Pulpal response to restoration of deep cavities with high-copper amalgam.

The effect on the pulp of a high-copper amalgam was studied in buccal cavities in 16 pairs of human premolars, 32 teeth, restored with ANA 2000. To minimize the risk of bacterial contamination, the cavities were treated with a cleanser, Tubulicid, and the outer portion of the filling was replaced by zinc oxide-eugenol cement (ZOE), i.e. surface-sealing. In one cavity in each pair, the control, a thin lining was used. The teeth were extracted after 5-13 days, sectioned, stained with hematoxylin-eosin or Brown and Brenn and evaluated for the degree of pulpal inflammation and presence of bacteria. The results showed that regardless of whether lining was used or not, no inflammation or only a very few inflammatory cells were found in the 21 teeth in which the thickness of the remaining dentin varied from 0.15 mm to 0.5 mm, except for one pair showing slight to moderate inflammation. However, in this pair bacterial growth were found on the cavity walls. No other teeth showed bacterial growth. In the remaining eleven teeth the thickness of the remaining dentin was less than 0.08 mm, including five pulpal exposures. Slight to severe inflammation occurred in eight of these teeth. ANA 2000 per se did not seem to irritate the pulp except in very deep cavities or on direct exposures. The reason for this reaction is not known, but it might be attributable to the zinc content of the amalgam.


An outpatient-focused program for childhood diabetes: design, implementation, and effectiveness.

Treatment of childhood diabetes mellitus has undergone many recent changes, one of which is an increasing focus on outpatient management. In mid-1988, the pediatric diabetes clinic at Texas Children's Hospital began adopting an outpatient-focused treatment program using a care team. This report reviews our experience during this transition. Between 1987 and 1990, the percentage of new-onset patients who were never admitted to the hospital increased from 0 to 38%. Length of stay for new-onset patients who are admitted has declined. The shift in program focus has also led to decreased diabetes-related readmissions and length of stay per readmission. Estimated total patient cost savings exceed $100,000 per year for new-onset patients alone. Our results regarding patient care and cost-effectiveness agree with reports from other such diabetes treatment programs and support greater acceptance and use of this outpatient-focused approach.


Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.

Asthma death rates are rising, with the greatest rise and highest death rates in old age. A reduced cardiovascular response in the elderly may lead to the underestimation by physicians of the severity of acute asthma attacks. This would be compounded if elderly patients had reduced awareness of bronchoconstriction. Methacholine provoked bronchoconstriction was compared in 34 elderly (17 asthmatic, 17 normal; age 60-83, mean 68 years) and 33 young subjects (16 asthmatic, 17 normal; 20-46, mean 30 years). None were smokers. All underwent inhaled methacholine challenge by the Newcastle dosimeter method, monitored by maximal expiratory flow-volume loops (MEFVL). The endpoints were a 35% fall in forced expiratory flow at 50% vital capacity or cumulative inhalation of 6.4 mg methacholine. The one second forced expiratory volume (FEV1) was derived from MEFVL. After challenge and before bronchodilatation subjects graded awareness of respiratory discomfort from 1 (no symptoms) to 4 (pronounced symptoms needing immediate treatment). Despite a greater fall in FEV1 in elderly asthmatic patients (mean (SE) 27.4% (2.2%)) than in young asthmatic patients (21.5% (1.7%)) elderly patients were less aware of bronchoconstriction (awareness score 2.00 (SE 0.15) than young patients (3.06 (0.11)). Similar differences in awareness score were seen between elderly normal subjects (1.53 (0.17)) and young normal subjects (2.76 (0.22)), despite no difference in degree of bronchoconstriction. Reduced awareness of moderate acute bronchoconstriction in old age may delay self referral in acute asthma and contribute to higher asthma mortality in the elderly.


Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids.

Asthmatic patients taking low to moderate doses of inhaled topical corticosteroids have been shown to have lower bone density than those taking bronchodilators only. There is little information on bone density in asthmatic patients taking high dose inhaled corticosteroids. Bone mass was studied in three age matched groups of asthmatic patients. These comprised: 17 asthmatic patients who had never taken inhaled or systemic corticosteroids (group 1); 20 patients who had taken beclomethasone diproprionate in a dosage of 1000-2000 micrograms daily for at least a year, who had also received courses of systemic corticosteroids in the past (group 2); and 20 patients who were taking both high dose inhaled corticosteroids and regular low dose prednisolone, at a median dose of 7 mg daily (group 3). Vertebral bone density was measured by quantitative computed tomography. Biochemical indices of bone formation and resorption were also measured. Mean bone density in group 2 (127.5(22.6) mg/ml) was similar to that in group 3 (114.5 (36.0) mg/ml). Bone density was significantly lower in both of these groups than in group 1 (160.4 (27.4) mg/ml). There were no significant differences between groups for any of the markers of bone formation and resorption. Asthmatic patients receiving high dose inhaled beclomethasone and intermittent courses of systemic corticosteroids have reduced vertebral bone density. The bone loss is similar in degree to that seen in patients taking high dose inhaled topical corticosteroids and continuous low dose systemic corticosteroids.


Bone turnover during short course prednisolone treatment in patients with chronic obstructive airways disease.

Although osteoporosis is a well known side effect of long term prednisolone, the effects of a short course are less clear. Biochemical markers of bone turnover were therefore studied in 10 men with chronic obstructive airways disease who required assessment of "steroid reversibility" (mean age 65 years, mean FEV1 1.2 1). Patients received, single blind, two weeks of placebo, four weeks of prednisolone 20 mg/day, and then two further weeks of placebo. The mean (SD) fasting urinary hydroxyproline:creatinine ratio, a marker of bone resorption, increased by 65% with prednisolone (from 8.9 (5.7) to 14.7 (8.5) mumol/mmol) and returned to baseline after placebo. Serum alkaline phosphatase, a marker of net bone formation, fell after prednisolone by 28% (from 113 (41) to 81 (30) IU/1). Substantial changes occurred after only two weeks of prednisolone. Serum osteocalcin, calcium, and phosphate concentrations did not change significantly. Short courses of prednisolone increased bone resorption and inhibited bone formation after two and four weeks.


Can lung function measurements be used to predict which patients will be at risk of developing interstitial pneumonitis after bone marrow transplantation?

Lung function often deteriorates after bone marrow transplantation for haematological malignancies. Whether pulmonary function measurements are useful for monitoring patients' progress after transplantation and for alerting clinicians to the development of pneumonitis is uncertain. Serial pulmonary function measurements were made in 39 patients with a haematological malignancy, and the values from 18 recipients of T cell depleted allogeneic (n = 17) or autologous (n = 1) bone marrow transplants who developed interstitial pneumonitis were compared retrospectively with values from 21 recipients of allogeneic (n = 17) or autologous (n = 4) transplants who did not develop pneumonitis. Lung function was measured at the onset of a further 18 episodes of pneumonitis. Measurements made before transplantation showed no difference in forced expiratory volume in one second (FEV1), transfer factor for carbon monoxide (TLCO), or total lung capacity between the two groups, but the forced vital capacity (FVC) was slightly higher in those who developed pneumonitis (mean (SD)% predicted 104 (12)) than in those who did not (93 (17%)). Six weeks and three months after transplantation all pulmonary function measurements had fallen slightly in both groups but TLCO had fallen considerably more in those who later developed pneumonitis, being 71% (SD 11%) and 77% (7%) of pretransplant values in patients who later developed pneumonitis compared with 109% (38%) and 96% (26%) in those who did not. All lung function measurements were significantly lower at the onset of pneumonitis than three months after transplantation, even in patients with no abnormal signs and a normal chest radiograph. Serial measurements of gas transfer before and after bone marrow transplantation may be useful for predicting which patients will be at risk of developing pneumonitis and may help to diagnose pneumonitis in breathless patients with no abnormal signs.


Extrapulmonary sites of Pseudomonas aeruginosa in adults with cystic fibrosis.

Pseudomonas aeruginosa infection is seldom eradicated in patients with cystic fibrosis despite intensive antipseudomonal treatment. Upper airway sites of infection may contribute to perpetuation of lower airways infection. This study was designed to find out which extrapulmonary sites are infected and whether the strains at these sites are identical to those in the lungs. Sputum and upper airway samples from 42 patients were cultured for P aeruginosa and stool samples from 20 patients were also tested. Nineteen isolates from sputum and extrapulmonary sites from four patients were genotyped with the pCM tox probe. P aeruginosa was isolated from the sputum of 36 patients, 34 of whom had infection in the upper airways. Six of the 20 patients tested were positive for P aeruginosa in the stool. The nasopharynx was colonised in 30 patients, the oropharynx in 29, the middle meatus in 13, the external nares in six, and the inferior turbinate in four. Three of four patients tested had the same strain of P aeruginosa (a different one in each individual) in the sputum and the upper airways, and in two of the three the stool isolate was a different strain. Most adults with cystic fibrosis and P aeruginosa pulmonary infection have upper airway reservoirs of the organism and strains from these sites are identical to those in the lungs.


Interpretation of bronchodilator response in patients with obstructive airways disease. The Dutch Chronic Non-Specific Lung Disease (CNSLD) Study Group.

There is no agreement on how a bronchodilator response should be expressed. Ideally, the index used should be able to distinguish asthma from chronic obstructive lung disease and be independent of initial FEV1. Two hundred and seventy four adults (aged 18-60 years) outpatients with obstructive airways disease were studied. Patients were divided into syndrome groups on the basis of a standardised history: asthma (n = 99), asthmatic bronchitis (n = 88), and chronic obstructive lung disease (n = 51); 36 subjects could not be attributed to any subgroup. FEV1 was measured before and 20 minutes after inhalation of 1000 micrograms terbutaline. Different expressions of bronchodilator response (delta FEV1) were compared with respect to their dependence on initial FEV1 and their efficacy in separating subjects with asthma from those with chronic obstructive lung disease. delta FEV1 was expressed as a percentage of initial FEV1 (delta FEV1%init), absolute value (delta FEV1[1]), percentage of predicted FEV1 (delta FEV1%pred), standardised residual (delta SR-FEV1), and percentage of maximal possible increase (delta FEV1%[pred-init]). delta FEV1%init was more dependent on initial FEV1 (p = -0.405) than delta FEV1[1] (r = -0.145), delta FEV1%pred (r = -0.166), and delta SR-FEV1 (r = -0.127). delta FEV1%[pred-init] reached infinity when initial FEV1 approached predicted levels. delta FEV1%pred had a higher likelihood ratio (1.71) for separating patients with asthma from those with chronic obstructive lung disease than other expressions of bronchodilator response. Asthmatic patients had larger mean bronchodilator responses than patients in other subgroups; this difference was largest for delta SR-FEV1 (F = 9.19) and delta FEV1%pred (F = 9.03); it was much smaller for delta FEV1%init (F = 5.89). Despite significant differences in mean response, there was a large overlap of individual responses between diagnostic subgroups. The bronchodilator response was continuously and unimodally distributed for all expressions. delta FEV1%pred appears to be the most useful method of expressing bronchodilator response, both for clinical and for research purposes. Reversibility of airways obstruction in response to a bronchodilator is a continuous variable and not a dichotomous triat. Any cut off level of a "positive" bronchodilator response is therefore arbitrary.


Intra-alveolar macrophage numbers in current smokers and non-smokers: a morphometric study of tissue sections.

The alveolar macrophage is believed to be important in the defence of the lung and possibly in the pathogenesis of lung disease. Cell counts in bronchoalveolar lavage fluid have suggested that smokers have an increased number of alveolar macrophages but have not enabled the number to be related to a measure of lung structure. The number of alveolar macrophages was counted in histological sections from lung resection specimens from a group of smokers and non-smokers. The results were related to a measurement of lung structure obtained by means of an automated morphometric technique and expressed in terms of units of lung volume or of lung surface area. The smokers had a significantly increased number of alveolar macrophages per unit lung volume and per unit surface area, through the relative increase was less than has appeared from bronchoalveolar lavage studies. When smokers and non-smokers with similar lung structure were compared the smokers had more alveolar macrophages, indicating that smoking and not loss of lung structure is responsible for the increase. Smokers had more alveolar macrophages than non-smokers when the number was expressed quantitatively with respect to the underlying architecture. Changes in cell populations postulated to be important in the pathogenesis of disease within the lung should be related to lung architecture because this may vary considerably between individuals.


A mask to modify inspired air temperature and humidity and its effect on exercise induced asthma.

Heat and moisture loss from the respiratory tract during exercise are important triggers of exercise induced asthma. A new heat and moisture exchange mask has been developed which both recovers exhaled heat and water and has a sufficiently low resistance for use during exercise. The effect of the mask on inspired air temperature was studied in four normal subjects. Eight asthmatic subjects performed identical exercise protocols on three separate days, breathing room air through a conventional mouthpiece, a dummy mask, and the new heat and moisture exchange mask. Seven different asthmatic subjects exercised while breathing cold air at -13 degrees C through a dummy or active mask. All subjects found the new mask comfortable to wear. The mean inspired temperature when the mask was used rose to 32.5 (1.4) degrees C when normal subjects breathed room air at 24 degrees C and to 19.1 (2.7) degrees C when they inhaled subfreezing air at -13 degrees C. The heat and moisture exchange mask significantly reduced the median fall in forced expiratory volume in one second (FEV1) after exercise to 13% (range 0-49%) when asthmatic subjects breathed room air compared with 33% (10-65%) with the dummy mask and 28% (21-70%) with the mouthpiece. The fall in FEV1 when the asthmatic subjects breathed cold air was 10% (0-26%) with the heat and moisture exchange mask compared with 22% (13-51%) with the dummy mask. Use of a heat and moisture exchange mask can raise the inspired temperature and humidity and ameliorate the severity of exercise induced asthma. The mask may be of practical value in non-contact sport or for people working in subzero temperatures.


Effect of carbohydrate rich versus fat rich loads on gas exchange and walking performance in patients with chronic obstructive lung disease.

High calorie intakes, especially as carbohydrate, increase carbon dioxide production (VCO2) and may precipitate respiratory failure in patients with severe pulmonary disease. Energy obtained from fat results in less carbon dioxide and thus may permit a reduced level of alveolar ventilation for any given arterial blood carbon dioxide tension (PaCO2). Ten patients with stable severe chronic obstructive lung disease underwent a six minute walk before and 45 minutes after taking 920 kcal of a fat rich drink, an isocalorific amount of a carbohydrate rich drink, and an equal volume of a non-calorific control liquid on three separate days, in a double blind randomised crossover study. Borg scores of the perceived effort to breathe were measured at the beginning and end of each six minute walk. Minute ventilation (VE2), VCO2, oxygen consumption (VO2), respiratory quotient (RQ), arterial blood gas tensions, and lung function were measured before and 30 minutes after each test drink. Baseline measurements were similar on all three test days and the non-calorific control drink resulted in no changes in any of the measured variables. The carbohydrate rich drink resulted in significantly greater increases in VE, VCO2, VO2, RQ, PaCO2, and Borg score and a greater fall in the distance walked in six minutes than the fat rich drink (mean fall after carbohydrate rich drink 17 m v 3 m after fat rich drink and the non-calorific control). The increase in VCO2 correlated significantly with the decrease in six minute walking distance and the increase in Borg score after the carbohydrate rich drink. The only significant change after the fat rich drink when compared with the non-calorific control was an increase in VCO2. Comparatively small changes in the carbohydrate and fat constitution of meals can have a significant effect on VCO2, exercise tolerance, and breathlessness in patients with chronic obstructive lung disease.


Ultrasound guided percutaneous cutting biopsy for the diagnosis of pulmonary consolidations of unknown aetiology.

Ultrasound has been used to guide percutaneous aspiration biopsy of thoracic tumours with high diagnostic yield. This study assessed the diagnostic value of ultrasound guided percutaneous cutting biopsy for pulmonary consolidation of unknown aetiology. Thirty patients with undiagnosed lobar or segmental consolidation underwent ultrasound guided percutaneous needle aspiration and large bore cutting biopsy. The needle aspirates and biopsy specimens were sent for cytological, microbiological, and histopathological examination. Percutaneous needle aspiration provided a diagnosis in nine of 30 patients (30%), whereas cutting biopsy obtained a satisfactory specimen for histological diagnosis in 28 patients (93%) and provided a definite aetiological diagnosis in 17 patients (57%). The combination of needle aspiration with Trucut biopsy provided a diagnostic rate of 63%. The underlying diagnoses were fungal pneumonia (five patients), tuberculosis (five), bacterial pneumonia (one), bronchioloalveolar carcinoma (three), lymphoma (two), adenocarcinoma (one), vasculitis (one), acute pneumonia of unknown aetiology (one), and chronic non-specific pneumonia (nine). Two patients, who had necrotic tissue only in the biopsy specimen, were found at thoracotomy to have an adenocarcinoma and aspergillosis. Two patients had complications from the technique, a small pneumothorax in one and a small haemoptysis in another. Ultrasound guided percutaneous cutting biopsy is a valuable method for diagnosing pulmonary consolidation of unknown aetiology. The diagnostic yield is high and the procedure appears to be relatively safe.


Randomised clinical trial of chest drainage systems.

Problems in the management of thoracic trauma have stimulated the search for an alternative to underwater seals for drainage of the pleural cavity. A chest drainage bag incorporating a one way flutter valve has been compared with underwater seal drains in a randomised clinical trial. During June-December 1989 119 patients undergoing elective thoracotomy were randomised to receive postoperative chest drainage by drainage bags (56 patients, 87 drains) or by underwater seal drains (63 patients, 98 drains). Daily drainage volumes, the requirement for pleural suction, mobility, and complications were recorded prospectively. There was no significant difference between the two groups in the mean volume drained, the requirements for pleural suction, or the occurrence of complications. Patients with drainage bags were fully mobile 23 hours (95% confidence interval 0-47 hours) earlier than the others. When used after elective thoracotomy drainage bags are safe and effective and permit earlier mobility than underwater seal drains.


Cocaine induced eosinophilic lung disease.

A patient developed fever, bronchoconstriction, hypoxaemia, pulmonary infiltrates, and serum and bronchoalveolar lavage fluid eosinophilia on two occasions after inhaling crack cocaine. Transbronchial biopsy specimens showed normal lung parenchyma but a dense eosinophilic infiltrate within the bronchial wall. Both episodes resolved promptly after treatment with corticosteroids. Eosinophilic lung disease may be a steroid responsive complication of crack cocaine abuse.


Retroperitoneal silicosis mimicking pancreatic carcinoma in an Alpine miner with chronic lung silicosis.

A miner, known to have had lung silicosis for 30 years, was investigated for abdominal pain. A retroperitoneal mass was found, in which histological examination showed an inflammatory reaction to silica.


Aeromonas hydrophila fulminant pneumonia in a fit young man.

A previously healthy 24 year old athletic man became ill suddenly with pneumonia the day after swimming in the sea. Despite intensive support measures in the intensive care unit he died three hours after admission and 21 hours after his first symptom. Necropsy showed bilateral haemorrhagic necrotising pneumonia. Aeromonas hydrophila was isolated from a blood culture taken at admission and from the lungs at necropsy. The infection may have come from contaminated sea water.


[The legal status of homeopathic medicines. Quality requirements, registration and permit procedures].

Homeopathic medicaments which are ready for application have to be approved or registered before they can be made available. This procedure is regulated by the "Arzneimittelgesetz (AMG)", a law regulating licensing and registration of medicaments. The commission in charge of the registration and licensing of homeopathic medicaments is the "Aufbereitungskommission D" of the German "Bundesgesundheitsamt (BGA)", the Board of Public Health. Application forms are dealt with on the basis of controlled and non-controlled clinical studies, application observations, and case studies, as well as specialized literature. The commission is trying to do justice to the particular features of the special field of homeopathy.


[Necessary care of newborn lambs using ovine colostrum. 2. Duration of administration].

Sheep colostrum, pooled from 0-12 h milkings, was fed to 38 newborn lambs for either 6, 12, 18 or 24 hrs after birth. The influence of the duration of feeding periods on the transintestinal passage of immunoglobulins, the growth performance, the loss rate and the onset of immunoglobulin synthesis were investigated by monitoring the serum concentrations of IgG1, IgG2, IgM and IgA during months 1 through 9 of life. Feeding of 3 portions of 100 ml at 2 h intervals resulted in lower serum levels of Ig's than the extension of the feeding to 12 x 100 ml every second hour. There was, however, no difference in the onset of endogenous Ig production between both groups. Growth performance and the loss rate were also identical.


[The selenium content in the blood of newborn sheep and goats--equally contributing to the effect of supplemental oral selenium as a prophylaxis].

The article is based on the analysis of selenium concentration in blood plasma of 9 goats and their kids (n = 17), from two different places, as well as of 12 sheep and their lambs (n = 19) from several flocks. The selenium concentration was measured using ASS. In addition, the activity of CK was determined enzymatically. There was a low plasma selenium level in lambs and goat kids immediately post-natal depending on the selenium state of the mothers. After application of vitamin E and selenium to a group of lambs their selenium levels increased remarkably over 24 hours. Ten days later the average selenium concentration in the plasma of those animals that had been treated was three times as high as that of the control group. It was shown that the absorption of vitamin E and selenium when given orally to newborn lambs is comparable with the absorption after parenteral application, and that a significant increase of the plasma selenium level is attainable by oral application.


[Symptoms and course of a parakeratosis outbreak in a boar raising facility].

A case of parakeratosis in pigs due to secondary zinc deficiency (zinc/calcium ratio 0.4 g/100 g; 68.7 mg zinc, 17.1 g calcium per kg food) is reported. Morbidity and symptoms were much more marked in growing boars than in female animals of the same age. In sows the disorder appeared ten days after the first symptoms were seen in the boars. Adult breeding pigs developed no signs of parakeratosis.


[Light and electron microscopic studies of Eperythrozoon suis].

A light and electron microscopic study was carried out on pigs experimentally infected with Eperythrozoon (E.) suis during the acute and chronic phase of infection. During the acute phase Eperythrozoon organisms can be recognised by light microscopy as bright to dark orange points or circles. In contrast, in the chronically infected pigs E. suis appear as bright yellow or green small dots on the edge of the erythrocytes or in the plasma. By scanning electron microscopy, immature, juvenile and mature forms of E. suis could be seen on the same erythrocyte during the acute phase. In chronically infected pigs ring-shaped, rounded resting-stage forms, measuring about 1 micron in diameter, can be observed.


[Skin and plumage changes in domestic birds. II. Plumage changes].

The study describes plumage modifications and specific feather malformations, as related to the domestication process of different poultry species. The modifications include naked necks, leg feathering, frizzle feathering, silky feathering, fat quills, and feather abnormalities caused by behavioural hypertrophies. Most of these plumage modifications correspond to the breed standard for exhibition poultry fancy. However, they impair the normal function of these animals. The negative influences comprise disorders in social behaviour, loss of typical plumage functions and disabilities of normal mobility, as well as genetic defects and pathogenic predispositions.


[Two rare lens abnormalities in horses].

Coloboma and ectopia of the crystalline lens are rarely encountered or diagnosed congenital defects of the equine eye. The clinical and ophthalmoscopic features of a congenital coloboma of the lens in a 3 year old Hanoverian stallion and of an ectopic lens in a 6-month old Hanoverian filly are described and depicted. In the stallion, the lens coloboma was associated with a partial coloboma of the zonules, and in the filly, the ectopic lens was small and spherical (microphakia, spherophakia) and associated with syneresis of and small floaters in the vitreous. Although it cannot be excluded that the ectopic position of the lens may have originated from prenatal uveitis, it was classified as congenital in this case. In both eyes, there were no other clinically detectable congenital defects.


[Weak viability syndrome in newborn foals. Retrospective studies of the etiological clarification and chance for recovery].

This review of therapeutic results involved 115 foals with delayed viability syndrome (DVS). The foals were up to four days old. It could be shown that prognosis quoad vitam depended very much on the severity of illness, which could be determined primarily by the foals' ability to stand (SA) and secondly by the presence of the suckling reflex (SR). Those foals that were (still) able to stand--while the suckling reflex was/was not present (anymore) (SA+, SR+; SA+, SR-)--had good prospects of recovery regardless of the causal disease. The chances for survival were significantly poorer if the foals were unable to stand--even if the suckling reflex was still present and especially if it was not present (anymore) (SA-, SR+; SA-, SR-). Glucose and IgG levels were measured following hospitalization and proved to be excellent prognostic indicators, no matter what the causal disease. DVS can vary in severity, but symptoms are rather non-specific. Non-infectious causes for DVS were--at a ratio of approximately 3 to 1--significantly more common than primarily infectious causes. The latter--except for diarrhoea--carried a very poor prognosis.


[Multiple myeloma/plasmacytoma in a young dog].

A multiple myeloma in an unusually young Cairn terrier (13 months, female) is described. Radiographically, pelvic tumor masses and characteristic systemic osteolysis were found at the end of the 4 week disease course. Therapeutic attempts were hopeless at this stage of the disease, but a form of chemotherapy is recommended.


[Fauna and incidence of endoparasites in kittens and their mothers from different husbandry situations in south Germany].

In this epidemiological study 100 litters of Southern Germany were investigated. 70 litters were kept on farms and 30 litters originated from mother cats kept indoors. At least 9 species were detected in litters from farms, 77.1% of these litters were infected with T. cati, 1.4% with hookworms, 10% with Capillaria, 10% with H. taeniaeformis, 67.1% with I. felis, 48.6% with I. rivolta, 17.1% with Toxoplasma/Hammondia, 4.3% with C. parvum and 1.4% with Giardia. In litters kept indoors only 5 species were established. 3.3% were infected with T. cati, 46.6% with I. felis, 33.3% with I. rivolta, 6.6% with Giardia and 3.3% with C. parvum. Analogous differences as regards to the keeping conditions existed also for the mother cats.


[The therapy of chronic diseases of the respiratory tract in dogs and cats].

Chronic conditions of the respiratory system are a diagnostic as well as a therapeutic challenge to the veterinarian. In the majority of cases the protective structures, e.g. the vibrating epithelium, have already been irreversibly damaged, so that therapy can only relieve the trouble, but not lead to a full recovery. Prior to initiating a long-term therapy that requires a lot of patience from the veterinarian as well as the owner, it is therefore crucial to carry out a thorough diagnostic procedure. This is a review of the pathophysiological basis and the resulting diagnostic consequences of chronic diseases of the respiratory system. A few selected cases are discussed and recommendations for medical treatment are given.


[Reptiles as patients in veterinary practice].

Important diseases of reptiles are described with references to the diagnostic material and patients of the Institute of Zoology and Hydrobiology between 1984 and 1990. The commonest causes of mortality were pneumonia, parasites and poor husbandry. Problems associated with the increasing popularity of reptiles as pets, and appropriate treatments are discussed.


[Use of the Reflotron system for the determination of creatine kinase (CK) in the blood of swine, sheep, cattle, horses and dogs].

The Reflotron-CK test was evaluated with blood samples of healthy and diseased pigs, sheep, cattle, horses and dogs in relation to the standard CK-NAC test (UV-method). The precision within the series on the day of blood sampling was better than VK = 7.5% (coefficient of variation) with both methods. The day to day precision was estimated by using deep frozen plasma and was in the same order of magnitude with the Reflotron-CK and the UV-method (CV less than 10%). While fresh whole blood of sheep, cattle, horses and dogs respectively should be applied directly onto the dry reagent carrier with the Reflotron-pipette (32 microliters), the blood samples of pigs must be diluted (200 microliters 0.9% NaCl-solution and 32 microliters blood, factor 7.25) before determination with Reflotron-CK. In the five species mentioned the correlation between Reflotron-CK and CK values obtained with the standard UV-method was satisfactory (r greater than 0.96). Systemic deviations of the Reflotron-CK values should be corrected by calculation formulae, given in the paper.


Optimal timing of administration of a free radical scavenger in lung preservation.

The optimal timing of administration of free radical scavengers in lung preservation has yet to be determined. In previous studies, the oxygen free radical scavenger dimethylthiourea (DMTU) has improved pulmonary function when added to Eurocollins flush solution at the time of lung harvest and infused at the time of lung reimplantation. To determine when DMTU must be administered in order to preserve lung function most effectively, 16 dogs underwent lung allotransplantation. Donor lungs were flushed with modified Eurocollins solution (50 ml/kg) and stored for 12 hr at 4 degrees C. DMTU was either added to the flush solution (5 g) or infused (20 g over 2 hr) at the time of reimplantation. Investigators were blinded to the time of DMTU administration. The contralateral pulmonary artery was ligated after a 1-hr stabilization period. Measurements were recorded for 8 hr while keeping FiO2 constant at 40%. The flush group demonstrated significantly improved survival and oxygenation compared with the infusion group. The mortality rate was 50% in the infusion treatment group, while no deaths occurred in the flush animals. Lung function is adequately preserved after 12-hr storage when DMTU is administered in the flush solution at the time of harvest. It would appear that oxygen free radical scavengers must be present in lung tissue during storage in order to be effective.


Evidence of metabolic activity of adult and fetal rat hepatocytes transplanted into solid supports.

This study was undertaken to assess the metabolic effect of fetal and adult hepatocyte transplantation in the Gunn rat, genetically incapable of bilirubin conjugation. A comparison was made between fetal and adult hepatocytes transplanted into the spleen, and those injected into polytetrafluoroethylene (PTFE) solid supports that had previously been implanted intraperitoneally. Between 4 and 12 weeks after intrasplenic transplantation of adult liver cells, serum bilirubin was significantly decreased when compared with control animals (39.6 +/- 5.6%; P less than 0.01 vs. controls). Intrasplenic transplantation of fetal hepatocytes resulted in a maximal decrease of 33.2 +/- 9.1% at 8 weeks postoperatively (P less than 0.02 vs. controls). Similar declines of serum bilirubin levels were found after transplantation of adult or fetal liver cells into the solid supports. At 12 weeks after transplantation, bilirubin conjugates were detectable in the bile of all animals that underwent intrasplenic hepatocyte transplantation and in 60% of those that underwent the solid support procedure, whereas none could be detected in control animals. Histological evidence of surviving cells was obtained in all but one animal at 12 weeks, and confirmed at 12 months postoperatively. It is concluded that the PTFE solid support technique offers an attractive alternative to the intrasplenic route, and that both fetal and adult hepatocytes, transplanted in either way still exert their conjugating activity after 12 weeks.


Prolonged survival of rat hepatic allografts after total-body irradiation of the donors.

The effect of total-body irradiation of the donor on hepatic allograft survival was studied in the rat, with ACI(RT1a) as the donor and LEW(RT1(1)) as the recipient. LEW recipients of ACI liver transplants experienced severe acute rejection, with a mean survival of only 10.2 +/- 0.3 days. The doses of irradiation were 450, 750, and 1000 rads administered 24 hr prior to harvesting or subsequent transplantation. TBI with a dose of 750 rads significantly prolonged the survival of the hepatic allograft to 30.3 +/- 1.7 days, without concomitant immunosuppression. However, neither 450 rads nor 1000 rads of TBI resulted in successful suppression of graft rejection. TBI appeared to have a beneficial effect on hepatic allograft survival and to have no deleterious effect on isograft survival, suggesting a possible modulation of the immunogenicity of the donor organ. Although the cause of this beneficial effect is not clear, TBI with a dose of 750 rads 24 hr prior to organ harvest seems to be optimal to eliminate-antigen presenting cells in the donor organs.


Peripheral tolerance of an allograft in adult rats--characterization by low interleukin-2 and interferon-gamma mRNA levels and by strong accumulation of major histocompatibility complex transcripts in the graft.

Congenic LEW.1W(RT1.u) heart grafts in LEW.1A(RT1.a) recipient rats are rejected in 15 +/- 6 days. Tolerance (greater than 100 days) can be induced by pretransplant donor-specific blood transfusion. In this case, the graft is not rejected, although it is infiltrated by mononuclear cells specifically cytotoxic, in vitro, against allogeneic donor splenocytes. We studied the expression of MHC class I and class II antigens, IFN-gamma, and IL-2 mRNA in the rejected and tolerated grafts by Northern blotting and in situ hybridization. Our data show that both class I and class II mRNA accumulate in both types of graft, and that class I mRNA accumulation occurs more rapidly in the tolerated grafts. IFN-gamma and IL-2 mRNA accumulate to lower levels and with delayed kinetics in the tolerated grafts compared with the rejected ones, suggesting a role for these lymphokines in the mechanism of rejection/tolerance in this model. This hypothesis is also supported by the observation that IFN-gamma treatment abrogates the induction of tolerance in the recipients receiving pretransplant donor blood transfusion. Furthermore, we observed an uncoupling of the accumulation of IFN-gamma mRNA and of MHC class I and class II mRNA. Our data confirm that the mechanisms of tolerance in this model depend, in part, on alterations of the IL-2/IL-2R pathway of lymphocyte activation but also clearly indicate a decrease of IFN-gamma mRNA accumulation, suggesting that the defect involves several activation molecules.


Effects of cyclosporine and corticosteroids on bile secretion in the rat.

In order to study their effects on the bile secretion, cyclosporine and methylprednisolone were injected intravenously into rats at a dose of 10 mg/kg b.w. for 30 min. Methylprednisolone had no effect on bile secretion. Cyclosporine led to transient intrahepatic cholestasis characterized by decreased bile flow as well as a decrease of bile salts and cholesterol in bile. Phospholipid levels were not affected. Liver biopsy showed no particular anomaly. These findings suggest that the observed cholestatic reaction may be due to impairment of the metabolism of cholesterol into bile salts or of the conjugation of bile salts rather than to disturbances in bile secretion. After liver transplantation in humans, cholestasis associated with acute rejection or nonspecific cholestasis cannot be attributed directly to the effect of cyclosporine. Cholestasis can be offset by administering taurocholate at a dose of 10 mumol/min/kg b.w. in order to maintain bile salt and phospholipid levels high enough to ensure proper "vectorization" of cholesterol to bile.


The effect of donor age on graft survival in pediatric cadaver renal transplant recipients--a report of the North American Pediatric Renal Transplant Cooperative Study.

Data from the North American Pediatric Renal Transplant Cooperative Study were analyzed to determine the effect of donor age on graft survival for pediatric recipients of cadaver donor renal transplants. Between January 1, 1987, and November 16, 1990, 787 cadaver donor renal transplants in children less than 18 years of age were registered in the study. The ages of the donors were less than or equal to 5 years in 203 transplants, between 6 and 9 years in 87, between 10 and 39 in 389, and greater than or equal to 40 years in 108. The risk of graft loss was related to donor age by a proportional hazards analysis. The ideal donor age was 20-25 years. The risk of graft loss was increased by both young and old donor age. The risk of graft loss from a neonate donor was 2.7-fold that of the ideal donor, and the risk from a 50-year-old donor was 1.8-fold that of the ideal donor. The relationship between donor age and graft survival was not affected by the age of the recipient. Cold storage time had an added impact on graft survival: grafts with cold storage time greater than 24 hr were 1.5 times more likely to fail than grafts with shorter cold storage time for all donor ages. Analysis of the causes of graft failure revealed that 9.9% of grafts from donors less than or equal to 5 years of age were lost due to vascular thrombosis, primary nonfunction, and other technical causes, compared with 4.6% in 6-9, 4.4% in 10-39, and 2.8% in greater than or equal to 40-year-old donors. We conclude that kidneys from both young and old donors are at increased risk for graft loss, and this increased risk is seen in all recipient age groups. Many of the losses from the young donors--but not older donors--may be due to technical causes. Knowledge of these risks can be used to develop strategies for optimal utilization of kidneys from young and old donors.


Mitogen responses of lymphocytes from lung transplant recipients--correlation with rejection and infection.

Proliferative responses to nonspecific mitogens were analyzed for 119 bronchoalveolar lavages and 108 concurrent peripheral blood samples from 35 lung transplant patients. The patients were classified at each time as normal, rejecting, or infected on the basis of trans-bronchial biopsy, culture results, clinical signs, and pulmonary function. During rejection episodes the bronchoalveolar lavage responses to concanavalin A and phytohemagglutinin were significantly increased (P less than 0.004 and P less than 0.006, respectively). The differences were less pronounced when rejection occurred within 30 days after bolus immunosuppressive therapy, either as immunoprophylaxis or as treatment for a previous rejection episode, and were not significantly different from normal. Differences in response during rejection were limited to the graft; analysis of circulating T cells was not helpful (P = NS). In contrast, markedly depressed responses to Con A and PHA were seen during infection. Significant differences were observed both in the graft (P less than 0.007) and in circulating lymphocytes (P less than 0.02), suggesting that global depression of mitogen response is associated with immunocompromise. Sequential analysis of 6 patients showed that individual changes in mitogen response paralleled those seen in the population (P less than 0.046, normal vs. rejection and P less than 0.043 normal). These findings suggest that mitogen assays of bronchoalveolar lavage lymphocytes and, to a lesser extent, PBL, are clinically useful in assessing intragraft immunocompetence and in distinguishing rejection from infection in lung transplant patients.


Positive crossmatches against mandatorily shared kidneys.

From October 1987 through February 1990 approximately 8.5% (29/341) of all donor kidneys shipped under the UNOS Mandatory Sharing Policy were denied to 27 intended recipients due to a positive final crossmatch [XM(+)]. The intended recipients included 18.5% hispanics and 7.4% blacks compared to 2.4% and 1.6%, respectively, for XM(-) recipients (1-3). Further, more were highly sensitized with 81% having a current PRA greater than 10% and 56% with a peak PRA greater than 80% compared to 65% and 14%, respectively, for XM(-) recipients. More importantly, 19/27 (70%) of the recipient candidates may have had irrelevant positive XMs. The XM(+) patients were classified into five categories defined by: I) autoantibodies; II) transfusions in the 2 weeks prior to the availability of the donor; III) the XM technique; IV) highly sensitized regraft candidates with current and peak PRAs greater than 85% and V) antibody to unreported MHC antigens. Of these, 70% may have been denied a transplant due to IgM autoantibodies or the use of XM techniques lacking extensive evaluation. The authors propose that all XM(+) mandatorily-shared kidneys be examined for IgM autoantibody and that kidneys not be denied to potential recipients due to IgM autoantibody. In addition, to minimize exclusions based on positive B-cell XMs, it is proposed that mandatorily-shared kidneys be shared on the basis of the DR subtypes, insofar as is currently practical.


The effects of dietary supplementation with fish oil on renal function and the course of early postoperative rejection episodes in cyclosporine-treated renal transplant recipients.

In a randomized prospective coconut oil (daily 6g[63% C8:0 and 36% C10:0] [EPA-] [n = 48])-controlled trial, we investigated the effect of a one-month dietary supplementation with daily 6 g fish oil (30% C20:5 omega-3 and 20% C22:6 omega-3 as their methyl esthers [EPA+] [n = 40]) on the incidence and course of early postoperative rejection in 88 first cadaveric, cyclosporine-treated renal transplant recipients. At one month there were no differences in renal function and incidence of rejection episodes. When analyzed separately for rejection (re+) or nonrejection (re-), the rejecting and fish oil-treated patients showed a significant better recovery of renal function after a histologically confirmed rejection episode, creatinine clearance being 43 ml/min/1.73m2 in the EPA+re+group versus 27 ml/min/1.73 m2 in the EPA-re+group (P less than 0.05), and serum creatinine being 183 and 283 mumol/l (P less than 0.05), respectively. The prerejection renal function and the decline of renal function during the rejection episode did not differ significantly between the EPA+re+ and the EPA-re+ groups. The nonrejecting fish oil-treated patients showed no better renal function than the nonrejecting coconut oil-treated patients. However, cyclosporine trough levels were significantly higher in the fish oil-treated group (EPA+re- 251 versus EPA-re- 200 ng/ml [P less than 0.05]). From these results we conclude that dietary supplements with fish oil favorably influence renal function in the recovery phase following a rejection episode in cyclosporine-treated renal transplant recipients. We further conclude that one month after grafting there is no difference in the incidence of rejection episodes between the fish- and coconut oil-treated patients. The same holds true for renal function in the absence of rejection, and for the decline in renal function during a rejection episode.


The introduction of microvascular surgery to hepatic artery reconstruction in living-donor liver transplantation--its surgical advantages compared with conventional procedures.

Microvascular surgery for the reconstruction of the graft artery has been used since the 8th case in our series of 14 liver transplantations using living-related donors, and the clinical results have been compared between the first seven cases (the Loupe group) and the last seven cases (the Micro group). Seven arteries in 7 grafts were reconstructed with the use of loupe magnification in the Loupe group, while 8 arteries in 7 grafts were anastomosed with microscopic techniques in the Micro group. Statistically, there was no difference between the two groups in general background, including age, body weight and primary disease of the recipient, and in medical and surgical factors possibly relating to postoperative thrombosis of the hepatic artery. In two cases in the Loupe group, one or two additional reconstructions were necessary to obtain sufficient blood flow, while 8 arteries were anastomosed in the Micro group without any arterial complication in the postoperative period. There was no difference in time required for completing the arterial reconstruction (45.1 +/- 18.1 min in the Loupe versus 44.4 +/- 6.9 min in the Micro [mean +/- SEM]). Postoperative ultrasonic Doppler duplex study demonstrated a temporary decrease in the arterial flow in 2 cases of the Loupe group, and partial thrombosis of the artery was suspected. Additionally there were two episodes of hepatic artery thrombosis in 1 case of the Loupe group, in which emergent revision for thrombectomy and reanastomosis was performed at the first episode. This illustrated the higher incidence of arterial complications in the Loupe group compared with the Micro group (4 episodes/7 arteries in the Loupe versus 0/8 arteries in the Micro, P less than 0.05). In the present series there were no graft failures or arterial complications in the three deaths in the series. The clinical improvements achieved by microvascular surgery in living-donor liver transplantation suggest an alternative technical strategy for dealing with problematic arterial reconstruction in adult liver transplantation.


The association of IgA deficiency but not IgG or IgM deficiency with a reduced patient and graft survival following liver transplantation.

Recipients of solid organ allografts require lifelong immunosuppression in order to prevent graft rejection and to maintain graft function. In general, such immunosuppression greatly impairs the cellular immune system, as this level of the immune system is principally responsible for self and non-self recognition. The consequences of allograft transplantation in terms of patient and graft survival when transplants are given to individuals who have a preexisting humoral immune deficiency characterized by a deficiency of the serum levels of one or more of the major Ig classes have not yet been reported. From February 1, 1981 through December 31, 1990, a total of 43 adult patients with a deficiency of 1 or more Ig classes received a ABO-matched liver allograft at this institution. This sample represents 2.5% of a total of 1684 adults transplanted during this interval. These 43 liver graft recipients could be divided into 3 major groups based upon the presence of an IgG, IgM, or IgA deficiency. IgG deficiencies were defined as levels less than 50 mg/dl. Patient and graft survival for the IgA-deficient group was significantly reduced (P less than 0.04 and P less than 0.009, respectively) compared with both the IgG- and IgM-deficient groups. The latter two groups did not differ from controls without an Ig deficiency for these same two endpoints. The major causes of death in the IgA-deficient group were sepsis and opportunistic infection. A third of the deaths in the IgA-deficient group occurred in the perioperative period (first 30 days) while greater than 50% of the deaths occurred within the first 3 months, and all deaths occurred before the first year. Based upon these data, the following conclusions can be made: (1) serum IgA deficiency but not IgG or IgM deficiency is associated with an increased post-OLTx death and graft loss rate; (2) the majority of these deaths are due to sepsis or an opportunistic infection; and (3) most of the deaths occur early. These data suggest that recognition of a deficiency of IgA prior to organ grafting necessitates meticulous attention to the prevention of infection in the immediate perioperative period if patient and graft survival of these patients is to be improved.


Intragraft immune events after human liver transplantation. Correlation with clinical signs of acute rejection and influence of immunosuppression.

Evaluation of graft morphology is regarded as a cornerstone for diagnosis of acute liver graft rejection. Here we have studied the clinical relevance of biopsy findings obtained either by aspiration cytology or by histology in the first month after human liver transplantation, and have assessed the influence of immunosuppressive induction treatment on the incidence of morphological and clinical rejection. Results of 865 aspiration biopsies (TAC) and 155 core biopsies in 141 patients were correlated with the retrospective clinical diagnosis concerning the presence or absence of acute rejection. This analysis demonstrated that there are almost no false negative findings either in cytology or in histology (less than 0.1% of negative biopsies). In contrast, with both methods a large number of positive biopsy results were obtained that were without clinical correlate ("false positive" biopsies; 46% and 41% of positive cytologies and histologies, respectively). The rates of clinical and morphological acute rejections were differently influenced by the type of immunosuppressive induction protocol used. The incidence of clinical rejection was particularly low with a quadruple drug regimen when cyclosporine therapy was started immediately after transplantation (29% vs. 62% when introduction of cyclosporine was delayed for 2-5 days). Morphological rejections were similarly frequent with immediate and delayed introduction of cyclosporine at 2 mg/kg during quadruple therapy (65-75%) and were only reduced with initial high dose cyclosporine treatment (5 mg/kg) (35%). Antirejection treatment was not required in patients with morphological evidence of rejection but without clinical symptoms. The study demonstrates that cytology and histology are similarly reliable for exclusion and similarly unreliable for diagnosis of clinical acute rejection. The clinical relevance of positive biopsy findings is strongly influenced by the basic immunosuppressive treatment. Certain types of induction treatment can obviously alter the alloresponse in a way that no graft damage occurs despite the presence of marked intragraft immune activation. "False-positive" biopsy findings, therefore, seem to represent a qualitatively modified and self-limited type of intragraft alloresponse that is without clinical consequences ("incomplete" or "subclinical" rejection).


The role of fibroblasts in dermal vascularization and remodeling of reconstructed human skin after transplantation onto the nude mouse.

The vascularization and the dermal remodeling of two different types of human skin reconstructed "in vitro" and grafted onto the nude mouse were studied. They were composed of human keratinocytes grown either on a human acellular deepidermized dermis (DED), or on a lattice composed of human fibroblasts embedded in bovine type I collagen, a living dermal equivalent (LDE). At different stages after grafting, the transplants were harvested and processed for an immunohistological study with species-specific and non-species-specific antibodies. At one month after grafting, the two types of grafted dermis contained blood vessels whose vascular basement membranes were labeled with a mouse-specific anti-type IV collagen antibody. With an antibody specific for human type IV collagen, a constant labeling of the vascular basement membrane was only observed in the LDE containing fibroblasts. In the DED, a constant association of the mouse endothelial cells with human type IV collagen was observed at early stages after grafting. At later stages, the human type IV collagen progressively disappeared. On the other hand, the dermal-epidermal junction underneath the human epidermis contained human type IV collagen in the two types of reconstructed skin. Labeling with the species-specific antibodies directed against human or murine type I collagen showed that the ratio murine type I collagen versus human type I collagen increased with time, suggesting that the DED is progressively invaded by mouse fibroblasts that produce the mouse collagen. On the other hand, in the LDE, the preexisting bovine type I collagen became progressively undetectable while both human type I collagen and elastic fibers were deposited by numerous human fibroblasts. Mouse type I collagen was not detected. Altogether, these observations made by grafting human skin reconstructed "in vitro" onto the nude mouse should be interesting for evaluating the usefulness of grafting a dermal substrate together with the epidermal sheet in the treatment of burns.


Binding of phycoerythrin-conjugated interleukin-6 to in vitro-activated human peripheral blood mononuclear cells--effect of immunosuppressive agents and of a calcium channel blocker.

We studied the effect of cyclosporine A, prednisolone, and the Ca2+ channel blocker verapamil on interleukin-6 binding to mitogen-activated peripheral blood mononuclear cells, using a flow cytometric technique and phycoerythrin-conjugated IL-6. All mitogenic stimuli up-regulated IL-6 binding to a variable degree. PHA alone or in combination with PMA was the most effective stimulant in up-regulating IL-6 binding in all the experiments performed. The main changes in IL-6 binding were seen in the large cell cluster, which consisted mainly of lymphoblasts. PHA and PHA/PMA, however, also up-regulated the mean fluorescence intensity on the small cell cluster, which consisted mainly of quiescent lymphocytes. The overall effect of the three pharmacological agents on mitogen-up-regulated IL-6 binding was minimal; most significant were a down-regulation by all three agents of IL-6 binding by small lymphocytes in PHA/PMA cultures, a down-regulation of IL-6 binding by CsA in PHA/PMA-induced large PBMC, and an up-regulation by verapamil of PMA-induced IL-6 binding in large PBMC. Measurements of IL-2 binding and of IL-6 production in the same cultures showed a different pattern than that seen with IL-6 binding, as well as different CsA, prednisolone, and verapamil action. In conclusion, by using a new flow cytometric technique providing information both about the quantity of bound cytokine and about the proportion of IL-6-binding cells, we have demonstrated that IL-6 receptor expression in vitro by PBMC can be up-regulated by the use of stimulants differing in the signal transduction pathways they activate. In addition, by using different pharmacological agents and stimuli to dissect different activation pathways of the in vitro immune response, we conclude that IL-6R generation is regulated differently from IL-6 production. Furthermore, since CsA and prednisolone are known inhibitors of in vitro IL-2 production, our results indicate that IL-6R generation does not rely exclusively on the presence of IL-2.


Cytokine gene expression in rejecting cardiac allografts.

Heart transplantation is now a viable therapeutic option for patients with certain end-stage cardiac diseases. However, episodes of rejection, opportunistic infection, and life-threatening side effects of generalized immunosuppression remain very real problems for these patients. A better understanding of the molecular mechanisms underlying rejection may provide the basis for the development of more specific, less toxic immunosuppressive therapies. While cytokines have long been implicated in the pathogenesis of rejection, the precise role of each cytokine in this process has yet to be defined. We report here the application of the polymerase chain reaction (PCR) to the detection of cytokine mRNA in biopsies obtained from heterotopic abdominal cardiac allografts in cynomolgus monkeys. With the exception of IL-6 and IL-8, cytokine transcripts were undetectable in samples obtained from the donor heart pretransplant. In contrast, IFN-gamma transcripts were detected in all transplants two days after surgery before evidence of rejection was demonstrable by histopathologic analysis. IL-1 beta, IL-2, and IL-6 transcripts were detected when minimal rejection was noted. At later times, IL-1 alpha, IL-1 beta, IL-2, IL-6, IL-8, TNF-beta, and IFN-gamma transcripts were detectable. Further characterization of the spectrum of cytokines expressed at various stages of rejection may lead to insights into the biology of transplant rejection and to the development of more specific and potent reagents to diagnose and/or treat rejection.


Increased islet allograft survival after extended culture by a mechanism other than depletion of donor APCs. Lack of correlation between the elimination of donor MHC class II-positive accessory cells and increased transplantability.

Neonatal rat islets derived by nonenzymic (in vitro) isolation procedures from the Fischer-344 (F-344, Rt1lv1) strain have been shown to be freely transplantable across complete MHC barriers without the use of any form of immunosuppression. However, islets obtained by in vitro isolation from some donor strains, such as the ACI, retain a degree of immunogenicity upon transplantation. This study examined the immunogenic nature of these neonatal ACI islets, and correlated this with the presence of a residual population of MHC class II-positive antigen presenting cells within the islets. In addition, further reduction of immunogenicity of isolated neonatal ACI islets by extension of the culture period was examined. Islets were obtained from neonatal ACI donors by culture-isolation and placed in secondary culture for either 2 days (10 day total culture period, standard culture) or 42 days (50 day total culture period, extended culture). Standard-culture ACI islets were rejected 33% to 100% of the time in five different recipient strains (depending on recipient strain). Compared with control grafts of fresh pancreatic fragments, rejection rates were significantly lower in two strain combinations (ACI to BUF, P = 0.044 and ACI to F-344, P = 0.028), and for all recipient strains combined (P less than 0.001). Extended-culture ACI islets survived significantly longer in all five recipient strains tested (ACI to BN, P = 0.024; ACI to BUF, P = 0.005; ACI to LEW, P = 0.004; ACI to F-344, P = 0.008 and ACI to WF, P = 0.024) and for all strains combined (P less than 0.001). No MHC class II-positive cells were detected upon examination of sectioned neonatal ACI islets using peroxidase immunocytochemistry (OX-6 antigen) in either the standard-culture or extended-culture groups. These results suggest that the increased survival of grafts of extended culture ACI islets is due to a mechanism other than the elimination of class II-positive APCs from the islets. Although possible down-regulation of MHC class II expression on residual APCs during the culture process may make identification of these cells difficult, alternative mechanisms such as the down-regulation of MHC class I antigen, resulting in the reduction of available donor target, or the existence of an accessory cell that is not constitutively MHC class II-positive, may be responsible for this increased graft survival.


B-B10 (anti-CD25)-saporin immunotoxin--a possible tool in graft-versus-host disease treatment.

An immunotoxin containing the B-B10 MoAb, directed against the CD25 determinant, and the ribosome-inactivating protein saporin, inhibits 3H-TdR incorporation in phytohemagglutin, allogeneic-stimulated lymphocytes (primary and secondary mixed-lymphocyte reaction), and in an alloreactive T cell clone. A lower degree of inhibition was obtained with the B-B10 MoAb, which is known to inhibit IL-2 activity, as well as with the unconjugated compounds. These results suggest that the in vivo administration of the conjugate might be a more effective tool in the treatment of patients affected by graft-versus-host disease than B-B10 alone, by inducing an efficient killing of allogeneic-reacting T lymphocytes.


Transplantation effects of a unique major histocompatibility complex class I mutation.

This study describes a novel MHC class I mouse mutant that was discovered because of loss of reactivity of its cells to monoclonal antibodies. The mutation occurred in the H-2Ks molecule and is the first in vivo mutation described that has a single altered amino acid residue (amino acid 107) distant from the regions considered to be peptide or TCR contacts. Nevertheless, skin grafts from the mutant to the parent are rejected by CD8+ T-cells. In the reciprocal direction, the mutant shows partial tolerance to parental skin grafts, suggesting that the mutant is inefficient in selecting alloreactive T-cells specific for the wild-type Ks molecule.


Telomere positional effects and the regulation of cellular senescence.

Normal cells have a limited capacity to proliferate but the molecular clock that regulates the onset of cellular senescence remains unidentified. The ends of chromosomes--telomeres--have been shown to shorten progressively with age in normal cells. Here, we present a working model of how telomeric shortening may induce programmed changes in the regulation of cellular proliferation.


Genetic testing in the workplace: a view from the USA.

Progress in human genetics, accelerated by the Human Genome Project, is leading to a rapid proliferation in the number of genetic tests. Although they have their benefits, genetic tests have in the past been used by various societal institutions, including employers, to discriminate against and stigmatize individuals. In the light of the increase in the number of tests and some current reports of discrimination in employment, a variety of legal and regulatory measures have been proposed to prevent genetic discrimination in the workplace.


Patterning of the Drosophila nervous system: the achaete-scute gene complex.

The genes of the achaete-scute complex (AS-C) confer on cells the ability to become neural precursors. Their expression is restricted to groups of cells, the proneural clusters, which occupy specific positions within the embryo neural anlagen and the larva imaginal discs. Neuroblasts or sensory organ mother cells are born within these clusters. Thus, the patterns of expression of the AS-C genes help to define the topology of the nervous system.


Developmental choices in mating-type interconversion in fission yeast.

Fission yeast cells follow a specific pattern of mating (cell) type switching in single cell pedigrees. Asymmetric cell divisions producing sisters of different developmental fates result from inheritance of specific parental DNA strands according to the classical model of semiconservative replication and segregation.


Models of plant-pathogen coevolution.

Plant populations are often genetically polymorphic for resistance to pathogens. The effectiveness of this resistance is limited because the pathogens are, in turn, polymorphic for virulence genes that can evade plant resistance. Theoretical models and intriguing preliminary data suggest that these plant-pathogen polymorphisms are maintained by continual cycles of coevolution within populations, combined with occasional immigration of new virulence and resistance genes from distant populations.


Prospects for synergistic immunosuppressive drug therapy in the coming decade.

The major clinical strategy during the past three decades has been to discover a single drug that achieves immunosuppression with minimal toxic side effects. Regimens to optimize CyA immunosuppressive therapy have been limited by marked interindividual variations in drug pharmacokinetics and pharmacodynamics that cause simple drug administration routines to produce variable clinical outcomes. The approach presented herein seeks to employ multiple immunosuppressive agents that act synergistically to inhibit alloactivation. Using the rigorous median effect analysis, synergistic interactions have been discerned both using in vitro systems, as well as in vivo transplant situations. CyA has a profoundly synergistic interaction with RAPA, and a moderately synergistic effect with QCA. The next decade presents important opportunities to determine whether these immunologic effects are beclouded by synergistic drug toxicities. Studies of this type may allow us to achieve a uniformly effective, yet well-tolerated, immunosuppressive regimens in the future.


Partial liver transplantation from living related donors.

Living related liver transplantation was performed in five cases between June 1989 and July 1991 at Shinshu University Hospital. All of the donors were fathers of the patients and blood type was identical in each case. All of them were discharged from the hospital 2 weeks after hepatectomy without any complications. They started to work 2 months after surgery. Four recipients are surviving but one died. Three are enjoying daily life 17 months after LT in case 1, 5 months after LT in case 4, and 4 months after LT in case 5. Case 2 is still in the hospital 14 months after LT. Advantages of LRLT we noted were (1) cases can be performed totally electively and allow full preparation for the family and the transplant team, (2) primary graft nonfunction has not been observed to date, and (3) 38 patients received the chance of liver transplantation in their own country, which under current legislation would not otherwise have been possible. Disadvantages of LRLT were (1) partial hepatectomy was performed in healthy persons, and (2) retransplantation is difficult.


Disappearance of Kayser-Fleischer rings following liver transplantation.

1. Four cases of Kayser-Fleischer rings of Wilson's disease were observed to disappear after liver transplantation. 2. The disappearance of Kayser-Fleischer rings was in reverse order from that in which they appear. 3. The duration of disappearance was variable. 4. The density of Kayser-Fleischer rings correlated with the duration of clinical symptoms.


Respiratory changes and pulmonary complications following orthotopic liver transplantation.

In conclusion, we observed a worsening of LIS post-OLT, especially on the fourth postoperative day. The drop in this score implies a complicated course accompanied by a high mortality rate and increased medical expenses. Among the four components, oxygenation index and chest roentgenography score play an important and practical role. Measuring the AaD(O2) has its clinical merit, while the PEEP score and compliance of the respiratory system are of limited usefulness in this setting. The pleural effusions developed after OLT showed a trend towards increasing in amount until the sixth day and then gradually decreasing, except those cases with complications.


Factors leading to improved outcome following pancreas transplantation--the influence of immunosuppression and HLA matching.

The results of pancreas transplantation continue to improve and do not appear to have plateaued worldwide. In the United States, pancreas graft survival rates are now similar or better than those for other organ transplants, particularly when the pancreas is transplanted simultaneously with a kidney. Since 1987, more than three fourths of uremic recipients of simultaneous pancreas and kidney grafts are insulin independent and dialysis-free more than 1 year after transplantation. Although there is room for improvement in the results of solitary pancreas transplants, more than half of these patients are insulin independent at 1 year. A successful pancreas transplant results in near normalization of glucose metabolism and lowers glycosylated hemoglobin to normal levels. While a successful pancreas transplant may not elevate all diabetic patients to the level of health and function of the general population, pancreas transplant recipients report a significantly better quality of life than do those patients who remain diabetic. As the success rate of pancreas transplantation continues to improve, this treatment should be considered as a means for restoring a normal glucose level in type I diabetic patients before the development of advanced, disabling complications of the disease. Our recommendation for an approach to minimizing the antirejection response and maximizing graft survival rates in pancreas transplant recipients is to use quadruple immunosuppressive therapy with the induction doses higher than those employed for other organ transplant recipients. For SPK recipients, the allocation of organs should follow the scheme used for that of a kidney alone.(ABSTRACT TRUNCATED AT 250 WORDS)


Parasitological, clinical and haematological response of children with Plasmodium falciparum to 4-aminoquinolines and to pyrimethamine-sulfadoxine with quinine in western Kenya.

Children with Plasmodium falciparum infections in Western Province, Kenya, were studied in 1987 for their parasitological, clinical and haematological response to chloroquine, to amodiaquine and to pyrimethamine-sulfadoxine plus quinine. Ninety-eight children under 5 years of age were treated in 1 of 2 hospitals. Of the 56 patients treated with chloroquine base 25 mg/kg, 91% had resistant infections, with 36% having no significant decrease in parasitaemia (RIII resistance); however, 69% responded clinically within a week. Of the 27 patients treated with amodiaquine base 25 mg/kg, 67% had resistant infections, with 7% RIII resistant; 81% responded clinically. The parasites cleared in all 15 children given pyrimethamine-sulfadoxine plus 3 days of quinine. Only when parasites cleared did patients have improved haemoglobins and haematocrits. This study shows that parasitaemia in children hospitalized in western Kenya responds poorly to 4-aminoquinolines, although the patients improve clinically, at least during the first 7 days. Young children may need to clear parasites to avoid the risk of severe anemia and the need for blood transfusions.


Three cases of human Sarcocystis infection with a review of human muscular sarcocystosis in Malaysia.

Three cases of muscular sarcocystosis from West Malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown Sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in Malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.


Visceral larva migrans in seven members of one family in Trinidad.

The occurrence of the first seven cases of visceral larva migrans in Trinidad and Tobago is described. All cases occurred in children of the same family. The ELISA test was used to confirm the clinical diagnosis.


Result of treatment in children with tuberculosis. Evaluation of indications for and results of treatment in a 5 years cohort of children treated for tuberculosis in Turiani Hospital Tanzania.

Between January 1983 and January 1988 a total of 146 children started tuberculosis (TB) treatment in Turiani Hospital, Tanzania. During the treatment period 16 children died and another 16 were transferred out. From the remaining 114 children, 84 could be traced and were visited at home. Out of this group 85% were found to be in good clinical condition, whereas 7% had a moderate condition and 1% were seriously ill. Tuberculin sensitivity testing has been carried out in 53 children from the follow-up group. The indications for treatment and the results of the follow-up study are discussed.


Prevalence of hepatitis B surface antigen (HBsAg) in blood donors from Bombay.

Analysis of serum samples from 3104 blood donors from Bombay screened for hepatitis B surface antigen (HBsAg) by ELISA. HBsAg was detected in 4.7% of the subjects. Relatives showed a significantly higher prevalence of HBsAg than volunteer donors. There was no significant association between HBsAg positivity and a particular blood group.


Glycosylated haemoglobin HbA1c and HbS1c in non-diabetic Nigerians.

Normal glycosylated haemoglobin levels were determined by the Bio-Rad Haemoglobin A1c by Column Assay, in a large series of non-diabetic Nigerians. Subjects having normal haemoglobin genotype (HbAA) and the common haemoglobinopathies, namely heterozygous sickle cell trait (HbAS) and homozygous sickle-cell anaemia (HbSS) were studied. The group mean uncorrected %HbS1c levels in the HbSS subjects were significantly higher than %HbA1c levels in the HbAA (p less than 0.02) and HbAS (p less than 0.001). However, after correction for HbS and HbF the sickle-cell trait group had a %HbA1c value significantly higher than the %HbS1c value in the HbSS subjects (p less than 0.001). Since the haemoglobinopathies influence the glycosylated haemoglobin results, hence its interpretation, the need to correct observed results for the presence of abnormal haemoglobin has been emphasised. Only then would the application of a glycosylated haemoglobin test be truely meaningful in the management of diabetic patients with the 'S' haemoglobin.


Obstructed duodenal ulcer syndrome. Observations from Kano, Northern Nigeria.

23 patients with obstructed duodenal ulcer syndrome presented in a government hospital in Kano, Northern Nigeria within a 14 months period. One presented in acute obstruction while the remaining twenty two were chronic cases. Only one patient sought medical attention before the onset of symptoms of obstruction. These figures suggest that obstructed duodenal ulcer syndrome is fairly common in Kano and that most patients with uncomplicated duodenal ulcer there do not seek proper medical attention. Duodenal ulcer is therefore probably not as uncommon there as current literature suggests.


Causes of blindness in children in the blind schools of Ethiopia.

A total of 721 children in the six schools for the blind in Ethiopia were studied. In 1988-1989 histories were taken to ascertain the predisposing factors and ophthalmological examinations and records were used to determine the causes of blindness. Ninety-five per cent of those examined had bilateral blindness, 12% did not know how they had become blind and, of those who provided information on how they became blind, 21% knew that they were born blind, 30% implicated measles as being responsible, and 13% implicated 'mitch' which is an Amharic term used to describe a very wide range of nonspecific and vague illnesses of which measles probably constitutes a significant proportion. Seventy per cent of the blindness was due to either corneal opacity or phthisis bulbi. Of those with non-congenital bilateral corneal opacity or phthisis bulbi, 40% were preceded by measles and 17% by mitch. A study of 66 adults in the handicraft and skill-training centres attached to the blind schools indicated that the principal predisposing factors of blindness were mitch (30%), smallpox (15%), cataract (12%), and traditional eye medicine (11%). Seventy percent had corneal scars of phthisis bulbi and 14% cataract.


A new EPI strategy to reach high risk urban children in Bangladesh: urban volunteers.

Many community based outreach programs in low income countries utilize illiterate women to provide health services. However, illiteracy may present special problems in immunization or other programs requiring extensive record-keeping and follow-up. In a trial involving twenty-nine volunteers from urban slum communities in Dhaka, Bangladesh, a community-based referral and record-keeping system for use by semi-literate and illiterate volunteers in immunization outreach activities was evaluated over a thirteen month period. The women were uniformly, regardless of literacy, able to use the system to effectively refer and follow-up clients. Although volunteer performance as measured by numbers of referrals was below initial targets, completion rates were high; 87% of children and 96% of women referred completed the full series of immunizations. By facilitating active community participation, the system provides a feasible approach to reducing the high drop-out rates currently associated with immunization programs.


Young coconut water for home rehydration in children with mild gastroenteritis.

Coconut water was evaluated as a home glucose electrolyte solution for well-nourished children with mild diarrhoea. We describe the chemical composition of coconut water by type and age of coconut (Cocos nucifera). Our results suggest that young coconut water can be used, together with early refeeding, as a home glucose electrolyte oral rehydration solution in the early stages of mild diarrhoeal disease, despite not having a balanced electrolyte composition. However, it should not be used in patients with severe cholera, or in patients who are dehydrated and/or in whom renal function is impaired.


The sixth case of lagochilascariasis minor in Surinam.

The sixth case of lagochilascariasis minor in Surinam is reported in a 13-year-old boy. He had abscesses on the right and left side of the neck, with fistulae out of which eggs, larvae and adult worms were expelled. Treatment with thiabendazole and levamisole were ineffective. Finally he was cured after prolonged treatment with albendazole. This is probably the 63rd case of lagochilascariasis minor in the world, but there is a possibility that infection with this rare nematode is underreported.


Fatal lipoid pneumonia in an infant complicated by Mycobacterium fortuitum infection.

We report a fatal case of lipoid pneumonia in a two and one half month old Saudi female caused by aspiration of animal fat, ghee and complicated by Mycobacterium fortuitum infection. It highlights the need to look for M. fortuitum in lipoid pneumonia and suggests the prevention of the condition through health education.


Combined intrauterine and extrauterine gestation with a general surgical presentation.

A case is presented of a combined intrauterine and extrauterine gestation. The diagnosis of the ectopic pregnancy was made intraoperatively with a pre-operative diagnosis of a simple intestinal obstruction, while the intrauterine pregnancy was diagnosed after a spontaneous abortion. A family history of twinning associated with a surgical evidence of chronic inflammatory disease is thought to be the cause.


Hysterical paralysis as a complication of snake bite.

Until recently, hysteria was believed to be uncommon amongst the indigenous inhabitants of tropical Africa. Though snake bites are common, there has not been any previous report of hysterical manifestations following snake bite. We report a case of hysterical paralysis in a nulliparous Nigerian female, with comments on its diagnostic and prognostic implications in an ethnic community.


Pregnancies too young, too old, too many and too frequent in Nigeria; prevalence and the effect on birthweight and perinatal mortality.

Among 2,865 consecutive singleton deliveries at Ilorin, Nigeria, high-risk pregnancies classified as too young, 206 (7.2%); too old, 74 (2.6%); too many, 234 (8.2%): too frequent, 216 (7.5%); and two or more variables 283, (9.8%) accounted for a total of 1013 (33.9%) deliveries. Low birth weight infants are significantly more among high-risk infants, 89 (8.8%), when compared to control infants, 87 (4.7%) (p less than 0.001). Similarly, the relative risk for perinatal mortality was 2.8 to 6.8 times higher among the high-risk pregnancies. A comprehensive programme offering family planning, education and economic opportunities is advocated for prevention.


The use and efficacy of Azadirachta indica ADR ('Neem') and Curcuma longa ('Turmeric') in scabies. A pilot study.

In the Ayurvedha and Sidha system of medicine (Indian system of medicine) Azadirachta indica ADR ('Neem') and Curcuma longa ('Turmeric') has been used for healing chronic ulcers and scabies. The 'Neem' and 'Turmeric' was used as a paste for the treatment of scabies in 814 people. In 97% of cases cure was obtained within 3 to 15 days of treatment. We find that this is a very cheap, easily available, effective and acceptable mode of treatment for the villagers in the developing countries. We have noticed no toxic or adverse reaction so far. However, further research is needed.


Chloroquine resistance of Plasmodium falciparum in Bukumbi, Tanzania. An in vivo study.

The sensitivity of Plasmodium falciparum to chloroquine was studied in 42 children in Bukumbi, Tanzania. The standard WHO in vivo test was used, and chloroquine phosphate 25 mg base/kg was administered in divided doses over three days. From the 42 patients 13 (31%) were sensitive to chloroquine and 29 (69%) had not cleared their parasites on day 7. From the resistant cases, 1 showed RI resistance (early recrudescence), 6 showed RII resistance and 18 cases showed RIII resistance. Four were resistant, not further specified. This high degree of resistance might indicate that chloroquine, without control of the intake and uptake, is no longer the drug of choice for this area.


Schistosomiasis in the Yemen Arab Republic. Prevalence of Schistosoma mansoni and S. haematobium infection among schoolchildren in the central highlands and their relation to altitude.

A study was carried out in March/April 1988 to determine the prevalence of Schistosoma haematobium and S. mansoni among schoolchildren in the Jebal ash Sharq District, Dhamar Governorate, Yemen Arab Republic. The average percentage of schoolchildren infected with schistosomies (one or both species) was 34.5%. The prevalence of S. mansoni was found to be 22.6% and S. haematobium was present in 16.8% of the urine samples. A negative correlation was found between prevalence and altitude.


The white cell count in typhoid fever.

Leucopenia with neutropenia and a relative lymphocytosis are believed to be common findings in patients with typhoid fever. This paper reviews 191 adult patients with typhoid. The total and differential leucocyte counts done on admission were analysed. In this study leucopenia was found in only 24.6% of patients. Whilst complications occurred at any white cell count, the prevalence of complications increased significantly to 70% in patients with a white cell count above 8 x 10(9)/l. Neutropenia was found in 25% of patients, and none of the patients had an absolute lymphocytosis, whereas 75.8% of patients had true lymphopenia.


Leprosy among university and high school students in Benin City, Nigeria. A eight years review.

36 cases of leprosy were seen among University and High School students in the Skin Clinic of the University of Benin Teaching Hospital during an 8 years period (1982-1989). The male to female ratio was 2 to 1. Borderline tuberculoid and tuberculoid leprosy were the commonest form of presentation, seen in 66.6% of all cases. Borderline lepromatous and lepromatous leprosy were seen in 22% while indeterminate in 11% of cases. There has been a gradual reduction of new cases from a peak of about 8 cases in 1983 to one in 1989. Most patients complied with treatment and were able to continue their education with little or no hinderance.


Prolonged undiagnosed fever in northern India.

A prospective study for five years along with a retrospective analysis of all patients admitted over 10 years with the diagnosis of prolonged undiagnosed fever was carried out in a referral hospital of North India to determine the specific disorders responsible for it. One hundred and fifty patients (80 prospective and 70 retrospective) were included in the study. Infections, especially tuberculosis, was the most dominant cause (50%), followed by lymphoreticular and haematological disorders (21.32%), collagen vascular disorders and neoplasms (8.67%) each. Miscellaneous causes were responsible in 6.67% and in 4.67% the cause of fever remained undiagnosed.


Anti-thrombin III deficiency in Nigerian children with sickle cell disease. Possible role in the cerebral syndrome.

A prospective study of Nigerian children with sickle cell disease was undertaken to determine serum levels of antithrombin III (AT-III) and compare these with normal controls. Mean serum AT-III was significantly lower in patients than in controls (14.51 +/- 4.84 mg/dl and 17.75 +/- 5.92 mg/dl) respectively. Seven of the 49 sickle cell patients had AT-III levels below 50% of normal values. Mean platelet counts were significantly higher in sicklers than in normal controls. AT-III deficiency may predispose to thrombotic complications in children with sickle cell disease.


The pathological basis of chronic renal failure in Nigerians. An autopsy study.

With the aim of determining the relative prevalence of the diseases underlying chronic renal failure (CRF) in a large homogeneous black tropical population, the autopsy records of the Obafemi Awolowo University Teaching Hospital over a four year period were studied. Out of a total of 702 cases coming to autopsy during this period, 66 (9.4%) died as a result of CRF. The highest number of cases of CRF fell within the 31-40 year age group with a male/female ratio of 1.28:1. Chronic glomerulonephritis was responsible for 40.9% of cases, malignant nephrosclerosis 16.6%, benign nephrosclerosis 7.6% while endstage renal disease (ESRD) was responsible for 15.4%. A miscellaneous group of diseases was responsible for 19.7%, about half of which was due to chronic pyelonephritis. Rarer causes of CRF were diabetic nephropathy, multiple myeloma, systemic lupus erythematosus and analgesic nephropathy.


Haematological nutrition of schoolchildren in the far northwestern cape.

The prevalence of anaemia and deficiencies of iron, folate and vitamin B12 were investigated in primary schoolchildren of mixed ethnic origin living in four towns in a remote semi-desert area of southern Africa, the Richtersveld. Anaemia was uncommon (6.3%); iron and vitamin B12 deficiencies were not observed. Sub-normal erythrocyte folate concentrations were present in 14.5%, but significant folate deficiency was rare (less than 2%). There were negligible differences in the haematological parameters of the children in the four towns, even though children living in Kuboes received milk at school and children at Dryfsandt a lunch of milk, brown bread and margarine. The results support the general observation that schoolchildren are not a risk group for nutritional anaemia.


Evaluation of community health services utilization. A case study from Columbia.

In a PHC project in Chocó, Columbia, Community Health Workers (CHWs) were trained in curative care of some simple diseases. Consultations were registered in a village-based monitoring system. Of registered cases, about 60% was treated by CHWs and 15% referred by them. Episodes were underregistered. A cross-sectional survey was carried out in 6 villages, among 890 persons. The CHW was consulted in 6.5% of the cases in which a consultation had been made. This low percentage of consulting the CHW is explained by the lack of perception of all diagnosed morbidity. Reasons for low consultation rates were found in a household survey. Suggestions on improvement of the utilization of CHW services are presented.


Post-operative transfusion malaria.

Two Saudi patients who underwent cardiac surgery, developed fever after being discharged from hospital. Both received blood transfusion during operation. The cause of fever was found to be due to malaria acquired from the transfused blood. As no single measure could prevent transfusion malaria, clinical awareness of the condition should lead to early diagnosis and management of such cases.


A case of fatal gastrointestinal strongyloidiasis in an otherwise healthy Nigerian, masquerading as gastric outlet obstruction.

A 46-year old man who presented with signs and symptoms suggestive of gastric outlet obstruction from carcinoma or cicatrisation of chronic duodenal ulcer is presented. The radiologic as well as laboratory findings confirmed strongyloidiasis. The lesion which has been associated with immunodeficient patients was found in an otherwise healthy patient. It is for this reason and the need to heighten the awareness of practising doctors to the salient radiologic features, that this report is presented.


Tracheal papilloma presenting as asthma in a child.

This report describes a child with a tracheal papilloma who was initially diagnosed and treated as having asthma. The case illustrates that all wheezing in children should not be attributed to asthma.


Multifocal Salmonella splenic abscess in a HIV-infected patient.

A case of spleen abscess complicating Salmonella bacteremia in a HIV-infected patient is reported for the first time. Chronic pancreatitis and the infection of a pre-existing pseudocyst of the pancreas tail might have been the predisposing factor. Infection developed before other AIDS criteria were evident in the patient. Splenectomy plus antibiotic therapy was required to eradicate the process. Salmonella enteritidis was cultured from two suppurated lesions of the excised organ.


Giant hemangioma of the liver. An observation from Samoa Islands.

Hemangioma of the liver is a benign tumor of vascular origin. Most of them are less than 2-3 cm in diameter and remain asymptomatic. Although hemangioma is the most frequent benign tumor of the liver large symptomatic hemangiomas, so-called 'giant' hemangiomas, are rare. In this paper a case of 'giant' hepatic hemangioma measuring 15 cm in diameter, seen in a middle aged Samoan woman, is presented. Clinical, pathological and therapeutical features are discussed.


The treatment of adult hyperglycaemia in an African rural hospital.

This paper describes the treatment of adult diabetic ketoacidosis in an African rural hospital in which there were only rudimentary diagnostic facilities. It is intended to be a practical guide to doctors working under similar conditions. It also deals with some of the pathophysiological mechanisms underlying diabetic ketoacidosis but emphasises the use of clinical skills in patient assessment and management.


Can mothers safely prepare labon-gur salt-sugar solution after demonstration in a diarrhoeal hospital?

Home-based salt-sugar solution (SSS) prepared with labon (locally produced sea salt) and gur (unrefined brown sugar) has been recommended as a cheap, locally available and a simple tool to prevent and treat diarrhoeal dehydration. Preparation of labon-gur SSS is demonstrated to the patients and the attendants at ICDDR, Bangladesh. To evaluate performances, 150 mothers were asked to measure labon and gur by finger pinch and first method and 100 mothers measured half a seer of water to prepare labon-gur SSS, shortly after the demonstration sessions. 4.0% of the samples exceeded the upper safety limit while 1.3% exceeded the upper danger limit for salt and 98.7% samples of gur were within safe and effective range. Mothers' performances were not different with regard to their educational status and prior practice at home. 80% knew about the solution before coming to the hospital and 45% had utilized this knowledge. Our study suggests that demonstration of home-based SSS in a diarrhoeal hospital may positively affect health education and that health personnel should actively participate in increasing health awareness.


Evaluation of 5.1-[NANP]19, a recombinant Plasmodium falciparum vaccine candidate, in adults.

In a randomized single-blind study, 13 healthy adult volunteers were subcutaneously immunized with 2 or 3 single 50 or 400 micrograms doses of a Plasmodium falciparum recombinant vaccine candidate designated 5.1-[NANP]19. The vaccine caused transitory reactions at the injection site. Eight (62%) volunteers had a greater than or equal to 4-fold increase of antibody titer against sporozoites in immunofluorescence assay, all 13 seroconverted in IgG enzyme-linked immunosorbent assay against [NANP]50 antigen, and in 6 (46%) a lymphocyte proliferation index greater than or equal to 3 against 5.1 antigen was observed. Seven volunteers were challenged with mosquitoes infected with P. falciparum. All developed detectable parasitemia after 7 to 12 days and all received drug therapy within 24 hours. One volunteer with a cellular response to 5.1 had two negative in vitro parasite cultures before treatment, despite overt parasitemia. He was the only challenged volunteer who remained free of malaria symptoms.


Malaria parasite density and body temperature in children under 10 years of age in Calabar, Nigeria.

1,188 children under 10 years of age who attended the children's Emergency Clinic were examined from January to December 1988. Their axillary temperatures were recorded and thick and thin blood smears made to determine the malaria prevalence rate and the parasite density. The results show a high prevalence rate (44.8%) for malaria and this was stable throughout the year. The number of subjects with parasite densities of 100,000/mm3 and over, increased progressively with increase in body temperature such that 74.9% of the parasitemic subjects had high grade temperatures of 38 degrees C and over, while only 11.8% had moderate temperatures of 37.5-37.9 degrees C. The ratio of parasitemic afebrile to parasitemic febrile patients was in the order of 1:6, suggesting that parasitaemia is usually accompanied by fever. There was a steady rise in temperature with parasite density up to 39.5 degrees C, when further increase in parasite density apparently caused no further rise in temperature, suggesting a self-protective efficient feed back mechanism.


Platelet count in deep saturation diving.

Platelet counts were measured in 10 divers during the course of 4 experimental deep dives (450 and 600 m) and different anticoagulants were tested. The use of sodium citrate as an anticoagulant was associated with artifactual thrombocytopenia, whereas ethylenediaminetetraacetic acid proved to be satisfactory. During one of the dives (450 m) the use of fluorocarbon to remove excess dissolved inert gas before decompression of the samples was systematically tested. Mean platelet count decreased from 272,600 +/- 29,400 mm-3 (mean +/- SD) on Day 7 (450 m) to 177,700 +/- 26,400 mm-3 on Day 12 (360 m). Platelet count had recovered to 209,900 +/- 20,700 mm-3 at the time of surfacing. Mean hematocrit (expressed in percent) increased from 44.7 +/- 2.2 predive to 59.4 +/- 2.0 on Day 7 (450 m) to 40.9 +/- 2.8 at the time of surfacing. These changes were statistically significant (P less than 0.05). Platelet counts on samples that had been degassed with fluorocarbon were not different from samples that had been decompressed without degassing.