Polysaccharide-coated liposomal amphotericin B for the treatment of murine pulmonary candidiasis. Amylopectin-coated liposomal amphotericin B was investigated in a murine model of pulmonary candidiasis. The LD50 of amylopectin-coated liposomal amphotericin B in normal mice was more than 10.0 mg/kg, and that of conventional amphotericin B was 1.2 mg/kg. Amylopectin-coated liposomes showed twice the concentration in the lungs of conventional liposomes. Candida albicans was inoculated intratracheally into BALB/C mice. Twenty-four hours later, the number of Candida in the lungs of mice treated with amylopectin-coated liposomes was less than in those treated with conventional liposomes, and amylopectin-coated liposomes improved the survival rate of inoculated mice. Coating liposomes with amylopectin aids the targeting of amphotericin B to the lungs.


Synovial fluid ferritin in traumatic hemarthrosis, rheumatoid arthritis and osteoarthritis. Synovial fluid ferritin levels in patients with traumatic hemarthrosis (HA), rheumatoid arthritis (RA), and osteoarthritis (OA) were measured by double antibody radioimmunoassay. Synovial fluid ferritin levels were significantly higher in 60 patients with HA (mean +/- S.D., 536 +/- 536 ng/ml) and 39 patients with RA (614 +/- 486 ng/ml) than in 20 patients with OA (130 +/- 119 ng/ml) (p < 0.01). Individual levels, however, considerably varied. In HA patients, the synovial fluid ferritin level correlated well with the duration of hemarthrosis, but not with hemoglobin, hematocrit, or an inflammatory synovial fluid index such as the leukocyte count. In RA patients, there was no significant correlation between the synovial fluid ferritin levels and any inflammatory parameter, such as catalase activity, synovial leukocyte counts (including polymorphs and monocytes) or the duration of arthritis. Our results indicate that the synovial fluid ferritin level reflects primarily hemoglobin degradation and appears unrelated to inflammation in joint diseases.


An improved method of bronchial stump closure for prevention of bronchopleural fistula in pulmonary resection. We performed 880 pulmonary resections from January 1982 to June 1988 using Sweet's procedure for closure of the bronchial stump, in which 39 patients (4.4%) developed bronchial fistulas. Bronchoscopic studies showed that bronchopleural fistulas were located mainly at the corner of the stump. This indicates that the corner is the point with the highest tension when Sweet's procedure is employed. In some cases, stumps were injured by suture materials, resulting in bronchopleural fistulas. Since July 1988, bronchial stumps have been closed by using two pairs of teflon pledgets with additional interrupted sutures. From July 1988 to April 1990, 288 patients were treated by this new method, and only one of them developed bronchopleural fistula. This new method prevents injury of the stump by suture material and reduces the tension at the bronchial stump for a long time. Thus, pulmonary resections can be safely employed even after anti-cancer chemotherapy and/or radiation therapy.


Effects of an anthelmintic treatment programme on sheep productivity in the Middle Atlas, Morocco. This study evaluated the production advantages of the strategic anthelmintic treatment of both lambs and ewes in an area endemic for gastro-intestinal nematodes, lungworms and liver flukes. The liver fluke infections were generally chronic. The lambs were treated with albendazole (SmithKline Beecham), fenbendazole (Hoechst Roussel) or a vitamin supplement and their weight gains were followed over the next 7 months. The control group, which received a vitamin supplement only, gained 6.67 kg from July to January. The group that received fenbendazole, an anthelmintic with no activity against liver flukes, gained 10.42 kg over the study period. The third group which received albendazole, an anthelmintic with efficacy against liver flukes, gained 13.07 kg over the same period. Lamb deaths apparently due to liver flukes were 12, 4, and zero for the control, fenbendazole and albendazole groups, respectively. Similar advantages were observed in the ewes. Deaths were 16, 8, and zero in the control, fenbendazole and albendazole groups, respectively. The lambing rate in the control group was significantly lower than that in either of the 2 treated groups. The number of services per conception was significantly lower in the albendazole treated group than that in either of the other groups. These studies demonstrated the advantages of anthelmintic treatment in sheep in a helminth endemic area. While removing gastro-intestinal nematodes and lungworms improved production, the additional removal of liver flukes enhanced production gains as well as reducing deaths.


Reproduction of pigs in the hills of eastern Nepal. A survey of 101 farmers with sows was conducted in the Koshi Hills of Nepal. Estimates of those reproductive traits which did not differ significantly between local and Pakhribas crossbred sows, are farrowing interval 7.4 months, litter size at birth 8.3, age of piglets at weaning 2.2 months and total number of farrowings 13.2. Local pigs reach sexual maturity sooner than Pakhribas crossbreds; age at first farrowing for the two genotypes is 10.7 and 12.0 months (P < 0.05), and age at first mating of boars is 6.5 and 7.4 months (P < 0.05). Sows farrow throughout the year and there is no clearly defined best season for farrowing. Pre-weaning mortality rates are estimated to be 22% for local piglets and 15% for Pakhribas crossbreds. Almost all farmers practise controlled mating in which either the sow is taken to the boar or the boar is brought to the sow. The proportion of farmers (with sows) who own a boar is only about 5 per cent.


Productivity and health of camels (Camelus dromedarius) in Somalia: associations with trypanosomosis and brucellosis. In Somalia, one of the world's largest dromedary populations of about 5.3 million animals are kept by nomadic pastoralists under traditional management. Interest in the development potential of camel herds in the semi-arid areas of central Somalia initiated an investigation to determine the productivity of herds, their major diseases and likely associations among these parameters. Using a systems approach, data were collected for herd production parameters, environmental factors, management and production systems, and health variables. One thousand and thirty nine camels in 33 herds were studied in the central regions of Somalia. Trypanosoma evansi prevalence ranged from 1.7% in blood-smears to 56.4% using enzyme-linked immunosorbent micro-assay (microELISA). Seroprevalence for brucellosis was determined as 1.9% by the standard agglutination test (SAT) and 0.3% by the complement fixation test (CFT). Using multiple regression, 15% of the total variation of the general fertility rate was explained by the results of the microhaematocrit centrifugation technique (MHCT) and the microELISA for T. evansi, CFT results for brucellosis, herdsize, and young stock death rate. Among herd production variables, herd size differed significantly for different management units. Young stock death rates, as well as general fertility rates varied in the ecological subzones with a marked effect in the zones labeled "Inland". Various other associations were noted among demographic, husbandry and disease variables. The importance of trypanosomosis and brucellosis to the productivity of herds and measures to control their limiting effects on production were discussed.


Therapeutic activity of isometamidium chloride in Boran cattle against a tsetse-transmitted clone of Trypanosoma congolense with a low level of drug resistance. Experiments were conducted with a clone of Trypanosoma congolense, IL 3580, which exhibited a low level of resistance to isometamidium chloride. Five cattle were treated intramuscularly with isometamidium chloride at a dose rate of 0.5 mg kg-1 body weight (BW) and challenged 28 days later with 5 Glossina morsitans centralis infected with T. congolense IL 3580. All 5 cattle and 15 untreated steers challenged on the same day became parasitaemic by day 15 post-infection. Thus, at a dose of 0.5 mg kg-1 BW, the prophylactic action of isometamidium chloride did not extend to 28 days following treatment. Subsequently, the 20 steers were divided into 4 groups of 5 animals each and treated with isometamidium chloride at one of the following dose rates; 0.5 or 1.0 mg kg-1 BW intramuscularly and 0.5 or 1.0 mg kg-1 BW intravenously (Groups A, B, C and D, respectively). Group A consisted of the 5 animals that had previously been treated with isometamidium chloride. Animals relapsed in all groups except those in Group B, treated intramuscularly with isometamidium chloride at a dose of 1.0 mg kg-1 BW. Four of the 5 animals in Group A, treated intramuscularly with isometamidium chloride at a dose of 0.5 mg kg-1 BW relapsed following a mean interval of 16 days post-treatment. Similarly, infections in all animals in Groups C and D, given intravenous injections of isometamidium chloride at a dose of 0.5 and 1.0 mg kg-1 BW, respectively, were not eliminated as a result of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)


Buffalo and Bali cattle--exploiting their reproductive behaviour and physiology. Water buffalo (Bubalus bubalis) and Bali cattle (Bos sondaicus) occupy production niches in much of the developing world's agricultural systems which in the developed world are occupied by Bos indicus and Bos taurus. Both the former species are better-adapted to these environments and systems. Both depend on population survival strategies different from each other's and from those of B. indicus and B. taurus. Water buffalo rely on longevity and late sexual maturity, while Bali cattle rely on high conception rates and sacrifice of juveniles when the population is under stress. Knowledge of these different strategies will help in formulation of management strategies for maximising nett reproductive rates. This paper briefly describes each species, reviews its survival strategies and summarises the available data on the reproductive characteristics of each.


Reproduction in female cattle in a communal farming area of Zimbabwe. Cattle in a communal farming area of Zimbabwe were identified and examined in the late dry and mid wet season of 1985/86. Ovarian activity rates were 17.9% and 38.6% in the dry and wet season respectively. Pregnancy rates were 16.1% and 24.6% respectively. A major limitation to reproduction was the percentage of anoestrous females. There was no evidence of a seasonal calving pattern. Median body condition score was 2.0 in the dry season and 1.5 in the wet season. Adult females of body condition score 2.5 and above had ovarian activity rates of 41.9% and pregnancy rates of 41.9 per cent. Those with a body condition score below 2.5 had rates of 26.8% and 16.4% respectively. Serum progesterone levels in pregnant animals were positively related to body condition score, with some animals having progesterone levels similar to non-pregnant animals. Metabolic profiles suggested that the major limiting nutrient in both seasons was nitrogen, although other micronutrients might also be involved in low reproductive rates.


Effects of an increased PO2 during recompression therapy for the treatment of experimental cerebral arterial gas embolism. In this study we investigated the efficacy of an initial compression to 6 atm abs on a 53% nitrogen:47% oxygen mixture (PO2 = 2.8 atm abs) before breathing oxygen at 2.8 and 1.9 atm abs for the treatment of feline cerebral arterial gas embolism. Neurophysiologic function was determined by measuring the cortical somatosensory evoked potential (SEP) amplitude in anesthetized ventilated cats. Air was infused into the carotid artery until the SEP amplitude was reduced to less than 10% of baseline values. The animals were randomly separated into 3 groups. The first group (CONTROL) (n = 7) served as control and remained at the surface, breathing air. The second group (NITROX) (n = 10) was compressed to 6 atm abs breathing a 53:47% nitrox mixture for 30 min followed by breathing 100% oxygen at 2.8 and 1.9 atm abs. The third group (HBO) (n = 10) was compressed to 2.8 and 1.9 atm abs breathing 100% oxygen. Air infusion suppressed the SEP amplitude to the same level in all groups. The CONTROL group recovered 27.6 +/- 31.2% (mean +/- standard deviation) of the baseline SEP amplitude, whereas the NITROX group recovered 63.2 +/- 28.2%, and the HBO group recovered 66.0 +/- 19.3%. An analysis of variance with repeated measures revealed that both treatment profiles promote significant (P = 0.03) recovery of the SEP amplitude compared to no treatment. We find no additional benefit, however, by initiating treatment at 6 atm abs, even when additional oxygen is provided.


Effects of hyperoxia on human endothelial cell proliferation and morphology in vitro. The effects of hyperoxia on endothelial cells from human umbilical veins were studied in vitro by flow cytometric DNA analysis, cell proliferation, and morphology. Exposure of the cells to PO2 of approximately 400 and 500 mmHg (corresponding to O2 concentrations of 65 and 95%, respectively) caused, after 24 h, an increase in the proportion of S-phase cells from 18 to 33%. This was followed by a dramatic decrease of S-phase cells to about 4% after 48 h of O2 exposure. This decrease was also sustained after 72 h of O2 treatment. Concomitant with the depletion of S-phase cells was an increase from 13 to 21% in the proportion of cells in the G2M phase, indicating that cells were unable to undergo cell division after a 48-h exposure to 65 and 95% O2. Cells exposed to various PO2 levels (124, 248, 400, and 500 mmHg) showed a dose-dependent reduction in cell proliferation leading to a total inhibition of cell growth after exposure to PO2 of 400 and 500 mmHg. Cells exposed to 248 mmHg PO2 exhibited similar growth rates as the control cells during the first 3 days. Thereafter there was a 50% reduction in cell density as compared to the control cells. Light and scanning electron microscopy showed that the hyperoxic cells underwent morphologic changes characterized by cell contraction and swelling. Thus it is shown that exposure to very high PO2 tensions first stimulates the cells to enter the S phase of the cell cycle. Thereafter changes take place leading to a nearly complete reduction of cell proliferation.


Physiologically and subjectively acceptable breathing resistance in divers' breathing gear. To determine acceptable levels of breathing resistance in divers' gear, 6 subjects were exposed to varying levels of breathing resistance under demanding and realistic conditions. The immersed air-breathing subjects exercised in the prone position at 60% of their maximum oxygen uptake for 25 min in a hyperbaric chamber at 1.45 and 6.8 atm abs (145 and 690 kPa, 4.5 and 57 msw, 15 and 190 fsw). The breathing resistance ranged from minimal to 8-12 cmH2O (0.8-1.2 kPa).liter-1.s at flow rates of 2-3 liter/s. The higher resistance levels interfered with the respiration in terms of end-tidal PCO2 and dyspnea scores. There were considerable individual differences, and changes in one parameter were typically not paralleled by changes in the other. None of maximal voluntary ventilation, forced expiratory volume, expiratory reserve volume, vital capacities, or oxygen uptake was influenced by resistance. We set the maximum allowable end-tidal PCO2 at 60 mmHg and maximum dyspnea score at 1.0 on a scale from 0 (none) to 3 (severe). Based on these criteria we concluded that the external work of breathing should not exceed 1.5-2.0 J/liter in the ventilation range 30 to 75 liter/min BTPS.


Pneumothorax as a complication of recompression therapy for cerebral arterial gas embolism. The danger from pneumothorax in patients who undergo compression chamber treatment for cerebral arterial gas embolism (CAGE) following pulmonary barotrauma is frequently emphasized. Two cases of CAGE treated by recompression after submarine escape tank training (SETT) accidents are described. Both were complicated by bilateral pneumothoraces but the first case, treated on an air table, required thoracentesis in the chamber, whereas the second case, treated on an oxygen table, escaped the need for in-chamber thoracentesis despite large pneumothoraces. Review of similar Royal Navy and United States Navy SETT accidents suggests that the danger from pneumothorax during recompression treatment of CAGE victims may be overstated. Modern management on oxygen-based therapeutic recompression tables may significantly reduce the risk. Thoracentesis while under pressure should be reserved for cases developing symptoms or signs of tension pneumothorax. Treatment options for these cases are discussed and a decision algorithm is proposed.


Posterior shoulder dislocation and humeral head necrosis in a recreational scuba diver with diabetes. An insulin-dependent diabetic who was previously a recreational scuba diver suffered a posterior shoulder dislocation after a trivial injury and was subsequently found to have local necrosis of the humeral head. The only definite conclusion that can be reached is that this patient should not dive again.


Description and evaluation of a simple method for microbiological studies on otitis externa. A simple cultural method for identification of the bacteria and yeasts likely to cause external otitis in divers is described. The method employs a commercial dip-slide system (Urotube) in which ear swabs are rolled onto the three agar surfaces, spread by a loop, and then incubated for a period of 18 h or more at 37 degrees C. The method was compared with traditional culture methodology on agar plates. Use of reference strains of bacteria and stored clinical isolates of bacteria and yeasts from ear infections showed stable patterns of growth for each species. Semiquantitative investigation of growth showed that there was a constant relationship between amount of growth on agar plates as compared to the dip-slide. Results were reproducible and were not affected by prolonged incubation. Directly inoculated swabs from normal ear canals and clinically infected ear canals showed identical findings by the traditional culture and Urotube methods. The Urotube method has also been evaluated in practical situations offshore with favorable experience. The Urotube method thus provides a rapid and simple way of identifying the causes of external otitis in divers in isolated areas where laboratory facilities are not readily available. This can have consequences for speed and choice of therapy in isolated environments.


Effects of systemic and intracerebral administration of glucose oxidase on the blood sugar level in rats. Intravenous administration of 10 to 40 U/g b.w. glucose oxidase produced hypoglycaemia in a dose-dependent manner. The enzyme-induced drop of the blood sugar level was associated with significant rise in serum potassium and the concentration of free fatty acids. Intracerebral application of glucose oxidase through chronically implanted cannula into the ventromedial, lateral hypothalamus, preoptic region and amygdaloid complex of nuclei failed to change the blood sugar level, although a moderate increase of the free fatty acids and corticosterone concentrations occurred. The local application of enzyme in the locus coeruleus region led to a significant rise of the blood sugar concentration. The observations suggest the sensitivity of brainstem catecholaminergic neuronal system to hypoglycaemia.


Extension of lifespan in mice treated with Dinh lang (Policias fruticosum L.) and (-)deprenyl. The effect of Dinh lang root extract (DLRE) and (-)deprenyl on memory function and lifespan was examined in OFA-1 male mice. Treatments of either DLRE, (-)deprenyl or their combination were carried out 3 times a week starting at 12 months of age and following to the end of life. DLRE and (-)deprenyl significantly increased the memory function as well as surviving time of aged mice. The drug-treated animals showed a lower rate of loss of body weight than saline treated ones. It suggested that DLRE and (-)deprenyl did not prolong lifespan of mice by suppressing food intake. The combined treatment of DLRE and (-)deprenyl proved to be the most effective.


Effect of (-)-para-fluoro-deprenyl on survival and copulation in male rats. Six-month old male rats were treated with 0.25 mg/kg, s.c., (-)p-fluoro-deprenyl (n = 40) or salt solution (n = 20) three times a week for 25 months. Three of the 20 saline-treated and 15 of the 40 drug-treated males survived (p = 0.05). Sexual activity of the survivors was tested at the end of the experiment. Three of the (-)p-fluoro-deprenyl-treated 31-month-old males proved to be sexually fully active, though, Wistar rats lose their ability to ejaculate by completing their second year of life. Non-copulator, 13 month old male rats were treated instead of the usually used 0.25 mg/kg dose with 0.01 mg/kg, s.c., (-)deprenyl (n = 9), (-)p-fluoro-deprenyl (n = 9) and salt solution (n = 9), three times a week, for 82 weeks and mating activity was tested weekly. The lifespan of the non-copulators was very short: 102 weeks for saline (n = 9), 106 weeks for (-)deprenyl (n = 8) and 104 weeks for (-)p-fluoro-deprenyl (n = 7). Survival was lightly changed by this very small dose treatment, one (-)deprenyl-treated male and two (-)p-fluoro-deprenyl-treated rats remained alive. The copulatory activity, however, was substantially improved.


Conventional and prospective molecular targets in antitumour drug design. Concepts in antitumour research. To introduce a rationale in a drug development program the molecular base of the pathological lesion must be carefully considered both for selecting test compounds and to apply the most appropriate assay systems. From the beginning of antitumour drug research the principal aim has always been to select chemical compounds which could selectively inhibit tumour growth. This strategy was in full harmony with the concept that tumours are build up by fast proliferating cells. Research based on this concept has resulted in the development of more than 40 cytostatic agents, which are rather diverse in their chemical properties, but all act on one of the molecular mechanisms participating in cell proliferation. However the unsatisfactory therapeutic responses which could be obtained by the cytostatic agents focused the attention on those molecular events in the tumour cells which may be more closely related to the progression of the malignant disease.


Effect of cyclosporin-A treatment on microsomal enzyme activities in rat liver. The effect of orally administered fixed dose cyclosporin-A (CsA) on rat liver monooxygenase activities was studied. Group I was treated for 3, group II for 7 and group III for 17 consecutive days. A time dependence in the degree of inhibition and number of microsomal enzyme activities inhibited was observed.


Pharmacokinetics of radiopharmaceuticals. The pharmacokinetics of various radiopharmaceuticals following i.v. administration in mice and rats has been studied and compared. Before injection the radiochemical purity (RP) of the compounds were determined by HPLC and PAGE. In all cases RP-s were higher than 90%. The biodistribution of 99mTc labelled anti CEA IgG was studied in mice bearing human colon carcinoma xenografts. Animals with different tumour weights showed different blood kinetic and tumor uptake. The pilot clinical study of the 99mTc labelled anti melanoma Fab and 111-In-DTPA labelled anti melanoma F(ab')2 showed differences in the pharmacokinetic parameters. (99mTc labelled: comp.A. 84.6%; T1/2:0.6 h, 111-In-labelled: comp.A.: 46%, T1/2 1.5 h.) The various isonitrile derivatives synthetized in our laboratory were labelled with 99mTc and the biodistribution were tested in rats. The kinetic study showed that all the three molecules have different half lives in the heart and liver (T1/2 for heart ranged 5.1-18.6 h, for liver T1/2:1.2-2.5 h). Reversed phase HPLC study of the collected bile showed the 15-100% of injected compounds are metabolized during hepatic excretion. Literature data and our recent observations confirm that the knowledge of pharmacokinetics of radiolabelled compounds both in research, development and clinical practice is of basic importance.


In experimental ricin intoxication there is a detectable gastric acid secretion in the rat. According to previous investigations, ricin the toxic protein of castor oil seeds (Ricinus communis, Euphorbiaceae) given in subtoxic dose, evokes a parathyroid lesion with a consecutive parathormone mobilization in the rat. The elevated parathormone level rises the plasma calcium-content resulting (among others) in endogenous gastrin mobilization. This latter increases the gastric acid secretion in significant degree. This, hitherto unknown effect of ricin directs the attention once again to the complexity of its toxic action.


Breathlessness in healthy subjects at physical load. The aim of the study was to ascertain the reasons which lead to discontinuance of exercise on the bicycle ergometer in healthy untrained subjects and to assess the dependence of dyspnea on breathing pattern and on ventilation. The physical load was progressively increased to the maximum in 11 volunteers at the age of 21 +/- 1 years. During exercise some cardiovascular and respiratory parameters were measured simultaneously with the degree of dyspnea. Breathlessness was rated by means of a scaling according Borg, where 0 indicates no, 10 maximal dyspnea. Dyspnea was not a reason for termination of maximal exercise, its value being 6 +/- 1.9 in men and 4.5 +/- 2.3 in women at the end of exercise. The reasons for termination of exercise were the sensations of general fatigue and pain in lower the extremities. The degree of dyspnea correlated with the minute ventilation, with the decrease of end-tidal CO2 concentration, with the duration of exercise and some other values. The grading varied among subjects. The mathematical dependence of dyspnea was summarised by two regression equations, one without suppression, the other with suppression of interindividual differences in responses.


[Klinefelter's syndrome and leg ulcers: role of blood coagulation disorders]. Genetically, Klinefelter's syndrome is characterized by a super-numerary chromosome X in male subjects presenting with clinical and biochemical hypoandrogenism and relative hyperoestrogenism. The association of Klinefelter's syndrome with chronic leg ulcer has given rise to numerous publications. The cause of the trophic disorders is unclear. We report two cases of this syndrome associated with chronic leg ulcers and anomalies of haemostasis. One of these two patients had platelet hyperaggregability followed by disorders of fibrinolysis, while the other had disorders of fibrinolysis. We reviewed the literature concerning the various aetiopathogenic hypotheses put forward to explain the cause of these leg ulcers, as well as their interactions and relationship with the hormonal anomalies. The position occupied by disorders of haemostasis is particularly developed.


[Immunohistochemistry of nodular vasculitis. A possible role of delayed cellular hypersensitivity]. The physiopathogenesis of nodular vasculitis is still unknown: there is probably an initial Arthus' phenomenon responsible for the lesions of the deep vessels, but the frequent recurrences and the long time duration of the hypodermic nodules are still not understood. Dendritic protein S100 positive cells had previously been observed within hypodermal granulomas. The purpose of this study was to confirm these observations in a large group of nodular vasculitis, and to compare the expression of S100 protein in other vascular diseases and in pure panniculitis. Immunohistochemical staining for S100 protein was performed on paraffine-embedded samples: 45 cases of nodular vasculitis, 21 of panniculitis, 10 of superficial leucocytoclastic vasculitis, 10 of periarteritis nodosa, and 10 of erythema nodosum were analyzed by means of optic microscopy. Numerous dendritic S100 protein positive cells were found within hypodermal granulomas in most of the cases of nodular vasculitis, but these cells were absent in the 3 cases of initial deep leucocytoclastic vasculitis lesions of nodular vasculitis. The mean percentage of these cells was 4.5 p. 100 in the hypodermal inflammatory areas; they were observed mainly around vascular lesions. Hypodermal dendritic cells were absent or less numerous in all other cases, and a high number of such cells seems to be observed only in nodular vasculitis. Because of their dendritic morphology, and the high expression of S100 protein, these cells could be interdigitated cells, which are known to present antigens to T-lymphocytes. They could play an important role in generating the chronicity of nodular vasculitis, by a mechanism of delayed cell-mediated hypersensitivity, after the initial lesions caused by immune complexes.


[Epidermal cyst and osteolysis of the cranial vault]. In a 40-year old man undergoing, under local anaesthesia, excision of an epidermal cyst located in the frontal region, at the border of the scalp, the operator had difficulties in removing the deep part of the cyst and perceived an underlying bone depression. The depression was caused by a 2 x 1.3 cm wide lacuna in the calvarium, which was subsequently treated by neurosurgeons. Histology showed only fragments of a simple epidermal cyst wall and no evidence of dermoid cyst. The causes of osteolysis associated with congenital or acquired skin lesions are reviewed. In this case, the old age and volume of the cyst may explain the osteolysis by mechanical compression. This case is exceptional since we were unable to find other examples in the literature, apart from dermoid and trichilemmal cysts.


[Mibelli's porokeratosis after bone marrow transplantation]. A 24-year old male patient developed, on both legs, lesions typical of Mibelli's porokeratosis 22 months after bone marrow transplantation, under treatment with cyclosporin A. He denied any family history. Mibelli's porokeratosis seldom develops after an immunosuppressive treatment, and to our knowledge it has exceptionally been described after bone marrow transplantation. A possible complication of Mibelli's porokeratosis is the development of Bowen's disease, basal or squamous cell carcinomas. Immunosuppressive treatment might facilitate the degeneration. For this reason, these subjects should be periodically and carefully examined.


[Association of sarcoidosis and Waldenström's macroglobulinemia]. Sarcoidosis is seldom associated with Waldenström's macroglobulinaemia. We report the case of a 58-year old woman, 7 years after cutaneous and pulmonary sarcoidosis had begun, developed Waldenström's macroglobulinaemia. Chlorambucil was effective on both diseases. The possibility of reactive sarcoidotic granulomas in neoplastic diseases may cast doubts on the reality of the sarcoidosis-malignant haemopathy association. However, most authors consider that such associations are not fortuitous and can be explained by the immunological abnormalities observed in patients with sarcoidosis.


[Cutaneous pigmentation induced by minocycline: ultrastructural analysis and X-ray microanalysis]. The authors report a case of cutaneous pigmentation induced by minocycline. The patient (aged 59) presented with a bluish-grey pigmentation on her face, legs and nails. She had been receiving minocycline for 8 years for asthma. The cumulative dose was 400 g. Skin biopsy specimens from the pigmented areas were examined by light and electron microscopy. Light microscopy displayed hyperpigmentation with Fontana's stain in the dermis, macrophages and basal layer of the epidermis. Electron microscopy showed an increase in melanosomes within the basal keratinocytes, and dense granules in macrophages of the dermis. An X-ray microanalysis of the electron-dense granules showed the presence of larger quantities of iron and smaller quantities of sulphur and calcium. The different types of pigmentation are reviewed. Several pigments are thought to be responsible for the pigmentation but the underlying mechanism remains unclear.


[Carcinoma of the tongue in xeroderma pigmentosum]. Xeroderma pigmentosum (XP) is a rare genodermatosis characterized by a defect in the repair of DNA damage induced by ultraviolet rays. The cutaneous tumours are frequent and occur at an early age, but neoplasias of the mucosae are seldom observed. Among the mucosae, the lipids and the conjunctiva clearly predominate. Tumours of the buccal cavity are much less frequent, and this is why we report a case of epidermoid carcinoma of the tip of the tongue in a Moroccan boy. Only 25 cases of intrabuccal tumour have been reported in patients with XP, and 22 were epidermoid carcinomas of the tip of the tongue. These carcinomas may be preceded by precancerous lesions such as leucoplasia. The early occurrence and elective location at the tip of the tongue clearly differentiate lingual carcinomas associated with XP from their homologues in adults. The aggressiveness of these lesions is difficult to determine due to a usually short follow-up and to the lack of details in reports. Treatment is surgical and non-specific. Concerning epidemiology, the predominance of African and Near-Eastern patients among those suffering from lingual carcinoma is striking. Moreover, when the complementation group is known it is always group C; our patients presented with characteristics of this group. Some authors believe that the lingual tumours are due to ultraviolet light (overexposure in case of natural pigmentation, with exposure of the tip of the tongue) and to certain toxic substances in food.(ABSTRACT TRUNCATED AT 250 WORDS)


Mefloquine-sulphadoxine-pyrimethamine (Fansimef, Roche) in the prophylaxis of Plasmodium falciparum malaria: a double-blind, comparative, placebo-controlled study. From July 1987 to June 1988 a randomized, double-blind, comparative placebo-controlled field trial was conducted in a group of villages near Ibadan, Nigeria. The aim of the study was to assess the suppressive tolerability and efficacy of four antimalarials (Fansimef, Lariam, Fansidar, chloroquine) given for 24 weeks. Fansimef and Lariam were given with loading and maintenance doses, Fansidar and chloroquine as one tablet per week for 24 weeks. Of 567 enrolled subjects, 114 (20%) had parasitaemia on entry. Eight episodes of symptomatic falciparum malaria occurred during the trial, seven in the placebo group, and one in the Fansimef group. Compared with placebo, parasitaemia was effectively suppressed by all four drug regimens. Adverse event data were not significantly different between groups: six adverse events per 114 participants in the Fansimef group, six/113 in the mefloquine group, five/111 in the Fansidar group, 17/115 in the chloroquine group and eight/114 in the placebo group. Safety of Fansimef for 24 weeks in endemic areas was comparable for standard antimalarials in this trial and provides support for the use of this drug for the treatment of resistant malaria in indigenous African populations.


An outbreak of Plasmodium vivax malaria in Trinidad, W.I. An outbreak of Plasmodium vivax malaria occurred in Trinidad some 25 years after a successful eradication programme. The 'index case' was infected while visiting Perdaneles, Venezuela, and was responsible for the renewal of malaria transmission by indigenous Anopheles aquasalis mosquitoes in Icacos, Trinidad, W.I. Nine cases (four females and five males) of P. vivax malaria were locally transmitted in Icacos. Most of the cases (70%) were in the 15-24 or 25-44 year age groups. In Granville/Chatham, another, unrelated case of locally transmitted P. vivax malaria was discovered through active surveillance. The intervention measures adopted, which successfully eradicated P. vivax malaria from Trinidad, are described. The need to maintain malaria surveillance is emphasized.


High seasonal malaria transmission rates in the intermediate rainfall zone of Sri Lanka. Malaria transmission was studied at Nikawehera, a long-established farming village, located in the intermediate rainfall zone of Sri Lanka. Observations were made over a 12-month period (October-September) that included the main rainy season which occurred during the north-east monsoon in November-January. Anolpheles culicifacies, the recognized vector of malaria in Sri Lanka, was the predominant anopheline mosquito collected by human night baiting at Nikawehera. High entomological inoculation rates with An. culcifacies (0.12/hour for Plasmodium vivax) were observed during the height of the transmission season which occurs during, and immediately after, the north-east monsoon. Anolpheles subpictus was identified as a possible additional vector at Nikawehera. Anopheles annularis, a major vector at Weheragala, a site in a new irrigation development (the Mahaweli Scheme) located 70 km away in the dry zone, was not collected by human baiting at Nikawehera. Clinical, entomological and parasitological data suggest that malaria is hyperendemic at Nikawehera, with high seasonal transmission rates.


Altered plasma lipid pattern in falciparum malaria. Plasma levels of HDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0.001). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0.001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0.001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0.001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r = 0.715 and r = 0.895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results if lipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.


Didelphis marsupialis: a primary reservoir of Trypanosoma cruzi in urban areas of Caracas, Venezuela. Direct blood examination and xenodiagnosis of 45 sylvatic, peridomestic or domestic mammals from the Caracas valley, Venezuela, revealed trypanosome infection in six of the 24 opossums, Didelphis marsupialis, collected in urban areas. Isolates were successfully made of trypanosomes from four of the opossums, using the parasites which developed in Rhodnius prolixus fed on the infected opossums to infect NMRI mice. The prepatent period, course of parasitaemia, morphology of bloodstream trypomastigotes, tissue tropism of parasites in the opossums and/or mice, host mortality, morphology of parasites in the bugs, and infectivity to mice of parasites in the faeces of infected bugs, were all characteristic of Trypanosoma (Schizotrypanum) cruzi. In mice, the parasites showed marked myotropism; the heart, skeletal muscle and the smooth muscle of the urinary bladder, penis, prostate, seminal vesicle, lung, stomach, jejunum and colon were frequently invaded, and pseudocyts were also occasionally found in the liver, brain and pancreas. The significance of the invasion of the genito-urinary structures as a possible alternative parasite transmission route is discussed. The possible role of D. marsupialis, as a primary reservoir of T. cruzi, in the establishment of foci of Chagas' disease in Caracas and other Latin American cities, is emphasized.


Decreased sensitivity to meglumine antimoniate (Glucantime) of Leishmania infantum isolated from dogs after several courses of drug treatment. Although unresponsiveness to antimonial drugs in human leishmaniasis appears to be increasing, resistance to antimony in Leishmania is not well documented. Treatment of leishmaniasis in dogs, the domestic reservoir of L. infantum, with meglumine antimoniate (Glucantime) is a common practice in many Mediterranean countries. The dogs, however, remain highly infective to the phlebotomine vectors, even after several courses of treatment. A study was therefore carried out to test the comparative susceptibility to meglumine antimoniate of L. infantum stocks isolated from four naturally-infected dogs, before (BT) and after treatment (AT) with three to six courses of the drug, and used to infect Balb/c mice. Significant differences in suppression between the BT and AT stocks were observed in the infected mice when they were given the drug at a rate of 0.01-10 mg kg-1 day-1 for five days. Each AT stock was between eight and 41 times more resistant to meglumine antimoniate than the BT stock from the same dog, in terms of the ratios of the AT ED50 values to the corresponding BT values, which were calculated as indices of resistance. This result underlines the futility and danger of repeated antimonial treatments of dogs with signs of leishmaniasis, as these may produce a permanent reservoir of parasites unsusceptible to the drugs in human clinical use.


Analysis of the in vitro lymphoproliferative responses and antibody levels to the arc-5 antigen in patients with cystic hydatid disease. Using a commercially-available, purified, arc-5 antigen, we examined the in vitro proliferative responses of peripheral blood mononuclear cells from hydatid patients and from healthy controls. Antibody levels of different immunoglobulin classes were also measured against the same antigen, in sera of both groups. Our findings indicate that lymphocytes from healthy controls do not proliferate to the arc-5 antigen, whereas lymphocytes from the majority of patients do. The negative or weak responses observed among a few patients were not due either to increased release of prostaglandins in culture or to a lack of responsiveness to Interleukin-2. Antibodies of all three classes, G, M and A, measured by an ELISA, were elevated in sera of patients when compared with controls. However, only levels of specific IgG antibodies gave an excellent discrimination of the disease state and these were of diagnostic value. No direct or inverse correlations between lymphoproliferative responses and antibody levels were observed in either group, although a few patients with relatively low antibody titres demonstrated very high proliferative responses. The possible use of the proliferative assay as an adjunct to serology in the diagnosis of hydatid disease is indicated.


Experimental schistosomiasis mansoni: modulation of granulomas by inhibition of collagen cross-link formation. Preliminary report. beta-Aminopropionitrile (BAPN) is an inhibitor of the lysyl oxidase required for cross-link formation in collagen maturation. The efficacy of BAPN, alone or in association with the anti-schistosomal drug, praziquantel (PZQ), was primarily assessed by measuring the reduction in liver and intestinal egg loads in murine schistosomiasis mansoni. Depending on the treatment group (PZQ, BAPN, BAPN + PZQ), organ-specific effects were observed using microscope image analysis. Most notable was the relatively small size of granulomas in the livers of BAPN-treated mice, which contrasted with the relatively large size and irregular shape of the granulomas in the intestinal tissues of these mice. Mice treated with the combination of BAPN and PZQ had decreased liver and spleen weights, and a significant reduction in the number of eggs trapped in both the liver (86%) and the intestine (99.1%), compared with untreated mice and those given PZQ alone. The lowest number of living eggs/g of tissue in both the liver and intestine was recorded in the combined BAPN + PZQ-treated group. These results suggest that the concurren treatment of infected mice with PZQ and BAPN enhances the release of eggs trapped in the intestine and also results in a significant reduction of liver egg load. The mechanism by which BAPN reduces the number of liver granulomas in PZQ-treated mice is currently being investigated.


Human onchocerciasis in the lower Jos Plateau, central Nigeria: the prevalence, geographical distribution and epidemiology in Akwanga and Lafia local government areas. An investigation of human infection with Onchocerca volvulus and the resulting clinical disease was carried out for the Nigerian National Onchocerciasis Control Programme between July and August 1989 [corrected]. The survey covered 10.6% of the rural population in 41 savanna villages of central Nigeria. Of the 8451 self-selected individuals examined, 900 (10.6%) had skin microfilariae (Mf). There were differences between villages in both endemicity and intensity of infection, but in general the number of both Mf carriers and cases of clinical onchocerciasis increased with age. The disease in the Mf carriers showed as blindness (0.8%), onchocercal nodules (0.6%), leopard skin (1.6%) and pruritus (2.8%). Of 35 persons with lymphatic complications, 19 had hanging groin, 10 had elephantiasis and six had hydrocoele. Onchocerciasis was mesoendemic in the rocky northern escarpments, and became hypoendemic and sporadic in the southern uplands of sedimentary geological origin.


Preliminary observations on the distribution of ivermectin in Nigeria for control of river blindness. A total of 118,925 individuals in four Nigerian states was treated for onchocerciasis between February and December, 1991, using centralized and house-to-house distribution of ivermectin. Pre-treatment prevalences of the disease ranged between 28% and 90%. Only 0.7% of those treated reported adverse reactions within three days of treatment: 230 individuals (0.19%) had headache, 210 (0.17%) general body pains, 150 (0.12%) pruritus, 120 (0.10%) oedema, 80 (0.06%) fever, 20 (0.02%) dizziness, 15 (0.01%) vomiting, 10 (0.01%) diarrhoea, and 25 individuals (0.02%) noticed that they passed intestinal worms. Treatment in the endemic communities continues. The results show that mass treatment of onchocerciasis with ivermectin is quite safe and the drug's acceptability increases its potential as the drug of choice for control of onchocerciasis in Nigeria.


The ultrastructure of the abdominal trumpet gland and antennal ascoid and papilla of Chinius junlianensis Leng, 1987 (Diptera: Psychodidae). When viewed with a light microscope, each trumpet gland of Chinius junlianensis appears as 15-20 small trumpet-shaped structures with their narrower proximal ends clustered together on the surface of a tergite. By scanning electron microscopy (SEM), however, the glands appear to be abdominal exosecreting organs with honeycomb-like openings at the inter-tergal junctions 3/4 and 4/5. Although the other ascoids of C. junlianensis are round in cross-section, each of those distal to antennal segment 8 is roughly triangular, with three ridges and three concave surfaces, and has a large oval depression at its base. The basal ridge has three to five rows of denticulations. The antennal papilla is oval, with a comb-like fence of four to five thin pointed processes on each side and a stout central spine.


Predation of Biomphalaria and non-target molluscs by the crayfish Procambarus clarkii: implications for the biological control of schistosomiasis. The North American crayfish Procambarus clarkii was examined under laboratory conditions for its ability to prey on Biomphalaria pfeifferi and B. glabrata, molluscan intermediate hosts of human schistosomiasis, and other, non-target gastropod species. Both male and female adult crayfish significantly reduced survival of neonate snails, even though alternative animal and plant foods were both available. In subsequent experiments, no differences in snail consumption were detected, for either adult or juvenile crayfish, in the presence or absence of a plant food alternative. Both adult and juvenile crayfish were able to consume small (2.5 mm) and large (17.5 mm) B. glabrata, suggesting that no size refuge from predation exists. Both adult and juvenile crayfish consumed Biomphalaria egg masses, although this consumption was significantly greater for juveniles. Procambarus clarkii adults were unable to consume substantial numbers of the relatively thick-shelled prosobranch snails Pila ovata and Lanistes carinatus. Crayfish did consume a third prosobranch, Melanoides tuberculata, and the pulmonate snail Physa acuta, but at a lower rate relative to consumption of Biomphalaria. Physa acuta, itself of North American origin, responded to the presence of crayfish by rapidly leaving the water and thereby avoided predation. Implications of these results for the biological control of schistosome-transmitting snails in East Africa are discussed.


Polyparasitism on the Kenya coast. 1. Prevalence, and association between parasitic infections. A partially-stratified sample survey of people living in the catchment area of Kilifi General Hospital, Coast Province, Kenya, identified 19 species of parasites in blood and intestines. Age-prevalence curves of the common infections were of two distinct types, possibly reflecting the host's ability to mount a partially effective immune response. Although statistically-significant associations between pairs of infections were clearly demonstrable, these were almost wholly explained by environmental heterogeneity and epidemiological coincidence. There was no evidence of positive or negative influence of one infection on another.


Long thoracic neuropathy from athletic activity. Four cases of long thoracic mononeuropathy associated with sports participation are presented. Each patient developed shoulder pain or dysfunction after an acute event or vigorous activity, and demonstrated scapular winging consistent with serratus anterior weakness. The diagnosis was confirmed with electromyography in each case. It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a favorable outcome in all patients.


The characteristics of the Ricketts maxillary canine retractor. The characteristics of the Ricketts maxillary canine retraction spring (Ricketts, 1974) have been derived using the complementary (strain) energy method. The theoretical predictions of the analysis have been confirmed by experiments on large planar models in a jig fitted with strain gauges capable of measuring the forces and couples developed when the springs were activated in a way simulating clinical use. The verified analysis was used to compare the horizontal stiffness and anti-tilt couple to retraction force ratios of the Ricketts with other simpler retraction components. The behaviour of the Ricketts mandibular sectional, as predicted by the analysis was also examined.


Rotator cuff disease: current trends in orthopedic management. Rotator cuff disease is a clinical entity that is frequently encountered in the typical primary care office. Of particular importance to the chiropractic physician is the close proximity of the shoulder joint to the cervical spine. Due to the relatively high level of morbidity in the population, rotator cuff disease should be looked at carefully on both the physical and advanced diagnostic level. Several factors contributing to rotator cuff pathology include subacromial impingement, the relative microvascular pattern of the cuff mechanism and prior trauma. The natural history of attrition and aging also play a role in rotator cuff disease. Advanced disease is successfully diagnosed through the efficient utilization and proper sequencing of advanced orthopedic imaging studies.


Transnasal stereotactic biopsy of a clivus tumor. Technical note. Computerized tomography-guided transnasal stereotactic tissue diagnosis of a lytic lesion in the clivus was performed successfully using the Cosman-Roberts-Wells frame, thus avoiding a major craniotomy. The authors recommend stereotaxis as the preferred technique for biopsy in this region.


Death and reductionism: a reply to John F Catherwood. This reply to John F Catherwood's criticism of brain-related criteria for death argues that brainstem criteria are neither reductionist nor do they presuppose a materialist theory of mind. Furthermore, it is argued that brain-related criteria are compatible with the majority of religious views concerning death.


An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. Since 1990 several clusters of multidrug-resistant tuberculosis have been identified among hospitalized patients with the acquired immunodeficiency syndrome (AIDS). We investigated one such cluster in a voluntary hospital in New York. We compared exposures among 18 patients with AIDS in whom tuberculosis resistant to isoniazid and streptomycin was diagnosed from January 1989 through April 1990 (the case patients) with exposures among 30 control patients who had AIDS and tuberculosis susceptible to isoniazid, streptomycin, or both. We also compared exposures among the 14 case patients hospitalized during the six months before the diagnosis of tuberculosis (the exposure period) with those among 44 control patients with AIDS matched for duration of hospitalization. Mycobacterium tuberculosis isolates were typed with analysis of restriction-fragment-length polymorphism (RFLP). Case patients with drug-resistant tuberculosis were significantly more likely than controls with drug-susceptible tuberculosis to have been hospitalized during their exposure periods (14 of 18 vs. 10 of 30) (odds ratio, 7.0; 95 percent confidence interval, 1.6 to 36; P = 0.006). Case patients hospitalized during their exposure periods were significantly more likely to have been hospitalized on the same ward as a patient with infectious drug-resistant tuberculosis than were either controls with drug-susceptible tuberculosis hospitalized during their exposure periods or controls matched for duration of hospitalization (13 of 14 vs. 2 of 10 and 23 of 44) (odds ratio, 52; 95 percent confidence interval, 3.1 to 2474; P less than 0.001; and odds ratio, infinity; 95 percent confidence interval, 2.4 to infinity; P = 0.005, respectively). Among those hospitalized on the same ward, the rooms of case patients were closer to that of the nearest patient with infectious tuberculosis than were the rooms of controls matched for duration of hospitalization. M. tuberculosis isolates from 15 of 16 case patients had identical patterns on RFLP analysis. Of 16 patients' rooms tested with air-flow studies, only 1 had the recommended negative-pressure ventilation. Multidrug-resistant tuberculosis is readily transmitted among hospitalized patients with AIDS. Physicians must be alert to this danger and must enforce adherence to the measures recommended to prevent nosocomial transmission of tuberculosis.


Toxoplasma gondii pneumonitis in patients infected with the human immunodeficiency virus. Pulmonary toxoplasmosis is a rarely recognized opportunistic infection in immunocompromised patients. A few case reports have described pulmonary toxoplasmosis in human immunodeficiency virus-infected patients in association with Toxoplasma gondii central nervous system disease. We encountered six cases of pulmonary toxoplasmosis in human immunodeficiency virus-infected patients who presented with a protracted febrile illness, respiratory symptoms, and an abnormal chest roentgenogram in the absence of neurologic findings. No clinical or roentgenographic features distinguished T gondii pneumonitis from more common opportunistic pulmonary infections. As the acquired immunodeficiency syndrome epidemic progresses, the presenting illnesses have evolved. Toxoplasma gondii must be considered a potential cause of pulmonary disease during the evaluation of human immunodeficiency virus-infected patients with respiratory symptoms.


Asymptomatic HIV infection does not cause EEG abnormalities: results from the Multicenter AIDS Cohort Study (MACS). We conducted EEG testing in 200 asymptomatic homosexual men, half of whom were HIV seropositive. We chose to include half of the subjects because they were rated as impaired on a neuropsychological screening test. We used both traditional visual EEG interpretation and quantitative EEG analysis. Abnormal EEGs and borderline degrees of EEG slowing occurred in 32% of these men. These EEG changes were not related to HIV serostatus. EEG changes did correlate with the impaired neuropsychological test performance. Clinicians faced with abnormal EEG results or borderline EEG slowing in an asymptomatic HIV-seropositive patient should not attribute the EEG change to effects of the serostatus itself but should look for other causes.


Regulatory mechanisms in leukocyte adhesion: flexible receptors for sophisticated travelers. Unstimulated leukocytes spend extended periods circulating in the blood, punctuated by migration through lymphoid areas and peripheral tissues. During transit, strong cell-cell interactions control immune surveillance and specialized effector functions. The structures and mechanisms that allow this flexible adhesion and migration behavior are the subject of this review.


Prolongation of tetracaine spinal anesthesia by oral clonidine. The effects of oral clonidine on the duration of isobaric tetracaine spinal anesthesia were studied in 30 patients undergoing urologic procedures. All patients received 15 mg of tetracaine intrathecally in isobaric saline solution. Group 1 (n = 10) received 0.25 mg of oral triazolam; group 2 (n = 10) received 0.15 mg of oral clonidine; and group 3 (n = 10) received 0.25 mg of oral triazolam and 0.75 mg of intrathecal phenylephrine. In group 1, the times for two- and four-segment regression of the level of analgesia to pin-prick were 80 +/- 17 and 123 +/- 22 min, respectively (mean +/- SD). The corresponding values of those measurements were 170 +/- 27 and 273 +/- 48 min in group 2 and 175 +/- 34 and 273 +/- 68 min in group 3. All the regression times in groups 2 and 3 were significantly longer than those in group 1. Regression times were not different between groups 2 and 3. The authors conclude that prolongation of tetracaine sensory analgesia may be produced by premedication with 0.15 mg of oral clonidine. The prolongation is similar to that produced by intrathecal phenylephrine.


HIV prevention and the two faces of partner notification. In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.


Is hearing assessed after bacterial meningitis? A questionnaire was sent to 686 paediatricians in the UK to discover whether or not they referred children for hearing assessment after bacterial meningitis and if not, why not; 90% replied. Of these, 10% did not refer all children. The reasons given were based on misunderstandings of the aetiology and not on a lack of provision.


Recent trends in the prevalence and severity of childhood asthma. To examine changes in the prevalence and distribution of childhood asthma and its relationship with various measures of children's health and functioning between 1981 and 1988. It was hypothesized that there would be an increase in the prevalence of asthma, especially among black children, and that available measures would suggest a deterioration in the health and functioning of children with asthma over this period. Analyses of data from the Child Health Supplements to the National Health Interview Survey. Nationally representative random sample of 15,224 children aged 0 to 17 years in 1981 and 17,110 in 1988. Changes in (1) the prevalence and distribution of asthma, and (2) among children with asthma, the percentage of children hospitalized, days spent in bed, school days lost in the year prior to survey, and parent ratings and reports of children's overall health status and behavior problems. The estimated prevalence of childhood asthma increased from 3.1% in 1981 to 4.3% in 1988 (P < .0001), with similar increases for children, adolescents, and both sexes. Increases occurred among white children (2.7% to 4.1%; P < .0001) but not black children (5.3% vs 5.1%; not significant). Among those with asthma in 1988 compared with 1981, there was better overall health status (11% vs 24% fair/poor; P < .0001) and fewer with 30 or more days spent in bed in the last year (3.9% vs 7.2%; P < .04). We also observed trends toward a lower rate of hospitalization in the last year (10% vs 14%; P = .07), fewer school days missed (2% vs 6% with > 30 days; P = .08), and a lower rate of extreme behavior problem scores (13% vs 18%; P = .09) in 1988 compared with 1981. Reductions were similar among both black and white children. These results indicate that the estimated prevalence of asthma among children in the United States increased by almost 40%, and that although the increase occurred exclusively among white children, the prevalence of asthma still remains higher in black children than in white children. There was no support for increasing asthma severity and functional impact among either black or white children with asthma in 1988 compared with 1981. These findings provide no evidence to support the beliefs that asthma prevalence is increasing largely among black children or that the severity of asthma among most children in the United States is increasing.


Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. A comprehensive review of transdermal nicotine treatment for tobacco dependence, with recommendations derived from the research literature. English-language clinical trials. Clinical trials using placebo-controlled, double-blind methodology (11 studies) with at least 6 months of follow-up after treatment (eight studies) and biochemical verification of smoking status. Nicotine patches produce end-of-treatment smoking cessation rates that range from 18% to 77%; these rates are about twice those of placebo-treated subjects. Nicotine patches produced 6-month abstinence rates of 22% to 42%, while placebo patches produced quit rates of 5% to 28%. Nicotine patches appear to reduce some, but not all, nicotine withdrawal symptoms. For instance, while the patch reduces craving for cigarettes and negative moods, it does not appear to reduce hunger or weight gain. The clinical trials literature suggests that proper adjuvant smoking cessation counseling is crucial in determining successful long-term outcome with the nicotine patch, and suggests that 6 to 8 weeks of patch therapy may be an adequate duration for most patients. Nicotine patches are an effective aid to tobacco dependence treatment. However, success rates vary greatly across research studies and may be influenced highly by the nature and intensity of adjuvant smoking cessation counseling. More research is needed to identify optimal duration, dosage, and individualization of patch therapy. The impact of nicotine patches (more than 5 million users with $1 billion in sales for 1992) also raises important ethical and public health issues.


Cytokine inter-relationships and their association with disease activity in arthritis. In order to investigate the relationships between cytokine production and arthritic disease we have determined the concentrations of immunoreactive interleukin-1 alpha (IL-1 alpha), IL-1 beta, IL-6, tumour necrosis factor-alpha (TNF-alpha), interferon-alpha (IFN-alpha), IFN-gamma, and soluble IL-2-receptor (sIL-2R), as well as bioactive IL-1 and IL-6, in synovial fluids (SF) and plasma of patients with a variety of arthritides. Careful assay revealed only minimal concentrations of IL-1, particularly its biologically active form, in SF. No IL-1 was detectable in the plasma of patients that had IL-1 in their SF. Concentrations of both immunoreactive IL-1 beta and TNF-alpha in SF of rheumatoid arthritis (RA) patients were significantly higher than those in SF from patients with other inflammatory arthritides or osteoarthritis (OA). IL-6 and sIL-2R concentrations in both SF and plasma were higher in RA patients than in OA patients, and were significantly correlated. Approximately half of the SF from patients with all arthropathies contained detectable IFN-alpha, whilst IFN-Y was present in less than 10%. There were significant associations between IL-6, sIL-2R, IL-1 beta, TNF-alpha and IFN-alpha. The concentration of these cytokines, where detectable, was also related to leukocyte counts in the SF, as well as to parameters assessing local and systemic disease activity. Although IL-6 was the cytokine most clearly related to other cytokines, and to parameters assessing disease activity, the relationship between general articular disease activity and IL-6 was only evident in patients with arthropathies other than rheumatoid arthritis.


[Effects of plant hormone on germination of Bupleurum falcatum L. seeds]. The germinant rate of Bupleurum falcatum can be raised by soaking the seeds in BA or GA3 solution. The effect of BA is better than that of GA3. BA and GA3 cannot be used together, otherwise the effect on germination will be decreased or checked. BA or GA3 should be used before the natural sowing time, for after this time they will be useless or even harmful.


[Pharmacological and clinical studies on the processed products of radix Polygoni multiflori]. The root of Polygonum multiflorum and its 2 processed products were compared by immune pharmacology and clinical observation on the aged high-fat-blood case. The results have shown that the product processed under new procedures is better than that under traditional procedures, thus providing scientific basis for spreading the application of the new one.


[Preliminary studies on arsenic content in cishi]. The results have revealed that arsenic content in pig cishi is about 11 times that in the calcinated samples. Therefore the toxic effect of cishi is eliminated or reduced after it is calcinated.


[Preparation and isolation of chitin and chitosan from Kronopolites svenhedini (Verhoeff)]. Chitin was isolated from Kronopolites svenhedini and deacetylated to produce the derivative chitosan. The yield for chitin was 9%, and chitosan yield 57.4% and 77.5% respectively. After purification, their structures have been determined by spectroscopic methods.


[Chemical constituents of Drynaria propinqua (Wall) J. Sm]. Four compounds isolated from the rhizomes of Drynaria propinqua collected in Sichuan have been identified. One of them was a new natural product, namely propinqualin, whose structure was established as (-)-epiafzelechin-3-O-beta-D-allopyranoside. The other three were 4-O-beta-D-glucopyranosyl caffeic acid, beta-sitosterol-3-O-beta-D-glucopyranoside and sucrose.


[Chemical studies on essential oils from 6 Artemisia species]. The constituents of the essential oils obtained from the leaves of Artemisia argyi, A. argyi cv.qiai, A. lavandulaefolia, A. mongolica, A. princeps and A. argyi var. gracilis were analysed by GC-MS. 96 compounds including alpha-thujene, 1,8-cineole, camphor and artemisia alcohol, etc. were identified. Their percentages in the oils were given.


[Effects of neutral oil of Ligusticum sinense Oliv. on anoxia]. The neutral oil at 2.5 and 5.0g/kg P.O. can significantly decrease the oxygen consumption and prolong survival time for mice, increase the ability of tissues to tolerate anoxia and extend survival time under cerebral ischemic anoxia in mice. It can also inhibit the pituitrin-induced depression of S point in rats.


[Anti-inflammatory and anti-bacterial functions of bezoar antipyretic tablets]. Bezoar Antipyretic Tablets can inhibit markedly acute exudative inflammation. It can also inhibit markedly drug-resistant Staphylococcus aureus, etc. It has no influence on Bacillus pyocyaneus, etc.


[Effects of Salvia miltiorrhiza Bunge on isolated perfused liver and portal vein of rats]. The experiment results showed that Salvia miltiorrhiza (SMB) had a protective effect on the isolated perfused liver injured by CCl4 of rats, made the activity of GPT in perfusate of SMB group lower than that of intoxicated groups and relieved the hepato-pathohistologic lesions of SMB group as compared to the intoxicated group. SMB had no significant effects on both the activities of SGPT in vitro and the portal vein of rats.


[Age of onset of spermaturia (spermache) in 669 Mexican children and its relation to secondary sexual characteristics and height]. The onset of production of spermatozoa (spermarche) indicates the beginning of reproductive capacity in men. With the purpose to establish the age of initiation of spermaturia, we performed a transversal study in 669 Mexican boys aged 9-16 years old, searching for the presence of spermatozoa in the first urine sample during five consecutive days. Besides, physical examination, including Tanner stages for genitalia and pubic hair was practiced. Spermarche (E+) occurred when the median age was 13.4 +/- 1.01 yr, the median height 155.2 +/- 8.9 cm, and the Tanner stage G2P1. The boys in Tanner stage G2P1 and E+ showed important differences in the following parameters, when they were compared with the boys in Tanner stage G2P1 and E-: height, weight, corporal surface and muscular area of the arm. The findings could be explained by the relationship between structure and function when the cellular lineages are established during different phases of development.


[Acute infections, growth velocity and nutritional status in children from developing countries: a meta-analytic review]. Aiming to explore the direction of the cause-effect relationship between the changes in the nutritional status, the physical growth and the selected acute infections, we performed a meta-analysis. It was based on 12 publications selected out of 993 eligible. In 6 papers (50%) a direct relationship between infections and growth velocity was found; in 5 a negative association was reported. A positive association between malnutrition (Gómez's criteria) and infection was found in 4 (33%). Two more reported no association between growth (Z score) and infection. The most remarkable confounding variables were: previous episodes of infection, duration, birth weight and feeding mode. Most of the studies did not met the criteria for causality. Better designed studies are in order to address this question.


[Survival of very low birth weight newborns (less than 1,500 grams) in relation to conventional mechanical ventilation]. One hundred and five very low birth weight neonates, selected through convenience sampling during 1989, were subdivided into those who received mechanical ventilation (MCV) and those who did not receive mechanical ventilation (W/O MCV) and later analyzed. The maternal morbidity in both groups were very similar; 66 of the cases were placed in group MCV and 39 in the W/O MCV. There were differences in birth weight, gestational age, severe asphyxia and hospital stay in the patients with MCV. The neonatal morbidity (SDR, intraventricular hemorrhaging, bronchopulmonary dysplasia, etc.) was more frequently seen in this group. The global mortality was 47%, all of the cases were from the ventilated group. The ventilated patients who died were in the hospital a lesser number of days and had a lesser frequency of prenatal control. We conclude that low weight neonates who require mechanical respiratory assistance have a greater risk of morbidity and mortality. The lesser weight and gestational age, the greater the risk. A group of neonates will have a lesser capacity to synthesize phospholipids and therefore a greater risk of dying. Physicians should be more attentive to the complications related to ventilated low-weight premature neonates.


[Frequency of external congenital abnormalities in abortions]. The purpose of this study was to calculate the incidence of external birth defects found in 1,650 aborted fetuses studied from September 1978 to February 1983 at the Department of Gynecology and Obstetrics of the University Hospital "Dr. José Eleuterio González" of the U.A.N.L. Medical School. Ninety five of fetuses had external birth defects and 85 had abnormalities in annexes. The Fisher exact test was applied to find the relationship between these abnormalities; no relationship was found. 67.4% had only one birth defect; 32.1% showed several defects. Those defects which were lethal constituted 67%, the majority being of the central nervous system. Defects found in the abdominal wall took second place in frequency followed by abnormalities in either extremity and ear defects. The birth defects seen in early gestational ages differ from those seen in live newborn babies. It is important to carry out morphological and teratological studies, not only in newborns but also during the embrion and fetal periods.


[Understanding and diagnosis of complex cardiopathies. I]. Even pediatricians and cardiologists the complex congenital heart disease is considered to be difficult chapter. The purpose of this review is to show that complex congenital heart disease is not difficult to understand it two avenues are followed: First, a detailed explanation of the methodology used for the segmental analysis is given; all possible segmental combinations are reviewed. Second, 5 basic rules for this analysis are proposed: symmetry of the first segment, a discordant intersegmentary connection, two discordant intersegmentary connections, absence or hypoplasia of one the elements of the ventricular or arterial segment and both components of the arterial segment join one instead of the two ventricles. If these concepts are mastered, the basis for a correct diagnosis and suitable treatment are established.


[Intravenous immunoglobulin in the treatment of neonatal septicemia]. Thirty-seven neonates with confirmed septicemia through hemoculture were studied. Of them, 18 were treated with antibiotic and the other 19 were given 500 mg/kg of intravenous immunoglobin with a pH of 4.25 (IGIV). The greater part of the neonates in this study were full-term or near full-term. There were no differences in age, gestational age and weight, nor in mortality, the bacterias found and the clinical manifestations which were seen in both groups. Yet, the hospitalary stay was shorter for those in the group treated with IGIV (13.9 +/- 5.7 days) than in the trial group (24.4 +/- 10.3 days); as well as some clinical manifestations like diarrhea and splenomegalia (P < 0.05). The serum of the neonates from the IGIV group showed a greater capacity of opsonization and inhibition of bacterial growth than those in the trial group (P < 0.001), coinciding with an increase of 300 mg/dL in the serum levels of IgG of the group treated with IGIV from the 3rd day of the study and the C4 and B-Properdine factor serum levels from the 7th day of the study, while in the trial group, there were no changes in these factors (P < 0.001). Even though no differences were seen in the mortality rate due to septicemia, the results suggest a much shorter evolution of the illness in patients treated with IGIV. In addition, the serum of those patients treated with IGIV showed in in vitro studies, a better bacteriostatic activity and a better capacity to opsonize the bacterias isolated in the hemocultures.(ABSTRACT TRUNCATED AT 250 WORDS)


[Puberty changes and various aspects of cervicovaginal infection]. The changes seen during puberty tend to modify genital anatomical, biochemical, immunological and microbiological conditions, which when associated to epidemiological factors, determine the participation of different infectious agents in pre-puberty women and women going through puberty. It is convenient to be aware of the biological variations which occur in these ages since it aids the clinician in the diagnosis and treatment of pathological vaginal secretions of girls and adolescents.


Variance component analysis of bristle characters in local populations of Drosophila melanogaster. The genetic variabilities of sternopleural and abdominal bristle numbers existing in local natural populations were assessed. Using second chromosome lines of Drosophila melanogaster extracted from three natural populations in Japan (the Ishigakijima, Ogasawara and Aomori populations), experiments were conducted to estimate the components of genetic variances, additive and dominance variances. The following results were obtained: For both sternopleural and abdominal bristle numbers, the additive genetic variances (sigma 2A) were much larger than the dominance variances (sigma 2D) especially in the southern populations. For example, in the Ishigakijima population, for females sternopleural bristle numbers of the inversion-free chromosome group, the additive and dominance variances were estimated to be 1.255 +/- 0.2034 and 0.0552 +/- 0.0180, respectively. The magnitudes of the estimates of additive genetic variances were nearly equal from north to south. By comparing the additive genetic variances of the inversion-free chromosome group with those of the In(2L)t-carrying chromosome group, it was inferred that sufficient number of generations to achieve the equilibrium state has not passed since the introduction of a single or a small number of the In(2L)t-carrying chromosomes to the Ishigakijima population.


Quantitative genetic study on sexual difference in emigration behavior of Drosophila melanogaster in a natural population. A quantitative genetic analysis was conducted on emigration response behavior using 140 second chromosome lines of Drosophila melanogaster. Fourteen sets of 5 x 5 partial diallel cross experiments were made in the parental generation. The emigration activity per batch of 50 male and 50 female F1 progeny was scored with Sakai's population system. Sexual difference did not appear in the emigration activity in these experiments. A significant genotype x sex x set interaction was detected. The genetic variance components of emigration activity differed between sexes: In males, additive genetic variance of emigration activity was 0.0497 +/- 0.0092 and dominance variance, 0.0018 +/- 0.0046; in females, additive, 0.0373 +/- 0.0076 and dominance, 0.0169 +/- 0.0044. Additive genetic correlation between sexes for the emigration activity was 0.685 +/- 0.150, deviating significantly from unity. These results suggested that the genes affecting emigration activity would operate differently between sexes of D. melanogaster in natural populations.


A novel cDNA clone for acid invertase in tomato fruit. The sequence of a novel cDNA clone, Aiv-1, for tomato acid invertase was similar to that of TIV1 (Klann et al., 1992) for the enzyme except for a unique intron-like insertion. It is considered that Aiv-1 is derived from either an alternatively spliced mRNA for an isozyme or a pre-mRNA of TIV1.


Health-related behaviors in Korea: smoking, drinking, and perinatal care. The prevalence of major health-related behaviors and the relationship of these factors with selected sociodemographic factors were studied in South Korea. Subjects studied were household heads and their wives from 989 households. Age-standardized prevalences of smoking were 74.8% and 2.9% for men and women respectively, with no urban-rural difference. There was a tendency of younger or less-educated men smoking more heavily. The prevalence of use of alcoholic drinks were 79.8% and 26.0% for men and women respectively. More drinking was associated with a younger age and higher level of education. The mean prevalences of prenatal care, clinic or hospital delivery, and breastfeeding were 75.0%, 62.6%, and 75.2% respectively in the urban area, whereas the corresponding rates were 63.0%, 50.9%, and 81.1% in the rural area. Higher rates in prenatal care and hospital delivery were associated with a younger age and higher educational level, while breastfeeding showed the opposite trend.


AIDS awareness amongst school teachers in a rural area of India. One hundred and eighty-two teachers from a random selection of 15 schools in a rural area of Lucknow district of northern India were interviewed to assess their awareness and knowledge about AIDS using a pretested CARC proposed questionnaire. Observations revealed that only 79.7% of the teachers had heard about AIDS, newspapers being the main source of information. Awareness amongst graduate teachers was significantly higher than non-graduates. Many believed AIDS to be mosquito-borne and less than 2% knew that condom usage make sex safer. The study reveals the need to undertake intensive health education efforts as school teachers are an important source of health-related information for rural populations.


Utilization of medically-trained birth attendants in rural Bangladesh. Using case-control methodology, this study compared the characteristics of women who requested medically-trained birth attendants at home with those who did not, in order to identify constraints to service delivery and suggest program changes to increase service utilization in a rural area of Bangladesh. By several different measures, prior contact with medical professionals were much more common among cases than controls, with the greatest differences observed in the frequency of antenatal visits. At least one antenatal visit was the strongest predictor that a woman would call a medically-trained birth attendant, though primiparity, proximity to the provider, previous contact with the clinic, and education (both of the mother and her spouse) were also predictive. Recommendations include increasing contact through antenatal visits, and extending midwife coverage through training and supervision of traditional birth attendants. This study demonstrates the usefulness of case-control methodology in evaluating health care utilization.


Factors contributing to the severity of childhood pedestrian injury in Perth, Western Australia. Pedestrian-motor vehicle collisions that involved children aged 0 to 14 years in Perth, Western Australia were examined for the period 1980-1989 in order to identify factors which contribute to the severity of injury. Nearly half (49%) of the 1,282 children injured during this period required hospitalization, with a further 46% of the children requiring some form of medical treatment. Multivariate analysis indicated that children aged 0 to four years had a higher risk of sustaining a severe injury compared with children aged five to nine and ten to 14 years, with relative risks of 1.6 and 1.7 respectively. A greater proportion of more severe injuries occurred after 3 pm. Injuries tended to be more severe when the collision occurred on a highway or main road, and when the child was actually on the road at the point of impact. Further research on more comprehensive datasets, which consider the child's behavior at the time of injury as well as driver attributes, will provide greater insight into factors contributing to the severity of injury.


Perinatal outcome amongst the Malays in an urban hospital. National data show that the perinatal mortality amongst the Malays is higher than that of the Chinese but less than that of the Indians. These figures include data from both urban and rural areas. In the University Hospital, Kuala Lumpur, however, the perinatal mortality amongst the Malays was found to be the lowest; an odds-ratio of 0.72 (95% confidence limits; 0.59-0.87; P < 0.0005) when compared to the non-Malays. This occurred despite a significantly higher parity amongst the Malays. The Malays in this group of patients however, had a significantly better social class distribution.


Factors affecting the duration of breastfeeding in a rural population of Saudi Arabia. A study was conducted to demonstrate factors influencing duration of breastfeeding in Al-Jamoom Western region of Saudi Arabia. Information was obtained on 476 children under the age of three years and their mothers in nine of the villages in this area. A predesigned questionnaire was administered to the mothers to obtain information on age, education, fertility parameters and antenatal care during pregnancy with the index children. Multiple regression analysis was used to analyze the effect of different biological and environmental factors on the duration of breastfeeding. The data showed that over 57% of the mothers breastfed their children for more than a year, and the mean duration of breastfeeding was 14.61 +/- 3.53 months. A considerable proportion of the mothers (42.3%) stopped breastfeeding during the first year. The most common reason for terminating breastfeeding during the first year was insufficient milk (30.9%), and recurrence of pregnancy (27.3%). A minority of the mothers (6.5%) were given advice about breastfeeding by health care professionals (physicians and nurses). Other factors such as the age of the mother, age of the infant when a supplement diet was first introduced, birth order of the child and attendance in an antenatal care clinic had a significant effect on the duration of breastfeeding. It is therefore recommended that Maternal and Child Health services must be strongly reinforced in the Primary Health Care Centers of the Ministry of Health and other health care providers.


Community demonstration programs for cardiovascular disease prevention: the Asia-Pacific experience. Cardiovascular diseases are an important and increasing cause of death in many countries in the Asia-Pacific Region. Formal demonstration programs for the prevention of cardiovascular disease are few in number and not likely to be widely used in the future. Prevention programs focused on key risk factors are widely used in the Region and have been successful. Smoking prevention remains a high priority for all countries in the Region.


The sampling design for the Korean National Nutrition Survey. Korea has been conducting the National Nutrition Survey annually since 1969. Due to the magnitude and budget of the survey, its sample size was limited to 1,000. Since 1989, however, the government has increased the size to 2,000. We developed a new sampling design suitable when budget is limited and cases to be covered are relatively very small, which has been in use since 1987. The outline of the design is introduced. Basic sampling method adopted was Probability Proportional to Size (PPS) sampling. Using the Enumeration Districts (EDs) as primary sampling units (PSU), we selected 300 EDs and constructed six identical sample sets, each having 50 ED's. From each ED, we selected 20 households. Therefore, one set has 1,000 households. Currently, two sets are being used for the survey.


Oesophageal reconstruction using the stomach. Between January 1975 and December 1989, the Cardiothoracic Unit of the University College Hospital, Ibadan (U.C.H.) carried out 47 oesophageal replacement procedures using the stomach. The ages of the patients ranged from 3 to 75 years (mean = 53.2 +/- 19.3 years). There were 24 males and 23 females. The indications for oesophageal replacement were as follows: Carcinoma of the oesophagus--34 patients (73.9%), Corrosive stricture--9 patients (17.4%), peptic stricture--1 patient (2.2%), granulomatous oesophageal lesion--1 patient (2.2%), submucous cysts--1 patient (2.2%), oesophageal perforation--1 (2.2%). Twenty patients (58.8%) with oesophageal carcinoma died between 9 and 33 days after operation. The patients with oesophageal perforation, granulomatous lesion and submucous cysts died from sepsis 8, 13 and 6 days respectively after operation due to anastomotic leak. Three patients with corrosive stricture (24%) died 10, 13 and 15 days respectively after operation. All the other 21 (54.7%) patients survived with good results as judged by the absence of dysphagia. Eight of the fourteen surviving patients with carcinoma are lost to follow-up and are presumed dead. There were two intra-operative deaths (4.3%). The operative approaches used were: Transthoracic (21 patients; 9 deaths), Transhiatal oesophagectomy (14 patients; 9 deaths) and retrosternal route (12 patients; 8 deaths). In terms of morbidity, more complications were observed with the transhiatal oesophagectomy (Orringer's technique). It is concluded that whereas oesophagoplasty with the stomach offers good results in patients with benign strictures, the results with carcinoma of the oesophagus in our environment is poor.


Trends in the supply of oxygen in hospital--oxygen concentrators--Korle Bu experience. The supply of Oxygen to hospitals in the West African subregion has been irregular for decades. This has added to the frustrations of Anaesthetists in the subregion. The availability of devices that absorb Nitrogen from the atmosphere, leading to an end product of high O2 concentration, appears to be the answer to chronic oxygen shortages in the developing countries. Korle Bu Hospital, Accra, has been producing its own oxygen within the hospital since 1986. Oxygen Concentrators are recommended as a solution to a chronic problem.


Normal levels of glycosylated haemoglobin in pregnant Nigerian women. Total glycosylated haemoglobin (HbA1) was measured in 16 healthy non-pregnant Nigerian women and in three groups of healthy women at various times during pregnancy. There was a statistically significant decrease in HbA1 in the first trimester. The values progressively increased thereafter and by term, the values were comparable to those in non-pregnant controls. The values were identical to those reported for caucasian women at similar stages of pregnancy.


Causes of mortality in drunkenness offenders followed-up for 2 years. Causes of death in 8 of 235 drunkenness offenders each followed up for two years, have been described. The subjects followed up were a heterogenous population of alcohol abusers. The majority were alcohol dependent irregular heavy drinkers. The main causes of death were suicide, road traffic accident, domestic accident, liver cirrhosis, hypothermia (from exposure) and ischaemic heart disease. More than one cause of death was listed in all cases. Chronic alcoholism was frequently listed. Depression was another sub-ordinate cause of death. The overall observed rate of mortality was 30 times the expected rate which was many times higher than those reported by earlier workers for alcoholics generally. These findings were discussed and it was concluded that drunkenness offenders are a particular at risk sub group of alcoholics. In view of the appreciable post mortem blood alcohol levels, it was further concluded that chronic alcoholism and the actual state of being drunk were the two major causes of death in this group of alcohol abusers.


Aetiology of status epilepticus in Ibadan: a neuropathologic study. In this neuropathologic study of 41 cases diagnosed as status epilepticus (SE) over a 10-year period at the University College Hospital, Ibadan (UCH), we found that the commonest cause was infection of the central nervous system (17 cases). The other aetiologic factors were: metabolic derrangement/toxic (14 cases) and cerebrovascular disease which was the most frequent cause in subjects above 12 years of age. It was encountered in 6 cases. Space occupying lesions which involved the frontal lobes were found in 4 cases. The conditions associated with the disease at death were: cerebral oedema, pulmonary oedema; pulmonary consolidation and pulmonary embolism. Our findings highlight the importance of looking for treatable conditions in patients presenting with this grave condition in this environment.


Assessment of anthropometric measurements, blood analytes and liver enzymes in Ghanaian alcoholics. Anthropometric measurements of alcoholics and non alcoholics of similar economic background were compared and the results reveal that there are no marked differences between the two. However, the biochemical analyses indicates that alcohol predisposes to fat storage, may contribute to iron deficiency and plays a direct etiologic role in liver disease.


Clinical trial of sulbactam/ampicillin in the treatment of typhoid fever, and in-vitro sensitivity of isolates to sulbactam/ampicillin and chloramphenicol. A trial of Sulbactam/Ampicillin in treatment of typhoid fever was carried out while in-vitro sensitivity of the drug was compared with chloramphenicol. Sulbactam/Ampicillin was found to be effective in 11 out of 12 patients who received the drug. The 1 patient who failed to respond had intestinal perforation with peritonitis. No side effects were encountered. The in-vitro study showed that 91.7% of the isolates were sensitive to sulbactam/ampicillin compared to 75% sensitivity to chloramphenicol. The difference was however not statistically significant (P < 0.05). It is concluded that sulbactam/ampicillin is effective and safe in the treatment of typhoid infection.


Glucose tolerance in psychiatric patients. The relationship between glucose tolerance and psychiatric disorders is controversial. Most of the reports which have emanated mostly from North America have found either increased prevalence of diabetes amongst psychiatric patients or no relationship between psychiatric disorders and diabetes. In this study, we screened psychiatric outpatients and performed a standard oral glucose tolerance test in 29 of them. Of 59 patients studied, one was diabetic and two were found to have impaired glucose tolerance. Amongst those subjected to OGTT indices of glucose disposal were either as good as in the controls or were better than in the control subjects even though the psychiatric patients were generally more obese. Results from this study do not support the suggestion that there is increased impairment of glucose tolerance in subjects with psychiatric disorders at least in the Nigerian Africans that were tested. The improved disposal of ingested glucose in the patients is likely to be related to some of the antipsychotic drugs particularly chlorpromazine. The number of subjects tested is however small and more subjects especially those yet to be started on antipsychotic drugs will need to be studied to define in greater detail the relationship between the prevalence of glucose intolerance and psychiatric disorders in the African.


Ventriculo peritoneal shunts in children. A ten year experience at the University of Nigeria Teaching Hospital, Enugu-Nigeria. In a ten year period (1977--1986) one hundred and fifty children with hydrocephalus who received ventriculo-peritoneal shunt as their modality of treatment were followed up. Seventy-one per cent of these children were neonates and infants, the majority of them presenting within the first 3 months of onset of symptoms and signs. The major causes of hydrocephalus in these children were congenital malformations, meningitis, tumours and trauma. Pudenz shunt systems were favoured in the 1977--81 period, while 1982--86 period witnessed an upsurge of self devised catheters because of dwindling national economy. The latter were cheaper and more readily available. Apart from blockage of shunts which occurred more in self devised catheters, the performance of these catheters in terms of shunt infections and other complications were same in both self devised and conventional catheters. The main complications encountered were blockage and infection of the shunts, while rare complications included migration and extrusion of shunts to and from the peritoneal cavity, CSF ascites and recurrent abdominal cysts.


Possible contribution of free radicals and lipid peroxidations on pathogenesis of post-ischemic brain damage. It has been widely accepted concept that peroxidate decomposition of membrane lipids contribute cellular damage in cerebral ischemia, and varieties of putative cascading reactions has been proposed in this regard as the underlying detrimental processes. But little is known about existence and significance of the blood born chemical mediator. In this communication, the authors tried to emphasize the prospective role of leukocyte invasion to the ischemic brain tissue. Effectiveness of some clinically applicable antioxidants against ischemic brain damage was also discussed.


Oral treatment of candida vaginitis: experience at the Special Treatment Clinic University College Hospital, Ibadan, Nigeria. Seventy-four patients with clinical and laboratory diagnosis of candida vaginitis at Special Treatment Clinic, U.C.H., Ibadan were treated with daily dose of 400mg Ketoconazole (Nizoral) for 5 days. Forty had primary infection and 34 (46.0%) had recurrent infection. Vaginal skin infection, discharge, vulva pruritus and dyspareunia were the key symptoms and signs. Follow-up showed disappearance of findings a week following treatment except vaginal infection which was still present in 2 (2.9%) patients. Four weeks after treatment, 4--7% of the cases had one symptom or the other but more experienced dyspareunia. Mycological tests showed positive results in wet smear examination in 6.7%. Nevertheless, 80% of the 34 with recurrent infection preferred oral treatment to topical vaginal applications which they had had in the past. The implication of this result in treatment of acute and chronic vaginal candidosis in our community is discussed.