Antiphospholipid antibodies in young adults with cerebrovascular ischemic disease. In this survey we reviewed some of the most recent laboratory and clinical studies on cerebral ischemia in young patients with antiphospholipid antibodies (aPLs). A strong association between aPLs and cerebrovascular ischemic disease has been documented, but the underlying pathogenetic mechanism remains unclear. Furthermore, long-term prognosis is not clear since too few controlled longitudinal studies had been reported. Further prospective clinical trials are needed to define risk factors, to identify different subgroups of patients, and to lead to an effective therapy.


Classifications of hereditary ataxias. A critical overview. The classifications of hereditary ataxias (HA) proposed from 1907 to 1984 are reviewed. An analysis is provided of the possible variables in the classification of HA, including inheritance, known metabolic or other cause, localization of pathological lesions, clinical signs, natural history, epidemiology, diagnostic tools. Harding's classification is assumed to be the best clinical tool to support molecular genetics studies. However, we suggest the inclusion of Late Onset Recessive Cerebellar Ataxias in Harding's classification. Some exceptions must be considered for the diagnostic criteria of Friedreich's disease. Early Onset Cerebellar Ataxia with retained tendon reflexes (EOCA) is probably a heterogeneous entity.


Congenital fiber type disproportion in two sisters. A clinical and histopathological study. Two sisters aged 27 and 29, respectively, born of nonconsanguineous parents, presented diffuse malformations at birth, followed by psychomotor retardation, reduction in muscle strength and easy fatigability at limbs. The clinical and neurophysiological examination as well as the histochemical study were indicative of a myopathic condition. Fiber type analysis in both patients showed that the type I fiber mean diameter was smaller than that of type II fibers by 12%. Clinical and laboratory findings are consistent with those observed in most cases of Congenital Fiber Type Disproportion, as described in literature.


Early onset hereditary ataxias of unknown etiology. Review of a personal series. Among 300 patients affected by hereditary ataxia, 94 received the diagnosis of Friedreich's disease, 12 of Late Onset Friedreich's disease, 27 of Early Onset Cerebellar Ataxia with retained tendon reflexes, 10 of Progressive Myoclonic Ataxia, 4 of Ataxia with hypogonadism and 2 of Ataxia with hearing loss. Only Friedreich's disease appears clinically homogeneous, whereas the others are not specific entities and each of them probably includes different diseases.


[Clinical, multimodal electrophysiological study of a family with progressive cerebellar ataxia and late deafness and an autosomal recessive inheritance]. We described the clinical, electrophysiological (electromyography, sensory and motor nerve conduction study, somatosensory evoked potentials, brainstem auditory evoked potentials, visual evoked potentials) and neuroradiological (brain magnetic resonance) data in 3 siblings (2 males and 1 female, age range: 54-48 years) affected by autosomal recessive late onset cerebellar ataxia. The 3 patients showed at the electrophysiological examination: mild peripheral neuropathy, involvement of somatosensory pathways both on central and peripheral side. A mild cerebellar atrophy, most evident in the female more severely disabled, was found by magnetic resonance.


[Eye movement disorders in hereditary degenerative ataxia. Electro-oculographic study of 11 cases]. An electro-oculographic study has been performed in 11 patients affected by hereditary degenerative ataxias (5 Friedreich's ataxias, 4 olivopontocerebellar atrophies and 2 late onset cerebellar ataxias). Electrooculographic records were obtained during saccades, pursuit movements and fixed gaze. Saccadic latency, saccadic speed and morphologic features were studied. In Friedreich's ataxia ocular motility was less accurate than in olivopontocerebellar atrophy and in late onset cerebellar ataxia.


Dopa responsive dystonia and juvenile Parkinson's disease: two subtypes of the same disorder? We report a sporadic case of Dopa responsive dystonia and two families with different combinations of parkinsonism and dystonia. The possible relationships between Dopa responsive dystonia and early onset Parkinson's disease are discussed.


Progressive myoclonus epilepsies. Criteria for diagnosis on the basis of the follow-up of 37 cases. The authors report the clinical criteria for the diagnosis of progressive myoclonus epilepsies on the basis of their experience following 34 cases (2 with sialidosis, 2 with MERRF, 4 with Lafora disease, 24 with Unverricht-Lundborg type, 4 with ataxic myoclonus). 3 rare forms of PME are also reported: a case of lipoma and PME, a family with dentato-rubro-pallido-luysian atrophy and a family of myoclonus epilepsy, Hartung type. The autonomy of Ramsay Hunt syndrome is discussed on the light of recent molecular genetic data.


Progressive rubella panencephalitis. Follow-up EEG study of a case. Progressive rubella panencephalitis is a very rare slow virus disease of the nervous system. The authors present a case, concerning a young man, aged 20 years, died 11 months after the onset of the disease. The following peculiarities of the case are emphasized: 1) the clinical symptomatology and the evolution (myoclonus, lack of cerebellar impairment) could suggest the diagnosis of SSPE; 2) the EEG recordings showed epileptiform abnormalities, long latency diffuse periodic complexes and--during interferon therapy and simultaneously with a temporary clinical improvement--the appearance of short latency anterior periodic complexes.


Cerebral toxoplasmosis and AIDS. Clinical, neuroradiological and immunological findings in 15 patients. Cerebral toxoplasmosis is the most common cause of focal CNS disease complicating AIDS and its incidence ranges from 3% to 40% of such patients. This opportunistic infection is generally due to reactivation of chronic toxoplasmosis as a consequence of severe immune deficiency. We present the clinical, neuroradiological and immunological findings of 15 AIDS patients with cerebral toxoplasmosis. All patients had focal neurological signs. CT-scan (13 cases) and NMR (2 cases) showed single or multiple mass lesions and edema. Serum IgG anti-Toxoplasma antibodies were positive in 14 patients; CSF specific IgG were positive in 5 out of 7 studied patients, while serum and CSF specific IgM were negative in all subjects. The intrathecal synthesis of anti-Toxoplasma antibodies were high in all 7 patients. A presumptive diagnosis of cerebral toxoplasmosis is based on the focal cerebral signs and neuroradiological findings. It is more frequently confirmed by the improvement of the clinical and neuroradiological picture during the treatment with pyrimethamine-sulphadiazine or clindamycin.


Upper airway muscles dysfunction and levodopa responsiveness in Parkinson's disease. Pulmonary function tests were performed before and at different times after 250 mg L-Dopa in 12 patients with Parkinson's disease (PD). Six were de-novo patients, the other six patients had been taking L-Dopa over different periods. All patients had an abnormal basal flow-volume loop, which significantly improved only in de-novo patients. This improvement occurred early and was independent on improvement of neurological symptoms. The effect of L-Dopa on pulmonary function could be a useful test in differentiating PD from related extrapyramidal syndromes.


Cavernous angioma does not exist?

Cavernous angioma does not exist? 12 cases of cerebral "venous angioma" are reported; pathological, clinical and radiological features of the lesion are reviewed. "Venous angioma" should be regarded as a developmental anatomic variation of the venous drainage system of the white matter. Its clinical significance is controversial, although it has been reported to cause hemorrhage, seizures, progressive neurological deficits, headaches. The clinical presentation of our patients was variable and, in some of them, dependent also on associated lesions. An hematoma was found in three patients, infarction in one and tumor in one. Angiography, CT and MRI demonstrated the typical appearance of the anomaly. Surgery was performed in one patient harboring a significant cerebellar hematoma and the coexistence of a cavernoma was pathologically confirmed. Venous developmental anomalies are often identified as the source of symptoms due to other conditions, that should be treated independently sparing the anomaly.


[Huntington chorea. Clinical correlations and preliminary neuropsychological data]. One of the cardinal features of Huntington's disease (HD) is the progressive cognitive deterioration. However, studies carried out on the neuropsychological profile in HD are discordant because there are differences in study designs, stage of disease and because of the coexistence of psychiatric disorders and cultural and educational background of subjects. Aim of this study is to relate the neuropsychological assessment with duration of illness and severity of motor impairment. Fourteen patients are given a neuropsychological battery, the results were statistically related to age and schooling. The data demonstrate very slow progression of cognitive deterioration without focal impairment of cognitive functions and without correlation with the severity of disease.


Essential mental anorexia. Psychopathologic considerations and analysis of a case. The AA. report the case of an anorexic girl, who could resume her evolutive process after an individual psychotherapy and parent's psychotherapy. In this way she could work out her defensive mechanisms and her EGO could internalize a previous menacing and persecutory maternal object.


Antiepileptic drugs in pregnancy: late effects on the children's cognitive abilities. Preliminary data. The authors report preliminary data on cognitive development of 57 children, perspectively followed, who were exposed to antiepileptic drugs in utero for maternal epilepsy. Cognitive impairments are associated with other risk factors in 5 cases, so that a direct AEDs responsibility is not easy to prove.


THINKable, a computerized cognitive remediation. First results. We have carried out the first study in Italy on the cognitive remediation by a new computerized system developed by IBM and called THINKable. Statistical analyses revealed that on some measures there was a significant improvement in the level of performance of the subjects at the time of the posttreatment assessment compared with the pretreatment assessment. Disorders of memory and higher cognitive functioning improved by structured retraining, independently of attention. Improvement has been matched by changes in the patients real-word functioning. Senile patients also took advantage from cognitive training. They were already followed before as outpatients and had no spontaneous recovery. The role of personal computers in neuropsychological training is discussed.


Progress and controversies in neuropsychology of memory. In the first part of this paper we discuss some of the most important areas of progress and of controversy in the field of memory functions and of memory impairment. Three main issues are taken separately into account: (1) the fractionation of memory into a number of sub-systems and the relationships existing among these subsystems; (2) the main theories of amnesia and the mechanisms underlying memory disorders; (3) the main anatomoclinical forms of amnesia and the brain structures subserving various components of the amnesic syndrome. In the second part we shift from the basic research to the clinically oriented investigations, reporting the results of two studies that we have recently conducted on some aspects of memory disorders in dementia. In the first study we have shown that severity and qualitative aspects of amnesia can be used to distinguish the two most frequent clinical forms of dementia, namely the dementia of the Alzheimer's type (DAT) from the vascular forms of dementia. In the second study we have demonstrated that a fine grained analysis of memory impairment can help improving the most difficult differential diagnosis in this field, namely the distinction between DAT and depressive pseudo-dementia.


Semantic paralexias facilitated by tachistoscopic reading in a patient with impairment of phonological recoding. This study of a dyslexic patient supports the view that the level of impairment of the phonological route plays a role in the production of semantic paralexias. The patient's reading was based on a defective phoneme-to-grapheme transcoding, in spite of evidence that semantic information was available through non phonological routes. The hypothesis that the residual ability to carry out phonological recoding could block the production of semantic paralexias was confirmed by tachistoscopic reading, assumed to interfere with phonological recoding in this patient, that provoked a definite rise of this type of error. The relationship between the degree of damage of phonological route and the clinical expression of the syndromes of phonological dyslexia and deep dyslexia is also discussed.


Solid-phase method for the purification of DNA sequencing reactions. A solid-phase method for the purification of the single-stranded DNA molecules produced in enzymatic sequencing reactions has been developed. A primer oligonucleotide is synthesized containing a biotin moiety at an internal position. This primer is utilized in enzymatic extension reactions, and the resulting products are bound to streptavidin-coated magnetic beads. Contaminating species such as protein, salts, template DNA, and unincorporated or degraded deoxy and dideoxy nucleotide triphosphates may be removed by washing the beads after immobilizing them in the sample tube with a fixed magnet. The resulting pure single-stranded DNA fragments are removed from the solid support by heating in 10 mM EDTA, 95% formamide, loading dye at 90 degrees C, and may then be directly loaded onto a polyacrylamide gel for sequence analysis. This method was used to investigate the effect of various contaminants upon DNA sequence data.


Are patients with constructional disorders different in visuo-spatial abilities? Many authors hypothesized a linkage between the anatomical region of damage and the nature of constructional apraxia. In particular, the functional impairment of right brain damaged patients should consist in a visuo-spatial defect. However a large amount of researches have showed impaired visuo-spatial abilities in apraxic subjects respect to non-apraxics, but independently by the side of brain damage. In these researches constructional and visuo-spatial abilities have been often evaluated by methods not comparable among them. Aim of this paper is to verify the constructional performances of left and right brain damaged patients, utilizing exclusively the copy of geometric figures and tasks considered specific in detecting visuo-spatial disabilities. The experimental results show that both left and right brain lesions produce impairments of visuo-spatial abilities. Lastly, the utility of a cognitive approach of study is discussed.


[Rehabilitative approach to ataxia].

[Rehabilitative approach to ataxia]. The author, after visiting the most common methods in use to value the ataxic patient, gives a video camera system as a good valuation device, good to give objective, complete and verifiable data. This kind of evaluation must offer the formulation of a personalized treatment plane and can demonstrate the improvements obtained during the treatment.


Video analysis of DNA sequence homologies. A method for the rapid quantitative analysis of dot blot assays is presented. A video camera, an NTSC compatible frame grabber board, and an AT personal computer are used to read photographic exposures of the assay plate. Image processing and image analysis techniques are used to calculate the orientation of the dot raster and then to compensate for the effect of variations in field illumination on measurements of local contrast. Local contrast (between dots and background) is an exponential function of the amount of hybridization between blotted DNA and complimentary oligonucleotide probes. The amount of hybridization between blotted DNA and oligonucleotide probes of known sequence is the criteria used to establish HLA-DR tissue types. Although the assay described here utilizes a chemiluminescent reaction, this algorithm may be used to read any assay that produces a rectangular raster of dots.


Megadolichobasilar anomaly. Clinical and diagnostic considerations on 30 cases. 30 patients with megadolichobasilar artery, explored by angiography, are reported; 23 among them were first studied by computerized tomography and 4 by magnetic resonance. From the clinical point of view, 9 had transient ischemic attacks or definitive ischemia, 7 had subarachnoid or intracerebral hemorrhage, and 7 had deficits of the cranial nerves; in the other 7 cases the condition was incidentally discovered as isolated asymptomatic anomaly or with other unrelated lesions. Among the patients with ischemic symptoms, vertebrobasilar insufficiency and pontine infarction were the most common clinico-radiological findings. Among the patients with intracranial hemorrhage, four had associated aneurysm or arteriovenous malformations. CT and MR allow a correct diagnosis of this anomaly. MR seems to be superior to CT in delineating the relationship of the anomalous artery with the nervous structures, and the coexisting pathology.


Axial evolution of the negative glow in a hollow cathode discharge. The purpose of these studies was to examine the axial evolution of the negative glow in a hollow cathode discharge. The time-average negative glow profiles along the central axis of a hollow cathode were recorded for 81 pulse widths over the range of 5-25 microseconds in increments of 0.25 microseconds at a constant interpulse delay of 206.4 microseconds. Subsequent numerical processing yielded the instantaneous negative glow profile. The negative glow was viewed through a mesh-covered slot along the length of the hollow cathode. The negative flow profiles were imaged using a vidicon video camera. A PC-based frame grabber digitized the video images and stored them for subsequent processing.


Acousto-optic tunable filter as a polychromator and its application in multidimensional fluorescence spectrometry. Acousto-optic tunable filter (AOTF) is an electronically driven dispersive device which operates on the principle of acousto-optic interaction in an anisotropic medium. Incident white light will be diffracted by the AOTF into a specific wavelength when a specific rf is applied to it. The diffracted light needs not be a monochromatic light. Multiwavelength light can be diffracted from the AOTF when several rf signals are simultaneously applied into the filter. Compared to conventional polychromators, advantages of this electronic AOTF polychromator include its ability to individually amplitude-modulate each wavelength of the diffracted multiwavelength light at different frequency. This is accomplished by individually and sinusoidally modulating each applied rf signal at the desired frequency. This feature makes it possible to develop a novel AOTF-based multidimensional fluorimeter in which the sample was simultaneously excited by two different wavelengths (514.5 and 488.0 nm) whose amplitudes were sinusoidally modulated at two different frequencies (100 and 66 Hz). Multicomponent samples, e.g., mixtures of rhodamine 6G and rhodamine B, were successfully analyzed using this novel fluorimeter and the developed data analysis.


252Cf plasma desorption mass spectrometry in the synthesis of porphyrin model systems. 252Cf plasma desorption mass spectrometry has been used in the characterization of more than 100 synthetic porphyrins ranging in mass from 614 u for tetraphenylporphyrin to over 2000 u for some porphyrin model systems. In virtually every case, 252Cf plasma desorption mass spectrometry yielded an intense ionized molecule ion [M.+ and/or (M+H)+], irrespective of the groups appended to the porphyrin. The appended groups include carboxylic acids, amides, imides, chloroacetamides, Fmoc-protected amino acids, aromatic amines, nitriles, alkynes, alkenes, esters, active esters, benzyl ethers, acetals, dithioacetals, ketones, imines, phenols, quinone, hydroquinone, ferrocene, cyanine dyes, trimethylsilyl protecting groups, nitro groups, and combinations of these functionalities. Metalloporphyrins and porphyrin-porphyrin dimers are also analyzed with ease. Resolved isotopic peaks were observed for porphyrins with molecular weights below 1000, and unresolved isotopic peaks yielding average masses were observed for porphyrin compounds with higher molecular weights. The limited resolution in the higher molecular weight range does not lessen the utility of the method because the observation of the molecule ions [M.+ and/or (M+H)+] provides unambiguous evidence concerning the success of the synthesis. The 252Cf plasma desorption mass spectra of porphyrins are not complicated by chemical transformations. This method is ideally suited for rapid analysis of synthetic porphyrins and provides a powerful tool for chemists engaged in the synthesis of complex organic molecules.


Capillary ultrafiltration: in vivo sampling probes for small molecules. Capillary ultrafiltration is a novel sampling method convenient for low molecular weight substances in living biological systems. By application of a negative pressure across a hydrophilic membrane capillary, small molecules are actively "pulled" across the membrane and collected. By elimination of large molecules and cellular matter, the ultrafiltrate collected is well suited for further analysis by liquid chromatography, capillary electrophoresis, or mass spectrometry. Ultrafiltration probes (UF probes) provide a simple means to obtain a small-volume sample from subcutaneous tissue, blood, saliva, or any other biological fluid in vivo. The dependence of recovery on flow rate, temperature, membrane dimensions, and vacuum magnitude are considered. The relative merits of capillary ultrafiltration probes and microdialysis probes are considered. UF probe applications presented include in vivo monitoring of drug disposition in human saliva and in the subcutaneous space of awake, freely moving rats.


Determination of intracellular species at the level of a single erythrocyte via capillary electrophoresis with direct and indirect fluorescence detection. Intracellular contents reflect the specific history of a cell including innate physiological heterogeneity as well as differing levels of exposure to environmental influences. A method capable of analyzing a variety of species from within a single human erythrocyte is demonstrated. Guided by a microscope, individual cells can be drawn into open capillaries of 10-microns i.d. On contact with a low ionic strength buffer solution, the cell lyses and releases its intracellular fluid. The ionic components are then separated by capillary electrophoresis. For glutathione, microderivatization with a fluorescent reagent can be accomplished in vitro with monobromobimane. The effects of extracellular oxidizing and reducing agents on the glutathione levels can thus be followed. For sodium and potassium, or any other ionic species, charge displacement of a fluorescent cation results in indirect fluorescence detection. The two detection modes are suitable for intracellular components present at low-attomole and sub-femtomole levels, respectively.


[Glycoprotein hormones, glycosylation and biological activity]. Glycoprotein hormones LH, FSH, TSH and hCG are heterodimeric molecules: each contains two subunits, a common alpha and a unique beta subunit. Each subunit bears one or two Asparagine linked carbohydrate moieties which have a biantennary complex-type or hybrid-type structure. Different technical methods as deglycosylation or molecular biology techniques have been used to study the role of carbohydrate residues in hormonal bioactivity. The carbohydrate chains are not directly involved in receptor binding events but their mechanisms of action is not fully understood. Two hypotheses are frequently emphasised: a conformational role or an involvement in the coupling of the receptor-adenylate cyclase system. At the post receptor level carbohydrate chains modulate the bioactivity in two ways: a global regulation following an all-or-none mode and slight one. The removal of the carbohydrate moieties leads to a loss of the in vitro hormonal activity. The results observed are dependent of the deglycosylation techniques and the bioactivity tests used. Hormone's deglycosylation reduces their capacity of production of cAMP and, to a lesser extent, their steroidogenic power. Deglycosylated hormones are antagonists to negative hormones although deglycosylated hCG has some agonist properties in vivo. Microheterogeneity of the glycoprotein hormones is due to slight variations in sialic acid and/or sulfate content. Glycoprotein hormones exist as several isoforms which differ in biological potency. Alkaline isoforms (less sialylated ones) are the most biologically active in vitro but have a short half live in vivo; acid isoforms are less active in vitro but have a longer circulatory half live. The polymorphism of glycoprotein hormones is a highly regulated process.(ABSTRACT TRUNCATED AT 250 WORDS)


[Structure an functions of IgG subclasses]. This review first deals with IgG subclasses according to the aspects that ascribe them their common class properties: general structure, enzymatic cleavage, synthesis, Gm allotypes. Then the subclass specific characteristics are described, comparing the main structural features (domains, hinge, disulfide bridges, kappa/lambda ratio). The IgG subclasses are further compared according to their effector functions, stressing those resulting from structural differences: classical pathway of complement activation, binding to Fc receptors, to protein A and to rheumatoid factors. Finally, a survey of the prolific works about antibody functions of IgG subclasses, allows a glimpse of the wide possible applications in this field.


[Interlaboratory tests: completion of a method of aluminum assay in serum by electrothermal atomic absorption spectrometry]. After carrying out a prior analysis of published literature, the members of the SFBC trace-elements study group present an interlaboratory trial on the measurement of aluminum in serum using electrothermal atomic absorption spectrometry. The means of measurement chosen, following methods reliability criteria, was the use of a standard addition calibration of the samples diluted 1/5 in nitric acid 0.02 mol.l-1. Standard addition calibration was performed on two serums and gives acceptable results. Measurements are preferably carried out in 'tantalised' graphite tubes or pyrolytic tubes with platforms. However, when using graphite tubes, their quality must be checked because measurements can be seriously affected by poor quality tubes.


Evaluation of bronchoalveolar lavage for the diagnosis of bacterial pneumonia in ventilated patients. Fourty-six patients requiring mechanical ventilation and suspected of bacterial pneumonia were examined by fiberoptic bronchoscopy. Specimens recovered by bronchoalveolar lavage (BAL) and using a protected specimen brush (PSB) were quantitatively cultured and the results compared. An assessment of the percentage of cells with intracellular organisms present on cytocentrifuged preparations made from lavage fluid was made to evaluate the utility of this method in early diagnosis of pneumonia. BAL cultures made a correct diagnosis in 43 out of 46 patients and detected 10 false-negative cultures of the PSB. With a threshold of more than 3% of cells with intracellular bacteria, direct microscopic examination diagnosed bacterial pneumonia in 36 out of 46 patients and allowed appropriate antibiotherapy to be instituted earlier. These results demonstrate the ability of BAL to diagnose bacterial pneumonia in ventilated patients.


Evaluation of five commercial tests: complement fixation, microparticle agglutination, indirect immunofluorescence, enzyme-linked immunosorbent assay and latex agglutination, in comparison to immunoblotting for Mycoplasma pneumoniae serology. A panel of 68 serum specimens from 41 subjects exhibiting various immunological patterns to Mycoplasma pneumoniae as determined by detection of a 180 kDa protein in immunoblotting was used to compare five commercially available tests based on different methods: complement fixation test (CFT), microparticle agglutination (MAG), indirect immunofluorescence assay (IFA), enzyme-linked immunosorbent assay (Elisa), and latex agglutination (LA). The tests were performed according to the manufacturers' instructions. For the determination of immunity to M pneumoniae, the five tests were in good accordance with immunoblotting: sensitivity was 100% for all the five assays, specificity ranged from 95.6% (MAG) to 82.6% (Elisa) and overall agreement ranged from 98.2% (MAG) to 92.8% (Elisa). The comparisons of antibody rates obtained by the four quantitative tests (CFT, MAG, IFA, Elisa) showed correlation coefficients ranging from 0.87 (CFT-IFA) to 0.67 (CFT-Elisa). Six significant antibody rises demonstrated by immunoblotting patterns were detected by all the tests but Elisa in one case. As a whole, the commercial assays gave satisfactory results for routine determination of immune status to M pneumoniae: CFT was the cheapest test and MAG and LA were the easiest to perform.


[Identification of Mycobacterium tuberculosis and Mycobacterium avium by non-radioactive probes: evaluation of the Snap Syngene system]. We evaluated an alkaline phosphatase-labeled oligonucleotide probe for the rapid identification of Mycobacterium tuberculosis and mycobacteria belonging to the M avium and M intracellulare complex (MAIS). Sixty-two strains of mycobacteria and eight strains belonging to related genera were studied. All M tuberculosis strains hybridized with the tuberculosis probe. All M avium and M intracellulare gave a strong signal with their probes. However the 3 M xenopi strains tested hybridized with all probes for MAIS complex.


[Antimalarial effect of n-hentriacontanol isolated from Cuatresia sp (Solanaceae)]. The antimalarial activity of the fatty alcohol, n-hentriacontanol, isolated from the bolivian Solanaceae, Cuatresia sp, is investigated in vivo through a classical four-day suppressive test against Plasmodium berghei and P. vinckei in mice. This product markedly reduced the virulence of experimentally induced P. vinckei infection. n-Hentriacontanol belongs to a new class of antimalarial natural compounds to be exploited for therapeutic purposes.


Interleukin-6 in psoriasis: expression and mitogenicity studies. Interleukin-6 (IL-6) is a multifunctional cytokine which has been suggested to function as an autocrine mitogen in psoriatic epidermis. We report here the results of several experiments designed to further examine this hypothesis. Blot hybridization was unable to detect 1.3 kb IL-6 transcripts in RNA extracted from normal or psoriatic epidermal (keratome) biopsies, suggesting that IL-6 expression is very low in normal and psoriatic epidermis. Therefore, qualitative and semiquantitative PCR/Southern blot analyses were performed on keratome-derived RNA, and revealed variable but significantly increased IL-6 mRNA levels in lesional psoriatic relative to normal tissue. To further examine the ability of normal human keratinocytes (NHK) to express IL-6, RNA was extracted from rapidly proliferating secondary NHK cultures. IL-6 transcripts were nearly undetectable by blotting in keratinocytes grown in low-calcium serum-free medium, but low levels could be induced by treatment with 1.8 mM CaCl2. IL-6 transcripts were strongly superinduced after cycloheximide treatment, suggesting that a labile protein regulates IL-6 mRNA levels in these cells. Finally, the mitogenic activity of IL-6 was examined in NHK under varying conditions of cell density and added growth factors. IL-6 did not stimulate high density keratinocyte growth in the presence or absence of other growth factors, but did stimulate clonal growth in epidermal growth factor (EGF)-deficient media at high concentrations (> or = 10 ng/ml). The proliferative effects of IL-6, but not of basic fibroblast growth factor, were abrogated by monoclonal antibodies directed against the EGF receptor.(ABSTRACT TRUNCATED AT 250 WORDS)


Phenotypic determination of T-lymphocytes responding to chemotactic stimulation from fMLP, IL-8, human IL-10, and epidermal lymphocyte chemotactic factor. Human T lymphocytes were collected after they had migrated towards N-formyl-methionyl-leukylphenylalanine (fMLP), rIL-8, human IL-10 (hIL-10), and epidermal lymphocyte chemotactic factor (ELCF). They were stained for determination of their phenotype by FACS analysis using anti-CD4, -CD8, -CD18, -CD45R0 and OPD4 antibodies. Human IL-10 increased the percentage of CD8+ T lymphocytes in the migrating cell population by 152% compared with cells migrating towards the medium and decreased the number of CD4+ T lymphocytes by 79%. ELCF increased the number of CD4+ T lymphocytes by 18%, and the number of CD45R0+ T lymphocytes by 52%, while the number of CD8+ T lymphocytes was decreased by 20%. rIL-8 increased the number of CD4+ T lymphocytes and decreased the CD8+ T lymphocytes. The distribution of the different subpopulations of T lymphocytes was not changed significantly by fMLP. The observed changes in the phenotypes did not occur when incubating T lymphocytes with the chemotaxins. Our observations demonstrate that individual chemotactic factors will attract specific subsets of T lymphocytes. They may help to explain the predominance of memory T lymphocytes (CD4R0+, CD4+) in allergic contact dermatitis and certain other skin diseases. They also confirm the results of a recent study, that showed hIL-10 to be selectively chemotactic for CD8+ T lymphocytes.


A two-colour flowcytometric study of cell kinetics and differentiation of human keratinocytes in culture. Double histochemical staining followed by flow cytometric analysis was performed to determine whether involucrin synthesis is associated with a particular phase of the cell cycle. In low-calcium medium (0.1 mM) monolayer cultures the expression of involucrin was confined to about 8% of the total cell populations. When the concentration of calcium was increased to 1.8 mM, the percentage increased and the distribution pattern of the cell cycle changed. The addition of retinoic acid at concentrations in the range 10(-8) M to 10(-6) M to a high-calcium medium induced a further increase. The greatest increase in involucrin expression (up to five-fold) occurred in both the G1/G0 and G2 + M phases, while S phase cells showed a two-fold increase. The results indicate that involucrin synthesis is induced by retinoic acid, which occurs at any stage of the cell cycle, even in the S phase.


UVA tanning devices interact with solar-simulated UV radiation in skin tumor development in hairless mice. The carcinogenic effect of three UVA tanning sources was studied in lightly pigmented hairless mice. The three tanning sources (Bellarium-S SA-1-12, Philips TL 09R and Philips TL 10R) have different emission spectra, and emit different amounts of UVB. Radiation from the tanning sources was administered for 20 min/day, 5 day/week in daily doses equivalent to those used in suntan salons. The radiation was given alone or after 12 weeks of exposure to solar-simulated UV radiation (SOLAR UV) (10 min/day, 4 day/week; daily dose, 19.5 kJ/m2 UVA and 3.9 kJ/m2 UVB). Irradiation with Bellarium-S SA-1-12 for 47 weeks and Philips TL 09R for 74 weeks induced skin tumours in 20/20 and 13/20 of the animals, respectively. When irradiation with Bellarium-S SA-1-12 and PHilips TL 09R was administered after 12 weeks of SOLAR-UV exposure, a strong enhancement of SOLAR-UV-induced photocarcinogenesis was observed (p < 0.001). Irradiation with Philips TL 10R was only slightly carcinogenic, and during 85 weeks of irradiation only one skin tumor appeared in a group of 20 mice. However, when irradiation with Philips TL 10R was administered after 12 weeks of exposure to SOLAR UV, an enhancement of SOLAR-UV-induced carcinogenesis was observed (p < 0.001). Our results suggest that the hazards of exposure to commercial tanning devices are increased when they are used after a period of natural sun exposure. Even tanning sources with a low carcinogenic potential are able to increase SOLAR-UV-induced carcinogenesis significantly.


Effect of the dose of ultraviolet radiation on the pigment formation by human melanocytes in vitro. Human melanocytes were cultivated under different conditions with phorbol ester (TPA), or with bovine pituitary extract (BPE). The cells altered their morphology with the different culture conditions. With TPA they were predominantly bipolar, while with BPE most of the cells had a dendritic cell shape. In order to investigate the effect of UV irradiation, the cells were irradiated with 50, 100 and 200 mJ/cm2 UVA/B. After irradiation with 200 mJ/cm2 UVA/B the cells cultured with TPA also showed a dendritic shape. We determined the tyrosinase activity, the cellular melanin content and the cell number 3 days after irradiation. In all cases the number of cells decreased depending on the UVA/B doses. In melanocytes we found a marked increase in tyrosinase activity and melanin content after irradiation with 200 mJ/cm2. The UV-induced effect on tyrosinase activity was higher in melanocytes cultured with BPE than in those cultured with TPA. The results were compared with two human melanoma cell lines. Only little pigment formation could be measured in the tested melanoma cell lines without change after UV irradiation.


Stratum corneum sphingolipids and free amino acids in experimentally-induced scaly skin. Stratum corneum sphingolipids are of particular importance in maintaining the water permeability barrier of mammalian epidermis. Free amino acids also play an important role in water retention in the stratum corneum. To clarify the way in which these substances affect scaly skin, stratum corneum sphingolipids and free amino acids collected from artificially-induced scaly skin were analysed. Scaly skin was induced by tape stripping. The total amount of sphingolipids was quantified by gas chromatography and five of sphingolipid fractions were isolated and quantified by thin-layer chromatography. Free amino acids were analysed using a high-speed amino analyser. The total amount of sphingolipid in scaly skin did not differ statistically from that in control skin. However, a significant change in the distribution of the five sphingolipid species was observed in scaly skin and the total amount of amino acids was decreased in scaly skin. These results suggest that the distribution of these five types of sphingolipid and the total amount of amino acids are responsible for scaly skin.


[Results of a randomized, double blind prospective study of intravesical chemoprophylaxis with 2 drugs: adriamycin and mitomycin; and 2 ways of initiating the instillations: early and late. Effect on recurrence and progression]. The results of a double blind prospective study comparing the chemoprophylactic effects of adriamycin and mitomycin C and two modes of instillation (early: 6 hours following transurethral resection; late: 7-14 days later) for superficial carcinoma of the bladder are presented herein. Since the minimum follow up is over 5 years, the effects on tumor progression and mortality achieved by each of the 4 arms of the protocol were also evaluated. Concerning tumor recurrence, early instillation of mitomycin and overall early instillation therapy achieved significantly better results (p < 0.01). No differences, however, were observed relative to tumor progression or mortality.


[Cystometry in recurrent stress urinary incontinence]. We reviewed the postoperative cystometries and clinical data of 33 patients with post-surgery recurrent stress urinary incontinence to determine the incidence of surgical failure and misdiagnosis. The results show that 63.6% of the cases were due to a technical failure. A second postoperative failure is likely to be due to an unstable bladder.


[Laparoscopic testicular autotransplantation]. The authors describe an experimental technique of endoscopic autotransplantation of the testis. Four trocars are utilized; one is placed at the level of the umbilicus, one in the right flank, another in the left flank, and one in the hypogastrium. Five or six cms of the epigastric vessels are dissected and sectioned. Then the spermatic vessels and released from the inguinal orifice up to their origin and sectioned. The testis is taken to the peritoneal cavity through the skin and the sustenaculum testis is sectioned. Both vascular pedicles are exteriorized through an incision at the level of the inguinal duct. Microvascular anastomosis is performed as in a routine procedure and the vessels are inserted into the abdomen again, the testis is taken to the scrotum and the inguinal duct is closed from inside.


[Extracorporeal arterial reconstructive surgery in complex vasculo-renal pathology]. Herein we describe a case of a 23-year-old male patient with severe hypertension that was refractory to medication, a hypoplastic left kidney and complex renovascular disease. Patient evaluation revealed stenosis of the right renal artery and saccular aneurysms of its three branches. Treatment with converting enzymes was discarded due to the risk of azotemia and the complex vascular disease advised against percutaneous transluminal angioplasty. He was therefore submitted to ex situ vascular repair (bench surgery) using the hypogastric artery with its three branches and autotransplantation in the right iliac fossa. The foregoing procedure achieved excellent results. The arterial pressure and overall renal function returned to normal 15 days postoperatively. In our view extracorporeal surgery is the procedure of choice in patients with complex renovascular disease involving the small branches of the renal artery.


[Villous adenoma of urinary bladder. Report of a new case]. We report on an 80-year-old female patient with a villous polyp of the bladder. We believe this lesion may correspond to an intermediate stage in the well known sequence of injury-metaplasia-dysplasia-carcinoma of the large intestine. Intestinal metaplasia in the bladder is a potentially malignant lesion. If villous adenomas are diagnosed early, before malignant transformation, simple excision can achieve cure.


[Retroperitoneal abscess. Report of 2 cases]. Two cases of retroperitoneal abscess that had recently been treated in our service are described. The primary infection was localized to the psoas muscle in one patient with a previous injury to the right lumbar region. The other case was secondary to an ascending urinary infection. Staph aureus were isolated in the first case and E. Coli in the second. The different clinical course and treatment of each case are described.


[Inguino-scrotal bladder hernia].

[Inguino-scrotal bladder hernia]. We report on a 61-year-old patient with massive scrotal herniation of the bladder and non-Hodgkin malignant lymphoma. We briefly describe this disease entity and its form of presentation, and discuss its diagnosis and treatment.


[Pyo-urachal cyst].

[Pyo-urachal cyst]. A case of infected and suppurating pyourachal cyst is described. The rarity of urachal pathology in the adult prompted us to report the present case. The clinical features, diagnosis and treatment of this urachal complication are discussed.


[Renal cyst communicating with excretory tract: report of a case]. Simple renal cyst communicating with the excretory tract is a rare complication frequently arising from obstructive uropathy. In most of the cases treatment continues to be conservative.


[Adrenal myelolipoma: a new case. Review]. We report a case of symptomatic myelolipoma with a good evolution at three and a half years' follow up. The clinical features and the diagnosis of this tumor type are discussed. In this case, as in most cases, CT proved to be the most useful in making the diagnosis. Like most of the cases, the patient was middle aged, obese and hypertensive. The etiology, pathogenesis, clinical features and diagnosis of this disease entity are reviewed. The treatment modalities utilized according to the specific features of each case are discussed.


[Calcification of seminal vesicles and deferent duct]. Herein we describe a chronic diabetic with calcification of both seminal vesicles and the deferent duct which had been disclosed by a plain film of the urinary tract and an IVP. Currently the foregoing condition can be considered to be pathognomonic of diabetes mellitus, although these patients generally do not present urological symptoms or signs.


Surgical treatment of obstructive azoospermia. The records of 325 azoospermic patients were reviewed. A total of 109 patients (33.5%) had obstructive azoospermia and 48 of them underwent surgical treatment. Three patients had vas deferens agenesia and underwent artificial spermatocele; 14 with epididymal obstruction were treated by an end-to-end microsurgical vasoepididymostomy; and 31 vasectomized patients were submitted to microsurgical reversal. There was no pregnancy in the spermatocele patients. In the vasoepididymostomy patients 60% became patent and 30% achieved pregnancy. In the reversal group 90% of patency and pregnancy rate of 80% were observed, in a mean follow-up of 21 months. The last 8 cases were treated with a biological glue and 7 showed patency and one pregnancy in a 3-month follow-up period. One was lost to follow-up.


[Injection of autologous fatty tissue in the bladder submucosa: experimental study in swine]. The results achieved by the use of inert materials via endoscopic injection for the treatment of urological pathologies have been disappointing. Furthermore, these materials are costly, carry the risk of migration and may not be tolerated locally. Autologous fatty tissue, however, is not costly and is tolerated better. The authors have conducted an experiment in the pig to evaluate the degree of resorption and persistence of autologous fat injected into the bladder submucosa. The results show that submucosal injection of autologous fat acts like an autograft and persists as mature fatty tissue. The degree of resorption and/or steatonecrosis is directly related to the amount injected; the smaller the amount used the better the results.


[Our caseload in Fournier's disease].

[Our caseload in Fournier's disease]. We reviewed the records of 17 cases of Fournier's gangrene that had been diagnosed and treated in the Urology Service of the Marques de Valdecilla Hospital from 1982-1991. The series comprised male patients aged 32 to 77. Eleven cases (64.7%) were due to a known cause, above all infection. Most of the patients had factors that predisposed to the development and progression of the disease, predominantly diabetes mellitus (5 cases, 29.4%). The clinical features frequently corresponded to those of acute infection, with high fever, chills, pain, nausea and vomiting that could progress to a septic state. The local symptoms and signs included pain, swelling, erythema and necrosis, depending on the compromised area. Infection was usually caused by Gram-negative bacteria, particularly E. coli, although Gram-positive bacteria and anaerobes have been observed. Mixed bacterial infections have also been observed. Treatment must be instituted early using a combination of broad spectrum antibiotics that cover both aerobes and anaerobes, and wide surgical debridement of the compromised area. In some cases hyperbaric oxygen therapy may be warranted. The disease continues to be severe. In the present series, the outcome was favorable in 12 cases (70.5%) and there were 5 deaths (29.4%).


[Sclerosing therapy of testicular hydrocele with tetracycline]. Twenty-six patients, aged 38 to 78 years, with testicular hydrocele were treated by aspiration, punction and tetracycline instillation. The cure rate was 79%. Inflammation of the scrotum was observed in all of the cases. Due to recurrence two patients underwent surgery, which revealed a hematocele.


[Histogenesis of isthmic nodular salpingitis]. Nodular salpingitis of the isthmus is a clinicopathological entity related to what is classically referred to as interstitial adenomyosis. These two lesions are due to the same aetiopathogenic process and result from inflammatory proliferation of the tubal epithelium with formation of pseudoglandular ducts. The only difference between the two is that one is ensheathed by a fine network of mesonephric muscle fibres and the other is surrounded by a thick layer of myometrial muscle fibres. These two lesions should be grouped under the same heading: nodular salpingitis. The term adenomyosis is incorrect due to the absence of endometrial glandular ducts and stroma in these lesions. Nodular salpingitis of the isthmus should be distinguished from tubal endometriosis, which is part of the clinical expression of extrauterine endometriosis. In particular, this lesion must be distinguished from interstitial endometriosis which, for some authors, corresponds to colonisation of the tubal mucosa by endometrium and, for others, to metaplasia of the tubal mucosa.


[Primary and secondary carcinomas of the thyroid gland with systematic discovery. Apropos of hundred thyroid glands removed at autopsies and review of the literature]. One hundred thyroids from autopsies performed in a Cancer Center were sectioned at 4 mm intervals. Each slice was processed to obtain one or several sections for histologic examination. Five primary microcarcinomas and ten secondary clinically unknown carcinomas were found. This study and the review of the literature confirm that the high prevalence rate of microcarcinomas, most of them papillary, in autopsies does not agree with the clinically diagnosed carcinoma rate. Tumors greater than 5 mm in diameter may sometimes be aggressive. Intrathyroid metastases are relatively frequent in cancerous dissemination observed in autopsies, but raise problems when they precede the primary tumor or are revealed on surgical samples a long time after because of a slow development. The authors emphasize the importance of differential diagnosis between primary and secondary tumors and the value of immunohistochemistry for histological diagnosis.


[Comparative study of the expression of CEA and a myelomonocytic antigen (CD15) in serous effusions using two monoclonal antibodies NEO 723 and Leu M1]. A comparative study of the reactivity of two monoclonal antibodies (MAb), NEO 723 (anti-CEA) and Leu M1 (CD15) was performed by immunocytochemistry on sixty five reactive effusions and sixty two neoplastic effusions, fifty eight due to metastases from carcinomas, two due to disseminations of sarcoma and two due to malignant mesotheliomas. The study of the expected reactivity of NEO 723 and the cross-reactivity of Leu M1 on exfoliated neoplastic cells in effusion fluids showed that the sensitivity of NEO 723 was superior to that of Leu M1 for the detection of carcinomatous metastases, as 78% reacted with NEO 723 versus 38% with Leu M1. Among the positive cases, the mean number of reactive cells was twice as high with NEO 723, while only three of the carcinomas no expressing CEA reacted with Leu M1. The study of the reactivity of benign and malignant mesothelial cells with these two antibodies also confirmed the absence of labelling of these cells. Thus, despite a good specificity for carcinoma, the combination of these two antibodies provides only a minor gain in diagnostic sensitivity (+5%) compared with the use of an anti-CEA antibody alone and a loss of sensitivity (-5%) compared with the combination of an anti-CEA and an anti-EMA antibodies. These results appear to justify the suppression of Leu M1 from the first panel of antibodies screening for carcinomatous cells in favour of a combination of anti-CEA and an anti-EMA antibodies. However, Leu M1 may be useful as a second-line test in order to define the primary tumour responsible for the effusion.


[Epidemiology of tumors of the testis].

[Epidemiology of tumors of the testis]. Testicular tumours are rare tumours affecting young adults (75% of tumours are diagnosed between the ages of 25 and 40 years). The descriptive epidemiological study of the data of the literature reveals a considerable improvement in the prognosis of testicular cancers, particularly since the introduction of cisplatin in the 1980. An epidemiological study conducted on a series of 200 testicular tumours treated at Val-de-Grace military hospital between 1979 and 1989 confirms this improvement with a mortality rate of 7.5% for all stages and histological types combined, with a follow-up of 2 to 12 years.


[Pathologic anatomy of tumors of the testis]. Pathological examination of testicular tumours demonstrates the heterogeneity of the histological types encountered. Germ cell tumours, with one or several components, represent 95% of all testicular tumours. The distinction between these various types is always based on morphological criteria, but may also be facilitated by the use of immunolabelling techniques on fixed sections. The local and regional extension and the distinction between seminomatous and non-seminomatous germ cell tumours are important criteria in the subsequent therapeutic strategy. At the present time, there is no consensus concerning the selection of other histoprognostic criteria, which may be observed in the primary tumour it its metastases. Residual masses also have a variable histology and their pathophysiology is sometimes difficult to interpret.


Vaginal metaplasia of the bladder associated with ectopic ureterocele. A clinicopathologic study of two cases. We report two cases of vaginal metaplasia associated with ectopic ureterocele with complete ureteric duplication. The theories proposed to explain this metaplastic change are briefly reviewed. This previously unreported association with ectopic ureterocele suggests that this may an example of heteroplasia, and that this relationship could be more than casual.


A case of perineurioma with prominent myxoid changes. A perineurioma with prominent myxoid changes is presented. The patient, a 41 year-old woman, presented with a small skin nodule on her back. Light microscopy revealed subtle cellular whorls within a myxoid background. Immunohistochemistry showed epithelial membrane antigen positivity. In contrast, S-100 protein, common leukocyte antigen, vimentin and AE1-AE3 cytokeratin were negative.


A survey of hospital attendances for skin disease in Perth. Analysis of hospital attendances for skin diseases is not a true prevalence study; however, it gives valuable information to the dermatologist. A two week study of hospital attendances at the skin clinics in three major hospitals in Western Australia was conducted. The most common conditions encountered were solar keratoses, psoriasis, malignant tumours and dermatitis. These results are similar to those of a population based prevalence study carried out in Western Australian in 1979.


Skin disease in general practice.

Skin disease in general practice. Out of 336 consultations in general practice 52 (15%) concerned a dermatological problem. Sun related problems, eczema/dermatitis and infection were encountered most frequently.


Modern treatment of lymphoedema. I. Complex physical therapy: the first 200 Australian limbs. Complex Physical Therapy (CPT) is discussed and its principles outlined. CPT involves: 1. skin care, 2. a special lymphatic massage, 3. compression bandaging and (later) garments, 4. special exercises which supplement the massage. CPT was used on 78 patients with postmastectomy lymphoedema (17 with Grade 1 and 61 with Grade 2). There were significant differences between the Grades. In the first four-week course the mean Grade 1 was reduced from 121% of normal to 107% (the mean change in the oedema was 103% of its initial value), and Grade 2 from 153% to 123% (with a mean change in oedema of 60%). All these were very highly significant. Over the next year there was a small, but very significant, decrease in the percentage of oedema. A further four-week course resulted in significant, and similar, reductions in the residual oedema. CPT was used to treat 128 lymphoedematous legs; 22 were Grade 1 lymphoedema, 84 were Grade 2 and 19 were elephantitic (Grade 3). After the first course of CPT the mean losses were: 1.1, 1.3 and 3.7 litres, respectively (all very significant). Over the next 11 months there were significant further reductions for all legs and in the amount of oedema of the unilateral legs. Some patients had a second course of CPT with similar reductions in the remaining oedema to that after the first course.


Modern treatment of lymphoedema. II. The benzopyrones. The benzo-pyrones reduce all high-protein oedemas, including lymphoedema and elephantiasis, by increasing the numbers of macrophages and their normal proteolysis. Thus they remove the excess protein, and thereby the oedema which is caused by it. They also remove the stimulus it provides for chronic inflammation and fibrosis, and its action as a culture medium for bacteria. Coumarin (5,6 benzo-[alpha]-pyrone, 56 BaP) and oxerutins (HR, O(beta-hydroxy-ethyl)-rutosides) have been used in many clinical trials on a variety of high-protein oedemas. Four such trials are summarised here: on lymphoedema and elephantiasis (from many causes in Australia, and filaritic in India and China). The drugs reduced these much more slowly than adequate physical therapy, but they did reduce them. About half the excess volume was removed over six months in the Australian trials. In India and China similar rates were achieved with lymphoedema, but elephantiasis reduced at a slower rate. The benzo-pyrones convert a slowly worsening condition into a slowly improving one. No compression garments are necessary. In addition, the drugs considerably reduce the number of attacks of secondary acute infection, reduce the deformities of elephantiasis and considerably improve the patients' comfort and mobility. They may be taken orally, or applied topically, have very low toxicities and only few, minor side-effects. They are useful in many other forms of high-protein oedema, and improve the results of physical therapy for lymphoedema.


The effect of bacterial colonization on venous ulcer healing. To determine the effect of bacterial colonization on venous ulcer healing, 82 patients with 100 venous ulcerated limbs were each studied prospectively for six months. Despite bacteriological swab results, topical or systemic antibiotics were not administered unless cellulitis supervened. Initial ulcer size, length of ulcer history and time to complete healing of colonized and uncolonized ulcers were determined and compared. Organisms were cultured from 83 limbs prior to commencement of treatment, the commonest isolates being Staphylococcus aureaus (48%), mixed coliforms (28%), Pseudomonas aeruginosa (21%) and anaerobes (17%). When compared with ulcers with no bacterial growth, colonized ulcers were of longer duration (p [symbol: see text] 0.01), had a larger initial size (p [symbol: see text] 0.001) and had significantly longer healing time (p [symbol: see text] 0.001). When analysed individually beta-haemolytic streptococci, anaerobes, Staphylococcus aureus and coliforms were associated with delayed healing. Delayed healing was not found with Pseudomonas aeruginosa, although pseudomonas-colonized ulcers were significantly larger and of longer duration than uncolonized ulcers. Bacterial colonization is associated with delayed venous ulcer healing. To further clarify the pathogenicity of colonizing bacteria, however, the effect of their eradiction on healing of venous ulcers needs to be established.


Treatment of basal cell carcinoma with intralesional interferon alpha: a case report and literature review. We report the case of a 76 year old man with three ulcerated basal cell carcinomas on his lower limbs. He was considered unsuitable for surgical therapy and was treated by intralesional interferon alpha-2b (Intron A) injections. Twenty months post therapy two of the three treatment sites remain clinically cured. Recurrence occurred at the site which received the smallest total dose of interferon. A review of the therapeutic trials of interferon alpha for basal cell carcinoma is presented. We conclude that interferon alpha-2b is a useful agent for treatment of basal cell carcinoma in selected patients.


Carbon dioxide laser treatment of periungual and subungual viral warts. This is a retrospective study of the cure rates of forty patients with subungual and periungual viral warts treated with carbon dioxide laser vapourisation (total of 69 lesions). 70.6% (48/68) lesions had failed treatment with cryotherapy and/or electrocautery treatment previously. 20/68 were treated with CO2 laser vapourisation as a first line treatment. The overall cure rate over 10 months follow-up period was 57.4% (39/68). Most recurrences (24/25) occurred within the first 3 months of vapourisation. The carbon dioxide laser vapourisation cure rate for warts in which previous cryotherapy and/or electrocautery had failed was 47.9% whereas those treated with carbon dioxide laser vapourisation as a first line treatment had a cure rate of 80% (p = 0.043). Subungual warts responded slightly better with a cure rate of 64.7% compared with periungual warts (54.9%) (n.s.). The carbon dioxide laser vapourisation cure rate for recurrent subungual and periungual warts (which failed previous carbon dioxide laser vapourisation) was 73.3% (11/15). Our findings appeared to indicate that periungual and subungual warts can be eradicated by CO2 laser vapourisation. Recurrent warts can be effectively eradicated by further vapourisation. Recalcitrant periungual and subungual warts which have previously failed to respond to cryotherapy and/or electrocautery can be effectively eradicated with CO2 laser vapourisation.


Cutaneous cryptococcosis: recurrence following oral fluconazole treatment. A case of recurrent cutaneous cryptococcosis in an immunocompromised patient is described. The patient presented with a non-healing cutaneous ulcer due to infection with Cryptococcus neoformans. Extensive investigation failed to reveal any evidence of associated systemic cryptococcosis. Treatment with oral fluconazole resulted in complete resolution of the ulcer but after several months a second cutaneous cryptococcal lesion appeared, strongly suggesting dissemination from an underlying systemic focus. This case illustrates the hazards associated with making a diagnosis of isolated cutaneous cryptococcosis and the necessity for prolonged follow-up of patients who present in this way.


Hypomelanosis of Ito: report of two cases. Hypomelanosis of Ito is an uncommon syndrome where bizarre, systematized hypopigmentation is often associated with neurological and other non-cutaneous abnormalities. We report two cases, one which was associated with laryngomalacia and sudden death (in which the parents were consanguineous), and one which was associated with episodes of loss of consciousness.


Electrogenic properties of the cloned Na+/glucose cotransporter: II. A transport model under nonrapid equilibrium conditions. The results of the accompanying electrophysiological study of the cloned Na+/glucose cotransporter from small intestine (Parent, L., Supplisson, S., Loo, D.D.F., Wright, E.M. (1992) J. Mémbrane Biol. 125:49-62) were evaluated in terms of a kinetic model. The steady-state and presteady-state cotransporter properties are described by a 6-state ordered kinetic model ("mirror" symmetry) with a Na+:alpha MDG stoichiometry of 2. Carrier translocation in the membrane as well as Na+ and sugar binding and dissociation are treated as a function of their individual rate constants. Empty carrier translocation and Na+ binding/dissociation are the only steps considered to be voltage dependent. Currents were associated with the translocation of the negatively charged carrier in the membrane. Negative membrane potential facilitates sugar transport. One numerical solution was found for the 14 rate constants that account quantitatively for our experiment observations: i.e., (i) sigmoidal shape of the sugar-specific current-voltage curves (absence of outward currents and inward current saturation at high negative potentials), (ii) Na+ and voltage dependence of Ksugar0.5 and isugarmax, (iii) sugar and voltage dependence of KNa0.5 and iNamax, (iv) presteady-state currents and their dependence on external Na+, alpha MDG and membrane potential, and (v) and carrier Na+ leak current. We conclude that the main voltage effect is on carrier translocation. Na+ ions that migrate from the extracellular medium to their binding sites sense 25 to 35% of the transmembrane voltage, whereas charges associated with the carrier translocation experiences 60 to 75% of the membrane electrical field. Internal Na+ ion binding is not voltage dependent. In our nonrapid equilibrium model, the rate-limiting step for sugar transport is a function of the membrane potential, [Na]o and [alpha MDG]o. At 0 mV and at saturating [Na]o and [alpha MDG]o, the rate-limiting step for sugar transport is the empty carrier translocation (5 sec-1). As the membrane potential is made more negative, the empty carrier translocation gets faster and the internal Na+ dissociation becomes increasingly rate limiting. However, as [Na]o is decreased to less than 10 mM, the rate-limiting step is the external Na+ ions binding in the 0 to -150 mV potential range. At 0 mV, the external Na+ dissociation constant KNa' is 80 mM and decreases to 24 mM at -150 mV. The external sugar dissociation constant KNaS' is estimated to be 200 microM and voltage independent. Finally, the internal leak pathway (CNa2 translocation) is insignificant.(ABSTRACT TRUNCATED AT 400 WORDS)


Breech delivery and epidural analgesia.

Breech delivery and epidural analgesia. To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks). A retrospective study. Data Bank, Aberdeen Maternity Hospital. 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65). Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.


Pre-employment colour vision testing.

Pre-employment colour vision testing. Male candidates (1020) for employment in occupations that required discrimination of colour were subjected to the Ishihara test and two trade tests of colour perception, the Giles Archer Lantern test and the Electricity Supply Industry (ESI) wire test. One hundred candidates failed the Ishihara test, 61 of the 100 passed both trade tests; 16 of the 100 passed the wire test alone and 7 of the 100 passed the lantern test alone but only 16 failed all 3 tests. Seventy-seven of the 84 who passed some part of their colour perception assessment were offered employment appropriate to their colour vision ability. Eleven of the 16 who passed the wire test alone and 3 of the 6 who passed the lantern test alone successfully entered employment. The Ishihara test, whilst being a useful screening test, is not sufficient on its own as a test of suitability for employment; one or more trade tests should be administered before rejecting candidates who fail it.


Schizophrenia following pre-natal exposure to influenza epidemics between 1939 and 1960. We examined the relationship between the dates of births of schizophrenic patients admitted to hospitals for the first time in England and Wales between 1970 and 1979, and the occurrence of influenza epidemics between 1939 and 1960. Our results indicate that exposure to influenza epidemics between the third and seventh month of gestation is associated with schizophrenia in adult life. The hypothesis that maternal viral infection is an important cause of schizophrenia can explain many aspects of the enigmatic epidemiology of the condition.


Accuracy of a portable interpretive ECG machine in diagnosis of acute evolving myocardial infarction. From a study of 526 patients having automatic ECG analysis, criteria were established which diagnosed acute evolving Q wave myocardial infarction with 71% sensitivity and 98% specificity. Specificity was 100% when patients with known previous Q wave infarction were excluded. In pre-hospital practice the high sensitivity and specificity were maintained. This method appears appropriate, when other criteria are met, for paramedic-initiated pre-hospital thrombolysis with remote supervision of a cardiologist by telephone.


Femoral and popliteal arteries: reanalysis of results of balloon angioplasty. The author presents an alternative statistical analysis of the results of the University of Toronto series of percutaneous transluminal angioplasty (PTA) of the femoral and popliteal arteries (n = 254). After recalculation of the data with the Kaplan-Meier method, the postprocedure success rate ranged from 88.8% +/- 2.0 at 1 month to 35.7% +/- 4.8 at 6 years. With Cox multiple regression analysis, the type of femoropopliteal lesion and the runoff were the variables that were useful to predict late results. For stenoses with good runoff, the success rate was 53% at 5 years; with poor runoff, 31% at 5 years. For occlusions with good runoff, the success rate was 36% at 5 years; with poor runoff, 16% at 5 years. In initially successful cases, ongoing clinical success at 1, 3, and 5 years was better in patients with good runoff at the time of PTA than in those with poor runoff. Now that more recent studies have documented improved technical success in femoropopliteal PTA, a comparative study of the relative safety, long-term clinical efficacy, and cumulative cost of PTA versus surgery seems warranted.


Coping with extraperitoneal insufflation during laparoscopy: a new technique. For most laparoscopists, pneumoperitoneum is essential before introducing a trocar into the peritoneal cavity. Extraperitoneal insufflation is one of the most common complications of laparoscopy; it is difficult to correct and may result in abandonment of the procedure. A technique for dealing with extraperitoneal insufflation is described. We have used this technique successfully on 11 consecutive patients. The gynecologist uses the view created by the extraperitoneal gas to place the Veress needle correctly into the peritoneal cavity. Insufflation proceeds under direct vision; the peritoneum will rise and obliterate the extraperitoneal space. This technique may be useful particularly when alternative methods are contraindicated.


Relinquishment of premarital births: evidence from national survey data. According to 1982 and 1988 NSFG data, unmarried white women are far less likely than they were in the early 1970s to place their children for adoption. The levels of relinquishment among black women have remained low throughout this period, and relinquishment among Hispanic women may be virtually nonexistent. Multivariate analysis of the determinants of relinquishment among unmarried non-Hispanic white women suggests that having a well-educated mother, being in school at the time of conception, having no labor force experience, and being older are positively associated with placing a child for adoption. Sons were found to be less likely to be relinquished than daughters.


Denture stomatitis--a review of the aetiology, diagnosis and management. Denture stomatitis is a common recurring problem of the denture wearers. The aetiology of the disease includes infection, trauma and probably a defect in the host defence mechanism. Current thinking suggests an interplay of most of these factors in the pathogenesis of the disease. The extent of interplay of these factors is still a controversy. Candida albicans has been implicated as the causative organism. However, in the light of recent research it is debatable if it is the only causative organism. Recently, cases resistant to antifungal therapy have been reported. In such cases other micro-organisms have been isolated. At the moment, comprehensive management includes meticulous denture hygiene together with anti-fungal or antibacterial therapy and correction of denture faults.


Fatal and near-fatal anaphylactic reactions to food in children and adolescents. Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days. Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.


Breast implant materials: sense and safety. Cosmetic breast augmentation, and post-mastectomy breast reconstruction surgery using synthetic implants, have become established in surgical practice over more than 20 years. The operative technique for implant placement have changed somewhat during this time, as many different implant presentations have become available, but the same basic materials have remained in use. We have reviewed the present state of knowledge about breast implant materials with particular reference to the possible connection between polydimethylsiloxane and polyurethane to the so-called "Human Adjuvant Disease", and to carcinogenesis. Problems related to capsular contracture and mammography are also discussed.


Further studies on the use of 2,2,2-trichloroethyl groups for phosphate protection in phosphoserine peptide synthesis. Boc-Ser(PO3Tc2)-OH, Z-Ser(PO3Tc2)-OH and Fmoc-Ser(PO3Tc2)-OH, derivatives useful for peptide synthesis, have been obtained in high yields by acylation of H-Ser(PO3Tc2)-OH.CF3COOH. The latter was obtained from Boc- or Z-Ser(PO3Tc2)-OBzl by simultaneous removal of the amino- and carboxy-protecting groups by Pd-catalyzed hydrogenolysis in acetic acid-trifluoroacetic acid solution. Removal of the Tc-protecting group was efficiently achieved by hydrogenolysis in aqueous ethanol.


Gastrointestinal endoscopy: an accurate and safe primary diagnostic and therapeutic modality. To review the place of gastrointestinal endoscopy in the management of upper and lower gastrointestinal disorders. We reviewed articles on endoscopy reported over two decades. A Medline search complementing our experience and knowledge of the literature was used to identify the articles. Papers were selected which focused on indications, comparison with radiology, including clinical outcome measures, and complications. One hundred papers, including those from radiology journals, were reviewed. Results of studies are referenced as appropriate. Endoscopy allows direct visualisation of the mucosa of the upper gastrointestinal tract, colon and terminal ileum. Subtleties of colour change, vascular pattern abnormalities and scarring are easily detected at endoscopy and are often of diagnostic importance. Endoscopy also provides access for tissue biopsy and allows a wide variety of therapeutic interventions. Traditionally barium studies have been the first step in the evaluation of many gastrointestinal symptoms and still retain cost advantages over endoscopy. However, endoscopy is frequently more sensitive and specific than barium studies. Costs associated with incorrect diagnoses may undermine the apparent cost benefits of barium studies. Advances in endoscopic design have allowed wider therapeutic options and increased safety. Gastrointestinal endoscopy should now be the first line of investigation where diagnostic precision is required or where therapeutic intervention is likely.


Day-to-day variation of blood glucose and insulin responses in NIDDM subjects after starch-rich meal. To study day-to-day variation of postprandial blood glucose and insulin increments in non-insulin-dependent diabetes mellitus (NIDDM) subjects and to analyze intra- and interperson variance of response. Ten NIDDM subjects attending the outpatient clinic at Aarhus Kommunehospital were studied. The subjects ate three meals of 90 g of white bread, with 7 days between tests. Mean +/- SD areas under the blood glucose response curve (above basal) over a 3-h period were 557 +/- 60, 569 +/- 74, and 565 +/- 67 mM x 180 min (NS), and areas under the insulin-response curve were 3350 +/- 448, 2815 +/- 359 and 3551 +/- 679 mU/L x 180 min (NS) on each of the three occasions. The 95% confidence intervals of blood glucose and insulin areas for the test meal repeated three times were 564 +/- 120 mM x 180 min and 3240 +/- 1645 mU/L x 180 min, respectively. Intra- and interperson components of variance were 25 vs. 75% (glucose) and 78 vs. 22% (insulin) of the total variance. The intraperson components of variance included all sources of variation other than between-person variation. There was no significant correlation between blood glucose and insulin response areas. A valid estimate of the glycemic response in a single patient is obtained after a single meal. Because of the large between-person variation, paired data should preferably be used when comparing glycemic responses to different foods.


Preventing violence through primary care intervention. Homicide was the United States' second leading cause of death among people aged 15 to 24 in 1988; non-fatal assaults occur 100 times more frequently. Yet as a society, we have ignored the problem. Risk factors for violent injuries comprise sociological, developmental/psychological and neurophysiological elements. Providers of primary care for children, young adults and their families can help parents develop healthy parenting techniques in child-rearing, help the grade-school-aged child develop non-violent conflict-resolution skills, and help young people learn to avoid violence and potentially violent activities and situations. Health care providers are able to reduce the incidence of violent injuries by addressing the issue of violence in periodic examination visits with both parents and children. Familiarity with risk indicators enables the health care provider to intervene early when needed. An anticipatory guidance outline and a violence-induced injury-visit form are included.


Youth and tobacco: addiction and death.

Youth and tobacco: addiction and death. Tobacco use by youth is a serious problem that can be handled by the combined attention of parents, youth advocates, health professional and youths themselves. Tobacco related addictions kill over 2,000,000 people worldwide every year and over 8,000 people in North Carolina. The best way to end such killings is to focus on prevention. Adolescents themselves can become leading advocates for a smokefree society and a healthier North Carolina for all of us.


Clinical performance of ceramic brackets: a survey of British orthodontists' experience. Eight-hundred-and-twenty-two British orthodontists were sent questionnaires regarding their use of ceramic brackets. Five-hundred-and-forty-six (66 per cent) responded, and from these, 512 (62 per cent) were analysed. Approximately half of these operators had experience with ceramic brackets, but only 32 operators had treated more than 30 patients. Clinicians' experiences and problems during treatment and debonding are discussed.


Developing a district diabetic register. To compile a district wide diabetic register of all diabetic patients registered with general practitioners in the catchment area of a single district general hospital and to compare different approaches to identifying patients. Information for a register was obtained from general practitioners' practice registers, the Prescription Pricing Authority, and hospital diabetic clinic records. Catchment area of an inner London district general hospital with a large diabetic clinic. All patients with a diagnosis of diabetes resident in or attending general practitioners or hospital clinics in the district or its catchment area. Prevalence of diabetes, population of patients elicited by different approaches, proportion attending the local district general hospital, cost of using prescription returns for identifying diabetic patients. 4674 patients with diabetes were identified from all sources of information, which corresponds to a mean of 22.4 patients per general practitioner and the prevalence of known diabetes of 1.17%. 39.4% of patients identified had Prescription Pricing Authority returns and 42.8% of patients appeared on practices' diabetic registers. Only 56.5% of patients identified attended the district general hospital. For practices where all sources of information were available, practice registers included 60.4% of all patients, and prescription returns and the clinic register identified 64.9% and 40.6% respectively. The cost of using prescription returns to identify patients not detected in other ways was 6.37 pounds per patient. The task of developing district diabetic registers may prove, even in one cross sectional attempt, a major task in many inner city health districts.


So, what is a clinical oncologist?

So, what is a clinical oncologist? The non-surgical management of patients with cancer often involves both radiation and medical oncologists. It is argued here that the term 'clinical oncologist' should encompass both specialties, but implicit in this is agreement in matters of both joint training and the delivery of treatment in integrated cancer centres. The provision of optimal care in district general hospitals as well as cancer centres also depends on a proper structure to which clinical oncologists provide the key. The newly created Joint Council on Oncology (involving representatives of the Royal Colleges of Physicians and Radiologists) should facilitate these agreements, breaking down old prejudices and helping to create a better standard of treatment for cancer patients in Britain.


Organization of the gene encoding the human macrophage mannose receptor (MRC1). The gene for the human macrophage mannose receptor (MRC1) has been characterized by isolation of clones covering the entire coding region. Sequence analysis reveals that the gene is divided into 30 exons. The first three exons encode the signal sequence, the NH2-terminal cysteine-rich domain, and the fibronectin type II repeat, while the final exon encodes the transmembrane anchor and the cytoplasmic tail. The intervening 26 exons encode the eight carbohydrate-recognition domains and intervening spacer elements. However, no simple correlation between intron boundaries and functional carbohydrate-recognition domains is apparent. The pattern of intron positions as well as comparison of the sequences of the carbohydrate-recognition domains suggests that the duplication of these domains was an evolutionarily ancient event.


Isolation, mapping, and characterization of two cDNA clones expressed in the cerebellum. In an effort to characterize genes expressed in the cerebellum, we have isolated two cDNA clones, H11B (D16S286) and 507 (D5S344), that hybridized to a cerebellar cDNA probe. Using a panel of human-rodent somatic cell hybrids, cDNA clone H11B was mapped to human chromosome 16, and clone 507 was mapped to human chromosome 5. TaqI RFLPs were identified with both clones and were used for linkage analysis in the CEPH families. D16S286 was tightly linked to several markers near chromosome 16p13, and D5S344 was tightly linked to several markers on chromosome 5q. Sequence tagged sites or expressed sequence tags were generated from the 3' untranslated regions of both cDNA clones.


Spinal abnormalities and the atypical form of the Mayer-Rokitansky-Küster-Hauser syndrome. In 96 patients with congenital absence of the uterus and upper vagina, the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, it proved possible to distinguish between the typical and the atypical form using laparoscopy. The typical form was characterized by symmetrical nonfunctioning muscular buds (the Müllerian duct remnants) and normal fallopian tubes, and the atypical form by aplasia of one or both buds, one bud smaller than the contralateral one, with or without dysplasia of one or both fallopian tubes. The atypical form was found in 52 patients (54.2%). Radiographs of the spine showed that congenital spinal abnormalities, especially the Klippel-Feil (KF) syndrome, were seen in 14 of the 52 patients with the atypical form only. Renal agenesis or ectopia together with the MRKH and KF syndromes, known as the MURCS association (MU: Müllerian duct aplasia; R: renal agenesis/ectopia; CS: cervical somite dysplasia), was diagnosed in 10/52 patients in the atypical group. From our results we conclude that additional cervical spine films in patients with the MRKH syndrome are indicated only in the atypical form the syndrome. In those cases where the MRKH syndrome is associated with the KF syndrome, the MURCS association should be considered.


Docking of dogs: practical and ethical aspects. Next month, the Council of the Royal College of Veterinary Surgeons will discuss the docking of dogs' tails, with a view to deciding whether docking for non-therapeutic purposes should be considered as prima-facie evidence of disgraceful professional conduct. Here, Professor David Morton considers the arguments for and against tail docking, and the ethical issues involved.


pH regulation in adult rat carotid body glomus cells. Importance of extracellular pH, sodium, and potassium. The course of intracellular pH (pHi) was followed in superfused (36 degrees C) single glomus (type I) cells of the freshly dissociated adult rat carotid body. The cells had been loaded with the pH-sensitive fluorescent dye 2',7'-(2-carboxyethyl)-5 (and -6)-carboxyfluorescein. The high K(+)-nigericin method was used for calibration. The pHi of the glomus cell at pHo 7.40, without CO2, was 7.23 +/- 0.02 (n = 70); in 5% CO2/25 mM HCO3-, pHi was 7.18 +/- 0.08 (n = 9). The pHi was very sensitive to changes in pHo. Without CO2, delta pHi/delta pHo was 0.85 (pHo 6.20-8.00; 32 cells), while in CO2/HCO3- this ratio was 0.82 irrespective of whether pHo (6.80-7.40; 14 cells) was changed at constant PCO2 or at constant [HCO3-]o. The great pHi sensitivity of the glomus cell to pHo is matched only by that of the human red cell. An active Na+/H+ exchanger (apparent Km = 58 +/- 6 mM) is present in glomus cells: Na+ removal or addition of the amiloride derivative 5-(N,N-hexamethylene)-amiloride induced pHi to fall by as much as 0.9. The membrane of these cells also contains a K+/H+ exchanger. Raising [K+]o from 4.7 to 25, 50, or 140 mM reversibly raised pHi by 0.2, 0.3, and 0.6, respectively. Rb+ had no effect, but in corresponding concentrations of Tl+ alkalinization was much faster than in K+. Reducing [K+]o to 1.5 mM lowered pHi by 0.1. These pHi changes were shown not to be due to changes in membrane voltage, and were even more striking in the absence of Na+. Intrinsic buffering power (amount of strong base required to produce, in the nominal absence of CO2, a small pHi rise) increased from 3 to approximately 21 mM as pHi was lowered, but remained nearly unchanged below pHi 6.60. The fitted expression assumed the presence of one "equivalent" intracellular buffer (pK 6.41, 41 mM). The exceptional pHi sensitivity to pHo suggests that the pHi of the glomus cell is a link in the chemoreceptor's response to external acidity.


[Rabies encephalomyelitis with myocarditis and pancreatitis. Report on a case recently imported into France]. We report the case of a 29 year-old man who died from rabies in France, following a dog-bite during a trip in Mexico. Although it was clinically suspected, the diagnosis was uncertain until he died because of digestive, cardiac and psychiatric misleading symptoms associated to the neurologic disorders. Post mortem diagnosis was based upon virological study in immunofluorescence on cerebral smears, viral isolation on cell-culture, and ELISA. It was confirmed by light microscopy examination which showed numerous Negri bodies, and ultrastructural study of the rhabdovirus in the central nervous system. Extranervous lesions, especially myocarditis and pancreatitis, were observed and their meaning is discussed. The physician is exceptionally confronted to the diagnosis of human rabies in France. Nevertheless, the lack of compulsory antirabic vaccination and the increase of touring in enzootic countries increase the risk of infection. As an intra vitam diagnosis in frequently lacking, the diagnosis of rabies infection needs a complete post mortem virological study as well as an histological and ultrastructural examination of the central nervous system.


[Immunohistochemical demonstration of ceruloplasmin and lactoferrin in a series of 59 thyroid tumors]. Fifty-nine thyroid tumors were re-examined and studied using immunohistochemistry to detect the presence of ceruloplasmin (CP), lactoferrin (LF), thyroglobulin, thyrocalcitonin, carcinoembryonic antigen and ferritin. In an attempt to study the contribution of the immunodetection of CP and LF in the diagnosis of malignant versus benign tumors, specially in follicular tumors, we compared our results of immunodetection with those of Tuccari and Barresi, and carried out our own studies on the usefulness of these immunolabelling. Concerning CP and LF staining, we have found the following data: 1) little (in contrast to Tuccari and Barresi) or no staining in normal thyroid and benign adenomas; 2) diffuse and intense staining in papillary and follicular carcinomas (as noted by the previous authors); 3) diffuse and weak staining for medullary carcinomas (in contrast to Tuccari and Barresi who found none). Our findings suggest that a diffuse and intense cytoplasmic staining with CP and LF concerning more than one third of all cells is a criterion of malignancy, whereas a weak paranuclear staining of a few cells is more in favor of a benign process.


[Neuroendocrine carcinoma of the esophagus. Case report with immunohistochemical study]. The authors report a case of neuroendocrine carcinoma of the lower third of the esophagus. Immunohistochemical study revealed that most tumor cells expressed neuron specific enolase, chromogranin A, carcinoembryonic antigen and glucagon. They insist on the usefulness of this study on biopsies in order to guide therapeutic decision.


[Colonic elastoma. A pathologic study of 7 cases]. The occurrence of elastic tissue abnormalities in the digestive tract is not common. There are sometimes observed in genetically transmitted connective tissue diseases in which numerous systemic complications are associated as in Ehlers-Danlos and in Grönblad-Strandberg syndromes. We report 7 cases of an unusual lesion localized in the colon in which abnormally increased amounts of elastic tissue were observed. This elastosis raises many nosological and diagnostic difficulties. We propose the term "colonic elastoma" to describe this lesion. The review of the literature allows to consider several etiopathogenetic possibilities.


[Cystic adenomatoid malformation of the lung, bilateral renal agenesis and left heart hypoplasia. An unusual association in Potter's syndrome]. We describe an autopsy case of congenital cystic adenomatoid malformation of the lung (CCAM) associated with bilateral renal agenesis. Prenatal ultrasound examination showed additional left heart hypoplastic syndrome. A therapeutic abortion was induced at 23 weeks of gestation. The association CCAM-bilateral renal agenesis is a rare condition (5 cases previously described) which has to be known because of the mitigation effect of the CCAM on the oligohydramnios determined by bilateral renal agenesis. However, this instance is usually associated with oligohydramnios. The pathogenesis of polyhydramnios in isolated CCAM is discussed in regard with these data.


Synthesis and anti-inflammatory activity of 2-pyridyl-2-thiobenzothiazole derivatives. A series of novel 2-pyridyl-2-thiobenzothiazole compounds was prepared and investigated by a number of in vitro methods in order to determine their anti-inflammatory properties. Results are discussed with reference to well known NSAIDs. (3-carboxy-2-pyridyl)-2-thiobenzothiazole had the most potent anti-inflammatory activity, being 1.34 times more active than indomethacin used as reference compound.


4H-thieno[3,4-c]pyrazole derivatives with antiinflammatory, analgesic, antipyretic and platelet antiaggregating activities. The synthesis of a series of 1-aryl-1,6-dihydro-4H-thieno[3,4-c]pyrazol-4-ones by cyclization of 3-[(2-arylhydrazino)methylene]thiophene-2,4(3H,5H)-diones, prepared by reacting 3-dimethylaminomethylenethiophene-2,4(3H,5H)-dione with arylhydrazines, is described. The 4-fluorophenyl derivative showed remarkable analgesic, antiinflammatory and antipyretic activities in mice or rats, as well as a platelet antiaggregating activity in vitro comparable to that of acetylsalicylic acid.


2-substituted 1H-pyrrolo [3,2-h] quinoline derivatives: synthesis and aspects of their biological activity. Certain 2-substituted 1H-pyrrolo [3,2-h] quinolines have been prepared and their biological activity in mammalian cells and in some microorganisms have been studied. These compounds represent a simplified ellipticine heterocyclic moiety: in addition they have a different ring condensation, leading to an angular molecular structure instead of a linear one. In mammalian cells all compounds appeared to be able of inducing an antiproliferative effect and an extensive DNA fragmentation, similarly to ellipticine, even if to a reduced extent. The new derivatives behaved in a comparable way also on some microorganisms, such as T2 bacteriophage (which appears to be less sensitive than mammalian cells) and in mutagenesis tests carried out with E. coli WP2 TM9 and S. typhimurium TA 98, which are reverted by base substitution and frame-shift mutagens, respectively. Similarly to the reference compound, all ellipticine analogues appeared to be no mutagenic. The obtained results suggest that they induce the antiproliferative activity in mammalian cells mainly as topoisomerase inhibitors, similarly to ellipticine itself. Therefore, they represent an interesting model to design new potential anticancer drugs.


Photobiological activity of certain new methylazapsoralens. The photobiological activity of a series of psoralen isosters carrying a nitrogen atom at 8 position, new potential drugs for the photochemotherapy of hyperproliferative skin diseases, have been studied; the more active derivatives appeared to be 5,4'-dimethyl-8-azapsoralen and 3,4,4'-trimethyl-8-azapsoralen which induced a strong inhibition of DNA synthesis in Ehrlich ascites cells, very similar to that provoked by 8-methoxypsoralen, the furocoumarin at present used in photochemotherapy. Such compounds induced a small amount of inter-strand DNA cross-links and were non phototoxic when assayed on guinea-pig skin; however, both derivatives appeared to be highly mutagenic in E. coli WP2 TM6. This strain contains the plasmid R46 and it is proficient in DNA repair, and therefore monoadducts do not should be mutagenic in such a strain. Because the first steps of excision, which remove monoadducts, and of the main cross-link repair use the same enzymes (produced by the uvrABC complex), in the presence of a great number of monofunctional lesions, it is possible that there are not sufficient enzyme molecules for removing cross-links according this pathway, which could be repaired by a second one, uvrABC independent and based on glycosilase activity, which works at reduced levels and is much less accurate.


Antifungal and antibacterial activity of 2-acetylpyridine-(4-phenylthiosemicarbazone) and its metal (II) complexes. 2-Acetylpyridine-(4-phenylthiosemicarbazone) and its metal (II) complexes have been synthesized and characterized by chemical and spectral methods. They were studied for their antibacterial and antifungal activities in vitro. The ligand and its metal (II) complexes exibited significant activity against a wide spectrum of bacteria and fungi.