[Content and distribution of collagen in aorta double velour DALLON grafts]. The aim of the study was to determine the collagen content, distribution and quantitative ratios between main types of collagen (found in normal vascular walls) in various layers of double velour DALLON grafts at different periods after implantation. Double velour DALLON prostheses were implanted into the abdominal aorta of 24 dogs. These grafts were excised 7 days, 1, 4 and 12 months after implantation and together with normal arteries, after dissection into intimal, medial, and adventitial layers, tested for their hydroxyproline content. Type I, III, V collagen was also determined (fractionation of pepsin digestion products). Already 7 days after implantation collagen appeared in all the newly-formed layers of the grafts. With the passage of time after the operation collagen content was gradually increasing. After 12 months collagen content in the intimal and adventitial layers was significantly higher than in normal arterial wall. Approximate quantitative ratio between collagen types I, III and V in all graft layers was 7:2:1 and did not change during the 1-year-observation. Rise in collagen content results in graft wall stiffening, and the presence of III type collagen increased platelet-aggregating activity. Both these factors created a tendency to the formation of thrombosis in the graft.


Circadian changes in the elimination of amitriptyline in rats. The circadian changes in elimination and absorption of amitriptyline after its intravenous and intragastric administration in rats were investigated. The values of such parameters as: AUC, MRT, t1/2, Cl, Vd, k(a) for amitriptyline change in the circadian rhythm. The fastest elimination of amitriptyline was observed in the dark phase (the acrophases for clearance were ca. 11 p.m. for iv administration and ca. 10 p.m. for po administration). The maximal value of clearance corresponds to the minimal values of MRT and t1/2. The acrophase for the constant absorption rate (po) falls at 7 p.m. Cyclic changes were not observed as far as the bioavailability is concerned.


[Attempts at modification of the polyester vascular prosthesis]. Polyester vascular bilaterally velour prostheses produced by the Enterprise of Medical Products TRICOMED in Lodz were modified through: putting negative electric charge on the internal surfaces of prostheses; additional cleaning with ethanol; covering of the surfaces of prostheses with silicone preparation; two-sided covering of the surfaces of prostheses with collagen by the radiative method; covering of the surfaces of prostheses with chitosane. Laboratory investigations, investigations of hemolytic and toxic effects of aqueous as well as experimental investigations has been carried on piglets. During these investigations it was observed that the carried preparations caused multiple increase of electrical conductivity of proper and dry remnant after evaporation of the aqueous extracts. Hemolytic and toxic effects were not observed. In radiological and pathomorphological investigations it was observed that none of the preparations used for modification of vascular prostheses influenced improvement of their biological properties. In comparison with the initial prostheses DALLONR these prostheses evoked a greater reaction of tissues which was manifested with a thick internal layer causing narrowing of the lumen of the section with prosthesis or closing it. A small improvement of the biological properties of the prostheses were achieved after cleaning them with methanol. However, this improvement is so small that it does not justify changes in the existing technology.


Circadian variations of phenacetin metabolism in rats in vivo and in vitro. The metabolism of phenacetin in vivo and in vitro at different periods of day was investigated in rats. In rats maintained on standard LD conditions the disappearance rate of phenacetin from blood and activity of phenacetin O-deethylase in liver were the highest in the morning and the lowest in the evening. Continuous illumination, adrenalectomy, phenobarbital or proadifen abolished this difference. It is postulated that these circadian changes of microsomal metabolism of phenacetin in rats liver are not fully responsible for the rhythmical changes in the antipyretic action of this drug that was observed previously. The mechanisms of this phenomenon are discussed.


[Polish vascular prosthesis sealed by albumin]. TRICOMED, Medical Articles has been conducting its research on textile vascular prostheses for over 35 years. In the seventies, a collagen coated graft was designed and fabricated which, however, after having been positively evaluated ceased to be used by clinics. In the eighties, double velour DALLONR prostheses was introduced which are now marketed by our company. The DALLONR graft has a low mass, developed surface area and moderate porosity. In the eighties, foreign manufacturers launched various types of coated grafts. Responding to that popular market trend we have resumed our early research on the preclotted prostheses and started studies on the use of albumin and chitosan as coating agents. The grafts impregnated with albumin have achieved satisfactory results of biological and experimental testing. These results are confirmed by current clinical examination.


Circadian changes of cytochrome P-450-dependent monooxygenase system in the rat liver. Circadian changes in cytochrome P-450 and cytochrome b5 content and activity of NADPH-cytochrome P-450 and NADH-cytochrome b5 reductases have been studied in rat liver microsomes in season autumn. The obtained results indicate, that cytochrome P-450 in 6-month-old animals shows 12 h rhythm, but in older ones 24 h rhythm. NADPH-cytochrome P-450 reductase activity shows 24 h rhythm in oldest animals only. Cytochrome b5 and its reductase has 24 h rhythm in all examined groups of rats.


[Clinical and tomographic evaluation of polyester prosthesis of the anterior crucial ligament made by TRICOMED in Lodz]. This study involves 38 patients in the age is 24-51 years with the III degree instability of the knee who underwent ACL replacement with PPT artificial ligament, beginning from 1986. For the majority the operation mentioned above was the second or even the third intervention after the previous ones, meniscectomy and suture repair included. In 6 patients, who underwent BJ plastic method, the return of the instability was observed. 24 patients were examined after an average follow up time of 34 months. 1 patient was operated on for the ligament replacement 4 years after the first operation, another one was operated on for synthetic arthritis one year after. Estimation of the results is based on clinical examination, subjective professional opinion and CT. 21 patients showed excellent results, which correspond with CT examination and confirm good quality of PPT ligament.


[Methods of testing materials made by a knitting technique]. The author describes the methods of testing biomaterials manufactured by TRICOMED, Medical Articles, in Lodz. Examination of raw materials, production control methods, quality control of semi-finished and finished products are discussed.


The consequences of passive smoking: an overview. Tobacco smoke contains a wide range of toxic vapors and particles that when inhaled are injurious to the smoker himself (active smoking) and to those around him (passive smoking). It is extremely difficult to define precisely the harmful effects of passive smoking on the individual's health because of the problems involved in quantifying the extent of exposure. A number of epidemiological studies indicate that exposure to passive smoking in public places is circumstantially but marginally linked to cardiovascular morbidity and mortality, as well as to benign and malignant pulmonary morbidity. There is an increased risk of cardiovascular and lung diseases among people living with spouses who smoke due to the exposure to tobacco smoke in the home. Passive smoking during pregnancy constitutes a health hazard for mother and fetus alike. Exposure to passive smoking during childhood may predispose the individual to benign and malignant pulmonary morbidity in both childhood and adulthood. For many people the worksite comprises the main exposure source. Many clinical conditions are further aggravated by exposure to a combination of tobacco smoke and industrial chemicals, mineral dust, or other carcinogens (asbestos, cadmium, radon daughters). Tobacco smoke exposure and the resultant morbidity can be reduced by regulations and legislation prohibiting smoking in public places and worksites.


Reduction in hepatitis A antibody prevalence among young adults in Israel. Hepatitis A (HAV) is endemic in Israel. A number of developed countries have reported marked reductions in prevalence of antibodies. The objective of this study was to determine whether change in prior infection took place over a 7-year period and to investigate the sociodemographic characteristics of infection in Israel. Recruitment into military service in Israel at the age of 18 is compulsory. Representative samples of male recruits were selected in 1977 and 1984. Antibodies to HAV were tested by solid phase radioimmunoassay in the 1977 sample and by an enzyme immunoassay in the 1984 sample. HAV antibody prevalence in 1977 was 69% (95% confidence interval (CI) 65% to 72%) versus 54% (95% CI 49% to 59%) in 1984 (p < 0.0001). The reduction was evident in all ethnic-origin groups comprising the Jewish population. In 1984 the prevalence was 28% for Jewish men of European origin, 60% for Asian origin, and 80% for the North African origin group. A statistically significant independent effect of education was evident. These findings point to a reduction in feco-oral transmission and hepatitis A virus infection in childhood in Israel, yet reveal considerable continuing ethnic and educational inequalities in prior exposure to infection. A potential for large outbreaks exists during transition from high to low endemicity, particularly in high-risk military populations. These populations are candidates for application of active hepatitis A vaccines now undergoing testing.


The 1991 measles epidemic in Israel.

The 1991 measles epidemic in Israel. INTRODUCTION AND METHODS. Prior to the institution of universal childhood vaccination against measles in Israel in 1967, large outbreaks occurred in epidemic cycles at intervals of 2-4 years. The mean annual incidence in the pre-vaccination period, 1950-66, was 470/100,000 per year. With the institution of routine measles vaccination, incidence rates fell, and since 1970 measles incidence has averaged less than one-tenth the pre-vaccination incidence rate, although epidemics occurred in 1975, 1982, 1984-85, and 1991. In this report, based upon cases of measles reported to and investigated by the Ministry of Health, we present an analysis of the 1991 measles epidemic, the measures taken to contain it, and an overview of the prospects for measles control in Israel in the future. RESULTS AND CONCLUSIONS. The 1991 measles epidemic, 1036 reported cases (incidence: 20.0/100,000), began in the south of the country among underimmunized Beduin children and spread to the Jewish population in the south and then to the rest of the country. The highest incidence was in children aged 12-23 months, followed by children less than 12 months of age and children aged 2-4 years. In the main, cases occurred in persons never immunized in the past, but in 37% of cases vaccine failure seems to have occurred. Control measures included mass vaccination of children in the south and lowering the age for routine measles vaccination nationwide to 12 months. Despite very substantial gains towards measles control in Israel, elimination of the disease is not a realistic goal, mainly because the transmission potential of the disease is too high and vaccine coverage and efficacy are not high enough. Trends in measles incidence over the last four decades allow a cautious optimism that measles containment can be achieved.


[Oral problems and approach to dental care in case of diabetes mellitus]. Diabetic patients often present oral symptoms and complaints at the moment of diagnosis of their disease. Recurrence of these symptoms is possible in periods of poor metabolic control. Long term complications of the disease are noticed at the level of the oral cavity. Dentists can contribute to early recognition of oral manifestations. A careful dental follow-up of these patients is essential in order to reduce the incidence and severity of long term oral complications (advanced periodontal disease, ...) This article reviews the general and oral implications of diabetes mellitus and discusses the results of a clinical study regarding the orodental condition and oral preventive behaviour of children with diabetes. Practical guidelines for the dental care of patients with diabetes are outlined.


[Survey on HIV and the control of infection]. During FDI World Dental Congress 1990, field specialists set up a scientific question form to obtain specific information about hygiene procedures in dental offices, knowledge about oral lesions in HIV infection and attitude against HIV infected patients. 540 Belgian dentists replied the question forms correctly. In general, there are no big differences between male and female. Younger dentists seem to be more hygiene minded than older colleagues. But more important is the discrepancy between the risk level and the use of specific hygiene procedures, and the knowledge about specific HIV associated oral pathology.


[The antiseptic role of saliva].

[The antiseptic role of saliva]. The oral flora is under the control of both immunity and non specific defense factors. The immunity factors are mostly represented by polymorphonuclears immunoglobulins Non specific defense factors include lysozyme lactoferrin high molecular weight proteins, such as mucins fibronectin and beta 2 microglobulin histidine rich proteins cystatins salivary amylases salivary peroxidase system.


Tuberculosis cases in the Negev 1978-1987: ethnicity, sex, and age. The incidence of tuberculosis (TB) in Sub-Sahara Africa is considered to be one of the highest in the world. During the past decade thousands of Jewish refugees from Ethiopia were settled in the Negev and might constitute a potential reservoir of infection for the indigenous populations. This study provides some baseline information about TB in the Negev just prior to and after an Ethiopian immigration peak. The files of every case of TB diagnosed during the decade 1978-1987 at Soroka Medical Center were reviewed and each diagnosis was validated by rigorous clinical and microbiological criteria. The age, gender, and ethnic background of each case were recorded, and approximate population denominators were estimated from Ministry of Health and Census data. Annual and decade incidence rates were then calculated for the different demographic categories. 279 cases of TB were verified. The main 10-year incidence rate per 10,000 Israeli Jews was 0.28; for the Negev Beduins it was 1.52; for the Ethiopian Jews, 91.9. In the Jewish population, cases among males (59) far exceeded those among females (7), but the reverse was observed, both among the Beduins (47 female and 31 male cases) and the Ethiopian immigrants (79 female and 56 male cases). In all three groups TB incidence increased with age, ranging from 0.03 per 10,000 for young non-Ethiopian Jews to a remarkable 623.8 per 10,000 for elderly Ethiopian Jews. The results of this study indicate the existence of a potentially large TB reservoir in the Negev. Health workers must be alerted to the importance of continued case finding, effective case management, and the control of infection transmission. The unique integration of the Negev Health Delivery System should help monitor intervention strategies.


["Safe for Teeth" confectionery and the International Sympadent Federation]. Preventive cariology has primarily focused on the protection of teeth with fluorides and on oral hygiene. Another important preventive approach, namely diet modification reducing the frequency of consumption of acid-producing carbohydrates has not yet gained enough attention. It can very well be implemented by making available a wide variety of non- or hypo-acidogenic snacks. This paper presents a model system, the Swiss Sympadent Association, initiated and currently used in Switzerland for developing, testing, labelling and promoting "tooth-friendly" foods that do not give rise to intraplaque acid production. Based on the success of the Association in Switzerland, an international extension of this model is well on its way.


Regional differences in appropriateness of cholecystectomy in a prepaid health insurance system. Previous studies have reported variation in the population-based use rate of diagnostic and therapeutic procedures. Cholecystectomy is one of the most common surgical procedures, and we conducted this study to assess whether in Israel the use of this procedure varied by region and whether differences in use can be related to differences in appropriateness of use. In Israel, there is a pre-paid health insurance system and all surgeons are salaried. Age-adjusted rates of cholecystectomy in four hospitals, each serving a defined population in Israel, were calculated. Two hundred and sixty-six potential clinical indications for performing cholecystectomy were rated as to their appropriateness by a panel of 9 expert physicians. A trained team abstracted the medical records of all patients who underwent the operation in the four Israeli hospitals in 1986 (n = 702) and recorded the clinical indication for the surgery. The population-based age-adjusted rates of cholecystectomy varied over threefold among the four hospitals. 29% of the cholecystectomies were performed for less than appropriate reasons, and this figure varied by hospital from 36% to 17% (p = 0.002). However, appropriateness did not vary systematically with the population-based use rate. Cholecystectomy was performed frequently for inappropriate or equivocal reasons, even in a country in which resources are limited, and physicians are salaried. Efforts to improve surgical decision making should be undertaken.


Personal determinants of health promoting behavior. This paper describes the personal determinants in health promoting behavior, and, in particular, life style changes. A review is made of internal factors, including personality factors, health beliefs, and health attitudes. Environment factors are also taken into account. Suggestions for future research are proposed.


[Chewing gum and dental health. Literature review]. Clinical studies have demonstrated the caries promoting effects of sugar based gum when compared with non sugar chewing controls. Sucrose gum has been shown to stimulate plaque growth and increase its adhesivity. Acid produced in plaque and mixed saliva whilst chewing sugar gum is counteracted by the buffering action of mastication induced saliva. However the vast majority of studies measuring plaque pH has demonstrated acidification of plaque during use of sugar gum into the decalcifying zone (pH < or = 5.5), or after the gum is taken out. Sugar gum causes a more pronounced fall in plaque pH in individuals with an increased caries risk compared to the pH drop in more caries resistant individuals. Sorbitol, by itself or in combination with mannitol is slowly converted to acids by the plaque microorganisms. Chewing gums sweetened with these sugar alcohols do not cause a critical acidification of the plaque and appear not to promote caries in the clinical trial. Twelve weeks use of sorbitol chewing gum has been shown to induce a plaque more adapted to form acids from this sugar alcohol. This adaptation has been shown to persist for up to twelve weeks after cessation of the use of the sorbitol gum. Xylitol has generally been considered non-cariogenic because of its non-fermentability by most important plaque microorganisms. Plaque pH and pH of mixed saliva is increased during and following the use of xylitol based chewing gum. Prolonged use of xylitol or xylitol containing chewing gum reduces Streptococcus mutans counts in plaque and saliva, at the same time fostering remineralization of early caries lesions. Regular use of xylitol reduces the acidogenic potential of the plaque as well as its adhesiveness, at the same time increasing its mineral content. No adaptive changes in plaque metabolism resulting in the fermentation of xylitol have been reported, not even after long term, intense use. Xylitol chewing gum therefore is eminently suited to be used as part of a caries preventive regimen notably for high caries risk patients and those suffering from xerostomia. Adding mineral salts to sugar based chewing gum has been demonstrated to significantly inhibit caries development. Possible additional caries preventive benefits of mineral compounds added to sugar-free chewing gum have, so far not been reported. Sugar-free chewing gum has been shown to be an excellent vehicle for Fluoride. The plaque-growth retarding properties of Chlorhexidine-containing chewing gum have been shown to equal that of a Chlorhexidine mouthwash. Ureum added to a sugar-free chewing gum helps to neutralize plaque acids by liberating basic ammonia.


Assessment of health risks from fallout radiocesium in a hunting and food-gathering society. Hunting and food-gathering societies are particularly vulnerable to the effects of fallout, since these people are often at the head of natural food chains which can bioaccumulate toxic substances. This paper describes a study on the effects of fallout radiocesium in caribou consumers of northern Canada. Portable whole body counting equipment was transported into five Arctic communities in 1989-90 and used to measure radiocesium body burdens in over 1100 people. The results were compared with a similar survey carried out in 1967-68. The mean body burden for adults in each community had decreased by a factor of 20 to 30 since the earlier survey. It was possible to derive an effective half time of about 4.5 years for the decrease of Cs-137 body burdens in the Arctic. The mean lifetime dose from the ingestion of radiocesium since 1967 amounted to not more than 12 mSv, with possibly an equal contribution from the period before 1967. The current radiation doses are much less than natural background and it is possible to reassure northern residents that caribou meat remains a safe and nutritious food source.


[Prevention of alveolar bone loss].

[Prevention of alveolar bone loss]. This article describes the bone resorption and remodeling of the edentulous jaw, starting right after extraction of teeth. This resorption is a physiological process, but can be influenced by wearing dentures. Load on the mucosa and disturbed blood circulation of the mucosa caused by the denture gives an additional bone resorption. The prevention of bone resorption can be executed in saving teeth or roots as long as possible. But when the jaw is already edentulous it is necessary to create an optimal function and load-dividing of the denture and regular controls are indicated. From time to time the denture has to be rebased or relined due to the changes in contour of the jaw. Also a daily massage of the mucosa after cleaning the denture is advisable to restore a normal blood circulation.


[Lack of healing following adequate endodontic treatment]. When an endodontic treatment is to be redone, generally the X-ray reveals some form of poor or inadequate filling. Most endodontic cases fail because of inadequate endodontic treatment (cleaning, shaping, filling). However, sometimes good clinical treatment isn't followed by healing! This article sums up the possible reasons to consider. In order to improve the success rate of the endodontic treatments, practical hints are given regarding the non-surgical as well as the surgical (re)treatments.


[Access to root canals].

[Access to root canals]. Both for the future of the residual dental crown and in order to work efficiently in the canals, preparation of the pulp chamber should be regarded as more than a mere stage. Although it is only a transitory stage, it is essential that the pulp chamber should be clean and well cleared without wasting healthy dental tissue. A good access, without excess, will increase the chances of success.


[Determination of tooth length in endodontics]. Determination of the exact tooth length and subsequent working length remains a corner stone of proper endodontic treatment. Up to now, no system has proven to provide the exact location of the apical constriction under all circumstances. Several possibilities of determining tooth length are discussed. Factors influencing the outcome of the different techniques are described. A simple and rather accurate way for calculating tooth length on X-rays is elaborated. Apparently, electronic devices are becoming increasingly accurate, and may become a challenge for the radiographic tooth length determination. Actually, dentists have most of all to rely on X-rays for tooth length determination.


[Electronic apex localizers: useful instruments or inconvenient gadgets?]. Apex locators offer definite advantages for certain patients over conventional radiographic methods of root canal length measurement. Current instruments do not appear to differ significantly in accuracy. The choice of locator has to be made therefore on cost and convenience in use. The current best buys seem to be the Evident RCM and NeoSono MC. Both offer good value for money, the Evident is the less expensive but lacks some of the additional features of the NeoSono. The decision to buy an apex locator should only be made after a period of testing in clinical practice.


[Rational basis for resumption of treatment in endodontics. Should it be "down to the root" in order to be satisfied in endodontics?]. Any endodontic treatment showing a symptomatology should be retreated or corrected. Should we start the asymptomatic treatments over again when the x-ray does not show a filling that is complete, hermetically sealed, biological and under control? When the case arises, the decision to resume the treatment will depend on the state of the crown restoration: should it be redone for any reason? 1. When the crown filling does not need to be removed and redone, watchful waiting is recommended. 2. When the crown filling is deficient, and has to be redone, it would be advisable to resume or try to resume all the canal treatments that are not hermetically sealed, when an opening to the canal has to be worked out. Several experiences show that the rate of success of endodontic treatments that have been resumed is lower than that of endodontic treatments that have been carried out for the first time. Should radiographically inadequate but asymptomatic endodontic treatments not be resumed, it would result in problems only in a very small number of cases, as long as the state of intracanal balance is not broken.


[Medications for endodontic use].

[Medications for endodontic use]. Medication can never disinfect a badly shaped canal and successful treatment will depend on the endocanal preparation. Despite the indisputable antibacterial efficacy of Rocklès 4 in vitro, use of this medicament should be banned because of its toxicity, its mutagenic and antigenic action and its long-term inefficacy in vivo. The same goes for all other antiseptics, anti-inflammatory agents and antibiotics mentioned, that should be discarded because of their harmful effects on patients or their inefficacy on endodontic flora. Our endodontic medicine cabinet should only contain the following products: irrigation agent: NaOCl 2.5% medication in 2 sessions: calcium hydroxide prescription or 'Réogan rapide'.


[Lasers in endodontics].

[Lasers in endodontics]. Laser technology has been developed rapidly in the last decade. New lasers with a wide range of characteristics are available now which are being used in various branches of dentistry. The application of these new technologies in endodontics has always been challenging. Today more experience and knowledge in applying lasers in endodontics is available.


Twenty-four-hour intragastric pH-metry: evidence of nightly gastric alkalinization in subjects with and without active duodenal ulcer. Continuous 24-hour gastric pH monitoring was performed in 68 subjects to evaluate the spontaneous nightly alkalinization phenomenon (SNA). Two groups of patients were compared: the first (group A) was composed of 27 subjects with active duodenal ulcer disease; group B included 12 healthy volunteers and 29 patients with gastroesophageal reflux. Patients with duodenal disease had an alkalinization of 196.2 +/- 97.9 seconds in duration, while healthy subjects and even gastroesophageal refluxers exhibit a SNA lasting 5269 +/- 748.3 seconds (t = 6.72; p < 0.001). The absence of SNA was used as a predictive test of duodenal ulcer disease and its discriminating ability was evaluated. The evidence of this phenomenon was able to exclude the disease in 90% of group B subjects (negative predictive value) while its absence suggested correctly the presence of duodenal disease in 82% of patients (positive predictive value). The lack of SNA in duodenal ulcer patients is so frequent that its absence might be a diagnostic sign of the peptic disease.


Long-term effects of isotretinoin in the treatment of severe nodulocystic acne. One hundred and sixteen patients with severe nodulocystic acne were treated with 0.75 mg/kg isotretinoin daily for 6 months. One hundred and seven (92%) were completely healed or markedly improved at the end of treatment compared to 94 (81%) 42 months later. There was no significant difference in the clinical response between male and female patients. Seven of the 40 female patients gave birth to 7 fully developed and healthy children 39 months after discontinuation of therapy. Cheilitis (84%) and dry skin (54%) were the most common side effects, the severity of the side effects being dose-related. Increased serum triglyceride values following treatment were found in 31 (27%) of the patients. A better life quality was experienced by 99 (85%) patients after isotretinoin therapy.


[Changes in lymphocyte subsets in chronic inflammatory diseases and neoplasms in the elderly. I. Multivariate analysis of variance and factoral analysis]. The variations of lymphocyte subsets have been studied both in neoplastic and chronic inflammatory elderly patients compared to a control group. The interpretation of the Multivariate Analysis of Variance (MANOVA) and of the Factorial Analysis has demonstrated the opposite role of TCD4 subset, mainly involved in the inflammatory process, and of TCD8 subset in regard of the neoplastic ones. We report the slight and yet significant increase of NK related to age. Independently from the disease pattern, factorial analysis permitted a comparison between the variations of lymphocyte subsets and the different grades of immunoresponse.


Intravenous propafenone for suppression of symptomatic atrial fibrillation and atrial flutter in a first aid hospital. The efficacy and safety of propafenone (PPF) were prospectively evaluated in 20 patients (13 men and 7 women, age 39 +/- 14 years) with atrial arrhythmias (AA) (atrial fibrillation: n = 13; atrial flutter: n = 7). All patients had arrhythmias from 109 +/- 63 minutes, (iT) without clinical evidence of heart failure. Intravenous PPF was given as a 1 mg/kg bolus over 5 minutes, with a therapeutical possibility of a second bolus (1 mg/kg) after 10 minutes if sinus rhythm was not restored. The conversion time (cT) was 6.4 +/- 2.2 minutes (range 3 to 18 minutes). In 19 patients (95%) sinus rhythm was restored and no serious adverse and proarrhythmic effects were noted in each patient. We conclude that 1) PPF is effective and acted significantly faster in controlling AA; 2) PPF appears to be well tolerated and relative safe with a low incidence of adverse and proarrhythmic effects in patients in a first aid station.


Food allergy, atopic dermatitis and superficialism in medicine. Although the essential immunology underlying atopic diseases is now being clarified, there are still few accountable diagnostic tests. Therefore the recognition and treatment of these diseases continues to be based mainly on clinical skill and, in particular, on the taking of a careful history. This means that the observer bias can be a significant factor, and so whether or not the diagnosis is made may dependent on a clinician's preconceptions. Furthermore, the general interest in the subjects has tended to divided the medical consensus between believers and nonbelievers. In infancy, food allergy has protean manifestations and is provoked by many different food allergens. In addition to the lack of really useful diagnostic tests, there is the difficulty of easily and reliably conducting double-blind challenges in general pediatric practice. Thus it is crucial that a scientific, and critical, approach is adopted and that doctors attentively record the case history and observe the response to elimination diets and challenges. True science has nothing to do with superficialism.


[Surgical treatment of inguinal hernias with local anesthesia]. Fifty-nine cases of inguinal hernia repair with local anesthesia are shown. The authors stress the advantages of this safe technique permitting an immediate postoperative ambulation and an early discharge of patients, thus reducing complications related a long term bed-stay.


[Pulmonary hamartoma in geriatric surgery]. The pulmonary hamartoma is a kind of disease frequently shown in elderly. The diagnosis is often difficult and fine needle aspiration (FNA) can be used for histological features. CT scan can be also a such useful technique in differential diagnosis. A case is presented and its problems are discussed.


[Tracheostomy: indications, techniques, and complications]. The authors report their experience relative to 46 tracheostomies performed over a 10-year period. In 6 cases the indication for a tracheostomy was a post-traumatic respiratory failure; in 20 cases a chronic respiratory insufficiency, in 6 cases a malignant neoplasm of the larynx; in 10 cases a postoperative respiratory insufficiency; in 4 cases for tongue and/or neck wounds. The authors stress the importance of a correct indication, the use of large volume-low pressure cuffs and an appropriate surgical technique to prevent complication of tracheostomy.


[Gingival hyperplasia induced by cyclosporin A]. Cyclosporine-A (Cy-A) selectively inhibits T cell function with minimal effect on humoral immunity. It is used specially in transplantation patients and in some cases, like other drugs, it causes gingival hyperplasia. In this article, after a review of the most recent pathogenetic hypothesis, the authors present their experience based on 10 cases of gingival hyperplasia in kidney transplantation patients in treatment with Cy-A.


[Morphologic changes in cardiac muscle in white rats in various models of hypoxia]. The authors have explored the effect of intermittent hypoxia in the cell membrane and histochemical changes in the cardiac muscle cells of the white rat. Every day the animals were exposed to experimental conditions characteristic of 7.000 m of high above sea level (first experimental group) and every odd day (second experimental group). Animals of the experimental groups were sacrificed immediately (first subgroup), 24 hours later (second subgroup) and 7 days after the final exposition (third subgroup). The hypoxical stress elicited the vacuolation of the cardiac muscle fibres of the subendocardiac layer of miocard which persisted, and did not reduce its number, intensity and extensity in the first experimental group, although it reduced its intensity and vacuoles size in the second experimental group, while in fuxinorrhagia which has been presented focally the intensity has been reduced in all the three subgroups of the first experimental group of animals. In preparations of animals from the second group, sacrificed 24 hours after the experiment intensity and extensity fell to the half number of those animals, and completely disappeared in those sacrificed 7 days after the final exposure. Glycogen pools, as well as the activity of sucinat-dehydrogenase were preserved in both experimental groups. It could be concluded that apart from hypoxia model, oxygen deficit, too, elicites ischemical changes in the sense of vacuolation of muscle tissue which does not disappear or its disappearance has been much slower than in positive fuxinorrhagia.(ABSTRACT TRUNCATED AT 250 WORDS)


[Occurrence of triplet births].

[Occurrence of triplet births]. The authors studied all cases of triplets who were born at the Department of Gynaecology and Obstetrics of University Clinical Centre in Belgrade, over a twenty-year period (1970-1989). Thirty sets of triplets were born in this period. This means that one set of triplets was born per 5845 births. Preterm deliveries occurred in 19 cases. Liveborn children had lower Apgar score. Common birthweight was slightly below 1800 grams. In more than one half of the foetuses malpresentation was found. More than one fourth of sets were delivered by Cesarean section. Total foetal loss reached 23.33% and purified perinatal mortality rate reached 11.11%. The triplet diagnosis on time is important because of the necessary prevention measures and appropriate therapy.


[Clear cell sarcoma of the kidney in children]. Clear cell sarcoma of the kidney (CCSK) is a distinct, highly malignant renal tumour of childhood which was diagnosed in 5 (3.9%) of 133 primary renal tumours in children under 15 years of age in the period from 1976 to 1990. The clinical and pathological features of these patients are presented. The most common clinical features were abdominal mass and haematuria. The male to female ratio was 1: 1.5 and there was predilection for the left side (4:1). The age of patients varied from 5 months to 4 years (average age 23 months). In four children the tumour was in Stage I, and in one child in Stage II. Three tumours showed classical microscopic pattern of CCSK. The treatment for all patients consisted of preoperative chemotherapy, radical surgery and additional aggressive chemotherapy. Four patients developed metastases: three of them to bones and one to the liver. Three patients died of the tumour, one is alive but with the tumour (3 years follow-up), and one child is alive and without any evidence of disease (3-years follow-up). Although relatively uncommon, these tumours are responsible for 50% of all children's deaths from renal tumours and, so, their precise classification is essential for proper treatment.


[Efficacy of therapy, recurrence of seizures and respiratory complications in the treatment of status epilepticus by intravenous administration of diazepam or midazolam]. During a nine-month period we have treated 46 patients with status epilepticus with intravenous application of diazepam or midazolam. The initial doze od diazepam was 10 mg (rate: 2-5 mg/min) and of midazolam 15 mg (rate: 5 mg/min). Diazepam was effective in 26 and ineffective in 15 patients. Midazolam stopped status in 4 out of 7 patients. Both drugs were more effective when they were administered at the beginning of status. After the initial termination of status and recovering of consciousness, seizures returned in 10 patients (22%). In the group treated with diazepam, 4 patients had sudden apnea and 6 respiratory depression (totally 10 out of 41). In the group treated with midazolam, 3 had apnea and 2 respiratory depression (totally 5 out of 7). All patients with apnea or respiratory depression received higher doses of both drugs at the higher rates than the others. We conclude that the efficacy of the therapy is moderate while the frequency of serious complications is high. In status epilepticus, where the life of patient is in danger, drugs with such activity are of limited value.


[Clinical-therapeutic considerations in pertussis]. One-hundred and seventy-one cases of pertussis were observed at the Institute of Infections Diseases and at the 2nd Division of Infectious Diseases of the Policlinico Umberto I in Rome from January 1, 1987 to June 30, 1991. All subjects were treated according to a therapeutic protocol consisting of macrolides (erythromycin or myocamicin) at doses of 40-50 mg/die, betamethasone 0.1 mg/kg/die, specific immunoglobulin G at doses of 0.5 ml/kg repeated after 24 hours (new born babies and babies still unweaned) and oxygen therapy during the paroxystic fits. In 20 patients who were over the first year of life and who had serious asphyxiated fits, bronchodilators (trimetochinol or salbutamol) were added to the previous therapeutic scheme. Our data show both efficacy of therapeutic protocol and importance of early starting the treatment to shorten the length of disease, the strength of asphyxiated fits, and the risk of contagion.


[Personal experience in the diagnosis and therapy of pulmonary thromboembolism]. The analysis of both clinical findings and diagnostic procedures results were performed in 26 patients with thromboembolic pulmonary disease in order to determine the incidence of signs indicating pulmonary thromboembolism. Sudden dyspnea, hemoptysis and chest pains are the most common symptoms of the disease. These symptoms associated with radiographically confirmed pulmonary infiltrations with the elevation of hemidiaphragm and pleural effusion, particularly if they are bilateral, are the main clues for the diagnosis of pulmonary embolism. Perfusion defect on the pulmonary scintigraphy makes this diagnosis almost certain. Hypoxemia and hypocapnia and respiratory alkalosis are frequent findings in thromboembolic pulmonary disease, as well. Fever, increases RBC sedimentation rate and leukocytosis are present in a great deal of patients. In addition, the presence of risk factors related to the development of thrombosis of the lower limbs deep veins, and particularly those related to the long term immobilization as well as diagnostically confirmed venous thrombus are basic guidelines for the diagnostic of pulmonary thromboembolism.


[Microscopic diagnosis of verrucous carcinoma]. Twelve cases of verrucous carcinoma of the orofacial region were reviewed for their clinical and pathological characteristics. Verrucous carcinoma made 3.5% of all primary epidermoid carcinoma observed during the period of investigation. The tumour occurred chiefly in older patients (from 25 to 81 years, mean age 57.5) and more often in males than in females (9 males: 3 females). The most common site of occurrence was the vermilion surface of the lower lip (seven cases). Macroscopic appearance of lesions was reported as exophytic, warty, and white. Microscopically, the thickened epithelium was well differentiated and stratification was preserved. Rete pegs of carcinoma were broad and blunt; they also appeared to "puch" into underlying tissues. Basement membrane appeared to be intact. Cells of tumours were displayed, and histologic features of the spectrum were generally associated with viral modification. The prognosis in verrucous carcinoma is very good, because of the absence of metastases. Radiotherapy should not be used, since not only local recurrence is common, but also anaplastic changes may occur with corresponding aggressive behaviour and metastasis.


[Mycobacteriosis].

[Mycobacteriosis]. Classification of atypical mycobacteria, problems related to their identification, epidemiological, clinical, radiological and pathohistological presentation of mycobacteriosis are given. Up-to-date alternatives for treatment of these patients are also given. Finally, three cases treated at the VII Clinical Ward of the Institute of Pulmonary Diseases and TBC in the course of 1990 are presented. In two of them Mycobacterium avium was isolated. In all three cases the same strains were isolated and identified repeatedly.


[Effects of a heparin-heparinoid combination on esthesiologic and trophic changes in deep periarticular tissues in gonarthritis]. We evaluated the efficacy of heparin-glucuronylglucosaminoglycane association topically used on periarticular deep tissues (subcutaneous and muscle), in 20 females divided into two homogeneous groups of 10 each, affected by painful osteoarthritis of the knee. Electrically stimulated subcutaneous and muscular pain thresholds have been assessed; ultrasound scan of subcutaneous tissue overlying articular rima and vastus medialis muscle, and ultrasound scan of vastus medialis muscle thickness have been also examined. The measurements have been done (at the beginning of the experiment) in basal conditions and respectively after one, two, and three weeks treatment with the drug or placebo administered in a double blind fashion. Subcutaneous and muscular pain thresholds have shown an important rise right from the first week of treatment; subcutaneous tissue thickness was significantly decreased after two weeks treatment and in the same period a significant increase of vastus medialis muscle was registered. No such variations have been shown after placebo treatment. The possible mechanisms of such effects have been assessed in a peripheral control action of inflammation, with decrease of nociceptive message and consequent limitation of dystrophic reflex phenomena.


[Subclinical disorders of left ventricular function in diabetics detected by echocardiography]. In diabetic patients, without coronary heart disease and hypertension, left ventricular filing dysfunction exist, that is registered by echocardiography. It is manifested as greater peak flow velocity during atrial systole and as shorter time from the aortic second heart sound to the peak of the early diastolic flow velocity curve. The diastolic dysfunction indicates increased left ventricular stiffness and may be the first maker of diabetic cardiomyopathy.


[Radiotherapy of metastatic brain tumors]. On the basis of data from literature, the authors present the role of radiotherapy in the treatment of brain metastases. This role has been considered as a sole treatment or as a combined treatment, especially with surgery. New techniques of radiotherapy which could enable better results in the treatment of brain metastases in the future, are presented.


[Clinical significance of the negative T wave and changes in the ST segment in the electrocardiogram of air force pilots]. More and more investigators, consider that nonspecific ECG changes are significant in prognosis of appearance of ischemic heart disease. It is seldom, appearance of disorder in ECG records in so high selected population, as pilots in Air Force. Around 4% of flyers present ECG record which could be of clinical importance.


[McArdle's disease].

[McArdle's disease]. Glycogenosis type V (McArdle disease) is a serious metabolic disorder with an exercise intolerance, myalgia, early fatigue and stiffness of exercising muscles, relieved++ by rest. The authors present a case report of patient with McArdle's disease, and diagnostic procedures which can be used in different diagnostic of metabolic myopathies, especially between myoadenylate deaminase deficiency and different types of gly(geno)lytic myopathies. The importance of "ischemic forearm test" and muscle biopsy is emphasized.


[Levels of immunoreactive atrial natriuretic peptide in the blood of children on hemodialysis therapy]. Expansion of extracellular fluid volume,--increasing right atrial pressure,--appears to be a major stimulus for the rise in plasma atrial natriuretic peptide (ANP). End-stage renal disease (ESRD) is associated with significant changes of several hormone systems. Recent studies have shown that plasma ANP concentration is significantly increased in patients with ESRD and that the concentration of the hormone declines following haemodialysis (HD). In patients with ESRD treated by HD "dry weight" for each individual patient is the body weight at which the patients has normal hydration status. The aim of the present study was to determine changes of plasma concentrations of ANP during haemodialysis. We also attempted to check whether the baseline levels of ANP were related to weight loss during dialysis. Eleven children (7 females, 4 males) participated in the study. The patients age related from 8 to 20 years. Plasma concentrations were markedly elevated (p < 0.01) before haemodialysis (251 ae 119) pg/ml) in comparison with control values (61 ae 23 pg/ml), but remained above normal range in all except 4 cases. During HD body weight was reduced in all but one patient. This patient was infused isotonic fluid during HD and did not show weight loss. The four patients who had normal plasma ANP levels at the end of treatment appeared to be in better overall condition than the other patients. In summary, plasma ANP measurements may be of value in establishing the volume status in patients with ESRD. Plasma ANP levels after HD may help to adjust the right dry body weight for each patient.


[Dietetic-hygienic measures in the control of arterial hypertension in obese females]. Since the evidence to data suggest that some obese person respond well to non-pharmacological measures, the aim of this study was to examine the extent of body weight reduction necessary to reduce blood pressure to normal values. A group of 250 obese women with hypertension (blood pressure measurements over 160/95) and an overweight of at least 20 per cent excess of ideal weight was included in the study. The patients were advised to take well balanced low-calorie (about 1000 kcal/day) diet containing 66 g proteins, 140 g carbohydrates, 13 g fat and 0.5 g salt. They were advised to increase daily physical activities. Low-calorie diets were used to decrease body weight in groups of patients with changed of unchanged antihypertensive drug therapy, also. Decrease in body weight resulted in significant decrease in blood pressure; over two-thirds of complaint patients achieve normal blood pressure with a loss of only 5-10 per cent of their weight excess even if at this point they were still overweight. In the group receiving no drug therapy 78 per cent reached normal blood pressure, 76 per cent in the patients whose antihypertensive treatment had to be modified during the study and 63 per cent in the group receiving unchanged drug therapy. It was concluded that weight reduction program (diet and physical activity) can be a possible approach to treat hypertension without drugs and patients can attain normotension long before achieving the ideal weight.


[Ophthalmologic manifestations in patients with ichthyosis]. Different manifestations on some ocular and adnexal structures may accompany ichthyosis. Some ophthalmological manifestations in the clinical course of ichthyosis may endanger the eye and even lead to the sight loss. The paper reports a case of a patient with congenital ichthyosiform erythrodermia and ophthalmological manifestations on the lids and cornea. In addition to ichthyosis of the lid skin, squamous blepharitis and cicatricial ectropium of the lower lids were also present, while signs of exposure keratitis on the right eye and corneal leucostaphyloma on the left eye were also noted. Presence of lagophthalmos and permanent exposure of both eyeballs led to deterioration of the condition which may result in the sight loss on the right eye, as well. Therefore, contracture release of both lower lids was performed followed by full-thickness skin graft. Surgical procedure and the postoperative course were uneventful. The operation successfully corrected position of the lower lids and enabled formation and reestablishment of the precorneal tears film which led to improvement of the condition of the cornea. The effect has been maintained for six postoperative years now.


[Correlation of sonographic and patho-anatomic findings in myomatous changes in the uterus]. In spite of the fact that ultrasound is an accessory diagnostic measure in gynaecology, added to clinical examination, it can help in a more accurate diagnosis and better preparation for surgery. The comparison of data obtained by ultrasonic and macroscopic measurements of uterine leiomyoma in 130 patients did not reveal a statistically significant difference between the two methods. The mean size of all measured leiomyomas was 61.47 mm in longitudinal diameter, 53.00 mm in anteroposterior and 53.95 mm in transversal. Measured by ultrasound the mean dimensions of the same diameters were 62.29 mm, 56.91 mm and 55.11 mm respectively. Differences in the mean values of all measured diameters obtained in some cases can be explained by subjective elements in the use of ultrasound, the examiners experience and postoperative reduction of the removed organ volume, as well as by technical factors which may influence the ultrasonic image. Thus, the accuracy of ultrasonic measurement completes the knowledge about the size of the pelvic mass; it is helpful in preparation for surgery, and decreases the possibility of unexpected situations during the surgery.


[Diagnostic value of the NBT-PABA test in the functional evaluation of the exocrine pancreas]. N benzoyl-L-tyrosil PABA was orally administered to 13 controls and 35 patients with pancreatic disease: 7 with chronic exocrine pancreatic disease, 7 patients after an attack of acute pancreatitis, 3 with carcinoma of the pancreas, 8 with biliary tract disease and 10 with diabetes. The amount of PABA excreted serves as parameter exocrine pancreatic function. PABA excretion in patients with chronic pancreatitis (p < 0.01) and diabetes (p < 0.05) was significantly less then in controls. The present data justify further investigation of this procedure as a possible new oral test of exocrine pancreatic function.


[Primary gastrointestinal non-Hodgkin's lymphomas]. A retrospective study of seventeen patients with primary gastrointestinal Non-Hodgkin's Lymphomas (GI-NHL) is presented. The sites of location were: the stomach (12 patients), the small intestine (2 patients), the ileocecal region (1 patient), the colon (1 patient), the stomach and the small intestine (1 patient). The mean age of the patients was 45.5 years. Histopathologic features were classified in accordance with the Working Formulation. Radical surgical resection of the tumour was performed in 14 patients. Laparotomy and biopsy were performed in one patient. The cases were grouped on the basis of: physical examination, surgical report and additional studies (bone marrow biopsy, lymphangiogram, radiograms..). Dawson et al have cited four criteria necessary for lymphoma of GI tract to be primary considered: 1) no enlargement of peripheral or mediastinal lymph nodes; 2) normal white blood cell count; 3) predominance of alimentary tract lesions with only regional lymph node involvement; and 4) no involvement of liver and spleen. After the surgical resection a combined chemotherapy was used in 15 patients. The operation was followed by irradiation in one case. Chemotherapy was refused by one patient. The better outlook in primary gastric lymphomas than in intestinal lymphomas was noted. The majority of investigators reported that gastric lymphoma was associated with better prognosis than intestinal lymphoma, one possible explanation being that gastric lymphoma was more likely to be diagnosed at an earlier stage.


[The effect of recombinant human erythropoietin on erythrocyte lines in patients with anemia and chronic renal insufficiency]. Blood counts, bone marrow cytology and iron status in 13 patients with severe renal anemia assessed prior to and after recombinant human erythropoietin treatment. The mean increase of PCV after 8 weeks of treatment was 50%. Simultaneously, we observed a fourfold increase of the reticulocyte count. This increment correlated with a twofold increase of the percentage of bone marrow erythroblasts. We also observed an increment of the relative number of erythropoietin-dependent early erythroblasts. The tager PCV of 0.30 was achieved in 4 of 5 predialysis patients, but was not achieved in 8 hemodialysis patients because they had an "absolute" bone marrow erythroblastopenia. In conclusion, conventional hematologic examination revealed that application of recombinant human erythropoietin leads to improvement of erythrocytopoiesis in different stages of chronic renal failure.


Behavioral effects of stem-leaves extract from panax ginseng C.A. Meyer. The behavioral effects of extracts from ginseng stem and leaves (GL), standardized with respect to the total saponines, and from ginseng roots (G115), standardized with respect to the content of ginsenosides were examined in experiments on rats with undisturbed memory and in rats with experimentally-impaired memory (electroconvulsive shock) using the methods for active avoidance (shuttle-box) and passive avoidance (step-down, step-through), the water-maze method and the method for studying exploratory behavior. On multiple administration G115 exerted favorable effects on learning and memory and on the higher nervous activity as a whole. These effects greatly varied with the dose and administration schedules, with the rat strain, with the rat's ability to perform adequately in any particular learning task, and with the behavioral method. The extract from the overground part of ginseng (GL) had, in the majority of cases, an effect weaker than that of G115 or was without effect at all. Based on previous and present results, we discuss the role of the changes in brain biogenic monoamines induced by the extracts for their mechanism of action.


[The hardness of drinking water and cardiovascular diseases]. The paper deals with the results of the investigations so far, which have pointed out an inverse correlation between drinking-water hardness and morbidity and mortality rates of cardiovascular diseases. Among the water hardness elements special attention has been given to magnesium, as its deficiency in organism is likely to present an important risk factor for cardiovascular disorders. The options of preventive measures in this field are discussed-adding of magnesium to soft drinking-waters, salt enriched with magnesium, consumption of natural mineral waters, or Mg supplements.


Effects of diazepam on somatosensory evoked potentials in rats at two different periods of day. The effects of diazepam (5 mg/kg i.v.) on somatosensory evoked potentials (SEPs) were investigated in rats in acute experiments. Generally an increase of the peak-latencies and a reduction of the amplitudes were observed immediately after diazepam (DZP) administration. An account was given of the differences in the DZP effect on SEP when the drug was applied at two different periods of day. The late cortical components were affected in both day and night, whereas the early and intermediate potentials were influenced by DZP only during the light period of day. The late N17 proved to be more sensitive to DZP in the night recordings. Our results suggest that the DZP effect on SEP in daylight conditions is more pronounced than that at night. The possible mechanisms responsible for this difference were discussed.


[A congenital lung cyst in a child with clinical manifestations after a 7-year latent period]. Congenital cysts of the lung originate from embryological malformation of the lung bud and usually produce clinical signs in the first months of life by expansion, causing respiratory distress, or by infection through its bronchial communication. We report a rare case of solitary congenital lung cyst in the middle lobe which was diagnosed in the 3rd month of life and remained silent until the 7th year when tension pneumothorax developed from rupture of the rapidly expanding cyst. An urgent lobectomy of the involved lobe was performed. This rare case supports the attitude that every congenital cyst of the lung should be excised as soon as the correct diagnosis is established in order to prevent serious complications.


[Wilson's disease and pregnancy].

[Wilson's disease and pregnancy]. Wilson's disease is rare autosomal-recessive disorder originated on the basis of metabolic copper over-storage. This is the case report of patient aged 28, who suffers Wilson's disease during last ten years. She has been treated by penicillamine unregularly from the beginning of her disease. She reported three spontaneous abortions in her previous history. She was treated by penicillamin and bedoxin in current pregnancy. Vaginal delivery was completed using oxytocin stimulation. Newborn was male, alive, with body weight of 2900 grams. Apgar score was 8. During puerperal period normal uterine involution was estimated, but lactation was ceased.


[House dust as a cause of disease].

[House dust as a cause of disease]. Allergens due to mites, especially to the most common species Dermatophagoides pteronyssinus and D. farinae has been recognized as a major health problem. The role of mites of the family Pyroglyphides as the single most important source of house dust allergens was established in 1964. There has been steady progress in understanding of the way in which allergen from mites can contribute to asthma, rhinitis and atopic dermatitis. Increased knowledge of the biology of mites has also allowed the development of improved protocols for reducing the quantities of mite allergens in house and has resulted in clear evidence that such measures can help patients.


[Extramedullary blast transformation in chronic granulocytic leukemia]. A patient with Ph1(Philadelphia chromosome) positive chronic granulocytic leukemia and extramedullary blast transformation (crisis) in lymph nodes of neck and axillae which appeared after 4-year of treatment with busulfan is presented. Biopsy of lymph node and histopathological examination showed lymphoblastic infiltration. The patient was treated with radiotherapy and chemotherapy with protocol COP. He survived 7 months and expired due to renal insufficiency.


Decreased circulation time in the upper limb reduces the lag time of the finger pulse oximeter response. To observe the influence of circulatory changes on the lag time of the pulse oximeter response, eight healthy patients scheduled for hand surgery were studied. After breath holding, the patients took a breath of oxygen and the time to an increase in SpO2 was measured before and after axillary brachial plexus block. It was found that the lag time with finger probe decreased from 28.6 +/- 7.1 sec to 15.8 +/- 1.1 sec (mean +/- SD) following brachial block (P less than 0.01). There was no change in arterial blood pressure. The results suggest that the lag time of the finger pulse oximeter response is primarily determined by blood flow.


How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Because economic evaluations of health care services are being published with increasing frequency it is important to (a) evaluate them rigorously and (b) compare the net benefit of the application of one technology with that of others. Four "levels of evidence" that rate economic evaluations on the basis of their methodologic rigour are proposed. They are based on the quality of the methods used to estimate clinical effectiveness, quality of life and costs. With the use of the magnitude of the incremental net benefit of a technology, therapies can also be classified into five "grades of recommendation." A grade A technology is both more effective and cheaper than the existing one, whereas a grade E technology is less or equally effective and more costly. Those of grades B through D are more effective and more costly. A grade B technology costs less than $20,000 per quality-adjusted life-year (QALY), a grade C one $20,000 to $100,000/QALY and a grade D one more than $100,000/QALY. Many issues other than cost effectiveness, such as ethical and political considerations, affect the implementation of a new technology. However, it is hoped that these guidelines will provide a framework with which to interpret economic evaluations and to identify additional information that will be useful in making sound decisions on the adoption and utilization of health care services.


The Zavanelli maneuver applied to locked twins. The Zavanelli maneuver was applied to locked twins. After the first infant was returned into the vagina, an emergency cesarean section was performed. After a not-too-good start, both children did well. The Zavanelli maneuver is presented as a method to reverse the potentially catastrophic situation of locked twins.


Qualitative holographic study of hemi-pelvic deformation caused by loading different hip prostheses. The dynamic biological response of bone can materially influence the longevity of artificial implants. This paper presents a series of in vitro experiments conducted on epoxy resin models of human hemi-pelves. Different commercially available acetabular components were implanted and used for the construction of simplified three-dimensional models of the artificial hip joint. Boundary conditions included simulation of muscle groups and femoral loading. Real-time holographic interferometry, a stress analysis technique permitting whole-field simultaneous inspection of deformation patterns, was used as the experimental method. The holographic interferograms were interpreted qualitatively rather than quantitatively. High stresses were identified in the hemi-pelvis and it is postulated that these stresses may be implicated in the mechanical pathogenesis of loosening. The observed changes in the detected stress levels could influence both future design of acetabular prostheses and surgical techniques.


Specific circulating anti-gliadin IgG-class antibody does not mediate intestinal enteropathy in gliadin-fed mice. The effects of specific circulating IgG antibody on the uptake of dietary antigen and in the generation of intestinal enteropathy have been investigated in Balb/c mice bred on a gluten-free diet. A monoclonal IgG1 antibody (GD3) was prepared against gliadin. After adoptive transfer into mice, this antibody was capable of mediating a type III hypersensitivity response in vivo to footpad challenge with gliadin. The titres of circulating GD3, as estimated in vitro by ELISA, correlated well with the degree of inflammation at sites of type III responses in vivo. Following footpad challenge with gliadin, titres of circulating GD3 antibody were reduced. GD3 antibody was tested for its ability to mediate inflammatory responses in vivo in the intestinal mucosa of mice fed with gliadin. Circulating GD3 antibody was removed selectively and specifically by dietary gliadin, compared to feeding with bovine serum albumin or maintenance on a gliadin-free diet only. However, we were unable to demonstrate any pathological changes in the intestine as a result of possible local antigen-antibody complex formation or deposition. Using radio-iodinated gliadin as a trace marker, no significant retention of gliadin in the intestinal mucosa was found in mice pre-injected with GD3 antibody. These data suggest that circulating IgG antibody has little effect on dietary antigen uptake in the gut, and alone is insufficient to mediate an enteropathy.


Large-volume suction lipectomy: an analysis of 108 patients. Suction lipectomy was initially advocated for the treatment of localized collections of fat and for the removal of less than 1500 ml of material. However, many patients wished to have multiple areas treated or had diffuse collections of fat. In such instances, the removal of over 1500 ml of material and circumferential lipectomy are necessary to provide optimal aesthetic results. However, when over 1500 ml of material is removed, anesthetic requirements, fluid replacement, and treatment of blood loss become important if the operation is to be performed safely. We have treated 108 patients who had over 1500 ml of material removed. Eight-eight percent of the patients were female; 12 percent were male. Using the body-mass index, 3 percent of patients were underweight, 70 percent were normal weight, and 27 percent were overweight. Fifty-five patients (51 percent) had 1500 to 2499 ml of material removed, 26 patients (24 percent) had 2500 to 3499 ml removed, 16 patients (15 percent) had 3500 to 4499 ml removed, and 11 patients (10 percent) had over 4500 ml removed. All patients were treated in the hospital; 44 percent were admitted after surgery. A total of 227 units of autologous and 2 units of homologous blood were transfused. As measured by a computerized monitor, the average amount of blood in the material removed from thighs was 30 percent; from abdomens, the blood loss was 45 percent. The aesthetic results were generally excellent. No complications were encountered. A few patients developed undesired sequelae, the most common of which was seroma formation, which occurred in 19 percent of those who had suction of abdominal-wall fat. We believe that large-volume suction lipectomy is safe and efficacious, provided attention is directed to such important aspects of patient care as anesthesia, fluid replacement, and blood loss.


Efficacy of lignocaine in alleviating potassium chloride infusion pain. A double-blind study was set up to investigate the effect of pretreatment with lignocaine on the incidence of potassium chloride infusion pain. Twenty-eight patients were randomly allocated into two equal groups. Patients in both groups were hypokalaemic and were scheduled for replacement consisting of potassium chloride 20 mmol diluted to 100 ml in dextrose 5% solution administered over two hours. Group A (lignocaine) patients were pretreated with a bolus dose lignocaine 3 ml 1%, Group B (control) received isotonic saline 3 ml. The incidence of potassium chloride infusion pain was significantly reduced in Group A. There was no adverse effect reported. This study demonstrates the efficacy of bolus dose of lignocaine in alleviating injection pain for the duration of a two-hour continuous infusion.


Neurobiology of alcohol abuse.

Neurobiology of alcohol abuse. Excessive consumption of beverage alcohol (ethanol) is a major health concern worldwide. Understanding the mechanisms by which ethanol affects neural functioning, after both acute and chronic exposure, has become a major goal in the study of alcoholism. With such an understanding, we should be able to institute more effective treatments and preventative measures for alcohol abuse problems. Recent studies have found, contrary to earlier assumptions, that ethanol has selective, dose-dependent effects on various neurotransmitter systems within the CNS. These effects are observed at all levels of analysis, from molecular to behavioral. This review by Herman Samson and Adron Harris covers these recent findings, with the intent of generating questions that will focus further research efforts.


Orbital pseudotumor in the differential diagnosis of pediatric uveitis. Pediatric orbital pseudotumor may be associated with iritis, unlike the adult form of this disorder. However, orbital pseudotumor is seldom considered in the differential diagnosis of childhood uveitis. We report two cases of children with uveitis who were ultimately diagnosed as having orbital pseudotumor. No proptosis was noted in either child. For those pediatric patients with a persistent or recurrent uveitis and a previous negative diagnostic workup, the possibility of an orbital pseudotumor should be considered and ultrasonography, magnetic resonance imaging, and/or computed tomography performed.


Chorionic villus sampling: the University of Maryland experience. The University of Maryland was the first program in the state to offer chorionic villus sampling (CVS). Since the program's beginning in 1984, 998 patients have been seen with successful sampling in 99.1 percent, using both transcervical and transabdominal approaches. The overall loss rate was quite low (2.3 percent), and no increased risk of birth defects was seen. These observations demonstrate that CVS provides a safe and accurate alternative to amniocentesis.


Antigen presentation by Toxoplasma-infected cells: antigen entry through cell membrane fusion. The antigen presentation of cells infected by Toxoplasma gondii (T.g.) for MHC class-I-restricted cytotoxic T cells (CTL) was blocked by treating the T.g.-infected cells with the fungal antibiotic brefeldin A. Electron microscopic analysis of T.g.-infected murine and human-antigen-presenting cells (APC) prepared by the combination of quick-freezing with the deep-etching or freeze-substitution methods revealed that the outer membrane of T.g. fused with some parts of the vacuolar membranes of APC to build up channel-like structures. Work station and cytofluorometry studies detected 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein (BCECF) in cells infected by BCECF-labeled T.g., which strongly suggested the direct entry into cells of BCECF derived from T.g. These findings provide evidence that T.g. antigens enter the cytoplasm of APC through cell membrane fusion of T.g. and T.g.-infected APC, and that T.g.-infected APC present T.g. antigen for MHC class-I-restricted CTL through the endogenous pathway of antigen presentation.


Assessment of specimen fixation in a surgical pathology service. The quality of specimen fixation was examined within a routine diagnostic histopathology service. For each specimen the adequacy of fixation was assessed and the transit time between operating theatre and the laboratory was measured. Preliminary fixation was found to be inadequate in 25% of specimens and some form of manipulation to assist fixation was required in 36% of specimens. The mean transit time was 22 (SD 10.7) hours. Specimen fixation and transport are additional factors to consider in quality assurance of histopathology.


Fentanyl and sufentanil increase intracranial pressure in head trauma patients. Although opioids frequently are administered to patients with severe head trauma, the effects of such drugs on intracranial pressure are controversial. Nine patients with severe head trauma were studied for the effects of fentanyl and sufentanil on intracranial pressure (ICP). In all patients, ICP monitoring was instituted before the study. Full neuromuscular blockade was achieved with vecuronium bromide before the administration of either fentanyl (3 micrograms.kg-1) or sufentanil (0.6 microgram.kg-1) as an intravenous bolus over a 1-min period in a masked and random fashion. Patients received the other opioid in the same fashion 24 h later. Arterial blood pressure, heart rate, and ICP were recorded continuously for the 1 h after drug administration. Fentanyl was associated with an average ICP increase of 8 +/- 2 mmHg, and sufentanil with an increase of 6 +/- 1 mmHg. These increases were statistically significant. Both drugs produced clinically mild decreases in mean arterial blood pressure (fentanyl, 11 +/- 6 mmHg; sufentanil, 10 +/- 5 mmHg) that nevertheless were statistically significant. No significant changes in heart rate occurred. These results indicate that modest doses of potent opioids can significantly increase ICP in patients with severe head trauma.


Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas. Forty-two patients who underwent a second-look laparoscopy after a unilateral or bilateral intraperitoneal cystectomy for treatment of an ovarian endometrioma of greater than 3 cm were included. At second-look laparoscopy, 92.4% of the adnexae treated for a large endometrioma had no deep ovarian endometriosis. Adhesion de novo formation occurred in 21% of the treated adnexae and in 17% of the contralateral adnexae. Complete or partial recurrence of dense adhesions occurred in 82% of the cases. Laparoscopic cystectomy is effective in treating large endometriomas. However, operative difficulties may be encountered, explaining persistent endometriomas and postoperative adhesions.


Exogenous control of the cycle simplifies thawed embryo transfer and results in a pregnancy rate similar to that for natural cycles. To determine if a satisfactory PR could be achieved in thawed ET using a simplified protocol, standard monitoring in the natural cycle was compared with a controlled preparation of the endometrium with exogenous E2 and P without hormonal or ultrasonographic monitoring. All patients had normal ovarian function, and no GnRH-a were administered. Pregnancy rates, ongoing PRs, and embryo implantation rates were similar in the two groups. The use of exogenous E2 and P without GnRH-a suppression to control the cycle for thaw ET is safe, convenient, and results in PRs at least as good as in the natural cycle. It may be of particular value in patients with an irregular cycle or in those for whom prolonged monitoring is undesirable.


Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study. To describe the incidence and clinical manifestations of long-term cardiac complications of endocarditis. Cohort study. University-affiliated tertiary medical center. One hundred twelve consecutive patients, survivors from a series of 140 non-addicted patients with a first episode of infective endocarditis on native valves hospitalized from 1975 to 1990. Thirty-two patients had had valve replacement during the active phase of the infection, and the remaining 80 patients received medical treatment alone. Relapse, recurrence, need for late cardiac surgery, and cardiac mortality. Relapses occurred in three patients (2.7%) and recurrences in five patients (4.5%, incidence density at 15 years, 0.0030 per patient-year). Late cardiac surgery was needed by 47% of the patients treated medically during the active phase, and most had surgery in the first 2 years of follow-up (incidence density, 0.25 per patient-year at 2 years). Aortic valve involvement (relative risk, 2.66; 95% CI, 1.15 to 6.17) and end-diastolic diameter greater than 60 mm (relative risk, 1.04; 95% CI, 1.03 to 2.43) were associated with the need for late surgery in univariate analysis. Multiple logistic regression analysis showed aortic valve involvement to be an independent predictor of the need for late surgery (relative risk, 3.04; CI, 1.23 to 7.54). Only 2 of the 32 patients who had surgery during the active infection needed a second operation during follow-up. At the end of follow-up, the number of patients who had surgery after the onset of the infection was 86 (60% of the whole series). Cardiac death occurred in 16 patients; most deaths were sudden or postoperative and occurred in the first 2 years of follow-up (incidence density, 0.047 per patient-year at 2 years). Independent predictors of death were not found. Survival was 90% at 2 years, 88% at 5 years, 81% at 10 years, and 61% at 15 years. Survival after infective endocarditis is fair (81% probability of survival at 10 years), and the most common types of cardiac death are sudden and postoperative. Aortic valve involvement is an independent predictor of the need for late cardiac surgery. The rate of recurrences is not negligible (incidence density at 15 years, 0.0030 per patient-year).


Prolonged resuscitation in acute deep hypothermia. A case report is described with successful outcome of prolonged cardiopulmonary resuscitation in a 30-year-old man suffering from acute deep hypothermia. His lowest temperature recorded was 23 degrees C. Continuous external cardiac massage was required for a total of 4.5 h whilst rewarming was instituted. The patient eventually left hospital with no permanent sequelae. A review of hypothermia follows, emphasising some important management principals and pitfalls.


Ventricular standstill complicating left heart catheterization in the presence of uncomplicated right bundle branch block. We report the unusual occurrence of complete heart block during attempted right coronary artery cannulation in a patient with pre-existing uncomplicated right bundle branch block (RBBB). This complication occurred due to accidental impingement of the Judkin's right coronary catheter on the left bundle when it transiently slipped across the aortic valve. The block resolved without any complication.


The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology. Anesthesiologists are at risk for acquiring blood-borne infections through contact with blood or body fluids. From prospective studies, the greatest risk of transmission is through a percutaneous exposure such as needlestick injury. Personal protective equipment such as gloves and gowns do not completely prevent these exposures. Although educational efforts can reduce the frequency of recapping of needles, they generally have not decreased the incidence of needlesticks. Therefore, in addition to practicing universal precautions, anesthesiologists can attempt to reduce their risk of needlestick injuries by eliminating nonessential unprotected needle use, through the use of needleless or protected needle devices (engineering controls) and by modifying anesthetic procedures requiring needles (work practice controls). Needleless or protected needle products are commercially available for use in many procedures performed by anesthesiologists. For tasks that require the use of needled devices, the practitioner should use safe techniques for handling (i.e., one-handed recapping if recapping is needed) and disposal (i.e., puncture-resistant containers) of these devices. Evaluation of the efficacy, cost, and safety of needleless or protected needle products should be continued as they are introduced into wider use. Additionally, anesthesiologists should be encouraged to report needlestick injuries so that appropriate postexposure treatment can be given and so that the incident can be studied to permit design of a work protocol or device to prevent similar accidents in the future.


Overwhelming postsplenectomy infection still a problem. Despite an extensive medical literature over the past ten years, patients continue to die needlessly of overwhelming postsplenectomy infection. Although physicians have become increasingly cognizant of this syndrome in children, many remain unaware of the risk to asplenic or hyposplenic adults with no underlying medical problems. In addition, many older asplenic or functionally hyposplenic persons are unaware that they are at risk for this syndrome. The identification of Howell-Jolly bodies on a peripheral blood smear should alert physicians to the need for further follow-up to establish hyposplenism and to consider possible antipneumococcal vaccination.


An interview with Nancy L. Johnson and Patricia Schroeder. Interview by Carmella A. Bocchino. In the U.S. Congress--440 members in the House and 100 members in the Senate--only 31 are women (29 House and 2 Senate members). This year over 100 women are seeking seats in the Congress, many are campaigning for governor, and still others are running for state and local offices. Women candidates are generally seen as outsiders who symbolize change and inspire a new vision for the future. This interview highlights two incumbent members of the House of Representatives, Nancy L. Johnson (R-CT) and Patricia Schroeder (D-CO), and their views on women's health, family medical leave, and future changes in the U.S. health care system.


Histologic study of chronic active hepatitis C; comparison with chronic active hepatitis B. Reports on the histologic findings of chronic active hepatitis C (CAH-C) have been rare, and the characteristic histologic findings of CAH-C have been not yet determined. To compare the differences in the histologic findings between CAH-C and chronic active hepatitis B (CAH-B) group, we analyzed the histologic findings of 19 patients with CAH-C, who had positive tests for HCV-antibody by EIA, and 19 patients with CAH-B who had negative tests for HCV-antibody but positive tests for HBsAg by RIA. Histologic features were analyzed between the CAH-C and CAH-B groups using a scoring system which is modified from Knodell's histologic activity index-looking at portal inflammation, periportal necroinflammation, portal fibrosis, focal necrosis, regeneration, polyploid nuclear change, sinusoidal lymphocytic reaction and fatty change. Portal inflammatory cell infiltrations with prominent lymphocytes and follicular arrangement were more frequent in the CAH-C group (10 of 19 cases) than in the CAH-B group (5 of 19 cases). Severe sinusoidal lymphocytic reactions were also more prominent in the CAH-C group (11 of 19 cases) than in the CAH-B group (6 of 19 cases). However, periportal necroinflammation, portal fibrosis, focal hepatic necrosis, regeneration and polyploid nuclear changes were more prominent in the CAH-B group than in the CAH-C group. In conclusion, follicular portal inflammation and severe sinusoidal lymphocytic reactions were common histologic findings in serologically proven CAH-C when compared to CAH-B.


Effects of buthionine sulfoximine treatment on cellular glutathione levels and cytotoxicities of cisplatin, carboplatin and radiation in human stomach and ovarian cancer cell lines. Chemotherapy failure remains a significant medical problem in the treatment of neoplastic disease and is thought to be due to many different factors including membrane transport, p-glycoprotein in multidrug resistance, glutathione and its related enzymes, topoisomerase II and DNA repair. Glutathione is a major constituent of non-protein thiol and participates in detoxification of chemotherapy and radiation. Thus, glutathione concentration is correlated with sensitivity to alkylating agents and radiation, and increased in resistant cell lines. Buthionine sulfoximine (BSO) is an inhibitor of glutathione biosynthesis and may increase cytotoxicities of alkylating agents, including melphalan and cisplatin, and radiation in sensitive and resistant cell lines. We studied effects on cellular glutathione levels and cytotoxicities of cisplatin, carboplatin and radiation by BSO treatment in human stomach cancer cell line (SNU-1) and ovarian cancer cell line (OVCAR-3). The results were as follow: 1) After BSO treatment of 1 mM and 2 mM for 2 days, the intracellular thiol concentration was depleted to 75.7% and 76.2% in SNU-1, and 74.1% and 63.0% in OVCAR-3, respectively. 2) The intracellular thiol concentration in SNU-1 was depleted to 33.4% after BSO 2 mM for only 2 hours incubation and 71.5% after small amount of BSO (0.02 mM) for 2 days. 3) The recovery of intracellular thiol concentration required more than 3 days after BSO removal. 4) BSO inhibited partially the growth of SNU-1 and OVCAR-3. 5) The cytotoxicities of cisplatin and carboplatin were markedly enhanced both in SNU-1 and OVCAR-3 by BSO treatment. 6) The cytotoxicities of radiation was increased in OVCAR-3 and SNU-1 by BSO treatment. Therefore, it is concluded that BSO can deplete effectively the intracellular thiol concentration and enhance the cytotoxicities of cisplatin, carboplatin and radiation.


Effect of periodic transfusion on erythropoietin concentration in end stage renal disease. It has been reported that a feedback circuit exists between erythropoietin (EPO) concentration and the degree of anemia even in end stage renal disease (ESRD), and growing experience with subcutaneous EPO administration confirms that only slight increases in EPO levels are required to correct renal anemia. Keeping in mind these findings, if a small portion of reserved EPO production could be reactivated in ESRD, it might be biologically significant and vice-versa. From this viewpoint, it is conceivable that periodic long term transfusion might suppress EPO production in ESRD. In order to see whether periodic transfusion influences the EPO concentration in ESRD, a cross-sectional retrospective study was undertaken by reviewing medical records of 28 non-transfusion patients and 22 transfusion patients with ESRD undergoing hemodialysis. The EPO concentration of the ESRD group (29.1 +/- 8.0 mU/ml) but only about one twentieth of the control group (578.8 +/- 69.1 mU/ml). In ESRD group, It was 27.9 +/- 8.0 mU/ml in transfusion group and 30.6 +/- 7.9 mU/ml in non-transfusion group. EPO concentration at varying hematocrit (Hct) levels did not differ between the non-transfusion group and transfusion group. There was an inverse relationship seen in the non-transfusion group (p < 0.05) but no relationship was seen between the EPO concentrations and varying Hct levels in the transfusion group. The EPO concentration at equal levels of Hct did not differ between the non-transfusion group and transfusion group. The relationship between EPO concentration and the changes in Hct during the observation period did not differ between the non-transfusion group and transfusion group. Both the total amount of transfusion and the frequency of transfusions did not influence EPO concentration. periodic long term transfusion does not seem to decrease the sensitivity of the EPO producing cell to the degree of anemia in ESRD.


Effect of probenecid on tetraethyl ammonium (TEA) transport across basolateral membrane of rabbit proximal tubule. The effect of probenecid on the transport of tetraethylammonium (TEA) was investigated in rabbit reanal cortical slices in an attempt to ascertain the interaction of organic anion with the organic cation transport system in proximal tubule. Probenecid reversibly inhibited TEA uptake by cortical slices in a dose-dependent manner over the concentration range of 1 and 5 mM. The efflux of TEA was not affected by the presence of 3 mM probenecid. Kinetic analysis indicated that probenecid decreased Vmax without a significant change in Km. Probenecid inhibited significantly tissue oxygen consumption at concentrations of 3 and 5 mM. However, probenecid did not significantly reduce TEA uptake in brush border and basolateral membrane vesicles prepared from renal cortex even at higher concentration of 10 mM. These results indicate that probenecid reduces TEA uptake in cortical slices by inhibiting the tissue metabolism rather than by the interaction with the organic cation transporter.


The effect of dilution, pH and ionic strength of plasma on t-PA precipitation in euglobulin fraction. In order to evaluate the influence of dilution, pH and ionic strength on the precipitation of t-PA and PAI-1 during euglobulin precipitation, we measured t-PA Ag, PAI-1 Ag and fibrinolytic activity in the euglobulin fraction made of pooled plasma from liver cirrhosis patients, under various conditions by changing pH, ionic strength and degree of dilution. The precipitation of t-PA Ag in the euglobulin fraction was enhanced by decreasing the ionic strength and greatest at pH 6.0. The fibrinolytic activity in the euglobulin fraction showed consistent changes with t-PA Ag under varying pH and ionic strength. The precipitation of t-PA Ag was not influenced by the dilution factor but the larger the dilution factor, the greater the PAI-1 and the smaller the fibrinolytic activity in the euglobulin fraction. PAI Ag in euglobulin fraction showed consistent changes with t-PA Ag in the euglobulin fraction regardless of the changes in ionic strength and pH. The amount of precipitation of t-PA and PAI-1 was increased by the presence of dextran sulfate, under varying pH, ionic strength and dilution conditions. Our results show that the currently used conditions for standard euglobulin precipitation are the most favorable for t-PA precipitation into the euglobulin fraction. The fibrinolytic activity exerted in the euglobulin fraction seems to depend on the amount of t-PA-PAI-1 complex rather than minimized protease inhibitor in the euglobulin fraction.


Plasma t-PA and PAl-1 antigen concentrations in non-insulin dependent diabetic patients: effects of treatment modality on fibrinolysis. Basal plasma tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAl-1) antigen levels were studied in 49 non-insulin dependent diabetic patients (23 men, 26 women: ages 51.3 +/- 14.9 years) and 16 age matched non-diabetic subjects (9 men, 7 women: ages 49.8 +/- 12.2 years) as a control group. Compared to a control group, the diabetic patients had a significantly higher mean t-PA antigen (5.15 +/- 3.02 vs 3.20 +/- 2.30 ng/ml) and PAl-1 antigen (35.89 +/- 18.59 vs 17.60 +/- 15.36 ng/ml) levels (p < 0.05). Plasma t-PA antigen level was not influenced by each treatment modality. There was a significant decrease of plasma PAl-1 antigen level after Metformin administration compared to that of before Metformin administration (39.74 +/- 19.39 vs 25.14 +/- 16.18 ng/ml) (p < 0.05), and the insulin-treated group showed a tendency for a decrease of plasma PAl-1 antigen levels after insulin administration but this did not reach statistical significance (29.93 +/- 15.37 vs 17.32 +/- 10.60 ng/ml). Sulfonylurea did not change both plasma t-PA and PAl-1 antigen levels. In conclusion, diabetic patients have high t-PA and PAl-1 antigen levels. Biguanide reduced plasma PAl-1 antigen levels, which might play some helpful role in the improvement of chronic complications in NIDDM.


Small airway disease in rheumatoid arthritis. Variety of pulmonary lesions are thought to be associated with rheumatoid arthritis (RA). These lesions traditionally have included pleurisy with or without effusion, Caplan's syndrome, pulmonary rheumatoid nodules, diffuse interstitial fibrosis, and pulmonary arteritis and hypertension. But little attention has been paid to the airways in RA. Recently, several reports have suggested an association between airflow limitation and RA, but its incidence is not known. Also whether there exists a parameter of disease activity of RA, suggesting the presence of small airway disease (SAD) is not clear. To answer these questions, the serologic parameters which reflect the disease activity of RA and pulmonary function tests which reflect small airway dysfunction were performed on 36 lifetime nonsmokers with RA who had normal chest x-ray findings. The prevalence of SAD and the relationships between the disease activity parameters of RA and pulmonary function were observed. The results were as follows. The percentages of patients with abnormal values for diffusing capacity, frequency dependence of compliance (C1.0/C0.0), forced expiratory flow 25-75%, Vmax50% and Vmax 75% were 45.5%, 62.5%, 40%, 22.8% and 11.4%, respectively. There was statistically significant negative correlation between C1.0/C0.0 and ESR. But consistent correlation between other pulmonary function tests and clinical and serologic parameters of RA, and differences in pulmonary function between patients who were serologically positive and negative for CRP and FANA, were not found. In conclusion, SAD, without the influence of smoking, is frequently associated with RA, but the presence of SAD cannot be predicted from any clinical and serologic parameters of RA currently in use.


Evaluation of finger blood flow with Tc-99m MDP (methylene diphosphonate). A variety of methods were used to establish objective diagnostic criteria of Raynaud's phenomenon. We intended to introduce another method, using radionuclide (Tc-99m methylene diphosphonate) scintigraphy, which is more objective, simple and economical than the past methods. The finger blood flow with radionuclide scintigraphy was evaluated in 10 patients of Raynaud's syndrome, 12 patients of connective disease without Raynaud's symptoms, and 20 normal persons. After immersing one hand in ice water (4 degrees C) for 30 seconds, the hand was exposed to 22 degrees C room air for 15 minutes, and then the patients received the intravenous (IV) bolus of 20 microCi of Tc-99m methylene diphosphonate (MDP). At the same time, scintigraphic image of both hands started with the region of interest, including the second, third, fourth and fifth fingers distal to the metacarpophalangeal (MCP) joints. Computer recording of the counts in the region of interest every 2 seconds for 310 seconds was started on IV bolus injection. The 310 seconds cumulative digital blood flow ratio of cold exposed hand to room air exposed hand was significantly lower in Raynaud's group (p < 0.001), and the ratio of initial slope of activity curve was also lower in the Raynaud's group (p < 0.001). Of the 8 patients showing Raynaud's syndrome, 4 patients of scleroderma and 1 patient of multiple myeloma showed no improvement of finger blood flow in the cold exposed hand after 2 weeks of pharmacological therapy, but 1 patient of mixed connective tissue disease, 1 patient of Behcet's syndrome and 1 patient of SLE showed much improved finger blood flow after combined administration of vasodilator, calcium channel blockers and antiplatelet drugs. The evaluation of finger blood flow with 99mTc-MDP could be considered to be one of the simple, economical and new methods that can be used in the follow-up, objective assessment of therapeutic effect, and giving an aid in the study of the pathophysiology of the Raynaud's phenomenon.


Role of the epithelial derived factors on airway reactivity. A tracheobronchial smooth muscle reactivity study on isolated guinea pig tracheal rings was done. The existence of two different factors active on the smooth muscle, an inhibiting one as well as an activating one were identified. Generated on different pathways, the epithelial derived relaxing factor is a cyclooxygenase dependent prostaglandin, while the activating epithelial factor seems to be a thromboxane derivative.


Studies regarding the efficiency of Supro isolated soy protein in Olympic athletes. 66 Romanian olympic endurance athletes (30 kayak-canöe, 36 rowing; 45 males and 21 females) participated in our trial, for the purpose to make evident possible biological effects of Supro isolated soy protein supply (1.5 g/kg/day, 8 weeks). At random the athletes were divided into two groups: A group (n = 38) and B group (n = 28). Daily programme (4-6 hours daily, endurance and strength), food and medication were similar for all athletes. The athletes of the A group received daily 1.5 g/kg SuproR soy protein, for 8 weeks while the athletes of the B group did not received soy protein supply. Two months soy protein supply induced increases of body mass (about 3 kg, especially by lean body mass), strength indexes, serum proteins, haemoglobin and total calcium and significant decreases of urinary mucoproteins and fatigue after training sessions, especially when comparing to the athletes of the B group. No damages of liver, kidney and metabolism tests were noticed in all athletes; no side effects were noticed and the product was well tolerated by athletes. When applying the cross-over method for other 2 months we obtained the same results. Based on these data the authors support the idea of a beneficial effect of this soy protein supply on the biological preparation of endurance top athletes.