[Differential neural influences on the heart rate and contractile force in different reflex reactions]. Chronotropic and inotropic responses of the cat heart to cooling of the nn. vagi, raising of arterial pressure, stimulation of central ends of the nn. vagi, were different under different actions but stable in their character. This makes unreliable the estimation of reflex and tonic effects on the heart on the basis of heart rate alone.


[The effect of large doses of corticosteroids on stomach ulcer formation: a new hypothesis]. A new hypothesis is suggested according to which the ulcerogenic effect of large corticosteroid doses is regarded as a consequence of suppression of hypothalamo-pituitary-adrenocortical system (HPAS) function. On the 7-th day after the administration of a large hydrocortisone dose to rats the HPAS block was observed. The HPAS block increased the area of hemorrhagic damages of the stomach mucosa induced by a stress factor. Similar data on the ulcer formation were obtained when using intrahypothalamic administration of dexamethasone. The replacement therapy decreased the effect of HPAS block in both cases. The data show that the stomach ulcer formation after the administration of high corticosteroid doses occurs as a result of endogenous hormone production insufficiency.


[The role of bile proteins in regulating the secretory function of the liver]. The bile's proteins were found to be one of the factors regulating the intensity of bile production. Hypocholeresis induced by cycloheximide was followed by suppression of the biosynthesis and secretion of the bile's proteins.


[The localization and functional status of serotonin-producing structures in the gastrointestinal tract of chum salmon fry]. The data obtained shows that serotoninergic structures of the juvenile Siberian salmon gastrointestinal tract involve individual goblet cells of the mucose epithelium, serotoninergic cells as the components of the stomach cardiac glands, fibre-like structures in subepithelial and muscular layers related, probably, to a neural plexus. The serotoninergic structures decrease in their number towards the distal portion of the tract.


[Second messengers in the triggering and adaptational-trophic effects of the antidiuretic hormone]. Vasopressin exerts a triggering effect upon the cells of the osmoregulating epithelium as well modulates this effect. The triggering effect is associated with the stimulation of V2-receptors in the frog bladder, whereas the modulating effect is related to the activation of the V1-receptors.


[Stress and arterial hypertension].

[Stress and arterial hypertension]. Subjects with normal arterial pressure, those with bordering values of the AP and patients with arterial hypertension were studied. The AB, heart rate and diuresis changed independently under stress in the first group subjects, whereas these parameters depended on each other to some extent in the "future patients".


[The spectral characteristics of the effect of central M-cholinolytics on rat behavior under open-field conditions]. Having estimated the rat behaviour in the open-field test, M-cholinolytics were divided into different groups. Haloperidol normalised the disturbance in the behaviour induced by one group M-cholinolytics and had no effect with the other group. The former group seems to have an explicit dopaminergic activity. The groups seem to correspond to different mechanisms of the behavioural activity.


[The effect of transcranial electrostimulation in an analgesic regimen on somatosympathetic reflexes]. The mechanisms of inhibitory effect of transcranial electrostimulation in analgesic regime on blood pressor nociceptive reflexes were studied in experiments in rabbits and cats. Considerable inhibition of the late (bulbar) somato-sympathetic reflexes and spino-bulbo-spinal somato-somatic reflexes as well was demonstrated. The probable basis of sympatho-inhibition during transcranial electrical stimulation is a reduction of excitatory input to bulbar sympathoexcitatory neurons. It was revealed in experiments with inhibition of sympatho-excitation elicited by temporal brain ischaemia and local electrical stimulation of different bulbar ventrolateral vasomotor zones. The role of periaqueductal gray activated by transcranial electrical stimulation as a source of inhibition and its opioid mechanisms are discussed.


[Changes in the functional activity of the brain stem system that inhibits movement during the development of cataleptiform states]. Electrical stimulation of the n.cuneiformis and medial parabrachial nucleus inducing the inhibition of locomotor behaviour, was performed in cataleptic and non-cataleptic rats. The stimulation of the inhibitory brainstem zones proved to be more effective in cataleptic animals, the state having been induced by a nociceptive stimulus.


[The influence of the anterior hypothalamus on the electrical activity of the retina]. Single stimuli applied to the suprachiasmatic and supraoptic nuclei of the hypothalamus evoked short-latency hypothalamo-retinal responses which exert influences upon formation of the "a" and "b" waves of the electroretinogram, the changes of the waves being opposite by character. The effects from the suprachiasmatic and supraoptic levels were opposite, too.


[The activation and inhibitory postactivation effects of chemical interoceptive stimulation under normal conditions and in experimental neurosis]. The realisation of hemointeroceptive effects was found to begin with a period of the brain activation. In normal conditions a positive correlation was found between the EEG arousal response and the concentration of mustard administered into the stomach. In experimental neurosis, both regulatory influences of the hemointeroceptive stimulation were decreased.


[The characteristics of the correlation of the functional activity, blood supply and structural organization in the sensory-deprived cerebral cortex in rats]. The feature of correlation between functional activity of the brain tissue and structural-functional characteristics of the vascular system after sensory deprivation by the removal of whiskers in newborn animals were studied in nembutal-anaesthetized rats in comparison to the animals under d-tubocurarine with local anesthesia. It has been shown that there are major changes of EP parameters and ECoG in the sensory-deprived brain area and diminution of brain cortex thickness. Changes in the vascular system are mainly structural, what are revealed as disorganization in angioarchitecture of radial arteries. At the same time, differences in the blood circulation intensity are found in d-tubocurarine animals only. The largest volume of the local blood circulation is observed in intact hemisphere of sensory-deprived animal. Thus, it can be concluded that sensory-deprived model is the alternative to the ischemia model. This model can be used in studies of physiology of brain blood circulation, and the "structure-function" correlation, in particular.


[The normal distribution of oxygen tension on the surface of the brain radial arterioles and in their surrounding tissues and under normobaric hyperoxia]. The pO2 on the arterioles' wall was shown to depend on the diameter of the vessels under study in rats. In normoxia, the pO2 tissue gradients are small and do not depend on the vessel diameter, whereas in hyperoxia a sharp drop of the tissue pO2 occurs at some distance from the vessel and the dependence of the pO2 on the arteriole diameter can be registered practically in all the sites of measuring. Radical arterioles and adjacent tissues of the brain cortex were shown to be most affected by a high arterial pO2 in hyperoxemia.


[The therapeutic advances in adult acute nonlymphoblastic leukemia. The experience at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI]. Acute adult nonlymphoblastic leukemia (ANLL) involves a large group of diseases which originate in an abnormal process of differentiation of the hematopoietic stem cell. This paper analyses the historical background of such a group of malignant hemopathies, current criteria to perform the diagnosis and also the most important therapies used in both the stage of remission induction and the period following this stage (post-remission status). In this context, the therapeutic achievements that have had place during the last two decades at the Hospital de Especialidades del Centro Medico Nacional Siglo XXI are analyzed.


[Cardiac myxoma. A report of 23 cases].

[Cardiac myxoma. A report of 23 cases]. Twenty-three cases of cardiac myxoma are reviewed during a period of 11 years. Seventeen patients were females and 6 males with an average age of 36 years. All patients were symptomatic for an average period of time of 4 months. Dyspnea was the main symptom (91%), congestive heart failure (52%), murmurs (74%), atypical chest pain (65%), palpitations (52%), constitutional manifestation (48%), congestive heart failure (36%), embolic events (23%) and ventricular tachycardia as a first manifestation of a right ventricular myxoma in one case (4.5). In all patients the diagnosis of cardiac tumor was made during life. Among they, in 83%, by echocardiogram, 14%, by cardiac catheterization, and in one case (4.5%) with both methods. Seventy percent were located in the left atrium, 18% in the right atrium, 9% in the right ventricule and 4.5% to both right cavities. Two patients died while waiting surgery, one due to pulmonary emboli and another due to refractory congestive heart failure. In all 21 patients who were sent to surgery a direct correlation was seen with the echocardiographic findings. All 23 patients had a confirmatory histopathological diagnosis. There were no surgical deaths. Excision of the tumor resulted in marked symptomatic improvement. The follow up by echocardiography showed that surgery has been curative with no recurrence up till now. We consider that this entity, that is capable to simulate multiple cardiovascular diseases must be removed surgically once it has been diagnosed in order to avoid fatal complications.


[Advances in the treatment of aplastic anemia]. The purpose of this paper is to describe the current advances in the pathogenesis, classification and treatment of acquired aplastic anemia (AA). The therapeutical experience obtained at the Servicio de Hematología, Centro Medico Nacional, Siglo XXI is described. Bone marrow transplantation is the first choice therapy for severe AA. This procedure succeeds in obtaining complete remission in nearly 80% of the cases. Nevertheless, few patients are eligible for such therapy, consequently other treatments should be considered. In this context some immunosuppressive therapies such as antilymphocyte globulin had shown to produce favorable responses in 60% of the patients. In addition, androgens and immunosuppressive drugs like methylprednisolone bolus and cyclosporin A do not have a definitive place in severe AA. Finally, it is important to describe the experience with lymphocytapheresis, a new procedure, that decreases the immunological response against the normal hematopoiesis by removing the population of T-lymphocytes inducing complete remission in a few patients.


[Immunosuppression and blood transfusions in patients with a kidney transplant]. 94 patients with renal allograft from a living related donor were studied in three different groups: 1 Patients with identical histocompatibility (n-32), treated with prednisone (PDN) and azathioprine (Aza); 2 Haploidentical patients (34) who received PDN, Aza and cyclosporine (CsA); 3 Haploidentical patients (28) who previous to the transplantation received specific donor blood transfusions and Aza/PDN after the transplantation. The survival for the patient and the graft after five years was 100% and 96% in group 1; 97% y 89% in group 2 and 82% and 72% in group 3. Five patients in group 1 received CsA also. There was no mortality in group 1, while there were one death in group 2 and two more in group 3. There was no significant difference between CsA and Blood transfusions in the patients and grafts survival.


[The evaluation of the kidney transplant patient by nuclear medicine technics]. In Mexico, approximately between 200 to 250 patients received a renal transplantation each year. Immediately after the surgical procedure it is important to evaluate the function of the transplanted kidney. Because some complications may arise mainly with unspecific symptoms which often produce oliguria, high levels of serum creatinine, fever and pain at the site of the graft. In this paper we report the nuclear medicine methodology, which we use in the diagnostic evaluation of this patients. These methods are highly specific and provide useful quantitative and qualitative information about these morphology and the function of the transplanted kidney.


[Acute pancreatitis. The classification of its severity by dynamic pancreatography and the results of surgical treatment]. In acute pancreatitis determination of glandular necrosis has been difficult because of the lack of an objective method; with dynamic enhanced tomography (bolus injection of contrast media) we have reasonably classify 28 patients with acute pancreatitis. With this technique 5 grades of sequelae of acute pancreatitis are identified: I. Non complicated acute pancreatitis; II. pancreatic abscess: III. peripancreatic necrosis; IV. less than 50% pancreatic necrosis and V. more than 50% pancreatic necrosis. A 100% correlation was found between tomography and surgical findings. This is the first report in Mexico of this method to identify pancreatic or peripancreatic necrosis; we also present the surgical results with a programmed pancreatic debridation; mortality has decreased form 80 to 31.9% in our hospital in recent years.


[Extracorporeal lithotripsy in children]. 14 patients of pediatric age with renal and ureteral calculi were treated with extracorporeal shock wave lithotripsy (Piezolith 2300). Three of the 14 patients had bilateral renal calculi. There were nine male and five female patients with an average age of 9.7 years. Most of the calculi were the renal pelvis. four calculi were smaller than 10 mm, 12 were between 10 and 20 mm and one was a partial staghorn calculi. A double "J" stent way placed in two patients, one with an ureterostomy and another with a partial staghorn calculi. The average number of shock waves received for patient was 4275 with an average voltage of 582 bars. Only 2 patients (16.6%) required sedation, six patients (47%) required more than one session of lithotripsy. The results at 3 months showed that 71.4% of the patients were free of stones. Hematuria was present in all the patients, hyperthermia greater than 38 degrees C and renal colic were present in 21.4% of the cases, two patients with retained ureteral calculi were rendered stone free by endoscopic procedures. In conclusion our results are similar to those reported in the world literature. The use of ultrasound for stone localization prevents unnecessary radiation of the children, and finally with the machine employed most of the treatments can be performed without anesthesia.


[The correction of metabolic acidosis by the instillation of 0.1N sodium hydroxide in an experimental model]. The critically ill patient, during the natural course of the disease often presents acid-base disturbances acidosis being the most common metabolic problem. Sodium bicarbonate has been used, for its correction but due to complications its use is restricted. In the present experimental study, mixed race dogs were artificially induced metabolic acidosis with in chloride acid. Arterial and venous blood gases were determined. Afterwards 0.1N sodium hydroxide was administered in the same amount statistically demonstrating modifications, in the pH values, as well as an excess of arterial and venous base which indicates the possibility of using this substance in humans to correct metabolic acidosis.


[The debridement of submandibular abscesses under locoregional block]. The efficiency of analgesic block of the inferior alveolar, auriculotemporal, lingual, buccal and superficial cervical plexus in patients requires debridement of unilateral submandibular abscess has been investigated. The technique was significantly more useful (p < 0.001) when compared with other analgesic block techniques utilized in these cases. This treatment can be performed in any medical office with minimal resources and be of use as an alternative for general anesthesia.


[The deterioration of cognitive functions in patients with dementia (a study of 18 cases)]. It appears that general intelligence, memory, and conceptual reasoning, and others are impaired in dementia. As previously noted, in general there is said to be evidence of apraxia, or agnosia until the dementia is quite severe, unlike, for example, Alzheimer's disease. A number of questions, however, remain unanswered.


[The somatostatin analog SMA (201-995) as adjuvant treatment in patients with external fistulae of the digestive system]. Six patients with gastrointestinal fistulae treated with a potent inhibitor of gastrointestinal hormones, the somatostatin analogue SMS 201-995 are reported. All patients had severe intraabdominal diseases and underwent a mean of 3.5 surgery procedures during their hospital stay. When the patients were analyzed individually a mean reduction of 42.5% (P < 0.050 of basal fistulae output was observed after treatment. In three patients the fistulae closed after seven and ten days of treatment with the analogue; the other three patients died after a protracted hospital stay which included multiple admissions to the Intensive Care Unit. When the output of all fistulae treated where analyzed together it showed a tendency to decrease, but it didn't reach statistical significance.


[120 biopsies of pituitary adenomas studied by immunohistochemistry and electron microscopy. A clinico-pathological correlation]. Study of biopsies from 120 pituitary adenomas from the Hospital de Especialidades, Centro Médico Nacional, and the Hospital 20 de Noviembre, ISSSTE, were studied over a period of 55 months. 70 cases were female and 50 male. Ages varied between 18 and 67 years of age (with an average of 31 years). Histologically 41 tumors were chromophobes, 34 acidophilic, 37 mixed and 8 basophilic. 101 patients were operated by trans-sphenoidal (84.5%) and 19 were operated (15.5%) by trans-cranial approaches. 99 tumors were macroadenomas (81.1%) and 21 were microadenomas (18.9%). More than one hormone was found in the cytoplasm of 69 adenomas, although only 20 fulfilled the criteria of being plurihormonal. Those adenomas classified as "non-functional", mostly produced glycoprotein hormones corresponding to oncocytomas and null cell adenomas, from an ultrastructural point of view. 85 patients developed different degrees of visual impairment, with 30 tumoral relapses, of which 10 received radiotherapy. 40 adenomas produced prolactin, although only 29 patients developed clinical signs of hyperprolactinemia; 38 tumors contained growth hormone, of which only 25 had acromegaly; 8 tumors contained ACTH in the cytoplasm, although only 7 developed Cushing's Syndrome and 57 patients (47.5%) were classified as nonfunctional and did not show any endocrinological data. All the cases are studied with a light microscope, electron microscope, and they were all submitted to a complete set of adenohypophyseal hormone with immunoperoxidase technique.


[The use of computers in medical emergency services]. Computers are being used successfully more often, in a number of medical facilities and specific medical care processes. Hospital emergency services have been including computer-assisted systems in solving a diversity of issues on administration, medical care delivery, research and teaching. An analysis is made about the possibilities of employment of computer-assisted information systems health administrative research in a continuous admission ward for non-elective patients to a tertiary-level care hospital, with its particular functional features.


Denial in terminal illness: to intervene or not to intervene. This research examined effects of psychosocial intervention on denial-related coping ability in terminally ill cancer patients. Most patients considered deniers were seen using interpersonal denial in the service of preserving relationships important to them. Denial use as a result of intrapsychic impoverishment was seen infrequently. Twenty-four patients with various terminal cancers were assigned to either an experimental (n = 13) or a control (n = 11) group. A pretest versus posttest multifactorial analysis of variance model was used. Experimental subjects received a structured psychosocial intervention just before posttest. Results showed that, as predicted, interpersonal deniers in the experimental group had a statistically significant (p < .005) decrease in denial scores at posttest, whereas denial scores increased in the control group. Data indicate that, in the absence of psychological dysfunction, patients using interpersonal denial may respond favorably to sensitive psychosocial intervention. Still others may benefit only after they have had sufficient time to muster adaptive coping strategies. Areas for further research are suggested.


The attitudes of beginning nursing and medical students toward care of dying patients: a preliminary study. The attitudes of entering classes of nursing and medical students toward the care of dying patients were compared using a self-administered instrument designed for the study measuring aversive and attractive components of these attitudes. Both groups exhibited similar aversive attitude items: Talking About Death elicited the most negative scores, General Interaction was slightly less negative, and Touching was the least negative. Among the attractive items, medical students were more positive on the Professional Challenge subscale, while the nursing students were more positive on the Personal Satisfaction subscale.


Grieving men: thoughts, feelings, and behaviors following deaths of wives. Despite the growing body of literature on bereavement, grief, and mourning, little attention has been given to the impact of bereavement on men. This is particularly true for studies on the impact of death of spouse on the survivor. Using in-depth interviews, we explored the thoughts, feelings, and behaviors of twenty men following the deaths of their wives. The findings do not support prevailing assumptions that men are less likely to be emotionally involved in the conjugal relationship and, thus, less likely to grieve than women; or, if emotionally involved, less likely to experience grief. This research suggests that men may be emotionally involved in the conjugal relationship and that the death of a wife may evoke intense feelings. The majority of the men in this study both hurt and knew they hurt. What they did not do was to reach out to others for help. This finding has important implications for bereavement program development.


[The serological exam for the human immunodeficiency virus (HIV) as part of the premarital exams]. Due to the presence of the acquired immune deficiency syndrome (AIDS), it has been frequently stated, by several segments of the society, that mandatory human immunodeficiency virus (HIV) testing as premarital requirement is useful for AIDS prevention. The usefulness of these tests among general population are discussed, as well as some problems for its eventual implementation, concluding that this screening procedure is impractical, inefficient and expensive as a public health measure. The overall HIV prevalence in Mexico is very low (4 per 10,000), therefore, a person from this population with a positive screening test, has a slight chance of being truly infected (16%), in other words, screening tests have a low positive predictive value in general population. Conversely, having a negative screening test, predicts this state accurately (negative predictive value greater than 99%). Several problems arise when HIV screening tests are applied: logistics, for example avoidance of the tests, economic, ethic, and human rights problems, among others. It is concluded that mandatory HIV screening tests are not cost-efficient and that there are other options, for instance education, which would imply better changes for HIV prevention.


Providing spiritual support: a job for all hospice professionals. This research examines spirituality as an aspect of professional practice. A questionnaire on spirituality was sent in 1991 to the hospice directors in New York, New Jersey, and Pennsylvania. The findings strongly indicate that spirituality is important in the hospice setting and plays a prominent role in the treatment of patients. Also, hospice programs were found to be supportive of the spiritual component of care. The spiritual approaches used by the respondents were the more traditionally religious ones such as listening to the patient talk about God or referring to clergy. Approaches such as meditation or guided imagery, which are not necessarily related to religion, were used less frequently. Clergy in the study placed greater importance on spirituality in hospice work and used more traditionally religious approaches than did non-clergy. While some professional caregivers choose to leave spiritual matters to clergy, the findings reveal that many non-clergy hospice professionals are assisting patients with spiritual concerns.


[The epidemiological panorama of cancer in Mexico, 1987]. The mortality, incidence, morbidity, partial data and opportune detection, of the main cancer types were reviewed from de information register corresponding to 1987, to analyze the epidemiological panorama of cancer in Mexico. The main causes of death in women were cervix uterine, breast, stomach and lung carcinomas, leukemias and lymphomas; and in men were lung, gastric, prostate, leukemias and lymphomas. The most frequent localization of women's new cancer cases were cervix uterus, breast, ovary, lymphoma, thyroid gland and endometrium; and in men were prostate, lymphoma, stomach, leukemia and lung. In according to tendencies about the main death rates in Mexico, we estimate that 55.3 by 100.00 inhabitants will be the rate of cancer deaths in the year 2000, numerical character virtually bigger considering demographic variation like human life's hope and increase population with cancer risk.


A study of bronchial reactivity in relation to baseline pulmonary functions in patients with chronic obstructive lung disease. Baseline bronchial reactivity was studied in 36 patients with chronic obstructive lung disease (COLD) and 20 normal healthy controls using the inhalational histamine challenge test. Using a cut off PD20 dose of 0.195 mg of histamine, 83.3% patients of COLD demonstrated bronchial hyper-reactivity. Presence of bronchial reactivity correlated significantly with the baseline FEV1, FEF25-75 and the ratio FEV1/FVC (p = 0.0019, 0.00001 and 0.008) respectively. Thus, bronchial reactivity in subjects with COLD correlates most significantly with the maximum mid-expiratory flow rate (FEF25-75).


Efficacy of stimuliv, an indigenous compound formulation, against hepatotoxicity of antitubercular drugs--a double blind study. Anti-tubercular drugs are known to cause hepatotoxicity, which may lead to noncompliance to drug therapy. Stimuliv, an indigenous compound formulation, is reported to be useful in liver disorders. Efficacy of prophylactic administration of stimuliv against anti-tubercular drugs-induced hepatotoxicity was studied in this double blind randomized clinical trial. One hundred and forty-five newly diagnosed patients of tuberculosis were included in the study. Out of these, sixty three patients were treated with stimuliv (2 tablets thrice daily), sixty received the placebo, while twenty-two dropped out of the study. The patients were assessed clinically and biochemically at two-week intervals over a period of two months. In stimuliv-treated group, the incidence and severity of hepatotoxicity was significantly less (p < 0.05) as compared to placebo-treated group. In addition, patients treated with stimuliv had better appetite and weight gain. Stimuliv treatment may be recommended in newly diagnosed adult patients of tuberculosis.


Dermatoglyphics in nasobronchial allergic disorders. Fifty persons having nasobronchial allergy diagnosed by a positive skin test were compared with age and sex matched normal individuals for dermatoglyphic palmer patterns. The palmer prints were obtained on white art paper using Kores duplicating ink. In female patients, total number of whorls was less, more so on digit IV of left hand. Digit V of right hand had low frequency of ulnar loops, the d-t ridge count was low. In male patients, ulnar loops were less frequent on digit III of right hand. Total finger ridge count was less in both sexes. High frequency of arches was observed in female patients and in total. Digit V of left hand in females and in total patients revealed high frequency of arches. a-b ridge count was high in males and in total patients.


Pulmonary function tests in healthy male Punjabi children [10-19 years of age]. We performed spirometry on 177 male healthy children from Patiala, North India between 10 to 19 years age. The best fit regression equations for different functions were determined for each parameter. A linear relationship of lung function was observed with age, height, weight and BSA. Our results have been higher than the South Indian studies but closer to other North Indian studies. Similar comparison with western studies reveals that their subjects have higher lung function values than our subjects. It is clear that grossly erroneous conclusions may be reached unless prediction equations for lung function tests for a given ethnic group are derived from studies upon the same ethnic group.


Pulmonary alveolar microlithiasis--report of three cases with pulmonary function and exercise studies. Pulmonary alveolar microlithiasis is a rare disease involving accumulation of calcific concretions in the alveoli of the lungs. Three cases of this disease are reported with their varying and unusual clinical features. Radiologic studies demonstrated presence of diffuse calcific densities in the lungs with varying degrees of emphysematous changes. Bone scans showed diffuse uptake of the tracer in the lungs. Pulmonary functions showed hyperinflation and small airways dysfunction in one case besides the presence of restrictive ventilatory defect. Exercise studies demonstrated arterial oxygen desaturation on exercise.


Sequential pattern formation in a model for skin morphogenesis. During morphogenesis regular patterns often develop behind a frontier of pattern formation which travels across the prospective tissue. Here the authors consider the propagating patterns exhibited in a two-dimensional domain by a tissue interaction mechanochemical model for skin pattern formation. It is shown that the model can exhibit travelling waves of complex spatial pattern formation. Two alternative mechanisms that can produce such sequential patterning are presented. In particular, it is demonstrated that the specification of a simple quasi-one-dimensional pattern is all that is required to determine a complex two-dimensional pattern. Finally, the model solutions are related to actual pattern propagation during chick feather primordia initiation.


Digital clubbing in sarcoidosis.

Digital clubbing in sarcoidosis. We present two cases with a rare association of sarcoidosis and clubbing. Therapy with prednisolone could not control the progress of interstitial fibrosis nor could clubbing be reversed. Both patients expired 5-1/2 years after diagnosis which suggests that clubbing, when present in sarcoidosis, may signify an unfavourable prognosis.


From stripes to spots: prepatterns which can be produced in the skin by a reaction-diffusion system. A key question in the area of spatial pattern formation in developmental biology is: how do groups of cells in a homogeneous tissue suddenly differentiate along entirely different developmental paths compared to neighbouring cells? Although experiments are now beginning to provide answers to this question, the mechanisms responsible for the development of repeated or periodic structures and spatial patterns, e.g., hair follicles and pigmentation patterns, are still unknown. Theoretical biologists and applied mathematicians have suggested various prepattern mechanisms as the primary cause of repeated or periodic spatial patterns. A class of biochemical reactions referred to here as reaction-diffusion (RD) systems, having the capacity to spontaneously generate stable stationary wavelike spatial patterns (Turing, 1952), has been suggested as a possible prepattern mechanisms, e.g., during hair follicle initiation and development (Nagorcka, 1989), and pigmentation patterns (Murray, 1989). Spatial patterns arising during development of the vertebrate skin are frequently complex. Spatial patterns in the skin can be seen to vary within an individual from one region of the skin to another. One pattern change commonly observed across the skin is from stripes to spots. An RD system is defined which is able to generate different spatial patterns depending on the value of a single parameter. The parameter varied controls the transport of the chemical components of the RD system across the basement membrane separating the epidermis and dermis. The patterns produced range from stripes to an irregular array of spots. Not only are different patterns produced, but a different time sequence of prepatterns is expected to arise in the different skin regions depending on whether the first prepattern in an array of spots or stripes. As a consequence it is possible to account for hair follicle initiation in the hair-bearing regions of the mammalian skin as well as the sequence of events required for the formation of dermatoglyphics in the volar regions.


Giant emphysematous bullae of the lung.

Giant emphysematous bullae of the lung. Emphysematous bullae may at times assume large proportions. We report a case of symptomatic giant bullae in a female which were removed surgically. The relevant literature has also been reviewed.


Factors associated with isolation of pathogenic bacteria from sputum of patients with acute bronchospasm. Patients with obstructive airways disease (asthma and chronic obstructive airways disease) with an acute exacerbation of symptoms were studied. Those requiring hospitalization were chosen to study the pattern of respiratory pathogens isolated on a supervised sputum culture. Certain variables were studied in a case control design to determine an association with culture positivity.


Modelling trypanosomiasis prevalence and periodic epidemics and epizootics. Existing mathematical models of trypanosomiasis epidemiology and epizootiology are extended by including some relevant biology of the disease vector, the tsetse fly. Rickettsia-like organisms, or RLO, are a vertically transmitted symbiont of tsetse, which confer an increased susceptibility to trypanosomiasis infection. Tsetse populations are also limited by density-dependent starvation. Modelling leads to the prediction of a stable dimorphism with a fraction of tsetse possessing RLO. The equilibrium prevalence of trypanosomiasis in the vertebrate hosts is no longer in RLO models determined simply by such traditional parameters as vectorial capacity. Only the RLO-positive tsetse carry infection, and their number is itself regulated by trypanosomiasis prevalence. The result of a naive model is that controlling tsetse numbers does not decrease prevalence until all tsetse are RLO-positive. However, under the density-dependent starvation model derived in this paper, the relative mortality of RLO-positive flies is greater at lower tsetse numbers. This tips the balance towards lower equilibrium prevalence of trypanosomiasis as tsetse numbers are decreased. The presence of RLO also gives rise to long-term oscillations in trypanosomiasis prevalence in humans and animals. However, when another mechanism that can also cause periodic epizootics (of shorter periodicity) is included, namely host immunity, the two epizootic processes combine to produce periodic epizootics (and therefore epidemics) at a single frequency. There are two decaying modes, one in which the tsetse population size quickly reaches equilibrium in a few weeks, and a second very slowly decaying mode in which host immunity and RLO effects interact. The equilibrium reached is shown to be asymptotically stable. In view of the seeming importance of RLO in trypanosomiasis epidemiology, it is important that field biologists enable RLO models to be validated by measuring the proportion of tsetse with RLO, in conjunction with vector density and trypanosomiasis prevalence and incidence in tsetse and vertebrate hosts.


Tropical pulmonary eosinophilia presenting as eosinophilic pleural effusion. A case of tropical pulmonary eosinophilia presenting as an eosinophilic pleural effusion is reported. The condition resolved by treatment with diethylcarbamazine. The patient has been well during the two year follow-up period.


On the Penrose hypothesis on fingerprint patterns. Penrose hypothesized that fingerprint patterns such as loops, whorls, etc. are formed by ridges corresponding to the lines of curvature of the skin of the embryo at the time when the ridges were being formed. Under this hypothesis, Smith (1979) has shown analytically how some patterns emerge. In this paper it is shown that (i) Smith's differential equation has an exact solution and (ii) the extension given here supplies the remaining important patterns.


Evaluation of dose-related pharmacokinetics and pharmacodynamics of prednisolone in man. The pharmacokinetics and pharmacodynamics of prednisolone were evaluated in normal male volunteers. Seven subjects completed 3 phases: 16.4- and 49.2-mg iv prednisolone, and a phase with no drug to assess baseline responses. Plasma concentrations of prednisolone and urine concentrations of prednisolone and 5 metabolites were assayed by HPLC. Protein binding of prednisolone was measured by ultrafiltration. The polyexponential disposition of free and total plasma prednisolone were evaluated and apparent parameters were compared between doses. Suppression of plasma cortisol and alterations in blood basophil and helper-T cell trafficking were used as pharmacodynamic indices. Pharmacodynamic models were used to relate total or free plasma prednisolone concentrations to each of these effects generating response parameters and IC50 (50% inhibitory) concentrations common to both doses. The pharmacokinetics of total drug were comparable to previous findings with CL and Vss increasing with dose. Free prednisolone exhibited slight capacity-limited elimination and distribution as CL and Vss decreased with the larger dose. Pharmacodynamic models jointly fitting all three phases characterized the suppression/trafficking phenomena equally well with use of total or free drug concentrations. In each case the models provided realistic values of parameters relating to steroid sensitivity--in particular IC50--and to the underlying physiology of the affected systems. This study comprehensively elucidates the complexities of prednisolone pharmacokinetics and demonstrates how plasma concentration--time profiles of total or free prednisolone can be utilized for evaluation of prednisolone pharmacodynamics.


A physiologically based pharmacokinetic model for nicotine and cotinine in man. Physiologically based pharmacokinetic (PBPK) models have been developed describing the disposition kinetics of nicotine and its major metabolite, cotinine, in man. Separate 9-compartment, flow-limited PBPK models were initially created for nicotine and cotinine. The physiological basis for compartment designation and parameter selection has been provided; chemical-specific tissue-to-blood partition coefficients and elimination rates were derived from published human and animal data. The individual models were tested through simulations of published studies of nicotine and cotinine infusions in man using similar dosing protocols to those reported. Each model adequately predicted the time course of nicotine or cotinine concentrations in the blood and urine following the administration of nicotine or cotinine. These individual models were then linked through the liver compartments to form a nicotine-cotinine model capable of predicting the metabolic production and disposition of cotinine from administered nicotine. The potential for integrating this functional PBPK model with an appropriate pharmacodynamic model for the characterization of nicotine's physiological effects is discussed.


Application of semilinear canonical correlation to the measurement of opioid drug effect. To examine the relationship between the electroencephalograph (EEG) and plasma opioid concentration, one would like to collapse the high-dimensional EEG signal into a univariate quantity. Such a simplification of the EEG is desirable because a univariate quantity can be modeled using standard nonlinear regression techniques, and because most of the information in the EEG is redundant or unrelated to drug concentration. In previous studies of the EEG response to opioids, the manner in which a univariate component was extracted from the EEG was ad hoc. In this paper, this extraction was performed optimally using a new statistical technique, semilinear canonical correlation. Data from 15 patients who received an intravenous infusion of the semisynthetic opioid alfentanil were analyzed. The components of the EEG that were nearly maximally correlated with plasma drug concentration were found, based on a standard pharmacokinetic-pharmacodynamic model. Two new EEG components were produced from the powers in the frequency spectrum of the EEG: a weighted sum of the logarithms of the powers, and a weighted sum of the powers expressed as percentages of the total power. These components both had a median R2 of 0.84, compared to median R2s ranging from 0.37 to 0.83 for five commonly used ad hoc EEG components. The new components also had less variability in R2 between subjects.


Ketamine and midazolam decrease cerebral blood flow and consequently their own rate of transport to the brain: an application of mass balance pharmacokinetics with a changing regional blood flow. Mass balance pharmacokinetics, with simultaneous blood sampling from an artery and the internal jugular vein, was used to characterize the cerebral uptake of ketamine, norketamine, and midazolam in normoventilated pigs. Intravenous injections of ketamine or midazolam decreased the cerebral blood flow (CBF) by one third, as measured by intermittent 133Xe washout. By means of pharmacodynamic models, the effects on the CBF could be predicted from the arterial drug concentrations. The high-resolution CBF vs. time curves thus generated allowed the calculation of cerebral drug levels from arterio-venous concentration gradients in spite of a continuously changing regional blood flow. By their effects on the CBF, ketamine and midazolam decrease their own rate of transport to the brain, the immediate 30-35% drops in CBF giving similar reductions in initial net influx of drug. Physiological pharmacokinetic models assuming a constant regional blood flow are therefore not appropriate. Under clinical conditions, the CBF is determined mainly by the effects of the anesthetics and by the arterial CO2 tension. CBF changes in either direction influence the transport of drugs to the brain and may consequently result in impaired or exaggerated drug effects.


Evaluation of Bayesian estimation in comparison to NONMEM for population pharmacokinetic data analysis: application to pefloxacin in intensive care unit patients. The pharmacokinetics of pefloxacin (PF) were investigated in a population of 74 intensive care unit patients receiving 400 mg bid as 1-hr infusion using (i) Bayesian estimation (BE) of individual patient parameters followed by multiple linear regression (MLR) analysis and (ii) NONMEM analysis. The data consisted of 3 to 9 PF plasma levels per patient measured over 1 to 3 dosage intervals (total 113) according to four different limited (suboptimal) sampling 3-point protocols. Twenty-nine covariates (including 15 comedications) were considered to explain the interpatient variability. Predicted PF CL for a patient with median covariates values was similar in both BE/MLR and NONMEM analysis (4.02 and 3.92 L/hr, respectively). Bilirubin level and age were identified as the major determinants of PF CL by both approaches with similar predicted magnitude of effects (about 40 and 30% decrease of median CL, respectively). Confounding effects were observed between creatinine clearance (26% decrease of PF CL in the BE/MLR model), simplified acute physiology score (a global score based on 14 biological and clinical variables) (18% decrease of median CL in the NONMEM model) and age (entered in both models) which were highly correlated in our data base. However, both models predicted similar PF CL for actual subpopulations by using actual covariate values. Finally, the NONMEM analysis allowed identification of an effect of weight on CL (decrease of CL for weight < 65 kg) whereas the BE/MLR analysis predicted an increase of CL in patients treated with phenobarbital. In conclusion, both approaches allowed identification of the major risk factors of PF pharmacokinetics in ICU patients. Their potential use at different stages of drug development is discussed.


Sexual misuse of children by family members: the dynamics of a complex problem. Studies suggest that, in the United States, as many as one of every three or four children have been or will be sexually misused, but most of these episodes will never be reported. Many of the victims are abused by members of their own family. Why this abuse occurs and why it often remains undisclosed are explored in this article. The types of abuse and the situational aspects that give rise to its occurrence are analysed both in terms of participants (offenders, victims and other family members) and in terms of form (incestuous relationships within the home and outside exploitation). Possible solutions to this complex problem are also considered with the realization that only by first understanding the many factors that create and reinforce the patterns of abuse, will we be able successfully to address this common and most disturbing matter.


The impact of AIDS on blood transfusion services in South Africa. The escalating incidence of AIDS in the African population will result in the occurrence of substantial numbers of transfusion-transmitted cases of AIDS. This can theoretically be controlled by using only blood from low-risk groups for the transfusion of cellular products, and using blood derived from the high-risk section of the community only for the production of plasma-derived products that can be virally inactivated. In the South Africa context, with its dichotomous first world and third world population, this will require certain steps which contravene various norms generally accepted by the blood transfusion discipline in Western Europe.


Doctors' death experience and attitudes towards death, euthanasia and informing terminal patients. In daily practice physicians are professionally obliged to interpret ethical precepts and laws in emergency situations under extreme pressure when resuscitation measures leave little or no time to consider deontological issues. The extent to which extraprofessional experiences influence physicians' attitudes towards death and terminal patients is a difficult issue to approach with precision. The purpose of this study was to analyse the influence of some personal biographical circumstances on physicians' attitudes towards death and terminal patients. A total of 153 doctors ranging in age from 22 to 77 years (mean 38.24; SD 13.08) were randomly chosen. Physicians, as an integral part of society, cannot be expected to be immune to the influences which mould our attitudes. We suggest that young physicians and medical students should receive information and training aimed at equipping them to face death and dying patients.


Legal and economic challenges to personal autonomy: a view from the United States of America. Steadily and surely, commonly accepted notions of individual rights and the place of the individual in society are subject to increasing scrutiny. This article critically analyses legal and economic parameters which directly affect both personal autonomy and the role of government, interpreted through its higher level state and federal judiciary, on the public.


Genetic testing and insurance.

Genetic testing and insurance. To what extent should insurance companies be allowed to collect genetic data on persons seeking insurance cover? This question has evoked public debate in the Netherlands. In March 1990 a temporary agreement was reached between insurers and the government. This article discusses the arguments underlying this agreement and in particular the question whether genetic information should have the same status under the law as other medical information.


Towards a new legal regulation of medically assisted reproduction: the Austrian approach. At long last Austria, too, has come round to a more or less final draft law on assisted reproduction (at the third attempt). It portrays a compromise of liberal and conservative views, which in some points has led to inconsistencies in its logical conception. The donation of semen, for instance, will be permitted, whereas ova donation will be strictly forbidden, the law will allow AID and at the same time prohibit heterologous IVF. The leading principles throughout this law, viz human dignity, procreative autonomy, and the best interests of the child, undoubtedly vital in this context, are sometimes applied to justify regulations, for example, those that deny single women access to assisted reproduction, violating the principle of equality. In this respect, the draft law definitely does not bear a closer examination.


Attitudes of physicians to medical malpractice litigation in Canada. This article reports the results of a survey of the attitudes of medical practitioners in the Sudbury and Manitoulin Health District of Northern Ontario with respect to their experience of litigation alleging medical malpractice. The survey is part of a research project, funded by the Foundation for Legal Research, Montreal, investigating the extent to which the very high incidence of medical litigation in the United States of America is likely to spread to Canada.


The legal status of the embryo in comparative perspective. Almost all decisions with regard to allowing or forbidding research with and on the embryo as well as any other diagnostic invasion into the embryo depend on what kind and range of protection human life in this early stage of its development is or should be entitled to. This question is commonly referred to as that of the 'moral status' of the embryo or-with special regard to legal provisions and sanctions-as its 'legal status'. The answer to this fundamental question, however, is much debated and highly controversial, both nationally and internationally. Therefore professional and legal regulations range from the rather permissive (as in the new English Human Fertilization and Embryology Act of 1990) on the one hand to the total prohibition of embryo research or certain reproductive procedures on the other (as has recently been enacted by the German Embryo Protection Act of 1990). Thus, trying to reach consensus with regard to an embryo's legal/ethical right to protection is made all the more difficult because such an opinion is often, consciously or unconsciously, prejudiced by the desire to give researchers either more or less freedom of action, depending on one's point of view: Those who wish to see diagnostic or other experimental procedures with embryos facilitated, are inclined to deny their human quality from the very start. They base their arguments on the lack of individual personality in the preinidation phase of development, or simply on the fact that in many countries abortion is not illegal at that stage. Those who, on the contrary, find abortion as well as embryo research indefensible, believe their position well-founded by assuming that the embryo, from the time of fertilization, has the individuality and personality of a human being and thus is entitled to its own basic legal rights. Since to me neither of these extreme positions seems to be particularly cogent, I will try in this article to show the reasons for and consequences of adopting a middle course which neither leaves the embryo at free disposition nor bars any kind of diagnostic or other scientific invasion.


Europe 1992: conflicts between European law and national health law. In this article conflicts between European law and national health law are discussed. National laws are no longer immune against the radical changes which are taking place within the European Community. National authorities also are not free to organize health care and develop health laws in their own countries without taking into consideration the consequences of the European legislation. Rules and regulations are needed for the organization and structure of health care, and health law regulations and directives are required. They have to contain stipulations to ensure, in the 'Europe Without Frontiers' expected after 1992, solidarity between the sick and the healthy, among age groups and income groups, in partnerships and regions with great and little demand for and the supply of health care services. For a consistent system of rules and regulations, a synthesis of the principles of European law and the principles of health law is indispensable.


Euthanasia, the right to die and the law in South Africa. In this article euthanasia is defined and classified. Each of the classification is examined in relation to the relevant South African law as are the possible defences to criminal charges flowing from a euthanasia situation. Further, the validity of the so-called 'living will' is examined. While most declarations or bills of human rights seek to protect an individual's right to life, this article shows that an individual enjoys no right (from a human right point of view) enabling him to choose the time and condition of his death, irrespective of whether he is terminally ill. The reason for this negative attitude to euthanasia by society is considered. In conclusion it is observed that due to the plurality of society in South Africa, it will be no easy task for the legislature to pass acceptable laws regarding euthanasia, however limited. Finally, positive suggestions are made for the implementation of a valid 'living will'.


Cooperation between experts in fitness proceedings. The handling of the mentally ill offender involves the law as well as psychiatry and it is, therefore, essential that a good relationship exists between the jurist and the psychiatrist. The answering of questions of law by the courts needs the assistance and cooperation of mental health experts. This cooperation between the law and mental health professions is inevitable and necessary because the court is not an expert in the field of psychiatry. The duty of the psychiatric expert is to furnish the judge with necessary scientific criteria for testing the accuracy of the conclusions, so as to enable the court to form its own independent judgment by the application of these criteria to the facts proved in evidence.


United Kingdom 'Crown' indemnity for medical negligence--an overview of the first 18 months of the new scheme. This article describes the background to the introduction of 'Crown' indemnity and summarizes the operation of the scheme. It also makes clear the limited nature of the scheme and how it does not apply, for example, to independent contractors such as general medical and dental practitioners. Also described is the nature and operation of United Kingdom medical defence organizations such as the Medical Protection Society and the services which they continue to provide to medical and dental practitioners worldwide. Early indications suggest that the new government scheme is placing a very heavy financial burden on health authorities which already suffer from underfunding and tight budgetary control.


Doctors' rights and patients' duties?

Doctors' rights and patients' duties? Currently, there is an increasing tendency to convert patients' rights into duties. At least three areas can be identified: The tendency of the health care provider to claim duties of the patient in the doctor-patient relationship; the trend to stipulate conditions when patients are in need of health care delivery; and the evolution towards the formulation of patients' legal duties when third-party interests are involved. The societal tendencies to convert legal rights into legal duties, to require counter-services from the patient and to control patients' behaviour, limit patients' rights to self-determination and essential human rights in health care. Ultimately, intervention through legislation might be necessary.


The doctor's duty of disclosure and excessive information liability. This article critically examines the recent phenomenon of legal liability for so-called excessive disclosure within the context of the informed consent doctrine. An attempt is made to formulate a set of workable principles to cater for both the doctor's dilemma and the patient's protection in over-information cases against the backdrop of the general principles of the doctor's duty to disclose.


Mistreatment of the aged in the home environment in northern France: a year survey (1990). As the percentage of the population which is aged increases in the developed countries, public health problems arise from the limited autonomy and physical or mental infirmity of the elderly. Cohabitation arrangements, often used to permit the elderly to stay at home, can give rise to conflict and the mistreatment of the aged. We analysed questionnaires distributed in 1990 to 25 home nursing units and two hospitals in a part of the northern region of France. Fifty-five observations of mistreatment were collected, 22 from hospital and 33 from home-based inquiries. The types of mistreatment and the characteristics of the victims and perpetrators are detailed and discussed. Penal and legal aspects of mistreatment of the aged in France are discussed.


The image of the insane in ancient Jewish lore. This article considers the attitude towards the insane and insanity in ancient Jewish sources. In the Bible, the most famous case of a psychopathological personality is that of King Saul, who was plagued by 'an evil spirit'. Saul also raises the problematic connections between prophecy and frenzy. Madness and confusion of mind are mentioned among the biblical 'curses for disobedience'. In the Talmud, there is a detailed symptomatic evaluation of insanity, in the context of legal liability. It is well-known that some individuals are at times insane, otherwise sane and responsible, which is legally taken into careful consideration. The Jewish historian Josephus describes in his works several cases of psychiatric patients. The most impressive case is that of Jesus ben Ananias, a delirious maniac who announced the fall of Jerusalem while roaming about the streets of the city. It may be argued that no clear attitude of derision or ostracism towards insane patients can be found in ancient Jewish literature. 'The Lord preserves the fools' (Ps 116: 6).


The medico-legal, social and ethical implications of surrogate parenthood. Infertility has existed for thousands of years and treatment has evolved with the advance of medical science. Surrogate parenthood was effected previously by sexual intercourse, but AIH, AID and GIFT have rendered this practice obsolete. The terms surrogate mother, partial and full surrogacy are defined. Medico-legal, social and ethical arguments for and against surrogacy are discussed. References are made to varying national attitudes as to the desirability of legalizing surrogate parenthood and the implications for commissioning parents, the surrogate mother and adequate counselling are considered.


Effect of premedication on the changes of neuropeptide Y (NPY) in anesthesia. Premedication is one of the popular techniques in anesthesia, not only for the decrease of side effects but also for the increase of actions. Clinically, we found that plasma neuropeptide Y-like immunoreactivity (NPY-IR) was lowered in patients who had received premedication. In rats, plasma NPY-IR was not modified by the intravenous injection of diazepam. Pethidine reduced the plasma NPY-IR level which could be reversed by naloxone. Direct inhibition of plasma NPY-IR through an activation of opioid receptors can thus be considered. To the cold-stress stimulation, plasma NPY-IR was markedly raised. Diazepam reduced this stimulation-induced increase of plasma NPY-IR in a dose-dependent manner. Similar derivative of benzodiazepine produced an inhibition in a way following the potency as that to produce anxiolytic action. Also, this inhibition was reversed by PK11195, an antagonist of peripheral benzodiazepine receptors. Moreover, pain-stimulated increase of plasma NPY-IR in rats was also reduced by pethidine. This action was totally reversed in the presence of naloxone, indicating the participation of opioid receptors in the process. The obtained results suggest that premedication of diazepam and/or pethidine has the ability to decrease plasma NPY-IR in animals.


[Changes of blood viscosity in patients undergoing cardiac surgery during cardiopulmonary bypass]. The patient undergoing open-heart surgery depends on hypothermia and cardiopulmonary bypass (CPB) to maintain organ perfusion during cardiac arrest. Increased blood viscosity during hypothermic CPB might be life-threatening, so hemodilution is imperative. Fourteen open-heart patients of ASA class II-III were included in this study. Pre- and intra-CPB viscosity changes were observed. Before CPB, 6 ml blood sample was drawn out from open-heart patients after systemic heparinization and another 6 ml blood sample was drawn out from the oxygenator after CPB was established. The hematocrit and relative viscosity of each sample in different temperatures were measured. The result revealed that as the temperature decreases, the viscosity of each sample increases apparently. As compared to the pre-CPB blood sample, the hematocrit of blood obtained intra-CPB decreases from 36.81 to 27.04, (p < 0.001), and the viscosity also decreases at all different temperatures (p < 0.001). Blood viscosity obtained at 37 degrees C pre-bypass is not statistically different from the sample at 25 degrees C during bypass. Obviously, increased viscosity due to hypothermia is buffered by hemodilution after using large amount of fluid as priming solution during CPB. Therefore, the hematocrit and viscosity remain within physiologic ranges.


The sedative effect of intravenous injection of low dose midazolam during spinal anesthesia in cesarean section. In a randomized blind study, we compared the neonate Apgar score, umbilical venous pH, incidence of maternal hypotension and intra-operative maternal discomfort in elective Cesarean section performed under spinal anesthesia in two groups of parturients with or without low dose midazolam as a sedative agent before the deliveries. Each group consisted of 20 parturients. Ninety percent of the mothers in the midazolam group fell asleep smoothly before the operations started. The neonates in the midazolam group were scored similar to saline control group on Apgar score and umbilical venous pH. The incidences of maternal hypotension during operation in both groups were 55%. However, the occurrence of intra-operative maternal discomfort was eleven fold more often in the saline control group. On the other hand, there existed a significant inverse correlation between uterine incision-delivery interval and Apgar score as well as umbilical venous pH. We concluded that low dose midazolam is a good sedative agent during spinal anesthesia in elective Cesarean section. It is also safe and effective even given before delivery.


Is routine preanesthetic hemoglobin test necessary in minor pediatric surgery? The value of preanesthetic assessment of anemia and analysis of the hemoglobin level prior to a minor pediatric surgery has been recently questioned in some reports. This study was to retrospectively analyse 8859 pediatric patients who underwent minor surgery in the period from January 1987 to December 1990 in our hospital. They were all ASA class I-II in physical status with age ranging from one month to 19 years. Those patients with their hemoglobin values determined at other laboratories or hospitals in spite of our recognition and those suspected of having an immune or oncologic disease were excluded from this study. The mean hemoglobin value of the patients under study was 12.99 +/- 0.82 g/dl. 0.62% of the patients (55) were found to have hemoglobin values less than 10 g/dl which were similar to the results obtained by Wood et al (0.7%) in 1981 and Roy et al (0.5%) in 1990. Among the 55 anemic patients, 41 (74.5%) were at the age between 2 to 4 months (within the physiologic anemic period of infancy). Sampling of blood for routine preanesthetic hemoglobin determination which caused discomfort and pain was often rejected by pediatric patients and struggle for escape also upset the children very much. Based on the results from our analysis, we suggest that in healthy pediatric patient scheduled for minor surgery routine hemoglobin test could be excluded. Hemoglobin test is selectively performed in a patient is anemic or under suspicious circumstances. The value and shortcomings of selective hemoglobin test before surgery require further evaluation.


Murine subcutaneous granulomatous zygomycosis induced by Absidia corymbifera. Subcutaneous zygomycosis developed in 90% of mice killed from 1 to 9 weeks following subcutaneous inoculation of spores from Absidia corymbifera. Initially the inflammation was characterized as pyo-granulomatous, but after five to six weeks of infection the dominant cells were mononuclear, and giant cells and more regular conglomerates of granulomata were formed. Within the granulomata necroses also became more abundant with time. In animals developing mycosis fungal elements were restricted to the site of infection and were never observed in regional lymph nodes or internal organs examined by conventional and immunohistochemical staining methods. The localized extension of infection was accompanied by development of specific antibodies against somatic antigens from A. corymbifera as assessed by counterimmunoelectrophoresis.


Relationship between digestive and killing abilities of neutrophils against Paracoccidioides brasiliensis. Peripheral blood neutrophils (PMN) from patients with paracoccidioidomycosis killed and digested Paracoccidioides brasiliensis much less than did PMN from normal individuals or from patients with other diseases. However, deficiency in killing ability was less specific than digestive deficiency and correlated poorly with it. We conclude that the capacities of PMN to digest and kill P. brasiliensis are not intimately related phenomena, and that in paracoccidioidomycosis the key deficiency of neutrophil function is that of digestion of P. brasiliensis.


Haematological alterations induced by biochemical fractions of Paracoccidioides brasiliensis in mice. Biochemical fractions of Paracoccidioides brasiliensis were obtained for experimental inoculation in mice followed by haematological analysis. Dead total fungus, total fungus disrupted by ultrasonic waves, lipids of the fungus, supernatant of the lipid purification, and integral and disrupted fungus free of lipids were obtained. The six fractions were obtained from lyophilized yeasts of a recent isolate of P. brasiliensis and from a pool comprising equal amounts of four strains maintained in the laboratory for some time. Different doses of the 12 fractions were intraperitoneally inoculated into mice and haematological analysis was done 30 days later. No significant alterations were detected in the red blood cell series. However, the white blood cell series showed marked alterations, such as leukopenia, with relative neutrophilia and lymphopenia. Thrombocytosis occurred widely. The haematological alterations revealed associations with the injected doses without relation to the biochemical composition of the different fractions. No difference in the capacity for inducing haematological alterations was found between the fractions obtained from the recent isolate and from the older ones.


Pathogenic fungi in human dwellings.

Pathogenic fungi in human dwellings. Airborne invasive fungal infections in various risk groups of people suffering from immunodeficiencies are an increasing problem for modern medicine. Because of the acute and rapid course of invasive infections, prevention is of principal significance. Such prevention mainly concerns the control of fungal spores in indoor air. In this connection the immediate environment offering ecological niches for growth and morphogenesis of infective particles of Aspergillus spp., Mucoraceae, Cryptococcus neoformans and some other yeast-like fungi is of main interest. The current problems of indoor air mycology, i.e. the epidemiology and ecology of pathogenic fungi in indoor air, can only be recognized and interpreted by centres routinely performing mycological diagnosis for all the various risk groups of patients. Models of specific surveillance of the most important fungal pathogens (e.g. Aspergillus spp. and Cryptococcus neoformans) in indoor air will be outlined and discussed.


Hyperthermic treatment of sporotrichosis: experimental use of infrared and far infrared rays. We used pocket warmers and infrared and far infrared rays to treat 14 cases of sporotrichosis, 7 in children and 7 in adults. There were 9 cases of the fixed cutaneous type and 5 of the lymphocutaneous type; 6 were located on the face and 8 on the limbs. Four cases were treated with pocket warmers, 5 with infrared rays, and 5 with far infrared rays. All lesions treated with pocket warmers were facial lesions in children; infrared and far infrared ray treatments were used in 3 children and 7 adults, 2 on facial lesions and 8 on lesions on the extremities. In treatments with infrared and far infrared rays, the amount of heat was greater than with the pocket warmers, and one 15-min treatment daily was sufficient to yield satisfactory results, but this method is difficult to use on children and on the face, and 40-min treatments two or three times a week proved unsatisfactory. Infrared and far infrared ray treatments allow the length of a single treatment to be reduced by three-quarters, in comparison with one pocket warmer treatment.


Trichoderma viride infection in a liver transplant recipient. A liver transplant recipient developed infection of a perihepatic haematoma due to Trichoderma viride. Before the infection was diagnosed, the patient received intense immuno-suppressive and prolonged antibacterial and anti-fungal therapies. Although the death of the patient was not directly related to the fungal infection, abundant quantities of this pathogen were recovered in the haematoma at post-mortem examination, despite previous surgical removal and treatment with amphotericin B and fluconazole.


Rhodotorula fungaemia: a life-threatening complication of indwelling central venous catheters. A 30-year-old woman receiving total parenteral nutrition via an indwelling central venous catheter for an intestinal motility disorder developed fever, tachycardia, tachypnea, and hypotension. Multiple blood cultures drawn through the catheter prior to these events, as well as a peripheral blood culture obtained earlier, grew the red yeast Rhodotorula rubra. The patient was critically ill for over one month but eventually recovered with therapy including the systemic antifungal agents amphotericin B and flucytosine and removal of the catheter. Although Rhodotorula has generally been regarded as having low pathogenicity, this case emphasizes the serious nature of Rhodotorula sepsis and suggests the need for both systemic antifungal therapy and removal of a colonized indwelling catheter.


Fungaemia due to Candida pelliculosa in a case of acute pancreatitis. We describe a case of fungaemia due to Candida pelliculosa (teleomorph: Hansenula anomala) in an otherwise non-immunocompromised patient with acute necrotizing pancreatitis of unknown origin. This species of Candida should be added to the list of pathogenic fungi which are increasingly important not only in patients with underlying immunosuppressive disease but also in patients with, for instance, severe surgical illness.


Hepatosplenic infection caused by Candida parapsilosis in patients with acute leukemia. Candida parapsilosis is an exceptional agent in hepatosplenic candidosis. Here we report two cases of hepatosplenic infection caused by Candida parapsilosis in two patients with acute leukaemia. Open liver-spleen biopsy and previously minimal exposure to systemic antifungal drugs led to a cultural diagnosis in both patients. This report confirms the importance of an early diagnosis of these diseases in order to undertake appropriate therapeutic regimens.


Successful treatment of a Candida albicans sepsis with a combination of flucytosine and fluconazole. A case of a severe Candida sepsis is reported, which was treated successfully by a combination therapy of flucytosine with fluconazole. After an extensive abdominal operation, a 70-year-old man developed a syndrome of fulminant sepsis due to Candida albicans with the beginnings of renal failure. The latter fact forced us to search for a therapeutic alternative to the classical amphotericin B plus flucytosine combination therapy.


Synergistic interaction of miconazole and fluconazole at sub-MIC level on Candida albicans. The in vitro combination effect of two azole antimycotics, miconazole and fluconazole, against Candida albicans was studied. When minimum (MIC) and sub-minimum (sub-MIC) inhibitory concentration and fractional inhibitory concentration (FIC) determinations were made, a synergistic interaction of the two agents at the concentration well below their individual MICs (at sub-MIC levels) was evidenced. The FIC index values ranged from 0.3 to 1.0 and the synergy was characterized by the potentiation of fluconazole activity with miconazole. The synergistic effect was also confirmed by a turbidometric method. On the other hand, such a synergistic effect against Candida krusei was not confirmed.


Shorter treatment for vaginal candidosis: comparison between single-dose oral fluconazole and three-day treatment with local miconazole. Fluconazole is an effective, simple and safe, although slightly expensive, agent for the treatment of vaginal candidosis. Single-dose fluconazole (150 mg) administered orally in capsule form was compared with three-day local treatment with miconazole pessaries in the treatment of vaginal candidosis in a randomized study in Finland. Cure rates were good (> 80%) in randomized patient groups assessed both clinically and by the results of yeast cultures. Oral administration was preferred to local therapy by patients in both the miconazole and fluconazole groups. For the time being, fluconazole is not recommended for use during pregnancy or lactation.


Low voltage scanning electron microscopy study of naftifine activity on Microsporum canis. Scanning electron microscopy (SEM) is at present considered a good way to observe the morphological alterations induced by an antifungal on pathogenic fungi. Owing to its high precision, low voltage scanning electron microscopy (LVSEM) improves the quality of observations. The Microsporum canis morphology alterations induced by naftifine at a concentration of 0.9 microgram ml-1 (10 times the minimum inhibitory concentration (MIC) for 7 days were studied in LVSEM. The young lateral ramifications and the aborted buds take on a granulous aspect. These granulations can be localized as brassard shapes around hyphae. The mycelial filaments often appear irregularly swollen with bulbous tips. Macroconidia are selectively covered with a microfibrillar network. In addition, LVSEM on control samples reveals pavimentous angular structures on the macroconidial surface and fine granulations on the filament surface of M. canis unknown until now. A cytological study with transmission electron microscopy (TEM) of filaments altered by naftifine permitted us to observe the disorganization of cell wall fibrillar structure, an excessive plasma membrane undulation and an intracytoplasmic accumulation of large vesicles with probably lipidic contents.


Preparation of antigens from Trichophyton mentagrophytes using a new semi-solid culture medium and their characterization by SDS-PAGE and immunological techniques. A new semi-solid culture medium was developed by substituting the agar in Sabouraud glucose medium by Lutrol FC 127 (BASF, Ludwigshafen, Germany). This culture medium can be liquefied by cooling it down from the incubation temperature to 5-10 degrees C, thus allowing the full harvest of fungal mycelium without any contamination by the gelling agent for antigen preparation. More than 25 protein bands with molecular weights in the range of 98 to 12 kDa were fractionated by SDS-PAGE in antigen preparations from Trichophyton mentagrophytes. Hyperimmune antisera were raised in rabbits and used for immunological studies. Heat-inactivated mycelium was used for the absorption of antibodies against heat-stable cell wall constituents. This absorption facilitated the detection of specific protein bands during immunoblotting which revealed 17 protein antigen bands reacting with antibodies over a range of molecular weights from 98 to 24 kDa.


Isoconazole nitrate versus clotrimazole in foot and nail infections due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes. A total of 40 coal miners, 35 with culturally proven mycotic infections of the feet and 5 with similarly proven infections of toenails due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes, were treated with 1% cream of either isoconazole nitrate (Travogen) or clotrimazole (Canestan) for 4 weeks. The clinical cure rates for the isoconazole-treated group for itching, inflammation, scaling and maceration in the cases of foot infections were 89, 88, 83 and 83% respectively. For the clotrimazole-treated group, the cure rates were 76, 71, 82 and 80% respectively, for the similar symptoms. Toe web was the commonest site of infection and also most easily treated with either clotrimazole or isoconazole. The clinical and mycological cure rates 6 weeks after treatment were 80% for the isoconazole-treated group and 70% for the clotrimazole-treated group but the difference was not statistically significant (P > 0.01). None of the cases of toenail infection could be cured by treatment with either of the two drugs.


Inhibition of growth of dermatophytes by Indian hair oils. A survey on the use of hair oils for hair dressings by the Indian population revealed that mustard oil is preferred by males and coconut oil by females. Amla oil is used equally by both. These oils contain different percentages of various saturated and unsaturated fatty acids which largely determine their toxicity against dermatophytes. For Microsporum canis, M. gypseum and Trichophyton rubrum, amla oil was most toxic, followed by cantharidine and coconut oil, while Trichophyton mentagrophytes was most susceptible to coconut oil followed by amla and cantharidine oil. Mustard oil showed least toxicity to all four test species. The rarity of tinea capitis in India has been concluded to be due to the common use of hair oils by the Indian population.


Dermatomycoses among industrial workers in Cross River State, Nigeria. A survey of dermatomycoses was carried out amongst industrial workers in three different factories during the period 1987-1988. A total of 194 workers were screened, out of which 54 proved to be mycologically positive by microscopy and/or culture. Incidence was apparently highest amongst workers in a cement factory (Calcemco, 33.3%) followed by those in a wood factory (Seromwood, 30.8%) and a rubber factory (CREL, 26.2%). Pityriasis versicolor was the predominant clinical type of dermatomycosis, followed by tinea pedis. A total of 51 fungal organisms were identified. Malassezia furfur was the most prevalent causative agent (74.4%) followed by Trichophyton soudanense (5.8%), T. rubrum (3.9%) and Epidermophyton floccosum (3.9%). Other species identified were one isolate each of T. tonsurans, T. mentagrophytes, T. verrucosum, Candida tropicalis, Candida spec. and Geotrichum candidum.


Dermatophytosis due to Trichophyton rubrum in northern Greece during the decade 1981-1990. During the years 1981-1990 Trichophyton rubrum was the most frequent causative agent of dermatophytic infections in Northern Greece, especially in cases of tinea pedis, cruris, corporis, and unguium, as well as dermatophytosis of the hands. Between sexes there was a prevalence in women in tinea pedis and toenail infections. Men were particularly infected in the groin, the hands and the face. The chronic follicular dermatophytosis in the lower legs was also presented in women, but tinea corporis and fingernail infections showed no significant differences between the sexes. Also studied were the age of the patients, the inflammatory component of the lesions and the morphotypes of T. rubrum isolated.


[Mechanism of self-maintenance of experimental atherogenic hyperlipoproteinemia]. Disorders of lipid catabolism in the liver and increased formation and intensified secretion into the blood of lipoproteins synthesized in the liver evidently play a significant role in the maintenance of experimental atherogenic hyperlipoproteinemia induced in rabbits by prolonged administration of atherogenic lipoproteins.


[Biological effect of laser radiation on the functional state of cardiomyocytes]. Experiments were conducted on Wistar rats to study the effect of laser radiation (LR) with a wavelength of 632.8 and 890.0 nm and power of 0.0005-0.005 and 0.003-0.003 W/cm2, respectively, on the action potential (AP) and mechanical contraction of smooth muscle cells, as well as myocardial ATPase activity. LR with a wavelength of 632.8 and 890.0 nm in a dose of 3.0 J/cm2 activates Ca-ATP-ase activity, increases the activity of the myocardial antioxidant system, reduces the Na-Ca current through the membrane, and accelerates the return of Ca2+ into the sarcoplasmic reticulum. LR with a wavelength of 632.8 nm reduces mainly the Ca flow, while LR with a wavelength of 890.0 nm reduces the Na current In a dose of more than 3.0 J/cm2 LR causes a damaging effect manifested by increased Ca2+ current in the slow channels, increase of amplitude, duration of AP and repolarization phase. Synergism of the action of LR with a wavelength of 632.8 and 890.0 nm and that of some antiarrhythmic agents (procainamide, lidocaine, ethmosin, ethacisin, verapamil) was encountered.


[Laser irradiation of venous blood for prevention of reperfusion syndrome in myocardial infarction]. The antioxidant effect encountered in laser irradiation of venous blood suggested the study of the possibility of its use for the prevention of the reperfusion syndrome in myocardial infarction (MI). Analysis of biochemical, electrophysiological, hemodynamic, and morphohistological data obtained in experiments on male rats and in clinical cases showed that irradiation of venous blood by the LG-75 helium-neon laser with a wavelength of 632.8 nm produced the best effect. The effect is realized through increase of collateral blood supply in the region of the MI and the antioxidant and antihypoxic action.


[Effect of extremely high-frequency electromagnetic radiation on the function of skin sensory endings]. The specific features of skin receptor function on the sole of the hind limb of an albino rat were studied in an acute experiment. Impulse activity recorded from the solitary fibres of the tibial nerve showed that receptor units (RU) responded to mechanical stimulation of the skin. Irradiation of the skin surface by low-intensity millimeter band electromagnetic field (frequencies of 55.61 and 73 GHz) in the zone of the RU led to diminution of RU sensitivity to the mechanical stimulus. One half of the RU ceased to respond to the mechanical stimulation 25 minutes after irradiation. The other half continued responding to stimulation even after 35 minutes of irradiation, but the character of the RU response was significantly changed. A strict frequency-resonance dependence of the biological effects was revealed. It is concluded that electromagnetic radiation has a modulatory-inhibiting effect on the skin RU. The authors suggest a possible mechanism of realization of the effect of electromagnetic radiation of extremely high-frequencies and low power on the skin receptor function.


[Effect of dibunol on lipid peroxidation and alpha-tocopherol level in the rat heart in acute hemorrhage]. The authors studied the effect of a single injection of dibunol in a dose of 120 mg/kg on lipid peroxidation (LPO) and alpha-tocopherol (TP) level in the heart muscle in acute blood loss. The LPO products and alpha-tocopherol level were determined simultaneously in a heart homogenate 2 hours after the blood loss. It was established that the loss of blood leads to activation of LPO and reduction of the TP level in the myocardium. Dibunol injection inhibited LPO activation, reducing the content of LPO products to that in animals with a false operation (without blood loss), and increased the TP level also to that in a false operation. The decrease of the TP level in acute blood loss depends, evidently, on increased mobilization of TP from the myocardium due to the increased level of catecholamines (CA), while the increase of TP under the effect of dibunol occurs due to its inhibited mobilization from the myocardium, which is mediated by reduction of the CA level.


[Noradrenaline metabolism in the brain of young rats during formation of inherited stress-induced arterial hypertension]. The noradrenaline (NA) metabolism rate was studied in discrete brain areas of young rats with inherited stress-induced arterial hypertension (ISIAH rats) in the period of rapid hypertension formation (4th week, 22nd-23rd days of life). The rate of metabolism was evaluated according to the NA concentration regression lines after inhibition of tyrosine hydroxylase oridopamine-beta-hydroxylase. The level of NA and the rate of its metabolism in the posterior hypothalamus, midbrain, and pons were higher in ISIAH rats than in normotensive Wistar rats. These parameters in the frontal cortex, anterior hypothalamus, and medulla oblongata were the same in the two rat strains. The possible role of NA metabolic changes in the development of inherited arterial hypertension is discussed.


[Effect of protectors on morphofunctional changes in rat kidneys in tourniquet shock]. The protective effect produced on the kidneys in tourniquet shock by thiol agents possessing antioxidant properties (unithiol, cystamine) was compared with that of a preparation of cell capsules of L. bulgaricus (CCLB). Tourniquet shock was modeled under ether Raush anesthesia by applying 8 turns of a rubber tourniquet to the hind limbs for 6 hours. Thirty minutes before removal of the tourniquet animals of the first group were given an injection of 1 ml of physiological solution, animals of the second group--20 mg/kg of unithol, those of the third group received an injection of 20 mg/kg of cystamine hydrochloride. Animals of the fourth group received 50 mg/kg of CCLB in 1 ml of physiological solution 7 days before the experiment. A marked protective effect of CCLB on the kidneys in tourniquet shock was established. According to the degree of the protective effect on the tissue of kidneys in tourniquet shock, the studied agents come in the following order: CCLB, cystamine, unithiol.


[One of the possible means of restoring the circulating blood volume in shock]. The possibility of increasing the efficacy of restoration of the circulating blood volume (CBV) in shock was demonstrated in experiments on 33 anesthesized female cats. Intramuscular injection of lactin one hour before blood loss (2% of body mass) in a dose of 5 U/kg or its intravenous infusion 90 minutes after blood loss in a dose of 50 U/kg was attended by restoration of the plasma volume in 5 hours. The prospects of further research into improvement of the efficacy of CBV in shock through activation of the body's reserves are substantiated.


[Frequency of acquired helplessness and initial probability of showing an elaborated reaction]. The defense reflex of random performance of instrumental reaction (RPIR) had been produced in rats with different probabilities which were equal to 0.5; 0.25; 0.125 and 0.05 in respective experimental groups. Learning of animals was found to take place much faster when probabilities of RPIR were equal to 0.125 and 0.25 as compared with 0.5 and 0.05 values. One third rats which learned at 0.05 and 0.5 probabilities did not produce the reflex; the decrease in aroused, fall of body weight and other disturbances were observed and these findings may evident development of acquired helplessness about. It is supposed that optimal circumstances are occurred at different probabilities of RPIR conditions.


[Relationship between metabolic changes in regional blood and tissues in ischemia of the extremities]. The authors examined 56 patients with obliterating diseases (OD) of arteries of the lower extremities and conducted experiments on 97 male albino rats. In patients with OD the lactate content in the regional venous blood of the involved extremity increases proportionally to the severity of ischemia. No essential changes occur in the concentration of ATP and glucose. In rats with transitory ischemia of the extremities the lactate level in venous blood increases in the absence of changes of the ATP and glucose content; reduced concentration of ATP and glycogen was encountered in the ischemic muscles of the extremities. The mechanisms and significance of the disorders of metabolic parameters in ischemia are discussed.


[Effect of peptide immunomodulators on microlymphodynamics]. Study of changes of some microlymphocirculatory parameters on the mesentery of anesthesized female albino rats in application of immunomodulators in 3-4 concentrations showed the following. Lympholin and gordox caused no changes of the studied parameters (tonic activity, rate and amplitude of rhythmic phase activity, rate of lymph flow). With gradual increase of concentration, Tactivin caused a greater constriction of the lymph vessels with a reduction of the amplitude of contractions. The changes of the rate of contractions was dose-dependent with increase of the concentration the proportion of vessels with a diminished rate increased. Myelopid increased the rate of contractions with some increase in the rate of lymph flow. Dose-dependence was not found. Leukopeptide caused narrowing of the vessels with a dose-dependent increase of the lymph flow rate. Lienin only reduced the rate of the lymph flow.


[Pathogenesis of fever after operations on the gastrointestinal tract]. It was established on dog experiments and in operations on patients that the severity and duration of a febrile response after operations on the intestine are determined by the degree of contamination of the abdominal cavity through a physically air-tight intestinal suture.


[Development of various forms of immunosuppression after exertion and heat exposure]. In Wistar rats, 3-hour moderate exercise precipitated the development of antigen-specific immunosuppression induced by large doses of sheep erythrocytes, while 5-hour exercise caused, in addition, the development of antigen-nonspecific immunosuppression. After 5-hour swimming splenic cells which did not adhere to the plastic secreted the antigen-specific factor (ASF), while cells adhering to the plastic secreted the antigen-nonspecific factor (ANSF). Immunosuppressive ASF had no effect on ANSF secretion, whereas the latter accelerated the secretion of ASF by the splenocytes of swimming rats. Administration of erythrocytes of swimming rats induced the secretion of immunosuppressive ANSF by splenic cells which adhered to the glass and this factor promoted ASF secretion in hyperimmunized rats. After warming, the erythrocytes lost their property of inducing ANSF secretion by cells which did not adhere to the glass, which led to secondary diminution of ASF secretion.


[Importance of determining halo-formation in comprehensive diagnosis of neoplasms in the large salivary glands]. An original diagnostic test in study of the functional state of segmented neutrophils, based on the halo-formation phenomenon, was investigated in patients with neoplastic and non-neoplastic diseases of the large salivary glands. Donors formed the control group. Analysis of the results showed a marked increase of the number of halo forming cells in patients with various forms of malignant new growths of these organs. The suggested test is recommended for use as an index of the functional activity of segmented neutrophils in malignant growth.


[Nociceptive sensitivity of rabbits in varying localization of pain stimuli and naloxone administration]. Study of the dynamics of changes of evoked potential (EP) amplitude in electrodental and electrocutaneous stimulation (EDS and ECS, respectively) as an index of the perceptual component of the nociceptive reaction showed that 0.2 mg/kg and 0.5 mg/kg doses of naloxone produce both a hyper- and an analgesic effect in rabbits. The effect of naloxone depended on the individual properties of the rabbits, while its degree was determined by the localization of the nociceptive stimulus. The animals' individual properties were manifested by the presence or absence of an analgesic effect of auricular electrostimulation--acupuncture-sensitive (AS) or acupuncture-resistant (AR) rabbits. Naloxone injection caused a dose-dependent hyperalgesic effect in AS animals and an analgesic effect in AR rabbits in EDS. Similar effects were recorded in ECS, but their degree differed: hyperalgesia in AS rabbits was demonstrated more clearly than analgesia in AR animals.


[Heterogeneity of immunoreactive prolactin in hyperprolactinemia of various origin]. Study of molecular heterogeneity of immunoreactive prolactin in patients with macro- and microprolactinomas and idiopathic hyperprolactinemia has shown heterogeneity of the total blood immunoreactive prolactin pool in all the examined patients. This pool included three basic forms with molecular masses about 23, 50, and over 100 kD (23K-, 50K-, 100K-prolactin), whose ratios essentially differed in individual patients. Physiologically the most active monomeric 23K form of prolactin predominated in the blood of patients with hyperprolactinemia due to hypophyseal micro- and macroadenomas, parallelled by manifest signs of galactorrhea and hypogonadism; the content of this form may reach 95% of the total immunoreactive hormone. Patients with hyperprolactinemia of obscure origin present with quite the contrary ratio of prolactin immunoreactive forms with the predominance of high-molecular 100K form of the hormone, whose share may reach 80-90%. Such cases of hyperprolactinemia may be associated with the absence of clear-cut clinical manifestations, including such as galactorrhea and menstrual cycle disorders, and with inefficacy of traditional therapy. Such cases were tentatively classified as 'the high-molecular prolactin syndrome' and need further research.


[UV-irradiation of the blood in the treatment of polycystic ovary syndrome]. Effect of extracorporeal UV irradiation of the blood on the clinical picture and hormonal profile of patients with the polycystic ovaries syndrome was under study. 119 women were administered 582 sessions, and in 54 of these the results were followed up for 1-25 months. A good clinical effect was achieved in 88.9% of these cases, it consisted in recovery of the cycle rhythm (70.7%), pregnancy (29.2%), reduction of hirsutism manifestations (19.04%), decrease of galactorrhea (41.7%), cessation or alleviation of headaches (86.2%), body mass reduction (40%), arterial pressure normalization (43.8%). Well-being of the majority of women was improved by therapy. 17-ketosteroids excretion normalized and persisted normal in a month after the treatment. Blood LH level and the LH/FSH ratio significantly reduced in those in whom these values were elevated in disease. Elimination of hyperandrogenism and a trend to normalization of gonadotropin secretion, resulting from extracorporeal UV irradiation of the blood, indicate that such treatment modality is pathogenetically grounded and justify its use in the treatment of women with the polycystic ovaries syndrome.


[Comparison of the data of palpation and ultrasonic examination in assessing the dimensions of the thyroid gland]. Comparison of the thyroid-sizes estimated by palpation and ultrasonic scanning in 282 women and 178 men has shown that if the thyroid is small (from 0 to 2nd degree, according to O. V. Nikolayev's classification), its size cannot be estimated by palpation and this method fails to assess the endemic goiter in epidemiologic surveys. Correlation between the thyroid size estimated by palpation and its ultrasonically assessed volume has made up 0.346 (p < 0.001) in women and 0.193 (p < 0.01) in men. Ultrasonic assessment of the thyroid volume appears useful both for clinical and epidemiologic studies.


[Bone tissue in patients with hyperprolactinemic hypogonadism]. Sixteen women with hyperprolactinemia were examined for Ca metabolism, osseous metabolism, mineral saturation of bone tissue in the thoracic portion of the spine and radius. Lowered mineral saturation of the thoracic vertebrae was detected in 69% of the examinees, that of the distal segment of the radius in 44%. Reduction of the mineral saturation of the spine was in negative correlation with the blood prolactin level and length of amenorrhea. No changes in the bone resorption biochemistry or Ca metabolism were detected. A marked reduction of blood osteocalcin level that reflects osteoblast function was detected, its blood concentration being in negative correlation with prolactin level. No relationships between mineral saturation of bone tissue, prolactin, and osteocalcin, on the one hand, and blood estradiol level, on the other, were observed. These data suggest that osteopathy in hyperprolactinemic hypogonadism is due to reduced bone formation and not to reduced estradiol production.