Diabetes in Mexico--a serious and growing problem. According to a recent national health survey, the prevalence of self-reported diabetes in Mexico is 1.2%, but this figure reflects the relative youth of the Mexican population. Age-specific estimates are similar to those for the United States of America, where crude prevalence is higher. Given that self-reporting usually underestimates prevalence by at least 50%, there may be as many as 1.7 million persons with diabetes in Mexico, with a prevalence of approximately 6% in the age range 30-64 years. The average age at death for Mexicans with diabetes is 57 years, compared to 69 years for the population as a whole. Diabetes is the fifth most important cause of death in the Mexican population, and the third cause in people over 45 years of age, in whom it accounts for 10% of all deaths. There is evidence for important increases in diabetes-related mortality over time. Most studies indicate high rates of complications in Mexicans with diabetes and data show that their average length of hospital stay is almost twice as long as for non-diabetic patients. The annual cost of diabetes to Mexican society may be estimated at US$ 15 million for metabolic control, US$ 85 million for additional health services and US$ 330 million for indirect costs--in total, approximately three-quarters of all government spending on health care, or approximately US$ 450 per known diabetic person per year.


Recent developments in the epidemiology of diabetes in the Americas. The prevalence of diabetes recorded in population surveys in the American region varies from < 1% (rural Mapuche Indians aged 20 years and over, Chile) to almost 50% (Pima Indians aged 20 years and over, United States of America). The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) was approximately 2.5 times higher among Mexican Americans than in non-Hispanic white Americans. In the Mexican Americans, prevalence followed a sociocultural gradient: 16% in low-income barrios, about 10% in middle-income neighbourhoods and 5% in high-income suburbs in San Antonio, Texas. Data from the Hispanic Health and Nutrition Examination Survey indicate prevalence of diabetes in the age range 45-74 years of 24% for Mexican Americans, 26% for Puerto Ricans and 16% for Cuban Americans, compared to 12% for non-Hispanic whites. Figures for a low-income district of Mexico City show a 36% lower prevalence than for Mexican Americans in the USA. Prevalence in Brazil is approximately 7% in subjects aged 30-69 years. Black Americans have a relatively high prevalence of NIDDM, though not as high as the Mexican Americans. There is evidence that complications of diabetes may vary between populations, and that they may be particularly severe in Mexican Americans, and higher in black than in white Americans. The extent to which these differences relate to access to health care and treatment remains to be clarified.


Recent developments in diabetes epidemiology in Europe. Recent developments in diabetes epidemiology in Europe have included the completion of the European Community sponsored Concerted Action on the Epidemiology and Prevention of Diabetes (Eurodiab), further studies of diabetes and coronary heart disease prevalence in ethnic minority groups in the United Kingdom, and studies of the effect of poor fetal and early post-natal nutrition on the risk of developing non-insulin dependent diabetes (NIDDM). The EURODIAB Concerted Action Programme has provided valuable new information on the incidence of insulin-dependent diabetes mellitus (IDDM) throughout Europe and has drawn attention to an unexpectedly high incidence in Sardinia. In the EURODIAB IDDM complications study, the prevalence of both large- and small-vessel complications of diabetes has been examined, using standardized methods, in 3,279 IDDM patients from 31 centres throughout Europe. The data on risk factors for complications obtained from this study will have significant health policy implications for diabetes in Europe which will be utilized by the current St. Vincent Declaration Action Programme for Diabetes Care and Research in Europe. In another part of the EURODIAB Concerted Action Programme, important information has been obtained on the validity of routinely-collected diabetes health information, such as mortality statistics based on death certificates, and estimates of diabetes prevalence obtained from drug-utilization data.


Diabetes in the eastern Mediterranean region. Socioeconomic development and changes in lifestyles have been accompanied by the emergence of diabetes as a major problem in Eastern Mediterranean countries, but reliable epidemiological data are still scarce and comparability is generally poor. For non-insulin-dependent diabetes (NIDDM) in adults, risk is higher in urban than in rural subjects, and in all populations prevalence increases with advancing age. Whereas several surveys have reported prevalence of the order of 5%, a recent national survey in Oman, which used the full WHO criteria for diagnosis, based upon the 2 hour blood glucose concentration after a 75 g oral glucose load in all subjects, reported a prevalence of diabetes of 10% in those aged 20 years and over. A further 8% of men and 13% of women had impaired glucose tolerance (IGT). Insulin-dependent diabetes (IDDM) was reported to be considerably rarer in Kuwait than in Europe and North America, but some more recent data suggest variability in frequency within the region. IDDM is frequently accompanied by ketoacidosis at diagnosis. For NIDDM, 75% of cases are associated with obesity. Long-term complications appear to occur to the same extent as in Western countries. A recent WHO Task Force meeting has set goals and targets for diabetes prevention and control within the Eastern Mediterranean Region.


A model protocol for a diabetes and other noncommunicable disease field survey. Field surveys of diabetes and other noncommunicable diseases and their risk factors are increasingly being performed in both developed and developing countries. Although individual priorities and circumstances will influence survey design, a model survey manual and protocol is described which might assist investigators in formulating plans and preparing manuals for their own surveys. The model presented has been successfully used in developing countries, for both rural and urban communities, over more than a decade. It describes examples of survey objectives, and gives specific details of survey procedures and measurement techniques which may be utilized. It contains sufficient flexibility to allow its adaptation to local circumstances.


[Experiences with HELLP syndrome].

[Experiences with HELLP syndrome]. Between 1988 and 1991 thirty-nine pregnant women suffering from HELLP-Syndrome were treated in our hospital. A retrospective analysis of clinical course and of the changes in the relevant laboratory values was performed. The incidence of the HELLP-Syndrome at Freiburg University Hospital was 0.85% for all pregnancies or 17% of the patients with toxaemia. 90% of the women were primipara, there was no prevalence of a certain group. The clinical course was characterized by the perseverance of symptoms for more than two weeks in 18% of the cases and a perinatal mortality of 25%, the latter mainly due to prematurity of the infants. This suggests that perinatal mortality due to respiratory distress syndrome can be reduced by conservative and expectative management of these patients. However on the other side a high rate of caesarean sections (77%) and sometimes even induced abortions were necessary to avoid maternal mortality and severe pre-or postpartal complications for these women.


[Diagnostic and therapeutic problems in HELLP syndrome]. The HELLP syndrome is a severe and life-threatening complication of preeclampsia. Despite obstetricians are more aware of this syndrome maternal and perinatal mortality could not be reduced during the last years. The diagnostic problems of the HELLP syndrome are early detection of the disease, problems concerning differential diagnosis to other diseases with similar symptoms, and the different definition of the HELLP syndrome itself. For early detection of hemolysis determination of serum haptoglobin should be included in laboratory screening methods. Manifestation of DIG is not a principal sign of the HELLP syndrome but reflects a secondary pathophysiological process of the primary disease. Therefore administration of heparin and antithrombin III is not indicated and may lead to induction or amplification of life-threatening bleedings in these cases. Conservative approaches have shown to improve the fetal and maternal condition in individual cases, however, termination of pregnancy is the only definitive cure for patients with HELLP-syndrome. With respect to our perinatal results (n = 84) immediate delivery, predominantly by caesarean section, is recommended after diagnosis has been confirmed.


[Activity of ATP-dependent protease and steroid metabolism in the human placenta]. Placenta play the important role of nourishment of fetus and for the regulation of fetal and maternal steroid metabolism. Steroid metabolism is synthesized in mitochondria and levels of enzymes in steroid metabolism are regulated by the rate of synthesis and degradation of these enzymes. Therefore, we studied protease in human placental mitochondria to clarify regulation mechanism of steroid-synthesizing enzymes. 50 micrograms of human early and term placenta homogenate, proteins were analyzed by immunoblotting technique after SDS-polyacrylamid gel electrophoresis. ATP-dependent protease was detected using antiserum raised against purified bovine adrenocortical ATP-dependent protease and avidin-biotin complex method. ATP-dependent protease activity was assayed using 14C-Caseins a substrate. Five cell fractions of homogenate placenta were electrophorated and antibody-stained using ATP-dependent protease, cytochrome P-450 scc and adrenodoxin antibody after the blotting, and the quantity was analyzed by the densitometry and the method of De Douve. We had the following results: 1) ATP dependent protease is present in human placenta and localized in mitochondria. 2) ATP dependent protease decomposes adrenodoxin reductase in human placenta. 3) ATP dependent protease present in almost same consistent in early and term placenta and there is no significant difference. It is suggested as follows that the ATP dependent protease in human placenta participates in the regulation of steroid hormone through the metabolism of steroid synthetic enzyme.


[Doppler ultrasound in monitoring twin pregnancies with early discordant growth]. Early growth retardation in one twin is complicated by a high fetal mortality and morbidity. It is often very difficult to determine the optimum time of delivery in regard to placental insufficiency and prematurity. We report of two cases in which doppler velocimetry was a helpful method in monitoring those pregnancies at high risk. A growth retardation of three weeks was found in one child of a twin pregnancy at 17 weeks of gestation. Doppler velocimetry at 23 weeks showed a reverse flow and centralisation and the child died at 27 weeks. The other twin then also developed pathologic flow patterns and had to be delivered by cesarean section. In the second patient, pregnancy could be continued in spite of a growth retardation of three weeks in one child at 15 weeks and an additional decrease in the growth rate of both children from 30 weeks onwards. Cesarean section had to be performed at 34 weeks because of premature rupture of membranes.


[Morphologic placenta findings in clinico-serologically verified and suspected rubella infection in the 2d half of pregnancy]. Rubeola is the congenital infection with the highest rate of embryonal damage. The hematogenous transplacental way of infection also causes morphological changes at the vessels of the placental villi. We examined 38 placentas from up to the 44th week of gestation and the fetus and children belonging to them. We regarded the clinical and serological findings. 6 out of 16 placentas from up to the 18th week of gestation (37.5%) showed endangitis obliterans. Two cases showed changes of the lenses. (Group I). In 10 out of 12 cases from the 19th to the 36th week of gestation (Group II) we found morphological changes in the vessels of the placental villi. The children belonging to them showed nonspecific malformations. From the 37th week of gestation (Group III) half of the placentas was histologically conspicuous. The children did not show malformations specific for rubeola. We refer to the possibilities and limitations of performing light microscopic diagnosis in placenta when there is the suspicion of rubeola infection, intrauterine death of the fetus and postnatal delay of the child's development.


[Umbilical blood flow indices in smoking women]. A collective of 154 pregnant women, who smoked at least 5 cigarettes a day was examined by doppler ultrasound. Measurements were taken at the two ends of the umbilical cord. The results had been compared to the physiological constellation of the resistance indices. Elevation of the PI was mainly to be registrated at the fetal abdominal insertion of the umbilical vessels. It seems to be dependent on the duration and amount of smoking. There was no correlation to be found to the fetal outcome.


[Vaginal ultrasound in puerperium. Cervix and lower uterine segment on the 1st p. p. day and uterus 6 weeks post partum]. In this study it was tried to demonstrate the involution of the puerperal uterus vaginosonographically. A collective of 54 patients with uncomplicated delivery and afebrile, inconspicuous puerperium was vaginosonographically examined on the 1st day postpartum and also 6 weeks post partum. To describe the uterus in its whole entity on the 1st day post partum an abdominal sonography was carried out too. The vaginosonographic examinations showed on the 1st day post partum an average cervical length of 40.7 +/- 8.4 mm, a width of 31.2 +/- 4.0 mm and an internal os of 5.6 +/- 3.0 mm. The width of the lower uterine segment was 15.7 +/- 7.7 mm. The control examination after 6 weeks result in a cervical length of 31.2 +/- 4.0 mm, a width of 28.2 +/- 3.9 mm and an internal os of 3.1 +/- 1.1 mm. The reformation of cervix occurs rapidly and can be seen even on the first day post partum.


[Detection of toxoplasma-specific IgA and IgM antibodies in serum samples of adults with acquired toxoplasma infection]. In a study of persons with and without toxoplasmosis, IgA-ISAGA (immunoglobulin A-immunosorbent agglutination assay) was found to be specific. However, serum samples from subjects recently infected wtih toxoplasma were less reliable than the DNR test (IgM-ISAGA by the original method, 1981) and the IgM-IIFT. On the other hand, some serum samples from persons infected for up to a year or longer were IgA-positive. The IgA-ISAGA should therefore not be included in serodiagnosis in pregnancy as a substitute for IgM-ISAGA or IgM-IIFT, but, if at all, in addition to them.


[Asymptomatic ablatio placentae].

[Asymptomatic ablatio placentae]. A 34 years old woman was admitted to our hospital with a retroplacental hematoma of more than 50% of placental area. It was diagnosed by routine pregnancy screening. The patient had no pain, bleeding or other clinical symptoms. 24 hours after inducing fetal lung maturation by betamethasone delivery was terminated by caesarean section in the 32nd week of gestation. Though the diagnose was confirmed by operation there was no influence of fetal outcome. The management of symptomless ablatio placentae is discussed by literature. Termination of pregnancy should be related the gestational age.


The role of membrane properties, synaptic input and electrical junction in determination of spike output of a pair of peptidergic neurons in the mollusc Lymnaea stagnalis. The two electrotonically coupled peptidergic neurons, VD1 and RPD2 show in the isolated central nervous system (CNS) a patterned activity. The cells fire in almost perfect synchrony in CNS's derived from animals of moderate age, while in old animals disturbances in synchrony are observed. The firing pattern varies from beating to bursting. Isolated VD1's show a beating firing pattern, indicating that the cell possesses pacemaker properties, while the isolated RPD2 is almost always silent. Hybrid current/voltage clamp experiments show that in the intact CNS spike generation in the two cells is due to VD1, indicating that the pacemaker properties of VD1 constitute the main driving force for the firing rhythm of the two cell system. In low calcium/high magnesium solutions the rhythm is a beating one, while in solutions which do not suppress synaptic input, sometimes a bursting pattern is observed. The idea that the bursting pattern is due to synaptic modulation of these cells is corroborated by the observation that application of certain transmitters induces a very prominent burst of activity in these neurons. These bursts are very reminiscent of the bursts, observed in semi-intact preparations, which are accompanied by penumostome movements. Increase in coupling resistance, which occurs at older age, is accompanied by irregularities in firing rhythm. Apparently the electrotonic junction is essential for the patterned output of the two cell system.


Vanillin modulates the fast outward and calcium currents in Helix neurons. A study was made to characterize the actions of vanillins on the resting membrane potential, action potential, membrane resistance and membrane ionic currents of identified Helix neurons. Two types of neurons can be classified according to the actions of vanillins. One type of neurons are the L and RPa 1-3 cells. Vanillin slightly depolarized these cells and moderately prolonged the action potential duration while increased the membrane resistance and initiated spontaneous spiking. Under voltage clamp, vanillin decreased the leak current, moderately suppressed the amplitude and decreased the time constant of decay of the A-currents in dose-dependent way (Kd = 5mM, nH = 0.6). The delayed outward currents were not influenced by vanillins. Vanillin decreased the plateau potential of the Ca-spike in Na-free TEA solution and decreased the peak Ca-currents under voltage clamp. Second type of neurons are some pacemaker cells around the RPa burster. Vanillin caused a burst-like transformation of the beating activity followed by slowly developing presynaptic activation. The most characteristic action of vanillins on these cells is a long-lasting enhancement of the Ca-currents under voltage clamp.


Peptidergic regulation of muscle movements in a prosobranch mollusc, Rapana thomasiana. Peptidergic regulation of the contraction of radula muscles and the heart beat in a prosobranch mollusc, Rapana thomasiana was investigated. In the radula muscles, FMRFamide-related peptides were suggested to act on presynaptic sites to enhance their contraction elicited by nerve stimulation, possibly by increasing the release of a main transmitter. A catch-relaxing peptide (CARP) was demonstrated to depress the contraction by acting on postsynaptic sites. In the heart, FMRFamide enhanced the amplitude and frequency of the beat, whereas CARP depressed it. Immunohistochemical studies of the buccal ganglia have revealed that FMRFamide- and CARP-like immunoreactive neurons are distributed in the same region, indicating a possible coexistence of the both peptides. In the visceral ganglia, on the contrary, coexistence of FMRFamide and CARP was not observed. FMRFamide- and CARP-like immunoreactivities were also detected in the nerve fibers in the radula muscles and the atria. The present results show that FMRFamide- and CARP-like peptides are involved in the regulation of the contraction of radula muscles and the heart beat.


The roles of local interneurons in the processing of olfactory information in the antennal lobes of the moth Manduca sexta. The antennal lobe (AL) of the sphinx month Manduca sexta is characterized by a typically glomerular neuropil and two principal classes to neurons local interneurons and projection neurons. The somata of these neurons reside in defined neural cell-body groups in the AL, and the neurons exhibit characteristic patterns of innervation of the glomeruli. Evidence gathered to date indicates that individual antennal olfactory receptor-cell axons project to single glomeruli in the ipsilateral AL and make excitatory, apparently cholinergic synapses with neurites of AL neurons (usually local neurons) innervating the target glomeruli. Much has been learned about the physiology of the projection neurons, but only recently have the physiological properties and functions of the local interneurons been examined systematically through the use of intracellular recording and staining methods. Immunocytochemical studies have shown that most of the local interneurons contain GABA as well as one or more putative neuropeptides. Physiological, pharmacological, and biochemical experiments support the view that GABAergic local interneurons are responsible for inhibitory synaptic inputs to projection neurons that predominate in shaping the activity of projection neurons conveying synaptically processed olfactory information to higher-order centers in the protocerebrum.


Diversity in tachykinin-like peptides in the insect brain. When testing a large number of antisera against tachykinins of various vertebrates and one insect (the cockroach Leucophaea maderae) we found three distinct populations of tachykinin-immunoreactive neurons in the blowfly: (1) one recognized by antisera against substance P, (2) another by antisera against the frog peptide kassinin and (3) a third with antisera raised against the cockroach peptide Leucokinin I. As a comparison tests on the cockroach Leucophaea showed that only antisera against neurokinin A (NKA) and leucokinin I gave immunostaining, RIA and immunocytochemical displacement tests demonstrated that the each of the three listed types of antisera was specific for the corresponding antigenic peptide and showed virtually no cross reactivity with the other tachykinin peptides. By immunocytochemistry we have mapped the three populations of tachykinin-immunoreactive neurons in the blowfly CNS. Two constitute unique sets of interneurons that were previously not detected with other antisera, the third, recognized by antisera against substance P, is a subpopulation of the FMRFamide immunoreactive neurons. The leucokinin immunoreactive material in the blowfly seems to be chemically different from that in Leucophaea and also the sets of neurons immunolabeled in the two insect species are to some extent different. The preliminary results presented here indicate the presence of multiple forms of tachykinin-like peptides in the blowfly and that these are distinct from those in the cockroach. From the immunocytochemistry it appears that the insect tachykinins may be involved in a variety of regulatory functions in the CNS and in some cases possibly act as neurohormones.


Evidence for octopaminergic nature of peripherally projecting DUM-cells, but not DUM-interneurons in locusts. In locusts, a median neuroblast in each segmental ganglion gives rise to numerous unpaired progeny--the well known peripherally projecting dorsal-, occasionally ventral-, unpaired median (DUM-, resp. VUM-) neurones together with the lesser known DUM-interneurones 12. We examine the reputed octopaminergic nature of this nerve cell lineage using an anti-octopamine serum recently developed by M. Eckert and J. Rapus 7. This antiserum labels in each segmental ganglion numerous midline neurones, identifiable as DUM- and VUM-cells by their some sizes and positions, projections in DUM-tracts and characteristic T-junctions with bilaterally projecting axons. All octopamine immunoreactive DUM-, and VUM-neurones appear to project to peripheral nerves; their numbers correspond to the number of peripherally projecting DUM- and VUM-neurones identified so far in the examined ganglia. Presumptive DUM-interneurones, i.e. smaller somata interspersed between the peripherally projecting DUM-cells are not octopamine immunoreactive, but, confirming other studies 25, display GABA-like immunoreactivity. We thus suggest, that of the whole DUM-cell population in the examined ganglia, all and only peripherally projecting DUM-neurons are octopaminergic.


The octopaminergic system within the ventral nerve cord of the American cockroach. Octopamine-immunoreactive neurons within the ventral nerve cord of the cockroach, Periplaneta americana, were mapped with a new anti-octopamine serum. The specificity of this antiserum was demonstrated by dot blot immunoassay and by comparing the immunocytochemical staining patterns obtained after incubation with anti-dopamine and anti-octopamine serum. Putative octopaminergic dorsal and ventral unpaired median (DUM resp. VUM) neurons showed octopamine-like immunoreactivity in all ventral ganglia. The numbers of DUM cells in the mesothoracic, metathoracic and terminal ganglia of females correspond to those previously characterized by retrograde staining 19, 33, 34. It could be shown that besides segmentally projecting there are also intersegmentally projecting DUM neurons within the thoracic ganglia. In addition various, previously unknown, paired octopamine-ir cells were revealed in all ventral ganglia except the abdominal ganglia 2-5.


Immunocytochemical and electrophysiological investigations of central neurones in the parasitic nematode Ascaris suum. Here we report on preliminary investigations into the morphological, neurochemical and electrophysiological characteristics of central neurones in the parasitic nematode Ascaris suum. The neurones do not display all or none action potentials and apparently have low resting membrane potentials. Neurones have been shown to respond to acetylcholine. Immunoreactivity to a diverse range of neuropeptides has been demonstrated.


Immunohistochemical study of the nervous system in earthworm (Lumbricus terrestris L.). In the present work it we describe serotonin, noradrenaline, proctolin, neuropeptide Y, substance P, and calcitonin gene related peptide immunoreactive structures in earthworm. A few large serotonin immunoreactive perikarya are located in brain and in the stomatogasric ganglia and many of them in the segmental ganglia. A serotonin immunoreactive fiber plexus can be seen beneath the epithelium of the body wall, both the sensory papillae and chaetae contain serotonin immunoreactive elements. Some of the sensory cells are serotonin immunoreactive, too. A serotonin immunoreactive network can ben found in the enteric network of the fore- and mid-gut. Only a few noradrenaline immunoreactive cells are observed in the caudal part of the brain, while their number in the segmental ganglia is high. Proctolin-, and substance P immunoreactive cells are small and numerous in the brain without any preference in their location. Such nerve cells are widely distributed in the ganglia of the stomatogastric system, in the subesophageal and in segmental ganglia. Many surface epithelial (probably sensory) cells are proctolin immunoreactive. Substance P immunoreactive nerve cells can also be located in the entire length of the enteric plexus together with substance P immunoreactive fibers. No neuropeptide Y- or calcitonin gene related peptide immunoreactive structures can be seen in the brain. A relative small number of neuropeptide Y- and calcitonin gene related peptide immunoreactive perikarya, and a rich network of neuropeptide Y- and calcitonin gene related peptide immunoreactive fibers can be detected in the subesophageal ganglion. According to preliminary studies, neuropeptide Y is probably co-localized with serotonin.


Sensory receptors in the head of Stenostomum leucops. I. Presumptive photoreceptors. General body sensitivity to light is present in Stenostomum leucops, expressed as increased activity and locomotion of resting animals by exposure to light. The sensory structures involved have not been identified so far. The head of S. leucops bears sensory cells in the ciliary pits, along the epithelium and in connection to the brain lobes. Two types of presumptive photoreceptor, quite distinct from eyespots, are found. The first type, a pair of ciliary lamellate bodies, is found on both sides of the worm between the ciliary pits and the anterior brain lobes. Both cells contain an internally ciliated vacuole. The sparse lamellae are derived from membranes of more than 20 milia, most of them consisting of a typical 9 + 2 axoneme pattern. The cells are connected to brain ganglia by nerve fibres, but there are no connections to the surface. No pigment cups are observed, either. The second type, two cells with light-refracting bodies, is observed more posteriorly, near the dorsal surface and in close nerve connection to the posterior brain lobes. Both cells contain numerous (20-30) refractile, round or ovoid granules of various sizes. They form a cup-shaped structure to one side of the cell, the concave surface directing forward. The granules resemble lipid spheres under the electron microscope. In addition to comparable similarities with presumed photoreceptors in other platyhelminths, the photoreceptive function of the ciliary lamellate bodies and light-refracting bodies was tested using tritiated thymidine ([3H]T) vitamin-A autoradiography. No specific labelling, however, was observed in these cells nor in other sensory cells in S. leucops.


Immunoreactive cytokines in Mytilus edulis nervous and immune interactions. We review evidence that an immune and nervous system linkage exists in invertebrates similar to that shown in vertebrates. Immunoreactive cytokines appear to play a role in this interaction. We have demonstrated that M. edulis, a marine bivalve mollusc, reacts to the vertebrate monokines interleukin-1, -6 and TNF. We have also demonstrated endogenous immunoreactive interleukin-1, -6 and tumour necrosis factor in M. edulis hemolymph, immunocytes and pedal ganglia. Our findings suggest an important common signalling mechanism that has been conserved over 500 million years of evolution.


Soluble and membrane-bound Met-enkephalin degrading peptidases in Mytilus edulis hemolymph. Recent reports have provided strong evidence indicating that Met-enkephalin is serving as a neuroimmune modulator. It acts as a bidirectional signal molecule in transmitting message between the endocrine system and the immune cells in the circulating fluid. In this study, we investigated peptidases which are capable of degrading Met-enkephalin in the hemolymph fluid and hemocyte membrane. Our results showed that aminopeptidase is present at a high level in the fluid and a low level in the membrane. Carboxypeptidase is not present in the fluid but it is present at a level higher than that of aminopeptidase in the membrane. Either ACE or neutral endopeptidase is also present in the hemolymph fluid and hemocyte membrane. Functional role of these peptidases in the overall scheme of the neuroimmune mechanism is currently under investigation.


Proopiomelanocortin-derived peptides as tools of immune evasion for the human trematode Schistosoma mansoni. Schistosomes are digenetic trematodes which share their life cycle between a definitive (vertebrate) and an intermediate (invertebrate) host. Their survival is highly dependent on their ability to reduce significantly the efficiency of the host defences. We have previously demonstrated the presence of POMC derived peptides (ACTH, alpha-MSH, beta-endorphin) in all stages of Schistosoma mansoni life cycle. Given the immunomodulatory properties of these peptides in vertebrates and invertebrates it has been postulated that they might be implicated in parasite immune evasion. We report the release of these neuropeptides during the cycle, associated with the inhibition by these peptides of the locomotory activity of immunocytes from both hosts, the hamster Mesocricetus auratus and the freshwater snail B. glabrata. The implication of these common signals in this new strategy of parasite adaptation is discussed.


Cytotoxicity and cell death: studies on molluscan cells and evolutionary considerations. In a previous study we demonstrated the presence of NK-like activity in the mollusc Planorbarius corneus. This activity can be ascribed to round hemocytes that have a morphology similar to that of vertebrate lymphocytes. We show here that this NK-like cytotoxicity is evident in serum-free culture medium. Moreover, the type of death induced by molluscan effector cells on their targets is probably similar to that induced by vertebrate effector cells, i.e. apoptosis or programmed cell death, as assessed by the protective effect exerted by 3-aminobenzamide when both types of effector cells were used.


Insect motion perception.

Insect motion perception. The first step in this work of reconstruction of a theory of insect vision was to demonstrate that visual behaviour relies on scanning by self-motion and apparently involves measurement of angular velocities of contrasts moving across the eye. The next step was to demonstrate that parallax is also significant as a way of segmenting the visual scene into separate objects. There followed a series of experiments to rule out the existing theory that motion perception depends on autocorrelation, and at the same time an alternative theory was developed. The new theory assumes that at the level of the optic medulla there are numerous parallel channels on each visual axis, representing different neurons, all looking out for their specific combination of signals. The combinations are formed by positive, negative or no-change temporal contrasts at two adjacent visual axes at two successive times, forming 3(4) = 81 possible templates. Simulation of this highly parallel system shows that it can represent the moving image in a compact form that would be adequate to explain what is known for motion and form vision (but not colour vision) in insects. Form, like colour, would be seen as the ratio of numbers of responses of particular templates, in the same way that colours are seen as ratios of responses of receptors for different wavelengths.(ABSTRACT TRUNCATED AT 250 WORDS)


Patterns of neural and behavioral activity in freely-moving Navanax inermis (Mollusca; Opisthobranchia). As part of an ongoing neuroethological study of complex behavior in the opisthobranch mollusc, Navanax inermis, I have extended the available gross anatomical descriptions and used cuff electrodes to obtain chronic recordings from whole nerves or connectives. The major anatomical findings concern a) finer branches of the pedal nerves, particularly P3C P4 and P5; b) the distribution of nerves from the abdominal and subintestinal ganglia; and c) a possible neurohaemal area of the supraintestinal ganglion. With cuff electrodes it has been possible to get good quality recordings (often with spikes in the mv range) during the full repertoire of sexual, predatory and cannibalistic behaviors. The high degree of cryptic neural activity and the fact that in Navanax behaviors are not mutually exclusive, make it difficult to identify one-to-one correspondences between behaviors and neural patterns, However, there is an apparent correlation between the activity of a very large unit(s) on P5 and an exploratory behavior, the Face-Down head posture when it is directed at the substrate rather than prey, or a conspecific.


Cerebral and buccal neurons involved in buccal motor pattern generation in Achatina fulica. In the African giant snail, Achatina fulica, two pairs of cerebral neurons, v-CDNs and Cls, and ten pairs of buccal neurons, Bls-B10s, were identified. B1-B6 and B10 were the excitatory motoneurons of buccal muscles. B7 and B8 innervated salivary ducts and B9 extended its axons to the cerebral ganglia although their functions were not clear yet. Serotonergic v-CDN exerted excitatory effects on various neurons in the buccal ganglia and had modulatory effects on buccal muscles. When v-CDN, Cl or B1 was continuously fired, each one could initiate and maintain the rhythmic motor activity (RMA) in the buccal ganglia of reduced preparation. Taste stimulation of the lip often elicited RMA. Nevertheless, v-CDN and B1 were not always excited by taste stimuli, and they appeared not to be critical elements in the generation of feeding rhythm. In contrast, Cl responded to taste stimuli with burst of spikes. Thus, C1 may play a role in taste-induced rhythm generation in intact animal.


Mating behavior in the pulmonate small melampus: can regeneration restore function? Previous anatomical observations have established that the penial complex of adult Melampus bidentatus is specifically reinnervated and that the penial complex itself can regenerate. This review describes experiments to determine whether a reinnervated penial complex and a regenerated penial complex can function in mating. The snails are not self-fertile, so the ability to transfer sperm, evaluated by production of fertile eggs, was the test of successful regeneration. Snails with nerve transections produced fertile eggs within the time-span expected for axonal regeneration to the target organ. Penial complex ablation interfered with sperm transfer for two egg-laying cycles but fertile eggs were laid within a time-span consistent with regeneration of a penial complex.


Heavy metal induced behaviour modulation in mussels: possible neural correlates. Filtering behaviour of bivalves can be monitored by recording the contraction and relaxation of the adductor muscles, which maintain the filtering activity by closing and opening of the shells having rhythmic and periodic pattern with a time scale of several minutes and hours. Heavy metals (Cu2+, Hg2+, Cd2+, Pb2+, Zn2+) applied into the water for one week cause a clear cut alteration in the adductor's activity characterized in general by changing of the duration of activity and rest. Threshold concentrations affecting the animal's behaviour were 0.005; 0.01 0.05; 0.1 and 10.0 mg/l, respectively. With increasing concentration the duration of activity could be reduced up to 10-20 per cent of the control at application of Cu2+, Hg2+ and Cd2+. Rest periods were also influenced by heavy metals. Wash-out in most cases restored the original activity, sometimes a reverse effect was observed. Since heavy metals, if present in the water, cause reduction of the level of 5HT and DA in the ganglia of mussels and they modulate the chemical sensitivity of molluscan neurons and influence the permeability of various ionic channels, it is suggested that heavy metal ions affect directly both transmitter metabolism and membrane excitability and this way alterations of basic neural mechanisms are responsible in the observed modulation of mussels' behaviour.


The Aplysia gill-withdrawal reflex revisited: components of the network. Attempts to understand how changes at identified synapses contribute to the behavioral changes that constitute learning in the GWR have been complicated by the complexity of gill innervation. In addition to the well-studied circuit between siphon sensory neurons and identified gill motor neurons of the PVG, both PNS and as yet unidentified CNS pathways are also involved in the control of gill movement. In this study we combine an anatomical study of the PNS with physiological and behavioral analyses of the CNS's contribution to the GWR. We tested the possibility that altering the activity of an identified gill motor neuron is sufficient to alter the GWR. The results show that altering activity of GMNs has no demonstrable effect on the GWR in the suppressed behavioral state. Furthermore, activity in identified MNs may vary in response to a uniform stimulus and is not a good predictor of gill behavior. Immunohistochemical staining in gill and siphon showed discrete and well localized serotonin and SCPB-like reactivity. This is the first report of serotonin and SCPB-like immunoreactivity in the PNS of Aplysia siphon.


Dynamic changes in neuronal volume resulting from osmotic and sodium transport manipulations. Electrophysiologic parameters such as input resistance and response to microperfusion of neurotransmitters vary under circumstances where neurons from isolated ganglia of Aplysia californica are subjected to either long-term (several hours) blockade of active sodium transport or to hypo- or hyperosmotic solutions. Since one of multiple possible events under these circumstances is neuronal volume changes, we have developed a system using cultured Aplysia neurons and confocal scanning laser microscopy to directly monitor cell volume when the osmolarity of the perfusing solution is altered and when sodium transport is blocked. Volume changes of greater than 30% were observed, accompanied by changes in surface area of greater than 15%. The volume increase secondary to sodium pump inhibition and hypotonic solutions and the volume decrease secondary to hypertonic solutions were reversible. Our results demonstrate that neuronal volume may change dramatically and raise the possibility that dynamic changes in neuronal cell volume may have physiological importance.


The respiratory central pattern generator of Lymnaea. We have recently described the respiratory behavior of a pulmonate mollusc, Lymnaea stagnalis, and identified relevant motor neurons and interneurons involved in this behavior. Three interneurons, namely right pedal dorsal 1 (R.Pe.D1), visceral dorsal 4 (V.D4) and Input 3 interneuron (Ip.3.I) comprise the central pattern generator (CPG). We demonstrate that appropriate connections exist between these interneurons and that they are sufficient to form the basis for the CPG.


The respiratory central pattern generator (CPG) of Lymnaea reconstructed in vitro. We have recently developed a model system for testing the necessity, appropriateness and sufficiency of individual components of the respiratory central pattern generator (CPG) in Lymnaea stagnalis. In order to examine the intrinsic and network properties of the three CPG interneurons (R.Pe.D1, V.D4 and Ip.3.I), these cells were isolated and cultured in vitro. All of these cells exhibited extensive neurite outgrowth within 18-24 h of plating in conditioned medium. These isolated neurons maintained their intrinsic properties in culture and also formed specific synapses with each other similar to those observed in vivo. However, only when all three interneurons were plated together was it possible to initiate the alternating rhythm characteristic of the respiratory activity observed in semi-intact or isolated brain preparations.


Mating termination in the male cricket.

Mating termination in the male cricket. The study indicates that the male cricket Gryllus bimaculatus extrudes the spermatophore in response to mechanical stimulation of specialized sensilla in the cavity enclosed by the epiphallus and terminates mating as revealed by spermatophore protrusion. The spermatophore extrusion, however, needs an increase in body tonus during cavity hair stimulation which is produced by male's copulatory actions in response to key stimuli on the dorsum, epiproct and cerci. At the same time, male's sexual excitation raised by courtship facilitates spermatophore extrusion. This is the first demonstration that mating can be artificially switched off in male insects.


Structure, receptor cell arrangement and function of the auditory organs in the foreleg tibia of three bushcricket species. Comparative physiological and morphological studies were carried out on the auditory receptor organs of the forelegs in three closely related tettigoniid species (Psorodonotus illyricus, Decticus albifrons and Decticus verrucivorus). Functional adaptations of the receptor organs to the carrier frequencies of the conspecific song were found. The proportions of low- to high-frequency receptor cells within the organs of the three species are clearly different. This proportion is large in Psorodonotus illyricus, smaller in Decticus albifrons, and smallest in Decticus verrucivorus. These proportions are responsible for the different "frequency weighting" found in the activity of the receptor populations of the organs. The physiology of the receptor cells of the three species have been correlated with the dimensions of the critical stimulus-transforming structures inside the organs. This leads to an explanation of the different frequency selectivity of the receptor cells.


Effect of serotonin and opiate peptides on ion-currents of dialysed Helix neurons. The effect of serotonin, Met- and Leu-enkephalin was studied on the dialysed neurons of Helix pomatia L. Both the Ca- and K-currents were modulated by the above agents. Two types of neurons could be distinguished by their response to serotonin in the case of the voltage activated Ca-current. One group responded by increasing the inward Ca-current, others by decreasing it. Met-enkephalin decreased the Ca-current on every studied neuron, while Leu-enkephalin had modulatory action to both directions. Opiate peptides and serotonin showed a dose-dependent effect, but had different threshold concentrations. The peptides and serotonin also influenced the voltage activated transient and delayed K-currents. Serotonin increased the K-current, while Met-enkephalin decreased it, and Leu-enkephalin could either decrease or increase it. The variations on the response to serotonin and the opiate peptides on non-identified dialysed neurons of Helix can be explained by the presence of different receptors on the neurons used.


Regeneration of an interneuronal network in Helisoma: re-establishment of synaptic contacts. We have identified a network of three interneurons located in the central ring ganglia of Helisoma. Two of these interneurons, designated Left Pedal Dorsal 1 (LPeD1) and Right Pedal Dorsal 1 (RPeD1), are the largest neurons of the pedal ganglia and appear to contain dopamine and serotonin, respectively. A third interneuron, identified as Visceral Dorsal 4 (VD4), is a small FMRFamide immunoreactive cell located on the dorsal surface of the visceral ganglion. Monosynaptic chemical connections exist between all these interneurons. For instance, a reciprocal inhibitory connection exists between LPeD1 and RPeD1, whereas VD4 has inhibitory effects on both LPeD1 and RPeD1. Furthermore, LPeD1, but not RPeD1, has an excitatory connection with VD4. We demonstrate that following axotomy these interneurons not only regenerate their axons but re-establish their appropriate synaptic connections.


[Effects of liensinine on haemodynamics in rats and the physiologic properties of isolated rabbit atria]. Liensinine(Lien), an alkaloid extracted from the green seed embryo of Nelumbo nucifera Gaertn, has been shown to have anti-arrhythmic action, its mechanism may be related to blockade of Ca2+, Na+ influx. Lien 3 mg/kg i.v. may temporarily inhibit all parameters of haemodynamics in anesthetized or pithed rats. The inhibitory effects on LVP, +dp/dtmax and SAP in anesthetized rats are slightly stronger than those of quinidine (Qui) 3 mg/kg. Lien 1-30 mg/kg dose-dependently produced these actions. Lien and Qui 12 mg/kg lowered LVP, +dp/dtmax and SAP by 33%, 37%, 29% and 9%, 12%, 9% respectively. While both of them inhibited the other parameters of haemodynamics with nearly equal degrees. The degrees of inhibitory effect of Lien 12 mg/kg on all haemodynamic parameters nearly corresponded to these of verapamil 1 mg/kg. Lien 1-100 mumol/L reduced the contractile force of isolated left atria and the spontaneously beating rate of isolated right atria of rabbits in concentration-dependent manner. These results indicate that the properties of the effect of Lien on haemodynamics may be similar to those of verapamil and different from those of Qui.


[The composition of phospholipid and biosynthesis of platelet-activating factor in earthworm (Eisenia foetida)]. Platelet-activating factor (PAF) was for the first time confirmed to exist in a lower animal, earthworm (Eisenia foetida). It amounts to 10.7 +/- 6.1 pmol/g wet body weight, and varied seasonally. Phospholipid analysis revealed that 1-O-alkyl-2-acyl-sn-glycerophosphocholine, a stored form of PAF precursor, accounted for 61.4% of the choline glycerophospholipids. Two kinds of enzyme activities operating in PAF generation in mammalian cells were also detected from this species. The PAF level increased markedly under some injurious stimuli such as cutting and pricking. The results suggest that PAF may be a primary mediator involved in pathological and physiological reactions even in lower animal like earthworm. The findings also cast a new light on the mechanisms underlying the antihypertensive and other effects of the Chinese medicinal earthworm, pheretima.


[Experimental study of tumor directed therapy with gastric cancer monoclonal antibody-mitomycin conjugate combined with propranolol or angiotensin II]. The effects of vasoactive agents propranolol hydrochloride and angiotensin (AT-II) on improving the directed therapy of cancer with the use of conjugate of gastric cancer monoclonal antibody (3H11) and mitomycin C (MMC) were studied. The antibody activity of the conjugate (3H11-HSA-MMC) was retained with the molecular ratio of 1:2:60. In tests with tumor-bearing nude mice, the tumor inhibitory rate of the conjugate alone was found to be 50%, while in conjugate treated mice that also received propranolol or AT-II the tumor inhibitory rate were 79% and 60%, respectively. In tumor-bearing nude mice given 131I-3H11 both propranolol and AT-II increased the tumor uptake of 131I-3H11. These results indicate that these vasoactive agents can change the tissue perfusion ratio via the effect on tumor blood vessels and increase the access of the conjugate to tumor, thereby, enhancing the effectiveness of tumor directed therapy with the use of conjugates.


[Synthesis and biological activity of some Val(Ala)-Tyr and Val-Tyr-Tyr peptides]. 15B2 and WF-10129, reported as potent angiotensin-converting enzyme inhibitors (ACEI), were used as lead compounds for design of novel ACEI. Some of Val-Tyr-Tyr and Val-Tyr peptides were synthesized and tested for ability to inhibit ACE in vitro and in Vivo. The most potent compound was found to be N-(1-benzoyl-1-carboxymethyl)-L-Alanyl-L-Tyrosine (II5, IC50 = 7.9 x 10(-10) mol/L) which was prepared by the addition of Ala-Tyr to benzoyl-acrylic acid in the presence of triethylamine. The structure-activity relationships were also discussed.


[Side chain cleavage of sterols by Mycobacterium sp. M12]. A mutant strain of Mycobacterium sp. M12 was obtained. It can convert cholesterol. 3 beta-acetyl-cholesterol, sitosterol and 3 beta-acetyl-sitosterol to 4-androstane-3,17-dione (4-AD) (main product, the yield is 69%, 70%, 26% and 22% respectively) and 1,4-androstadiene-3,17-dione (ADD) (little amount). Optimum conditions for the side chain cleavage of cholesterol and 3 beta-acetyl-cholesterol by Mycobacterium sp. M12 were studied.


[Chemical structure of glutinic acid, a new diterpenoid from Caryopteris glutinosa]. A new diterpenoid compound named glutinic acid had been isolated from Caryopteris glutinosa Rehd by liquid chromatography on Al2O3 and silica gel column. The structure of glutinic acid was elucidated on the basis of IR, UV, MS, H1-NMR, 13C-NMR, DEPT and 13C-1H-COSY spectral analyses.


[Structure determination of saponin IX and X from Dipsacus asper Wall]. Two new triterpenoid glycosides (IX and X) were isolated from the ethanol extracts of the roots of Dipsacus asper Wall. Their structures were deduced as 3-O-[beta-D-xylopyranosyl (1-->4)-beta-D-glucopyranosyl(1-->4)] [alpha-L-rhamnopyranosyl (1-->3)]-beta-D-glucopyranosyl(1-->3)-alpha-L-rhamnopyranosyl(1-->2)- alpha-arabinopyranosyl-hederagenin (IX) and 28-O-beta-D-glucopyranosyl(1-->6)- beta-D-glucopyranosyl ester of IX (X), based on spectral and chemical analysis.


[Two new steroidal saponins from Allium macrostemon]. Two new steroidal saponins, macrostemonoside A and D, were isolated from the bulbs of Allium macrostemon Bung (Chinese name as Xie bai), a Traditional Chinese Medicine used for the treatment of myocardial infarction. Their structures were established as tigogenin-3-O-beta-D-glucopyranosyl(1-->2) [beta-D-glucopyranosyl(1-->3)1]-beta-D-glucopyranosyl(1-->4)-beta-D- galactopyranoside (1) and tigogenin-3-O-beta-D-glucopyranosyl(1-->2)[beta-D-glucopyranosyl (1-->3)(6-O-acetyl-beta-D-glucopyranosyl)] (1-->4)-beta-D-galactopyranoside (2) by spectral and chemical evidences. 1 showed remarkable inhibitory effect on rabbit platelet aggregation induced by ADP in vitro (IC50 = 0.065 mmol).


[Studies on pharmacokinetics of 9-beta-D-arabinofuranosyl adenine nanocapsules]. A method to determine the concentration of Ara-a in plasma by reversed phase high performance liquid chromatography is established. The method offers the advantage of rapid and simple preparation of plasma samples and sampling volumes as small as 0.5 ml. There is no need to extract Ara-A (adenine arabinoside) or to remove or modify sugar moieties to obtain samples of adequate separation. In pharmacokinetic studies, when amounts of clinical material are small and large numbers of assay are required, the present method is very useful. The calibration curve is linear for a wide range of concentration. The recovery is 87.5%. After a single dose of Ara-A-NC adenine arabinoside nanocapsules or Ara-A injection via intravenous administration in rabbits, the Ara-A concentration in plasma was determined by this method. The pharmaceutical parameters of Ara-A-NC and Ara-A injections were obtained by using PKBP-N1 program in NEC computer. The data obtained fitted an open two-compartment model well with two correlation coefficients more than 0.99. In mice given Ara-A injection a shorter elimination half-time (20.32 min), MRT (9.647 min) and a smaller AUC (233.4 micrograms.min.ml-1) were obtained compared with the group given Ara-A-NC injection. For the latter, the figures were 67.82 min, 156.7 min and 309.9 micrograms.min.ml-1, respectively. It can be concluded that NC can alter the pharmacokinetic behavior of Ara-A in mice significantly and keep the drug at a higher level and for a longer time.


[Differential pulse voltammetric measurements of cholesterol based on its oxidation after adsorption at the mercury electrode]. Cholesterol can be adsorbed on the surface of the static mercury drop electrode, and then oxidized during anodic potential scan. The stripping peak potential in differential pulse voltammetry is at -0.08 V in 0.1 mol/L K2HPO4-KH2PO4 buffer solution. The stripping current is linear with the concentration of cholesterol in the range of 10(-7)-10(-6) mol/L. The detection limit found is 8 x 10(-8) mol/L after a 5 min pre-concentration period. The adsorption and oxidation mechanisms of cholesterol at the mercury electrode were then explored. The experimental conditions for measuring free cholesterol in human sera were examined.


[Studies on the TLC scanning determination of lignans in Diphylleia sinensis Li]. A simple, sensitive and accurate method for the separation and determination of the lignans: podophylltoxone (I), isopicropodophyllone (II), picropodophyllone (III), dehydropodophyllotoxin (IV), picropodophyllin (V), podophyllotoxin (VI), 4'-demethylpodophyllotoxin (VII) and diphyllin (VIII) is described. The sample solution was applied at a point 1 cm from the bottom edge of the HPTLC silica gel plate (10 cm x 10 cm), dichloromethane-diethyl ether (4:1) was used as the developing solvent. The plate was saturated for 30 min and then developed twice for 9.5 cm using ascending technique. The plate was sprayed with 2.5% ammonium ceric sulphate--20% nitric acid and toasted for 15 min at 120 degrees C, then fumigated with ammonia solution for 20 min at room temperature to intensify the spot color. The spots were scanned with a Shimadzu CS-930 TLC scanner. The contents of eight lignans in Diphylleia sinensis was calculated by comparison with standards spotted on the same plate. The standard curves were linear in the range of 0.48-2.52 micrograms for the eight lignans. The method has been applied to the analysis of various samples and can be used for the quality control of Diphylleia sinensis, podophyllum and dysosma preparations used in clinic.


[Exposure to low-frequency electromagnetic fields and pregnancy outcome: a review of the literature with particular attention to exposure to video terminals]. Exposure to extremely low frequency electromagnetic field (EMF) is very common and concern about its harmful effects has been raised. Video display terminals (VDT) in the office are among the most important sources of exposure. Animal studies have shown adverse effects on reproduction, but the role of EMF in human reproduction is not clear. Twelve papers considering the effects of VDT and other EMF exposure on pregnancy outcome are reviewed. Concerning VDT exposure, the pooled OR for spontaneous abortion was 1.0 (95% Confidence Interval, CI, 0.9-1.0). There was no significative trend in risk with exposure intensity. No significative risk emerged for low birth weight nor for congenital malformations. Regarding other sources of EMF (electric blankets, heated waterbeds, ceiling cable electric heat and power lines), some studies have suggested that spontaneous abortion, growth retardation and congenital defects are more frequent during the coldest month of the year (when the exposure to these EMF would have been higher). However, data on the issue are scanty.


[Transvaginal echography in the evaluation of the grade of myometrial invasion in locally advanced endometrial carcinoma]. Neoplastic myometrial invasion is an important prognostic factor in local advanced endometrial carcinoma, conditioning therapeutic choice. In 34 patients with stage I and II endometrial carcinoma, the depth of myometrial invasion was evaluated by transvaginal sonography (TVS). In comparison with pathological findings, TVS showed an overall accuracy of 82.3% with a sensitivity of 82.6% and a specificity of 81.8%. The principal error was related to the underestimation of the lesion: negative predictive value of 49.2% vs positive predictive value of 90.4%. In conclusion, TVS is an accurate imaging method for staging of local advanced endometrial carcinoma.


[Scleroderma and esophageal reflux, surgical monitoring]. Ten patients with documented scleroderma were assessed before and after antireflux operations over a twelve year period. The approach was through the left chest in 9 of 10 patients (7 short Nissen, 1 Collis Nissen, 1 Collis Belsey) and through the abdomen for 1 (vagotomy, antrectomy and Roux en Y). Clinically, 5 of 10 patients still mention episodes of heartburn. Dysphagia, which was present in 8 patients before the operation, has been replaced by a slow emptying impression in five. Endoscopically five patients had a columnar lined esophageal mucosa. Four more were considered to have ulcerative esophagitis and stricture which proved to be also Barrett's esophagus in the postoperative assessment. Three patients had preoperative 24 h pH assessment when the technique became available. Their postoperative control studies revealed persistent acid exposure but to a lesser degree. All ten patients had 24 h pH studies in their postoperative assessment and 5 out of 10 still show abnormal exposure to acid. Esophageal motility studies did not reveal significant changes to the hypomotility of the distal esophageal body and to the decreased tone of the Lower Esophageal Sphincter area. Both radiologically and using esophageal transit scintigrams the esophagus shows atony and poor emptying before the operation. Retention is increased following the creation of an antireflux technique at the esophagogastric junction. The success rate of antireflux operations in scleroderma patients is limited. The ideal procedure to use in this condition remains unclear.


[The intermittent "warm" blood cardioplegia]. Even today, a plethora of cardioplegic solutions are in clinical use. In the study presented here, sixty-six consecutive coronary bypass procedures received normothermic (37 degrees C) blood cardioplegia (NBC) intermittently. This group of patients was compared to an historical group of 68 patients having received cold crystalloid cardioplegia (CCC), and a second group of 41 patients having received cold blood (10 degrees C) cardioplegia (CBC). The number of patients, as well as their age, sex, functional class, ejection fraction and urgency of intervention were comparable between the three groups. The preoperative use of inotropic drugs was less prevalent in the normothermic blood cardioplegia group (NBC 24% v. CCC 52% and CBC 51%, p < 0.05), as was the use of a pacemaker (NBC 8% v. CCC 52% and CBC 51%, p < 0.02). Finally, the rates of myocardial infarction and mortality were comparable between the three groups. These results suggest that normothermic blood cardioplegia is efficient in reducing the demand in O2, by inducing the electromechanical arrest of the heart and, that intermittent normothermic blood cardioplegia can be safe and effective.


[Homologous intrauterine insemination: our experience]. Sixty-five couples with male infertility or unexplained infertility or infertility due to cervical factor underwent 156 cycles of homologue intrauterine insemination. The overall pregnancy rate was 16.5% with 2.4 mean value of insemination cycles for each couple. The highest pregnancy rate was observed in cases of cervical factor infertility. The mean age of patients who had pregnancy was 30 years (overall mean value 34 years) and the mean time of sterility was 3 years (overall mean value 4.4 years).


[Salvage heart surgery after percutaneous mitral valvuloplasty]. Percutaneous mitral valvuloplasty (PMV) for selected patients with symptomatic mitral stenosis (MS) has been proposed as a safe alternative to open mitral commissurotomy (OMC) or mitral valvular replacement (MVR). Among 146 consecutive patients undergoing PMV from March 1987 to April 1990, 18 (12%) needed urgent (8) or delayed (10) (average 7 days) corrective surgery following PMV. There were 15 women and 3 men, with a clinical incapacity class II (3) or III (15), and with an intermediate risk for PMV according to echo score (mean = 8). The indications for corrective surgery were: massive mitral regurgitation due to tearing of the anterior leaflet (6), cardiac perforations (left atrium in 2, left ventricle in 3), PMV technical failure (5), severe atrial shunting (2). Operative procedures included MVR (14), cardiac wound suturing only (3), OMC (1). Operative mortality (30 days) was 22% (4/18), equally distributed among the urgent and delayed group. The causes of postoperative death were hemorrhage (2), severe cerebral ischemia (1) and sudden death (1). Compared to operative mortality after OMC (0/17.0%) or MVR (1/32, 3.1%) as the initial treatment for MS during the same time period, cardiac operation after failed or complicated PMV carried a significantly higher mortality (p = 0.004). Therefore, optimal patient selection and aggressive corrective surgery are necessary to decrease the PMV related mortality and morbidity.


[Angioscopy in peripheral vascular surgery]. At Saint-Luc's Hospital of Montreal, between January 1, 1990 and February 1, 1991, 47 angioscopic procedures were done in 43 patients submitted to peripheral vascular reconstructions. The purpose of the study was to evaluate the role of angioscopy during those procedures. The operations were as follows: twenty femoropopliteal bypasses done with reversed saphenous vein, 15 done with in situ saphenous veins and 10 done with synthetic grafts. Two patients had popliteal embolectomies. Seventeen percent of the cases showed technical problems with the use of controlled angioscopy and were subsequently corrected. Three residual valves and one unsuspected venous stenosis were found in 15 in situ grafts, for a total of 27% correctible defects. In the reversed saphenous group, one case of venous sclerosis and one case of anastomotic stenosis were found for a total of 10%. For the synthetic grafts group we found an intimal flap distal to the anastomosis in one case (10%). Finally, we found a significant residual clot in one case (50%) after embolectomy. The technique of angioscopy is simple, the equipment reliable, and the learning period is short. Angioscopy is a very useful approach and should be readily available in the armamentarium of every vascular surgeon.


[3-D study of the immediate effect of the Boston brace on the scoliotic lumbar spine]. In order to study the immediate 3-D effect of the Boston brace on lumbar scoliosis, 31 adolescents with idiopathic scoliosis King type I or II had a 3-D computerised reconstruction of their deformity with and without the brace. Results demonstrate that the brace produces a distraction of the lumbar spine similar to that produced by the Harrington instrumentation by correcting the frontal deformity at the expense of a significant reduction of the physiological lumbar lordosis. No significant effect on rotation of the apical vertebra or "detorsion" of the spine could be measured. We feel that a orthosis that provides a real 3-D correction of the deformity has yet to be developed.


[Cysts of the choledochus in children: experience of the Sainte-Justine hospital]. Choledochal cyst remains a rare pathology in western countries. Over the past 15 years, 18 children were diagnosed with choledochal cyst at Hospital Sainte-Justine. There were 14 girls and 4 boys with an average age of 7.4 years ranging from newborn to 15 years. Abdominal pain, jaundice and abdominal mass were present in 70%, 54% and 7% respectively. Only one patient, a 15 years old girl had all three symptoms. Abdominal ultrasonography was diagnostic in all cases and in two cases, a cystic dilatation was found in the antenatal ultrasonography. Transvesicular cholangiography was performed successfully in 11 patients and showed a detailed anatomy of the biliary tract preoperatively. Sixty-seven percent of the cysts were type I while 33% were type IV. A common channel was found in 43% of the cases. Sixteen patients underwent cyst excision followed by Roux en Y hepatico-jejunostomy, one patient with associated biliary atresia had a porto-enterostomy and one patient had a cysto-duodenostomy. The last patient had recurrent episodes of cholangitis and required reoperation while the others are doing well and free of infection. With the liberal use of ultrasonography, the diagnosis of choledochal cyst is being done earlier improving the long term prognosis. Transvesicular cholangiography is a very useful addition in the preoperative investigation of these patients. Roux en Y hepatico-jejunostomy was associated with minimal morbidity and mortality and gave excellent result.


[Breast feeding after breast reduction]. Few authors have addressed the feasibility of breast-feeding after a reduction mammaplasty. Nowadays, the majority of plastic surgeons perform breast reductions with techniques preserving the continuity of the nipple-areola complex with the retained breast tissue. These pedicle techniques should permit lactation as opposed to the free nipple grafting technique used earlier. To find out how many women nurse their children after a reduction mammaplasty, we reviewed 806 charts to identify 243 women having had a pedicle technique breast reduction, between 1967-1987, at the age of 15 to 35 years. These women were contacted and 98 of them were reached. Eighteen women had become pregnant after their surgery. They agreed to answer a questionnaire regarding their decision to nurse their children, the duration of breast-feeding and the difficulties encountered. Eight of eighteen mothers (45%) nursed their children up to 32 weeks (mean 11 weeks). Among them, 3 nursed for less than 3 weeks and 5 nursed from 3 to 32 weeks (mean 20 weeks). Only one mother had to supplement nursing with formula. Two mothers used mixed formula and breast-feeding when they returned to work. Ten of eighteen mothers (55%) did not breast-feed for the following reasons: 6 by personal choice, 2 due to premature delivery, one was advised that nursing was not feasible and one had no lactation. We believe that the nursing capacity of the breast is preserved after a breast reduction and that women should be encouraged to nurse their children.


[Quality of life of patients after restorative surgery for cancer of the rectum]. During the last decades surgeons have put a tremendous effort to perform low anterior resection (LAR) as a curative procedure for rectal cancer treated classically by abdomino-perineal resection (APR) and permanent colostomy. A psychological evaluation testing the multi-dimensional concept of quality of life was done in 32 patients (M = 21; F = 11) treated by APR and compared to 28 patients (M = 16; F = 12) treated by LAR. Patients were assessed for quality of life on the following dimensions: physical well-being, psychological well-being, dietary habits, surgical response, social concerns, body image, stress and marital adjustment. Using as covariables social support and time elapsed since surgery, a covariate analysis was used to determine the presence of group ans sex interaction. Patients with LAR had a better body image (p.001), dietary habits (p.003) and tolerance to stress (p.004). Better global quality of life (p.001), physical well being (p.001) and less surgical sequela (p.001) were found with LAR in women only. No significant difference was found on psychological well being, social concerns and marital adjustment in both surgical groups.


[Endoscopic retrograde cholangiopancreatography in the context of cholecystectomy under celioscopy]. This descriptive cohort study documents the results of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) in the perioperative period of laparoscopic cholecystectomy (LC). Of 630 consecutive patients undergoing LC, 83 (13.2%) sustained 96 ERCP, of which 65 were performed preoperatively (67.7%) and 31 postoperatively (32.3%). The common bile duct cannulation rate was 96.9% after the first attempt and 100% after the second in three patients. Common duct stones were found in 40 patients (6.3%) and three other anomalies were demonstrated ES was performed in 42 patients and 100% clearance of the common bile duct was achieved after 45 extraction procedures. Six patients (1%) were found at follow-up with unsuspected common duct stones and were all successfully treated with ES. At present time, the morbidity of ERCP and ES (7.2% and 11.9%) make them worthwhile adjuncts to perative cholangiography for the diagnosis and treatment of common bile duct stones found during the perioperative period of LC.


[Murine surgical model for the study of cultured grafts]. The objective of the study was to establish an animal model for in vivo studies of cultured cutaneous equivalents. The model on athymic mice that we already described (López-Valle C.A. et al., Plast Reconstr Surg, 1992, 89, 139-143) satisfied the criteria of immobilization of the recipient site and physical stability of the graft, but still allowing complete movement freedom of the animal used. Nevertheless, this technique encountered two long term weaknesses; a) a significant grafted surface reduction caused by the wound contraction and b) the absence of a physical barrier between human and murin keratinocytes. We propose some modifications to this technique to correct both problems. Moreover, the implantation of polypropylene, instead of glass pellets, to generate granulation tissue on the recipient bed when needed, constitutes an easier method for both the surgeon and the animal. Finally, in order to minimize wound care, some modifications were made to the rodent cages. Immunohistological analyses of the biopsies, 21 days post-grafting, revealed a continuous basal membrane. This animal model allows in vivo studies on the behavior, cicatrization and immunology of human cultured skin equivalents.


Specific allergen induced motility of peripheral blood mononuclear cells and polymorphonuclear leukocytes in insect sting allergy. The motility of peripheral blood mononuclear cells (MNC) and polymorphonuclear (PMN) leukocytes from normal and bee venom allergic subjects was investigated by a modified Boyden micropore filter method. The study comprised MNC locomotion in bee venom and histamine gradients and PMN locomotion in bee venom and fMLP gradients. We demonstrated statistically significant increase in MNC and PMN motility towards bee venom in allergic patients group. This effect disappeared after the preincubation of MNC with anti-human IgE antibodies. We observed no such effect in PMN leukocytes. Increased MNC motility in histamine gradient was observed only in control subjects group. Similarly significant increase in PMN locomotion towards fMLP was found in both allergic and control subjects. The results here demonstrated suggest that a specific allergen might be a chemoattractant for peripheral blood MNC and PMN leukocytes from atopics and could be capable to induce non-infectious inflammatory reactions as a result of its interaction with these sensitive cells.


Specific immunotherapy stimulates the binding of histamine H2 receptor antagonist by lymphocytes. The binding of antagonists of histamine receptors H1 (promethazine) and H2 (ranitidine) by peripheral blood lymphocytes from pollinotics was determined before and after the course of immunotherapy. We found that lymphocytes from atopic subjects showed significant decrease in the binding of H2 receptor antagonist as compared to control subjects. Specific immunotherapy induced statistically significant increase in H2 receptor antagonist binding, which correlated with the improvement of clinical symptoms.


HLA-DR antigens in children with mumps meningitis. The frequency of HLA-DR antigens was studied in 54 patients with mumps meningitis, and in two control groups. The first control group comprised 333 randomly chosen subjects while the second group was composed of 46 subjects who have passed mumps without meningitis. The DR5 antigen was more frequent in patients than in the second control group with relative risk of 2.4 and significance at the level of p < 0.05. The p value became insignificant after the correction for the number of antigens investigated.


Studies on immunity in mice immunized with outer membrane proteins of Hafnia. Nonspecific protection induced in mice after administration outer membrane proteins of Hafnia alvei against infection with homologous and heterologous bacteria was transferred into other mice with lymphocytes isolated from spleens of mice immunized with outer membrane proteins. It was also found that mice sensitized with outer membrane proteins derived from H. alvei or with living bacteria induced in animals delayed hypersensitivity (DTH) in homologous and heterologous systems. The observed type of hypersensitivity was transferable to normal mice by lymphocytes obtained from donor animals which were previously sensitized with OMP. The experiments revealed that immunity induced with outer membrane proteins of Hafnia alvei is cell-mediated.


Some biological properties of outer membrane proteins of Hafnia. Outer membrane proteins (OMP) isolated from four antigenically different strains of Hafnia alvei were tested for the toxicity, pyrogenicity, ability to induce Shwartzman reaction as well as for their influence on the leukocyte system. LD50 doses for the studied preparations determined on inbred mice were 18, 20, 28 and 34 mg/kg. These differences in the toxicity of the preparations were reflected in manifestation of Shwartzman reaction; more toxic preparations induced strongest necrohemorrhagic changes at the site of injection. The OMP preparations injected intravenously to rabbits caused moderate increase of body temperature. They induced changes in the number of leukocytes in the animals comparable with those of other preparates of bacterial origin.


Effect of outer membrane proteins from Shigella on humoral immunity induced in mice by SRBC. Shigella flexneri outer membrane proteins (OMP) which had been earlier found to exert immunomodulatory effect on cell mediated immune response were also found to act as immunomodulator of the humoral immune response. Effects of OMP were investigated in the experiments in vitro and in vivo, where the level of humoral immune response, measured as the number of plaque-forming cells (PFC) to SRBC in the spleen was evaluated. We demonstrate that small doses of OMP (1-5 micrograms) stimulate, whereas higher doses (10-50 micrograms) suppress the humoral immunity.


Fraction of spleen cells responsible for suppression of cellular immune response to SRBC in mice treated with outer membrane proteins of Shigella. Effect of splenocytes isolated from mice immunized with suppressive dose of OMP from Shigella on delayed hypersensitivity, induced in mice with sheep red blood cells was investigated. Only the population of T lymphocytes was found to suppress the delayed hypersensitivity, as measured by the footpad reaction. The results suggest that OMP of Shigella are able to induce in the spleens of animals active T cells which are responsible for the suppression of cellular response induced by SRBC.


In vitro cytostatic activity of some amino acid 4-N-substituted cytosines. Cytotoxicity of 22 amino acid 4-N-substituted cytosine derivatives was studied on KB and HeLa human tissue cultures. A 4-N-(1H-2-oxo-4 pyrimidyl)-tryptamine with ED50 activity values of 0.145 x 10(-3) mole/l and ED0 = 0.4 x 10(-5) mole/l showed the highest cytotoxic activity and was qualified for further in vivo investigation. The secondary modification of tryptamine substituent seems to be a determining factor of the cytotoxic activity of 4-N-pyrimidinyl amino acids. The activity of the investigated compounds was inversely dependent on their solubility limited by the results of the solubility-activity relationship analysis.


HLA-A, B, C, and DR gene and haplotype frequencies in 600 poles by a maximum likelihood method of gene counting. A population sample of 600 healthy, unrelated persons was used for estimating HLA-A, B, C and DR antigen, gene and haplotype frequencies. The Polish population is characterized by a high value of HLA-A10, B13, B27, DR1 and DR5 gene frequencies. Strong gametic associations between genes A1 and B8, A3 and B7, as well as between B8 and DR3, and B7 and DR2, typical for many European populations, are also present in the Polish population.


The effect of thymic hormones (TFX) on lymphocyte subpopulations and proliferation after maximal physical effort. The studies were performed on healthy well-trained cyclists. Maximal physical exercise was performed on a Monark bicycle ergometer according to individual schemes. Heart rate amounting to about 200 bts/min and oxygen consumption stabilization were considered as criteria for maximal physical exercise. In this study we have investigated the effect of short-term stimulation of conditioned sportsmen with thymic hormones and evaluated T cell subsets, DR antigen and transferrin receptor expression as well as mitogen-induced proliferation of lymphocytes before and after maximal physical effort. The results suggest that intensive physical exercise may be responsible for transient decrease of CD4/CD8 ratio and mitogen responsiveness, and increase of mononuclear cells number bearing HLA DR+ and CD71 antigens. These changes were modified by the treatment with thymic hormones.


Antilymphocyte globulin with a small dose of cyclosporine A and prednisone as the induction of immunosuppression in renal allograft recipients. In attempt to avoid a detrimental synergism between CsA and renal ischemia in the immediate postoperative period, ALG (425 lymphocytotoxic units/kg) with small doses of CsA (6-8 mg/kg) and P were applied as the initial immunosuppressive therapy in 14 recipients of cadaveric kidneys. ALG was administered for 5 to 14 days and 2 days before withdrawing ALG, Aza (2 mg/kg) was introduced. Results of this protocol were compared with those of 19 pts treated with CsA (12 mg/kg) and P. All the pts were followed for at least 12 months. The duration of posttransplant anuria was significantly reduced in the ALG/CsA/P group (p < 0.02). The sCr concentration after 12 months of observation was significantly lower (p < 0.05), no alterations in urinalysis were detected, the number of hypertensive pts was decreased. The acute rejection rates were equivalent in both groups, however 3 of 4 rejections in ALG/CsA/P group were resistant to steroids and occurred in pts with shortened period of ALG administration. The one year patient and graft survival in the ALG/CsA/P and control groups were respectively: 78.5%, 71.4% and 89.4%, 78.9%. Severe infectious complications in the group treated with ALG/CsA/P occurred in pts who were subsequently treated with OKT3.


Inferior vena cava "birds nest" filters--2 year follow-up. This study examines long term efficacy and saftey of "birds nest" filters (Cook), and the use of doppler ultrasound to assess patency. Of the seventeen "birds nest" filters inserted twelve were available for study. All patients were reviewed for evidence of recurrent pulmonary emboli or filter complication. Mean length of follow up was 10 months, (7 had follow up of > 12 months). Three have had further episodes of deep venous thrombosis, with probable recurrent pulmonary embolism in one. No patient had evidence of thrombosis of the inferior vena cava. No fracture or migration of the "birds nest" filters was found. Ten of the twelve filters studied with ultrasound could be visualized within the cava. In all, turbulent flow was detected with colour and duplex doppler study. We conclude that insertion and use of the "birds nest" filters is safe, with a high long term patency rate and few initial or long term complications. Doppler ultrasound is a simple and rapid method of assessing venous patency.


Use of percutaneous transluminal balloon angioplasty to treat renovascular disease. This is a retrospective study of the ability of percutaneous transluminal balloon angioplasty (PTA) to treat hypertension and renal impairment in patients with haemodynamically significant renal artery stenoses (those over 50%). Thirty-two patients underwent PTA procedure in a 4 year study period. Seventeen were male, 15 female, with an average age of 61 years. Thirty patients had atherosclerosis and 2 had fibromuscular hyperplasia (FMH) lesions. The procedure was technically unsuccessful in 28% of 37 arteries attempted, primarily in the > 80% stenosis group. The mean clinical follow-up period was 20 months. In those patients with technically successful PTAs, none was cured, with no change in the status of hypertension or medication required. Clinical improvement was seen in 37% (7 of 19) patients with atherosclerotic disease and who had PTA of significant unilateral lesions or of the haemodynamically significant side in cases of bilateral disease. Two patients with FMH lesions had improvement. Five patients with PTA of only one side in cases of significant bilateral disease gained no benefit. Nine patients with pre-existent renal insufficiency and technically successful PTAs had no improvement of renal function. No mortality or any significant morbidity resulted from the procedure. These results are more compatible with more recent than the earlier literature.


Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease. The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.


The bony crescent sign--a new sign of facial nerve schwannoma. Schwannomas of the facial nerve are rare slowly growing lesions that have a predilection for the geniculate ganglion. Radiological evaluation is important in their diagnosis and in the assessment of their extent. In our series of 4 cases the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed sign of facial nerve schwannoma which appears on the basis of this small series to be strongly indicative of the presence of this tumour. Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate CT scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. Lesions occurring in the petrous area are all rare. The differential diagnosis includes cholesterol granuloma, epidermoid, carotid aneurysm and, very rarely, primary and secondary bone tumours. We describe a new sign associated with facial nerve schwannoma on CT, that of a bony crescent. Recognition of this sign makes those tumours arising in the region of the geniculate ganglion easy to diagnose prospectively.


CT appearances of rounded atelectasis.

CT appearances of rounded atelectasis. Five patients examined with CT had lesions fulfilling criteria for a diagnosis of rounded atelectasis (RA) and these were managed without biopsy. In three patients unsuspected contralateral lesions were identified as RA variants, and one of these was biopsied at thoracotomy and proved to be benign. All patients remain well at 6-22 months follow-up. We concur with recent reports that there is a spectrum of CT appearances of RA and that even atypical lesions seldom need further investigation. We also suggest that the appearances of some atypical lesions add support for the fibrosing theory of pathogenesis of RA.


Traumatic rupture of the aorta.

Traumatic rupture of the aorta. In a series of 28 patients with suspected ruptured thoracic aorta, only three were shown to have sustained such an injury. To minimise the number of negative examination, the importance of optimising the initial radiological examination of the chest is discussed along with the importance of visualisation of the descending aorta. The signs that lead to the suspicion of rupture of the aorta are numerous and non specific and indicate some change in the mediastinum which could be significant in the given clinical context. This paper wishes to emphasise a negative sign, namely visibility of the descending aorta.


Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation. The effect of dose rate to the lungs and development of interstitial pneumonitis (IP) was evaluated in 114 bone marrow transplant patients receiving fractionated total body irradiation (TBI) (1200 rads TD in 6 fractions twice daily over 3 days) as part of their pre-conditioning regimen. The tumour dose (TD) was calculated as the mean lung dose as previously described (1). A 6MV linear accelerator at a mid-line dose rate of 7.5 rads/minute was used between March 1981 and June 1985 and a Co-60 source at 5 rads/minute thereafter. This resulted in a range of dose rates to the lung of between 6.9 and 8.9 rads/minute and 2.9 and 6.5 rads/minute respectively. In the majority of patients the aetiology of IP was investigated by lung biopsy with histology and culture. There was no statistically significant difference in the incidence of IP over the two sets of dose rates. Our study suggest that the incidence of IP using fractionated TBI is not influenced by dose rates below 8.9 rads per minute.


Foetal radiation dose in radiotherapy for breast cancer. Management of breast cancer during pregnancy is complicated by the high risks of abortion and foetal malformation from the use of radiotherapy and chemotherapy. A case of breast cancer during pregnancy, treated with radiotherapy, and the estimated foetal dose is reported.


Technical report: fallopian tube recanalization facilitated by a hydrophillic glide wire. Fallopian tube recanalization is now a well established radiological procedure (1). We describe a case in which the tubal obstruction was resistant to the standard technique of recanalization by the passage of a platinum tipped wire but in which we were able to achieve success with the aid of a hydrophillic "glide" wire (Radifocus angled tip, Terumo Corporation, Tokyo, Japan).


Percutaneous ultrasound guided cholecystostomy with double bubble catheter. We have used a prototype double bubble cholecystostomy catheter in four very ill patients. This has been done under local anaesthetic using a Seldinger technique, ultrasound guidance, and a trans-peritoneal approach to the gallbladder. The catheter provides drainage, cholangiography, and is intended to allow instrumentation of the biliary tract at a later stage.


Enterogenous cyst of the cervical spinal canal. A case of an enterogenous cyst of the cervical spinal canal in an 18 year old man is presented, high-lighting the radiological findings. A brief overview is given of these rare cysts, together with their clinical and radiological features and associations.


Organo-axial volvulus of the sigmoid colon. A 59 year old man presented with subacute abdominal distension and diarrhea. Plain radiographs and barium enema demonstrated organo-axial volvulus of the sigmoid colon. The radiologic, surgical, and pathologic findings are presented. The radiologic differences between organo-axial volvulus and the common mesentero-axial volvulus of the sigmoid colon are discussed.


Neoplastic involvement of the sacroiliac joint: MR and CT features. The radiological findings in five patients with pelvic soft tissue neoplasms directly involving the sacroiliac joint, are described. All patients had Computed Tomography (CT) examinations, two of the patients also having Magnetic Resonance Imaging (MRI). The role of imaging in this uncommon entity is discussed as well as the importance of making this diagnosis, thereby excluding unilateral sacroiliitis. The therapeutic implications of this diagnosis relate to local neural involvement, especially the sciatic nerve, and the fact that involvement of the sacroiliac joint by tumors significantly compromises chances of a successful surgical outcome. The role of MR in this condition is not yet certain, but it may prove to be the method of choice in view of its excellent depiction of skeletal neoplasms.


Assimilation of the atlas with associated syringomyelia and Chiari 1 malformation (Klippel-Feil type 2). This case report describes an unusual congenital anomaly of the craniovertebral junction in a 14 year old male. Cervical radiographs showed the bony anomaly, while thin slice CT (with 2-D and 3-D reformations), MR imaging, and angiography were particularly useful in accurately assessing the bony, soft tissue and vascular anatomy, prior to and following surgery.


Wegener's granulomatosis: parotid involvement and associated pancreatitis with C.T. findings. Parotid enlargement is an uncommon physical sign and even less commonly the reason for referral for computerised tomography (CT) as the aetiology is usually self-evident. In cases referred for CT examination Wegener's granulomatosis should be considered, particularly if the pathology appears bilateral. This diagnosis may be confirmed by biopsy and/or supported by Anti-Neutrophil Cytoplasmic Antibody (ANCA) assay. A case of Wegener's granulomatosis with parotid gland involvement and temporally related pancreatitis with pseudocyst formation is reported. This is the second reported case of possible pancreatic involvement in Wegeners granulomatosis and approximately the tenth reported case of salivary gland involvement.


Biological adaptation of the myocardium to a permanent change in loading conditions. Cardiac hypertrophy due to permanent mechanical overloading is only one example among thousands of the general process of biological adaptation. The process is randomly governed and results in at least one thermodynamical benefit: to be adaptational and to induce several changes in gene expression. Some of these changes are detrimental, some can even be useless. The cascade of events which finally leads to a permanent modification of the genetic expression involves an initial signal, likely to be the stretch, a pathway which transducts the signal, and a transient change in genetic expression which transmits competence to the cell to be transformed. The permanent modifications occur at all cellular levels including the sarcomere, sarcolemma, energy metabolism, and extra-cellular matrix, but they are species-specific and differ in the ventricles and the atria.


Afterdepolarizations and triggered activity. One of the possible cellular mechanisms for certain types of ventricular arrhythmias is afterdepolarizations. There are two types of afterdepolarization. The delayed afterdepolarization (DAD) arises from the resting potential after full repolarization of an action potential and it may reach threshold for activation. It is favored by cellular Ca overload, and rapid preceding activation rates. The inward current generating the DAD is caused by one of two mechanisms: a Ca-dependent opening of non-specific cation channels, or Ca activation of a rheogenic Na/Ca exchange. The early afterdepolarization (EAD) arises on the shoulder of a preceding action potential plateau and it is favored by slow preceding activation rate and prolonged action potentials. Ca channels are usually responsible for the inward current for EAD's, and cellular Ca overload is not related. These afterdepolarizations have characteristics that suggest their etiological role in certain arrhythmias found in heart failure.


The contribution of nonreentrant mechanisms to malignant ventricular arrhythmias. Evidence obtained from experimental animals and man indicates that reentry is a major mechanism underlying arrhythmogenesis. However, focal or nonreentrant mechanisms also appear to be operative under a wide variety of pathophysiologic conditions. For example, results obtained using three-dimensional (3D) mapping from 232 simultaneous sites in the feline heart in vivo revealed that nonreentrant or focal mechanisms were prominent during both ischemia and reperfusion. During early ischemia, nonreentrant mechanisms were responsible for initiation of ventricular tachycardia (VT) in 25% of cases and, in cases where VT was initiated by reentry, it often could be maintained by a nonreentrant mechanism. During reperfusion of ischemic myocardium, nonreentrant mechanisms were responsible for initiation of VT in 75% of cases. Most importantly, the transition from VT to ventricular fibrillation in response to reperfusion was secondary to acceleration of a nonreentrant mechanism in either the subendocardium or subepicardium. Potential cellular mechanisms include: 1) sarcolemmal accumulation of amphiphiles such as long-chain acylcarnitines and lysophosphatidylcholine; 2) alpha- and beta-adrenergic mediated effects of catecholamines on the transient inward current (ITI) secondary to an increase in intracellular Ca2+; and 3) alpha-adrenergic receptor-induced decrease in IK mediated by activation of protein kinase C. Recent findings obtained using 3D intraoperative mapping in patients with refractory VT and a previous myocardial infarction also indicate that both reentrant and nonreentrant or focal mechanisms contribute. For example, in 13 selected patients, mapping was of a sufficient resolution to define the mechanisms of 10 runs of VT. Intraoperative mapping indicated that five runs of VT were initiated by intramural reentry, whereas five runs of VT were initiated by a focal or nonreentrant mechanism. The mechanisms underlying ventricular arrhythmias associated with ischemic cardiomyopathy have recently been delineated in dogs after multiple sequential intracoronary embolizations with microspheres (with a decrease in mean ejection fraction from 64% to 25%). Spontaneous VT initiated by focal mechanisms from the subendocardium in 82% and epicardium in 18%, with no evidence of macroreentry. Thus, in divergent pathophysiologic settings, nonreentrant mechanisms appear to contribute importantly to the genesis of lethal ventricular arrhythmias, suggesting that development of novel therapeutic approaches should be directed at inhibition of not only reentrant circuits, but also nonreentrant mechanisms, including triggered activity.