Subsurface deformation associated with hardness measurements of composites. This study was prompted after a series of composites had been hardness-tested with the Vickers (pyramidal diamond indenter) and Barcol tests (flat-ended steel cone indenter). The results were found to differ markedly from the supplied Barcol/Vickers conversion chart. A sectioning and silver staining technique was therefore developed to examine the modes of subsurface deformation of four composites under the two indenters. Under the Vickers indentations, the large particle hybrid, Occlusin, showed a clear hemispherical area of subsurface disruption while the small particle hybrid, Brilliant Dentin, had a less distinct zone of disruption. The microfilled materials, Heliomolar and Isosit, showed minimal silver uptake, suggesting a less disruptive mode of plastic deformation. Under the Barcol indentations, Occlusion and Brilliant Dentin produced clear hemispherical zones of deformation, while Heliomolar and Isosit were badly crazed with distinctive patterns of subsurface flaws. These consistent patterns of failure to some extent explain the comparison of hardness measurements and may be of use in explaining the wear mechanisms of composite restorations.


Dentin thickness, hardness, and Ca-concentration vs bond strength of dentin adhesives. The relationship between the tensile bond strength (TBS) and three dentin characteristics: remaining dentin thickness (RDT), Ca-concentration, and hardness, were investigated. Sixty-two extracted bovine incisors, divided into four groups, were prepared using 600-grit SiC paper to create flat dentinal surfaces. The materials tested in this study consisted of three commercially available and one experimental dentin bonding systems. The TBS and modes of failure were determined after storage for 24 h in 37 degrees C water. Then RDT, Ca-concentration, and hardness were measured. Data were statistically compared with TBS of each group. The mean bond strength of the commercial materials ranged from 2.5 +/- 0.9 MPa to 7.7 +/- 2.8 MPa. Correlations with Ca-concentration and RDT varied, depending on the product. The bond strength of the experimental material was 9.2 +/- 4.4 MPa and significantly correlated with RDT and hardness. With two of the dentin bonding agents, specimens showed a high number of cohesive fractures in dentin, 40% to 82%. It was concluded that the variability of TBS was influenced by dentinal characteristics in three of the four materials tested.


A new light-activated adhesive composite: shear bond strength and microleakage. A new light-activated adhesive composite has been formulated. Its shear bond strength and marginal microleakage were compared with glass ionomer cements: Fuji Ionomer Type II, Ketac-Fil and Ketac-Bond. The new material showed significantly (p < 0.05) higher bond strength to non-etched enamel (7.9 MPa) and dentin (7.3 MPa) than commercially available materials. It also performed significantly better (p < 0.05) in the microleakage test. Ease of use and the excellent marginal sealing ability of the new material are expected to allow considerable innovation in restorations of root caries, cervical erosion and other conditions where the marginal seal of the gingival cavosurface is difficult.


The influence of surface conditions and silane agents on the bond of resin to dental porcelain. The influence of porcelain surface condition and the application of silane agents on the adhesion between resin and dental porcelain were investigated. The experimental variables included three porcelain surface preparations, as polished, etched with phosphoric acid, or etched with hydrofluoric acid and three kinds of commercially available silane coupling agents. The shear bond strength between the light-cured composite and the dental porcelain was measured after one-day immersion in 37 degrees C water. Samples without the silane agent application were also tested as controls. Without the silane agent, hydrofluoric acid-etched specimens had a higher bond strength than polished or phosphoric acid-etched specimens. The combination of hydrofluoric acid-etching and an application of Cosmotech Porcelain Primer increased the bond strengths more than that of phosphoric acid-etching. With the application of Laminabond Porcelain Primer or Optec Silane Coupling Agent, high bond strengths were obtained regardless of the porcelain surface condition. Therefore, it seems the chemical reactions between the porcelain surface and silane agents were responsible for the high shear bond strengths.


Corrosion testing by potentiodynamic polarization in various electrolytes. The effect of different electrolytes on the results from potentiodynamic polarization corrosion testing was studied for nine different dental alloys. In general, the difference in the results was greater between certain alloys using the same electrolyte than between the electrolytes with the same alloy. However, there were some differences between the electrolytes, most pronounced when testing dental amalgams. The electrolyte consisting of 1% NaCl seemed to offer the most corrosive environment. Darvell's and Fusayama's solutions were much less corrosive, at least for dental amalgam specimens. With regard to the ranking by corrosion sensitivity of the amalgams, only the results obtained by using Fusayama's solution were consistent with the clinical experience of the materials.


Clinical evaluation of four anterior composite resins over five years. Four hundred and thirty nine chemical-cured composite resin restorations were placed in the anterior teeth of 86 patients treated in a private dental practice. Four anterior resins were used, and placement was performed with acid etching and appropriate enamel bonding resins. Assessments were made of the handling characteristics, condition of the gingiva, surface staining, marginal staining, color deterioration, and of the longevity of the four materials. Clinical deterioration rates and failures of the different types of composites were evaluated over periods of up to five years. Although all the assessed clinical factors deteriorated with time, there were very few unsatisfactory rating scores. Most of the composite restorations performed well over the study. Eight per cent of the restorations failed during the study. Class IV preparations showed the highest restoration failure rates.


An in vitro comparative analysis: scanning electron microscopy of dentin/restoration interfaces. One hundred maxillary premolar teeth were randomly allocated to ten groups. Each group was restored with one of ten different restorative techniques. The teeth were stored in deionized water for 7d prior to longitudinal sectioning in a mesio-distal plane. Following sectioning, ten specimens from each group were chosen at random from the 20 available sections. The sectioned surfaces were polished using 600-grit SiC abrasive paper and etched for 10 s with 50% phosphoric acid to remove the smear layer produced by sectioning. Five tooth sections from the dentin bonding resin groups were allowed to dry at 20 degrees C for 24h. The glass ionomer-based groups were reimmersed in deionized water during this period. The remaining five sections from each group were replicated using an addition-cure vinyl polysiloxane impression material and an epoxy resin. A comparison was made of the sections and the replicas. All tooth specimens were sputter-coated with gold for 4 min and examined using a scanning electron microscope. Replicas were gold-coated for 3 min. Different tooth/restoration interfaces, associated with different materials, were observed. A marked difference between the replicas and tooth sections was observed for glass ionomer-based restorations but not for resin-based bonding systems. Representative samples of replicas and specimens are shown, and the significance of the observed differences is discussed.


Dentin adhesion of "modified" 4-META/MMA-TBB resin: function of HEMA. This study investigated adhesion to dentin of a modified 4-META/MMA-TBB resin (4-methacryloxyethyl trimellitate anhydride in methyl methacrylate initiated by tri-n-butyl borane) which does not require PMMA powder to polymerize. Ground bovine dentin specimens were pre-treated with an aqueous solution of 10% citric acid and 3% ferric chloride (10-3). This solution removes the smear layer and demineralizes the dentin, exposing collagen. Improved bond strengths were obtained when a HEMA-primer was applied to 10-3 pre-treated dentin. SEM examination revealed the formation of a transitional zone of resin-reinforced-dentin (hybrid layer) in 10-3 pre-treated, HEMA-primed samples. The adhesive monomer impregnated exposed collagen fibrils and, upon polymerization, became entangled with them to create the hybrid layer, essential in achieving significantly high tensile bonding strengths. HEMA enhanced the penetration capability of dentinal substrates. After polymerization and formation of the hybrid layer, auto-cured acrylic resin, photo-cured composite and amalgam were all capable of adhering to the dentin. The modified 4-META/MMA-TBB resin created significant adhesive bonds to 10-3 pre-treated ground bovine dentin.


Influence of selected variables on adhesion testing. Three variables associated with adhesion testing were examined: (1) the test mode, shear and tension; (2) design of the tensile apparatus; and (3) tooth substrate, human and bovine. Findings revealed no significant differences in bond strength by one tensile test and a shear test. However, the shear test produced more true adhesive failures; thus it may be preferable to use a shear test for adhesion testing. Bond strengths with some adhesive systems differed significantly when tested by two different tensile apparatus. Design of the test apparatus appeared to affect values. Bond strength measurements obtained with human and bovine enamel were essentially comparable. Values with dentin varied. There appeared to be a trend for higher bond strength values with bovine than with human dentin.


Evaluation of methylene lactone monomers in dental resins. alpha-Methylene-gamma-butyrolactone (MBL), which can be described as the cyclic analog of methyl methacrylate, exhibits greater reactivity in free radical polymerizations than conventional methacrylate monomers. Unfilled resin formulations composed of Bis-GMA/MBL or Bis-GMA/TEGDMA/MBL were light-cured. The effect of the more reactive methylene lactone monomer on mechanical properties and the degree of conversion of the polymers was examined. The infrared absorption bands for the carbon-carbon double bonds of MBL and the methacrylate monomers are well resolved and allow the conversion of each component to be calculated individually. The incorporation of a small amount of MBL (5 w/o) to Bis-GMA significantly increased the conversion; however, additional MBL (10 to 30 w/o) did not further increase the Bis-GMA conversion level. This appears to indicate an incompatibility between MBL and the bulky Bis-GMA monomer. Addition of 10 w/o MBL to Bis-GMA/TEGDMA (7:3) resulted in a cured resin with 71% methacrylate and 75% overall conversion efficiencies compared with the 57% conversion of the control formulation. The diametral tensile and the transverse strengths were approximately 10% greater for the MBL resin compared with the Bis-GMA/TEGDMA control; however, these differences were not statistically significant. The synthesis and polymerization of several substituted methylene lactones was also studied.


A comparison of monomer conversion and inorganic filler content in visible light-cured denture resins. Visible light-cured (VLC) denture resins are relatively new products used for the reline and repair of dentures. The conversion of monomer into polymer in 3 brands of visible light-cured denture resins was investigated. The relationship of the inorganic filler content to this conversion was also studied. It was determined that these reline materials vary in monomer conversion and weight percentage of filler, and this variation is brand dependent. The monomer conversion ranged from 77% to 97%. Significant differences in these values were found when duration of light exposure was increased. In addition, resin nearest to the light source polymerized to a greater extent when compared to resin that was 1 mm deep to this surface, hence furthest from the light source. The inorganic filler content ranged from 0% to 15%. For the resin systems studied, the relationship between monomer conversion and inorganic filler loading was inversely proportional. Results indicated that monomer conversion of VLC repair resins was affected by the duration of light exposure as well as the amount of inorganic filler present in the material.


Effects of surface-active resins on dentin/composite bonds. Effective dentin bonding systems based on para-PMDM diadduct of pyromellitic dianhydride and 2-hydroxyethyl methacrylate (HEMA) have been developed (Bowen et al., 1982). Para-PMDM, a solid of limited solubility, is usually applied from an acetone solution to dentin that has been preconditioned with acid and N-phenylglycine. The feasibility of using a liquid, surface-active bonding resin to substitute for or to supplement para-PMDM was explored. Mono(2-methacryloyloxy)ethyl phthalate (MMEP), a liquid, monofunctional homolog of para-PMDM (derived from the reaction of phthalic anhydride with HEMA) was used to formulate several bonding resin systems and solutions. Dentin surfaces were pretreated according to several variations of a three-step bonding protocol involving sequential application of 6.8 w/o ferric oxalate in 2.5 w/o HNO3, N-phenylglycine in acetone, and an experimental bonding resin before placement of a chemically cured composite restorative material. Tensile bond strengths were tested after 24 h storage in distilled water at 23 degrees C. The results suggest that solutions based on MMEP and/or para-PMDM in acetone or in other monomers, especially those containing HEMA, can effectively promote bonding to dentin. A new mechanism for the observed self-polymerization of MMEP or para-PMDM with N-phenylglycine is proposed.


The Weibull distribution applied to post and core failure. In this study, data on initial failure loads of direct post and core-restored premolar teeth were analyzed using the Weibull distribution. Restorations consisted of a prefabricated titanium alloy post, and an amalgam, composite or glass cermet core buildup in human upper premolar teeth. The specimens were subjected to compressive forces until failure at angles of 10, 45 and 90 degrees to their long axis. The two- and three-parameter Weibull distributions were compared for applicability to the failure load data. For estimation of the parameters of the two-parameter distribution: sigma 0 (reference stress) and m (Weibull modulus), linear regression was used. In this distribution, it is assumed that the third parameter, sigma u (cut-off stress), equals 0. The Maximum Likelihood (MLH) method was used to estimate all three parameters. It was found that the choice of distribution has a strong influence on the estimated values and that the three-parameter distribution is best fitted for the failure loads in this study. Comparisons were made between the failure probability curves as found by MLH estimation for the different core materials and loading angles. The results indicated that the influence of loading angle on the failure mechanism was stronger than that of core material.


Non-steroidal anti-inflammatory drugs inhibit the processes of mucosal cell proliferation associated with duodenal ulcer healing. We demonstrate that, in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), there is inhibition of the proliferation of mucosal cells that normally leads to healing of duodenal ulcers. A microdissection technique was used to quantitate mitosis in duodenal crypts at the ulcer edge, giving a regeneration index of mitotic rate at that site, as compared to nearby mucosa. In patients with duodenal ulcers occurring in the absence of NSAID therapy, there was a brisk regenerative response (median index 2.48, range 1.55-9.81, n = 8), significantly greater than in patients taking NSAIDs (median index 1.10, range 0.73-2.16, n = 10, p = 0.014). Inhibition of the process of epithelial cell division normally involved in duodenal ulcer healing could contribute to the delay in ulcer healing which may explain the higher complication rate for duodenal ulcer during NSAID therapy.


Antimicrobial therapy of bacterial diarrhea in adult residents of Mexico--lack of an effect. Two clinical trials in adults in Mexico are reported. In the first trial, long-term residents of Mexico with acute fecal leukocyte-positive diarrhea were randomized to receive trimethoprim/sulfamethoxazole (TMP/SMX), clioquinol or a placebo. Neither antimicrobial shortened the illness for all cases or for those with shigellosis or enterotoxigenic Escherichia coli diarrhea. In a second study, US and Mexican students received enoxacin, TMP/SMX or a placebo on a blind random basis. While the placebo-treated subjects with bacterial diarrhea tended to be more ill after treatment than other groups, no statistical differences were seen in treatment groups. These studies cast doubts on the value of antimicrobial drugs for 'invasive' and other forms of bacterial diarrhea in adults living in endemic areas and indicate the importance of a placebo control group when conducting clinical trials in these populations.


Use of an ammonia electrode for rapid quantification of Helicobacter pylori urease: its use in the endoscopy room and in the assessment of urease inhibition by bismuth subsalicylate. The use of an ammonia electrode to quantify ammonia liberated by urease from Helicobacter pylori was assessed in an in vitro study. It was found to be highly sensitive (down to 0.7 ppm NH3) and highly reproducible (coefficient of variation 6.0%). Inhibition of urease by bismuth subsalicylate was evaluated as urease testing is often used to assess clearance of H. pylori in patients treated with bismuth. Concentrations of bismuth subsalicylate up to 5 mg/ml had no inhibitory effect but bismuth subsalicylate at 50 mg/ml resulted in 21% inhibition of the urease activity of an ultrasonicated H. pylori suspension. As a preliminary study, the ammonia electrode was assessed in the endoscopy room in comparison with conventional techniques for H. pylori diagnosis. Antral biopsies from 39 patients attending for routine diagnostic endoscopy were subjected to culture, histology, detection of urease activity with a commercially available slide test (CLO) and with the ammonia electrode to detect ammonia liberated from samples placed in urea solution. 21 patients were positive after 1 h with the ammonia electrode, compared to only 17 with the commercially available slide test. 20 were positive on histology and 19 by culture. All samples positive with the ammonia electrode were either positive by culture or by histology. The ammonia electrode offers a quick, sensitive, quantitative and cheap method for the detection and quantification of H. pylori.


Effect of serotonin on the immunoreactive thyrotropin-releasing hormone concentrations of the rat stomach. The effects of serotonin and its related compounds on immunoreactive thyrotropin-releasing hormone (ir-TRH) concentrations of the rat stomach wall and gastric juice were studied. Either serotonin, cyproheptadine or GR38032F was injected intraperitoneally, and the rats were decapitated at various times after the injection. ir-TRH concentrations of the stomach wall and gastric juice were measured by radioimmunoassay, and gastric serotonin concentrations were measured by HPLC. ir-TRH concentrations of the stomach wall decreased, and ir-TRH concentrations of gastric juice increased significantly after serotonin injection. On the other hand, both cyproheptadine and GR38032F did not affect ir-TRH concentrations of the stomach. The effects of serotonin on ir-TRH concentrations of the stomach were significantly blocked by the pretreatment of cyproheptadine and GR38032F. The reciprocal changes of gastric ir-TRH and serotonin concentrations were observed without changes in gastric juice pH. These findings suggest that serotonin stimulates ir-TRH release from the stomach wall into gastric juice, and the effects of serotonin on ir-TRH release may be partly mediated via 5-HT2- and 5-HT3-receptors.


A clinical and laboratory evaluation of the behavior of tissue polypeptide antigen in liver cirrhosis. Serum tissue polypeptide antigen (TPA) was determined in 86 cirrhotic patients who underwent a thorough clinical and laboratory evaluation. Increased serum TPA levels were found in 87.2% of the patients (81% of Child's A, 81.3% of Child's B and 97% of Child's C) with very high levels in some cases. There were significant correlations between TPA and several clinical and biochemical tests, especially AST (r = 0.678, p < 0.000001), and this enzyme was the best predictor of TPA levels. Patients with abnormal AST had also significantly higher serum levels of TPA than those with normal AST in each of the Child's class (p < 0.01 for each). TPA values were found to be more frequently abnormal than AST ones in cirrhotics (p = 0.009) and could be used as indirect markers of activity in these patients. The underlying mechanism involved in the increase in TPA in cirrhosis was probably related to the cytolytic/regenerative activity of the liver. TPA cannot be used as a tumor marker in these patients.


Comparison of once-daily intravenous and oral omeprazole on pentagastrin-stimulated acid secretion in duodenal ulcer patients. The effect of 5 days of once-daily dosing with 20 mg p.o. and 40 mg i.v. omeprazole on pentagastrin-stimulated acid secretion was studied in 8 patients with duodenal ulcer. In addition they also received a 10-mg i.v. dose on day 6 during the oral treatment period. The antisecretory effect was measured 6-7 h after dose at a time point when maximal inhibition during the dosing interval is anticipated. The median percent inhibition of peak acid output (PAO) markedly increased from 43% on day 1 to 100% on day 5 during treatment with 20 mg p.o. The first 40-mg i.v. dose produced a median inhibition of 98% of PAO already on day 1. After 5 days of dosing, the inhibition had increased to 100%. On the other hand, a 10-mg i.v. dose could essentially maintain the degree of PAO reduction reached after 5 days of oral treatment. Plasma omeprazole concentrations increased during repeated dosing both with 20 mg p.o. and 40 mg i.v.


Role of endogenously released cholecystokinin in determining postprandial insulin levels in man: effects of loxiglumide, a specific cholecystokinin receptor antagonist. To estimate the contribution of postprandial cholecystokinin (CCK) responses to circulating insulin concentrations and insulin secretion, a specific CCK receptor antagonist (loxiglumide; 10 mg/kg body weight/h) or saline were infused intravenously in normal volunteers, beginning 90 min before insulin secretion was stimulated on separate occasions by the intraduodenal administrations of glucose, glucose and protein, and glucose plus protein with the admixture of pancreatin. The release of CCK (radioimmunoassay) was stimulated by the protein component of the nutrients from basal 2.4 +/- 0.4 to 8.0 +/- 1.2 pmol/l. CCK plasma levels were significantly higher with loxiglumide (p < 0.05). Glucose-dependent insulinotropic polypeptide (GIP) was also released by all nutrient mixtures. Loxiglumide significantly inhibited the amount of bilirubin and pancreatic enzymes recovered from duodenal aspirates. In contrast, in none of the experiments, C-peptide increments and hence insulin secretion rates were altered by loxiglumide. With glucose and protein as intraduodenal stimulus (no pancreatin added), the plasma amino acids rose significantly less (by approximately 50% of the control experiment) and the increment in insulin (but not C-peptide) concentrations was significantly reduced by loxiglumide. This is most likely explained by a change in insulin metabolic clearance. This effect cannot be a primary action of CCK because there was no similar effect of loxiglumide with the same intraduodenal stimulus plus added pancreatin. Pancreatic enzymes reduced maldigestion secondary to loxiglumide effects on pancreatic exocrine secretion: The increment in circulating amino acid concentrations was similar with and without loxiglumide. In conclusion, CCK does not alter insulin secretion and, therefore, is not an incretin hormone in man. Blocking CCK actions on the exocrine pancreas by loxiglumide, however, can secondarily cause reductions in postprandial insulin profiles by altering insulin clearance. These changes are possibly related to reductions in circulating amino acid concentrations.


[Risks of contraception and pregnancy in patients with congenital cardiopathies. Retrospective study on 108 patients]. 108 women with congenital heart disease in child-bearing age (16-38 years, mean age 28) were followed up for a period of ten years. Possible complications of contraceptive methods, and incidence of full-term pregnancies, spontaneous abortions and cardiovascular complications during pregnancy and delivery, were considered. Half of these patients had a cyanotic congenital heart disease, 23 had left-to-right shunt mainly at atrial level, 18 had right and 14 left ventricular outflow tract obstruction. 60 women had previous surgical procedures for their congenital heart disease. 83% of the patients were in NYHA functional class I-II. No complications were found during oral contraceptive regimen during intrauterine device insertion with antibiotic prophylaxis, except for the development of pulmonary hypertension in one patient with an atrial septal defect. 146 pregnancies occurred, but only 89 were full-term. There was a high number of interrupted pregnancies, rarely for medical reasons. The incidence of spontaneous abortion was similar to that of normal population (18% versus 10-15%). Maternal cardiovascular complications were found in the 22% of the full-term pregnancies, but were well controlled by medical treatment. In conclusion, good family planning and pregnancies are possible in most young females with congenital heart disease. In the absence of cyanosis and pulmonary hypertension, oral contraception does not carry any particular risk. With appropriate medical care intrauterine devices may be an alternative in high risk patients. In the presence of a good cardiac function, a normal full-term pregnancy with an healty baby is the rule. A cesarean section is seldom needed.


[Ventricular stimulation triggered by esophageal atriogram: a new technique of temporary physiologic stimulation in the course of acute myocardial infarct complicated by atrioventricular block and low cardiac output]. Advanced atrio-ventricular (AV) block during acute myocardial infarction (AMI) is considered a complicating dysrhythmia as the well as mechanism responsible for occurrence of life-threatening hemodynamic changes. Often, simple VVI pacing can result insufficient in improving the decreased cardiac output. VDD pacing, which preserves atrial contribution, should represent the most effective electrical approach; therefore, it requires intracavitary placement of 2 catheters. In 10 pts (6M, 4F, mean age of 63.8 +/- 6.6 years) with advanced AV block due to AMI (4 inferior, 6 anterior) and without sinus node dysfunction, we performed stable VDD stimulation (mean 16.6 +/- 20.6 hours) using only one catheter positioned in the right ventricle while the atrial impulse, filtered (50-70 Hz) and amplified through a special device, was derived from the esophagus. Such technique is rapid and reliable, avoiding problems associated with atrial sensing and catheterization.


[Diltiazem in paroxysmal supraventricular tachycardia: electrocardiographic findings at termination]. The effects of diltiazem hydrochloride (0.3 mg/kg i.v. over 2 min.) was studied by continuous electrocardiographic monitoring in 60 patients. Conversion to sinus rhythm was achieved in 55 patients (91%). Electrocardiographic findings were: undisturbed sinus rhythm in 20 patients; A-V junctional rhythm in 4 patients; complex ventricular arrhythmias (ventricular tachycardia or complex VPCs) in 19 patients. Patients with complex ventricular arrhythmias were matched against patients with normal sinus rhythm, with respect to the following parameters: age, sex, heart disease, tachycardia duration, tachycardia cycle length, sinus cycle length, pre- and post-infusion blood pressure. No differences between the two groups of patients were found. Ventricular arrhythmias occurring at the termination of supraventricular tachycardia are difficult to explain. Nevertheless, these arrhythmias are not associated with organic heart disease. They could be the expression of triggered activity.


[Relationship of Doppler indexes of left ventricular filling and exertion tolerance]. The aim of this study was to evaluate if Doppler indexes of left ventricular filling are related to exercise capacity. Since a correlation between left ventricular filling pattern and causal blood pressure has been recently reported along a wide range of pressure values, a group of subjects with blood pressure ranging from normal to severely elevated values was studied. Twenty-four subjects (11 normotensives, 13 mild to severe hypertensive patients) underwent an echo-Doppler study and a maximal multistage cycloergometric exercise test. Since the cycloergometric test was limited by fatigue or dyspnea in all subjects, exercise duration was used as an effort tolerance index. Echocardiographic indexes of systolic function resulted normal in all subjects. Significant relationships with exercise duration were found for several indexes of left ventricular filling (A peak: r = -.743, p < .0001; A/E ratio: r = -.606, p < .005; early filling fraction: r = .639, p < .001). Exercise time was also significantly related to casual blood pressure, both systolic and diastolic. The relationships between transmitral blood flow and exercise capacity seem to indicate that an impairment of ventricular relaxation (as indicated by the progressive increase of atrial contribution) is associated with a decreased exercise tolerance, possibly because a progressively lower activation of Frank-Starling mechanism. Diastolic function thus seems to be able to affect exercise tolerance even in subjects with normal systolic function and blood pressure ranging from normal to severely elevated values.


[Reconstructive surgery of pure mitral insufficiency. Operative results and follow-up in 128 patients]. Short and long-term results of valve repair for pure mitral insufficiency are reported in 128 consecutive patients with a mean age of 49 years (range 4-75). The etiology of the mitral valve dysfunction was degenerative in 54% of the cases, rheumatic in 30%, ischemic in 9.5%, endocarditic in 6.5%. Preoperatively, 91% of the patients were in NYHA class II or III. The anatomic lesions and the mechanism of mitral regurgitation were identified preoperatively by transthoracic and/or transesophageal echocardiography. Cardiac catheterization was performed only in patients with multiple valvular dysfunction and/or with evidence of concomitant coronary artery disease. Mitral repair was performed according to the techniques proposed by Carpentier. Only one patient died in the hospital (operative mortality: 0.8%). By actuarial methods, 96% of the patients were alive 4 years postoperatively, and 84% were reoperation free. Freedom from reoperation was significantly higher in patients who received a prosthetic ring than in those who had other types of anuloplasty (96% vs 67%; p < 0.05). During the follow-up period no patient had thromboembolic episodes. Ninety-seven per cent of the 112 patients who survived the operation and were not reoperated were in NYHA class I or II. These results confirm the validity of reconstructive surgery in pure mitral insufficiency. The use of a prosthetic ring gives stability to the repair and improves long-term results.


[Surgical pathology of the aortic valve: a morphologic study on 912 surgically excised valves]. A consecutive series of 912 surgically excised aortic valves was evaluated by means of macroscopic and histologic study. Pure aortic stenosis was diagnosed in 203 patients (p.) (22.25%), pure incompetence in 125 (13.72%) and combined dysfunction in 584 (64.03%). The diseases affecting the valves were: a) chronic rheumatic disease (593 p., 65%); b) dystrophic calcifications (214 p., 23%); c) noninflammatory aortic root disease (NIARD) and/or myxomatous infiltration of aortic cusps, floppy aortic valve (FAV) (55 p., 6%) d) infective endocarditis (50 p., 5.5%). Males outnumbered females with a ratio ranging from 2.4 (dystrophic calcific disease) to 1.6 (infective endocarditis). The mean age ranged from 37 +/- 7.5 (NIARD) to 61.2 +/- 6.3 (dystrophic calcific disease). Chronic rheumatic disease was the most frequent cause of stenoincompetence (542 p., 91.4%) while isolated stenosis was prevalently due to dystrophic calcification (172 p., 80.4%). The diseases causing isolated aortic incompetence were (in order of frequency): a) NIARD and/or FAV (55 p., 44%); b) infective endocarditis (50 p., 40%); and c) rheumatic disease (30 p., 16%). The 55 patients with NIARD and or FAV were divided into 3 groups: a) 23 p. with aortic root dilatation and normal cusps; b) 20 p. with aortic root dilatation and FAV; c) 12 p. with FAV but undilated aortic root. Aortic regurgitation was caused by cusp derangement in rheumatic disease (shortening, retraction) and infective endocarditis (perforations, erosions). Cusps diastasis and prolapse were the cause of regurgitation in aortic root dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)


[Follow-up of patients undergoing surgery for aortic dissection: evaluation with transesophageal echocardiography]. Transesophageal echocardiography (TEE) is a useful means in the diagnosis of acute aortic dissection (AD), owing to its very high sensibility and specificity. In this study, TEE was performed to assess post-surgical evolution. Between 1982 and 1991, 119 pts. were operated on in our institution for AD (De Bakey I and II type): 87 pts. underwent replacement of the ascending aorta with a composite tubular graft bearing a mechanical valve; 26 had a simple tubular graft and 6 had aortic reconstruction. Sixty-eight of 72 discharged pts. were followed for up to 9.5 years (mean 4.5 +/- 2.6). Nine years after surgery actuarial survival of discharged pts. was 75%. Seven pts. died after a mean period of 3.4 years from surgery: only one died from postoperative complication (dehiscence of proximal anastomosis), none for aortic rupture distal to the graft. TEE was performed in 32 of these pts. and in other two operated on elsewhere, after 4.4 +/- 2.7 years from surgery; before the operation, type I AD was diagnosed in 23 pts. and type II in 11 pts. In 10/11 pts. with type II AD the aortic arch and the descending aorta looked normal; in one patient a localized intimal flap was found up to the arch. The descending aorta diameter was somewhat higher than in normal subjects (25.2 +/- 2.8 vs 21.9 +/- 3.7 mm), but in only one case was it beyond 2DS (32 mm). In all type I pts. an intimal flap persisted distal to the graft, along the whole thoracic aorta. Within the false lumen a flow was detected by color-Doppler in 14/23 pts. (61%), and spontaneous echo-contrast was noted in 14 pts. (61%). A thrombus was observed in 7 pts. (30%) and it was generally localized; in only one case it was extensive with total obliteration of the false lumen. In 16 pts. (70%) communications between the two lumina were found. The descending aorta diameter ranged from 25 to 53 mm, and mean value was higher than in normal subjects (34.2 +/- 6.2 vs 21.9 +/- 3.7 mm). In most pts. with type II AD, surgery can be a definitive treatment, as the remaining aorta keeps to normal size and appearance. In type I AD, operation is only palliative, as the dissection persists: the false lumen is often perfused through one or more communications with the true lumen and seldom its obliteration is noted. The persistence of dissection does not necessarily seem to be an ominous finding, as the survival of the study population was high and no patient died from aortic rupture. Nevertheless, long-term prognosis can be affected by aorta dilation that often (but not always) follows the persistence of wall dissection. For its high reliability, easy feasibility and low cost TEE is a very useful method for following up patients operated on for AD and for detecting those who are at higher risk of aortic rupture because of lumen dilation.


[Clinical significance of blood pressure response to posture]. To assess the clinical significance of the blood pressure reaction to orthostatic posture, 55 normotensives and 369 subjects with different degrees of hypertension were studied with non-invasive 24-hour blood pressure monitoring. During the recordings blood pressure response to standing was evaluated at 8 a.m., and at 2, 4 and 7 p.m. All subjects were attributed a target organ damage score on the basis of ECG, chest x-ray and fundoscopic findings. To assess whether the orthostatic reaction may represent a marker for the severity of hypertension, subjects were divided into 4 classes of increasing blood pressure levels, and each class was further subdivided into two groups of subjects with orthostatic reaction above and below the mean value. On average, blood pressure rose by 2.7 +/- 9/7.2 +/- 7 mmHg while standing up, an increase which was inversely correlated to that of heart rate (p < 0.05). The orthostatic response was substantially constant throughout daytime hours. The systolic orthostatic change from lying to standing was directly correlated with age (p < 0.02) and average daytime blood pressure (p < 0.01), and inversely correlated with lying blood pressure immediately before standing up (p < 0.001). Both systolic (p < 0.05) and diastolic (p < 0.01) pressure responses to standing were related to the day-night blood pressure difference and to the standard deviation from mean daytime blood pressure. The degree of target organ damage was not significantly greater in the 4 groups of subjects with high orthostatic response compared to those with low response. The present results show that the pressure reaction to orthostatic stress is constant throughout daytime, even though a large intraindividual variability in the extent of the response is present. Orthostatic pressure change seems to be an important determinant of diurnal pressure rhythm, while it is not a marker for the severity of hypertension.


[Validity of the proximal isovelocity surface area color Doppler method for calculating the valve area in patients with mitral stenosis; comparison with the two-dimensional echocardiographic method]. The proximal isovelocity surface area (PISA) method, assessed by color Doppler echocardiography, has gained acceptance as a means of calculating flow rate through regurgitant orifice. The method can also be used to derive mitral valve area (MVA), by continuity equation, in patients with mitral stenosis (MS). The aim of this study was to compare the PISA method with the two-dimensional echocardiographic planimetry (2D) method and pressure half-time method (PHT) in MVA calculations in a group of 37 patients with MS. All of these patients had satisfactory MVA by 2D method. There were 22 female and 15 male; age 56 +/- 11 years (range 32-71); 19 were in sinus rhythm (SR) and 18 in atrial fibrillation (AF); 17 patients had pure MS, while the remaining 20 had associated mitral regurgitation (MR); in 23 patients the orifice morphology was circular or elliptic, and was defined as regular; while in 14 patients the morphology was irregular for the presence of two or more nodular calcifications on the commissures or leaflet's edges. MVA by PISA method was calculated assuming a uniform radial flow convergence region along a hemispherical surface, according to the formula: MVA = 2 pi r2 Vn(1-cos theta)/Vmax; where r was the PISA radius measured in 2D from the first alias to the mitral leaflet's edge; Vn was the flow velocity at radial distance from the mitral orifice; Vmax was the peak transmitral velocity by CW Doppler; 1-cos theta was a factor that accounted for the inflow angle formed by the mitral leaflets. The Nyquist limit was lowered to 29 cm/sec. Alpha angle formed by the mitral leaflets ranged between 86 degrees and 134 degrees; average 110 degrees +/- 10 degrees. 2D MVA was 1.33 +/- 0.37 cm2; range 0.69-2.2 cm2; PHT MVA was 1.29 +/- 0.34 cm2; range 0.70-2.1 cm2; PISA MVA was 1.18 +/- 0.36 cm2; range 0.47-1.95 cm2. The PISA method underestimates MVA by 0.15 +/- 0.21 cm2, in comparison with the 2D method; and by 0.11 +/- 0.18 cm2 in comparison with PHT method (p ns). The correlation between 2D and PISA MVA was: r = 0.84; p < 0.001; y = 0.83x + 0.06; 95% confidence intervals +/- 0.40 cm2; and between PHT and PISA MVA was: r = 0.79; y = 0.84x + 0.09; p < 0.001; 95% confidence intervals +/- 0.46 cm2. The correlation coefficient was similarly good in patients with SR or AF, and did not significantly change in patients with pure MS or MS+MR; neither did it vary with respect to the orifice morphology (p < 0.001 for all the variables considered), except for the correlation PHT-PISA in the group of patients with irregular orifice morphology (r = 0.70; p = 0.005). The interobserver and intraobserver variability were, respectively: 2.2% and 4.4% for 2D MVA; 3.4% and 3.8% for PHT MVA; 5.2% and 3.5% for the PISA radius; 6.1% and 4.4% for the alpha angle; 10.2% and 7.2% for PISA MVA (F ratio of variances ns). In conclusion, the PISA method allows accurate assessment of MVA in patients with MS, regardless of cardiac rhythm or additional MR. Moreover, our study suggests that orifice morphology does not affect the accuracy of this method.


[Involvement of the heart valves and great vessels in homozygote familial hypercholesterolemia]. Homozygous familial hypercholesterolaemia is characterized by cutaneous xanthoma development from infancy, precocious and accelerated atherosclerosis with clinical signs of ischemic heart disease and frequent involvement of left heart valves resulting in stenosis and/or incompetence. Two cases are described of this condition, both associated with aortic stenosis. In one case mitral incompetence and thromboembolic pulmonary hypertension were also found. The mitral valve is involved in the atherosclerotic process at the level of the cusps. These become thickened and stiff. Aortic stenosis is mainly due to atheromas infiltrating the Valsalva sinuses and the ascending aorta. Pulmonary hypertension, never reported before in this disease, is probably due to concomitant atheromatosis involving the pulmonary artery with secondary fatty embolism.


[Age-induced changes in the cardiovascular system in normal subjects]. To assess the effect of age on cardiac structure and function, we performed echocardiograms on 104 physically active, normal, community-dwelling volunteers (68 men and 36 women), ranging in age from 18 to 84 years and having no evidence of hypertension or cardiovascular disease. With advancing adult aging, the following were observed: a decrease in aortic compliance (r = 0.42); an increase in systolic (r = 0.61), diastolic (r = 0.24), pulse (r = 0.60) and mean (r = 0.48) arterial pressure; and a modest enlargement of aortic root (r = 0.47) and left atrial dimension (r = 0.30) were observed. Left ventricular end-diastolic volume (r = 0.25), wall thickness (r = 0.30) and mass (r = 0.37) also increased with aging, while left ventricular end-systolic volume was not age-related. Furthermore, a stepwise multivariate linear model identified the decrease in arterial compliance (R2 = 0.06; p < 0.02) and the increase in left ventricular stroke work (R2 = 0.38; p < 0.0001) as the only variables independently related to the increase in left ventricular mass that occurs with advancing age. Regarding left ventricular systolic function, aging was also related to an increase in left ventricular stroke work (r = 0.40) and ejection time (r = 0.44), while pump function, (measured as ejection fraction and cardiac index at rest), and contractility (measured by load independent end-systolic indexes) were unaffected by aging. Conversely, pulsed Doppler analysis of mitral inflow showed a significant age-related decline in the peak early filling velocity (r = -0.45) and in the ratio of early and late diastolic filling velocity (r = -0.66), while peak late diastolic flow velocity (r = 0.50), diastolic pressure half time (r = 0.34) and duration of isovolumic relaxation (r = 0.56) increased significantly with age.


[Prognostic value of the dipyridamole-echocardiography test immediately after a non-complicated myocardial infarct: a large scale multicenter study. Echo Persantine Italian Cooperative Study]. Any new diagnostic test should follow a pathway similar to that of a new drug, from initial studies in highly selected populations under strictly controlled conditions, up to large scale multicenter trials more likely to represent the true performance of the test in the clinical arena. To evaluate the capability of prognostic stratification of high dose (up to 0.84 mg/kg over 10') dipyridamole-echocardiography test (DET) early after an acute myocardial infarction in a "phase IV" study, based upon 11 different echocardiographic laboratories, all with established experience in stress echo and fulfilling quality control requirements for stress echo readings. Nine-hundred twenty five patients were evaluated after a mean of 10 days from an acute myocardial infarction and followed up for a mean of 14 months. During DET, one major adverse reaction occurred, consisting of a prolonged ischemia resistant to aminophylline and nitrates, and progressing to small uncomplicated reinfarction. In 11 patients the lower dipyridamole dose (0.56 mg/kg over 4') gave limiting side effects. Patients were followed up for 14 +/- 9.9 months (range = 1.53). During the follow-up, there were 34 deaths and 37 non-fatal myocardial infarctions; 104 patients developed class III or IV angina, and 149 had coronary revascularization procedures (bypass or angioplasty). Considering all spontaneous events (angina, reinfarction and death), the most important univariate predictor was the result of DET (chi-square = 45.8). With a Cox analysis, echocardiographic positivity, age and sex were found to have an independent and additive value. Considering survival (and therefore death as the only event) age was the most meaningful parameter, followed by the Wall Motion Score Index during dipyridamole (chi-square = 12.1); among other parameters, the resting Wall Motion Score Index was a significant predictor of death. By Cox analysis, age (relative risk estimate = 1.02) and Wall Motion Score Index during dipyridamole (relative risk estimate = 14) showed an independent and additional prognostic value. In particular, considering death only, the event rate was of 2% in patients with negative DET, 4% in patients with high dose positive DET and 7% in patients with low dose positive DET. Dipyridamole echocardiography is feasible and safe early after uncomplicated myocardial infarction and allows an effective risk stratification on the basis of the presence, severity, extent and timing of the induced dyssynergy. In particular, the risk of death doubles in patients with high dose positivity and almost quadruples in patients with low dose positivity.


[Long-term treatment of stable angina pectoris with gallopamil]. The effects of long-term treatment with gallopamil 50 mg t.i.d were assessed in 8 patients, 7 males and 1 female, aged 47-69 years, with stable angina pectoris, positive exercise tests, coronary artery disease and no previous myocardial infarction. Clinical and ECG parameters as well as exercise testing, 24-hour Holter and echocardiography were assessed before treatment, after 3 months, after 1 and 2 years of treatment, and following final wash-out. Comparing each treatment period to baseline, a significant decrease in resting heart rate (from 66 +/- 9 beats/min at baseline to 56 +/- 7 beats/min after 3 months [p < 0.01], 59 +/- 8 beats/min after 1 year [p < 0.05] and 58 +/- 9 beats/min after 2 years [p < 0.05]), systolic (from 162 +/- 19 mmHg at baseline to 147 +/- 12 mmHg after 3 months [p < 0.05], 146 +/- 20 mmHg after 1 year [p < 0.01] and 146 +/- 27 mmHg after 2 years [p < 0.05]), and diastolic (from 89 +/- 6 mmHg to 82 +/- 7 after 3 months [p < 0.05], 82 +/- 4 after 1 year [p < 0.05] and 83 +/- 4 after 2 years [p < 0.05]) blood pressure was observed. Exercise time significantly improved (from 596 +/- 209 seconds to 802 +/- 66 seconds after 3 months [p < 0.01], 710 +/- 167 seconds after 1 year [p < 0.05] and 723 +/- 125 seconds after 2 year [p < 0.05]), while heart rate and rate-pressure product at peak exercise did not change. The number of ischemic episodes and the total ischemic time per 24 hours significantly decreased (from 35 +/- 15 min to 12 +/- 10 min after 3 months [p < 0.05], 10 +/- 8 min after 1 year [p < 0.05] and 11 +/- 9 min after 2 years [p < 0.05]). Ejection fraction increased (from 66 +/- 10% to 77 +/- 7% after 3 months [p < 0.01], 80 +/- 5% after 1 year [p < 0.01] and 80 +/- 3% after 2 years [p < 0.01]), while contractility, as expressed by the end-systolic stress/end systolic volume ratio remained unchanged. No serious side-effects or biochemical abnormalities developed. Gallopamil appears to be safe, well tolerated and effective in the long term control of angina pectoris; its effects are fully developed at 3 months and persist unchanged after 2 years. For its hypotensive action and the lack of significant effects on myocardial contractility, gallopamil appears to be potentially useful in patients with associated angina and hypertension and in patients with impaired left ventricular function.


[Lipid parameters and cardiovascular risks in elderly patients hospitalized for ischemic cardiopathy. A case-control study]. In order to evaluate whether and to what extent elevated blood lipid concentrations and clinical expressions of coronary heart disease (CHD) are associated in the elderly, we studied the risk of CHD (myocardial infarction and angina pectoris) in a population of elderly hospitalized patients (210 subjects, 126 men and 84 women, average age 76 +/- 6 years) exposed to risk factors. 210 patients, free from current and previous cardiovascular diseases, age and sex matched, were recruited as the control group. Advanced senile decline, severe hepatic or renal failure and malignancies were considered exclusion criteria for both groups. The following dichotomic variables (familial history of CHD, cigarette smoking, clinical history of arterial hypertension or diabetes mellitus, hypercholesterolemia, hypertriglyceridemia) and continuous variables (total, LDL and HDL cholesterol, triglycerides, total/HDL cholesterol ratio, body mass index (BMI), years of exposure to risk factors) were considered. Using a stepwise multiple logistic regression forward method, the following variables resulted significantly associated with the risk of CHD: total/HDL cholesterol ratio (OR 1,89), BMI (OR 1,04), period of hypertension (OR 1,04) and cigarette smoke exposure (OR 1,007). We conclude that in the elderly the total/HDL cholesterol ratio can be a more predictive and reliable index of coronary risk than blood total cholesterol concentration.


[Management and prognosis of acute myocardial infarct in advanced age: comparison of the cardiac intensive care unit and the cardiology ward]. The aim of this prospective study was to assess the prognostic and most suitable management of AMI in elderly patients (age > or = 75 years). From September 1988 to August 1991, 129 such patients (pts) were evaluated: 35 (27%) were admitted to CCU because of arrhythmias or severe hemodynamic complications; 94 (73%) were addressed, according to bed availability, to CCU (55 pts) or Cardiology Ward (39 pts), where all patients underwent continuous ECG monitoring for at least 72 hours. Age, gender, history of previous angina or myocardial infarction, presence of chest pain or ECG ischemia on admission, site and extent of AMI, delay on admission, CPK-MB peak, recurrent angina, arrhythmias, heart failure, emotional disorders, hospital mortality and length of hospital stay were compared. Our results show that elderly patients who suffered from complicated AMI were at high risk for death and severe in-hospital complications. No significant prognostic differences were observed between the two groups with uncomplicated AMI. Thus hospitalization in the Cardiology Ward seems to be valuable, safe and well tolerated in our population of elderly patients with AMI, and without initial complications.


[Clinical and prognostic significance of echocardiographic parameters in dilated cardiomyopathy: a prospective study on 225 patients. The Italian Multicenter Study of Cardiomyopathies Group]. To assess the prognostic role of echocardiographic indexes and their relation to clinical conditions, 225 patients with dilated cardiomyopathy were studied prospectively. All cases had a normal coronary angiogram and non specific endomyocardial biopsy findings. 163 men (72.4%) and 62 women (27.6%), mean age 41.5 +/- 12.3 (range 8-61), were studied. Clinical, electrocardiographic and echocardiographic parameters, normalized for body surface area, were tested according to NYHA class and presence of segmental or diffuse wall motion abnormalities. One hundred-four patients were in NYHA class I-IIa, 94 were in class IIb-III and 27 were in class IV. Left ventricular end systolic diameter index, right ventricular end diastolic diameter index, left atrial diameter index, left ventricular fractional shortening and ejection fraction, and radius to wall thickness ratio were significantly more impaired in patients with more severe symptoms. Twenty-eight patients (13%) showed segmental wall motion abnormalities and had smaller left ventricular end systolic and left atrial diameter index and higher left ventricular fractional shortening and ejection fraction. During a mean follow up of 23 +/- 15 months (range 1-67 months), 25 patients (11.1%) died from cardiac causes and 16 (7.1%) underwent heart transplant because of refractory heart failure. Prognostic evaluation was performed separately for cardiovascular mortality alone and for cardiac events (cardiovascular mortality and heart transplantation). At Cox multivariate analysis only right ventricular end diastolic diameter index (p < 0.005) predicted cardiovascular mortality, while left atrial diameter index (p < 0.001), right ventricular end diastolic diameter index (p < 0.01) and left ventricular ejection fraction (p < 0.05) were significant independent predictors of cardiac events.


[Primary cardiac rhabdomyosarcoma involving the mitral valve]. Primary cardiac rhabdomyosarcoma is rare and its extension to the mitral valve even rarer. We report a case of left atrial rhabdomyosarcoma involving the mitral valve. The patient was a 62-year-old man who complained of recurrent pre-syncopal episodes, dyspnoea often sudden in onset, asthenia and major weight loss (10 kg in one month). 2-D echocardiography revealed a 4.9 cm2 wide mass attached to the atrial side of the anterior mitral leaflet and to the adjacent inferior interatrial septum, where it seemed to have origin. CT scan and scintigraphy revealed bone, kidney and spleen metastases. The patient underwent emergency cardiac surgery because of increasing pre-syncopal and dyspnoeic episodes due to obstruction by the intracardiac mass. At surgery a tumor was found infiltrating the left atrial wall, the interatrial septum, the mitral anulus and the anterior mitral leaflet up to its tip. Invasion of mitral anulus did not allow mitral valve replacement, so that an excision of the intracardiac mass was performed as extensively as possible. Histology revealed a rhabdomyosarcoma. A post-operative chemotherapy cycle had to be stopped due to onset of atrial fibrillation and dyspnoea. 2-D echo monitoring revealed rapid new growth of the tumor across the basal portion of mitral valve leaflet to the atrioventricular orifice. After several episodes of increasing dyspnoea, the patient had a pulmonary oedema and died.


Calcium-binding proteins: basic concepts and clinical implications. Calcium ions exert their effects in part via interactions with a wide variety of intracellular calcium-binding proteins. One class of these proteins shares a common calcium-binding motif, the EF-hand. A consensus amino acid sequence for this motif has aided the identification of new members of this family of EF-hand proteins, which now has over 200 members. A few of these proteins are present in all cells, whereas the vast majority are expressed in a tissue-specific fashion. The physiological function of a few of these proteins is known to be achieved via a calcium-dependent interaction with other proteins, thereby regulating their activity. Some members, like parvalbumin, calbindin, and calretinin, proved to be useful neuronal markers for a variety of functional brain systems and their circuitries. Their major role is assumed to be buffering, transport of Ca2+, and regulation of various enzyme systems. Since cellular degeneration is accompanied by impaired Ca2+ homeostasis, a protective role for Ca(2+)-binding proteins in certain neuron populations has been postulated. Another protein family are the annexins, members of which interact with phospholipids and cellular membranes in a calcium-dependent manner. In some cases members of the annexin family were even found to interact with EF-hand proteins. Certain annexins have been suggested to be involved in anti-inflammatory response, inhibition of blood coagulation, membrane trafficking or cytoskeletal organization, but several of these functions have been questioned recently. The elucidation of the interactions and functions of the majority of these proteins remains a challenging task for the coming years.


Distribution of calcium during contraction and relaxation of crayfish skeletal muscle fibre. A model of activation of muscle contraction has been applied to the crayfish isolated skeletal muscle fibre. The model is based on calcium diffusion and binding to specific regulatory sites in a sarcomere. Calcium ions activate interactions of contractile proteins and thus the generation of force. The model quantifies the relation between calcium released from intracellular stores and force elicited. Experimental tension records from isolated crayfish skeletal muscle fibres under voltage clamp conditions are analyzed. Model parameters were determined either via approximation of the onset of tension by the model solution or from the model based relations between the tension maximum, and depolarizing pulse length and amplitude. This allowed to determine time changes of free and bound calcium distribution in the sarcomere and the calcium release from terminal cisternae. The steady state calcium concentration at terminal cisternae showed S-shaped voltage dependence with saturation below approx. 10 mumol/l at positive membrane potentials.


Comparison of 9-aminoacridine and atebrine induced changes in optical, electrical and mechanical characteristics of lipid bilayers. The effects of fluorescent probes 9-aminoacridine (9AA) and atebrine (AT) on physical properties of liposomes and planar bilayer lipid membranes (BLM) were studied. The method of fluorescence spectroscopy and the electrostriction method based on measurement of higher current harmonics were used. At low concentrations (10(-5)-5 x 10(-5) mol/l), 9AA increased fluorescence intensity, while in liposomes from soybean phosphatidylcholine fluorescence quenching occurred at higher probe concentration. Fluorescence quenching occurred over the entire concentration range tested (10(-5)-10(-4) mol/l) in liposomes made from a mixture of egg phosphatidylcholine and cardiolipin. In contrast to 9AA, AT, thanks to its hydrophobic chain, penetrates deeper into the hydrophobic membrane moiety; thus, immobilization of the molecule and an increase in fluorescence intensity was always observed. Probes adsorbed to membranes, leaving their electric capacitance effectively unchanged. Adsorption of charged dye particles induced small changes in transmembrane potential. In the presence of 10(-5) mol/l AT, the modulus of elasticity E perpendicular increased somewhat for soft membranes (E perpendicular approximately 2.5 x 10(7) Pa), whereas it decreased for hard membranes (E perpendicular approximately 5 x 10(7) Pa). pH gradient present on the membrane affected the ability of the dyes to incorporate into the membranes. Our results provide evidence against the proposed model of the quenching mechanism introduced by Rottenberg and Lee (1975).


Model of distribution of anticancer agents transplanted into the brain tissue using the random walk method. A Monte-Carlo approach to analysis of dispersion in the tissue of a locally administered drug is presented. The distribution of a drug in the tissue is simulated as a distribution of randomly walking particles. The approach is demonstrated on a simple situation for which both experimental results and an analytical solution are known. The approach can be used in situations, where common numeric methods are difficult to use, especially for analyses of drug transport in an inhomogeneous space, and problems with complex boundary conditions, e.g. in analyses of dispersion of anticancer agents locally applied into tumours.


The graviosmotic hypothesis of xylem transport of water in plants. This paper presents a full version of the graviosmotic hypothesis postulated earlier in outline (Kargol 1978), which concerns xylem rise of water in plants. According to this hypothesis water is transported by xylem vessels (at respective development stages of these vessels) using the graviosmotic mechanisms. A detailed description of hypothesis is introduced by a discussion of the development stages of xylem vessels and a presentation of graviosmotic mechanisms postulated to be involved. These mechanisms include: convective graviosmosis and related effects, gravidiffusional graviosmosis, and osmotic transport aided by gravitational force in multi-membrane systems. The presented hypothesis does not contradict the theory of transpiration-cohesion or that of root pressure; rather, it is complementary to them.


Comparison of cytochrome P-450- and peroxidase-mediated activations of carcinogenic azo dyes and N-nitrosamines. Carcinogenic azo dyes (dimethylaminoazobenzene, Sudan I) and N-nitrosamines (N-nitrosomethylaniline, N-nitrosomethylbenzylamine) are oxidized by cytochrome P-450 isoenzymes and peroxidase yielding metabolites which in vitro bind to DNA and transfer RNA (tRNA). The parallelism and differences in oxidative reactions are described. Peroxidase is more effective than P-450 in activating reactions of some carcinogens studied. The presence of either of these enzymes is supposed to be responsible for the organ and/or cell type specific effects of the carcinogens studied.


Critical cell volume and shape of bovine erythrocytes. The relationship between erythrocyte shape and the critical cell volume was investigated. Agents able to increase the critical cell volume induced three main stable shapes of erythrocytes: discocytic, stomatocytic, and echinocytic. The absence of correlation between shape and critical cell volume under isoosmotic conditions suggests that relative differences between the surface areas of the inner and the outer leaflet of the cell membrane do not influence the critical volume of a cell.


A scanning electron microscope study of Toxocara genettae Warren, 1972 (Ascaridae), with data on morphometric variation. We have carried out a morphometric study of the ascaridoid nematode Toxocara genettae, parasite of the small intestine of the genet Genetta genetta, with the aid of scanning electron microscopy (SEM). Host specimens were trapped in Galicia, NW Spain. The most characteristic features of this nematode are the absence of cervical alae, replaced by narrow lateral crests running along the length of the body and the presence of a mucron at the end of the male tail. Other features of interest include the number of labial denticles (90-98 and 96-102 on the dorsal lip, 82-96 and 90-96 on the subventral lip of male and female, respectively), the width of the transverse striations (25-28 microns) and, in many of the specimens examined, the position of the precloacal median papilla at the base of a well-defined cuticular pit.


Immunization of rabbits with antigens from Psoroptes cuniculi, the rabbit scab mite. Rabbits immunized with the whole body extract of Psoroptes cuniculi (Delafond, 1859) developed partial immunity to the infestation with this mite. These rabbits manifested P. cuniculi antigen-induced cell response and a high level of specific serum antibody after the immunization. Electrophoretic separation of the mite extract followed by immunostaining with various sera revealed differences between artificially immunized and naturally infested rabbits to most of the P. cuniculi antigens. However, the specific antibody pattern, that was developed by the immunized rabbits, was not changed after these rabbits were infested with the mites.


An experimental transmission of porcine strains of Blastocystis sp. in the laboratory mice and gerbils. Outbred laboratory mice were successfully infected with porcine strains of Blastocystis sp. using faecal stages as well as stages from fresh or passaged cultures. In contrast, inbred BALB/c mice and gerbils were only rarely infected and the intensity of their infection was mostly negligible. Blastocystis sp. was never observed inside the host cells. These results indicate a low host specificity of Blastocystis sp. as well as different sensitivity of investigated hosts to Blastocystis sp. infection.


Inhibition of proliferation of tumour cell cultures by biologically active substances isolated from the tissues of Fasciola hepatica and Fasciola hepatica-infected rat liver. Biologically active substances (BAS) were isolated from the tissues of Fasciola hepatica L. and from F. hepatica-infected rat liver by ethanol precipitation from aqueous tissue homogenates. A marked inhibiting effect of the newly isolated BAS on hepatoma MC29 cell culture proliferation and a slight inhibiting effect of the newly isolated BAS on myeloma cell culture proliferation was found. The strongest inhibiting effect was by BAS isolated from the tissues of F. hepatica. The inhibiting effect of the BAS isolated from F. hepatica-infected liver was stronger than the effect of the BAS isolated from normal liver tissue.


Gyrodactylus bohemicus sp. n. (Monogenea: Gyrodactylidae) from Oncorhynchus mykiss (Walbaum) and Salvelinus fontinalis (Mitchill) (Clupeiformes: Salmonidae) in Czechoslovakia. Gyrodactylus bohemicus sp. n (Gyrodactylidae: Monogenea) is described from the fins, skin and gill filaments of Oncorhynchus mykiss (Walbaum) and Salvelinus fontinalis (Mitchill) (Clupeiformes: Salmonidae) from a trout farm in Czechoslovakia. G. bohemicus sp. n. is most closely related to G. thymalli Zitnan, 1960 and G. magnus Konovalov, 1967 in the shape of the anchors, the ventral and the dorsal bar, but can be distinguished from both these species by the shape of the marginal hook proper.


Childhood diarrhoea due to rotavirus in a community. The etiologic role of rotavirus in acute diarrhoeal illness in children under five years of age was studied over a period of one year in an urban slum community. Rotavirus was detected in 17.7 per cent of 376 children with diarrhoea and 4 per cent of 299 healthy children with maximum prevalence at 19-24 months of age with statistically comparable detection in 0-6 months of age. The overall prevalence was significantly higher in children below 2 yr as compared to those between 2-5 yr of age. Girls (24.1%) were more susceptible amongst the diarrhoeal group in comparison to boys (13.8%). Diarrhoea due to rotavirus was more prevalent during the cooler months (November-February) of the year and no correlation was observed with rainfall and relative humidity. Rotavirus as the sole pathogen was observed in 9 per cent children with diarrhoea and in the rest, association of Cryptosporidium (3%) was observed for the first time with this virus along with other known enteropathogenic bacteria and parasites, enterotoxigenic Escherichia coli being the commonest organism.


Viability of acid-fast bacilli from gamma-& UV-irradiated lepromatous armadillo tissues infected with Mycobacterium leprae. Gamma-irradiated splenic homogenates of armadillos infected with M. leprae proved sterile by conventional tests and media. However, on media for chemoautotrophy, these could repeatedly grow as a single type of acid-fast nocardioform bacterium like the unirradiated specimens, although with a much reduced count. In the slide culture, transition from the initial AFB/coccoid bodies, to sporulating mycelia and granules in the final stage, could be observed sequentially. The gamma-irradiated tissue specimens failed to yield any other mycobacterium/corynebacterium tested according to standard protocols.


Poor diagnostic value of adenosine deaminase in pleural, peritoneal & cerebrospinal fluids in tuberculosis. Adenosine deaminase (ADA) was estimated in 84 pleural, 140 peritoneal and 136 cerebrospinal fluids to study its diagnostic usefulness as a routine test for tuberculosis. The sensitivity, specificity, positive and negative predictive values for diagnosing tuberculosis in pleural fluids (ADA > 30 U/l) was 67, 92, 78 and 87 per cent respectively, in peritoneal fluids (ADA > 15 U/1) it was 89, 81, 25 and 99 per cent respectively and in cerebrospinal fluids (ADA > 10 U/l) it was 50, 90 21 and 97 per cent respectively. The differences in mean ADA levels between tuberculous (28.0 and 19.5 U/1) and non-tuberculous (9.7 and 4.8 U/1) peritoneal and cerebrospinal fluids although statistically significant (P < 0.001), were of no practical clinical value. A wide scatter in ADA values was seen in both tuberculous and non-tuberculous fluids. ADA estimation in plasma, lymphocytes and cell fractions of fluids was also not diagnostically useful nor did it throw light on the source of elevated ADA in fluids.


Intestinal colonization & production of diarrhoea by enteroadherent-aggregative Escherichia coli. The ability of HEp-2 cell adherent Esch. coli of aggregative phenotype (EA-Agg EC) to cause diarrhoea and to colonize the bowel of rabbits was studied. Thirty six rabbits were challenged with one of three EA-Agg EC strains (F23A; H766C and F17A-15, 3 and 3 rabbits respectively) or a control strain (K12-15 rabbits) in reversible ileal-tie in adult rabbit diarrhoea (RITARD) model. The animals were sacrificed 72 h post challenge. Severe diarrhoea occurred in greater number of F23A challenged rabbits than the controls (P < 0.05). Mucosal cultures from proximal and distal small intestine and colon yielded about 1000 times more Esch. coli in the test than control rabbits (P < 0.001 in each case). EA-Agg EC were consistently grown from mucosa in the test rabbits who commonly showed mild to moderate villous stunting and grade + to nuclear fragmentation (karyorrhexis) in the small and large bowel epithelium. The control animals had either normal villi or very mild villous stunting. Results comparable to F23A were obtained with the other two EA-Agg EC strains tested in a smaller number of animals.


Loss of some virulence factors of enterotoxigenic Escherichia coli on repeated subcultures. Thirty enterotoxigenic Esch. coli (ETEC) strains of predominant serogroups, isolated from patients with diarrhoea in Ludhiana, Punjab were investigated for expression of heat labile (LT) enterotoxin and colonization factor antigens (CFAs) on repeated subculture. These belonged to serogroup 078 (10), 080 (2), 0114 (6), 020 (3), 0128 (3), 0153 (2) and 08 (4) respectively. The isolates exhibited a differential response for expression of LT and CFAs on repeated subculturing. All the strains were positive for both LT and CFA up to six subcultures. Three strains of serogroup 0114 and one of 080 failed to express CFA while one strain each of serogroups 080, 0114, 020 and 08 failed to elaborate LT in the 8th subculture. Only 25 and 19 isolates were detected as stable producer of LT and CFAs up to 10th subculture.


Effect of Vibrio cholerae-L-asparaginase on surface structure of splenic lymphocytes. The surface ultrastructure of splenic lymphocytes and rosetting properties of lymphocytes of Swiss mice were studied under scanning electron microscope following transplantation of Dalton's lymphoma and ascites fibrosarcoma tumour cells and administration of Vibrio cholerae-L-asparaginase. The results were compared to those obtained with the standard Escherichia coli-L-asparaginase. The surface structure of the lymphocytes (T cells) following L-asparaginase administration was not so different from that of normal lymphocytes. V. cholerae-L-asparaginase did not cause higher number of rosette formation in T cells as compared to the normal group. The study thus revealed that V. cholerae-L-asparaginase did not have a significant stimulatory or non-immunosuppressive effect on the lymphocyte functions.


Role of iron in the virulence of Vibrio vulnificus isolated from Cuddalore coastal waters (India). V. vulnificus strains isolated from different sources of Cuddalore coastal waters were tested for their virulence activity through their LD50 values in mice. As infections of V. vulnificus have been correlated with pre-existing liver disease and hemochromatosis, the role of iron on virulence was determined using. iron overloaded mice. The LD50 was in the range of 10(4)-10(7) cells in normal mice but 10(1)-10(2) cells in iron-injected mice, thus providing evidence that iron may play a major role in the pathogenesis of V. vulnificus.


Biting rhythm & biting activity of phlebotomid sandflies. The biting behaviour of Phlebotomid sandflies was studied in a rural village of Pondicherry through all night collections for a period of one year, using human volunteers and cattle as baits. Phlebotomus papatasi was caught only on human bait, showing anthropophily while Ph. argentipes was caught on cattle baits, showing zoophily. The biting activity was seen throughout the night, reaching a peak of 0100 h in Ph. papatasi and 0200 h in Ph. argentipes.


Clinical significance of kidney biopsy in acute renal failure (ARF). Out of 152 cases of Acute renal failure (ARF) 32 patients (21%) were subjected to kidney biopsy. All patients had intrinsic ARF. Prerenal azotemia and obstructive uropathy were excluded. Histologic observations were: Crescentric glomerulonephritis in 7 (21.9%), acute endocapillary proliferative glomerulonephritis 5 (15.6%), acute interstitial nephritis 7 (21.9%), necrotizing vasculitis 4 (12.5%), acute tubular necrosis in 5 (15.6%) and membrano-proliferative GN with superimposed crescent in 2 (6.2%) while renal cortical necrosis was seen in 6.2% of cases. Prebiopsy diagnosis was correct in only 10 (31.25%) cases. The result of biopsy had altered clinical diagnosis in 22 (68.75%) patients and precise renal biopsy diagnosis resulted in therapeutic changes in 54.8% of patients with ARF.


Evaluation of Ehrlich's test as screening test for cancer. Ehrlich's test, serum mucoproproteins, phosphohexoisomerase (PHI), and lactate dehydrogenase (LDH) levels were studied in patients with cancer and age matched controls. All parameters studied were found to be significantly increased in cancer. Evaluation of Ehrlich's test, PHI and LDH for their validity as screening tests revealed that Ehrlich's test is better suited as a screening test for cancer. A positive correlation observed in the study between serum mucoproteins and Ehrlich's test strengthens the postulation that mucoproteins are responsible for the colour development in Ehrlich's test.


Effect of yoga training on reaction time, respiratory endurance and muscle strength. There is evidence that the practice of yoga improves physical and mental performance. The present investigation was undertaken to study the effect of yoga training on visual and auditory reaction times (RTs), maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), 40 mmHg test, breath holding time after expiration (BHTexp), breath holding time after inspiration (BHTinsp), and hand grip strength (HGS). Twenty seven student volunteers were given yoga training for 12 weeks. There was a significant (P < 0.001) decrease in visual RT (from 270.0 +/- 6.20 (SE) to 224.81 +/- 5.76 ms) as well as auditory RT (from 194.18 +/- 6.00 to 157.33 +/- 4.85 ms). MEP increased from 92.61 +/- 9.04 to 126.46 +/- 10.75 mmHg, while MIP increased from 72.23 +/- 6.45 to 90.92 +/- 6.03 mmHg, both these changes being statistically significant (P < 0.05). 40 mmHg test and HGS increased significantly (P < 0.001) from 36.57 +/- 2.04 to 53.36 +/- 3.95 s and 13.78 +/- 0.58 to 16.67 +/- 0.49 kg respectively. BHTexp increased from 32.15 +/- 1.41 to 44.53 +/- 3.78s (P < 0.01) and BHTinsp increased from 63.69 +/- 5.38 to 89.07 +/- 9.61 s (P < 0.05). Our results show that yoga practice for 12 weeks results in significant reduction in visual and auditory RTs and significant increase in respiratory pressures, breath holding times and HGS.


Effects of undernutrition and sex difference on skeletal muscle function in young rats. The effects of undernutrition and sex difference on skeletal muscle contractile characteristics were studied in young albino rats. The skeletal muscle (gastrocnemius) of 8 week old pups with only one-third normal food intake (undernourished group = UN group; n = 18), as compared to free fed pups (control group = cont. group; n = 16), showed prolongation of contraction time (23.6 +/- 1.0 Vs 20.9 +/- 0.8 msec, Mean +/- SE, P < 0.05) and relaxation time (31.5 +/- 1.8 Vs 22.9 +/- 1.1 msec, P < 0.001) and retention of contraction force and endurance time. In 18 week old rats the effects of sex difference in females (n = 10), as compared to males (n = 10) were prolongation of contraction time in gastrocnemius (32.2 +/- 1.5 Vs 27.8 +/- 1.5 msec, P < 0.05), less force production in gastrocnemius (668.9 +/- 48.0 Vs 895.4 +/- 93.3 g, P < 0.05) and extensor digitorum longus (20.1 +/- 3.3 Vs 29.9 +/- 2.5 g, P < 0.05) and shorter endurance time (160.8 +/- 10.2 Vs 187.2 +/- 7.1 sec, P < 0.05) in soleus. Thus, it is concluded that early undernutrition has prolonged the contraction and relaxation times of the skeletal muscles and the effect of sex difference in the early adulthood was different in different skeletal muscles.


Inhibition of lipid peroxidation and cholesterol levels in mice by curcumin. Effect of oral administration of curcumin (diferuloyl methane) on lipid peroxidation in various organs of mice like liver, lung, kidney and brain was studied in control animals as well as those given carbon tetrachloride, paraquat and cyclophosphamide. Oral administration of curcumin significantly lowered the increased peroxidation of lipids in these tissues produced by these chemicals. Administration of curcumin was also found to lower significantly the serum and tissue cholesterol levels in these animals, indicating that the use of curcumin helps in conditions associated with peroxide induced injury such as liver damage and arterial diseases.


Differential role of ovarian hormones for taste preferences in rats. The effects of estrogen (OVX-EB) and progesterone (OVX-P) administration to ovariectomized (OVX) rats on food and fluid intakes were studied in fifty five animals grouped into three series. Animals in each series were given a choice of two fluids viz. tap water and either 5% glucose (5 G/W) or 12% glucose (12 G/W) or 1.5% Sodium chloride (S/W) by two bottle preference. Both hormones had a differential effect on the ingestion of the two concentrations of glucose while progesterone markedly increased the intake of Sodium Chloride. Could the putative role of the ovarian hormones be hedonic for glucose and homeostatic for salt?


Pharmacological screening of few new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles. Nine new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles were synthesised and confirmed on the basis of IR and nitrogen analysis. These were screened for spasmolytic, anti-inflammatory and their effects on blood pressure after determining ALD50. Compounds GK-4 i.e. 2-(diethylaminoacetyl)- amino-5-methyl-1,3,4-oxadiazole and GK-8 i.e. 2-(din-propylamino acetyl)-amino-5-ethyl-1,3,4-oxadiazole were found to be spasmolytic. Compound GK-6 i.e. 2-(diethylaminoacetyl)-amino-5-n-propyl-1,3,4-oxadiazole was found to be a potent hypotensive agent with the effect lasting for more than two hours.


Chronopharmacokinetics of rifampicin.

Chronopharmacokinetics of rifampicin. Chronopharmacokinetics of rifampicin was studied in four healthy adult male human volunteers after drug (2.0 g) ingestion at 6.00, 12.00, 18.00 and 24.00 hr. The absorption rate constant was found to be lower and the time to reach peak concentration was longer after drug administration at 24.00 hr than at other dosing times. A second peak was observed in all individual volunteers between 6-12 hr after drug dosing at 24.00 hr. This may be due to the influence of biliary rhythms on the disposition kinetics of rifampicin.


Background noise in healthy volunteers--a consideration in adverse drug reaction studies. In adverse drug reaction studies proper control over 'Back ground noise' is to be maintained to avoid erroneous conclusions to be drawn for adverse drug effects. Healthy volunteers, not taking any medication, were surveyed by a questionnaire to obtain data on the occurrence of any symptoms, often ascribed to side effects of drugs. Only 62 subjects out of a total of 236 (26.27%) stated experiencing none of these symptoms during the previous 3 days. The remaining subjects reported some symptoms, with an median number of symptoms experienced per person being 2; the most common being fatigue; headache, inability to concentrate and excessive sleepiness.


Sex variation in ascorbic acid catabolism. Male and female albino rats of same age and body weight were pair fed with laboratory stock diet and ascorbic acid, dehydroascorbic acid and diketogulonic acid were determined in the liver and urine, while in blood only ascorbic acid was estimated. Male rats had concentration higher of ascorbic acid in liver and urine as compared with females, while there were no significant variations in the contents of dehydroascorbic acid and diketogulonic acid. Hepatic and renal 2, 3-diketoaldonate decarboxylase, and hepatic dehydroascorbatase were also found to be significantly higher in male rats. Similar sex variations were also observed in ascorbic acid catabolism in guinea pigs without any differences in urinary ascorbic acid contents.


Poor reliability of the first meal tolerance test. The poor reproducibility of oral glucose tolerance test (OGTT) has been known for a long time. Some recent reports indicate that postprandial glycaemia achieved during the test is likely to be higher on the first occasion than on subsequent visits. We have analysed our recent data on meal tolerance tests (MTT) from this angle. Fifteen healthy subjects and 9 subjects having NIDDM were administered two essentially identical meals one or two weeks apart. In case of healthy subjects, the absolute as well as incremental postprandial glycaemia achieved at 0.5 h and 1.0 h on the first visit was significantly higher (P < 0.05) than on the subsequent visit. The effect of visit was insignificant in case of NIDDM subjects. The effect observed in healthy subjects may be due to the release of adrenaline during the first visit brought about by apprehension. In NIDDM subjects the apprehension is likely to be much less because of their having undergone such tests in the past. Hence a single casual OGTT or MTT is unreliable as a diagnostic tool in borderline cases of impaired glucose tolerance test. The test needs to be repeated at least once more to eliminate false positives.


Behavioural change in rats due to chronic oral and systemic formaldehyde. Impact of chronic formaldehyde exposure in respect of route on behaviour was studied. Preconditioned (environmental) male albino rats (340-400 g) in 3 groups (n = 5) under 60 days oral and systemic exposure to 10 mg/kg/day HCHO were examined for their behavioural performance (i.e. short term memory) in Cook's apparatus. Twenty percent rats settled in grade III (unconditioned avoidance response) in the i.p. (i.e. systemic group) whereas in oral fed (HCHO route in drinking water) rats, 60% settled in grade II (conditioned avoidance response) at the end of sixty days.


Effect of oral curcumin administration on serum peroxides and cholesterol levels in human volunteers. The effect of curcumin administration in reducing the serum levels of cholesterol and lipid peroxides was studied in ten healthy human volunteers, receiving 500 mg of curcumin per day for 7 days. A significant decrease in the level of serum lipid peroxides (33%), increase in HDL Cholesterol (29%), and a decrease in total serum cholesterol (11.63%) were noted. As curcumin reduced serum lipid peroxides and serum cholesterol, the study of curcumin as a chemopreventive substance against arterial diseases is suggested.


Reticuloendothelial function in acute noise stress. Wistar strain albino rats of either sex were subjected to acute noise stress (3000 Hz at > 97 dB) for 30 minutes. Carbon clearance test was conducted in noise stressed animals immediately after the stress period. Significant (P < 0.001) increase of the clearance constant K was observed in stressed animals compared to the controls, indicating increased phagocytic activity of the reticuloendothelial system.


An epidemiological study of febrile seizures with special reference to family history and HLA linkage. One hundred and forty four cases of febrile seizures, 95 simple (typical) and 49 complex (atypical); were studied and compared for clinical and epidemiological data and family history of febrile and afebrile seizures. Major results were: maximum age of onset below three years (75%) in both simple and complex groups, male preponderance, respiratory infection as the commonest etiology (69.4%) and maximum seizure onset within 24 hours of fever (73%). The familial prevalence of all seizures was 29.1%, 23.2% in the simple and 40.8% in the complex group (p < 0.01). The familial prevalence of febrile seizures was 20%; similar in both groups. The familial prevalence of afebrile seizures was 13.9%; 6.3% in simple and 28.6% in complex group (p < 0.01). The commonest relative was a sibling (13.2%). The prevalence in parents was 4%. Families with two additional members with history of seizures revealed complex seizure patterns in two-thirds of index cases. There was no correlation between family history of seizures and age at onset or sex. No clear inheritance pattern emerged and polygenic inheritance is likely. One third of eighteen families had siblings with identical segregation of parental HLA-A and B haplotypes. Five families showed the presence of HLA All. This small though adequate sample size did not reveal an HLA marker for febrile seizures.


Parental attitudes towards epilepsy.

Parental attitudes towards epilepsy. Parents of 352 children with history of epilepsy were interviewed by a pretested, open ended questionnaire to ascertain the nature of first aid care during an epileptic fit, complications arising out of this care, and parents' perceptions regarding causes of epilepsy. The commonest form of care provided was to force liquids by mouth (50.6%), followed by pressure over body to restrain convulsive movements (13.0%) or to put some object to force the teeth open (11.9%). The various causes of epilepsy according to the parents were: due to an evil spirit (26.7%0, heritable causes (13.9%), physical or mental weakness (6.6%) and brain damage (5.9%). The need of imparting knowledge and clear understanding about epilepsy among parents is emphasized.


Subclinical group A streptococcal throat infection in school children. Seven hundred and forty nine apparently healthy school children aged 5-15 years were investigated for throat infection with Group A streptococci (GAS) during December 1990 to May 1991. The prevalence of beta hemolytic streptococci (BHS) was 18.8%; most organisms belonged to Group A streptococci (13.7%). The prevalence of BHS in throat was significantly higher (p < .001) in girls as compared to boys. Immune response to extracellular antigens was studied in 53 children who had GAS strain in their throat, 54.7% had elevated titers of antistreptolysin O or antideoxyribonuclease B or both indicating subclinical infection with GAS. Thus it is recommended that serological examinations should be done along with throat culture to identify subclinical Group A streptococcal throat infection.


Carnitine supplementation in diphtheria. We studied the effect of carnitine supplementation in patients with diphtheria. Six hundred and twenty five children of diphtheria received either DL-carnitine (100 mg/kg/day in two divided doses orally for four days), or no carnitine, in addition to the routine treatment for diphtheria. The patients receiving carnitine (n = 327) and controls (n = 298) were matched for age, sex, duration of symptoms, grade of toxemia and immunization status. Patients receiving carnitine showed a significant reduction in incidence of myocarditis as compared to controls (p = 0.001). Cases with myocarditis receiving carnitine therapy showed a significant reduction in mortality as compared to controls (p < 0.001). In view of a significant decline in incidence and mortality of myocarditis in cases of diphtheria, we recommended that all cases with diphtheria should receive carnitine supplementation.


Effects of maternal labetalol on the newborn infant. Forty eight neonates, born to mothers suffering from pregnancy induced hypertension and receiving labetalol for control of blood pressure, were studied for the possible adverse effects of the drug. These were compared with eighty one neonates matched for gestation and weight and born to mothers with pregnancy induced hypertension treated with drugs other than labetalol. Incidence of birth asphyxia and intrauterine growth retardation (IUGR) in the study population was 10.4 and 22.9%, respectively and in the control group 5 and 19.7%, the difference between two groups was not statistically significant (p > 0.05). However, the incidence of hypoglycemia was significantly higher (p < 0.01) in the study group (47.9%) as compared to the control group (17.2%). Two-thirds of the hypoglycemic babies in the study population were asymptomatic and they were managed with sugar-fortified milk feeds. In the study population, the symptomatic hypoglycemic babies had hypoglycemia for prolonged duration of 43.3 +/- 23.3 hours as compared to 11.5 +/- 6.3 hours in symptomatic hypoglycemic babies of the control group (p < 0.01). The mothers of the symptomatic babies in the study group received higher doses of labetalol in the range of 287.6 +/- 142.3 mg/day while rest of the mothers in the same group whose babies had either asymptomatic hypoglycemia or normal blood glucose levels, received 239.5 +/- 118.5 mg/day, though the difference was not statistically significant. It is concluded that maternal labetalol therapy is associated with increased risk of neonatal hypoglycemia.


Acceptability trials with ready to eat foods in a rural area. Acceptability trials with three types of recipes was carried out on 184 young preschoolers (6 months to 35 months) residing in four nearby villages around Hyderabad. Results of this study indicated that among the 3 types of supplementary foods (Sweet Ready Mix, Sweet Ready Mix with Amylase and Therapeutic food tested here, the Therapeutic food was more acceptable (taste, smell and bulk) to the children. The criteria for acceptability of the food was defined as the ability of 75% of the children to consume 75% or more of the food supplement at one sitting for 70% of the days of the trial. The Therapeutic food, a calorie dense supplement, met the above criteria. The acceptability was poor for the Sweet Ready Mix and Sweet Ready Mix with Amylase (< 4%) mainly due to quantity rather than taste and smell as revealed by the mothers. The mothers of the children also liked the taste and smell of the therapeutic food better. Consumption of the therapeutic food caused minimal side effects like diarrhea and vomiting when compared to side effects after eating Sweet Ready Mix and Sweet Ready Mix with Amylase in children.


Risk factors for fatal pneumonia: a case control study. We conducted a case control study to identify the risk factors for death among hospitalized children with acute pneumonia at the Institute of Child Health, Madras. All the 70 patients who died of pneumonia constituted the case--patients and 140 children recovered from pneumonia, selected by systematic sampling, during the same period served as controls. By univariate analysis, the risk factors for death in pneumonia observed were associated illnesses--Odds Ratio (OR) 22.2. (95% confidence interval [CI] 9.8-51.4; p = < 0.001); congenital anomalies--OR 10.4 (2.9-37.8; p = < 0.001); severe pneumonia--OR 4.2 (1.2-14.4; p = 0.09); marasmic status--OR 2.9 (1.5-5.7; p = 0.001); age under 6 months--OR 2.8 (1.3-5.7; p = 0.004); and severity of the pneumonia (lobar versus segmental)--OR 2.0 (0.9-4.5; p = 0.09). By logistic regression analysis the following risk factors were significant--associated illnesses. (51.6; 18-146.9; p = < 0.001); age under 6 months (6.5; 2-20.6; p = < 0.001), marasmic status (5.8; 2.2-15.6; p = < 0.001); and congenital anomalies (3.8; 2.0-7.1; p = < 0.001). These risk factors should be kept in mind by the clinicians for appropriate intervention at an earlier stage to minimize death.


Breastfeeding and weaning practices in relation to nutritional status of infants. During the critical period of infancy, breastfeeding and weaning practices play an important role in determining the growth of an infant. The present study investigates the issue by observing 225 infants from Low Socio Economic (LSE) class (n = 150) and High Socio Economic (HSE) class (n = 75) for weight, height, and feeding practices. Almost all artificially fed (AF) infants in LSE class were malnourished while this was not so in the HSE class. However, the proportion of malnourished children in the LSE class for partially breastfed (BF + AF) group was comparable with exclusively breastfed (BF) group and was significantly lower (p < 0.01) than AF group indicating protective effect of partial breastfeeding against risks of contamination associated with weaning foods in such communities: The real bottleneck thus appears to be the lack of knowledge of handling and giving weaning foods in adequate quantities. Educating mothers appears to be the meaningful solution for improving the nutritional status of infants in poor communities.


Lactation failure.

Lactation failure. Seventy five mothers with lactation failure were studied, whose less than 4-month-old babies were admitted to the hospital. Partial lactational failure (94.7%) was noted more often than complete lactational failure (5.3%). Initiation of breastfeeding was delayed for 2 to 5 days usually for traditional reasons (77.3%) and because the mothers felt that the milk output was inadequate (92%). The various causes of lactation failure were determined and the relationship to various factors was analyzed. The commonest cause of lactation failure was insufficient milk or no milk (80%). The age, parity, education, socio-economic status, religion, family structure and urban vs rural status of mother--all had a bearing on the occurrence of lactation failure. An attempt was made to relactate all these mothers. The outcome was successful in 69.3 cases and failed in only 4% cases. In 26.7% cases, we cannot predict the outcome as the mothers hospital stay was very brief with no follow up.


Influence of surgical treatment of periapical lesions on serum and blood levels of inflammatory mediators. Changes in the serum levels of immunoglobulin IgA, IgG, IgM, positive acute phase proteins and complement activity, as well as the lymphocyte subpopulations and the neutrophil leucocyte-related chemiluminescence in the blood of patients with apical granuloma as related to endodontic and surgical treatment were investigated. Measurements were performed on admission, and 7 days and 3 months after the treatment. Elevated IgM concentration, positive acute-phase protein levels and spontaneous whole-blood chemiluminescence were noted at admission. However, a significant decrease in the serum level of each of the six investigated acute-phase proteins, and in the spontaneous chemiluminescence of blood was observed during the 3-month follow-up period. The significant increase in serum complement activity following therapy suggests that complement fixation might have occurred in these patients. A significant increase in the ratio of early sheep erythrocyte rosette-forming lymphocytes was also observed. The results of this study provide evidence for complete recovery after elimination of local inflammation by proper endodontic treatment and apicectomy in patients with apical granuloma.


The radiographic incidence of multiple roots and canals in human mandibular premolars. The aim of this study was to investigate the incidence in mandibular premolars of multiple roots and root canals that could be demonstrated radiographically. The images of mandibular premolar teeth as seen on intraoral full-mouth radiographic surveys (547) taken with the paralleling technique were examined. In 99 patients (18.1%) there was at least one premolar tooth with either divided canals or roots. First premolars were involved in 15.7% of patients, and second premolars in 7%.