Biochemical and immunohistochemical demonstration of a tightly bound form of prostaglandin E2 in the rat brain.

Basal levels of prostaglandin E2 in the rat brain were determined by radioimmunoassay to be 0.68-0.79 pmol/g brain. About one-third of the prostaglandin E2 (0.23-0.28 pmol/g) was resistant to extraction with ethanol, but could be recovered with a mixture of ethanol and 1 N HCl (9:1, v/v), indicating that a tightly bound form of prostaglandin E2 exists in the brain. The amount of the bound form of prostaglandin E2 was almost unchanged by pentylenetetrazole-induced convulsion or by transcardial perfusion with a formaldehyde solution, although these treatments resulted in 40- to 80-fold increases in prostaglandin E2 content extracted with ethanol at neutral pH. A polyclonal antibody against prostaglandin E2-albumin conjugates recognized the bound form of prostaglandin E2, giving a punctate appearance in many neuronal cell bodies in the brain. Although almost all of the neuronal perikarya were immunoreactive for prostaglandin E2, intense immunoreactivity was observed in the mitral cell layer of the olfactory bulb, layer V of the cerebral neocortex, anterodorsal and reticular nuclei of the thalamus, supraoptic, paraventricular, accessory neurosecretory and lateral mammaillary nuclei of the hypothalamus, mesencephalic trigeminal nucleus, nucleus of the trapezoid body and deep cerebellar nuclei. When the cerebral neocortical regions were observed electron microscopically, immunoreaction products were seen as fine granules which were clustered into small patches in the cytoplasm of neuronal cell bodies and proximal dendrites. No immunoreaction products were seen in glial cells or endothelial cells. These results suggest that prostaglandin E2 is involved in fundamental processes of neurons.


The tuned displacement response of the hearing organ is generated by the outer hair cells.

The motile responses of the guinea-pig hearing organ in response to a tone applied to the ear were measured by laser interferometry. Two types of responses can be recorded: (i) a vibration at the frequency of the applied tone; and (ii) a displacement response consisting of a shift in the position of the organ surface. The purpose of this study is to characterize the displacement response. The results are as follows. There is a relationship between the frequency of highest sensitivity (best-frequency) of the displacement response and the site from which it is recorded. High best-frequencies are noticed at more basal locations, low best-frequencies towards the apex. The displacement response is more frequency-selective than the vibration response. The displacement response is observed within physiological sound pressure levels. Its sharpness is dependent on the stimulus intensity, it shows biological variability and can be manipulated by drugs that are known to modify the receptor potential of the sensory cells, or to interfere with outer hair cell motility. These results suggest that the displacement response is an important step in the transduction process in the mammalian hearing organ and that it is generated by the motile action of the outer hair cells.


Expression of c-fos-like immunoreactivity in brainstem after meningeal irritation by blood in the subarachnoid space.

The expression of c-fos protein was examined by immunohistochemistry in serial sections of brainstem following the instillation of either autologous arterial blood (0.3 ml) or mock cerebrospinal fluid (0.3 ml) through a catheter placed in the cisterna magna, or following catheter placement alone in pentobarbital-anesthetized Sprague-Dawley rats. After injection, blood was distributed within the subarachnoid space surrounding the brainstem and in the region of the circle of Willis. c-fos protein-like immunoreactivity was present at 1 h, peaked at 2 h and decreased by 8 h. At 2 h, immunoreactivity was strongly expressed within trigeminal nucleus caudalis (lamina I, IIo), as well as within nucleus of the solitary tract, area postrema, ependyma, pia mater and arachnoid in every animal. Moderate labeling was found in parabrachial nucleus, medullary lateral reticular nucleus and central gray. Sparse labeling was present in trigeminal nucleus caudalis (lamina III-V) and trigeminal nucleus interpolaris; few or no labeled cells were detected in other parts of the trigeminal nuclear complex, thalamus, cerebral cortex, cerebellar cortex or trigeminal ganglion. The number of positive cells was not related to the volume of injectate but was related to the amount of injected blood. The density of cell labeling evoked by injecting mock cerebrospinal fluid or after catheter placement was markedly lower than after blood in all brainstem areas. The number of labeled cells was greatly reduced within trigeminal nuclear complex, parabrachial nucleus and medullary lateral reticular nucleus, but not within the nucleus of the solitary tract, area postrema or ependyma when blood was injected into adult animals in which unmyelinated C-fibers were destroyed by neonatal capsaicin treatment. Similar results were obtained after blood was instilled into the cisterna magna of rats in which meningeal afferents were chronically sectioned at the ethmoidal foramen bilaterally. We conclude that blood in the subarachnoid space is an effective stimulus for activating c-fos expression within subpopulations of brainstem neurons. Activation within trigeminal nucleus caudalis is mediated in large part by excitation of small-caliber meningeal afferents (trigeminovascular fibers), whereas c-fos expression within nucleus of the solitary tract and area postrema may reflect direct stimulation of blood or blood products, or possibly the response to autonomic activation from noxious stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)


Persistent pain inhibits contralateral somatosensory cortical activity in humans.

To assess cortical activity during pain perception, regional cerebral blood flow (rCBF) studies were done in humans using single photon emission computed tomography (SPECT) with the radiotracer Tc99m-HMPAO and magnetic resonance imaging localization. Normalized SPECT data were analyzed by region of interest and change distribution. Contralateral somatosensory rCBF was decreased when the digits of the hand were immersed in a hot water bath for 3 min which was rated as moderately painful (persistent pain). No decrease was observed when the hand was immersed in tepid water (control). In contrast, cortical rCBF was increased during vibratory and sensorimotor tasks, in the contralateral somatosensory and sensorimotor areas, respectively. These results indicate that pain perception in man is associated with somatosensory cortical inhibition.


Evidence for L-dopa systems responsible for cardiovascular control in the nucleus tractus solitarii of the rat.

Microinjections of L-DOPA (10-100 ng) into the medial area of the nucleus tractus solitarii (NTS) led to dose-dependent decreases in arterial blood pressure and heart rate in rats treated with i.p. 3-hydroxybenzylhydrazine, a central inhibitor of DOPA decarboxylase, or similarly with intraventricular 6-hydroxydopamine. D-DOPA, dopamine or noradrenaline (100 ng) produced no effect. L-DOPA methyl ester (1 microgram), a competitive antagonist for L-DOPA, microinjected into NTS, blocked the depressor and bradycardic responses to L-DOPA. High K+ (40 mM) released endogenous DOPA in a Ca(2+)-dependent manner from slices of the rat dorsomedial medulla including NTS. These results support the hypothesis that there exist systems of L-DOPA itself responsible for cardiovascular regulation in NTS of rats. This regulatory action of L-DOPA seems to be postsynaptic in nature.


A neuropeptide Y (NPY)-related peptide is present in the river lamprey CNS.

Pancreatic polypeptide (PP)-like material from brain+spinal cord, and retina extracts of Lampetra fluviatilis was studied by HPLC and RIA. The brain+spinal cord extract showed a complex elution profile with multiple peaks of immunoreactivity. The retina extract showed a much simpler pattern with a single significant peak along with a trace of a second peak corresponding to the latest and penultimate peaks in the brain extract. Twenty-one out of 36 residues could be sequenced from the latest eluting peak in the brain extract. This sequence showed 81% identity with porcine neuropeptide (NPY) suggesting that both the brain/spinal cord and retina of the river lamprey contain a peptide homologous to NPY.


Dendritic integration of motion information in visual interneurons of the blowfly.

Dendritic integration plays a key role in the way information is processed by nerve cells. The large motion-sensitive interneurons of the fly appear to be most appropriate for an investigation of this process. These cells are known to receive input from numerous local motion-sensitive elements and to control visually-guided optomotor responses (e.g., Trends Neurosci., 11 (1988) 351-358; Stavenga and Hardie, Facets of Vision, Springer, 1989). The retinotopic input organization of these cells allows for in vivo stimulation of selected parts of their dendritic tree with their natural excitatory and inhibitory synaptic input signals. By displaying motion in either the cells' preferred or null direction in different regions of the receptive field we found: (i) Responses to combinations of excitatory and inhibitory motion stimuli can be described as the sum of the two response components. (ii) Responses to combination of excitatory stimuli show saturation effects. The deviation from linear superposition depends on the distance and relative position of the activated synaptic sites on the dendrite and makes the responses almost insensitive to the number of activated input channels. (iii) The saturation level depends on different stimulus parameters, e.g. the velocity of the moving pattern. The cell still encodes velocity under conditions of spatial saturation. The results can be understood on the basis of passive dendritic integration of the signals of retinotopically organized local motion-detecting elements with opposite polarity.


Contribution of protein kinase C to central sensitization and persistent pain following tissue injury.

This paper provides evidence that central sensitization and persistent nociception following formalin-induced tissue injury in rats is dependent on the production of protein kinase C. Persistent nociceptive behavior in rats induced by subcutaneous formalin injection was significantly reduced by intrathecal pretreatment with a phospholipase C inhibitor (neomycin), and an inhibitor of protein kinase C (W-7), and was significantly enhanced by a phorbol ester (phorbol 12-myristate 13-acetate, PMA) and a stimulator of protein kinase C (SC-10). It is expected that noxious inputs associated with tissue injury produce a release of aspartate and glutamate within the spinal dorsal horn which by acting at ionotropic (NMDA) and metabotropic excitatory amino acid receptors produce an increase in intracellular messengers such as calcium and diacylglycerol which stimulate protein kinase C.


An electron microscopic study of neurosecretion in the cerebral ganglion of the earthworm.

Non-synaptic, exocytotic release of neurosecretory granules in cerebral ganglion neurons was observed electron microscopically in 3 species of the oligochaete annelids Aporrectodea caliginosa, Octolasion cyaneum and Lumbricus terrestris. In addition to the features indicating exocytotic release of neurosecretory granules into perineuronal space, possible features of neurosecretion into blood vessels were seen within the cerebral ganglion. Axon terminals in synaptic contact with perikaryal profiles of cerebral ganglion neurons were also found.


Characterization of a glial associated antigen GA-1 by monoclonal antibody.

A glial antigen (GA-1) was identified by monoclonal antibodies (MAb) raised against C6 rat glioma cells. MAb-7D3 (IgG2a kappa) revealed GA-1 as a single protein band with a Rf value of 0.09 by the use of basic-PAGE Western blot. SDS-PAGE Western blot and radioimmunoprecipitation (RIP) further resolved GA-1 into two subunits with a molecular weight of 200 and 78 kDa respectively. Subcellular localization by immunocytochemical staining revealed its cytosolic presence with a punctate pattern perinuclearly. Significant expression of GA-1 may be detected in 4 glioma or glial cell lines derived from rat brain. However, no expression may be detected in the rest of the 18 mammalian cell lines or primary neural cell cultures examined. All of the above data thereby suggest that GA-1 may be glial specific whereas the epitope of GA-1 defined by MAb-7D3 is species (rat) specific.


Evidence that biocytin is taken up by axons.

Unexpected anterograde labeling is systematically observed in the pontine nuclei following iontophoretic injection of biocytin in the substantia nigra pars reticulata. Control experiments using WGA-HRP have led to deny the existence of a nigro-pontine pathway. The possibility that biocytin is taken up by fibers of passage has been tested. Deposits of biocytin in the corpus callosum result in a massive axonal labeling of this fibrous system. This study, in contrast to previous reports, stresses that biocytin is easily taken up and transported by axons. Hence, this tracer has to be used with careful controls when injected in structures crossed by fibrous tracts.


Ultrastructural characterization of gonadotropin-releasing hormone (GnRH)-immunoreactive terminal nerve cells in the dwarf gourami.

Recently we have been studying gonadotropin-releasing hormone (GnRH) cells of the terminal nerve (TN) in the dwarf gourami, which may serve as a good model system for the study of neuromodulator functions. Here we report on the ultrastructural characterization of TN-GnRH cells using postembedding immunoelectron microscopy. The GnRH immunoreactivities could be demonstrated on dense-cored vesicles (DCVs) in cell bodies, fibers and varicosities. However, we could find no evidence of GnRH-immunoreactive synapses which are characterized by active zones. This may suggest that GnRH is released non-synaptically from DCV-containing fiber varicosities and that it exerts its modulatory action on GnRH receptors located on nearby as well as distant target neurons.


Reduction of NGF protein level in rat dorsal hippocampus following administration of kainic acid.

Intraperitoneal administration of kainic acid (KA) into adult rats caused a profound increase in nerve growth factor (NGF) mRNA and a significant reduction of NGF protein level in the hippocampus. Diazepam pretreatment suppressed both. The reduction of NGF level was apparent in the dorsal hippocampus at 2 h after KA administration, but a marked elevation of NGF protein was observed in the ventral hippocampus at 4 h. These results suggest that non-N-methyl-D-aspartate (NMDA) receptor agonists negatively influence NGF synthesis or stimulate NGF protein degradation in the dorsal hippocampus involving the CA1 sector.


Increase of plasma neuropeptide Y-like immunoreactivity following chronic hypoxia in the rat.

In an attempt to understand the changes of circulating neuropeptide Y (NPY) during hypoxia, the plasma level of NPY was investigated by radioimmunoassay. Exposure of rats to hypobaric hypoxia at an altitude of 18,000 ft for 4 weeks causes an increase of pulmonary pressure and an elevation of plasma NPY-like immunoreactivity (NPY-LI). However, the systemic blood pressure was not elevated by this chronic hypoxia. Also, plasma noradrenaline (NA) estimated by chromatographic analysis (HPLC-ECD) was not markedly raised. Failure of bretylium and guanethidine, sympathetic neuron blockers, in reducing the plasma NPY-LI level of these rats ruled out the participation of adrenergic nervous terminals. Adrenal medulla seems responsible for this elevation of plasma NPY-LI because this magnitude disappeared in adrenalectomized rats. These data suggest that chronic hypoxia induced an elevation of circulating NPY from the adrenal gland of rats.


Noradrenergic innervation of vasopressin-containing neurons in the rat hypothalamic supraoptic nucleus.

The noradrenergic innervation of vasopressin (VP)-containing neurons in the supraoptic nucleus (SON) of the rat hypothalamus was studied electron microscopically by using double-labeling immunocytochemistry combining the pre-embedding peroxidase-anti-peroxidase method with post-embedding immunocolloidal gold staining. Noradrenaline-like immunoreactive axon terminals were found to make synaptic contacts with neurophysin II-like immunoreactive neurons in the SON. This provides morphological evidence for noradrenergic control of neuronal activity of VP-containing neurons at the SON level.


Acute morphine induces oscillatory discharge of noradrenergic locus coeruleus neurons in the waking monkey.

Neurons were recorded extracellularly from the locus coeruleus (LC) of a waking, chair-restrained cynomolgus monkey before and for 0.5-4 h after intramuscular injections of morphine sulfate (0.3-10 mg/kg). Tonic discharge of each LC neuron tested (n = 11) decreased after morphine injection; this effect appeared to be dose-dependent for the range of 0.3-3.0 mg/kg. Unexpectedly, these same doses of morphine also induced a pronounced burst-pause discharge pattern in all LC neurons recorded. Thus, whereas in the naive animal pauses in discharge longer than 3 s were rare during waking, after morphine injection LC neurons frequently exhibited pauses in impulse activity of 10 s or longer during non-drowsy waking. The bursts in activity following morphine corresponded to orienting behaviors or apparent alertness, whereas pauses were associated with eye closure or slowly drifting gaze. Closer analysis revealed that this burst-pause activity pattern was somewhat regular, with a period of about 15-35 s. This observation was confirmed by autocorrelogram analysis. In view of previous findings in rodent LC, we suggest that acute morphine elicits a dual effect on primate LC neurons: inhibition of discharge by direct effects on opiate receptors located on LC cells, and periodic phasic activation mediated by excitatory afferents to the LC.


Neuroprotective actions of riluzole in rodent models of global and focal cerebral ischaemia.

Riluzole (2 amino 6-trifluoromethoxybenzothiazole), when administered at 4 and 8 mg/kg i.p., 0.5, 4.5, 24 and 28 h after the initiation of ischaemia, significantly reduced the prevalence of slow wave, and increased the proportion of higher frequency activity seen in the quantified electrocorticogram (ECoG), during the weeks that followed a 6 min bilateral occlusion of the common carotid arteries in the Mongolian gerbil. In focal ischaemia, provoked in Fischer rats following the occlusion of the middle cerebral artery, administration of riluzole (8 mg/kg) at 30 min and 24.5 h post occlusion significantly reduced the volume of infarcted cortex. These activities of riluzole could be related to its inhibition of sodium channel activity, which in turn inhibits glutamate release.


Time-dependent disruption of passive avoidance acquisition by post-training intra-amygdala injection of tetrodotoxin in rats.

The role of the amygdala (AM) in the consolidation of the passive avoidance reaction (PAR) has been examined with the tetrodotoxin (TTX)-induced functional block of this structure. Rats were trained in the step-through PAR and anesthetized with ketamine. TTX injected immediately after acquisition into both AM (2 x 10 ng) significantly reduced avoidance of the dark compartment in the retrieval test performed two days later. The amnesic effect was significant when the acquisition--TTX delay was prolonged to 90 min but not to 6 h or 24 h. Earlier research indicated that TTX blockade of the parabrachial nuclei caused similar PAR disruption when elicited 24 h but not 48 h after acquisition. Comparison of the TTX-induced retrograde amnesias indicates that the two structures play different roles in the formation of the PAR engram.


Muscarinic modulation of acetylcholine release from slices of guinea pig nucleus basalis magnocellularis.

Spontaneous and electrically evoked endogenous acetylcholine release and [3H]-choline efflux from slices of guinea pig nucleus basalis magnocellularis (nbM) were studied. Tetrodotoxin reduced the spontaneous endogenous release by 55%, while the Ca(2+)-free medium reduced it by about 30%. Evoked [3H]-choline efflux was Na+ and Ca2+ dependent and frequency related. Physostigmine, 30 microM, nearly halved the stimulation-evoked efflux; atropine, 0.15 microM, not only antagonized, but even reversed this effect into facilitation. Pirenzepine, 1 microM, and AFDX 116, 1 microM, were less effective than atropine, and reversed the inhibitory effect of physostigmine only when applied together. 4-DAMP, 0.01 microM, was ineffective. These findings indicate that acetylcholine release in guinea pig nbM slices is inhibited by the cooperation of muscarinic autoreceptors, possibly belonging to the M1 and M2 subclasses.


Event-related potentials in auditory backward recognition masking: a new way to study the neurophysiological basis of sensory memory in humans.

Task-irrelevant pairs of short tones were presented to healthy human subjects while electric potentials were recorded from their scalp ('event-related brain potential', ERP). Infrequent increments in the frequency of the first tone of the repetitive tone-pair elicited an extra ERP component termed 'mismatch negativity' (MMN) when the silent interval between the first and second tone of the pair ('inter-tone interval') was long (150, 300, or 400 ms) but not when this interval was short (20 or 50 ms). This effect did not depend on whether the two tones of the tone-pair were presented to the same or to different ears. The present inter-tone interval effect is consistent with the effects of backward-masking on recognition performance in audition, suggesting that the MMN reflects the neurophysiological basis of echoic memory.


Cortical and quasi-cortical regions innervate ventrostriopallidal structures in the rat: an electrophysiological analysis.

Antidromic unit driving was utilized to demonstrate afferent projections from prefrontal cortical (PFC) and quasi-cortical structures (main olfactory bulb, MOB; anterior olfactory nucleus, AON; basolateral amygdaloid nucleus, BLA) to the ventrostriopallidal region (VSPR) of the rat. In all regions explored, a substantial number of antidromically invaded neurons were found following electrical stimulation of the VSPR. In addition, both the AON and the amygdalostriatal zone harbor cells with branched axons which innervate the MOB and the VSPR and the agranular insular cortex and the VSPR, respectively. These results support and extend previous neuroanatomical and neurophysiological data on afferent connections of the VSPR and emphasize the fact that several regions of the basal forebrain, which are actively involved in processing of olfactory information, and the VSPR, are more closely interrelated than hitherto suspected.


Noradrenergic-induced expression of c-fos in rat cortex: neuronal localization.

beta Adrenoceptors in the rat forebrain have been shown to exist predominantly on astrocytes. Studies were undertaken to determine whether the cellular localization of c-fos expression caused by the activation of brain beta receptors would have a similar cellular localization. Double label light and electron microscopic immunohistochemical experiments with a glial (glial fibrillary acidic protein, GFAP) and neuronal marker (neurofilament protein, NFP) were undertaken in rats treated with the adrenergic drug, yohimbine. These studies revealed a predominantly neuronal localization of Fos protein in the cerebral cortex. The latter results indicate that neurons are the postsynaptic noradrenergic target cells in which this immediate early gene is expressed in response to the stimulation of beta adrenoceptors. The possible relation of these findings to the glial localization of these receptors is discussed.


Sleep-wake disorganization in cats exposed to ozone.

The effects of the exposure to ozone in the central nervous system are unknown, as it is doubtful if ozone enters beyond the respiratory tract. However, ozone exposure impairs human performance and induces subjective complaints such as fatigue, lethargy and headache. We studied electrographic aspects of sleep-wake organization in cats, and found that paradoxical sleep was promptly reduced during ozone exposure, followed by a dose-related increase of slow-wave sleep. These findings suggest that high concentrations of ozone or its reaction products induce striking changes in sleep patterns.


Syphilis: a review and update of this 'new' infection of the '90s.

Reported cases of primary, secondary and congenital syphilis are reaching epidemic proportions in the United States. Several factors have been associated with this increase, including budget reductions for syphilis-control programs, the growing use of cocaine among women of childbearing age and the practice of trading sex with multiple partners for illegal drugs. This article reviews the pathogenesis, clinical stages and presentation, serologic testing, treatment, and pertinent patient education for syphilis. Recommendations for the identification and prevention of syphilis are provided.


AIDS dementia complex in the elderly. Diagnosis and management.

Ten percent of acquired immunodeficiency syndrome cases are reported in people 50 years of age or older. These older people have been infected with the human immunodeficiency virus primarily through homosexual contact, heterosexual contact or blood transfusion. AIDS in the elderly can be described as the new great imitator, often manifesting as an undetected dementia. This article focuses on the diagnosis and management of the AIDS dementia complex, a subcortical dementia with subtle and variable manifestations. The pathogenesis of AIDS dementia complex is not well understood; however, studies have shown that two-thirds of patients with AIDS exhibit overt dementia, and less than 10 percent of the brains of AIDS patients are found to be normal upon post-mortem examination. Clinical features of AIDS dementia complex include impairment in cognitive, motor and behavioral function. Since the primary care practitioner is the first line of defense in controlling the AIDS epidemic, including AIDS in the differential diagnosis for dementia is imperative.


Canada's health care system provides lessons for NPs.

With increasing economic pressures, swaying public opinion and new government policies rationing health care resources, nurses in Canada are again challenging physicians for room to practice as nurse practitioners. Although the last Canadian nurse practitioner program was discontinued in 1983, and it was argued that the death of the role was inevitable in Canada's health care system, nurse practitioners have not vanished. Social plans in the United States are drawing heavily on the Canadian model of universal access and a government-funded health care system, and dramatic changes are taking place in Ontario's health care system. Now more than ever it is important that nurse practitioners understand Canada's health care system, why the NP role in Ontario has not been highly successful, and why the time is right for reintroduction of nurse practitioners into Ontario's health care system.


Nurse practitioner management of hospital-affiliated primary care centers.

Escalating health care costs have forced hospitals to develop alternative sources of revenue. Hospital-affiliated primary care centers that provide comprehensive health services to patients may also supplement hospital revenues with referrals for admission and/or special services. With their documented history of effectiveness, nurse practitioners are well-qualified to manage these primary care centers. This article provides guidelines to help nurse practitioners establish and manage a hospital-affiliated primary care center. Identification of clinical-services and staffing needs, and determination of office, administrative and facility requirements are also discussed.


Tuberculosis in New Zealand, 1985-90.

to examine recent trends in tuberculosis in New Zealand. histologically and bacteriologically confirmed cases of tuberculosis notified to area health boards from 1985 to 1990 were analysed. a total of 843 cases were reported during 1985-90 for an average annual incidence rate of 4.2 cases per 100,000 population; incidence rates for each year were similar. The incidence of tuberculosis was higher among males than females and increased with age. Maori were five times more likely to develop tuberculosis than Europeans, Pacific Islanders were 10 times more likely, and persons of other ethnic groups combined were 15 times more likely. From 1985 to 1990, the number of cases decreased among Europeans, remained stable among Maori and Pacific Islanders, and increased among persons of other ethnic origin. although the overall incidence of tuberculosis is relatively low, it continues to be a public health problem in New Zealand, particularly among Maori and immigrants from Asia and the Pacific Islands.


Primary malignant melanoma of skin in four regions of New Zealand.

to describe the incidence and thickness of a representative collection of melanomas occurring in recent years in New Zealand. all pathology reports of primary malignant melanoma of the skin, in defined periods in 1987-9, were collated for four regions of New Zealand. nonMaori incidence rates were 52 and 58 melanomas per 100,000 person years for men and women, respectively. These rates are much higher than the 24 per 100,000 person years for melanoma registrations in 1983-4. The age standardised invasive melanoma rate of 35 per 100,000 person years was higher than those of most Australian states and close to the rate for Queensland in 1986. Preinvasive melanomas comprised 26% of all melanomas. Of invasive melanomas, 58% in men and 55% in women were less than 0.76 mm in thickness; 7% of invasive melanomas in men and 5% in women were at least 3.5 mm thick. increasingly early detection of malignant melanomas in successive years is likely to have contributed to the recent increase in incidence, perhaps to a major degree, but an environmental cause cannot be excluded.


Taking an infant's temperature: axillary or rectal thermometer?

to examine the validity of routine use of axillary thermometers to measure body temperature in infants. comparison of 49 simultaneous paired axillary and rectal temperature recordings in infants between one and 11 months of age, who were considered afebrile by their clinicians. Regression analysis of the paired measurements, and a plot of the differences between the paired measurements against their means, were used to examine the limits of agreement of the two methods. the limits of agreement ranged from 0.2 to 1.6 degrees C difference between simultaneous paired measurements. As there was no consistent relationship between axillary and rectal temperatures, the use of a correction factor added to axillary values is invalid. The axillary thermometer may record almost the same as the rectal temperature or more than 1.5 degrees C lower at the same point in time. we question the validity of current clinical practice in assessing infant body temperature by using axillary thermometers, and we suggest that such measurement does not reflect the rectal temperature in a reliable or consistent fashion. If infant body temperature is sought, a rectal thermometer should be used.


The difficulties and costs of ethical assessment of a national research project.

In 1990 we applied to the 14 area health board ethical committees for approval of a national study of childhood cancer. All the committees approved the study, but the process was time consuming and costly. The times taken for the committees to grant approval, ranged from two to 36 weeks. The committees had differing requirements. We recommend that a single ethical committee should take responsibility for dealing with each multicentre study in New Zealand. This would ensure uniformity of approach, and minimise delays and costs.


Diabetes--inpatient utilisation, costs and data validity. Dunedin 1985-9.

to describe the impact of diabetes on the public hospital inpatient services in one New Zealand region over the period 1985-9, from one 450 bedded university teaching hospital in a major urban centre in New Zealand serving a population of approximately 125,000 people. by the analysis of routinely collected hospital discharge data and the application thereto of the resource utilisation system (RUS). Data validation was performed by means of a survey of clinical notes. admission, bed utilisation rates and associated costs for diabetes rose over the period by factors of 3.2, 3.8 and 2.8 respectively; due primarily to the management of macrovascular disease in the elderly. The rise was most marked in those 75 years and over; admission rates, bed utilisation rates and costs in this age group being respectively 1.9, 4.3 and 2.9 times greater than the 60 to 74 year age group. For admissions with diabetes as principal diagnosis, admissions for glycaemic control showed a significant decrease in lengths of stay over the period. Admissions with diabetic peripheral vascular disease were cumulatively, and per case, the most costly, the mean cost, at $16,000 per case, being 5.1 times greater than the mean cost of all admissions with diabetes as principal diagnosis. In 1989 diabetes accounted for 5% of the cost of all inpatient care provided by the hospital. These results are an underestimate, as 45% of admissions of people where diabetes should have been cited as a subsidiary diagnosis were omitted from the discharge data. diabetes is a major consumer of hospital resources in this region. As the majority of diabetes associated resource use is in the elderly, a population projected to increase significantly, consideration needs to be given to the options for the provision of care. More work also needs to be done on the reasons underlying these changes. If routinely collected data is to be used for these purposes then audit of the data must be performed or use should be restricted to certain defined groups, eg, diabetes as principal diagnosis only.


[Surgical implications of chronic liver diseases].

Complications of chronic liver diseases requiring surgical interventions are the following: esophageal varices and bleeding, ascites hypersplenism, some forms of liver insufficiency. The most widely accepted method for treatment of esophageal varices is endoscopic sclerotherapy. Portal systemic shunts are indicated in some cases. Intractable ascites is to be treated by peritoneovenous shunt insertion. "Ressissance" of paracentesis is not confirmed by late results. Splenectomy is proposed if clinical signs are prominent. If portal hypertension exists, shunt should be performed simultaneously. Liver transplantation is indicated in cases of irreversible liver damage. Optimal selection of patients and timing of transplantation remains of critical importance. As a consequence of numerous technical modifications liver transplantation becomes more popular. Statistical data on liver diseases in Hungary call for urgent development of hepatology. Cooperation of physicians is of outmost importance to realize it.


[Obstructive ectopic ureterocele: review of the literature in the light of the authors' own experience].

The epidemiology, clinical presentation, evaluation and methods of surgical management of ectopic ureteroceles was studied. The prenatal detection of hydronephrosis of the upper pole of duplex systems allows early surgical correction, and this effectively decreases the risk of urinary tract infection, urosepsis and irreversible loss of renal function. Yet a precise prenatal diagnosis of accompanying ureterocele is not necessary for efficient postnatal management.


[Cellular DNA determination and its significance in the identification of tumor recurrences, metastases and second primary tumors].

The DNA content of 30 malignant tumors and their metastases were compared. The DNA indices of tumors (expressed by the mean DNA content of G0.1-phase tumor cells and leukocytes) differ from each other, but in metastases they are almost the same with the values of primary tumors. It can also be observed, if a tumor consisted of more than one subpopulation of tumor cells, the metastatic potential of clones can be different. However, there is no significant relationship between the degree of ploidy and the occurrence of metastasis. The stability of DNA index in tumors and their metastases were used to distinguish two primary tumors even if their histological patterns were very similar. We present an example of the above mentioned phenomena in which the results of DNA analysis is supported by the results of mucin histochemistry and the follow up data.


[Newest method for the detection of chronic intestinal ischemia: color Doppler sonography].

Authors describe the case of a patient with chronic abdominal pain due to the occlusion of the superior mesenteric and the significant stenosis of the inferior mesenteric artery, discovered by color-Doppler ultrasonography. The role of this new non-invasive method in the diagnose of chronic intestinal ischaemia is emphasized. It seems to be suitable for the replacement of angiography also in the postoperative period.


[Collagen sprue--a rare form of adult celiac disease].

The authors report the first case of collagenous sprue in Hungary. This condition is characterized by coeliac type small bowel malabsorption, resistant to gluten free diet and other therapeutic efforts, associated with poor prognosis. The diagnosis depends on the histological demonstration of extensive collagenization of the lamina propria in the flat jejunal mucosa. This disease must be kept in mind at differential diagnosis of chronic diarrhoea with progressive malabsorption, especially if it is resistant to gluten withdrawal than conventional coeliac disease.


[External irradiation of differentiated thyroid cancer: 30 follow up].

Following surgery which left no macroscopic residue 114 patients with differentiated thyroid cancer (58 papillary, 56 follicular) were subgrouped on the basis of the dose of prophylactic postoperative external radiation applied: group I--an adequate dose of radiation (greater than or equal to 4500 cGy of telecobalt, greater than or equal to 4000 R of orthovolt therapy); group II--an inadequate dose of radiation (including non-irradiated patients). Local/regional relapse-free survival (LRRFS), distant metastatic relapse-free survival (DMRFS) and total cause-specific survival (TCSS) were calculated by means of life-table analysis for both histologic types separately. Results. 1. TCSS and LRRFS were significantly (p less than 0.001) better for group I in papillary cancer. No difference was found in DMRFS. 2. LRRFS was significantly (p less than 0.001) better for group I in follicular cancer. No differences were found in TCSS and DMRFS. 1. The prophylactic postoperative external irradiation is an effective method for survival prolongation in papillary cancer, the local/regional recurrences thereby being reduced. 2. External irradiation, in conjunction with radioiodine treatment, should be considered in the postoperative management of follicular cancer to diminish local/regional relapse.


[Barrett esophagus].

There are a lot of contradiction and uncertainty related to Barrett's esophagus. Authors review the literature about the incidence, the aetiology, the pathology of the ailment, the possibility of diagnosis and treatment. 25 Barrett's esophagus were observed in the course of controlling of patients after antireflux operations and investigations of patients suffering from gastroesophageal reflux disease. X-ray examination, endoscopy, biopsy, 24-hour pH monitoring of the distal esophagus and esophageal manometry were performed. Because of the possibility of malignant transformation Barrett's esophagus requires yearly endoscopic surveillance and biopsy at least. Antireflux procedure does not protect against the development of adenocarcinoma.


[Comparison of human milk with 3 different types of infant food in the nutrition of full-term neonates].

Healthy, term infants who were either breast-fed, or received conventional formula (Mildibé, EGIS; Pre-Aptamil, Milupa), or a formula containing hydrolyzed proteins (Aptamil H. A., Milupa) were investigated. Each group consisted of 10 infants who were fed ad libitum. Somatic development (gain in weight, length and head- and chest circumferences), serum Ca and P levels, alkaline phosphatase activities and basic biochemical parameters of protein metabolism (serum total protein, albumin, uric acid, creatinine and urea nitrogen levels) were determined at the ages of 2, 4 and 8 weeks. Anthropometric measurements did not reveal considerable differences between the groups investigated. At the age of four weeks, serum calcium levels were significantly higher in the breast-fed infants than in those receiving formula. Both at the ages of four and eight weeks, serum total protein levels were significantly lower in the infants receiving the formula consisting of hydrolyzed proteins than in the breast-fed controls. No difference of considerable extent was seen in the other biochemical parameters measured. The results obtained indicate that, in the lack of the possibility of breast-feeding, all the three formulae investigated can be used as substitute of breast milk.


[Experience with the Direx Tripter X-1].

In nonselected patients 81.5% stone-free rate could be reached in 3 months. In authors's opinion Direx Tripter X-1 is suitable in the treatment of renal and ureteral calculi. They treated staghorn calculi by ESWL monotherapy with success. The Direx lithotripter was found to be effective and easy to operate; the potential cost reduction is of great significance. The treatment requires general anaesthesia and the equipment causes significant noise. After all, Direx lithotripter is a useful machine in the armamentarium of stone disease treatment.


[Primary neonatal liver cyst].

The authors found with neonatal ultrasound screening a cyst in the epigastrium sized 45 x 18 x 36 mm. The newborn was operated at age of 7 days. The cyst was in the right lobe of the liver and after extirpation healed.


[Comparison of ST depression and various exercise test indices in the diagnosis of coronary stenosis].

Various modifications and refinements have been proposed to improve the diagnostic accuracy of standard ST-segment criteria for identifying coronary artery disease using exercise testing. To ascertain if the treadmill exercise score (TES), the ST integral, or the ST/HR index are significantly better markers for coronary disease the standard ST analysis, measured visually or by computer, a retrospective study of 173 male patients was performed. Exclusions were clinical or electrocardiographic evidence of prior myocardial infarction, left ventricular hypertrophy, left bundle branch block, or resting ST segment depression on their baseline electrocardiogram, digitalis, previous revascularization procedure or any significant valvular or congenital heart disease. Ninety-six patients (55.5%) had at least one epicardial coronary stenosis (more than 70% diameter stenosis). Cutpoints were chosen for each method, that maximized their best combination of sensitivity and specificity. There were no statistically significant differences between any of the five methods (TES, ST integral, ST/HR index, standard and computer ST analysis) for identifying any coronary disease. careful visual or ST-segment analysis continues to be the simplest as well most effective marker for coronary disease during exercise testing.


[A new method for the classification of neonates based on maturity and somatic development].

The author points out the sad fact that the methods of estimating classifying, comparative examining of the maturity, somatic development of newborns and the methods of marking off the retarded newborns used up to now are essentially centering round the birth-weight. He exposes the errors, deficiencies of these methods and confronts them with the possibilities of the NDN-system (newborn's somatic development and nutritional state) worked out earlier by him. He thinks the NDF-system to be able to express simultaneously and exactly the gestational age, weight- and length-development, state of being fed of the newborns and the relation to the populational average, the fact and type of retardation, as well. The informational means of NDF-system in NDF-index. The NDF-system makes it possible to break down the birth-weight centric view as it offers a more suitable and qualified method than used before to describe the maturity and somatic development and the classifying of the newborns on the basis of these.


[Practical questions concerning the laboratory diagnosis of monoclonal immunoglobulin A (IgA)].

Authors discuss about the laboratory determination and differential diagnostic problems of the homogenous and heterogenous immunoglobulin increases--in respect to the monoclonal IgA--in the serum and urine. Their investigating system is convenient for the early detection of the small M-components and to discover the other rare protein anomalies too.


[Reasec poisoning in childhood].

Three cases of severe accidental poisoning with "Reasec" in infants and young children are reported. Patients' medical history, the clinical features and ways of antidote administration are described. In severe poisoning in addition to symptomatic intensive care administration of "Narcanti" in continuous infusion is recommended. The necessity of strict observation and ventilation facilities because of the potential respiratory failure is emphasised.


[Successful electroconvulsive treatment of a schizophrenic patient suffering from severe hemophilia A].

Experiences obtained with the electroconvulsive treatment of a schizophrenic patient suffering from severe haemophilia A are reported. No haemorrhagic complications were observed. According to our experiences electroconvulsive therapy can be applied also in severe haemophilia A if satisfactory replacement therapy can be ensured. Similar case has not been found in the literature.


[A case of Lyme carditis].

The authors introduce their patient suffering from Lyme carditis. This causes III. degree AV block, then spontaneous remission, and complete recovery. Depending on the bases of other scientists' works they introduce their experiences in the clinic and therapy of the disease.


[Analysis of human growth hormone-binding protein in plasma by high pressure liquid chromatography].

A technique using high pressure liquid chromatography gel filtration was used to evaluate GH-binding proteins (GH-BPs) in human plasma; eluate was monitored for radioactivity in a gamma-detection system connected to a computer. Plasma (200 microliters) was incubated with 125I-human (h) GH (200,000 cpm) at 4 degrees C for 20 hours. Our GH binding assay offers important gains in terms of rapidity and resolution; it has permitted a clear separation and characterization of the two GH-binding components present in human plasma.


Biochemical properties of the growth suppressor/oncoprotein p53.

The cellular p53 protein is so called because of its molecular weight as determined by SDS-polyacrylamide gel electrophoresis. It was originally classified as a nuclear oncogene product when it was shown by DNA transfection experiments that p53 is able to extend the lifespan of primary rodent cell cultures and to cooperate with an activated ras oncogene to achieve complete transformation of primary cells. However, there is now conclusive evidence that loss of normal p53 expression may be an important step in cell transformation and tumorigenesis. Furthermore, it has been shown that mutant p53 was used for the experiments demonstrating the immortalizing and transforming capacity of p53. Wild-type p53 seems to negatively regulate cell growth and division. So far, the basic function of p53 is not known. Biochemical variability seems to be a key feature of p53 and an understanding of biochemical variations in the p53 protein may contribute to an understanding of how p53 is regulated or how p53 may regulate cell proliferation. Thus, the present review will focus on the biochemical properties of p53.


The functional domain of the stimulatory GDP/GTP exchange protein (smg GDS) which interacts with the C-terminal geranylgeranylated region of rap1/Krev-1/smg p21.

rap1/Krev-1/smg p21 (smg p21), a member of the small GTP-binding protein (G protein) superfamily, has a geranylgeranylated cysteine residue and clustered basic amino acids in the C-terminal region. The GDP/GTP exchange reaction of smg p21 is regulated by smg GDS, which is also active on Ki-ras p21 and rho p21. The C-terminal region of smg p21 is essential for its interaction with smg GDS. Moreover, smg p21 is phosphorylated by cyclic AMP- and cyclic GMP-dependent protein kinases at the serine residue between the polybasic region and the prenylated cysteine residue, and this phosphorylation initiates the smg GDS-induced smg p21 activation. Thus, the C-terminal cationic and hydrophobic region is important for the regulation of the smg p21 activity. In the present study, we attempted to determine the functional domain of smg GDS which interacts with the C-terminal region of smg p21 by use of a cross-link method and a site-directed mutagenesis method. The region of smg GDS cross-linked with the C-terminal region of smg p21B was residues 444-492, which is located at the C-terminal fifth of smg GDS. On deletion of these residues, smg GDS became inactive on smg p21B, Ki-ras p21 and rhoA p21. These results indicate that residues 444-492 of smg GDS are at least one of the domains which interact with the C-terminal region of its substrate small G proteins.


Genomic dispersal of the ets gene family during metazoan evolution.

Evolutionary homologs of the ets proto-oncogene have been discovered in the genomes of widely divergent eucaryote species from Drosophila to sea urchin to vertebrates. The prototype mammalian ets-1 and ets-2 genes are divided into three coding domains that differ in their rate of accumulation of sequence divergence. An analysis of sequence divergence of ets gene homologs in various species has produced a phylogenetic history of the ets gene family in the context of metazoan evolutionary radiation. A minimum of five duplication events of ets primordial genes were evident, namely (1) a duplication that separates primitive ets genes (Drosophila precursor of 74E, mouse PU.1 and human ELK1) from the ets-1, ets-2, erg ancestor; (2) and (3) two duplications that established separate ets, erg and elg/GABP-alpha lineages which occurred prior to invertebrate-vertebrate divergence; (4) divergence of ets-1 and ets-2 gene family also associated with vertebrate-invertebrate divergence; (5) duplication of ets-1 and ets-2 in Xenopus laevis to produce two ets-1 genes and two ets-2 genes during genomic tetraploidation in the recent ancestry of this species.


Mapping of UV photoproducts within ras proto-oncogenes in UV-irradiated cells: correlation with mutations in human skin cancer.

Mutations in ras proto-oncogenes have been found in human skin cancers. Since ultraviolet light is implicated in the development of skin cancers, we have investigated the formation of UV-induced photoproducts along exons 1 and 2 of the three ras proto-oncogenes, H-ras, K-ras, and N-ras, in UV-irradiated human cells. The two major types of DNA photoproducts, cyclobutane pyrimidine dimers and pyrimidine (6-4) pyrimidone photoproducts [(6-4) photoproducts], were mapped at the DNA sequence level by ligation-mediated polymerase chain reaction (LMPCR). No significant differences were seen between irradiated purified DNA and irradiated cells, implying that local chromatin structure does not influence the distribution of photoproducts along exons 1 and 2 of the three ras genes. We find that the transcribed strand near codon 61 in H-ras, K-ras and N-ras shows a high frequency of potentially mutagenic cyclobutane dimers and (6-4) photoproducts. Codon 12 of H-ras, K-ras and N-ras displays only barely detectable photoproducts at a CpC dinucleotide. In human skin cancers, mutations were most frequently detected at codon 12 of H-ras and K-ras. These results imply that the initial frequency distribution of a mutagenic DNA adduct may not correlate with mutation spectra in human tumors.


Transcriptional activator Tax of HTLV-1 binds to the NF-kappa B precursor p105.

Human T-cell leukemia virus type 1 (HTLV-1) induces adult T-cell leukemia and also a neurological disease, tropical spastic paraparesis. Tax protein (p40tax) of HTLV-1 activates in trans its own transcriptional enhancer in the long terminal repeat and also those in some cellular genes such as interleukin 2 receptor alpha, granulocyte-macrophage colony-stimulating factor, Fos, Jun and MHC class I. Thus, Tax has been proposed to play a critical role in the pathogenesis induced by HTLV-1 infection. Here, we report formation of a complex of Tax protein with the precursor protein p105 of the NF-kappa B p50 subunit. p105 was co-immunoprecipitated with Tax protein from cells infected with HTLV-1 from cells transfected with the Tax expression plasmid, but not from cells transfected with inactive mutants of Tax. Furthermore, a GST-p105 fusion protein produced in Escherichia coli bound to Tax protein. These results strongly suggest that the trans-activator Tax protein forms a complex with precursor NF-kappa B p105 and plays a role in trans-activation of transcriptional initiation.


Functional analysis of the N-terminal domain of Tat protein of the human immunodeficiency virus type 1.

The Tat protein of human immunodeficiency virus type 1 (HIV-1) is a potent trans-activator of the viral long terminal repeat (LTR). The N-terminal region of Tat is rich in proline and acidic residues analogous to the activation domains of other transcription factors such as GAL-4 and CTF/NF-1. Several basic residues are also present in this region. To investigate the role of these structural features in the Tat-mediated trans-activation, we have chemically synthesized and evaluated Tat analogs with alanine or glutamine replacing one or more of these amino acid residues. Our data show that substitution of Glu-2, His-13, or all the proline in the Pro-Xaa3-Pro triad drastically reduced activity. In contrast, changes at Arg-7, Lys-12 and any one proline residue in the triad moderately reduced, and substitution of Lys-19 showed little effect on, activity. These results show that the native structure of the N-terminal 19 amino acid sequence is essential for Tat function, and that the overall topology of this domain and not the acidic residues alone appears necessary for trans-activation.


Activation of interleukin-2 receptor alpha expression by extracellular HTLV-I Tax1 protein: a potential role in HTLV-I pathogenesis.

The Tax1 protein of human T cell leukemia/lymphoma virus type I (HTLV-I) has been shown to stimulate the proliferation of human lymphocytes. Here we report that lymphocyte proliferation can be induced at extracellular Tax1 concentrations as low as 25 pM. The proliferative response induced by extracellular Tax1 is accompanied by an activation of endogenous interleukin-2 receptor alpha-chain (IL-2R alpha) expression in human lymphocytes. Functional activation of IL-2R alpha expression in peripheral blood lymphocytes treated with Tax1 was demonstrated using an [125I]IL-2-binding assay. In addition, an enzyme-linked immunosorbent assay demonstrated that soluble IL-2R alpha in the medium of IL-2- and Tax1-treated cells was over 13-fold greater than in the medium of control treated cells. Overexpression of IL-2R alpha is a common clinical feature of some patients with adult T-cell leukemia (ATL) and tropical spastic paraparesis/HTLV-I-associated myopathy (TSP/HAM). The ability of extracellular Tax1 protein to activate expression of IL-2R alpha in both infected and uninfected lymphocytes may contribute to the abnormal lymphocyte proliferation observed in both ATL and TSP/HAM.


Max and c-Myc/Max DNA-binding activities in cell extracts.

We have examined the interactions and DNA-binding activities of the c-Myc oncoprotein and its partner Max. In cell extracts virtually all c-Myc molecules are associated with Max in heterodimeric complexes. Moreover, DNA-binding studies with in vitro-translated protein and cell extracts show that both Max alone and c-Myc/Max bind the same DNA sequence. Conversely, c-Myc is unable to bind this sequence in the absence of Max. These findings suggest that c-Myc may function via obligate complex formation with Max.


Rapid, complete and reversible transformation by v-sis precedes irreversible transformation.

v-sis is the oncogene of simian sarcoma virus, but whether tumor growth is maintained by v-sis expression alone or requires additional changes is unknown. To distinguish these possibilities we studied a model of reversible transformation including tumorigenicity using NIH3T3 cells bearing a metallothionein promoter-v-sis construction. Cells subcultured from 10 out of 18 tumors from athymic mice, all less than 0.1 g and less than or equal to 21 days in age, reverted to a normal phenotype but exhibited transformation upon addition of zinc as judged by morphology, growth rate, saturation density and anchorage independence of growth. Thus, activation of v-sis alone is sufficient for initiation and early autocrine-based growth of tumors. However, the cells from the remaining and predominantly larger, 0.5 +/- 0.7 g, tumors did not revert and exhibited zinc-independent transformation as judged by the same criteria. Southern analysis and examination of the regulation of v-sis product expression in cells derived from these tumors showed no change in zinc-dependent and reversible regulation of v-sis sequences. These results suggest that subsequent tumor growth strongly favors acquisition of additional irreversible change(s) in the tumor cell genome at high frequency (44%). Thus an early event of a multistep process stimulated by v-sis-dependent transformation best accounts for the sum of results.


The binding of transcription factor Sp1 to multiple sites is required for maximal expression from the rat transforming growth factor alpha promoter.

Transcription from the rat transforming growth factor alpha (TGF-alpha) promoter initiates at multiple sites within a 200-bp G+C-rich region that lacks TATA and CAAT motifs but contains multiple potential binding sites for the transcription factor Sp1. In the present study, we used deletion analysis to establish the 5' boundary of sequences required for efficient transcription from the predominant -58 start site. We then examined the functional activity of several putative Sp1 binding sites that occur within the transcriptionally important region downstream from -155. In the presence of either crude HeLa cell extract or purified Sp1 protein, two double-stranded oligonucleotides from this region, each of which contains three Sp1 elements, both displayed gel mobility shifts that were specifically inhibited in the presence of excess bona fide Sp1-binding sequence from the hamster dihydrofolate reductase (DHFR) gene. Methylation interference analysis of the major gel-shift complex produced with one of these oligonucleotides revealed a series of critical guanine residues located in, or adjacent to, one of the putative Sp1 recognition elements. The functional importance of Sp1 binding was confirmed by the findings that transcription in vitro from the -58 start site was inhibited in the presence of excess consensus Sp1-binding sequence and that coexpression of Sp1 dramatically induced TGF-alpha promoter-directed chloramphenicol acetyl transferase (CAT) expression in transfected Drosophila Schneider cells that otherwise lack functional Sp1. Additionally, the introduction of mutations into any of several putative Sp1 elements inhibited transcription in vitro from the -58 site, with the most proximal element tested having the largest effect. Sequential mutation of more distal elements produced a synergistic inhibition of transcription, suggesting that cooperative interactions between Sp1 sites are necessary for full expression from the TGF-alpha promoter.


Constitutive expression of exogenous myc in myelomonocytic cells: acquisition of a more transformed phenotype and inhibition of differentiation induction.

The effects of deregulated expression of the human c-myc and MC29 v-myc oncogenes have been examined in a murine myelomonocytic cell line J774 (c-myc) and in a variety of myelomonocytic cell lines of different degrees of maturity generated from primary hematopoietic tissue (v-myc). Introduction of a Moloney murine leukemia virus long terminal repeat (LTR) c-myc construct into J774 cells resulted in constitutive expression of the exogenous myc gene and a concomitant increase in the degree of transformation and tumorigenicity of the cells. In addition, constitutive expression of exogenous myc inhibited induced differentiation of these cells by a variety of treatments including addition to the medium of lipopolysaccharide (LPS) or the phorbol ester 12-O-tetradecanoyl phorbol 13-acetate (TPA) as well as complete withdrawal of serum from the medium. The degree of increased transformation, tumorigenicity and inhibition of terminal differentiation was dependent upon the level of exogenous myc expression. For the v-myc-generated myelomonocytic cell lines, introduction of v-myc resulted in a high degree of transformation and, irrespective of the differentiation status of the cells, a block of induced differentiation. These results indicate that the level of constitutive myc expression can affect the transformed phenotype, tumorigenicity and differentiation inducibility of myelomonocytic cells.


In vivo footprints between the murine c-myc P1 and P2 promoters.

Assuming that when transcription starts at the P2 promoter of the c-myc gene sites located immediately upstream from P2 are occupied whereas in the absence of initiation they are not, the polymerase chain reaction (PCR)-based method of Mueller & Wold [(1989). Science, 246, 780-786] was used to map in vivo footprints upstream from the P2 promoter in various mouse cell lines. In cultured Friend erythroleukemic cells induced to differentiate with dimethysulfoxide (DMSO), a clear protection corresponding to ME1a2 and E2F sites was observed, consistent with in vitro band-shift and footprint data. However, in cell lines in which the gene was either silent or truncated the footprints were no longer visible. Friend c-myc transcripts decreased to a barely detectable level after 3 h of DMSO treatment. Transcription, as measured by in vitro run-on, was turned off at the level of RNA polymerase elongation rather than initiation [Mechti N., Piechaczyk, M. Blanchard, J.-M., Marty, L., Bonnieu, A., Jeanteur, Ph. & Lebler, B. (1986). Nucleic Acids Res., 24, 9653-9666]. The state of occupancy of the sites did not vary from the first hours up to 9 days of DMSO treatment, suggesting that DNA occupancy per se cannot explain premature termination, which rather would involve a more complex phenomenon.


Expression of the normal p53 gene induces differentiation of K562 cells.

The multistep nature of human cancers is well illustrated by chronic myelogenous leukemia (CML), a clonal hematologic malignancy with two distinct phases: chronic and acute. Transition between these phases is characterized by unregulated growth and loss of differentiation of myeloid cells and their progenitors. We recently reported that loss of normal p53 expression correlates with transition from the chronic to acute phase in at least 25% of cases of CML. However, the precise relationship between this loss and biologic features of acute-phase CML is uncertain. To study this question, we artificially expressed normal p53 in K562, an erythroid acute-phase CML cell line lacking normal p53 expression. Biological effects were assessed by determining several growth parameters and by measuring synthesis of hemoglobin, a feature of mature erythroid cells. K562 cells expressing normal p53 had an increased proportion of cells in G1 versus S + G2, a longer doubling time and a lower growth saturation density than control K562 cells or K562 cells with antisense p53. Cells with normal p53 also expressed up to 50-fold more hemoglobin than controls. These data are consistent with the notion that loss of p53 expression may be responsible for many of the features of acute-phase CML cells. The data also demonstrate direct involvement of p53 in differentiation processes.


Lack of expression of tumor-suppressor genes in human malignant glioma cell lines.

Human malignant gliomas (glioblastomas and anaplastic astrocytomas) are the most frequent brain tumors and are associated with a variety of genetic alterations including retinoblastoma (RB) and p53 gene mutations, loss of interferon alpha and beta (IFNA, IFNB) genes and lack of O6-methylguanine-DNA methyltransferase (MGMT) expression. Yet, in the studies performed to date, the relationship between these alterations has not been addressed. In this report, we have studied gene expression in 29 malignant glioma cell lines and have determined that, although loss of the interferon genes and loss of RB, p53 and MGMT mRNAs are frequent events, combinations of genetic alterations involving these four proven or putative tumor-suppressor genes are relatively infrequent. The exception was loss of RB mRNA, which may be associated with lack of MGMT mRNA.


Characterization and cell cycle-regulated expression of mouse B-myb.

We have isolated a full-length mouse B-myb cDNA clone and used this to examine cell cycle-regulated expression of this gene. Mouse B-Myb was predicted to comprise 704 amino acids and to be 84% homologous with human B-Myb. There were three regions of extensive amino acid homology which may indicate functional domains: the first corresponded to the c-Myb DNA-binding domain, while the second had no counterpart in c-Myb but was instead homologous to a short segment of the related A-myb protein. The third region of homology is partially conserved in both c-Myb and A-Myb and may correspond to the c-Myb negative regulatory domain. Stimulation of quiescent 3T3 fibroblasts with serum was found to result in induction of B-myb expression in late G1 and to lead to high levels of gene transcripts that persisted through S phase. Similarly, maximum B-myb mRNA levels were reached in G2/M synchronized cells prior to entry into S phase. These results are consistent with a role in G1/S transition as has been suggested for c-myb.


[Evaluation of early results and failures of radiotherapy in patients with cancer of the oral cavity and throat].

Since 1986 to 1989 in the Department of Teleradiotherapy of Center Oncology--Institute branch Gliwice 102 patients with oral cavity cancers and 114 with pharyngeal cancers were treated. Patients underwent external radiation, which was delivered with Co60 to the dose 70 Gy on the tumor and additionally regional lymph nodes were irradiated with 10 MeV linear accelerator. There were 69 patients (32%) with stage T-2 and 147 patients (68%) in stage T-3. Metastatic regional lymph nodes in 130 patients (60%) were recognized. Free of disease one year survival in 98 patients (45%) was observed: 41% with oral cavity cancer and 49% with pharyngeal cancer. The conclusion suggests that the results depend on the size of the tumor and presence of the metastatic lymph nodes. Among the patients with oral cavity cancer in 40% with free nodes and 69% with metastatic nodes unsuccessful treatment was observed. In the group with pharyngeal cancer percentage were 35% and 63% respectively. Results of the treatment, were unsatisfactory when diameter of metastatic nodes was more than 5 cm (N-3).


[Clinical course of laryngeal cancer in relation to sex].

In 1960-1987 2352 cases of larynx cancer were cured and observed. The number of the side men to women was in the ratio of 11.5:1. The cancer of epiglottis was prevailing in both sex but percentage of these cancers was higher in women's cases than men's (67.6% vs 62.7%). Besides women called for the treatment more often with the cancer in initial states of the disease (62.2% vs 53.4%). Five--year survivals (actuarial method) were higher amongst women (69.8% vs 60.0%). In the same state of clinical advancement of the disease, the 5-year survivals were also higher with women. In the cases of cancer in the early states of larynx cancer (I and II) the difference was about 5.0%, and among patients with cancer in the late state of the disease (III and IV) the difference was 8.4%. The last premise caused the authors to put forward the hypothesis that apart from the sooner calling for the treatment of women, there may also be other unknown phenomena, perhaps hormone--immune, conditioning higher index of survivals in women.


[Supracricoid reconstructive laryngectomy with cricohyoidopexy and cricohyoidoepiglottopexy].

On the base of the personal material, comprising 19 patients with glotto-supraglottic cancer, an operative technique on supracricoid reconstructive laryngectomy with CHP and CHEP has been presented. The data achieved within 3 years allowed to evaluation of preliminary oncological and functional results. In the group of 19 operated patients, one case of local recurrence was found. Cervical recurrence was observed in 2 persons in the first year after the operative treatment. No remote metastases and secondary neoplastic++ focus were found in the digestive and respiratory tract. One patient died of massive pneumonia in the course of disturbances in deglutition. The most difficult problem of the postoperative period in the cases of CHP were the disturbances in deglutition. For that reason pneumonia was observed in 4 patients. Nasogastric tube was left in place for a mean time of 20 to 60 days. All CHEP patients were decannulated and 5 ones out of 14 persons group after the operation of CHP remain with tracheotomy tube.


[Cancer of the pharynx--results of treatment with cobalt-60].

One hundred two patients with pharyngeal cancer had been treated from 1980 to 1984 in Center Oncology--Institute branch Gliwice. Total radiation doses were 60-65 Gy. From the group of 44 patients without metastatic lymph nodes, 5 year survival rate was 36%. In cases with advanced pharyngeal carcinoma and with metastases to the lymph nodes (58 patients), 5 year survival rate was 18%. The results of this study suggest that survival rates depend on the size of the tumor and presence metastases to the local lymph nodes.


[Serum ceruloplasmin activity in patients with cancer of the larynx].

The ceruloplasmin activity of serum was measured in 50 patients with larynx cancer and 50 healthy subjects. The determination of serum ceruloplasmin based on the diamine oxidase activity with o-dianisidine as a substrate. In patients with laryngeal cancer the ceruloplasmin activity was significantly higher than that in healthy controls. The increase in the ceruloplasmin activity was correlated with clinical stage of larynx cancer.


[Organization of the bone system of the nasal septum and its homologues. V].

The aim of these anatomo-comparative investigations was the differentiation and systematization of the osseous nasal septum and vomer complex in rhesus monkeys (Catarrhina). ). The material consisted of 66 monkey heads: 52 of the fixed in formaline solution and 14 naturally macerated. The methodology was described elsewhere (part--1). The nasal osseous system philogenetically was presented in rhesuses only by alar bone. As lower--secondary part of septum emerges the typical parasphenoid complex. The alar bone in monkeys is homologous monominal elements (septal and subnasal bones) in pairhoofed mammals, birds, fishes and amphibians. It proves that in rhesuses as others Craniota the "mesoethmoid" and "ethmoidal bone" do not exist. In the skull of these monkeys the axially palate system was proved. This system does not dominate in the mechanics of the splanchnocranium.


[The role of sclerotherapy in the treatment of esophageal varices in children].

The authors presented the actual views and their own results of using sclerotherapy in children with oesophageal varices. Oesophageal varices exist almost every time as a most dangerous complication in patients with portal hypertension. Acute haemorrhage caries a high mortality and the extremely important priority is control of bleeding as soon as possible. Traditional conservative methods of treatment often do not improve long-term survival and portal systematic shunt is rarely possible in patients under the age of 10. Because of it sclerotherapy may be proposed as a treatment of choice for children with oesophageal varices.


[Vestibular function in calcium and phosphate metabolism disorders in chronic renal failure].

45 patients with chronic renal failure (25 dialysed and 20 undialysed) were examined for function of vestibular organ and 35 patients with chronic renal failure treated by diet and drugs were examined for hearing acuity by pure tone audiometry and above-threshold audiometry. All patients serum sample's were examined for calcium, inorganic phosphates and uric acid. The examination revealed the damage of vestibular organ in 84.4 per cent of patients and statistically significant increase of parathormone serum concentration in patients with central type of damage. The hearing loss was found in 51 per cent of patients. The hearing loss in most number of cases was symmetrical and it was mainly the extracochlear auditory damage. The role of disturbances in calcium and phosphates metabolism in the pathogenesis of hearing loss seems to be unsure.


[A case of metastasis of clear cell carcinoma of the kidney to the hypopharynx].

A rare case of kidneys clear cell carcinoma metastasis to the laryngopharynx was described. The observed metastasis manifested itself only just three months after total left-sided nephrectomy and partial right-side nephrectomy because of clear cell carcinoma.


[35th anniversary of surgical activities at the Otolaryngology Department of the District Merged Hospital in Zielona Góra 1953-1987].

40,506 patients were treated at the Laryngology Department in the last 35 years. 30,787 surgical interventions were performed. The type and number of operations were analysed as well as their upward and downward tendencies. A considerable decrease in radical operations of the ears, antrotomies, antromastoidectomies and intracranial, ear and sinusal complications was noted; whereas the number of tracheotomies, laryngectomies and radical neck lymphadenectomies due to larynx neoplasm was increased.


Surgical management of cerebral palsy.

Musculoskeletal manifestations of cerebral palsy (CP) change with growth, necessitating orthopaedic management. The goal of orthopaedic management, which may involve surgical and/or rehabilitative intervention, is to help each individual reach optimal functional ability and prevent deformity. Goals of surgical intervention are to improve function, decrease discomfort, and prevent structural changes that may become disabling. Knowledge of the basic surgical procedures to correct deformities as well as understanding the special needs of CP patients will help nurses successfully care for these individuals.


Osteoporosis: the silent disease.

Osteoporosis is a major health problem in the United States. It affects 24 million Americans; women are affected 6-8 times more often than men. It is a disease that is associated with pain, disability, and death due to complications from fractures. Health interventions that prevent bone loss are more effective than trying to retard bone loss once an individual has osteoporosis. This article discusses prevention practices as they relate to nursing assessment and intervention.


Transportation resources for pediatric orthopaedic clients.

Pediatric orthopaedic surgery clients may be unable to safely, comfortably, and affordably use child safety seats (car seats) for a variety of reasons. This article describes commercially available child safety seats suitable for transporting pediatric orthopaedic surgery clients. Discussed are those children with cerebral palsy, spina bifida, hip dislocations, arthrogryposis, scoliosis, and osteogenesis imperfecta.


Noncompressive spinal radiculitis.

Sciatica can be caused by a herniated disc (compressive neuropathy) or by the process of disc degeneration (noncompressive neuropathy). Laminectomy and discectomy usually produce a good result in compressive neuropathy, whereas surgery for noncompressive neuropathy, if necessary, consists of complete excision of the disc and anterior interbody fusion, posterior fusion, or both. Noncompressive spinal radiculitis is a biochemical, not a biomechanical, problem. Phospholipase A2, substance P, and increased fibrinolytic activity have been implicated in the process.


Using pulse oximetry to make clinical nursing decisions.

Pulse oximetry provides intermittent or continuous evaluation of a patient's oxygen saturation. Sound clinical nursing judgments can be based on oximetry readings if the nurse combines effective operation and trouble-shooting of the oximeter with knowledge of the principles of oxygenation and their relationship to a patient's total clinical picture.


Biomechanics of the human anterior cruciate ligament. ACL structure and role in knee motion.

Surgical reconstruction of the anterior cruciate ligament (ACL) to restore knee stability has introduced many subjects of debate, including graft selection, reconstructive technique, and postoperative rehabilitation. In the first part of this two-part review, the tensile properties of the human ACL and the role of the ACL in knee kinematics are discussed. Reconstructive techniques for ACL replacement with regard to the biomechanics of the ACL in normal and ACL-deficient knees will be addressed in Part II.


Postoperative course after total hip arthroplasty: wound drainage versus no drainage.

This retrospective study of 364 patients with total hip replacements performed between 1985 and 1990 showed no benefit in the use of drains and found an increased rate of transfusion associated with the use of drains. The two study groups (171 patients with two closed-wound suction drains in the wound and 193 patients closed without drains) differed in the type but not in the rate of wound problems; the drained group had more drainage at the port site, whereas the undrained group had more ecchymosis and swelling. There was no significant difference between the groups in operative blood loss; however, the drained group did require transfusions significantly more often than the undrained group (98 of 171 [57.3%] as opposed to 83 of 193 [43%], respectively). Of the patients requiring transfusions, patients with wound drains required significantly more blood than those without drains (1.12 versus 0.62 transfusions per patient for men; 1.73 versus 1.03 transfusions per patient for women).


Orthopedic nursing practice guidelines. The NAON Standards Task Force.

The NAON Standards Task Force has revised Orthopaedic Nursing: Process and Outcome Criteria for Selected Nursing Diagnoses published jointly by the American Nurses' Association (ANA) and NAON in 1986. The new document is entitled Orthopaedic Nursing Practice Guidelines. It contains guidelines for the care of orthopaedic patients with 11 selected nursing diagnoses and is an important decision-making tool for orthopaedic nurses. This article contains excerpts from the new guidelines with suggestions for its use.


Congenital pseudarthrosis.

Five cases of congenital pseudarthrosis of the clavicle were treated with open reduction and fixation with appropriate-sized contoured plates and screws. Iliac bone grafts were used to bridge the gap in four patients; local bone graft was used in the fifth patient. Consolidation was noted an average of 3 months postoperatively in all five cases. The plate and screws were removed in all patients at an average of 16 months postoperatively. Average length of follow-up for the five patients is 4 years. Roentgenograms demonstrate that the clavicle has continued to grow normally. All five patients have pain-free full range of motion and are engaged in unrestricted activities.


Variables associated with hypotension in postoperative total knee arthroplasty patients receiving epidural analgesia.

The purpose of the study was to identify variables that may place the total knee arthroplasty patient receiving epidural analgesia at risk for hypotension postoperatively. A review of medical records of this convenience sample of 99 subjects was conducted in this retrospective, descriptive, correlational study. Variables predictive of postoperative hypotension using stepwise multiple regression included low postoperative systolic BP on the nursing unit the day of surgery (R2 = .26, p less than .001), low diastolic BP in postanesthesia room (R2 = .31, p less than or equal to .01), low hemoglobin the third postoperative day (R2 = .37, p less than or equal to .01), use of diuretics preoperatively (R2 = .40, p less than or equal to .05), and total fluid intake first day postoperatively (R2 = .43, p less than or equal to .05). These variables accounted for 43% of the variability in the occurrence of hypotension. Identification of variables predictive of hypotension should provide direction for future care givers and researchers.


Chondromyxoid fibroma.

Chondromyxoid fibroma (CMF) is the least common cartilage-producing tumor. In Dahlin and Unni's series of 8,542 bone tumors, 39 of which were CMF, none were found in the femoral shaft. In this case, a CMF in the femoral shaft presented initially as a pathologic fracture. Attempts at curettage and autogenous bone graft failed, and en bloc resection and segmented allograft reconstruction were eventually required.


Imaging rounds. Bizarre parosteal osteochondroma.

The following case is presented to illustrate the roentgenographic findings of a condition of interest to the radiologist and orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are presented along with the final histologic and roentgenographic differential diagnosis.


A new goniometer.

A newly designed goniometer is presented for rapid and accurate measurement in the orthopaedic practice. This new instrument consists of two extensible arms with special calibrations. With proper adjustment of these arms, common and specific angles, such as the Cobb angle, can be measured easily and accurately. Specific calculations of various indices can be done quickly with special calibrations on the arms. This new instrument is simple, convenient, and accurate.


Use of the tibial curved driving piece for AO femoral nail insertion.

The purpose of this article is to demonstrate an improved method of AO femoral nail insertion. The AO/ASIF Universal Femoral Nail (Synthes, Paoli, Pennsylvania) has proven effective in the treatment of femoral shaft fractures. The procedure is sometimes difficult when nailing in the supine position, especially with large or obese patients. The ram device impinges on the flank soft tissue of the patient. By using the curved driving piece (355.16) attached to the femoral set, the ram and the ram rod are brought away from the patient's side, thus allowing a less obstructed nail insertion.


Improving the C-arm image of small bones.

The C-arm image of a small bone can sometimes be improved by suspending the extremity in the air, rather than positioning it flat on the operating-room table in the traditional manner. The C-arm roentgenogram is a modern development that allows rapid visualization of a roentgenographic image via computer enhancement of a low, k-voltage shot. As with any technical advance, it has its limitations; for small bones and bones involving growth plates, it is frequently deceiving.


The bubble sign in the gasless abdomen of the newborn.

The bubble sign (BS) in the gasless abdomen of the newborn is a helpful clue in the diagnosis of an upper gastrointestinal obstruction. The already swallowed air serves as the natural contrast agent. The single, double and triple BS are described in view of 23 cases indicating the level of the obstruction, and its differential diagnosis is discussed. The presence of BS in the gasless abdomen of the newborn is an indication for surgery until proved otherwise. With the increasing experience by ultrasonography, this modality should be considered as the first bed-side procedure when suspecting upper gastrointestinal obstruction, and then be confirmed by radiograms.


Sonographic imaging of the thyroid gland in congenital hypothyroidism.

We have attempted to facilitate differential diagnosis of etiological types of congenital hypothyroidism using real-time ultrasonography. Sonography of the thyroid gland was performed on 418 normal children, and 23 patients with congenital hypothyroidism and hyperthyrotropinemia. The thyroid gland was imaged by transverse scanning at the neck; the maximum thickness and the maximum width of the right and left lobe were measured. On the basis of the normal thyroid gland size obtained from normal children, the thyroid gland image of the patients were classified into 4 types: large image, normal image, small image, and no image of the thyroid gland at the neck: no image of the thyroid gland indicated agenesis or ectopia; large thyroid gland image indicated goitorous hypothyroidism. On the other hand, normal or small thyroid gland image probably included mild or transient forms of hypothyroidism, and transient hyperthyrotropinemia; these 2 types required further examination to complete the diagnosis. We concluded that real-time ultrasonography of the thyroid gland was a useful diagnostic imaging technic for patients who revealed elevated serum thyrotropin on neonatal mass-screening.


The plain abdominal film in intussusception: the accuracy and incidence of radiographic signs.

The incidence of four plain abdominal film features associated with intussusception was recorded by four observers in 180 films of patients with intussusception mixed with 100 films of control subjects. The crescent sign and target sign were the most accurate indicators of intussusception. The target sign was the commoner being seen in 68% of films. Signs of small bowel obstruction were not useful in the diagnosis of intussusception. The soft tissue mass was the commonest indicator of intussusception. The soft tissue mass was found more commonly, however, than small bowel obstruction in the control subjects who did not have intussusception.


Value of sonography including color Doppler in the diagnosis and management of long standing intussusception.

15 cases of intussusception with presenting symptoms of more than 24 h duration were studied by sonography and Doppler. The aim of the study was to determine the validity of the sonographic criteria of peritonitis and bowel ischaemia in order to reduce the risk of colonic perforation and to increase confidence in achieving a successful hydrostatic reduction. The results were reviewed retrospectively and cases divided into 2 groups. Cases in group 1 were reducible by barium enema while those in group 2 required surgical intervention. Sonographic features of peritonitis were absent in all cases of group 1 and 3 cases of group 2. These 3 cases were reduced manually at surgery while the other 5 cases in group 2 with positive features of peritonitis required bowel resection. Blood flow was documented by colour flow Doppler in all cases except the 3 cases with gangrenous bowel in group 2. When sonographic features of peritonitis and loss of blood flow to the intussusception are present in late intussusception, surgical intervention is required. On the other hand, enema reduction should be pursued when such features are absent.


Contrast enema diagnosis of necrotizing enterocolitis.

Contrast enema was performed in a select group of 126 neonates with ambiguous diagnosis of necrotizing enterocolitis (NEC). Enema findings were compared with that on plain abdominal radiographs (AXR) and the clinical outcome. Thirty-one of the 34 patients with a discharge diagnosis of NEC were interpreted to have a positive contrast enema, and 91 of the 92 patients without a discharge diagnosis of NEC were interpreted to have a negative contrast enema. The AXR was interpreted as positive in 57 patients and as negative or indeterminate in 69. Not a single case of perforation was produced. Judicious use of contrast enema can improve specificity of diagnosis in cases with discordant clinical and plain radiographic findings.


Recurrent pneumatosis intestinalis in young infants.

In 67 infants with necrotizing enterocolitis (NEC) at Children's Hospital of Michigan from 1987-1990, three had recurrent pneumatosis intestinalis (PI) after the neonatal period and after hospital discharge. All three infants were premature (26-34 weeks), and one had an additional risk factor of gastroschisis. All three had their initial episode of NEC within the first month of life. Two had bowel resections, and one was treated medically. 15 h to seven months after discharge from the hospital, all three infants developed recurrent PI at ages ranging from 2.5 to 9 months. Two of the infants had free intraperitoneal air. Though all three infants had PI, only one had true recurrent NEC with ischemic bowel and died. This baby was the only one with rotazyme positive stools. The second infant, who had surgery for gastroschisis, had incomplete obstruction secondary to adhesions resulting in PI. Since surgery this infant has thrived. The third infant had extensive PI of the colon with free air. At surgery there was no evidence of bowel perforation. The free air was attributed to rupture of one of the many colonic cysts of PI. Subsequently, the child has done well. Recurrent PI in infants who have had NEC is unusual and the causes are varied. Because more neonates are surviving NEC, the pediatric radiologist needs to be aware of this delayed complication.


Deep cerebral venous thrombosis in thalamo-ventricular hemorrhage of the term newborn.

Unilateral thalamic bleeding with associated intraventricular hemorrhage is reported in three full-term neonates. The first presented within 48 hours from birth with early onset streptococcal meningitis, persistent pulmonary hypertension, tonic seizures and a tense fontanelle. The second presented 6 days after birth with irritability, opisthotonus, a tense fontanelle and tonic seizures. The third was admitted three days after birth with seizures and a tense fontanelle. In the latter two infants NMR and CT imaging documented thrombosed superficial and deep cerebral veins. The etiopathogenesis of intracranial venous thrombosis in the neonate is diverse: asphyxia, dehydration, polycythemia, sepsis-meningitis and difficult delivery are the main causes. In one of our patients jugular vein compression by the collar of a negative-pressure ventilation chamber probably initiated the intracranial events. More than half of the survivors sustain severe neurological impairment.


Reverse flow in the intracranial arteries--the possible significance of comparative flow in the anterior cerebral and the basilar arteries.

Four infants with reverse flow patterns of the intracranial arteries are reported. Two with severe brain damage, had a reverse flow pattern in the anterior cerebral artery, which was recorded during the recovery stage from cardiac arrest. The other two patients showed a reverse flow pattern in the basilar artery and had a good prognosis. Reverse flow in the anterior cerebral artery suggests severe brain damage, but that in the basilar artery does not.


Dysplastic gangliocytoma of cerebellum in a newborn. Diagnosis by ultrasonography and MRI.

A cerebellar lesion was detected by ultrasonography (US) in a symptomatic newborn. Magnetic Resonance Imaging (MRI) demonstrated this lesion as a gyriform structure. Therefore a rare dysplastic gangliocytoma was suspected, which was compatible with histopathology. Immunohistochemical studies (monoclonal antibody Ki-67) showed signs of progression.


Congenital primary cerebral angiosarcoma: CT, US, and MR findings.

Congenital primary intracranial angiosarcoma (CAS) is an exceptionally rare tumor. To our knowledge the imaging features of intracranial angiosarcomas have only been briefly mentioned in the neuropathologic literature. To our knowledge, only one case of CAS has been reported. We present a case of a pathologically proven CAS found in a neonate.


Bilateral choroid plexus carcinoma of the lateral ventricles. US, CT and MR findings.

This is a case report of a bilateral choroid plexus carcinoma (CPCa) of the lateral ventricles in whom contralateral ventricular dissemination was thought to be due to seeding. The disease was diagnosed by ultrasonography; CT and MRI confirmed the pre-operative diagnosis.


Early childhood presentation of neurovascular disease in hereditary haemorrhagic telangiectasia.

This paper describes an unusual case of hereditary haemorrhagic telangiectasia related cerebrovascular disease with an arteriovenous malformation and aneurysm presenting with intracranial haemorrhage in early childhood.


"Brown tumor" of the maxilla.

A case of brown tumor of hyperparathyroidism in a young girl with a long history of chronic renal failure and hemodialysis therapy is reported. The diagnosis can be reached with the aid of the classic skeletal radiological sign which address the evaluation of both CT and MR imaging.


Pedunculated colonic polyp diagnosed by colonic sonography.

A solitary hamartomatous polyp of the colon in a four year old boy was diagnosed by colonic sonography while barium enema and colonoscopy were non-diagnostic. Colonic sonography provides an additional simple, relatively non-invasive modality for evaluation of the colon.


Benign mediastinal lipoblastoma in a 14-months-old infant.

Lipoblastomas are rare benign tumors arised from the fetal-embryonal fat that occur almost exclusively in children. About 70% of them arise in the limbs but several other sites have been reported. To date there are only 4 cases of mediastinal lipoblastoma in children, described in the international literature. The radiologic examination, including the chest X-ray, sonography and CT scan, can be used to detect the mass and its relationship to surrounding structures, and to define the typical features of the fat-like tissue. A case of a mediastinal lipoblastoma in a 14-months-old infant is reported, with a respiratory stridor and occasional dyspnoea, appearing only in the supine position. The radiologic findings, treatment and follow-up are also described.


Branchial fistula: CT manifestations.

A patient with a recurrent left neck abscess was found to have a branchial fistula from the pyriform sinus. This uncommon anomaly was demonstrated by CT and barium swallow. The embryology, pathology and clinical features of this lesion are discussed and contrasted with those of the branchial cyst.


Bronchoesophageal fistula of tuberculous origin in a child.

Bronchoesophageal fistulas (BEF) are uncommon in children, the etiology being congenital or acquired. Acquired bronchial perforation of tuberculous origin is common in children with pulmonary tuberculosis but bronchoesophageal perforation secondary to tuberculosis and leading to a fistulous tract formation is rare. To date, there have only been 4 case reports of BEF of tuberculous origin in children. We present yet another case of an acquired BEF of tuberculous origin in a child who presented with a sudden onset of dysphagia and choking sensation.


Lymphangioma of the lung associated with respiratory distress in a neonate.

Congenital pulmonary lymphangioma involving the entire left lower lobe in a newborn is reported. Respiratory distress was the presenting symptom. Radiography was suggestive of congenital diaphragmatic hernia or congenital cysts of the lung.


Echocardiographic assessment of radiation-induced mitral valve disease in a child.

A young girl, previously treated with mediastinum irradiation because of a pulmonary fibrosarcoma, developed mitral valve disease with valvular insufficiency. In consideration of the clinical course and the echocardiographic findings, authors hypothesize a relation between the radiation therapy and the valvular damage.


An autosomal recessive variant of spondylo-epiphyseal dysplasia in three sibs.

A report of one male and two female sibs with an unusual form of spondylo-epiphyseal dysplasia (SED) manifesting in late childhood. The anomalies are pronounced at the femoral head. There is platyspondyly with biconcave deformation and irregular vertebral end-plates. As the parents are healthy autosomal recessive inheritance is likely.


Spondylometaphyseal dysplasia, type VII.

Spondylometaphyseal dysplasia was first described by Kozlowski et al. in 1967 as a new dysplastic bone disease, characterized by metaphyseal dysplasia associated with generalized platyspondyly in the vertebral column [1]. Kozlowski et al. have pointed out the autosomal dominant transmission of this disorder at that time. However, later reports showed that the manner of genetic transmission and the degree of the manifestation of the radiological findings could be variable and accordingly seven types of spondylometaphyseal dysplasia were described [2]. In this article, three cases displaying one of the rare forms of spondylometaphyseal dysplasia, "type VII" are presented and the diagnostic findings as well as the differential diagnostic criteria are discussed.


Platyspondylic lethal osteochondrodysplasia: Shiraz type with radiological-pathological correlation.

We report two cases of a platyspondylic lethal osteochondrodysplasia in siblings. The condition affects predominantly the metaphyses of the axial skeleton associated with limb shortening and mild platyspondyly. The radiological and pathological features correlate very closely with Sedaghatian's lethal metaphyseal chondrodysplasia, which has previously been described only in Iranian Nationals. Both the radiological and pathological appearances will be described, together with a discussion of the differential diagnosis, the genetical implications and a review of literature.