[Increase in neuroendocrine secretion granules in submaxillary and parotid glands in patients with non-insulin dependent diabetes mellitus]. The amount of neuroendocrine granules in microgranular cells of salivary glands were investigated in necropsies of 20 non-insulin dependent diabetics (NIDDM) and in 20 non-diabetic subjects with Grimelius and Fontana-Masson stainings. Granules in serous acini, and intercalated ducts were observed in both groups; however, a significant higher number of granules and microgranular cells were observed in NIDDM subjects as compared with non-diabetics. Both parotid and submaxillary glands were significantly heavier in NIDDM than in the non-diabetic group. These granules may be related to immunoreactive glucagon which has been found in submaxillary glands of rodents and might play a role in the pathogenesis of NIDDM. Further investigations should be performed to clarify whether these cells are the site of glucagon synthesis and also clarify the pathogenesis of NIDDM.


[Fever of unknown origin. Presentation of 180 pediatric cases]. Fever of unknown origin (FUO) is a frequent disorder in pediatric age. FUO is defined as the presence of fever over 38.4 centigrades in a patient for more than three weeks in which the etiology remains undetermined. From 30.736 consecutive admittances into our hospital, 180 patients with FUO were detected, and studied in a systematized way and according to a predetermined protocol. FUO was commonly found in children under six years of age. Our patients presented fever from three weeks to six and a half years of evolution; however, in the vast majority of the cases (n = 115) fever had a three weeks course. Several symptoms and physical manifestations other than fever were observed in our patients but they were widely variable and nonspecific. Infectious diseases were the commonest etiological factor encountered; among them, thyroid fever, and urinary tract infections were the most frequent infectious disorder found; in four children fever was associated to ampicillin administration; in 19 patients, fever was no demonstrated. A large number of laboratory investigations were done in the diagnosis of neoplastic diseases. We think that the study of a patient with FUO requires of a systematized approach.


[Lymphoblastic lymphoma in the adult].

[Lymphoblastic lymphoma in the adult]. We report a series of 57 adults patients with lymphoblastic lymphoma treated at our Institution between 1975 and 1987. Mediastinal involvement was seen in 74% (42 cases); extranodal involvement (not including bone marrow) in 24% (14 cases); stage IV in 84% (48 patients) and leukemic phase in 19% (11 patients). In 15 cases immunologic studies were performed 14 proved to be of T type and the other one lack both T and B markers. Survival and duration of remission was better when the patients were treated with aggressive chemotherapy that included maintenance and central nervous system prophylaxis. In the multivariable analysis we observed that mediastinal mass, attainment of a complete remission and high levels of lactic dehidrogenase were associated with a worse prognosis. We believe that patients with lymphoblastic lymphoma have an aggressive disease and that the treatment should be more aggressive than in other non-Hodgkin's lymphomas, and include central nervous system prophylaxis.


[Evaluation of nopal capsules in diabetes mellitus]. To find out if commercial capsules with dried nopal (prickle-pear cactus, Opuntia ficus indica may have a role in the management of diabetes mellitus, three experiments were performed: 30 capsules where given in fasting condition to 10 diabetic subjects and serum glucose was measured through out 3 hours; a control test was performed with 30 placebo capsules. OGTT with previous intake of 30 nopal or placebo capsules was performed in ten healthy individuals. In a crossover and single blinded study 14 diabetic patients withdrew the oral hypoglycemic treatment and received 10 nopal or placebo capsules t.i.d. during one week; serum glucose, cholesterol and tryglycerides levels were measured before and after each one-week period. Five healthy subjects were also studied in the same fashion. Opuntia capsules did not show acute hypoglycemic effect and did not influence OGTT. In diabetic patients serum glucose, cholesterol and tryglycerides levels did not change with Opuntia, but they increased with placebo (P < 0.01 glucose and cholesterol, P = NS triglycerides). In healthy individuals glycemia did not change with nopal, while cholesterol and triglycerides decreased (P < 0.01 vs. placebo). The intake of 30 Opuntia capsules daily in patients with diabetes mellitus had a discrete beneficial effect on glucose and cholesterol. However this dose is unpractical and at present it is not recommended in the management of diabetes mellitus.


[Preservation of the pancreas for the simultaneous transplantation of kidney-pancreas]. This paper studies the advances that have participated in the development of preservation solutions for the combined kidney-pancreas transplantation. These developments have been associated most importantly with hypothermia, the use of colloid solutions with high oncotic pressure, and the maintenance of near-intracellular ionic concentration. At the present time, the more effective solutions are the plasma-like modified Silica Gel Fraction and the starch and lactobionate based solution such as, the UW. Further advances in this area, would allow for improved results in the combined kidney-pancreas transplant preparation.


Antigenic and genomic differences of two Jasper strains of infectious pancreatic necrosis virus. Strains of infectious pancreatic necrosis virus (IPNV-Jasper) obtained from two different laboratories were compared serologically with polyclonal and monoclonal antibodies. Nucleotide sequence and restriction endonuclease patterns of 359-bp fragment of genome segment A cDNA were also compared. Substantial differences were found in both analyses that will support the fact that the two Jasper strains are not identical.


Inefficient transmission of HTLV-I to MOLT-4 cells by cell-free virus and cocultivation. Transmission of human T cell leukemia virus type I (HTLV-I) to a T cell line (MOLT-4#8) was studied using cell-free virus infection or cocultivation with an HTLV-I-transformed T cell line (MT-2). Immunofluorescence and FACS analyses showed that HTLV-I was efficiently adsorbed onto MOLT-4#8 cells. However, after adsorption, no extrachromosomal viral DNA in the cells was detected by the Southern blot method. In contrast, when MT-2 cells were cocultured with MOLT-4#8 cells, generation of extrachromosomal DNA was clearly observed. These data suggest that the cell-free HTLV-I may have difficulties in penetration, uncoating or reverse transcription. After cocultivation, MOLT-4#8 cells chronically infected with HTLV-I were cloned and analyzed. Only four provirus-positive cell lines were obtained. The transmission rate of the virus by cocultivation seemed to be low in our experimental system, although marked cell fusion was observed. Moreover, none of the cloned cell lines which harbored HTLV-I provirus expressed any viral protein. Inefficient integration and expression of the provirus might be hypothesized as compared with human immunodeficiency virus type 1 transmission.


[Corneal autograft, an additional alternative in corneal transplantation]. Corneal autotransplantation is a process in practice for various years. This procedure has the advantage of providing corneal tissue which will not be immunologically rejected in the host. This paper reports five cases in which this procedure was undertaken by changing a transparent cornea from a blind eye on the other side.


Bacterial luciferase produced with rapid-screening baculovirus vectors is a sensitive reporter for infection of insect cells and larvae. Bacterial luciferase, derived from a fusion of the luxA and luxB genes of Vibrio harveyi, has been expressed at very high levels in caterpillars and insect cells. The coding sequence for luciferase was inserted into vectors developed in our laboratory which were designed to expedite screening of recombinant virus. These vectors contained the beta-galactosidase indicator gene under control of immediate early (IE1), early (ETL), or very late (P10) promoters and a cloning site for inserting the fused luciferase gene next to the polyhedrin promoter. Recombinant baculoviruses containing the luciferase gene as well as the beta-galactosidase gene could be easily selected when Bluo-gal (beta-galactosidase indicator) was included in the plaque assays. Using cells derived from the fall armyworm (Spodoptera frugiperda), luciferase was strongly expressed very late in infection (48-72 h). The bacterial luciferase assay was sufficiently sensitive that light production could be detected from an extract of a single cell. In addition, live insects, including the cabbage looper (Trichoplusia ni) and saltmarsh caterpillar (Estigmene acrea) were infected by mixing recombinant baculovirus into their diet. Cabbage loopers (with an average wet weight of 223 mg) produced at least 195 micrograms of active luciferase and levels of synthesis peaked between 96-120 h. The results indicate that bacterial luciferase may be used as a reporter of gene expression in insects.


[Improvement in the quality of medical care]. The object of this research was investigating the existence of programs, as well as the patient's and healthy worker's opinions, concerning the quality of Medical Attention in the representative medical institutions in Mexico City (Distrito Federal). Eighteen directors of medical institutions were interviewed; as well as fifty university graduates, one hundred out patients from health centers and three hundred patients treated at general hospitals. A poll was applied to two hundred and fifty physicians and two hundred and fifty nurses from health centers and general hospitals. The eighteen institutions studied had permanent programs for Supervision and assemend. Other activities were also detected: sixteen had Technical Committees, five had a Department for Complaints, three had Quality Circles, two had programs for Evaluation of Educational Needs, two had Patients Polls, two had Worker's Polls, one had a Shadow Study and two had Quality Control Programs. The 86% of university graduates belonged to the social security system. Among these, 36% attended public services, 36% of them did this selectively and 28% did not use social security. 30% felt that public medical services were good, 14% less than good and 56% bad. 36% felt that public services were better than private ones, 36% said both were equally good and 28% judged the public system as worse than the private ones. The main deficiency reported was a lack of personal warmth. The patients from both the general practice and hospitalization graded the opportunity, warmth and process of medical attention as variables with figures of 80% or more. The frequency of diverse "complications" was 66% in out patients and 36% in the hospitalized ones. The physicians and nurses graded the infrastructure, teaching, laboral motivation and satisfaction, and continuity of services as variables with percentages of 50% to 60%; whereas the variables of warmth, control and supervision with values of 60% to 80%. Hospital nurses were less satisfied. These results show patients to have an acceptable satisfaction whereas the health personnel was unmotivated. Practical actions are suggested to improve the quality of medical attention.


[Epidemiology of mycetoma in Mexico: study of 2105 cases]. A survey was carried out in Mexico to determine the incidence and epidemiological characteristics of mycetoma. Data was collected from a total of 2105 cases of mycetoma throughout a 30 year period (1956-1985), with an average incidence of 70 cases per year. Results showed a sex distribution of 76.1% male and 23.9% females. Age distribution indicated a 35% between 16 to 30 and 23% between 31 to 40 year old population. Most cases occurred in land-workers (60.2%) and in housewives with rural residence (21.3%). Lesions occurred most frequently in lower limbs (64.1%), trunk (17.4%) and upper limbs (13.6%). The geographic distribution within Mexico revealed that the States with the highest incidence were: Jalisco, Nuevo León, San Luis Potosi, Morelos and Guerrero The predominant etiologic agents found 97.8% corresponded to actinomycetes, from which Nocardia brasiliensis (86.6%) and Actinomadura madurae (10.2%) showed the higher frequency. Eumycetoma (2.2%) was due to Madurella grisea and M. mycetomatis in most cases.


Haematological and coagulation profile in acute falciparum malaria. The haematological and coagulation profile of 30 cases of acute falciparum malaria were studied. Anaemia, mostly normocytic, normochromic, was observed in 86.7% of cases majority of whom had complications. Severe anaemia (HB < 6gm.) observed in 10% of cases was associated with 100% mortality. Leucocytosis and leucopenia were observed in 13.3% and 6.6% of cases respectively. 90% of cases had thrombocytopenia, the lowest count recorded being 26,000/- cmm. 16.7% of cases had evidence of intravascular coagulation but manifested as generalised bleeding in only one case. Bone marrow aspiration done in 10 cases revealed no abnormality, except for falciparum parasites observed in 2 cases.


Comparative immunogenicity of different hepatitis B vaccines among certain high risk groups in India. The immunogenicity of three different commercially available, well established Hepatitis B vaccines was determined. Three groups of high risk individuals were administered the vaccine, viz, Albugam (20 micrograms), Engerix-B (20 micrograms) and vaccine produced by Cheil Sugar & Co. (3 micrograms) respectively in a schedule of 3 doses as recommended by the manufacturers. A fourth group was administered a combination of the Albugam (2 doses) and Engerix-B (1 dose) vaccine. The sera collected 2 months after the 3rd dose showed seroconversion rates to be 100 percent and 95.34 percent respectively in the group which received the Albugam and Engerix-B vaccines respectively. The group which received a combination of both, the seropositivity rate was also 100 percent. The Chiel Sugar vaccine gave a seroresponse of only 52.38 percent. Geometric mean titres among the groups which received Albugam vaccine (501.30) were comparable to those receiving the combination of Engerix-B and Albugam (442.28). Those who received all 3 doses of Engerix-B vaccine showed a significantly lower GMT as compared to the above tow groups (GMT--43.14, p < .001, P < .001 respectively). The GMT in the group that received Cheil Sugar Vaccine was 3.81. Seroresponse was found to be inversely proportionate to age.


Advisory committees for agencies that provide services for children with special health-care needs. The Children's Special Health Care Services Advisory Committee is an advisory group that includes stakeholders in the delivery of care for children with special health-care needs. An emphasis has purposely been placed on consumer participation to ensure adequate voice and balance with other provider, legislative, and bureaucratic interests. The Advisory Committee has assumed an aggressive and complete role in reviewing and recommending every aspect of the program. As a result of this active co-ownership, the program has repeatedly survived threats of serious budget cuts and reductions to its base. Agreement between providers and consumers on values, structure, and operational needs has been reached. A win-win approach has been possible, not only in the planning and growth of the program but also in the policy arena, legislatively, and with the administration.


Parent consultants in the health-care system: a new approach in the care of children with special needs. A unique and innovative role for parents has emerged from the recent emphasis on family-centered, community-based health care for children with special health-care needs. The role of parent consultant is described in the following article. Identified are the characteristics of the consultant role, benefits as well as challenges, how the role is enacted, and ways to finance the position. Nurses can serve to support and nurture the parent consultant role to ensure positive role development. Parent consultants have a unique and important perspective to offer in the delivery of a family-centered approach.


Care management for children who are medically fragile/technology-dependent. Care management is a nursing role that has received more attention over the past decade as the number of children with special health-care needs has increased. The particular role of the specialized care manager within the Michigan Department of Public Health is described in the following article. The purpose is to highlight how the role emerged from a philosophy of care and how families receive the care management services. Future challenges for the state-supported role of care manager are described.


Air pollution related respiratory morbidity in central and north-eastern Bombay. A study of 4 comparable communities in central & northeastern Bombay (2 each) among randomly matched 349 subjects in 1988-9, along with ambient sulfur dioxide (SO2), Nitrogen dioxide (NO2) & suspended particulate matter (SPM) air monitoring was carried out. The levels in winter were higher particularly for SO2 in Parel (upto 584 micrograms) in Maravali; Deonar showed lower pollution. There were inter-area differences for housing, income, residential history but age-sex differences were small; these were reduced by matching. Clinical respiratory symptoms were higher in Parel & Maravali (cough 12% and 11.2%, dyspnoea 17% & 13.3% respectively). Cardiac problems are commoner in Parel (11.0%). Smoker had cough more often but not dyspnoea. Maravali had a high prevalence for headache and eye irritation (9.5%). Those using kerosene suffered more than those using gas (22.2% as compared to 9.2%) Lung functions (FVC, FEVI) were lowest in Parel for males and in Maravali for females. Expiratory flow rates were lower at Dadar and then at Maravali. Despite lower SO2 pollution, Maravali residents suffered equally as in Parel. This may be due to added effect of diesel exhausts (NO2, SPM) or other unmeasured chemicals.


Establishment of a state-supported, specialized home care program for children with complex health-care needs. Establishment of a systematic approach to home care for children who require complex, technology-dependent care requires a well-thought-out process of collaboration and planning between all parties involved--the family, the professional, and the hospital. The State of Michigan Department of Public Health elected to assist families in taking their children home through a Specialized Home Care Program funded by combined sources that emphasized child care needs first rather than cost savings. This review identifies the development of roles, processes and products, and methods to enhance the discharge planning and home care processes. These processes indicate the need for parent involvement and teamwork with health-care professionals. Refinement of the program is suggested as well as further development of an evaluation component and family assessment tools.


Wegener's granulomatosis in northern India. Till recently, Wegener's granulomatosis (WG) was considered a rare disease in India. Over the last 5 years we studied 13 proven cases of WG. This paper describes the details of the disease as seen in these patients, and response to corticosteroid and cyclophosphamide therapy, and compares these observations with a Western and an Indian study.


Wegener's granulomatosis: clinical experience with eighteen patients. Wegener's granulomatosis is being recognised with increasing frequency in India. Our 18, histologically confirmed, patients had a clinical profile similar to that described from developed countries. Delayed diagnosis led to the death of nine patients, usually within days of hospital admission, due to extensive vasculitis and renal failure. Tuberculosis was the most frequently considered diagnosis and 12 patients had been treated for it in spite of progressive clinical deterioration. Those who could be adequately treated with low dose daily cyclophosphamide and corticosteroids did well. Six of seven such patients are alive and well 1-8 years later. We believe that if prompt lung biopsy and ANCA determination are resorted to in patients with "resistant tuberculosis", it will greatly expedite case detection, diagnosis and optimum treatment of this remediable disease.


Diuretic induced hyponatraemia in the elderly. Diuretics are an important cause of symptomatic hyponatraemia in the elderly. The hyponatraemia is often associated with hypokalaemia which may play a role in the aetiology. Diuretic induced hyponatraemia must be considered in the differential diagnosis of elderly patients presenting with altered sensorium or seizures. This is especially important in those known to be hypertensives since diuretics are frequently used to treat hypertension in the elderly.


Dystrophin test in differential diagnosis of childhood muscular dystrophies. Two cases of childhood muscular dystrophy are described. One of them had clinical features suggestive of Emery-Dreifuss muscular dystrophy and the other with some features of Prader-Willi syndrome, besides proximal muscle weakness. Muscle biopsy from both cases revealed a clear abnormality of dystrophin, and were diagnosed as having Duchenne muscular dystrophy (DMD) by immunofluorescence examination; that is, absent dystrophin at the membrane of the muscle fibers. The clinical spectrum of DMD-related myopathies and the importance of dystrophin testing in childhood muscular dystrophies is discussed.


Double orifice mitral valve: report of 4 cases. Double Orifice Mitral Valve (DOMV) is a rare congenital abnormality. Reports of 4 patients with DOMV are presented. As associated anomalies, one had ostium primum atrial septal defect (ASD). Second one had Ebstein's anomaly. Third one had grade IV tricuspid regurgitation, thickened tricuspid valve and right atrial mass. Fourth one had sinus venosus ASD. Echocardiography is the gold standard investigation. Surgical treatment depends upon the mitral valve function and associated anomalies.


Multiple meningiomas.

Multiple meningiomas. True "multiple meningiomas" as defined by Cushing are rare. A case of multiple meningiomas without stigmata of neurofibromatosis, in a 53 year old man, treated surgically is reported. The relevant literature on multiple meningiomas has been reviewed.


Fluorescein angiography in systemic hypertension. This study evaluates the role of fluorescein angiography (FA) in detecting changes in the retinal and choroidal capillary bed in hypertension and defines its advantages over direct ophthalmoscopy. 37 patients with varying degree of severity of hypertension were studied. Direct ophthalmoscopy and FA was done in all cases. No significant difference was found in documenting vessel calibre and arteriovenous crossing changes with either of the methods. Hard exudates were not visualized on FA. Capillary bed and choroidal abnormalities could be better studied on FA which can be employed in selected patients of hypertension but its use is not advocated as a routine in all hypertensives.


Biochemical assessment of cholelithiasis. Bile and serum were analysed in 45 cases of cholelithiasis and 25 control subjects for cholesterol, phospholipids, bilirubin, alkaline phosphatase and LCAT activity. Serum phospholipids were found to be elevated in sixty percent of cases, whereas phospholipids in bile were found to be decreased. Serum alkaline phosphatase and alanine aminotransferase were normal. Serum and bile LCAT activity was found to be significantly depressed.


Quantitative estimation of urinary protein excretion by refractometry. Quantitative estimation of proteinuria done by the refractometric method was compared with that done by the sulphosalycilic acid method and biuret method in 102 urine samples. The analysis of results by students' t test showed no statistically significant difference between the three methods. It is concluded that quantitative estimation of urinary protein excretion by refractometric method is a simple cheap and reliable method and can be performed easily in the outpatient clinic. The instrument is quite handy and can be carried in the pocket.


Circadian variation in the onset of pain of acute myocardial infarction in Indian patients. Two hundred patients admitted with acute myocardial infarction (AMI) to the coronary care unit of a tertiary-care-teaching hospital over a period of 1.5 years were studied prospectively, with regard to the time of onset of pain of infarction. The maximum number of infarctions (i.e. 71) (35.6%) occurred between 4.00 AM and 10.00 AM, significantly higher than other 6 hour periods of the day (P < 0.01). Various possible mechanisms leading to this early morning increase in the incidence of AMI and its therapeutic implications are discussed.


Rare poisoning with cerebra thevetia (yellow oleander). Review of 13 cases of suicidal attempt. Clinical presentation, course and management of thirteen patients of suicidal poisoning with seeds of yellow-oleander were studied. All patients who took more than two seeds had gastro-intestinal as well as cardiovascular toxic effects. Patients responded well to symptomatic and supportive treatment when they had four or less than four seeds and reported to hospital within four hours intake. Progress was bad when patients took more than four seeds and reported after four hours of intake, cause of death in all the patients was cardiogenic shock.


Prognostic significance of reciprocal changes in acute myocardial infarction. Study on 108 patients of acute myocardial infarction has shown the incidence of reciprocal ST depression in ECG in 58.3% patients. Those showing reciprocal changes had higher (65.0% Vs 15.5%) incidence of complication such as dysrhythmias, conduction disorders. hypotension, left ventricular failure or CCF which was more conspicuous in inferior myocardial infarction. There was higher incidence of complications (74.4% vs 18.7%) whenever ST depression was 2 mm or more (P < 0.001) and there was steep rise in complications whenever the ST depression persisted for 2 days and beyond.


Falling standard of examinations in the medical sciences. Despite the strictly specified criteria laid down by the Medical Council of India the standard of examinations in the medical sciences in the country is continuously falling. This is mostly because of lack of sincerity and integrity of many examiners. This is an unwelcome situation and requires serious thought and appropriate urgent remedy.


Hormones and bioactive substances in milk: a rudiment or a message? The composition of milk is the result of an evolutionary process with both positive and negative natural selection mechanisms where variants with components supporting offspring development from birth to reproduction (but not later) are preferred. Almost all known hormones and many other bioactive substances are present in milk of various species. Some of them are synthesized by the mammary gland, the others are passively or selectively transported (and eventually modified) from blood into milk. Hormones in milk are of importance for the regulation of the functions of the mammary gland itself. There are indications that they affect (sometimes permanently) both functions of suckling GIT and other functions after their resorption during the defined developmental periods. The definite role of these messages for further offspring development remains to be established.


Antioxidant systems--physiology and pharmacotherapy trends. Metabolic processes connected with the effects of oxidation and antioxidation with participation of cellular energy are presented and therapeutic possibilities connected with coenzyme Q and N-acetylcysteine are discussed.


Magnesium deficiency impairs rat soleus muscle glucose utilization and insulin sensitivity. Insulin resistance (IR), probably a common pathway of atherosclerosis development in various diseases, was suggested to be related to magnesium (Mg) deficiency. The in vivo observations required an in vitro extension. The study was performed on isolated rat soleus muscle incubated in Ringer bicarbonate with/without Mg. Mg deficiency inhibited basal, insulin- and tolbutamide-stimulated glucose utilization. Insulin-stimulated glucose utilization was inhibited even in the case that insulin was given to rats before sacrifice. Similar inhibition of glucose utilization was found in Ca deficiency and the simultaneous lack of Mg had no additive effect. It is concluded that Mg deficiency inhibits glucose utilization at the level of Ca mediation of glucose transport regulation.


The effect of a cholecystokinin receptor antagonist lorglumid on the proteinase-antiproteinase balance in taurocholate acute experimental pancreatitis (AEP) in rats. The effect of new CCK receptor antagonist, lorglumid on taurocholate AEP in rats was studied. Lorglumid was applied intraperitoneally at a dose of 5.6 mg/kg BW immediately after taurocholate injection into choledochopancreatic duct. Activity of amylase, antithrombin III (AT III), alpha 1 protease inhibitor (alpha 1 PI), alpha 2 antiplasmin (alpha 2 AP) and alpha 2 M) in plasma, trypsin and chymotrypsin in pancreata were measured after 1, 3, 6 h of AEP. In AEP treated by lorglumid serum amylase activity and pancreatic wet weight was significantly reduced. The use of lorglumid prevented the increase of alpha 1 PI and alpha 2 AP compared to not treated animals. AT III and alpha 2 M in plasma and trypsin and chymotrypsin activity in pancreata did not change significantly in all groups. The mortality of the lorglumid treated rats was significantly lower in comparison with control group. It is concluded that lorglumid in taurocholate AEP moderates the changed plasma proteinase-antiproteinase balance. Our results indicate a protective effect of lorglumid in this model of acute experimental pancreatitis.


Protective action of vitamin E on the subcellular structures of lymphocytes intoxicated with pesticides in vitro. Vitamin E was used as a protection for human lymphocytes in vitro against the toxic effects of dichlorvos, an organic phosphate pesticide. As the markers of the toxic changes in the lymphocytes lysosomes were chosen as a membrane structure, and nucleoli as a structure connected with protein synthesis. The obtained results were compared with the effects obtained previously in analogous studies after intoxication of lymphocytes with lindan and fenarimol. The experiment showed that vitamin E protected the lysosomal membranes more effectively than the nucleolar structure in these cells.


Prostaglandins during haemodialysis treatment. The prostaglandins 6-keto Pgf1 alpha,PG F2 alpha and thromboxane B2 before and during haemodialysis were studied by means of radioisotope method. A significant increase of 6-keto PGF1 alpha and decrease of PGF2 alpha was found. The concentration of thromboxane B2 was markedly, but not significantly decreased. This constellation inhibiting the thrombocytes aggregation and promoting vasodilation seems to be favourable as far as biocompatibility is concerned. Dialysis treatment caused no significant changes in prostaglandins concentration.


Helicobacter pylori in experimental acute and chronic gastric and duodenal ulcer in Buffalo [correction of Bufallo] rats. The experiment was performed using inbred Buffalo rats to confirm the coincidence between peptic, gastric and duodenal ulcer and Helicobacter pylori infection. The results suggest an unquestionable meaning of Helicobacter pylori appeared to be as strong ulcerogenic factor in rats as ligation of pylorus and diffusely administrated histamine.


Long-term antiarrhythmic pharmaco-therapy guided by Holter monitoring in patients with malignant ventricular arrhythmias and ischemic heart disease. In 126 patients with clinical ventricular tachycardia and/or fibrillation, ischemic heart disease and repetitive and/or frequent ventricular ectopic beats long-term therapy guided by Holter ecg was assessed. Criteria for efficacy of antiarrhythmic drugs were following: 1) > 75% decrease in ectopic beats, 2) elimination of salvos, 3) > 90% reduction of couples and R/T and 4) reduction of multiformity up to 2 forms. They were fulfilled in 71% of patients (responders). During follow-up 1-49 months, mean 20, rate of sudden death was lower in responders as compared with nonresponders (p < 0.05). However, suppression of ventricular ectopic beats was not predictive for a favorable outcome, because the incidence of arrhythmic events and total cardiac death was similar in the two groups.


A study of circadian rhythms of estriol secretion in the third trimester of gestation complicated by gestosis and intra-uterine growth retardation (IUGR). The circadian changes in serum estriol concentration in the case of gestosis (at 30-36 weeks gestation) and intra-uterine growth retardation-IUGR (at 28-36 weeks) were examined. The control group consisted of pregnant patients without placental insufficiency at 26-34 weeks gestation. No circadian rhythms of estriol secretion was found in patients with gestosis and IUGR, whereas such a rhythm was confirmed in normal pregnancies. The evaluation of circadian changes in estriol concentration in the third trimester of gestation may be useful when diagnosing chronic placenta insufficiency.


Evaluation of blood coagulation tests in deep venous thrombosis. On the basis of the hemocoagulation and hemostasis parameters study the actual hemostasis state was evaluated in 30 patients treated for active deep venous thrombosis (DVT) in dependence on its extent. In comparison with 30 healthy persons there were found statistically significant changes in a majority of laboratory parameters that can indicate thrombophilic state. Platelet activation, increased coagulation system activity, decreased fibrinolytic activity as well as increased fibrinogen and fibrin degradation products were demonstrated. The positive correlation between the extent of DVT and the relevance of hemostasis changes was revealed which results to these conclusions: the more extensive DVT--the more intensive tendency to thrombophilia up to intravascular blood coagulation activation was observed. Although the adequate prolongation of the prothrombin time (during the coumarin therapy) or APTT (during the heparin therapy) was achieved, the laboratory parameters showed a therapy insufficiency. In the cases of laboratory signs of the activated intravascular blood coagulation we can recommended a fortification of the oral anticoagulant therapy by its combination with antiplatelet drugs or by its temporary replacement by the heparin therapy.


The alteration on serum thyroid hormones and iodine levels when the 10% povidone iodine solution was topically performed on ano-rectal mucosa. In this experiment, the 10% povidone-iodine (PI) solution was topically administered on ano-rectal mucosa by enema and its effects on thyroid hormones and iodine levels in serum were examined in rabbits. The solution was given in a volume of 20 ml daily for three days. Blood samples were drawn at 1st, 4th and 7th days after the first enema. The serum iodine levels reached maximum values at the first day was still elevated at the 4th and 7th days, but T3, T4 and TSH values remained within the normal limits. Iodine did not produce alterations in the levels of thyroid hormones and TSH, although it is known that a considerable amount of it is absorbed from the intestinal lumen.


Albumin and packed red blood cells in the treatment of severely isoimmunised pregnancies. The most effective method of treatment of severe cases of fetal haemolytic disease are intrauterine intravascular transfusions. In some hydroptic cases however, the administration of only packed red blood cells produces unsuccessful results. We found that albumin supplementation paralleled with PRBC injection significantly increases the effectiveness of intravascular treatment.


The effect of cytotoxic drugs on the development of murine granulocyte-macrophage (GM) progenitor cells. The effect of cytotoxic drugs was tested on the hematopoietic system by assay of the ability of granulocyte-macrophage colony forming cell (GM-CFC) in mice to create GM colonies. The in vivo ability of bone marrow progenitor cells to granulocyte-macrophage colony formation, was tested after long-term peritoneal cytotoxic drug administration. The direct effect of these agents on cells in vitro culture was evaluated also. It was found that cytotoxic drugs inhibit the GM colony formation. The degree of damage to the bone marrow progenitor cells by assaying in vivo colony formation inhibition, depends on the drug dosage and length of therapy (after 25-30 days of treatment the colony growth was below 50%). The in vitro inhibition of granulocyte-macrophage colony formation depends on the concentration of drug (10(-7)-10(-5) M is critical for GM colony growth). The results suggest the possibility of the GM-CFC growth testing as an indicator of the progress or side effects of cytotoxic therapy.


New perspectives and hope for cure-reflecting recent genetic developments in cystic fibrosis. The isolation of cystic fibrosis gene at the CF locus assigned to the long arm of chromosome 7 band q31 and definition of its protein product named CFTR (cystic fibrosis transmembrane conductance regulator) permits to understand the basic defect in this inherited disorder known as cystic fibrosis (CF) or mucoviscidosis. A variety of mutations of CF gene was revealed and the most common, a deletion of the 3 nucleotides that encode phenylalanine (Delta F508) with the variable incidence among the different ethnic groups of CF patients was delineated. CF is a variable disease and genetic testing can be useful to explain this variation but to date the phenotype-genotype correlation is not clarified. Polymerase chain reaction (PCR) amplification is used to test CF gene in CF patients and their families but is not sufficiently genetically informative to population screening for carrier detections. Recently identified glycoprotein encoded by CF gene is responsible for the regulation of the membrane chloride channel of epithelial cells and the experiments used retro-virus-mediated gene transfer demonstrated complementation CF defect in vitro. The way for gene therapy in this disease is open. An alternative approach to use the germ line cells to CF gene therapy is prerequisite of the development of the preimplantation preconception genetic CF diagnosis. The researchers managed already to express human CFTR gene in vivo in cotton rats lungs through the viral delivery system. It will be generalized into the airways of CF patients with hope that normal CFTR will reverse the physiological defect in CF cells.


ABO blood groups system in laryngeal cancer patients and after survival of 3 and 5 years. The analyzed material comprised 200 patients with cancer of the larynx with various locations of the tumour and patients surviving 3 and 5 years after operation. The frequency of ABO blood groups was analysed separately in cases of epiglottis cancer (n = 153) and glottis cancer (n = 37). The frequency of A1, A2, B, A1B, A2B, O blood groups was compared with that in 22,422 healthy individuals living in South Poland. The A2B blood group was significantly more frequent in patients with epiglottis cancer and in those with laryngeal cancer. The difference was not significant after survival of 3 and 5 years.


Monoclonal antibodies--why should surgeons be interested? Many different monoclonal antibodies used experimentally and clinically are highly tumor-specific. Radiolabelling of these antibodies has been successfully accomplished. Immunoscintigraphy of primary and metastatic cancers has a reported sensitivity of 59-70%. However, in many studies, operative and histologic confirmation is lacking. Radioimmunoguided surgery is a promising new adjunctive technique for the surgical treatment of colorectal cancer. Its reported sensitivity ranges between 70 and 100% and specificity between 66 and 100%. In approximately one-third of patients with colorectal cancer, additional intraoperative information concerning the presence of subclinical tumors was gained using radioimmunoguided surgery. This system has the potential to assist the surgeon in performing complete resection of cancer and decrease the local recurrence rate. This could be of particular clinical importance for rectosigmoid tumors where the reported local recurrence rate is as high as 30%. Despite the advances made, many problems still need to be resolved. Radioimmunoguided surgery, however, has the potential to change the way surgery for colorectal cancer is being performed. It offers the possibility of improvement in patient survival.


The influence of the regional basic diet from northeast Brazil on health and nutritional conditions of mice infected with Schistosoma mansoni. Protein nutritional status indicators were studied in weanling albino Swiss mice infected with S. mansoni and fed the Regional Basic Diet (RBD) from Northeast Brazil, a multideficient diet of low-protein content. Each mouse was infected percutaneously with 80 cercariae. The experiment lasted 63 days. The growth curve, food consumption, protein intake, weight gain, Protein Efficiency Ratio (PER) and Net Protein Ratio (NPR) were the parameters investigated. RBD-fed mice showed a marked weight loss, a lower food and protein intake, a slower body weight gain and lower rates of food protein utilization when compared to casein-fed animals. Differences between infected and non-infected mice were not consistent. The present results suggest that the effects of RBD-induced malnutrition on health and nutritional conditions of the mice are more severe than those of Manson's schistosomiasis, in the initial phase of the disease.


[Fonsecaea pedrosoi-caused chromoblastomycosis in the state of Maranhão. I. The clinical, epidemiological and evolutionary aspects]. The aim of this study was to observe the clinical and of epidemiological behavior of chromoblastomycosis in the State of Maranhão. A retrospective and prospective study of 13 cases was performed at the infectious diseases section of the Hospital dos Servidores do Estado do Maranhão, from November, 1988 to July, 1991. In the investigation a protocol record was used with a view to further analysis. A higher prevalence between 50 and 60 years of age (46.1%) and in male patients (92.3%) was noted. Twelve patients (92.3%) were from Maranhão State, and 10 of them (76.9%) came from the western microregion of the State of Maranhão. Regarding occupation, 92.3% were land workers, and most of them presented the lesions on the lower limbs (84.6%) of a vegetant warty aspect, brown in color with itching. Histopathological examination diagnosed chromomycosis in 100% of the cases. Culture was performed in 11 cases, and Fonsecaea pedrosoi isolated in 9 of them. Treatment with 5-fluorocytosine resulted in a good evolutive response. This study indicates the existence of a probable endemic area of chromomycosis in hinterland of Maranhão (western microregion) that hither to unknown.


[A quantitative analysis of the mastocytes and eosinophilic granulocytes in the myocardium of Wistar rats chronically infected by Trypanosoma cruzi. A contribution to the knowledge of myocardial fibrosis]. We did mast cell and eosinophil granulocyte counts in the myocardium of forty chronic chagasic Wistar albino rats. We used 10 controls rats and 30 animals with late-stage (8th month) infection of São Felipe, Y and Colombian Trypanosoma cruzi strains, with variable degree of chronic myocarditis. We found chronic fibrosing myocarditis (fibrosis) in 40% of the infected animals. It was detected increased mast cell count in the chagasic rats associated with infection and not related with myocardial fibrosis. There was no increase in the eosinophil counts.


[The epidemiology of Chagas' disease in a rural area of the city of Teresina, Piauí, Brazil]. In the rural areas of Teresina, 129 triatomines were captured distributed in (a) artificial ecotopes; a house with one Triatoma brasiliensis, one Panstrongylus geniculatus, Rhodnius pictipes, and one Rhodnius prolixus and in a uninhabited chicken house (7 Rhodnius nasutus). (b) Natural ecotopes; Pahus Orbignya martiana (41 Rhodnius neglectus, 33 Rhodnius prolixus and 41 Rhodnius nasutus) and Copernicia cerifera (3 Rhodnius neglectus). The 22.6% of captured triatomines were infected by flagellates similar to Trypanosoma cruzi. Twenty-eight sylvatic mammals were captured and examined. Seven Didelphia albiventris, 2 Rattus rattus and a Tamandua tetradactyla were infected with flagellates. The flagellates found in both triatomines and mammals were morphologically indistinguishable from Trypanosoma cruzi. Serology by the indirect immunofluorescence test for Chagas disease revealed two positive seroreactions of positivity among 123 inhabitants examined.


[Pulmonary compromise in leptospirosis]. To study the pulmonary complications in leptospirosis case records of 23 such patients admitted at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil, were reviewed. Hemoptysis were seen in 21.7% and sputal blood in 30.4% of patients. Arterial gasometry detected hypoxemia and hypocapnia in most cases. Thoracic radiology showed an alveolar pattern in 60% of the patients, alveolo-interstitial in 20%, interstitial in 6%, and in 14% the lungs were considered to be normal. Necropsy of 13 cases showed edema, congestion and hemorrhage in the lungs in all cases. Hyaline membrane was found in 30% and fibrin thrombi in 46% of these cases, resulting in a diagnosis of adult respiratory distress syndrome and acute disseminated intravascular coagulation (consumption coagulopathy) in leptospirosis.


The specialty choice of clinical year students at the Ibadan Medical School. This is a cross-sectional study of first and final year clinical students of the University of Ibadan, aimed at highlighting the students' preference for specialties, its evolution in the course of training and its correlation with demographic variables. One hundred and twenty-one first year clinical and 150 final year students participated, representing 81% and 89% response rates, respectively. Whereas at the time of study 92.9% of the students intended to specialise, over 81% of this group opted for surgery, internal medicine, paediatrics, obstetrics and gynaecology and general practice. Only 5.5% of the cohort chose radiology, psychiatry, community medicine, anaesthesia and pathology. Surgery was the most popular specialty. No socio-demographic factors seemed associated with specialty choice. Specialty choice, evident before entry into the University in 42.9% of the cohort, evolved during the course of training, being affected mainly by interest aroused during the postings and the need for self-fulfilment. Specialty choice tended to fluctuate over the years. Innovativeness and dedication on the part of teachers can arouse the interest of students during posting, so that specialty choice can be more evenly spread to meet national health manpower needs.


Crusted scabies in a child with systemic lupus erythematosus. A child with systemic lupus erythematosus who has been treated with prednisone for three years, developed crusted scabies. Scrapings from lesions revealed Sarcoptes scabiei adult mites mad eggs. The patient died with septicemia and renal failure soon after starting topical 20% sulfur. A marked improvement was observed in the cutaneous lesions.


[The experimental infection of Cebus apella sp. monkeys with Trypanosoma cruzi. Its clinical, electrocardiographic and anatomicopathological assessment]. Thirty-two monkeys were captured and adapted to laboratory conditions captives isolated. They were submitted to multiple xenodiagnosis which were negative. Twelve were infected intraperitoneally with different strains of T. cruzi (1.10(5) to 5.10(6)). Twenty were the control group. Between on to six years both the control group and the infected monkeys, were submitted to xenodiagnosis, serological testing clinical examination and electrocardiography. The clinical examination and the electrocardiogram were always normal. The monkey were autopsied and histological examination detected in the infected group four monkeys with evidence of disease: one with parasites in the tissue and three with chronic myocarditis. Parasitaemia was in 66.66% of the monkeys in the acute phase and the serology was positive in 91.66% in the chronic phase. The authors concluded that Cebus monkeys were not susceptible to the development of the disease but they could be utilized to maintain of such strains and studies of serological research in long-terms infections.


Alpha-hydroxybutyrate dehydrogenase and the diagnosis of painful crisis in sickle cell anaemia. To assess the value of alpha-hydroxybutyrate dehydrogenase (alpha-HBDH) in the diagnosis of painful crisis (PC) of sickle cell anaemia (SCA), we studied plasma enzyme levels in 55 children with HbSS and 21 control subjects with haemoglobin genotype AA. In 21 children with SCA, mean plasma alpha-HBDH was 373.8 +/- 113.5 micrograms/l during PC and during steady state in 34 children, it was 341.2 +/- 103.4 micrograms/l. These values were significantly higher than that of 128 +/- 19.5 micrograms/l obtained in control subjects. However, the difference between mean plasma alpha-HBDH levels in SCA children in PC and in steady state was 32.6 micrograms/l, t = 1.095; P < 0.2. There was no correlation between alpha-HBDH levels and reticulocyte counts (r = 0.0856; t = 0.4565; 0.7 < P < 0.6). The high levels of alpha-HBDH in patients with SCA is probably due to chronic haemolysis and not marrow infarction. Therefore, alpha-HBDH is of doubtful value in the diagnosis of painful crisis.


African histoplasmosis (Duboisii) of the skull with neurological complication--a case report and review of literature. A case of African histoplasmosis of the skull associated with neurological deficit has been reported. There was complete recovery of neurological features after excision of the lesion followed by a course of co-trimoxazole. A review of the available literature indicates the rarity of this particular mode of presentation. The reversibility of the neurological complications makes it important that clinicians increase their awareness of this treatable condition.


The role of neutrophils in acute and chronic inflammation in rats. The effect of neutropenia on acute and chronic inflammatory oedema in rats was assessed using histamine, carrageenan and Freund's complete adjuvant as inducers. Neutropenia (about 85% reduction in peripheral blood neutrophil count) was induced with intraperitoneal administration of 2.5 mg/kg methotrexate for three consecutive days. Acute paw oedemas induced with carrageenan and Freund's complete adjuvant, but not that induced by histamine, were significantly decreased in neutropenic animals compared with controls. In adjuvant-induced chronic knee swelling (Adjuvant arthritis), neutropenia produced small, statistically non-significant, suppressive effect. In contrast, it significantly suppressed adjuvant-induced chronic paw swelling, although suppression was observed only in the late phase component of the swelling. The results suggest that neutrophils are involved in certain acute and chronic inflammatory responses but not in others.


Factors influencing academic achievement of medical students in the basic medical sciences. A structured questionnaire was administered to 236 medical and dental students who had just finished the Part I M.B.B.S./B.D.S. degree examination. Apart from personal data of each student, the questionnaire sought information on issues that may affect the student's learning of Anatomy, Biochemistry and Physiology. The scores of all the students in their continuous assessment tests and the finals of the Part I M.B.B.S./B.D.S. examinations in the three subjects were recorded. The results showed that age, repeating the year, performance in continuous assessment tests, having one, seven or eight 'A' grades in the Ordinary Level (O/L) examination significantly affected the overall performance of the students. On the other hand, likeness for a particular subject, mode of entry of the student whether direct or concessional, types of books read, time spent on each subject, having between two and six 'A' grades in O/L, access to hostel accommodation, adequacy or otherwise of financial support and the student's rating of his/her state of health did not significantly influence the performance of the students. The students gained most from lectures while tutorials were rated as being more helpful than practical classes. Multiple choice questions (MCQs) is the preferred mode of assessment. The possible explanation for these findings and their implications for medical education are discussed.


Immune complex levels and HBs-antigenaemia in healthy Nigerians and patients with liver diseases. Circulating immune complexes (CIC) were precipitated and assayed in the blood of 19 adult patients with liver diseases and 39 healthy adult Nigerians. The presence of hepatitis-Bs antigen (HBs-Ag) was also investigated in both the sera and CIC of both study groups. CIC levels were not significantly different in the three different liver diseases studied (acute hepatitis, chronic hepatitis and liver cirrhosis). Higher mean CIC levels which were not correlated with the presence of HBs-Ag, were found in the blood of patients, as compared to blood donors. While HBs- Ag was detected in 42.1% of patient's sera, only 12.8% of blood donor sera had detectable antigen. However, 42.1% of CIC from patients had the antigen, while 53.8% of CIC from blood donors also contained the antigen. It is suggested that the high frequency of HBs-Ag in the precipitated CIC of healthy subjects could account for the occurrence of some post-transfusion hepatitis-B infections.


"Antimalarial" medicinal plants and their impact on cell populations in various organs of mice. We have investigated the effects of leaf and bark decoctions of Ocimum gratissimum, Azadirachta indica, Morinda lucida and Enantia chlorantha on (a) the course of Plasmodium yoelii nigeriensis malaria (b) reticulocyte and haematocrit values and (c) nucleated cell numbers in the spleen, bone marrow, peritoneum, liver and peripheral blood of Swiss albino mice. Results obtained showed that normal mice infected with the parasite (10(4)/mouse) suffered fulminant parasitaemia which resulted in death, 7-10 days later. All infected mice treated with chloroquine survived. On the other hand all infected mice treated with the medicinal plants exhibited varying percentages of chemosuppression of early parasitaemia which did not lead to their survival. The total number of nucleated cells in the liver, spleen and peripheral blood of malaria-infected mice increased enormously before the animals died. Such increases were maintained in other groups of mice treated with the medicinal plants. In the non-infected mice, O.gratissimum and E. chlorantha administration increased the number of nucleated cells in the spleen, liver and peripheral blood. Chloroquine on the other hand decreased the number of nucleated cells in both the malaria-infected and un-infected mice. There was also a decrease in reticulocyte numbers in the blood of normal mice injected with chloroquine. Conversely reticulocyte numbers increased in normal mice administered with some medicinal plants. Acute and chronic toxicity tests revealed that some of the medicinal plants were much more toxic than others.(ABSTRACT TRUNCATED AT 250 WORDS)


Screening for Listeria monocytogenes and other related species from faecal specimens at the Lagos University Teaching Hospital, Lagos. Four hundred and twenty faecal specimens from patients with acute gastroenteritis and apparently healthy persons who reported at the Lagos University Teaching Hospital (LUTH) between October, 1988 and May, 1989 were investigated for faecal carriage of Listeria monocytogenes and other related species. Of these specimens, none was positive for Listeria species. However, the mannitol--fermenting Listeria species now Murraya grayi sub species grayi and Murraya grayi sub spp. murrayi representing 0.95% (4 out of 420) were isolated. Other well known enteric pathogens isolated in the course of this study were Escherichia coli (11.4%), Salmonella typhi (7.1%) and Yersinia species (1.4%).


Puerperal haematological indices in the Nigerian. Haematological indices were studied longitudinally in 84 healthy pregnant women at term and on days 1, 3, 5, 7 and 42 in the puerperium. Haemoglobin and haematocrit increased on day 1 after delivery, reduced on days 3 and 5 then started rising such that by day 42, the normal haemoglobin in African non-pregnant women was achieved. Leucocyte and neutrophil count increased significantly on day 1 but started falling thereafter and by day 5 the value had returned to normal. The lymphocyte, eosinophil and monocyte count did not show significant variation within the period of study. The platelet count in the primipara showed significant change on days 3 and 5. The variations in haemoglobin, haematocrit, leucocyte and platelet count in the puerperium were more marked in the primipara than the multipara and grandmultipara.


Ultrasound monitoring of ovarian follicular growth during spontaneous cycles in Nigerian women. Thirty-nine spontaneous cycles in 34 women (22 patients from the infertility clinic and 12 normal volunteers) were serially studied by ultrasound to monitor follicular growth for ovulation prediction and detection. Ovulation was also confirmed by a mid-luteal phase progesterone assay using WHO match RIA kits. Ovulation occurred from the left ovary in 21 cycles (54%) and from the right ovary in 18 cycles (46%). The maximum follicular diameter prior to ovulation was 21.0 +/- 3.48mm with a range of 15-28 mm. The maximum pre-ovulatory size in the group of infertile patients 21.4mm (range 15-28 mm) was not statistically different from the size in normal volunteers 20.8mm (range 15.5-27mm) (P > 0.05). Bilateral ovulation occurred in two patients. Changes in shape and/or size of the follicle mostly associated with increased internal echoes were the indices of ovulation in 84.7% of cases. Follicular diameter of 15mm may indicate imminent ovulation in Nigerian women. Infertility management procedures such as artificial insemination, timed sexual intercourse may commence just before or once this follicular size has been attained until ovulation is detected.


Malignant childhood tumours in Calabar, Nigeria. Children suspected with cancers seen during a 5-year period (Jan 1983-Dec 1987) in the University of Calabar Teaching Hospital (UCTH) Calabar, Nigeria were prospectively studied. A total of 60 cases were confirmed in those aged below 15 years with a majority (38.3%) of the children under 3 years. The pattern shows a preponderance of Burkitt's lymphoma followed by nephroblastoma and soft tissue sarcoma as the commonest malignancies. A low relative frequency of leukaemias (8.3%) and no intracranial tumours were encountered. This pattern closely resembles that of other Nigerian reports but contrasts with the situation in Britain and America, with their high leukaemia and intracranial tumour frequency ratios. Generally, there appears to be a low prevalence of malignancies among children in Calabar and presumably the south-eastern part of Nigeria. Difficulties in their management are attributable to late presentation, high patient default rate, complete lack of radiotherapy, and shortage of chemotherapeutic agents.


Alzheimer's disease in Nigeria.

Alzheimer's disease in Nigeria. The age-related dementias of the elderly (those aged 65 years or more) are of major public health importance in developed countries. Developing countries, most of which are undergoing epidemiological transition and greying of population, currently contain more than half of the world's population of elderly, a proportion that would reach 75% by 2020. Apart from reports from China, there is little or no information on the dementias of the elderly in developing countries. Alzheimer's disease, which accounts for two-thirds of dementia of the elderly in Caucasian population, is under-documented and believed to be rare in black Africans. But black Americans who are of black African lineage commonly suffer from Alzheimer's disease. A recent autopsy survey of the brains of elderly Nigerians showed absence of senile plaques and neurofibrillary tangles, the pathognomonic histologic lesions of Alzheimer's disease and ageing found in 25% to 80% of normal undemented elderly Caucasians and Japanese. In a community-based door-to-door survey of a population of 9000, including 932 elderly Nigerians, no subject with dementia as defined by DSM-IIIR was found, although there was significant decline of cognition with age, female sex and less than 6 years of formal education. The distribution of cognitive scores is a highly skewed unimodal curve. We emphasize the potential value of cross-cultural epidemiological studies of ethnic groups in different environments and with different prevalence ratios of Alzheimer's disease, in identifying putative environmental factors for this disease.


Screening for obstruction of the vas deferens in Nigerian men with azoospermia using the alpha-glucosidase reaction in semen. Obstruction of the vas deferens has been screened for, using the alpha-glucosidase reaction in seminal plasma as previously described by Comhaire. Eighteen patients with azoospermia were studied. The result showed positive reaction in 17 patients (95.0%) and only a weak yellow reaction in 1 patient. The results did not corroborate the working hypothesis that the azoospermia was due to obstruction of the vas deferens. The implications of this findings in the management of male infertility in Nigeria are discussed.


Influence of four Nigerian food additives on the mutagenicity of aflatoxin B1. The mutagenicity of aqueous extracts of four Nigerian food additives namely Xylopia aethiopica (Xa), Monodora species (Ms); fermented Litrillus lanatus-ogiri (Og) and fermented Parikia africans (African locust bean)-Iru (Ir) alone and in combination with different concentrations of aflatoxin B1 (0.05 microgram-0.25 micrograms) in the presence and absence of fecalase was studied using the Ames' salmonella mutagenicity assay system. Preliminary screening tests show the tester strain TA98 to be the most sensitive of the four tester strains (TA97, TA98, TA100, TA102) screened. The most mutagenic of the doses of the extracts are 3mg each of Xa and Ms per plate and 5mg each of Og and Ir per plate. A combination of these doses with different concentrations of aflatoxin B1 resulted in an enhanced mutagenicity of aflatoxin B1. The increases could not be accounted for by additive mutagenicity of the extracts and aflatoxin B1. Fecalase further increased the effects resulting from these combinations with the exception of Xa which showed a decrease in mutagenic induction. The increase may be indicative of the presence of some mutagenic glycosides in the extracts.


Beliefs and attitudes of clinical year students concerning medical specialties: an Ibadan medical school study. In order to understand their attitudes to 10 medical specialties, a 40-item self-report questionnaire was administered to the first and final year clinical students of the University of Ibadan. One hundred and twenty-one first year and 150 final year students participated, constituting 81% response rates respectively, in the two classes. The findings indicate that many factors influence specialty choice, the principal ones being: expectation of material rewards; societal appreciation of specialty and specialists; response of specialty patients to treatment; and the role of specialty teachers. It seems that specialties viewed positively in these dimentions (such as surgery, paediatrics, internal medicine, and obstetrics and gynaecology) are more highly favoured than the others (such as radiology, pathology, psychiatry, anaesthesia and community medicine), which were viewed rather negatively in this regard. Generally speaking, opinion on specialties was similar, not only between the two classes, but also between this cohort and comparable groups in developed nations. In order to enhance the spread of specialty manpower development to meet the goal of health care for all, suggestions are made about how to improve the positive appreciation of the less favoured specialties among undergraduates.


Lasers in surgery.

Lasers in surgery. In January 1991 the winter meeting of the Surgical Research Society was held at St. Bartholomew's Hospital and the Institute of Education, London. During the meeting a symposium was held entitled 'Shedding light on lasers'. Speakers addressed the general principles of lasers, laser-tissue interactions and the applications of lasers in gastro-enterology and in vascular disease. This was followed by an open discussion of the current indications, complications and outcome, together with future possible applications for lasers in medicine.


Risk factors for female and male infertility: results of a case-control study. In order to evaluate male and female risk factors for infertility in a case-control study, we have compared all couples in a French administrative region consulting for primary or secondary infertility (of more than one year's duration) with couples in which the woman had given birth during the year of the study. For any one couple, a history of varicocele, male genital infections or testis damage multiplies the risk of primary infertility by a factor of 28, 3 and 4 respectively, and previous female infections (salpingitis) multiply the risk by 45. Similarly, a history of ectopic pregnancy, sexually transmitted diseases or salpingitis multiplies the risk of secondary infertility by a factor of 5, 4 and 7 respectively, and a history of varicocele multiplies this risk by 4.


Post-traumatic stress disorder.

Post-traumatic stress disorder. The management of post-traumatic stress disorder depends on the nature of the stress, the personality of the victim, and the clinical orientation of the therapist. Traumatic situations may be experienced by individuals or by groups, and may be isolated incidents (such as unexpected civil disasters) or continuing occupational hazards, such as are experienced by soldiers, firemen or police. The first concern of therapists, whatever their methods of treatment, is an understanding of the nature of the trauma, and of the inherent differences in each type. This paper seeks to identify such differences. Some general therapeutic principles are then suggested.


Suicide in the home in relation to gun ownership. It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period. For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5). Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.


Objective clinical evaluation of physical impairment in chronic low back pain. The aim of this study was to investigate physical impairment in patients with chronic low back pain, to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment. Twenty-seven physical tests were investigated. Permanent anatomic and structural impairments of spinal deformities, spinal fractures, surgical scarring, and neurologic deficits were excluded as not relevant to the patient with low back pain in the absence of nerve root involvement or previous surgery. Three consecutive 20-patient reproducibility studies were used to develop reliable methods of examination for 23 of the tests. Only four tests were excluded as unreliable: sacral angle, pelvic tilt, and separate lumbar and pelvic extension, none of which are part of routine clinical examination or have any proven relationship to disability. The remaining 23 physical tests were evaluated in 70 asymptomatic subjects and 120 patients with chronic low back pain. Passive knee flexion, passive hip flexion, hip flexion strength, hip abduction strength, pain reproduction on each of these tests, and the prone extension strength test were excluded because they were too closely related to nonorganic and behavioral responses to examination. Eight tests successfully discriminated patients with low back pain from normal subjects and were significantly related to self-report disability in activities of daily living: pelvic flexion, total flexion, total extension, lateral flexion, straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up. Factor analysis failed to demonstrate an underlying statistical dimension of physical impairment. However, an empirical combination of total flexion, total extension, average lateral flexion, average straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up provided an equally satisfactory alternative. Simple cut-offs from normal subjects made the scale simple and quick to use. This final scale successfully discriminated 78% of patients and normal subjects and explained 25% of the variance of disability, with a specificity of 86% and sensitivity of 76%. This scale provides an objective clinical evaluation that meets the criteria for evaluating physical impairment, yet is simple, reliable, and suitable for routine clinical use. It should, however, be emphasized that all the tests included in the final scale are measures of current functional limitation rather than of permanent anatomic or structural impairment. This raises questions about the physical basis of permanent disability due to chronic low back pain.


Sural nerve conduction parameters in normal subjects related to age, gender, temperature, and height: a reappraisal. Failure to take body height into considerations in the evaluation of nerve conduction velocities (CV) has recently been deemed unacceptable. This statement prompted the present study. Besides height, the influence of age, gender, and temperature was studied in 92 normal subjects, half of whom were females. The CV decreased 0.9 m/s per 10 years increase in age, the same in women and men aged 15 to 44 years. Mean temperature between distal and proximal ends of the nerve segment examined increased 6.1 +/- 0.3 degree C after heating followed by a CV increase of 7.0 +/- 0.5 m/s. The CV decreased 0.15 m/s per 100-mm increase in heights. When considering 37 individuals aged 25 to 34 years only, the CV increased 0.34 m/s per 1-m increase in height. In both instances, the changes were within the experimental error (2.3%) of the method.


Sleep related upper airway obstruction and hypoxaemia in sickle cell disease. A cohort of 53 patients (age range 1.9-16.5 years) with sickle cell disease (49 homozygous SS and four S beta zero-thalassaemia) was studied for evidence of sleep related upper airway obstruction (UAO). This involved (i) a clinical assessment based on a history of snoring, a score of tonsillar size, and (for 50 patients) overnight multichannel respiratory recordings, and (ii) a blinded analysis of arterial oxygen saturation (SaO2) from the above recordings, and comparison with results from 50 healthy age matched controls of both white (n = 25) and Afro-Caribbean race. There was no difference in the baseline SaO2 values of the white and Afro-Caribbean controls. Eighteen patients with sickle cell disease (36%) were found to have sleep related UAO. The blinded analysis showed that eight patients (16%) had episodic hypoxaemia (SaO2 less than or equal to 80%, a value not observed in controls) and/or low baseline SaO2 values (less than 95.8%, the lowest value seen in the controls). Postoperative assessment was undertaken in 15 patients who underwent adenotonsillectomy. All demonstrated an improvement in symptoms and a reduction or abolition of episodic hypoxaemia. Of the 47 patients assessed when free of UAO (not demonstrated on screening, n = 32, or resolved following surgery, n = 15), seven continued to show baseline hypoxaemia. Sleep related UAO and baseline hypoxaemia are common complications of sickle cell disease in children.


Serum lipoprotein(a) levels in racially different populations. Lipoprotein(a) is an atherogenic lipoprotein which has been studied predominantly in white populations. Serum lipoprotein(a), serum lipids, and apolipoproteins A-I and B were quantified in 1991 in a total of 300 sex-matched samples derived from five different ethnic groups. Three population samples of Asian origin (Tibet, Korea, and China), one population sample of West African origin (Nigeria), and one Western population sample (Belgium) were included. All serum samples had been collected in the past (3-11 years previously) and had been stored at -80 degrees C since then. Thirty serum samples from males and 30 serum samples from females were analyzed from each ethnic group. Overall median lipoprotein(a) levels in Koreans, Chinese, Tibetans, Nigerians, and Belgians were 99, 89, 49, 134, and 80 mg/liter, respectively. Lipoprotein(a) frequency distributions were highly skewed to the right in all populations, with the Nigerian distribution showing less skewness than the Asian and Western plots. All distributions became nearly gaussian after logarithmic transformation. No statistical difference was found between the mean log lipoprotein(a) values of the sexes (4.43 +/- 1.01 mg/liter (standard deviation) in men; 4.44 +/- 1.08 mg/liter in women). Pearson correlation analysis of both sexes combined revealed no statistically significant correlation (at the p less than 0.01 level) of log lipoprotein(a) with age, height, weight, body mass index, cholesterol, high density lipoprotein cholesterol, apolipoprotein A-I, or apolipoprotein B within any of the population groups studied or after pooling of all population groups.


Sex ratios of affected and transmitting members of multiple case families with neural tube defects. In order to study the genetic aspects of the relation between neural tube defects and sex, we selected families with at least two closely related affected members. The sex ratios of both affected and normal transmitting persons were determined in these multiple case families. Our results indicate that there is a relation between the position of the lesion in the spine and sex. Furthermore, the affected persons in one family show significant concordance for sex as shown by the analysis of families with just two affected members. To our surprise, the group of normal transmitters appears to consist of significantly more females than males. This is in contrast to similar families with non-syndromic cleft lip +/- palate, where males predominate both among affected persons and normal transmitters. Finally, affected females most often inherited the predisposition to a neural tube defect from their mother. The possible role of inherited factors is discussed.


Subaortic obstruction in hearts with a univentricular connection to a dominant left ventricle and an anterior subaortic outlet chamber. Results of a staged approach. In 1984 we reported a 56% mortality after major cardiac operations for patients with univentricular connection to a dominant left ventricle, an anterior subaortic outlet chamber, and subaortic obstruction. Since then we have adopted a staged approach to this repair. Between 1984 and 1989 32 patients had such operations. The overall mortality has decreased (16%; p < 0.001). The current cohort was divided by subaortic gradient into three subgroups for comparison with the cohort reported in 1984. Staging improved the outcome in patients with gradients greater than 40 mm Hg (mortality of 17% compared with 67% from 1984; p = 0.05). Patients with gradients from 10 to 25 mm Hg who had a single-stage operation had the best outcome (mortality 6%). Survival has improved. Many factors, including increased awareness of the detrimental effects of subaortic obstruction, improved surgical techniques, better perioperative care, and the appropriate application of a staged repair, have contributed to this improvement. We recommend simultaneous relief of obstruction and a modified Fontan operation for patients with subaortic gradients less than 25 mm Hg. Those with gradients greater than 40 mm Hg should have repair in two stages. It is unclear whether a one-stage or two-stage approach is better for patients with gradients between these extremes.


Recombinant versus plasma-derived hepatitis B vaccine: comparison of immunogenicity in medical students. A group of 92 medical students were immunized with a commercial recombinant hepatitis B vaccine (Engerix B). Antibody responses were determined and compared with those to plasma-derived Pasteur vaccine, obtained in 1986. Antibody concentrations were significantly higher in the group given recombinant vaccine, therefore this vaccine has superior immunogenicity and probably confers extended duration of protection.


Laryngospasm during transtracheal high frequency jet ventilation. A 74-year-old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.


Everyone should be tested for iron disorders. Routinely measuring iron status is necessary because about 6% of Americans have negative iron balance, about 10% have a gene for positive balance, and about 1% have iron overload. Deviations from normal iron status are as follows. (a) Stage I and II negative iron balance, ie, iron depletion: In these stages iron stores are low and there is no dysfunction. In stage I negative iron balance, reduced iron absorption produces moderately depleted iron stores. Stage II negative iron balance is characterized by severely depleted iron stores. More than half of all cases of negative iron balance fall into these two stages. When persons in these stages are treated with iron, they never develop dysfunction or disease. (b) Stage III and IV negative iron balance, ie, iron deficiency: Iron deficiency is characterized by inadequate body iron for normal function, producing dysfunction and disease. In stage III negative iron balance, dysfunction is not accompanied by anemia; anemia develops in stage IV negative iron balance. (c) Stage I and II positive iron balance: Stage I positive balance usually lasts for several years with no dysfunction. Supplements of iron and/or vitamin C promote progression to dysfunction or disease. Iron removal prevents progression to disease. Iron overload disease develops in stage II positive iron balance after years of iron overload has caused progressive damage to tissues and organs. Again, iron removal stops disease progression. There are a variety of indicators of iron status. Serum ferritin is in equilibrium with body iron stores.(ABSTRACT TRUNCATED AT 250 WORDS)


Glycemic control and complications in type II diabetes. Design of a feasibility trial. VA CS Group (CSDM). To determine, after 1 yr of follow-up in type II diabetes patients, whether a statistically and clinically significant difference can be achieved in HbA1c between a standard therapy group and an intensively treated group, while maintaining HbA1c levels in both groups within ranges acceptable in regular community practice. Secondary objectives include assessment of patient adherence to protocol, side effects, and accuracy of data collection. This is a prospective, randomized, controlled VA CS conducted with 151 patients at five VAMCs. Patients are males, age 40-69 yr, treated at entry with a maximum dose of sulfonylurea or with insulin, exhibiting an HbA1c level > 3 SDs above the normal mean (5.05 + 3 x 0.50 = > 6.55%). Standard control is achieved with insulin and intensive control with a step-up regimen including insulin alone or insulin/glipizide combinations. Education and management of cardiovascular risk factors are handled similarly in both groups. Primary macrovascular end points are nonfatal myocardial infarction, congestive heart failure, stroke, amputation, and cardiovascular death. Primary microvascular end points are appearance and progression of retinopathy, documented by centrally read seven-field-stereo fundus photographs. Other measured indicators include resting and ambulatory ECGs, ventricular function (MUGA scan), serum lipid and apolipoprotein levels, plasma fibrinogen, nonsymptomatic peripheral vasculopathy, neuroautonomic status by heart-beat variation on Valsalva maneuver, and microalbuminuria. This study may be the basis for a long-term trial, involving 1400 patients, to assess the long-term effects of metabolic control on macro- and microvascular end points.


Diagnosis of systemic histoplasmosis in patients with AIDS. To compare various laboratory methods for diagnosis of systemic histoplasmosis, we retrospectively reviewed the charts of 165 patients with AIDS (acquired immunodeficiency syndrome). In eight of those patients, systemic histoplasmosis was confirmed by laboratory techniques. The laboratory methods used were histomorphology and microbiology. Tissues and fluids used for fungal cultures and histochemical stains included blood, bone marrow, lung, skin, pleura, esophagus and colon biopsy specimens, sputum, cerebrospinal fluid, bronchial washing/brushing, and pleural and peritoneal fluids. Results were positive in 83% of blood cultures and 71% of bone marrow cultures, making these tissues the best sources of Histoplasma organisms for microbiologic study. Similarly, Histoplasma sp could be demonstrated by fungal stains in 75% of bone marrow biopsy specimens as the main source for morphologic documentation of systemic histoplasmosis. The other tissues and fluids were only occasionally positive either microbiologically or morphologically. There was cross-positivity between morphologic and microbiologic methods in 80% of confirmed cases, making both methods equally reliable. However, the results were obtained within 48 hours by histomorphology, allowing prompt initiation of antifungal therapy. Although more specific results were produced by microbiologic methods, it took 18 to 35 days to grow the organism.


Peripheral and central regulation of IL-6 gene expression in endotoxin-treated rats. The distribution of IL-6 mRNA in the rat brain was studied by in situ hybridization using 35S-labelled oligonucleotides. The mRNA encoding IL-6 was found in hippocampus, hypothalamus, cerebellum as well as in other brain areas. Microscopic analyses revealed both neuronal and glial cell localization of the mRNA. Subsequently, Northern blot analyses were performed with RNA isolated from spleen, adrenals, pituitary gland, hypothalamus, hippocampus and cerebellum of rats injected intraperitoneally with a non toxic dose of LPS. A rapid induction of the IL-6 mRNA was observed in the peripheral organs, whereas no change in IL-6 transcripts could be measured in the brain. It is concluded that the local synthesis and release of IL-6 in pituitary and adrenal gland might be involved in the activation of the HPA axis following an endotoxin challenge.


Is the 5 alpha-reductase-3 alpha-hydroxysteroid dehydrogenase complex associated with the myelin in the peripheral nervous system of young and old male rats? The formation of the 5 alpha-reduced metabolites of testosterone, 5 alpha-androstan-17 beta-ol-3-one (dihydroxytestosterone, DHT) and 5 alpha-androstan-3 alpha, 17 beta-diol (3 alpha-diol) was evaluated in sciatic nerve fragments and homogenates and in the myelin purified from the sciatic nerve of adult (60-90-day-old) male rats. The effects of aging on the metabolism of testosterone in the sciatic nerve was also evaluated using 20-month-old animals. In the sciatic nerve, tissue homogenization and myelin purification are associated with a marked decrease in the 5 alpha-reductase activity; these data do not appear to be consistent with a possible association of the enzyme with myelin membranes, as it occurs in the CNS. However, the results may be subject to other interpretations which are presented in the discussion. The formation of 3 alpha-diol is higher in sciatic nerve fragments than in homogenates or in the purified myelin. This occurs when testosterone is used as the substrate. In aged animals, the same pattern is observed but at a lower level. In the incubations in which the formation of 3 alpha-diol was evaluated using DHT as the substrate in fragments, homogenates and purified myelin of the sciatic nerve of either adult or old animals, it was found that the yields of this metabolite are higher than those obtained following incubation with testosterone.(ABSTRACT TRUNCATED AT 250 WORDS)


Effect of protease inhibitors and substrates on 3,5,3'-triiodothyronine binding to rat liver nuclear receptors. The effect of protease inhibitors N-tosyl-L-phenylalanine chloromethyl ketone (TPCK) and N-carbobenzoxy-L-phenylalanine chloromethyl ketone (ZPCK) at concentrations ranging from 1.5 x 10(-6) mol/l to 1.5 x 10(-4) mol/l on the specific binding of 3,5,3'-triiodothyronine (T3) to rat liver nuclear receptors was evaluated. Both TPCK at 1.5 x 10(-5) mol/l (P < 0.001) and ZPCK at 1.5 x 10(-6) mol/l (P < 0.05) showed the inhibition of T3 binding to nuclear receptors. The evaluation of T3 binding data following separation of unbound TPCK from treated nuclear receptors on a Sephadex G-25 column showed that the inhibition of T3 binding was irreversible, since a substantial decrease of the equilibrium association constant (Ka) was found when compared to the mock samples lacking TPCK. In addition, similar inhibitory effect on T3 specific binding to rat liver nuclear receptors was found at 5.0 x 10(-4) mol/l by protease substrates L-tyrosine benzyl ester (P < 0.001), L-tyrosine ethyl ester (P < 0.02), L-tryptophan methyl ester (P < 0.02) and L-tryptophan ethyl ester (P < 0.05). The data suggest that: 1. both protease inhibitors and substrates tested inhibited T3 specific binding to T3 nuclear receptors; 2. this may support the hypothesis that T3 receptors like other receptors encoded by c-erbA gene possess a site that recognize both serine protease inhibitors and substrates in its hormone binding domain.


Role of serotonin in heat adaptation: an experimental study in the conscious young rat. The possibility that serotonin may play a role in heat adaptation was examined in a rat model of heat stress (HS). Subjection of animals to acute 4 h HS (but not to 1 h and 2 h duration) in a biological oxygen demand (BOD) incubator (relative humidity 50-55%, wind velocity 20-25 cm/s) resulted in profound hyperthermia (41.68 +/- 0.25 degrees C) associated with behavioural salivation and prostration. This experimental condition simulates the out door environmental conditions of Varanasi, India during the month of June. Measurement of serotonin (5-hydroxytryptamine, 5-HT) content in the plasma and brain showed a profound increase of the amine by 462% and 187% respectively from the control group. Morphological examination in these animals revealed marked cell changes in the brain at both light and electron microscopic level. Thus chromatolysis, shrunken and dark neurons along with a general sponginess of the gray and white matter was quite frequent in all the brain regions. At ultrastructural level, perivascular edema, damage to pre- and postsynaptic terminals, swollen neurons and glial cells, splitting of myelin and vacuolation was very common throughout the whole brain. The microvessels were mainly collapsed and a diffuse infiltration of lanthanum ion within the endothelium was common. Occasionally, lanthanum could also be seen within the basement membrane. However, the tight junctions were mainly intact. On the other hand, when animals exposed to chronic heat stress of 1 h duration at the same intensity for 7 days and then subjected to a 4 h HS on the 8th day, resulted in only minor symptoms. Thus these 4 h heat stressed animals did not exhibit hyperthermia or increased serotonin levels in plasma and brain as compared to the animals exposed to chronic HS of 1 h duration until alone 7th day. These heat adapted animals did not show any marked cell changes in the brain. However, the values of circulating 5-HT level and rectal temperature of these chronically heat stressed animals (for 1 h daily) were mild but significantly elevated on the 7th day as compared to the intact control animals. These results show that: 1. chronic HS of short duration induces heat tolerance; 2. the circulating 5-HT level some how appears to play an important role in the pathophysiology of HS; hand in the physiological mechanism(s) of secondary heat adaptation.


Neonatal erythropoiesis. II. Bone marrow and splenic erythropoietic activity: data suggest erythropoietin transfer via maternal milk. In this study we examined erythropoiesis in the bone marrow and spleen of 9 to 12-day-old neonatal rats suckled by bleeding-induced anemic mothers. Quantitative evaluations of the spleen revealed a significant decrease in total numbers of nucleated RBC/mg spleen in 11-day-old pups nursed by the anemic mother which returned to control values by day 12. A significant reduction in total numbers of nucleated RBC/mg marrow was seen in both 11 and 12-day-old pups of anemic mothers when compared to control values. These results suggest that: 1. Ep is transmitted to suckling rats via the maternal milk; 2. Ep in the neonate exerts its influence predominantly at the level of the differentiated erythroid compartment probably by causing a shortening of the mean transit time of the proliferating erythroblast compartment and/or by decrease in the maturation time of the nonproliferating orthochromatic and reticulocyte compartments; 3. the regulation of erythropoiesis in the neonate differs from that in the adult.


Immunoreactive glucagon and insulin in mammary secretion and blood in women during the periparturient period. The concentrations of glucagon (G) and insulin (I) in the isolated when fraction of colostrum and plasma were determined by radioimmunoassay in 30 women on the last day of pregnancy, on the parturition day and during 7 consecutive postpartum days. The levels of G and I in colostrum were high on the last day of pregnancy (15.41 +/- 0.75 ng/ml and 256.9 +/- 32.7 microU/ml, resp.) and on the day of parturition (13.41 +/- 0.63 ng/ml and 279.5 +/- 41.9 microU/ml, resp.), while relatively lower values were observed on the next day (10.1 +/- 0.41 ng/ml and 194.7 +/- 19.3 microU/ml, resp.). During the next 4 days after parturition the concentrations of these hormones gradually decreased almost to the same basal level as observed in plasma. High hormone concentrations in mammary secretion during the periparturition period were probably caused by intensified transfer through blood-mammary gland barrier, and could reflect increasing needs for these hormones by developing mammocytes and by the newborns adapting to the extrauterine life. In conclusion, a high amount of G and I in mammary secretion may have physiological importance for the neonate. No statistically significant correlation in the hormone concentration between colostrum and plasma were noted.


Implant fixture position registration at the time of fixture placement surgery. The implant registration procedures usually take place at the fixture uncovery surgery, months after the implant placement. In this article, the authors describe a technique for single implant fixture registration during the surgical placement of that fixture. The rationale and advantages of this procedure are also discussed.


The sinus lift procedure: an alternative to the maxillary subperiosteal implant. Technical advances now allow implants to be placed when pneumatization of the sinus has left insufficient bone to engage an endosseus implant. Augmenting material, such as a mixture of resorbable hydroxylapatite and demineralized freeze-dried bone, is grafted into the sinus cavity. This creates a new alveolar ridge to support endosseous implants.


Treatment of implants demonstrating periapical radiolucencies. This article presents two implant cases where a periapical radiolucency developed, with a sinus tract, while the implants were still submerged. A corrective surgical treatment for these unique lesions is detailed, and the possible etiologies are discussed.


Translocation t(6;9) in acute non-lymphocytic leukaemia results in the formation of a DEK-CAN fusion gene. The t(6;9) that characterizes a specific subtype of ANLL fuses the 3' part of a gene located on chromosome 9q34, CAN, to the 5' part of a gene located on chromosome 6p23, DEK. On the 6p- chromosome, the resulting DEK-CAN fusion gene is transcribed into a leukaemia-specific 5.5 kb chimaeric mRNA that encodes a putative DEK-CAN fusion protein. No transcription could be detected from the reciprocal CAN-DEK fusion on chromosome 9q+. Analysis of 17 t(6;9) ANLL cases showed that the translocation breakpoints occur in a single intron of 7.5 kb in the CAN gene (ICB9) and in a single intron of 9 kb in the DEK gene (ICB6). As a result, the presence of a t(6;9) in blood or bone marrow cells can be faithfully diagnosed by Southern blotting. Moreover, the result of the translocation is an invariable DEK-CAN transcript, which can be sensitively monitored by RNA-PCR. Surprisingly, a SET-CAN fusion gene was found in leukaemic cells from a patient with AUL. Like CAN, SET is located on chromosome 9q34, which explains the apparently normal karyotype of the leukaemic cells. The occurrence of a SET-CAN fusion gene indicates that CAN may be the relevant oncogene involved in leukaemogenesis, and that activation of CAN can be effectuated through fusion of its 3' part to either DEK or SET. As yet, the function of CAN, DEK or SET is unknown. None of the proteins shows consistent homology to any known protein sequences. However, preliminary localization data and analysis of sequence motifs suggested that DEK-CAN may have a role in transcription regulation. CAN contains several dimerization domains and a repeated motif that can function as an ancillary DNA-binding domain. DEK and SET are non-related proteins, but they share a stretch of acidic amino acids, which is also present in the fusion proteins.


Replacing a failed resin-bonded fixed partial denture with a single tooth implant. When adequate width and height of remaining alveolar bone is present, the implant-supported fixed prosthesis is an excellent alternative in replacing a missing tooth. The prosthetic tooth, supported by an endosseous implant, emerges from the tissue in a manner which resembles the natural tooth it replaces better than any other treatment option available. This article presents one clinical case history, preclinical treatment phase, and actual clinical treatment.


The use of free gingival grafts to improve the implant soft tissue interface: rationale and technique. Utilization of implants of all types to restore partially or fully edentulous patients to occlusal form and function continues to increase. The ability of the implant/bone/soft tissue interface of the implant-retained prosthesis to ward off a constant influx of microorganisms and their byproducts becomes a critical factor in the health and longevity of dental implants. The purpose of this article is to describe the rationale and technique for providing an improved quality of tissue adjacent to implant abutments.


Philadelphia chromosome-positive leukaemia: the translocated genes and their gene products. Overwhelming evidence indicates a role for the deregulated ABL protein tyrosine kinase in the aetiology of CML and Ph-positive acute leukaemia. These disorders are characterized by the generation of BCR/ABL fusion proteins with elevated tyrosine kinase activity. Although much is known concerning the transforming potential of ABL proteins in various systems, very little is understood of the normal function and mode of regulation of ABL activity. The mechanism of oncogenic activation is therefore also obscure. In spite of this, our understanding of the molecular details of these chromosomal translocations allows the design of therapies directed against their unique, leukaemia-specific proteins and RNA products.