized by a diffuse cytoplasmic expression in a few discrete hepatocytes, while HBcAg was expressed in the nuclei of the hepatocytes in 70% of the cases and in half of the positive cases it was also detected in the cytoplasm. In conclusion, HBsAg expression in a few scattered hepatocytes correlates with active liver disease and positive HBcAg, while varying HBsAg cytoplasmic expression in a rather high number of clustered hepatocytes is related to chronic inactive liver disease and negative expression of HBcAg.


The phylogenetic odyssey of the erythrocyte. III. Fish, the lower vertebrate experience.

The piscine erythrocyte can be considered the prototype of the red cells that are distributed among inframmalian vertebrates. It is a permanently nucleated, hemoglobin-ladened, oval, flattened, biconvex disc. Ultrastructurally it demonstrates a cytoskeleton comprised of a marginal band and a membrane skeleton which are responsible for the erythrocyte's conversion to an ellipsoid during morphogenesis and endow it with resilience to physical trauma. Erythropoiesis initiates in the yolk sac, followed in many fishes, by the intermediate cell mass. These sites are the sources of the transitory, primitive generation red cells which apparently make their first phylogenetic appearance in fishes and which are subsequently represented in all classes of vertebrates including mammals. Production of definitive generation erythrocytes is centered in evolutionary "pre-splenic" tissue of the gastrointestinal tract or in the spleen in cyclostomes, dipnoi, and chondrichthyes while in teleosts it is typically located in the kidneys with or without splenic participation. The blood is a major site of erythrocyte maturation in the lower fishes and exhibits significant numbers of immature erythroid cells plus occasional mitotic figures. Some teleosts also circulate developing erythroid cells. Certain fishes have occasional circulating erythroplastids, conceptually a portent of phylogenetic changes in higher vertebrates. Remarkably, some bristlemouths have denucleated erythrocytes exclusively in the circulation. The largest piscine erythrocytes are found in the dipnoi, myxines, and chondrichthyes. Primitive fish with the exception of the endothermic sharks tend to have lower hemoglobin concentrations than the modern teleosteans. The very highest hemoglobin concentrations are attained by the endothermic scombrids. Erythrocyte-based data have a broad extent and are variably affected by age, sex, season and environment. This report includes a substantial selection of illustrations (fish species and rbc micrographs).


Epidemiology of essential hypertension and diabetes mellitus.

Essential hypertension and diabetes mellitus are highly prevalent and potentially lethal chronic diseases in the US population. Both have ocular complications that can result in permanent vision loss. Ten risk factors for hypertension and six risk factors for diabetes are discussed to help practicing doctors of optometry screen, refer, educate, monitor and co-manage patients who have one or both of these diseases.


In-office laboratory testing for diabetes mellitus.

New technology has made accurate blood glucose determination a possibility within all optometric practices. This paper reviews the technology, methodology, and potential sources of error in office glucose testing.


Hypertension and diabetes: a clinicolegal review.

The optometric management of patients with essential hypertension and diabetes mellitus is determined by both clinical and legal requirements. The most common cause of litigation is failure to recognize retinal changes requiring treatment, combined with a failure to refer. To comply with appropriate standards of care, an optometrist should perform a thorough eye examination (including evaluation of the retina with a dilated fundus examination), educate patients concerning the risks of hypertension or diabetic retinopathy and the need for periodic assessment, describe pertinent findings to the patient's treating physician, schedule patients for periodic reevaluation (as required by examination findings), and refer patients promptly if sight-threatening retinal changes are encountered.


Diagnosis, pathogenesis, and management of essential hypertension.

Hypertension, defined as systemic blood pressure equal to or exceeding 140/90 mm Hg, is a common health problem afflicting approximately 20% of the adult population of the United States. Ninety-five percent have "essential hypertension" for which the pathogenesis is unknown, although both genetic and environmental factors probably are important. Using proper technique, multiple blood pressure determinations made both inside and outside the physician's office are used to diagnose hypertension and assess the effects of treatment. The goal of therapy is to reduce the morbidity and mortality attributable to high blood pressure, which is accomplished by reducing blood pressure to below 140/90 mm Hg. Treatment involves both nonpharmacologic and pharmacologic modalities. Because noncompliance remains a major problem, proper selection of therapy is important. Cooperation of all health care professionals who deal with hypertensive patients is important to ensure control of this common health problem.


Ocular manifestations of hypertension.

Systemic hypertension is a highly prevalent clinical condition encountered in optometric practice on a daily basis. Hypertension produces, both directly and indirectly, a variety of ocular manifestations for which the patient may seek optometric care, or which may be detected by the optometrist during the course of examination. Determination of the patient's blood pressure status through thorough history taking and patient examination, including in-office sphygmomanometry screening, offers a tremendous opportunity for holistic optometric care that has a positive impact on patient longevity and quality of life. This review of hypertensive fundus changes provides an in-depth historical perspective of the ocular manifestations of systemic hypertension, the current clinical and basic research thinking on the pathophysiology of observed hypertensive ocular changes and its appropriate documentation, and the clinical application of this important information in the primary care optometric setting.


Diagnosis, pathogenesis, and management of diabetes mellitus.

Proper care of the patient with diabetes mellitus poses a challenge for all health care professionals. The diagnosis is often established at the onset of symptoms. Early diagnosis through screening of patients at high risk allows prompt initiation of therapy and may help prevent long-term complications. The fasting plasma glucose determination is the most useful diagnostic test, but random plasma glucose and the oral glucose tolerance test are also used to diagnose diabetes, depending on the circumstances. Complex insulin programs and frequent self-monitoring of blood glucose are required to achieve acceptable glucose control in patients with insulin-dependent diabetes mellitus. Treatment of non-insulin-dependent diabetes mellitus requires a choice among diet, sulfonylureas, insulin, or a combination of these therapies. Achievement of treatment goals requires diet, monitoring, education, and continuing care in addition to medication. A general understanding of these goals may help the optometrist participate more effectively in the care of this challenging and important class of patients.


Ocular manifestations of diabetes mellitus.

Diabetes mellitus afflicts approximately 14 to 15 million Americans and is a leading cause of new blindness in the United States. Since eye disease represents an end-organ response to a generalized medical condition, all structures of the eye are susceptible. Furthermore, diabetes produces multiple effects on visual function and visual acuity that require specific clinical consideration. This paper offers a review of some of the key ocular manifestations of diabetes mellitus.


[The concept of continuing education in medical service--competence of physicians in counseling in the field of (social) medicine, law and economics].

The paper describes the performance of continuing education programmes of the Medical Advisory Services in Germany and explains the methodical background. Elements of conceptional structure comprise basic and advanced seminars, professional und special training courses. Realizations of this training concept are described with special regard to demand, utilisation and acceptance with prospects of future.


[Behavior and attitude regarding skin cancer prevention and early detection in relation to current knowledge--studies of visitors to an industrial fair].

During the course of the 42nd International Trade Fair 1990 in Munich a total of 1245 visitors were interrogated with regard to their education in the early recognition of skin cancer, and their behaviour in respect of exposure to sunlight. The same persons were also subjected to melanoma screening, both with regard to special assessment of pigment lesions and inspection of the entire skin. The questionnaire showed that women were better informed than men. Approximately 87% of the questioned women had heard of the problems of melanoma, whereas only about 55% of the men belonged to the informed group. The knowledge of cancer education proved to be above average in the age group between 30 and 60 years. Persons with ample knowledge on melanoma education demonstrated more motivation to take part in cancer prevention examinations and also in examinations relating to other organ systems. Thus, the necessity of cancer screening examinations was substantially more often a matter of course among women than among men. The occurrence of skin cancer on the own body as well as its occurrence in members of one's own family does not guarantee essential knowledge on melanoma education, although in the informed group the percentage of persons directly or indirectly affected by melanoma, was higher. With regard to the behaviour towards sunlight, young people dealt more cautiously and consciously with the sun than those aged 45 and over who had exposed themselves to sunlight without exercising any caution, especially in the past.(ABSTRACT TRUNCATED AT 250 WORDS)


[The Charlottenburg Allergy Prevention Program 90. Early detection and prevention of allergic diseases by modifying mass screening of 3d grade students].

On the one hand, the Charlottenburg allergy prevention programme showed the spread of allergic diseases among the pupils of the third form of public schools, and on the other hand it familiarized parents, teachers and pupils with health promotion schemes under the slogan These who are informed well in time will suffer less. For the first time within the area of Berlin, the Charlottenburg district developed a quality standard in respect of screening and health promotion connected with allergy. This new focal point of attention was set up by means of mass screenings of pupils while at the same time critically reviewing previous routine methods, weeding out unnecessary procedures and emphasizing the essential. The difficult tasks confronting Public Health services in this regard could not be managed without outside help. This was forthcoming from partners recruited from the university, the sickness insurance bodies and self-help groups. The cooperation that developed in this manner was exemplary and might serve as a model for future on-target health prevention programmes.


[Epidemiologic studies of the occurrence of Salmonella heidelberg in the Leipzig area].

This paper reports on observations regarding the appearance of Salmonella heidelberg (S. heidelberg) in the Leipzig district. Included are all isolations of S. heidelberg from 1985 to 1989 in human and veterinary materials as well as surface water and sewage. Our results show that this serovar--originating in a poultry farm--is spreading quickly among the animal stock of the northern part of the former Leipzig district. Parallel to that, S. heidelberg infections in the population increase strongly, with territorial differences. Besides partially very severe clinical findings, the incidence of human germ excretors is very high. Temporal and local parallels to the spreading of the serovar in animal and man are also seen in the surface water and sewage samples. The epidemiological observations and the possible routes and modes of transmission of S. heidelberg are discussed.


[The aims of German medical anthropology in countries of the European Community].

Medical Anthropology deals with the anthropological conditions of health, illness and health care in different societies and cultures, and has to be distinguished in that respect from Social and Industrial Medicine in German language countries which could be considered a kind of official and governmental medicine. While in North America Medical Anthropology has been established at nearly all universities and medical colleges during the last 25 years, corresponding activities in Germany and most other European countries have not reached university level up to now. After referring to general anthropology during the period of enlightenment and to philosophical and medical anthropology in the first half of our century, both to be considered forerunners of medical anthropology in german-speaking countries, an outline of medical anthropology in German-speaking countries, an outline of medical anthropology in the USA is given followed by a survey of questions and problems with which medical anthropology in German-speaking and other European countries has to cope, and would be confronted after the opening of the EC Market in 1993. The article concludes by briefly going into the circumstance of teaching medical anthropology in the Federal Republic of Germany.


[Correlation between traditional Chinese medicine classification of 53 patients with aplastic anemia and varieties of hemopoietic progenitor cells in vitro culture].

Aplastic anemia can be classified distinctively three types as progenitor depletive; immunosuppressive and androgenic sensitive. Using bone marrow culture in vitro which had been accomplished in our laboratory, 53 patients with aplastic anemia were also classified according to TCM term in three groups as Yin deficiency, Yang deficiency and both Yin and Yang deficiency, and the correlation was observed between TCM classification and lab character of these patients. The results showed that the number of CFU-GM, CFU-E and BFU-E in Yang deficiency group was significantly higher than that in the other two groups (P less than 0.01 and P less than 0.05). It also showed that the sensitivity of progenitor cells to androgenic hormones of Yang deficiency group was preferential to all (P less than 0.005 and P less than 0.05). The percentage of immunosuppressive type of aplastic anemia in Yin deficiency group was much higher than those in the other two groups (P less than 0.005). These observations suggested that TCM classification for aplastic anemia in this paper has objective material foundation.


[Relation of T-lymphocyte subsets and symptom complex groups of patients with chronic aplastic anemia].

The T-lymphocyte subsets of 38 patients with chronic aplastic anemia (CAA) were measured by monoclonal antibody (McAb) and ABC method and the relationship of T-lymphocyte subsets and symptom complex groups by traditional Chinese medicine theory were also analysed. It was shown that the T subsets of patients with CAA have remarkable changes: Ts (41.3 +/- 11.2%) increased more than the control (22.9 +/- 4.5%), Th/Ts decreased significantly more than the normal control (0.98 +/- 0.38 to 1.59 +/- 0.38). From the group of deficiency of both vital energy and blood to the group of deficiency of Kidney-yang to the group of deficiency of Kidney-Yin to the group of deficiency of both Kidney-Yang and Kidney-Yin, the Th lymphocyte gradually decreased, Ts lymphocyte successfully increased (from 33.8 +/- 7.9% to 57.7 +/- 7.5%), Th/Ts ratio declined (from 1.29 +/- 0.36 to 0.57 +/- 0.19). The Th/Ts ratio of the latter two groups decreased more than the former two groups (P less than 0.01). These results indicated that the T lymphocyte subsets and symptom complex group of patients with CAA were closely related and when deficient Yang affects Yin the immunologic function of body has a more obvious change. This revealed the connotation of Kidney-Yin and Kidney-Yang on the immuno-regulating cells (T lymphocyte subsets) level.


[High dose cinobufocini in attenuation and treatment of infection and granulocytopenia during combined chemotherapy of malignant blood diseases].

The use of high dose Cinobufocini in attenuation and treatment of infection and granulocytopenia during combined chemotherapy was observed in patients with malignant blood diseases. The study was designed in such a way that each patient served as self control. The patients, 18 males and 12 females, aged 16-66 (average 34), 62 experiments in 20 patients with acute leukemia, 8 with malignant lymphoma and 2 with multiple myeloma were observed. In patients with the treatment of high dose Cinobufocini, infection was significantly decreased and the number of granulocytes was not markedly changed before and after the treatment. The observation demonstrated that high dose Cinobufocini can significantly reduce the risk of infection and degree and duration of granulocytopenia associated with chemotherapy of patients with malignant blood diseases. The use of high dose Cinobufocini is simple and convenient and with very little side effects.


[Relation between cardiac function and the pulse condition, sphygmogram in patients with hemopathy].

The authors determined the impedance plethysmogram, differentiator (dz/dt), carotid arterial pulse wave, apexcardiogram, electrocardiogram and radial sphygmogram of 106 cases with hemopathy by using a RM-6000 polygraph systems. The results showed that the cardiac function of the patients with hemopathy had obviously been injured. The time of ejecting blood was shortened markedly in the left ventricle. The heart rate increased, total peripheral resistance and cardiac output decreased. These led to the formation of rapid slippery and thready pulse. The formation of string-like pulse is related to the injury of cardiac function and decrease of the arterial compliance.


[Pathology of syndrome-differentiation types of superficial deficiencies in patients with gastric cancer].

Analysing the relations between TCM syndrome differentiation type and pathology in 312 patients with gastric cancer, the authors put forward the syndrome differentiation type of deficiency of vitality and excess in superficiality. The studies showed that the four syndrome types of deficiency of vitality such as Spleen-Stomach deficiency, Qi-Xue deficiency, Yin deficiency and inner heat, Spleen-Kidney Yang deficiency and the three syndrome types of excess in superficiality such as Liver-Stomach disorder, blood stasis and stagnation of Qi, Phlegm-dampness and stagnation of toxic. The same changes in pathologic characteristic of both were from early to late stage, the infiltration getting deeper, the tumor getting larger and the metastasis of lymph nodes around the stomach from little to much. Their difference was that in the deficiency of vitality syndrome-type, the chief manifestation was in nest or spread infiltration type which became serious by degrees, whereas in excess in superficiality type, the reaction of lymphoidocytes around the cancer was decreasing. The studies also showed that in most syndrome types of Spleen-Kidney Yang deficiency and Phlegm-dampness and stagnation of toxic, the tumor occurred in wide-range and the degree of tissue differentiation was quite low. The authors suggested that there might be morphopathologic basis in TCM syndrome differentiation types and the conclusion has practical value in guiding clinics.


[Antitumor effect of Tripterygium wilfordii].

A new component of antitumor action TG has been isolated from the ethyl acetate extract of Tripterygium wilfordii (besides Triptolide, Tripdiolide and Triptonide). TG was shown in this study to have obvious antitumor effects. The average life span of H22, S180, EAC and breast carcinoma-bearing mice treated with TG ip x 2 days were 100% more than those of the control mice (P less than 0.01) TG was able to inhibit tumor growth of S37-bearing mice at the dose of 150 mg/kg per day, ig x 3, its inhibitory rate was 42% (P less than 0.01). TG could also inhibit squamous epithelial lung carcinoma induced by 3-methylcholanthrene. The inhibitory rate was 65.13% (P less than 0.05). TG had remarkable killing effect on human HL60 and Daudi cells and two direction effects on function M phi of mouse abdominal cavity in vitro.


[Effects of Chinese materia medica in activating blood and stimulating menstrual flow on the endocrine function of ovary-uterus and its mechanisms].

Effects of Salvia miltiorrhiza (SM), Ligusticum chuanxiong (LC) and Artemisia anomale (AA) on the endocrine function of ovary-uterus were studied. In immature Wistar rats, SM increased the level of estradiol (E2) in plasma (131.8 +/- 7.4 pg/ml, P less than 0.01), the weight of uterus (35.3 +/- 4.5 mg, P less than 0.05) and the ovarian PGF2 alpha content (495.0 +/- 41.7 pg/ova., P less than 0.05), but the ovarian PGE2 content was reduced (2198.3 +/- 139.0 pg/ova, P less than 0.01), as compared with that in the control (96.6 +/- 3.2 pg/ml, 23.3 +/- 2.6 mg, 339.0 +/- 30.0 pg/ova, and 3840.8 +/- 480.0 pg/ova. respectively). LC and AA had no influence except that they decrease PGE2 content in ovary (2534.8 +/- 351.3 and 2629.7 +/- 290.7 pg/ova). AA decreased the receptor binding capacity for E2 in uterus (P less than 0.05). SM stimulated the ovulation in immature mice pre-treated with PMSG. LC and AA had no significant effect on ovulation. In pseudopregnant rats (with PMSC-hCG), SM, LC and AA all inhibited the function of corpus luteum, decreased the level of progesterone in plasma (11.1 +/- 2.8, 15.5 +/- 2.5, 19.3 +/- 5.6, respectively, 55.4 +/- 5.4 ng/ml in control, P less than 0.01) and hCG/LH receptor binding capacity of ovary (P less than 0.01). In pseudopregnant animals treated with AA, endogenous PGE2 content of ovary (50.2 +/- 2.7 pg/ml ova.) and the formation of PGE2 form AA in vitro in ovary (1765 +/- 166 pg/mg ova.) were reduced. The PGF2 alpha content in uterus was increased.(ABSTRACT TRUNCATED AT 250 WORDS)


The use of hypochlorite solutions in wound management.

Hypochlorite solutions have been an issue of controversy for many years. Research has highlighted their harmful effects and yet doctors and nurses continue to use them. This article will review the literature both for and against the use of hypochlorite solutions and will examine alternative wound dressings.


Neuropsychopathology of HIV/AIDS.

Most, if not all, patients with HIV/AIDS experience significant problems in adjusting to a probably fatal illness and require psychological or psychiatric assistance. This places an enormous neuropsychiatric burden on the psychiatric services.


Juvenile chronic arthritis.

Juvenile chronic arthritis affects one in a thousand children in Great Britain. This article will outline the acute systemic forms and describe the impact that this condition has on child and family so that nurses may better manage their care.


The nurse as patient educator.

This article aims to examine the andragogical theory of adult learning and the implication that knowledge of adult learning theory is a prerequisite for successful patient teaching.


Primary nursing and the law.

All professional nursing activities carry legal implications as nurses owe a legal duty of care to their patients. As primary nursing is being increasingly adopted as a system of organizing care nurses need to be aware of the accountability it entails.


How to respond at interview.

Interviewers use a wide range of questioning techniques to explore candidates' potential. Understanding the techniques helps the candidate make a response. This is the first of two articles which consider questioning skills and how to respond.


Promoting continence following head injury.

Assessment and identification of related problems are crucial in the management of incontinence and the promotion of continence. Assessment checklists and regular recording of incontinence using appropriate charts (toilet charting) help the nurse to diagnose the problems. It is not sufficient just to identify incontinence as the problem; assessment should be much more specific, e.g. identifying problems such as nocturia, nocturnal enuresis, urgency, urge incontinence and polyuria. Planning and implementing care should always promote the optimum level of continence as its final ideal goal. Appropriate and adequate management of any specific aspect/type of incontinence should be considered only if the ideal goal is unachievable. The tools and charts used for assessment are also useful in evaluating the effectiveness of care. Incontinence aids should be chosen only after careful assessment and should be used to lessen the specific problem and help promote continence. They should not be used to encourage continuing incontinence.


Staff support groups: are they necessary?

The NHS has the reputation of being a poor provider of emotional care and support for its staff. However, informal data suggest that staff support work is increasing dramatically and is gaining a higher profile on the management agenda.


Measurement of quality of life for elderly people on dialysis.

Renal nurses face certain difficulties when caring for a rapidly increasing population of elderly people. This article examines quality of life and analyses the appropriateness of a self-care philosophy for this group of patients. In addition, the process of adaptation to chronic illness is discussed.


Caring for people with learning difficulties in Czechoslovakia.

In June 1992 a massive step forward was made in Czechoslovakia when the first school for people with learning difficulties was opened. This article examines the problems facing this school and the background to its creation.


Preoperative fasting of patients undergoing elective surgery.

Preoperative fasting regimens tend to be based in ritualistic practice causing physical and psychological harm to patients. This research study investigates current nursing practice and concludes that it must be research based.


Advances in the clinical practice of psychiatric nursing.

Understanding mental health needs forms the basis of psychiatric nursing care. Analysis of these needs and knowing what resources are available determines the clinical practice of psychiatric nursing.


Feeding the critically ill patient.

Evidence for the active role of the gut in multiple organ failure has turned attention away from total parenteral nutrition back to enteral nutrition as the optimal nutritional support in the critically ill. With proper feeding protocols it is possible to feed enterally the most critically ill patients.


Accountability in principle and in practice.

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) has again declared its position on the subject of accountability by publishing the third edition of its Code of Professional Conduct for the Nurse, Midwife and Health Visitor and a new The Scope of Professional Practice. This article examines what these documents mean for professional nursing practice.


How to respond at interview: 2.

The previous article in this series considered some of the extensive questioning techniques that interviewers use to explore candidates' potential. This article will consider in depth the remaining types of questions used in selection interviews.


Health visiting in a well-baby clinic.

This article highlights the changes that were implemented after research was carried out into health visiting practice in a well-baby clinic. The study was the result of collaboration between practitioners and nurses working in the academic field.


Analysis of training needs of qualified nurse practitioners.

Training needs analysis is essential in the development of continuing education programmes. This article outlines a study that attempts to identify a systematic approach to the assessment of training needs of qualified nurse practitioners within three separate health authorities.


Perception of pain management in a hospital in Thailand.

After winning the American Medical International Nurse Scholarship Award in 1990, the author went to the Chulalongkorn University Hospital in Bangkok to study how the nurses in the surgical intensive care unit manage patients in acute pain.


A critique of the Barthel Index.

This article provides a critical review of a popular functional index, the Barthel Index. The strengths and weaknesses of the index with an emphasis on its use by nurses is considered and the need to use this and other functional indices for measuring disability is addressed.


A nursing muse.

The nursing process and nursing models can obstruct nurses' understanding and prevent them from caring for patients in a personalized way. This article introduces a 'nursing muse' as a way of extending understanding beyond scientific intellectualization.


Community care: are we putting all our eggs in one basket?

The forthcoming community care legislation due in April 1993 has been adopted largely without criticism. While supporting the general principles underpinning community care this article sounds a cautionary note, highlighting the need to keep appropriate institutional alternatives to retain an element of choice.


The ontogenesis of skin and organ characteristics in the Syrian golden hamster. III. Ontogenetic and intraspecific allometry for strain and sex as well as body weight- and age-dependent correlations.

The allometric relations, i.e. bodily characteristics, body weight-relationships as well as age-dependent organ and biochemical data were studied in a total of 464 golden hamsters of both sexes of an acromelanic white inbred and agouti coloured outbred strain. In the 3 age sections studied (I = day 1-20, II = day 25-100, III = day 110-365) the body weight- and age-dependent relations were found to be altered between and within the various characteristics. The body weight correlations predominated in the case of organ weights and skin muscle thickness. By contrast, age correlations were seen above all in the skin compartments with cyclic growth, hair follicle density and reticular thickness in the age sections I and II. Papillary thickness showed a positive relation to body weight and age after weaning, but no long-term relations were observed with both plasma insulin and blood glucose levels. The allometric behaviour of skin compartments could be explained particularly by thermoregulatory and "geometric" similarities and that of the organs by metabolic and other similarities. Most sex and strain differences in the absolute data, except for the kidney and adrenal weights, disappeared on allometric analysis and were thus mainly due to differences in body weight. For long-term toxicological investigations, the documentation of age and body weight as well as the determination of ontogenetic allometry is a "must".


Morphological aspects of early and late collagen degradation in granulation tissue.

A sequential histologic, ultrastructural and immuno pathologic study was carried out in the Selye's inflammatory pouch model to observe extracellular matrix and cellular changes during granulation tissue formation. Besides changes involving different components of the connective tissue, it was observed that collagen resorption occurred under a biphasic process. At an early phase (3rd to 15th day), in which exudative inflammatory changes predominated, signs of collagen synthesis and degradation were seen simultaneously. Extracellular breakdown and internalization of collagen fragments within fibroblasts and myofibroblasts were observed. Later on (30th to 60th day), changes affecting collagen had a different ultrastructural appearance. Collagen fragmentation, focal "lytic" and "electron dense" changes occurred in the extracellular space specially at the periphery of fibroblasts, myofibroblasts and smooth muscle cells. Collagen degradation, thus seems to be a continuous process in granulation tissue, occurring with different morphologies at different times.


Local research ethics committees and nursing: a critical look.

The Department of Health guidelines on local research ethics committees are now in operation. But, are they enforceable and what relevance do they have to nursing?


Poverty: a challenge for nursing in the 1990s.

How seriously is poverty considered in nursing practice? This article aims to provide an introduction to poverty in the UK today for all nurses, midwives and health visitors.


Studies on quantitative morphology. XIV. Morphometry of connective tissue in normal and cirrhotic rat livers between accuracy and working expense.

The percentages of connective tissue in sections of normal and cirrhotic rat livers up to values of about 40% are measured by point counting with net point distances between 160 microns and 5,120 microns. For a test area of about 1 cm2 a suitable distance of 640 microns led to a sufficient number of data for an always acceptable accuracy, therefore the measuring time per organ was not more than 10 min for approximately 250-400 hits. In the case presented the coefficient of variation for 10 repeated measurements decreases from 26.9% for normal livers down to 3.5% for livers with about 40% connective tissue. An enlargement of the net point distance for this test area to 1,280 microns and about 100 or less hits results in higher coefficients of variation and inacceptable differences between the x min and the x max data during a series, which becomes more clear for lower percentages. A further enlargement of the net point distance is accompanied by a further inaccuracy, but an enlargement of the test area allows larger net point distances.


How to choose the right applicant.

Appointing staff to a post is a complex process for nurse managers. The cost of failing to select the best person can be high. Careful preparation on the interviewer's part is essential if the selection process is to be effective.


Ex vivo investigation of blood monocyte and platelet behaviour in pigs maintained on an atherogenic diet.

Domestic pigs aged 4 months were fed for 16 weeks an atherogenic diet rich in cholesterol and saturated fatty acid. The increase of plasma cholesterol and triacylglycerol levels was found to be accompanied by a significant increase in the number of blood monocytes and platelets when compared to control animals. Furthermore, the atherogenic diet produced a small but significant reduction in the blood monocyte phagocytic capacity and adhesion to plastic surface. No significant differences between both groups were found when spontaneous platelet aggregation in whole blood was studied. However, platelets from pigs fed the atherogenic diet had a smaller mean cell volume compared to controls. The results indicate than an atherogenic diet may affect blood monocytes and platelets in pigs.


The male reproductive organs in experimental Chagas' disease. II. Morphometric study of the vas deferens in the chronic phase of the disease.

A previous study showed that the vas deferens of mice in the acute phase of Chagas' disease had a slight increase in the muscle layer area associated with a small decrease in the luminal area. The vas deferens of chronic chagasic mice, investigated in the present experiment, presented a marked increase in the luminal area in addition to a significant thinning of the muscle and epithelium layers. The structural alterations of the vas deferens observed in the acute and chronic phases of Chagas' disease were compared with the evolution of chagasic esophagopathy.


In vivo changes of heterogeneity of mouse peritoneal macrophages induced by cis-diamminedichloroplatinum (II) (cis-DDP) and related platinum compounds.

The s.c. injection of cis-DDP into ABD2F1 mice (8 mg/kg b.m.) resulted in alterations of size and surface structure of peritoneal macrophages (PM) and in a reduction of the mean number of Concanavalin A (ConA) binding sites of PM. The PM population of control mice which received physiological saline only consisted of 2 subgroups with a higher and a lower mean ConA binding site number per cell. Contrarily, PM of cis-DDP-treated mice failed the subpopulation with higher ConA binding site number. A loss of this subpopulation was also found in mice treated with platinum salt K2PtCl4 or K2PtCl6. X-ray microanalytically determined elemental contents of PM of control and treated mice showed a correlation between ConA binding site number and cellular concentration of phosphorus or sulphur with the exception of a small group of PM which was characterized by a high content of sulphur and a low number of ConA binding site. This correlation was not found in normal mice.


Healthcare in an Indian hospital.

The Hospicio Hospital of Margoa provides a vast array of services that cater for diverse healthcare needs. This article describes what it is like to nurse in an Indian hospital.


Outpatient nurses must adapt to survive.

Outpatient nursing has long been considered a clinical backwater. However, recent critical reports, the NHS reforms and other trends in healthcare are likely to change this. Outpatient nurses must move quickly to develop a new role for themselves or the opportunity will be lost. They should aim to make the best possible use of their nursing skills, given that outpatients need nursing care.


Liver regeneration in partially hepatectomized rats infused with carnitine and lipids.

Male Wistar rats were subjected to 65-70% hepatectomy. Immediately after surgery a 6-hour infusion was given containing 115 kJ/kg b.w. of long-chain fatty acids (Nutralipid Spofa) (N) or N combined with L-carnitine (Carnitene Sigma Tau) in doses 8 mg (12.4 mumol), 40 mg (62 mumol) and 200 mg (310 mumol)/kg b.w. The rats were killed 6, 18, 21, 24 and 30 h after surgery. The results of our study demonstrate that infusion of lipids combined with carnitine, has a stimulating dose-dependent effect on liver regeneration in partially hepatectomized rats, excluding the low dose of carnitine--8 mg/kg. The dose of carnitine of 40 mg/kg had the highest stimulating effect on the course of the liver DNA synthesis, culminating 21 h after partial hepatectomy. Later, 24 and 30 h after hepatectomy, the mitotic activity of hepatocytes was highest in rats infused with carnitine in doses of 200 mg/kg b.w.


Extracellular enzymes: gene regulation and structure function relationship studies.

The first conclusion that one could make from the literature covered in this section is that most single mutations in subtilisin BPN'n do not cause major structural alterations. Even multiple mutations, though they may cause local minor perturbations at each of the altered sites, do not affect the overall structure to a large degree. Bott and Ultsch (1986) observed that the subtilisin BPN' structure is very tolerant of single mutations, and this tolerance may have been necessary for survival of the enzyme during the course of evolution. This structural tolerance is not all that surprising if one considers that the structure of subtilisin Carlsberg is very similar to that of subtilisin BPN' while the protein sequences differ by 31%. A superposition of the 274 alpha-carbon atoms of the two enzymes gives a root mean square (rms) deviation of 0.053 nm, a value indicating significant structural similarity (McPhalen and James 1988). Furthermore, the fungal enzyme proteinase K, which is classified as part of the subtilisin family, has approximately 38-40% sequence homology with bacilli subtilisins, particularly in the catalytic site and substrate-binding regions (Betzel et al. 1988). For these sequence-homology regions there is also a structural similarity indicated by a least squares superposition of alpha-carbons giving an rms deviation of 0.11 nm (Betzel et al. 1988). Thermitase, also a member of the subtilisin family, has 47% sequence homology to subtilisin BPN' (Gros et al. 1989). If the best 203 alpha-carbon atoms are superposed, then an rms deviation of 0.05 nm is obtained (Gros et al. 1989). Apparently a significant amount of sequence variation still allows for overall structural similarities in the subtilisin family of enzymes. Though the overall structure of subtilisin is not easily perturbed by single or even multiple mutations, it is clear from the evidence reviewed here that single mutations can lead to very significant effects on the catalytic efficiency, substrate preference, and stability of the enzyme. Analyzing the structural alterations in subtilisin mutants will lead to an understanding of the molecular effects of the mutations at the atomic level. This understanding enables investigators to model and predict the effects of other substitutions, and allows them to focus their efforts on those mutants that are most likely to have the desired properties.(ABSTRACT TRUNCATED AT 400 WORDS)


Development of genetic engineering in Bacillus megaterium.

The opportunities for industrial genetic engineering in several species of Bacillus other than B. subtilis and B. thuringiensis are now becoming a reality. Many species have advantages for certain industrial applications, such as the lack of alkaline proteases, stable plasmid maintenance, and production of thermostable enzymes. It is now possible to increase production levels in many Bacillus strains that are already high producers of amylases, proteases, penicillinases, and penicillin amidases, by the introduction of such genes on high-copy-number plasmids. Possible problems in gene regulation, expression, limits on protein production, and secretion will be encountered, but recent reports on comparisons of expression of bacterial and eukaryotic genes in B. subtilis and B. megaterium (Shivakumar et al. 1989; Donovan et al. 1989a, 1989c; Ginsburgh et al. 1989) suggest that some species may prove to be better expression hosts for specific genes than others. What is needed is extensive comparative studies in promising species to better understand the parameters affecting cloning, gene expression, and protein secretion in the bacilli. In this chapter we have emphasized the development of genetic analysis and rDNA methods in B. megaterium. While the chromosomal map is still not a complete circle, many gene loci have been mapped, some with three-factor crosses, and have been characterized by enzyme assays (leu, trp, hem, cob, cbl) as well as complementation with B. subtilis genes (trp, dnaK, pur, met, ssp) E. coli genes (ATPase), hybridization (spoVG, abrB, sigK, ssp), and by growth on intermediates (trp, leu, thy, gua, ade, pur, pyr, his, arg). A mapping kit of 12 strains is available, and can facilitate the mapping of new mutations rapidly. This is of great advantage in strain construction since genes can be transferred at will by cotransduction. A partial physical map generated by pulse gel electrophoresis is also available (Muse 1990). It remains to be determined whether gene conversion occurs in B. megaterium as it does in B. subtilis. This is a powerful tool for rescuing genes and mutations of interest from the chromosome. There are now over 600 mutants available in our laboratory, over 100 in the laboratory of J.C. Vary, and several more that have been characterized in various laboratories throughout the world. Many of these are available in stock culture collections, although this source needs to be expanded. Mutants that should be useful for genetic engineering include recombination negative, protease negative, and plasmidless wild type, as well as Lac negative and several auxotrophs in the plasmidless background, and many sporulation negative mutants.


Patent protection for Aspergillus-related inventions.

Patents are important indicators of trends in biotechnological developments. Patents involving Aspergillus have stimulated growth in bioindustry, particularly in the fermentation and food industries. Patent specifications of Aspergillus-related inventions contain a voluminous amount of technical information and scientific data concerning Aspergillus biotechnology. A review of U.S. patents where Aspergillus cultures are cited in the disclosure demonstrates the value and versatility of the fungus. Identifying and evaluating these inventions is one measure of assessing the technical changes resulting from the use of Aspergillus cultures and of helping the industry maintain its innovative edge.


Protein synthesis in Aspergillus nidulans.

In this review of protein synthesis, we have described a system for translation of mRNA using extracts of A. nidulans. This system is useful for characterizing mutants suspected to have defects in protein synthesis and for assessing the toxicity of various antibiotics and their effects on misreading the genetic code. The well developed genetical system of A. nidulans has enabled us to map at least 27 new genes whose mutation disturbs the level of translational accuracy. These mutants could be used to identify new components of translation or new roles for established components. The abundant fidelity mutations themselves could be used to elucidate the mechanism for maintaining the accuracy of protein synthesis. The large number of mutations in the control of fidelity indicate that mutations in other parts of the translation system could be easily obtained. This would be particularly important for initiation where many factors are thought to be needed and yet their exact roles are unknown. A. nidulans appears to have normal eukaryotic ribosomes and translation factors that can be used to study the mechanism of protein synthesis, its regulation, and the maintenance of its high fidelity. If highly purified factors were used, requirements for hitherto undiscovered factors could be seen. Since A. nidulans has typical eukaryotic responses to inhibitors of translation, it could be used to study new inhibitors, their mode of action, and their potency. Among the fungi, A. nidulans could be a worthy competitor to S. cerevisiae in the field of protein synthesis, particularly because so many translation genes have been identified. The system awaits further exploitation.


The human genetic map.

The introduction of new technology and increased effort from around the world is driving the completion of the human gene map. In parallel with the creation of the map, we are beginning to see the biomedical benefits that are a direct consequence of learning more about our own genome.


CEPH maps.

There are CEPH genetic maps on each homologous human chromosome pair. Genotypes for these maps have been generated in 88 laboratories that receive DNA from a reference panel of large nuclear pedigrees/families supplied by the Centre d'Etude du Polymorphisme Humain. These maps serve as useful tools for the localization of both disease genes and other genes of interest.


Integrating maps of chromosome 21.

The past year has seen major progress in the construction of various types of maps of human chromosome 21. Perhaps more significantly, the chromosome 21 research community is making very significant progress on integration of these maps through the use of common resources and increased collaboration and communication.


The mouse genome: an overview.

A genetic map with one molecularly marked locus per cM will be available for the mouse in the near future. A map of this density should provide molecular reference points that connect genetic and physical maps, identify sites to initiate positional cloning studies for the molecular characterization of mutant loci, and define homologous regions of mouse and human genomes.


Genome mapping: cDNA approaches.

Clones of cDNAs have several practical advantages as start points for making physical maps of genomes: they are mainly single copy; they expand the map because of the introns in the genomic version of the gene; and they are conserved between species. They also address biologically important regions of the genome. Sequence information helps to identify new gene functions.


The gene for X-linked Kallmann syndrome: a human neuronal migration defect.

A new gene from the distal short arm of the human X chromosome has recently been cloned and characterized. Mutations in this gene lead to the neuronal migration defect observed in Kallmann syndrome. Although there is no direct proof for the involvement of this gene in neuronal migration, significant similarities between its predicted protein product and neural adhesion molecules have been found. X-linked Kallmann syndrome represents the first example in vertebrates of a neuronal migration defect for which the gene has been isolated.


Molecular genetics of the fragile-X syndrome: a novel type of unstable mutation.

Fragile-X syndrome, the most common inherited form of mental retardation, has a very unusual mode of inheritance. The disease is caused by a multistep expansion, in successive generations, of a polymorphic CGG repeat localized in a 5' exon of FMR-1, a gene of unknown function. Two main mutation types have been categorized. Premutations are moderate expansions of the repeat and do not cause mental retardation. Full mutations are found in affected individuals and involve larger expansions of the repeat, with abnormal methylation of the neighboring CpG island. The full mutations demonstrate striking somatic instability and extinguish expression of FMR-1. Premutations are changed to full mutation only when transmitted by a female with a frequency that increases up to 100% as a function of the initial size of the premutation. Direct detection of the mutations provides an accurate test for pre- and postnatal diagnosis of the disease, and for carrier detection. A similar unstable expansion of a trinucleotide repeat occurs in myotonic dystrophy.


Beckwith-Wiedemann syndrome, tumourigenesis and imprinting.

The concurrent development of cytogenetic, clinical, genetic and molecular studies has led to the recognition that the different hereditary and non-hereditary forms of the Beckwith-Wiedemann syndrome and associated tumours result from an imbalance between maternal and paternal alleles. The most exciting development in the past year was the discovery of uniparental paternal disomy and the increased understanding, arising from studies in the mouse and in hereditary cases, of the role possibly played by imprinting and somatic mosaicism in partial and complete expression of this complex syndrome.


Mammalian X-chromosome inactivation and the XIST gene.

X-chromosome inactivation is a unique developmental event that results in the cis-limited transcriptional inactivation of most genes on one of the two X chromosomes in female mammals. Studies in both human and mouse have demonstrated that X inactivation requires the presence in cis of a locus, the X-inactivation center, that is thought to be involved in the initiation and/or spreading of the inactivation signal in early development. Identification and characterization of a gene, XIST, which is located at or near the X-inactivation center and which is expressed specifically from the inactive X chromosome in both humans and mouse, suggests that it may be involved in X inactivation.


Prion diseases.

There have been remarkably rapid advances in the understanding of prion diseases over the past year. The controversial notion that the transmissible agent may be an abnormal isoform of a host-encoded protein, the prion protein, is now gaining wide acceptance. The conundrum of how a disease can both be inherited as an autosomal dominant condition and also be experimentally transmissible by inoculation is beginning to make sense.


Mutations in signal transduction pathways and inherited diseases.

Intracellular signal transduction pathways have central roles in processes such as growth, differentiation, neurotransmission and development. The aberrant expression of components of various signal transduction pathways has profound consequences for cellular functions. Recent findings indicate that many cases of neoplasia and inherited diseases have, at their roots, mutations in key steps of signalling pathways.


Molecular genetics of inherited retinal degenerations.

There has recently been substantial progress in categorizing the vast range of human retinal degeneration phenotypes. A molecular approach has assigned chromosomal locations for approximately a dozen such diseases and has identified four of the genes involved.


The olfactory multigene family.

A novel multigene family has been identified that is likely to encode odorant receptors on olfactory sensory neurons. Further studies on this gene family are likely to shed light on the molecular mechanisms underlying information coding in the mammalian olfactory system. This review is also published in Current Opinion in Neurobiology 1992, 2:282-288.


Diabetes mellitus.

Developments on four fronts have contributed to an exciting year for the study of diabetes. These include advances in molecular genetic mapping, analysis of animal models of disease, understanding of disease phenotype, and the extension of statistical methods to the study of complex, non-Mendelian traits.


Mammalian artificial chromosomes.

A mammalian artificial chromosome would enable analysis of the cis-acting DNA sequences necessary for mammalian chromosome function and would allow large numbers of genes in a defined sequence environment to be introduced into experimental animals, agricultural livestock or human cells. Recent technical progress suggests that a route to mammalian artificial chromosome construction is now open.


The Y chromosome as a tool for studying human evolution.

The use of the Y chromosome in human evolutionary research has only recently begun to gain momentum, partly because of a paucity of polymorphism. Differences in male/female behaviour patterns and the unique mode of inheritance of the Y chromosome also complicate interpretation of the data on Y chromosome variation.


The MHC: relationship between linkage and function.

It is intriguing that several genes with associated functions, including all of class I and class II genes, as well as some genes affecting antigen presentation of both class I and class II pathways, are linked in the MHC. Recent observations have led to speculation that there may be a functional explanation for keeping these related genes together.


An overview of developmental genetics in mammals.

Publications in mammalian developmental genetics during the past year reflect a shift of emphasis from the phenotypic level to the primary level of gene expression and the nature of the gene product. A result of this, the developmental role of a considerable number of regulatory genes and specific gene sequences have been identified. The cell type-specific effects of several mutations analyzed in the past have been correlated with effects on growth factors and signal transduction pathways. Specific gene sequences such as those containing the homeobox domains and paired-box sequences have recently been implicated in the control of pattern formation and positional information.


Stages of change for smoking cessation among former problem drinkers: a cross-sectional analysis.

Recent research suggests that problem drinkers are less successful in quitting smoking. Stages of change, decisional balance, and self-efficacy measures were used to assess readiness for smoking cessation in a cross-sectional sample of former problem drinkers who were current smokers. As was expected, a very high percentage of recovering problem drinkers had been or currently were regular smokers. Distributions across the stages of change and relationships between stages and decisional balance in this problem drinker sample was found to be similar to results from more general smoking populations. Of those who had quit both smoking and alcohol, 62% quit drinking before or at the same time as smoking (53% before; 9% simultaneous). Those who quit drinking before or at the same time as smoking were characterized by a more problematic alcohol history. A stages-of-change perspective with this group is discussed, as are new avenues for future research with such populations.


Parental history of alcoholism and probability of marriage.

Personal interview data for 16,795 U.S. adults 18-39 years of age were analyzed to assess the effect of positive parental history of alcoholism on the probability of ever having been married. The data were collected as part of the 1988 National Health Interview Survey. The effects of parental history were estimated using logistic regression models that adjusted for age, race, gender, and respondent history of alcohol problems. Nonblack adults who lived with one or more alcoholic parents when growing up were 50% more likely ever to have been married than those with no parental history. The effect was of the same magnitude regardless of whether the alcoholic parent was the mother or the father, but was larger if both parents were reported to be alcoholics. Among blacks, positive parental history of alcoholism did not affect the odds of marriage. The greater likelihood of early marriage among children of alcoholics may help explain their excess risk of marital disruption.


Assessing total exposures to gasoline vapor using the source exposure model.

Recent developments in source apportionment modeling of volatile organic compounds (VOCs) include receptor modeling (RM) applications to "total" (indoor and outdoor) exposure assessment for source of VOC. Source fingerprints are available for major VOC sources such as gasoline vapor, automobile exhaust, refinery emissions, cleaning solvent vapors, printing inks, and waste-water treatment facilities. The relative proportion of each VOC species in the source fingerprint enables the RM method, through a least squares analysis, to identify each source's presence and quantify its contribution to ambient air concentrations. Sampling periods and locations may be selected to represent microenvironmental exposures. Receptor modeling has direct applicability to determining the relative contribution of gasoline vapors to VOC exposures in the general population.


Physical and mathematical simulation of gasoline component migration in ground water systems.

Results are presented from a research study examining the transport and fate of gasoline components in ground water systems. A two-phased modeling approach is described: first, physical laboratory pilot scale models of aquifer systems are constructed and second, mathematical models are constructed to simulate the data generated in the laboratory studies. In general, single-component batch studies overpredicted the degree of retardation shown by multi-component column experiments.


Effects of nicotine on subjective arousal may be dependent on baseline subjective state.

The often disparate and contrasting effects of nicotine on subjective arousal in smokers may be due in part to differences in presmoking subjective state. In Study 1, on each of 2 days, 10 male smokers were divided into high- and low-baseline subgroups on the basis of median split of resting predrug baseline subjective arousal. Then, subjects received intermittent nicotine (15 mu/kg) or placebo via measured-dose nasal spray, with drug conditions counterbalanced between days. In Study 2, 32 male and female smokers were similarly divided into high- and low-baseline subgroups on subjective arousal prior to either smoking or sham-smoking (n = 16 each) during a single session. Results were virtually identical between studies in showing that subjective arousal responses to nicotine (Study 1) or smoking (Study 2) were significantly inversely related to baseline arousal level; those initially low in arousal showed large increases following nicotine or smoking whereas those high in arousal showed little change. No such baseline dependency of responses was seen following placebo or sham smoking. Baseline dependency of cardiovascular responses to nicotine or smoking was also evaluated in similar fashion to determine generalizability of these effects to nonsubjective responses. In each study, systolic blood pressure response was related to baseline level but there was no effect of baseline level on heart rate and diastolic blood pressure responses. Implications of these results for explaining differential rewarding effects of smoking are discussed.


Relationship of Tridimensional Personality Questionnaire scores and smoking variables in female and male smokers.

The Tridimensional Personality Questionnaire (TPQ) was developed by Cloninger (1986) to measure heritable variation in three patterns of response to environmental stimuli: novelty seeking, harm avoidance, and reward dependence. Cloninger (1987) used the TPQ to identify two types of alcoholism: Type 1 (low novelty seeking, high harm avoidance and reward dependence; both male and female) and Type 2 (high novelty seeking, low harm avoidance and reward dependence; predominantly male). To determine whether characteristic patterns exist in smokers, we administered the TPQ to 119 female and 121 male smokers, along with the Fagerstrom Tolerance Questionnaire (FTQ, a measure of nicotine dependence), the Russell Motives for Smoking Questionnaire (RMSQ), and the Spielberger State-Trait Anxiety Inventory (STAI/trait). Compared with a normative sample, our sample exhibited elevated scores on the Novelty-Seeking scale; female smokers were somewhat overrepresented in the highest quartile of the Harm-Avoidance scale; both genders tended to be clustered in the lower quartiles of the Sentimentality-Attachment-Dependence subscale of the Reward-Dependence scale and in the highest quartile of the Persistence subscale. Female smokers showed a significant positive association between Harm Avoidance and FTQ scores, and Harm Avoidance was positively correlated with several RMSQ factors (including Additive smoking) in both genders. These findings suggest that the likelihood of becoming a smoker may be a function of novelty seeking and reward dependence, whereas degree of dependence or addiction once the habit is entrained may be linked to harm avoidance. Our observations establish the potential utility of the TPQ as a tool for examining environmental and heritable variation in smoking behavior and may contribute to improved strategies for prevention and treatment of smoking.


Patterns of alcoholism inheritance.

Like many other common, complex disorders, alcoholism tends to run in families. Evidence from animal studies as well as biochemical, electrophysiologic, and personality studies of alcoholics and their offspring indicate the existence of heritable factors predisposing to the development of alcoholism. Twin and adoption studies also support the idea that vulnerability to alcoholism depends in part on genetic factors. The observed inheritance, however, does not fit any simple pattern, indicating a substantial degree of etiologic heterogeneity in the alcoholism phenotype, with the ultimate manifestation of the disorder dependent on poorly understood gene-environment interactions. Efforts to address these issues, including the hunt for biological markers, defining more homogeneous subtypes of alcoholism, and molecular genetic strategies of potential use in alcoholism are reviewed.


Gasoline and vapor exposures in service station and leaking underground storage tank scenarios.

Exposure to gasoline and gasoline vapors from service station operations and leaking underground storage tanks is a major health concern. Six scenarios for human exposure were examined, based primarily on measured air and water concentrations of total hydrocarbons, benzene, xylenes, and toluene. Calculated mean and upper limit lifetime exposures provide a tool for assisting public health officials in assessing and managing gasoline-related health risks.


The association of drinking levels and drinking attitudes among Japanese in Japan and Japanese-Americans in Hawaii and California.

This study examined cross-cultural differences in drinking attitudes and drinking levels and their correlation among Japanese in Japan and Japanese-Americans in Hawaii or California. In most situations, an increase in drinking levels was associated with more tolerant drinking attitudes in all three groups. Abstainers were less likely to say that getting drunk is sometimes all right, whereas the reverse was true for heavier drinkers. Drinking levels among Japanese, especially among Japanese women, were not highly associated with how much drinking was perceived as acceptable in each situation, whereas among Japanese-Americans, drinking levels were highly associated with drinking attitudes. Although the Japanese had generally tolerant attitudes toward drinking, they indicated higher abstention rates before driving than Japanese-Americans regardless of their drinking levels. This may reflect the impact of public education on drunken driving in Japan.


Pediatricians' perspectives on fetal alcohol syndrome.

Since the identification of fetal alcohol syndrome (FAS) in 1973, significant inroads have been made towards understanding the effects of alcohol on fetal development. However, it is not clear if these findings are considered clinically relevant by pediatricians. This survey was designed to assess clinical knowledge, practice, and attitudes concerning alcohol-related birth defects. Data were collected in a questionnaire that was mailed to 234 randomly selected Massachusetts pediatricians. Responses suggest that a substantial proportion of pediatricians have knowledge about the effects of alcohol on pregnancy. However, many considered themselves unprepared to deal with this topic. More physicians suspected FAS/FAE than made the diagnosis. Almost three fourths reported they would find professional education in this area helpful. Broader dissemination of research findings in clinically relevant formats and improving the sense of preparedness among pediatricians have the potential to improve the care of children born to heavily drinking pregnant women.


Effects of fasting on responses to intravenous fentanyl in healthy volunteers.

The effects of food deprivation on the subjective, psychomotor, and physiological responses to intravenous fentanyl (50 micrograms/70 kg) were studied in 6 healthy male volunteers. A randomized, placebo-controlled, crossover design was used in which subjects were injected with fentanyl or saline after either 2, 12, or 24 hours of fasting. Subjects completed several subjective effects questionnaires as well as psychomotor tasks prior to, and at regular intervals, following the intravenous injection for a 3-hour period. An observer-rated behavioral checklist was completed at regular intervals during the session and several physiological measures (including measurement of pupil size) were recorded. Fentanyl induced opiate-like mood changes, miosis (pupil constriction), and impairment of extraocular muscle control, and 4 of the 6 subjects reported liking the effects; however, fasting had no impact on any of fentanyl's effects. We conclude that food deprivation up to 24 hours does not alter the subjective, psychomotor, or physiological response to the opiate, fentanyl.


Gender issues in the treatment of abusers of alcohol, nicotine, and other drugs.

This review considers gender issues in the recent literature for alcohol, nicotine, and other psychoactive drug abuse and for each of the three drug types reports: (1) the ratio of men to women treated; (2) gender differences in treatment outcome; (3) whether the senior author's gender is related to the gender ratio of subjects in studies; and (4) the percentage of studies reporting methodological variables by gender (e.g., dropouts, outcome). No evidence for sex differences was obtained for any drug class. However, despite the recognized importance of gender as a treatment variable, the majority (72%) of studies failed to address gender differences in treatment outcome.


[The secular trend of standing height in adolescent girls from longitudinal data].

In this study which is based on the longitudinal data aggregated from health examination records, the subjects consist of 287 girls who attended a private school in Tokyo. The subjects are divided into five groups according to birth year from 1950 to 1970 in order to find secular trend during twenty years with one-way analysis of variance. Age at Peak Height Velocity (APHV), Peak Height Velocity (PHV) and Height attained at Peak Height Velocity (HPHV) were computed in each height velocity curve derived from differential calculus of height distance curve. The result show that HPHV is gradually getting taller by year although APHV and PHV do not change. It may be considered that our subjects of the private school are girls of families in the relatively upper-middle class.


[A survey on the graduates of the baccalaureate program who elected the midwifery course at St. Luke's College of Nursing].

A survey was conducted on the Midwifery Graduates (MG) at the college. 244 students completed midwifery course from 1968 to 1990. The questionnaire was sent to 229 whose address were known, and 133 were responded. The questionnaire consists of demographic data, engagement status with job, expectation to the job, attitude toward the job, and comment on the midwifery course. The results of this study were compared with the study done on the all graduates from 1968 to 1984 at the same school in 1984. As a result, among MG it was shown high rate of higher degree holders and higher in engagement with job. Rate of job holders decreased in the period of childbearing and childrearing, which was similar to the '84 study. But higher in MG who kept their job after marriage. MG who are working in the area of maternal-infant nursing at the time of study, the highest number were being in the clinical nursing, and in the teaching next. The shorter the period from graduation, more number in clinical area, and those who staying in job longer, they were more in either teaching or community nursing area. Among all the subjects worked maternal-infant nursing area, the length of experience as a clinical nurse was approximately 4 years, and it as a teacher was approximately 3 to 4 years. 30 percent of clinical nurse in the maternal-infant nursing, later moved to teaching area. Those who have left their job for personal reasons or earning higher degree, most of them took the job in the area of maternal-infant nursing again. Among MG who were out of job, the rate of willing to return to job were similar to the '84 study.(ABSTRACT TRUNCATED AT 250 WORDS)


Cell targeting by murine recombinant retroviruses.

Cell targeting by murine retroviruses carrying recombinant genes would have numerous applications such as immortalization of under-represented cell types from complex cellular mixtures, increasing therapeutical yields in the case of gene therapy and delivery of specific genes at any location and at any moment of the life-time of living animals. To this aim, we are currently developing techniques that allow binding of viral particles to specific cell membrane markers different from the natural receptors. We have shown that biochemical bi-specific molecular adaptors able to bind both viral particles and cell surface molecules may reveal appropriate for piloting viruses toward specific cell types. More recently, we have undertaken the genetic engineering of the retroviral envelope glycoprotein in order to modify its natural tropism. This approach is discussed below.


Retroviral-mediated gene therapy--safety considerations and preclinical studies.

Retroviral mediated gene transfer (1) is now a clinical reality, with several protocols being conducted. The features that have made these vectors appropriate for the first clinical studies in humans are (i) they are derived from well characterized murine retroviruses (ii) many foreign genes have been expressed in many different cell types, and transduction efficiency can be very high (iii) helper or wild type virus free vectors can be obtained in good titer and (iv) the number of sites of proviral integration is limited although the site of integration in the genome is random. Most of the work described has been conducted in the laboratories of our collaborators, notably Drs. W. French Anderson, R. Michael Blaese, Steven A. Rosenberg, and Arthur W. Nienhuis at the National Institutes of Health, Bethesda, MD, and Dr. Malcolm K. Brenner at St. Jude's Hospital in Memphis, as well as work conducted at Genetic Therapy, Inc. But it is very important to appreciate that retroviral vectors themselves were developed from the pioneering work of researchers in a large number of laboratories in the early and mid 80's.


Feasibility of adenovirus-mediated gene transfer in vivo.

We have evaluated the use of Adenovirus as a new vector for gene transfer in vivo. The capacity of this virus to express a foreign gene even in the absence of viral and cellular replication makes it attractive to deliver a gene to quiescent cells. We show here that organs like lung, liver and muscles are relevant to this strategy.


Clinical application of intrauterine bone marrow transplantation for treatment of genetic diseases--feasibility studies.

Intrauterine bone marrow transplantation (BMT) may represent a new approach for correction of a large variety of genetic disorders in utero. The procedure may become feasible for more genetic disorders in the future, since a large majority of potentially correctible diseases can be diagnosed at an early stage of gestation in utero using molecular probes that permit analysis of small biologic samples and even few cells that may be obtained by chorionic villi biopsy and/or amniocentesis. Haploidentical paternal marrow (2 cases) and sibling bone marrow cells from a disease-free family members, were infused into the fetus. GVHD was avoided following in vitro T-lymphocyte depletion using monoclonal antilymphocyte (CDW52) antibodies (Campath-1) without affecting stem cell viability, similarly to the procedures in routine use in clinical BMT programs in man. Three women underwent intrauterine BMT at 34, 23 and 25 weeks of gestation for metachromatic leucodystrophy (Arylsulfatase A deficiency, 2 cases) and beta thalassemia major (1 case), respectively. A total of 33 x 10(8), 30 x 10(8) and 30 x 10(8) bone marrow cells were infused intraperitoneally (1 case), intraportally plus intraperitoneally (2 cases) with no fetal distress. Although the procedure was uneventful and no clinical evidence of GVHD was observed following delivery, correction of the basic disorders was not accomplished because of anticipated rejection of marrow allografts.(ABSTRACT TRUNCATED AT 250 WORDS)


Hematopoiesis in the human yolk sac: quantitation of erythroid and granulopoietic progenitors between 3.5 and 8 weeks of development.

In a first attempt to investigate the regulation of the early steps of human embryonic hematopoiesis, we measured the number of erythroid and granulopoietic progenitors in 38 human yolk sacs and 15 embryonic livers between 27 and 62 days of development. Both erythroid and granulopoietic progenitors were identified in the yolk sac as soon as 27 days, while in the embryonic liver significant numbers were not observed before 40 days. In the yolk sac, the number of granulopoietic and/or macrophagic progenitors was significantly negatively correlated with gestational age. Such a correlation was not observed for CFU-E and BFU-E, even though in the youngest (less than 30 days) and the oldest embryos studied (greater than 40 days), the number of BFU-E was clearly lower.


The bare lymphocyte syndrome.

The bare lymphocyte syndrome is a combined immunodeficiency resulting from the lack of expression of either class I or class II HLA antigens at the cell surface. The main clinical manifestations are infections of the respiratory or the digestive tract. The immunodeficiency involves the absence of antibody formation and the absence of cell-mediated response, to specific antigen, contrasting with virtually normal transplant immunity to allogeneic determinants. The responsible gene(s) is not born by chromosome 6. The best treatment appears, at the present time, to be in utero stem cell transplantation into the sick fetus, and it may, in the future, be gene therapy.


Characterization of lymphocyte subpopulations in cord blood.

27 cord blood samples from healthy newborns were processed according to a "whole blood" flow cytometric analysis. The CD3-positive T cells are characterized by their variability: 44.8 +/- 13.3% of lymphocytes with a lower expression of the gamma delta T cell receptor. The majority of the CD3+ cells are CD38+. Newborn T cells have less ability than adult T cells to express IL-2 receptors as well as HLA-DR. The CD4-positive T cells are equal to 31.0 +/- 10.8% of lymphocytes with a great prevalence of the CD4+/CD45RA+ population. The CD3+/CD8+/CD11b+ cells are increased to 23.4 +/- 7.1% of lymphocytes. The CD57 antigen is not expressed. The NK population, CD16+/CD56+ is increased to 25 +/- 11% of lymphocytes. 68% of CD19+ cord blood B lymphocytes coexpressed CD5. Thus the "suppressive" and "naïve" cells are prominently represented in cord blood.


Growth and maturation requirements of human B cell precursors.

The present study describes our efforts to induce the proliferation of human B cell precursors (BCP). Committed BCP (CD10+, sIgM-) isolated from fetal bone marrow (18-25 weeks) were induced to proliferate at low levels in the presence of IL7. IL3 potentiated this effect of IL7 on BCP, while IL4 partially inhibited this proliferation. However, neither of these cytokines allowed the emergence of mature B cells. The growth of BCP was strongly potentiated by the presence of an adherent fibroblastic bone marrow stromal layer devoid of cells of hematopoietic origin. Addition of IL7 to such cocultures further increased BCP proliferation. BCP were shown to proliferate as stroma-adherent and non adherent cells. Total cell numbers expanded during 3 weeks, as much as 8 fold in the presence of IL7 when compared with input BCP numbers. Finally, BCP remained sIgM- in stroma dependent cultures, and only a subpopulation of cells became CD20+ in the presence of IL7. Our present study demonstrates the feasibility of human BCP expansion in vitro. However, the signals required for the transition of BCP to mature B cells remain to be determined.


Fetal liver cell transplantation in various murine models.

Allogeneic fetal liver cell transplantation has been shown to be able to reconstitute lymphopoietic systems of mice when these systems are defective or destroyed. Lethally irradiated mice or mice with inherited severe combined immunodeficiency disease (SCID) were grafted with 14 days gestation allogeneic fetal liver cells, then subjected to a follow-up for the immune tolerance to the donor and the normal or subnormal immune reconstitution allowing prevention of diabetes in NOD mice or cure of leukemia in AKR mice and of immunodeficiency in SCID mice. Briefly, when normal CBA mice were lethally irradiated and then grafted with allogeneic fetal liver cells from Balb/c mice, a specific immune tolerance was induced to donor skin grafts. Unrelated skin grafts were rejected and a response to antigens was observed in these chimeras. However, despite the capacity to develop hyperacute rejection of skin allografts, following hyperimmunization, these chimeric mice did not produce anti-H2 cytotoxic antibodies. In SCID mice (CB17), the immune reconstitution occurred when mice were grafted with allogeneic (C57/B16) as well as with syngeneic fetal liver cells. Human cells were found in SCID mice following implantation of human fetal liver and thymus cells. When NOD mice were irradiated, then grafted with allogeneic fetal liver cells, a large part of donor cells were found in NOD recipients, correlating with a low incidence of diabetes. Leukemic AKR mice grafted with allogeneic fetal liver cells had virtually no leukemia relapse, suggesting a strong graft-versus-leukemia effect following such a transplant.


Nursing interventions for children with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder frequently coexists with a variety of psychiatric and developmental disorders of child psychiatric inpatients. The author highlights characteristics of these patients and examines nursing contributions to treatment. She emphasizes issues of medication administration and monitoring, as well as the development and implementation of interventions to decrease disruptive behavior, enhance self-control, and develop social skills. Effective management techniques are supported by research evidence and illustrated by case examples.


Psychotherapeutic interventions with brain-injured children and their families: I. Diagnosis and treatment planning.

Children who suffer brain injuries are at high risk for the development of psychiatric disorders. Using a case study of a healthy, well-endowed boy who suffered a serious brain injury in early childhood, the author highlights typical psychological problems encountered in these children and their families and describes psychotherapeutic issues in diagnosis and treatment planning.


Psychotherapeutic interventions with brain-injured children and their families: II. Psychotherapy.

Drawing on the case of a boy who was treated in an expressive psychotherapy process in childhood and followed for more than 15 years, the author explores a number of critical issues in the literature on psychotherapy with brain-injured children. These issues include: (1) the efficacy of psychotherapy with neurologically impaired children, (2) its relationship to other modes of treatment, (3) the nature of the therapeutic process, (4) the role of concomitant work with parents in treatment, and (5) the importance of follow-up contacts.


Headlock: psychotherapy of a patient with multiple neurological and psychiatric problems.

Psychodynamic psychiatrists seldom engage in psychotherapy with brain-injured patients because psychodynamic treatment typically depends on the patient's highly developed verbal skills, reflectiveness, tolerance of frustration, and capacity for abstract thinking and generalization--characteristics impaired by brain injury. The author describes the difficult but successful extended treatment of a young adult patient with preexisting attention-deficit hyperactivity disorder and personality disorders who had also abused alcohol and drugs and had suffered severe brain trauma. Treatment was characterized by a lengthy developmental process, the success of which depended on several factors, particularly the maintenance of the therapeutic alliance.


Learning disabilities in children with borderline personality disorder.

Children with borderline personality disorder are known to have a variety of school problems, including low achievement. Clinicians working with these youngsters have estimated that one third or more may be learning disabled; however, no empirical studies have confirmed these estimates. The author reports the results of a study of 56 hospitalized borderline children in which score profiles from academic and cognitive measures were cluster analyzed. She examines the incidence of independent learning disabilities as well as subgroup membership, and discusses implications for treatment.


Active management of infertility.

Management of infertility is slow, time consuming and, paradoxically, costly. It needs to be streamlined so that diagnosis and management go hand in hand with proper division between primary physicians at district level and highly trained specialists at regional level. Incorporation of assisted conception techniques is the key to the success of such an approach.


Transtracheal oxygen catheters.

Transtracheal oxygen catheters enable oxygen to be delivered directly into the trachea without the need for a facemask or nasal cannula. They reduce oxygen requirements by approximately 50% and are, therefore, particularly useful when a portable oxygen system is required. These devices are also indicated in selected patients receiving long-term oxygen treatment.


Shared diabetic care.

Increased diabetic mini-clinic activity in general practice offers an unparalleled opportunity to spread the net of integrated care. Important lessons from results of published schemes must, however, be applied to harness the new energy and resources for maximum patient benefit.


Uses of labelled white cells.

In addition to an established clinical role, labelled white cells have great potential for clinical research. This review will therefore outline the clinical use of labelled white cells and briefly consider their contribution to developments in clinical science.


Fluid balance in severe pre-eclampsia.

Women with severe pre-eclampsia are at high risk of pulmonary oedema, especially 12-24 hours postdelivery. Effective vasodilatation with fluid restriction and early diuretic therapy are the cornerstones of preventative therapy.


Haemophilus influenzae type b vaccines.

Haemophilus influenzae type b (Hib) is a major cause of serious infections in childhood. New vaccines have been developed which are effective in invoking immunity against this organism when administered to children of all ages, including young infants. Their widespread introduction in the UK should lead to a dramatic decline in the incidence of Hib disease.


Role of cardiotocography.

The cardiotocograph (CTG) is a composite record of fetal heart rate and uterine activity. During pregnancy, the CTG is a diagnostic test of fetal condition whenever acute or chronic complications arise. In labour, the CTG provides a continuous indication of fetal response to uterine contractions and interventions.


Quality of life during treatment for cancer.

Assessment of quality of life produces a hard outcome measure of treatment which allows us to tailor therapy to the patient's needs. This article look at ways in which quality of life can be measured and at its clinical importance in the treatment of cancer.


Doctors, confidentiality and the law.

Doctors risk erasure from the register and legal action by breaching patients' confidentiality. They should be aware of the instances in which it is legally acceptable.


MRCP (Paeds) exam: the present and the possible future.

In this article I will give some general advice on how to prepare for the MRCP (Paeds) exam and outline the exam's present structure. I will also discuss the changes that may occur subsequent to the proposed establishment of a college of paediatricians.