Putrescine uptake and metabolism in isolated rat pancreatic acini. In addition to de novo synthesis, polyamine uptake is one of the major mechanisms in the regulation of intracellular polyamine concentrations. The aim of the present study was to investigate the uptake of putrescine (PUT) in isolated rat pancreatic acini and its further metabolic transformation. PUT accumulation was nearly linear over 60 min, showed saturation kinetics with an apparent Km of 3 x 10(-5) M and a Vmax of 346 pmol [14C]-PUT/min/mg DNA and decreased with decreasing temperature. Potassium cyanide (KCN) and dinitrophenol (DNP) inhibited PUT uptake. In the absence of a transmembrane Na+ gradient, PUT uptake decreased by 50%. After 60 min of incubation, 31% of the accumulated [14C]-PUT was metabolized. PUT uptake was stimulated by several amino acids, except for lysine, by decreasing the apparent Km for PUT uptake. PUT accumulation was reduced by spermidine (0.1 mM) by about 90%. Acetylated polyamines had only a minor effect. The release of radioactive material from prelabelled acini was only 10-20% after 90 min.


Risk of ulceration with long-term indomethacin: endoscopic and histological changes in upper gastro-intestinal mucosa. Twenty patients taking long-term indomethacin were chosen for the study because all had a normal endoscopic examination; biopsies, however, from the oesophagus, gastric antrum and duodenal bulb revealed histological inflammation in all patients in at least one site. After 8 weeks during which indomethacin therapy was continued, a further endoscopy revealed lesions in 5 patients--peptic ulcer in 3 and erosions in 2--but only 1 of these had any change in gastro-intestinal symptoms. Irrespective of whether mucosal lesions are seen on endoscopy in patients established on non-steroidal anti-inflammatory drug therapy, they remain in danger of developing both ulcers and erosions which are likely to be asymptomatic. At no time can one justifiably feel this patient group is not at risk of peptic ulceration.


Fecal fat concentration in the screening of steatorrhea. We studied if the fecal fat concentration as measured by the near infrared reflectance analysis in a spot sample is an acceptable screening test for malabsorption. This measurement was compared with the more complex fat balance in 120 patients with a suspected malabsorption [53 with chronic pancreatic disorders (CP), 67 with other digestive disorders (nCP)]. The fecal fat concentration proved to be well correlated with steatorrhea in CP (r = 0.86) but not in nCP (r = 0.35). A fat concentration of 9 g% had a sensitivity and a specificity for steatorrhea of 88.8% and of 97.1% in CP, but only of 53.8% and of 94.4% respectively in nCP. The fecal fat concentration was significantly higher in CP than in nCP, even considering patients with steatorrhea only; however, the overlap between the two groups was too high to suggest a clinical usefulness of this test in the differential diagnosis of steatorrheas. It is concluded that the fat concentration in a small sample, easily obtained also in outpatients, is useful in the selection of patients with chronic pancreatitis to submit to a proper fat balance study.


Higher erythropoietin secretion in response to cobaltous chloride in post-hypoxic than in hypertransfused polycythemic mice. We have shown previously that both erythrocyte production rate (EPR) and plasma erythropoietin (EPO) levels in response to hypoxia or to compounds able to stimulate EPO secretion are very much higher in post-hypoxic (PH) than in hypertransfused (HT) polycythemic mice with similar levels of hematocrit. Since it has been demonstrated that cobalt (Co) treatment rises renal EPO-mRNA and increases plasma EPO levels, the present study was conducted to determine whether there is a difference between PH and HT mice in relation to the erythropoietic response to Co and whether the stimulatory effect of Co on EPO secretion can be blunted by polycythemia. Adult female mice of the CF-1 strain were made polycythemic by either exposing them to 270 h of discontinuous hypoxia (18 h/d) in a hypobaric chamber maintained at 456 hPA (PH mice) or by injecting them with 0.8 ml of washed packed red cells on two consecutive days (HT mice). Measurement of the erythrocyte production rate (EPR) was made by RBC-59Fe uptake. Plasma EPO concentration was determined by RIA. Cobalt chloride (CoC12) was dissolved in saline and injected in doses of 4 and 8 umoles/mouse. Recombinant human EPO (HEMAX 4000, Bio Sidus SA, Argentina) was dissolved in PBS + albumin to the desired concentration. By comparison with the corresponding dose-regression line for rHu-EPO, it was estimated that the responses (EPR) (measured as RBC-59Fe incorporation) of PH mice to sc injections of 4 and 8 umoles of CoC12 were equivalent to 95 and 145 mU of rHu-EPO, respectively. The response of HT mice to 4 umoles of the drug was not detectable. At the upper dose level, the response was equivalent to 52 mU of rHuEPO. Plasma immunoreactive EPO (iEPO) titers 12 h after COC12 (8 umoles) were not significantly different between normocythemic and PH mice. The observed values were significantly higher than those found in HT mice. These findings demonstrate that EPO production in response to COC12 is depressed by polycythemia when induced by transfusion but not when induced by chronic exposure to hypobaric hypoxia. They also confirm, but not explain the nature of the conditioning effect of exposure to hypoxia which makes the mechanism controlling EPO secretion either more sensitive to EPO-secreting stimuli or unable to recognize the polycythemic state.


Hereditary spherocytosis (HS) due to loss of anion exchange transporter. Hereditary spherocytosis encompasses a heterogenous group of inherited disorders due to alteration of r.b.c. surface/volume ratio. Spectrin deficiency is the most common observed defect. We analyzed a case of HS associated with band 3 deficiency without spectrin reduction. In the study of a family originating from southern Italy, we show that a 20% deficiency of band 3 with normal spectrin content may be responsible for dominantly inherited hereditary spherocytosis (HS). The proband is a 12 years old girl consulting for jaundice, chronic anaemia and splenomegaly. Her mother had a similar haematologic phenotype. Electrophoretic analysis of erythrocyte membrane proteins showed a deficiency in band 3 protein. Band 3 protein chymotryptic fragments, deglycosylated band 3, and its isolated cytoplasmic domain, all displayed normal electrophoretic migrations. Furthermore, the tryptic peptides profile of the cytoplasmic domain of the protein did not demonstrate any abnormality, nor did the amino acid composition of the peptides. Analysis of the membrane proteins during erythrocyte ageing, evaluated in density-fractionated red cells, showed that band 3 content was normal in the lighter fraction, whereas in the denser fraction band 3 deficiency was more pronounced than in membranes from non fractionated red blood cells. This case describes HS due to anion exchange transporter deficiency. Our results on fractioned red cells support the hypothesis that the defect was probably due to a band 3 protein loss during cell ageing and not to a primitive quantitative defect.


High-dose cyclophosphamide followed by GM-CSF is a safe and effective procedure for the recruitment of trilineage circulating progenitor cells. Several methods for the recruitment of circulating progenitor cells (CPC) to be used for hemopoietic rescue after myeloablative therapy have been described. The present study was designed to verify the effectiveness and safeness of one of such procedures, involving the administration of high-dose cyclophosphamide (HD-CTX) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Eight tumor patients were treated with HD-CTX (7 g/m2), followed by GM-CSF (7 mcg/Kg/day, continuous infusion) from day +2 to the completion of leukocyte recovery, when aphereses for CPC harvesting were performed. CPC were evaluated by clonogenic assay for granulocyte-macrophage colony-forming units (CFU-GM), megakaryocyte colony-forming units (CFU-Meg) and erythrocyte burst-forming units (BFU-E) before therapy as well as during the hemopoietic recovery. In each patient, a significant increase of trilineage CPC was observed, at a mean of 14 days from HD-CTX, with peak increment of 224, 268 and 230-fold for CFU-GM, CFU-Meg and BFU-E respectively. The mean duration of leukocyte count < or = 0.5 x 10(9)/l was 6.6 days, with severe thrombocytopenia (grade 4 WHO) lasting 2.8 days in 5 patients. GM-CSF infusion was well tolerated without any need for dose reduction or discontinuation. The administration of HD-CTX and GM-CSF induces a significant enhancement of CPC including CFU-Meg other than CFU-GM and BFU-E. The procedure is suitable for the recruitment of CPC in patients with CTX sensitive tumors.


Limiting dilution analysis of IL-2 producing cells: I. Studies of normal human peripheral blood. After marrow transplantation, the interaction of helper T lymphocytes from the donor with the patient alloantigens leads to cellular activation and release of IL-2 as initial events of the graft versus host reaction. A method for assessing the size of the pool containing allospecific helper T cells capable of producing IL-2 could be applied in the selection of better donors for marrow transplantation. PBMC are added to replicate sets of wells each containing various amounts of EBV-LCL cells and PHA. After culture for some days the supernatant is removed from each well and added to IL-2 dependent CTLL-2 line. The proliferation of the CTLL-2 line is assessed by pulse labeling with 3H-thimidine. The precursor frequency of cell capable of producing IL-2 per ml/blood is estimated from the minimum X2 regression of the function of non-responding wells plotted as logarithmic function of the number of PBMC added per well. Approximately 30-40% of PBMC are found to produce IL-2 under the following conditions in culture: the optimal PHA concentration is 1.25 micrograms/ml, the optimal number of stimulator EBV-LCL cells is 1 x 10(3) and 3 days of culture are required. Here we report a rapid and quantitative technique of limiting dilution analysis that can estimate the frequency of peripheral blood mononuclear cells capable of secreting interleukin-2 following interaction with specific alloantigen.


A pilot External Quality Assessment Scheme for haemocytometry in Italy. An Italian EQA scheme for haemocytometry, organized by the Istituto Superiore di Sanità, has been active for about five years (1984-1989). The aims of this programme were to evaluate the state of the art and to introduce in Italy a scheme recommended by ICSH. N. 126 public laboratories from different provinces joined voluntarily the programme and trials for haemoglobinometry (A01, A02), full blood count (B01-B08) and platelet count (D01-D03) were performed. Materials for testing consisted of blood lysate, preserved blood preparation containing native red cells and pseudoleukocytes, suspension of fixed platelets. The performances of laboratories was evaluated by consensus values (median, mean and standard deviation) and individual deviation index. The instrument survey demonstrated that fully automated systems had the highest frequency. Non Gaussian distributions of results were often obtained and this was particularly true for WBC, PLT and MCV. The overall variability was lower than 5.5% for Hb, RBC and MCH and lower than 9.3% for other erythrocyte parameters; WBC and PLT counts displayed a higher dispersion (CV* = 9.8% and 25.4%); the spreading of results was strongly reduced in the homogeneous group of Coulter counters. In the course of the programme CV*s didn't show any relevant modification, a steady state performance being apparent. As regards the nature of variability, the random component was prevalent for all parameters, with the exception of MCV. This pilot programme allowed to demonstrate the practicability of a national EQAS for haemocytometry according to the ICSH guidelines. Materials for testing showed acceptable stability, homogeneity and commutability. As regards analytical equipment as well as analytical variability, hospital centers participating in these EQA trials were comparable with laboratories taking part in similar EQAS of other European countries.


ANLL patients with normal karyotype are not a homogeneous prognostic group. Karyotype in ANLL is referred as an independent prognostic factor. The prognosis of diploid ANLL subjects has been defined as "good" by some authors, or, more recently, "intermediate" by others. This is a retrospective study on 30 consecutive heavy treated ANLL diploid patients with the aim to make a correlation among age, normal karyotype and response. Chromosomal banding studies were performed at presentation with GTG technique. Diploid patients were divided into two age groups < 60 years (17 cases) and > or = 60 (13 cases). Data were analyzed by NCSS software. CR rate for the two diploid age groups was 94% and 38% respectively (p = 0.002). Median DFS and overall survival were 14.4 and 23.3 months, 4 and 5 months for the two subgroups respectively: these data were not statistically significative. The probability of achieving CR was not affected by blood counts and Karnofsky performance status on admission, but only by age. Though ANLL patients with the same karyotype have the same course regardless of other prognostic factors, this does not occur in our series of diploid patients. We suggest that a normal karyotype, at least as defined with the GTG technique, does not characterize a homogeneous group of patient. Heterogeneity in this group might be due to submicroscopic or molecular genetic changes; it can enhance the age as prognostic factor.


Evaluation of erythroid marrow response to recombinant human erythropoietin in patients with cancer anaemia. Anaemia is a frequent finding in patients with cancer and may be due to different causes, including blunted erythropoietin production. In a pilot study, we administered recombinant human erythropoietin (rHuEPO) to twelve patients with solid tumours and secondary anaemia. rHuEPO was given subcutaneously 5 d per week at escalating doses (75 to 150 U/kg per day): the aim of treatment was a Hb level > or = 10 g/dl without blood transfusion. We evaluated endogenous EPO production through serum EPO levels and erythroid marrow activity by means of serum transferrin receptor (TfR). Six out of 12 subjects had defective endogenous EPO production. All patients but two responded to treatment with steady increases in Hb levels above 10 g/dl, and the median dose of rHuEPO required for correction of anaemia was 75 U/kg. Response was associated with an early increase in serum TfR. Six patients developed functional iron deficiency and required iron supplementation to obtain response. Treatment improved functional ability in 4/10 responders. Subcutaneous rHuEPO can stimulate erythroid marrow activity in cancer anaemia, even in patients with advanced disease, and marrow response can be adequately monitored by serum TfR. Functional iron deficiency as a cause of nonresponse to rHuEPO is frequent in these patients and may require parenteral iron administration. Although erythropoietin can improve the anaemia of cancer, the decision to treat should be individualised for each patient, looking more at the quality of life and cost-effectiveness than at cosmetic increases in the haemoglobin level.


alpha-Interferon treatment of chronic hepatitis C in young patients with homozygous beta-thalassemia. Chronic infection with the hepatitis C virus (HCV) and iron overload are the main causes of chronic liver disease in subjects with homozygous beta-thalassemia (HBT). Iron overload can be counteracted by intensive chelation. alpha-interferon reduces viremia and necroinflammation in patients with chronic HCV hepatitis. To assess the effectiveness and safety of alpha 2b-Interferon (IFN), we enrolled in an open pilot trial of treatment 12 patients with HBT and biopsy-proven anti-HCV positive chronic hepatitis. IFN was given at a dose of 5 MU/m2 thrice weekly for 8 weeks, then 3 MU/m2 thrice weekly for 18 weeks. Patients were followed up to 24 months after stopping treatment when a second liver biopsy was performed in subjects with sustained response (normal ALT during follow-up). Two patients discontinued IFN at 7 weeks because of haemolytic anemia and one after 8 weeks due to persistent fever. Among 9 subjects completing the protocol, 5 normalized ALT while on treatment and a further 2 within two months after stopping IFN. A sustained response was obtained altogether in 5 patients, since ALT relapsed in 2 responders. None of the 3 subjects who discontinued IFN and of the 2 patients who did not respond to treatment normalized ALT over a 24 months follow-up. Post-treatment liver histology in long-term responders showed a reduction of portal, periportal and lobular necroinflammation, while siderosis was essentially unchanged. Although the pattern of response to IFN in HCV-infected subjects with HBT might differ from that of non-thalassemics, due to peculiar side effects and delayed response, the drug appears to be effective and deserves further investigation.


Acute renal failure occurring during intravenous desferrioxamine therapy: recovery after haemodialysis. A patient with transfusion-dependent thalassemia was undergoing home intravenous desferrioxamine (DFX) treatment by means of a totally implanted system because of his poor compliance with the nightly subcutaneous therapy. Due to an accidental malfunctioning of the infusion pump, the patient was inadvertently administered a toxic dosage of the drug which caused renal insufficiency. Given the progressive deterioration of the symptoms and of the laboratory values, despite adequate medical treatment, a decision was made to introduce haemodialytical therapy in order to remove the drug and therapy reduce the nephrotoxicity. From the results obtained, haemodialysis can therefore be suggested as a useful therapy in rare cases of progressive acute renal failure caused by desferrioxamine.


Antiphospholipid antibodies and splenic thrombosis in a patient with idiopathic myelofibrosis (antiphospholipid antibodies and thrombosis). A case of idiopathic myelofibrosis and hepatosplenic myeloid metaplasia associated with antiphospholipids antibodies is described. The patient developed a lethal complete splenic vein thrombosis in spite of an intravenously heparin treatment had been started soon after a clinical pattern of "acute abdomen".


[Radical prostatectomy--experience with 50 patients]. Between 1986-1991 we treated 50 men with adenocarcinoma of the prostate by radical prostatectomy. Ages ranged from 44-74 and clinical stages were A-C. Follow-up lasted 1-63 months (mean 15.1) and was designed to rule out recurrence and/or spread of the disease and to evaluate quality of life. The rate of complications was low, the postoperative course short and uneventful, and there was preservation of urinary continence in 96% and of potency in 10.2%. As compared with radiotherapy, surgery gave superior results and is recommended.


[Percutaneous endoscopic gastrostomy].

[Percutaneous endoscopic gastrostomy]. Although percutaneous endoscopic gastrostomy (PEG) for feeding purposes has been in use for the past 10-12 years, many practitioners are unaware of this option. We describe 10 patients who underwent PEG with only 1 major, but nonfatal, complication. We stress that PEG is indicated for those who cannot swallow, and is safe, easy to perform, and a relatively cheap procedure. It is therefore a useful substitute for surgical gastrostomy.


Soluble factors levels in the initial staging of high-grade non-Hodgkin's lymphomas. Plasma levels of several soluble factors were assayed in 31 untreated patients with high-grade non-Hodgkin's lymphomas (NHL). The results showed statistically significant higher average levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-2 receptor (IL-2r) and transferrin receptor (TF-r) in NHL patients compared to controls (p = 0.045, p = 0.047, p = 0.020, p = 0.026 and p = 0.033 respectively). IL-2, IL-2r and TF-r levels were found more elevated in Stages III/IV than in Stages I/II (p = 0.031, p = 0.016 and p = 0.048 respectively), whereas IL-6 concentrations were higher in patients presenting B symptoms (p = 0.011). Significant correlations were found between the erythrocyte sedimentation rate (ESR) and IL-6 (r = 0.681), and between beta 2 microglobulin (B2-m) and IL-2r (r = 0.622).


[Pneumatic-retinopexy scleral buckling for retinal detachment]. 30 eyes with rhegmatogenous retinal detachment due to retinal tear at the upper half of the circumference or due to a macular hole underwent SF6 gas injection into the vitreous. In 25 eyes (83%) the retina had re-attached 1-2 days following the injection and the tear was then photocoagulated. Final visual acuity was 6/12 or better in 13 eyes, 6/15-6/20 in 4 eyes, 6/30-6/60 in 8 eyes and less than 6/60 in 5 eyes, 3 of which had a macular hole. There was no morbidity or irritation compared to conventional scleral buckling, and the functional results were better. 4 of the 5 failures underwent successful surgery. In only 1 eye the retina could not be attached by surgery. Pneumatic retinopexy can substitute for surgery in selected cases of retinal detachment.


Cutaneous involvement of systemic fungal infections in neutropenic patients. Skin nodules can be the first evidence of a disseminated fungal infection in febrile neutropenic patients. We present our experience in the diagnosis of this clinical problem in five patients treated for serious hematologic conditions in our Service. There were two cases of Candida sp., two of Fusarium sp., and one of Trichosporon sp.. The immediate assessment of any suspicious lesion, including a biopsy of the lesion for microbiological and histopathologic examinations, will usually lead to the correct diagnosis.


[Cimetidine hepatitis].

[Cimetidine hepatitis]. A 41-year-old man with rheumatoid arthritis developed severe acute hepatitis 3 days after starting cimetidine for duodenal ulcer. Other causes were ruled out and he recovered after cimetidine was discontinued. Mild transient elevations of hepatic enzymes have been reported in 3.6% of patients taking cimetidine. However, only 12 cases of severe acute hepatitis associated with cimetidine, mostly secondary to idiosyncrasy, have been reported in the English literature. This rare but serious complication of cimetidine should be kept in mind.


[Transient hyperphosphatasemia of infancy]. Transient hyperphosphatasemia of infancy was diagnosed in 4 children hospitalized during a 6-month period (0.3% of all hospitalized children). The characteristic features of this disorder are: 1. elevation of serum alkaline phosphatase (of both liver and bone origin) up to 3-30 times the upper limit of normal for age (usually discovered during intercurrent infection); 2. return of the serum alkaline phosphatase to normal in a few weeks; 3. no residual clinical or laboratory evidence of bone or liver disease. The child is usually less than 5 years old. Recognition of the benign nature of this disorder prevents extensive laboratory workup and unnecessary anxiety.


[Jacuzzi-immersion for obstetric analgesia]. The effect of immersion in a jacuzzi in relieving labor pains, and on cervical dilatation was examined in 40 parturients. They were immersed in the jacuzzi during labor for an average of 25.5 minutes. Labor pains decreased during immersion by 2.59 degrees (scale of 0-10) compared with an average increase in labor pains of 0.25 degrees in 40 control women who were not immersed (p < 0.01). The cervical opening increased during immersion by an average of 1.5 cm in the test group, compared with 0.3 cm in the controls (p < 0.01). Immersion in a jacuzzi during labor is apparently associated with analgesia and accelerated cervical dilatation.


[Subcutaneous emphysema complicating laparoscopic cholecystectomy]. Laparoscopy using carbon dioxide has been a standard gynecological procedure for many years. During the past 3 years, it has become commonly used in general surgery as well. Laparoscopic cholecystectomy is rapidly spreading world-wide. Although minor and major complications have been attributed to this procedure, their frequency is low. We report a case of subcutaneous emphysema following laparoscopic cholecystectomy.


[Aortocaval fistula].

[Aortocaval fistula]. Aortocaval fistula is a rare phenomenon which has both acute and chronic clinical presentations. Its diagnosis and treatment are difficult and it presents a surgical challenge of the first degree, requiring intensive perioperative care. A patient with an aortocaval fistula is described. It was found during emergency operation for a ruptured abdominal aortic aneurysm.


Sizing of balloons in balloon mitral valvotomy. In twenty six consecutive patients who underwent balloon mitral valvotomy (BMV) by the transseptal double balloon technique, the mitral valve area (MVA) increased from 0.78 +/- 0.1 cm2 to 1.80 +/- 0.3 cm2, (p < 0.001). Effective balloon dilating area (EBDA) of each combination of balloons used was calculated using a standard formula. Patients were classified into 4 subgroups with approximate EBDAs of 3.3, 4.0, 4.9 and 5.7 cm2 and they had mean post-BMV MVAs of 1.28, 1.78, 1.89 and 1.98 cm2 respectively (ANOVA F = 3.32, p < 0.05). Patients were reclassified after normalisation of EBDA and post-BMV MVA to square metre of body surface area. Three subgroups with mean normalised EBDAs of 2.32, 2.96 and 3.62 cm2/m2 had mean normalised post-BMV MVAs of 0.99, 1.17 and 1.40 cm2/m2 respectively (ANOVA F = 6.85, p 0.01). A trend towards increasing mitral regurgitation with increasing balloon size was noted. Three cases of mitral regurgitation including one case of severe mitral regurgitation occurred in the subgroup of 9 patients with largest normalised EBDAs. The overall correlation between normalised EBDAs and normalised post BMV MVA was strong r = 0.67, p < 0.01). The optimal normalised EBDA for Indian patients undergoing BMV is around 3.6 cm2/m2. Balloons used should be sized accordingly.


Balloon angioplasty for native aortic coarctation. From May 1987 to August 1990, eighteen patients underwent balloon angioplasty for native aortic coarctation. The age of the patients ranged from four to fifty six years (mean age 17.5 years). The procedure was successful in all cases with a reduction in the peak gradient across the coarctation from 61 +/- 19 mm Hg to 11.7 +/- 8.1 mmHg (p < 0.05). The coarcted segment increased from 4.5 +/- 1.9 mm to 10.7 +/- 3.9 mm (p < 0.05). Peak gradient at six to twelve months follow up, obtained in ten patients, was 19.8 +/- 10.1 mmHg (p = NS). There were no life threatening complications, although seven patients had local vascular problems after the procedure. In two patients, there was persistence of hypertension necessitating drug therapy. On haemodynamic and angiographic restudy in 10 patients, one patient had restenosis and none had aneurysm formation. We conclude that balloon angioplasty is a safe, and less invasive alternative to surgery for native aortic coarctation with gratifying immediate and short term results.


Relation between major indices of prognosis in patients with chronic congestive heart failure: studies of maximal exercise oxygen consumption, neurohormones and ventricular function. Peak exercise capacity (Peak VO2), neurohormonal changes, ventricular enlargement and ejection fraction are among the most important determinants of prognosis in congestive heart failure. However, the inter-relation between these parameters is unknown. We, therefore, correlated these indices in patients with hemodynamically severe congestive heart failure (NYHA class II, pulmonary artery wedge pressure 25 +/- 2 mm Hg, cardiac index 2.5 +/- 0.2 l/min/m2, ejection fraction 43 +/- 2% and fractional shortening 19 +/- 1%). Peak VO2 measured directly during exercise by breath to breath expiratory gas analysis using a metabolic cart was 23 ml/min/kg. Plasma epinephrine (E) and norepinephrine (NE) were measured by high performance liquid chromatography (HPLC) and plasma renin activity (PRA), aldosterone (Aldo), cortisol, prolactin, growth hormone, anti-diuretic hormone (ADH) and antinatriuretic peptide (ANP) by radioimmunoassay. Ejection fraction was measured by echocardiography. There was no relation between peak VO2 and any of the neurohormones E: r = -0.43, NE: r = -0.43, ANP: r = -0.49, Cortisol: r = -0.37, ADH: r = -0.07, Aldo: r = -0.45, 2 tail critical value 0.55. PRA showed a modest correlation (r = -0.61). Similarly, there was no relation between ejection fraction or degree of ventricular enlargement and any of the other indices (r = -0.05). We conclude that although peak VO2, neurohormonal profile and ventricular function are important individual prognostic determinants, there seems to be no direct relation between them.


Long term follow up study of prognostic significance of exercise duration during treadmill stress test in patients with stable coronary heart disease. Treadmill stress tests provide useful noninvasive prognostic information in patients with coronary heart disease (CHD). The present study has prospectively analysed the long term prognostic value of exercise tolerance as measured by exercise time during treadmill stress test in 335 consecutive patients with stable CHD. 161 had exercise time of 6 minutes or less (mean 4.58 +/- 1.54 minutes) on a modified protocol (Group A) and 174 had exercise time of more than 6 minutes (mean 9.30 +/- 0.74 minutes)(Group B). Both groups were matched for major coronary risk factors (hypertension, smoking, diabetes and cholesterol levels) and type of drug therapy (betablockers, nifedipine, diuretics and aspirin). The patients have been followed up for upto 9 years with a mean of 6.28 +/- 2.99 years (Group A) and 7.87 +/- 1.98 years (Group B). Actuarial analysis shows that the overall survival after dropout due to death or coronary artery bypass surgery was significantly lower in group A [dropouts = 66 (41.0%)] than in Group B [dropouts = 19 (10.9%)] (Logrank test = 39.94, p < 0.001). The mortality was significantly higher in Group A with 58 deaths (36.0%) as compared to Group B with 16 deaths (9.2%) (x2 = 34.98, p < 0.001). The crude death rate was 5.73% per year in Group A as compared to 1.17% per year in Group B. The incidence of sudden deaths was also higher in Group A with 28(17.4%) instances as compared to 5(2.9%) in Group B (x2 = 19.85, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


Association between incidence of lipoprotein(a) positivity and coronary heart disease. Serum samples from 167 (109 male, 58 female) hospital based staff as controls and 760 (596 male and 164 female) clinically documented patients of coronary heart disease (CHD) were subjected to 3.75% polyacrylamide gel electrophoresis for lipoprotein profile and the presence of lipoprotein(a) [LP(a)], which is reported to be an independent risk factor for CHD. Serum total cholesterol, triglyceride and ratio of the electrophoretically separated LDL/HDL lipoprotein fractions were also evaluated. The significant observations are (i) a large proportion of both male and female CHD patients showed the presence of LP(a) as compared to controls, (ii) The incidence of LP(a) positivity was found to be independent of sex and age in controls. Female patients however showed marginal increase (p < 0.05) with age. Male patients of < 40 years demonstrated three times higher incidence of LP(a) presence as compared to their female counterparts, (iii) Comparison of LP(a)+ and LP(a)- patients for serum lipid levels did not show any significant difference. It is inferred that LP(a) positivity may be independent of these lipid variables.


Silent myocardial ischaemia and cardiac autonomic neuropathy in diabetics. Treadmill exercise electrocardiography was performed in 47 patients of diabetes to detect latent coronary artery disease. Eighteen patients (36.3%) were found positive on treadmill test. All forty seven subjects were evaluated for cardiac autonomic neuropathy. The incidence of cardiac autonomic neuropathy in treadmill positive group was 72.2% as compared to 31.0% in treadmill negative group, (p < 0.01). Nine patients from the positive group and 4 patients from the negative group were subjected for coronary angiography, which revealed significant CAD in 8 and 1 subjects in both groups respectively. It is concluded that the incidence of silent myocardial ischaemia in diabetics is very high and cardiac autonomic neuropathy seems to be the most probable reason for absence of pain.


Haemodynamic advantage with single chamber rate responsive pacemakers over dual chamber pacemakers during exercise in chronotropic incompetence. Sequential cardiac chamber activation and chronotropic response are amongst the important determinants of cardiac performance. This study compared VVIR mode with DDD and VVI mode to assess the contribution of these two factors in the determination of cardiac performance during exercise. Ten patients with a mean age of 68 +/- 5 years were studied during 1988-90, who had complete heart block and sinus node dysfunction with a mean LV ejection fraction of 51.5 +/- 6.25%. Five patients had DDD pacemakers and the rest had VVIR pacemakers. Patients were exercised first in VVI mode followed by either DDD or VVIR mode. Exercise duration, maximum rate pressure product, exercise capacity and cardiac output were measured with graded treadmill test in Bruce protocol. There was remarkable increase in the exercise duration (P < 0.001) and the maximum rate pressure product (P < 0.001) in patients with VVIR as compared to DDD and VVI mode. In DDD mode, as compared to VVI mode, this increase was less remarkable, though statistically significant (P < 0.005). Therefore, it is concluded that patients with chronotropic incompetence as well as complete heart block do better during dynamic exercise when they have VVIR mode compared to VVI or DDD mode.


Effects of peroxidized oil on the development of experimental atherosclerosis in rabbits. Ingestion of peroxidized oil under hypercholesterolemic dietary conditions resulted in a number of biochemical and pathological changes in rabbits. Total lipids, cholesterol and glyceride levels of plasma, liver and aorta were significantly higher in peroxidized oil fed rabbits, compared to the ones receiving normal oil. The degree of atherosclerosis and the severity of histopathological changes were significantly higher in rabbits fed with peroxidized oil.


Rheumatic heart disease: a school survey in a rural area of Rajasthan. Thirty four of 10168 school going children were found to have rheumatic heart disease (RHD) in a school survey conducted in the rural areas of Churu district in Rajasthan. The prevalence rate was 3.34/1000. A high prevalence of RHD was found in 11 to 15 year age group. Maximum prevalence of RHD was in low socioeconomic group. Out of these thirty four cases of RHD, isolated mitral stenosis was present in sixteen, isolated mitral regurgitation in four, combined mitral stenosis and mitral regurgitation in ten patients.


Genetic variants of serum albumin: a study of albumin Kashmir. The study of human serum albumin variants is reviewed with reference to albumin Kashmir, a typical variant. Its published instances are listed and its position in this field of investigations is indicated.


A 500 MHz proton NMR study of interaction of tripeptides Lys-Tyr-Lys and Lys-Phe-Lys with deoxydinucleotide d-CpG. The binding of di- and tetranucleotides with tri- and tetrapeptides containing Tyr, Trp, Phe having lysine on both ends has been studied using a 500 MHz proton NMR. The results show that d-CpG exists as a right-handed B-DNA structure with both sugars in 01'-endo sugar conformation and glycosidic bond angle as in anti domain. On binding to tripeptide Lys-Tyr-Lys, the Tyr ring protons shift upfield by 0.015 ppm at 285 degrees K, while the conformation of d-CpG remains unchanged. Change in chemical shift of Tyr and nucleotide protons decreases with temperature. This upfield shift is attributed to stacking with bases/base-pairs. The presence of intermolecular NOE's also supports this. Results of binding of d-CpG to Lys-Phe-Lys are similar to those with Lys-Tyr-Lys except that the chemical shift changes occur to a lesser extent. On comparing the results obtained with three different peptides, it is found that interaction decreases in the order Trp > Tyr > Phe which is similar to that found by theoretical energy calculations (reported elsewhere) and fluorescence measurements. The results also exhibit a specificity in recognition of these amino acid residues by dinucleotides.


Crystal structure of cadaverine dihydrochloride monohydrate. The structure of cadaverine dihydrochloride monohydrate has been determined by X-ray crystallography with the following features: NH3+ (CH2)5NH3+.2Cl-.H2O, formula weight 191.1, monoclinic, P2, a = 11.814(2)A, b = 4.517(2)A, c = 20.370(3)A, beta = 106.56 degrees (1): V = 1041.9(2)A3; lambda = 1.541A; mu = 53.41; T = 296 degrees; Z = 4, Dx = 1.218 g.cm-3, R = 0.101 for 1383 observed reflections. The crystal is highly pseudo-symmetric with 2 molecules of cadaverine, 4 chloride ions and 2 partially disordered water molecules present in the asymmetric unit. Though both the cadaverine molecules in the asymmetric unit have an all trans conformation, the carbon backbones are slightly bent. Between the concave surfaces of two bent cadaverine molecules exists water channels all along the short b axis. The water molecules present in the channels are partially disordered.


Spectrophotometric study of the relative affinities of teichoic acid for different metal ions. Spectrophotometric study of the relative affinities of teichoic acid (TA) for Na+, Ca2+, Mg2+, Cd2+, Hg2+, Cu2+ and Pb2+ described on the basis of the disruption of metachromasia of dye 1,9-dimethyl methylene blue (DMMB)-polyanion (TA) system has revealed the following sequence of relative affinities of TA for these metals: Na+ < Ca2+ < or = Mg2+ < Cd2+ < Hg2+ < Cu2+ < Pb2+. Some of the metal ions particularly Pb2+ and Hg2+ have specific interactions with the dye, and induce distinct metachromatic band of the dye even in the absence of the polyanion.


Studies on induction of metachromasy in cationic dye pinacyanol chloride by Klebsiella K7 capsular polysaccharide. The acidic capsular polysaccharide isolated from Klebsiella K7 induced metachromasy in the cationic dye pinacyanol chloride indicating its chromotropic character. Interaction of the biopolymer with the cationic dye was studied by visible absorption spectrophotometry, and thermodynamic parameters of the interaction evaluated. The polymer induced a metachromatic blue shift in the spectrum from 600 nm to 495 nm. The spectral changes were studied during interaction of the dye with the polymer at different polymer/dye molar ratios (P/D = 0 approximately 50). Effects of co-solvents on the stability of the dye-polymer compound were studied. A complete reversal of metachromasy was observed upon addition of different alcohols and urea solution. Thermodynamic parameters obtained from the spectral data indicated chromotropic character of the polymer in interacting with the cationic dye molecules in solution.


Effect of nitrous oxide and methionine on hepatic S-adenosylmethionine levels and in vivo histidine oxidation in rats. Nitrous oxide (N2O) decreased in vivo oxidation of histidine in rats fed a basal diet marginally deficient in methionine, although hepatic levels of S-adenosylmethionine (AdoMet) were not significantly altered. Excess dietary methionine increased hepatic levels of AdoMet and increased histidine oxidation. However, it did not protect histidine oxidation when the rats were treated with N2O. Parenteral administration of methionine greatly increased hepatic levels of AdoMet and increased histidine oxidation in normal and N2O treated rats. This indicates that when hepatic levels of AdoMet are greatly elevated by administration of methionine, N2O does not affect in vivo histidine oxidation.


Identification of a non-microsomal cinnamic acid 4-hydroxylase from potato tuber (S. tuberosum) and its partial purification. The cytoplasmic localisation of cinnamic acid 4-hydroxylase (CA4H) has been shown by isolation and subcellular fractionation of the enzyme in Hepes buffer. The enzyme was purified by ammonium sulphate fractionation followed by AcA-34 molecular sieve chromatography. The enzyme existed as a high molecular mass which dissociated to a lower form on dilution on the column. The pH optimum, sulphydryl requirement, molecular and preliminary kinetic characteristics were investigated.


Effect of picroliv on low density lipoprotein receptor binding of rat hepatocytes in hepatic damage induced by paracetamol. Picroliv from root and rhizome of Picrorhiza kurroa showed reversal of low density lipoprotein (LDL) binding to paracetamol-induced damaged hepatocytes of rats. Changes in levels of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, conjugated dienes and lipids of hepatocytes were significantly prevented by picroliv at different doses. The effect of picroliv on enzyme levels, LDL receptor binding and lipids in damaged hepatocytes was found to be comparable to silymarin, a known hepatoprotective agent.


Interaction of pulmonary surfactant-associated protein (SP-A) with surfactant lipids. A pulmonary surfactant-associated protein complex with components of 36, 32 and 28 kDa was isolated from human lung homogenates and reassembled with surfactant lipids prepared as small unilamellar liposomes. The role of divalent cations in the assembly of this recombinant lipoprotein complex was studied by monitoring the changes in turbidity, intrinsic tryptophanyl fluorescence and surface activity. The protein-facilitated lipid aggregation was promoted on addition of 5 to 20 mM Ca2+. Intrinsic fluorescence measurements on SP-A (28-36 kDa) indicated that the tryptophan side chains were in a relatively hydrophobic environment, that the wavelength of maximum fluorescence emission and also the relative fluorescence, were changed upon the binding of lipid. Tryptophanyl fluorescence of the lipoprotein assembly was quenched as indicated by a reduction in the effective Stern-Volmer constant. These results suggest that Ca2+ lipid-protein interactions are involved in the structure and function of extracellular lung surfactant assembly.


Synthesis and secretion of VLDL by rat hepatocytes--modulation by cholesterol and phospholipids. The synthesis and secretion of apoB, the major protein component of very low density lipoprotein (VLDL) and low density lipoprotein (LDL), were studied using rat hepatocytes maintained in primary culture. Supplementation of hepatocytes with rat serum VLDL and LDL increased the production of apoB while delipidated lipoproteins had no significant effect, suggesting a role for lipids in the production of apoB. Addition of cholesterol to the culture medium also increased the production of apoB in a concentration-dependent manner. Pulse labelling followed by chase in presence of cholesterol indicated enhancement in apoB secretion. Mevinolin which inhibits cholesterol synthesis significantly reduced the secretion of apoB. The presence of phosphatidylcholine and phosphatidylethanolamine in the culture medium also increased the secretion of apoB into the medium. These data suggest that availability of lipids, particularly cholesterol, is an important determinant of apoB synthesis and secretion as VLDL.


Bordetella pertussis extract induces increase in the activities of glycolytic enzymes in mouse liver. The hypoglycemic effect of Bordetella pertussis (Challenge strain No.18323) purified cell extract (protein with traces of carbohydrates, 2 mg%) administered (0.1 mg/100 g body wt. i.v.) into mice on the activities of the key regulatory enzymes, viz. glucokinase, phosphofructokinase, pyruvate kinase, glyceraldehyde phosphodehydrogenase, glucose-6-phosphate dehydrogenase (G-6-PD) and lactate dehydrogenase, of glycolytic pathway in liver has been studied at varying intervals after injection. The maximum hypoglycaemic effect was observed at the end of 12 hr, while activities of all the enzymes studied showed significant enhancement after 18 hr, thus suggesting increased glucose utilization towards the formation of pyruvate. Actinomycin D is found to inhibit stimulation of G-6-PD activity in B. pertussis treated animals, thereby indicating the role of B. pertussis in synthesis of this enzyme.


Value issues in biomedical science: public concerns and professional complacency. Biomedical research was once an unquestioned good, and generous funding for a short time allowed researchers to work on whatever interested them. Two contradictory pressures have changed this. As costs have risen and economic rationalism has become politically dominant, governments, private corporations and granting agencies have increasingly demanded compliance with their own priorities, instrumental values and performance criteria. On the other hand, social and ethical critics have characterized biomedical research as being out of touch with real health needs and community values and as being an agent of social control that entrenches the power of a technocratic hegemony. The profession has largely acquiesced in bureaucratic and corporate intervention in exchange for continued funding, and assumed that social concerns could be allayed by 'top down' paternalistic education of the public. However, this response tends to add weight to the criticism that biomedicine is an agent of social control. What is needed is a spirited defence of the value of independent scholarship and research that is not limited to science but includes the humanities. Equally important is a process of community education in which scientists not only transmit their knowledge and enthusiasm to the public, but themselves become open to the social and ethical concerns of the community.


Inhibition of adjuvant arthritis in the rat by phosphosugars and the alpha-glucosidase inhibitor castanospermine. The development of joint inflammation of adoptively transferred arthritis in rats was inhibited by treatment with the simple sugar mannose-6-phosphate or the alkaloid inhibitor of alpha-glucosidase, castanospermine. Mannose-6-phosphate was effective at a dose of 25 mg/kg per day delivered via mini-osmotic pumps implanted either subcutaneously or intraperitoneally. Castanospermine was given orally in the drinking water and rats ingested on average 60-65 mg/kg per day. Histological examination of tissue from treated rats revealed greatly reduced inflammatory infiltrates into the synovium and surrounding tissue. Castanospermine not only inhibited the development of arthritis but also inhibited the progression of the disease when treatment was commenced after the onset of symptoms. Possible mechanism(s) of action of these compounds could be their ability to inhibit the passage of leucocytes through vascular subendothelial basement membranes by inhibiting the function or expression of leucocyte cell surface-bound enzymes that are essential for such migration. Castanospermine could also inhibit inflammation through its ability to prevent the expression of adhesion molecules, which may be necessary for the capture and retention of leucocytes in the inflamed tissue.


Serological responses and immunity produced in salmonids by vaccination with Australian strains of Vibrio anguillarum. The Australian populations of rainbow trout (Onchorhynchus mykiss) and Atlantic salmon (Salmo salar) were found to have similar immunological responses to local strains of Vibrio anguillarum as those reported for the more genetically diverse populations of these fish and strains of V. anguillarum found in the Northern Hemisphere. In addition, our studies more precisely defined the respective responses of rainbow trout and Atlantic salmon to immersion vaccination by the bath and dip methods.


What is the selective pressure that maintains the gene loci encoding the antigen receptors of T and B cells? A hypothesis. The dominant view is that the gene loci encoding the B cell antigen receptor (BAr) or the T cell antigen receptor (TAr) specify a vast array of combining sites. The 'germline' repertoire is estimated to be > 10(10) by multiplying numbers of subunit complements by DN-region variability. This implies that the germline can be maintained by a selection imposed by all or most of the antigenic universe. Its unchallenged popularity, notwithstanding, this neo-germline view is untenable and hence the need for a competing concept, as presented here. The immunoglobulin (Ig) loci are under a totally different selection from the T loci. The Ig loci are selected upon largely by carbohydrate determinants on pathogens that vary more slowly than the proteins produced by the Ig loci, which are necessary to rid these selective antigens. By contrast, the T loci are selected to recognize the allele-specific determinants on restricting elements encoded in the major histocompatibility complex (MHC). The expression of the germline results in a high copy number (HCN) repertoire; this repertoire is the substrate for 'mutation' that yields the low copy number (LCN) repertoire. For the B cell, these two repertoires interact to optimize the response to the unexpected. For the T cell, only the LCN repertoire is functional. The immunoglobulin (Ig) loci are selected upon as light(L)-heavy (H) pairs; the T loci are selected upon as single units alpha or beta (i.e. the VT-gene segments act as a single pool). This competing concept carries with it many important and testable consequences.


The importance of T cell homing and the spleen in reaching a balance between malaria immunity and immunopathology: the moulding of immunity by early exposure to cross-reactive organisms. It takes a number of years to develop clinical immunity to malaria and malaria pathology is also most evident a number of years after birth. T cells are known to play an important role in defence from malaria parasites but may also contribute to the disease symptoms associated with malaria. T cells which react against malaria parasites have arisen through stimulation with organisms which cross-react with malaria or through exposure to the malaria parasites themselves and express a memory phenotype (CD45Ro+, CD45Ra-, CD4+). T clones which have arisen through exposure to cross-reactive organisms may be expected to home to the tissues where initial exposure occurred as determined by tissue-specific adhesion molecules on the lymphocyte surface. Such tissues may not be appropriate to parasite killing and localization of T cells in such sites may contribute to the immunopathology of malaria. The sharp increase in immunity and decline in pathology observed in later childhood in malaria endemic areas may result from an increase in the number of T cells induced by the parasite itself (as opposed to cross-reactive organisms). Such T cells may not have a preferential trafficking to other organs and may be more likely to circulate through the spleen. Splenic changes may also allow more malaria-specific T cells to concentrate in the spleen and may facilitate interactions between T cells, monocytes, neutrophils and parasites resulting in parasite death. Whereas cytokines secreted by parasite-reactive T cells in all locations may contribute to cerebral malaria and other forms of pathology, cytokines in the spleen at least, should directly contribute to parasite death.


Development of human ABO blood group A antigen on Escherichia coli Y1089 and Y1090. Studies by other workers have shown that some strains of Escherichia coli have surface antigens analogous to the human blood group ABH antigens, and that these are carbohydrates associated with membrane lipopolysaccharides. This study has demonstrated that E. coli strains Y1089 and Y1090 possess the H antigen, which can be converted to the A antigen by incubation with A-transferase (N-acetyl-galactosaminyl transferase) and A-sugar (UDP-N-acetyl-galactosamine). Such cells will then form mixed agglutinates with human A red cells and human polyclonal (but not mouse monoclonal) anti-A antibodies. E. coli Y1089 and Y1090 have endogenous enzymes that use the A-sugar (in the absence of A-transferase) to produce a variant A antigen. Cells expressing this variant antigen adsorb anti-A antibodies but do not participate in mixed agglutination with human group A red cells. It is estimated that E. coli Y1089 and Y1090 possess approximately 5000 H epitopes per cell that can be converted to A epitopes.


Macrophages in protective immunity to Hymenolepis nana in mice. When mice were treated with carrageenan just before infection with eggs of Hymenolepis nana, they failed to exhibit sterile immunity to the egg challenge, with evidence of a decrease in the number of peripheral macrophages (Mø) and the rate of carbon clearance. Although there were high levels of interleukin-1 (IL-1) released into the intestinal tracts of the parasitized mice at challenge infection, there was almost no release of IL-1 in those treated with carrageenan just before challenge. These results strongly suggest that Mø have an important role in protective immunity to H. nana in mice.


Effect of alcohol on serum lipids & lipoproteins in male drinkers. The evaluation of the effect of moderate and high doses of ethanol on the serum levels of triglyceride (TG), total cholesterol (TC), cholesterol content of very low density lipoprotein (VLDL), low density lipoprotein (LDL), high density lipoprotein (HDL), HDL2, HDL3 subfractions and apoproteins: apo-AI and apo-B was undertaken in 45 (25 controls, 10 moderate and 10 high dose drinkers) healthy males. The results of this preliminary study showed a significant rise in total HDL-cholesterol and apo-AI levels of alcoholics of both the groups. Out of the two subfractions, HDL2 appeared to be induced more. Increased levels of atherogenic lipids (TG, VLDL-chol., LDL-chol. and apo-B) were found in high as well as moderate drinkers. Our results suggest that the benefit of alcohol intake need to be weighed carefully against its considerable risks.


An interactive image analysis system for quantitative cytology & to classify cervical cells. Introduction of computers and image analysis systems are gaining faster momentum in order to quantitate the assessment of cells for diagnosis and prognosis, and this system aims to relieve the operator from the tedium of microscopic observation and reduce operator bias and human error. This paper discusses the design and configuration of an interactive image analysis system built in the laboratory for the purpose of cell analysis and classification. The software developed to compute various textural and morphological parameters of cells on smear are briefly described. The results of the experiments carried out to classify normal and abnormal cells on cervical smear show 94 per cent success rate.


An immunoradiometric assay for measurement of serum thyroglobulin. A two-site immunoradiometric assay (IRMA) for estimation of serum thyroglobulin (tg) is optimized using partially purified rabbit anti-tg antibodies (ammonium sulphate precipitated) as a solid phase antibody and affinity purified 125I labeled anti-tg antibodies as a tracer. The IRMA correlated well (r = 0.93, n = 200, P < 0.001) with conventional radioimmunoassay (RIA). The inter- and intra-assay coefficient of variation were comparable for both methods. The IRMA method gave a superior sensitivity and working range (2 ng/ml, 3-1000 ng/ml) as compared to that of RIA method (6 ng/ml, 9-500 ng/ml). Using IRMA the total incubation time was curtailed to 4 h as compared to 90 h required for conventional RIA. The shelf-life of tracer antibody used in IRMA was much longer (3 months) as compared to tracer tg (3-4 wk) used in RIA. The optimized IRMA for quantitation of serum tg has superior assay characteristics as compared to RIA.


Volume of semen as a parameter of its quality. A total of 1655 semen samples obtained from men who underwent initial semen analysis before enrolling for IVF-ET programme were analysed. The semen samples were categorized arbitrarily on the basis of volume as high (> 4.5 ml), normal (1.5-4.5 ml) and low (< 1.5 ml). The semen parameters studied vis-a-vis volume of the sample were viscosity, osmolality, motility, sperm count and morphology. The different volume groups were also compared to the overall quality of the sample. The study showed that high and low volume semen were associated with high incidence of spermatozoa exhibiting subfertile characteristics. Normal volume per se did not indicate the quality of the sample, however high and low volumes were indicators of semen of subfertile quality. There was an inverse correlation between osmolality and volume of semen sample. Thus the parameter 'volume' gives a rough estimate of the quality of the sample.


Cytogenetic investigations in Down syndrome patients & their parents. A total of 1343 mentally retarded patients referred for cytogenetic evaluation were studied. Of these Down syndrome was confirmed in 365 (21.17%). There were 316 patients of trisomy 21 (86.58%); 21 of mosaicism (5.75%) and 28 of translocation (7.67%). Trisomy 21 patients with chromosomal variants were observed in 17 (4.65%). A 1.37:1 male:female ratio was seen. Karyotyping was also done on 182 parents (of patients of mosaic Down, translocation Down and trisomy 21 with chromosomal variants and in parents with suspected low mosaicism). Mosaic trisomy 21 cell line was found in one mother (0.27%); 6 parents (1.65%) were seen to be translocation carriers and 7 had chromosomal variants (1.92%). Cytogenetic investigations help to give appropriate genetic counselling to patients and their families.


Serum leucine amino peptidase levels as a marker in testicular tumours. Serum levels of leucine aminopeptidase (LAP) were studied in 60 patients with testicular tumours and 26 normal individuals, and were found to be significantly elevated in patients with seminomas, nonseminomas and benign tumours of the testis. After treatment the LAP levels decreased in patients with seminomas, nonseminomas and mixed cell carcinomas indicating response to therapy. The quantitative method used for estimation of LAP, which is simple, quick, accurate and cost-effective, could be used more effectively as a tumour marker in testicular malignancies.


Testicular biopsy in male infertility.

Testicular biopsy in male infertility. A total of 134 testicular biopsies from infertile men were studied. The potentially treatable causes of infertility viz. Normal spermatogenesis with post-testicular obstruction, maturation arrest and hypospermatogenesis together constituted about 54 percent of all cases. The incurable causes viz., germ cell aplasia, tubular fibrosis and Klinefelter's syndrome together constituted about 42 percent of all cases. Testicular biopsy in male infertility is a very useful procedure since it gives a lot of information on the diagnosis and helps in planning treatment.


Sequential MTX-5 FU chemotherapy in pallination of advanced cancer cervix. Twenty four patients with advanced cancer of cervix were submitted to sequential chemotherapy 5FU and MTX. The response rate was 85% in stage III and 50% in stage IV. Overall response rate was 75%. Patients who had not received radiotherapy earlier responded better than those who had received it earlier. This easy and economical modality has importance in view of late reporting and advanced stage of disease encountered in our set up.


Use of bovine osteogenic protein to promote rapid osseointegration of endosseous dental implants. An enriched bovine osteogenic protein preparation in combination with bone collagen matrix (osteogenic protein device) was used to effect new bone growth in extraction sites in the presence or absence of titanium dental implants. Incisor and canine teeth were extracted from each of three cynomolgus monkeys, and implants were inserted directly into the sockets without surgical site preparation. The osteogenic protein device induced new bone formation in close apposition to the titanium implants in all trials within 3 weeks. A lesser amount of new bone formation in both sets of control sites was limited to the bony socket walls and not closely apposed to the implant. These data show that the osteogenic protein device is capable of inducing new bone formation in tooth sockets within 3 weeks in the presence or absence of titanium implants. This is the first known demonstration of the therapeutic induction of bone formation in close apposition to metallic implants.


Optimization of surface micromorphology for enhanced osteoblast responses in vitro. In vitro cellular responses of osteoblast-like cells were studied on titanium surfaces with different surface morphologies. Surface profilometry was used to determine whether rough or smooth surfaces with regular or irregular morphologies can be produced by conventional fabrication techniques. Significantly higher levels of cellular attachment were found using rough, sandblasted surfaces with irregular morphologies. These results correlate with recent in vivo findings and suggest that implants should be prepared with roughened surfaces at bony contact areas.


Prosthesis design for osseointegrated implants in the edentulous maxilla. The position of osseointegrated implants in the edentulous maxilla is dictated by available bone and can vary widely among patients. Anatomy limits the amount of bone available for placement of osseointegrated implants. With increasing resorption, the number, length, and position of implants are further compromised. Bone grafts are frequently needed to place implants of adequate length. The variability of implant placement indicates the need for multiple prosthesis designs in the maxilla. Prosthesis design considerations are suggested for patients with minimal, moderate, and severe resorption of the edentulous maxilla.


A 3-year clinical study of Astra dental implants in the treatment of edentulous mandibles. A prospective study for the treatment of mandibular edentulism using the new Astra dental implant system was conducted on 54 patients. The clinical performance of 310 implants was monitored over 3 years. The survival rate was 100% for the prostheses and 98.1% for individual implants. Four implants failed during the first 3 months after placement, one was retained as a "sleeper," and two more were removed because of persistent discomfort. Both resorption and deposition of mandibular marginal bone were observed. Bone changes from baseline to the end of the first year ranged from -0.4 to +1.0 mm (median 0.00), from the first to the third year from -0.8 to +0.6 mm (median 0.04), and over the 3 years ranged from -1.1 to +1.0 mm (median 0.01). No marked mean bone resorption was observed during the first year compared to the two following years. A significant gain in marginal bone level was recorded in males, but in females the level was unchanged. There were no serious inflammatory reactions in the surrounding soft tissues during the 3-year follow-up period.


Plaque-induced inflammation around implants. This article is a review of plaque-induced inflammation around dental implants. The microflora around successful implants is similar to healthy sulci, while that associated with failing implants is similar to periodontally diseased sites. Implant microflora is similar to the tooth microflora in the partially edentulous mouth. The microflora of implants in partially edentulous mouths differs from that in edentulous mouths. This seems to indicate a bacterial reservoir around the teeth and the possibility of reinfection of the implant sulcus by periodontal pathogens. The maintenance of a tooth microflora consistent with periodontal health in partially edentulous mouths may lead to maintaining an implant microflora consistent with peri-implant health. Thus, periodontal and implant maintenance are linked and neither can be overlooked.


Reduced corrosion of CP Ti and Ti-6A1-4V alloy endosseous dental implants after glow-discharge treatment: a preliminary report. Inductively coupled argon plasma spectroscopic analysis was used to quantify titanium, aluminum, and vanadium corrosion products released by superficial layers of identically shaped commercially pure titanium and Ti-6A1-4V alloy dental implants. Halves of each of two originally sterile groups were analyzed directly from the manufacturer's packaging and the other halves received glow-discharge treatment prior to their corrosion assay. The implants were incubated in pH 3 modified saline solution and were analyzed after 2- and 12-week corrosion periods. Implants treated with glow discharge showed statistically significant reduction in the amounts of corrosion products released, apparently as a result of glow-discharge-produced surface oxides of greater passivity than originally present.


The influence of occlusal surface material on peak masticatory forces using osseointegrated implant-supported prostheses. Masticatory forces associated with porcelain and acrylic resin occlusal surfaces on osseointegrated implant-supported prostheses opposing natural teeth were studied in five healthy subjects. A three-channel electronic force transducer carrying a fixed prosthesis with either acrylic resin or porcelain occlusal surfaces and balanced articulation was used to record masticatory forces while the subjects chewed various foods. It was found that mean peak masticatory forces varied considerably from subject to subject but were consistent within each subject. No differences related to tooth material could be detected in the load rates. Forces directed away from the implants were noted in all subjects.


Loads and designs of screw joints for single crowns supported by osseointegrated implants. The problem of screw stability was approached in this study by calculating the maximum occlusal forces in vivo for patients with single implant restorations (which use only one screw to secure the prosthetic reconstruction to the implant). The measurements of occlusal forces together with geometric parameters for the individual patients were used to determine the necessary holding capabilities of the screw joint. Different screw designs were tried in bench test situations and the results were compared with clinical situations. A gold alloy screw with a flat head and high tightening torque (35 Ncm) produced the best results.


Reconstruction of maxillary alveolar defects with mandibular symphysis grafts for dental implants: a preliminary procedural report. Partially edentulous patients with alveolar defects contraindicating implant placement were treated with bone grafts obtained from the mandibular symphysis. Complications encountered were minor and uneventful. Evaluation 4 months after surgery revealed minimal graft resorption, thus implant placement was possible in all potential sites. Advantages of the symphysis graft include easy access, availability of greater quantities of bone over other intraoral donor sites, low morbidity, no hospitalization, minimal discomfort, no alteration in ambulation, and no cutaneous scar. Compared with other bone regenerative methods for implant placement, a superior quality of bone was found and a shorter healing period is required. Results of this preliminary clinical investigation demonstrate that chin grafts offer a viable alternative for reconstruction of alveolar defects prior to dental implant placement.


Risk factors associated with dental implants in healthy and medically compromised patients. A total of 104 consecutive patients treated with 313 Nobelpharma implants was studied to determine the medical risks associated with dental implants. There did not appear to be an increased implant failure rate or an increase in perioperative morbidity in patients with a compromised medical status. Age; sex; and concurrent use of hypoglycemic agents, supplemental female hormones, or steroids also did not correlate with increased implant failure or perioperative morbidity. Implant procedures using a variety of pain-/anxiety-control agents failed to reveal any increase in anesthetic-related complications. However, the number of implants placed per patient did correlate with implant failure. It appears that implant surgery and the required anesthetic appear to be safe procedures even in the medically compromised patient.


The role of computerized tomography in dental implantology. Dental implant therapy has dramatically expanded the treatment options available for both the partially and completely edentulous patient. Advances in the use of dental implants have necessitated the inclusion of additional diagnostic procedures in the treatment planning process to optimize the site and angulation of fixtures and, consequently, the success of prosthetic restorations. One of these procedures is computerized tomography. Originally introduced as a medical diagnostic technique, it has been adapted for many uses in dentistry. This article reviews the role of computerized tomography in dental implantology. Its advantages, disadvantages, and indications are presented.


A utility analysis of dental implants.

A utility analysis of dental implants. By applying a utility (usefulness) scale termed the "Feeling Thermometer" to 111 edentulous patients, a measure of effectiveness (quality-adjusted prosthesis years) that can be compared across several treatment strategies was developed. The results suggest that the utility scale was a valid (known group, P < .05), reliable (intraclass correlation coefficient = .713) measure of patients' preferences for the three treatment strategies: (1) conventional complete dentures (controls, n = 77), (2) transosteal implant-supported prostheses (n = 19), and (3) endosseous implant-supported prostheses (n = 15). The implant-treated patients rated their prostheses as high or higher (Feeling Thermometer score of 86.3 [endosseous] and 82.3 [transosteal]) than a functional fitting, esthetic conventional denture (score of 85.0 [endosseous] and 82.0 [transosteal]). They were also younger, more educated, and had received more sets of dentures (P < .05) than conventional denture patients.


Isotope diagnostics, CT and MR in urinary tract diseases of infants and children. Ninety-nine isotope, 4 CT and 10 MR examinations were carried out in 1990 to test urogenital disorders in infants and children. The procedures are described with sidelights on indication, difficulties of technical nature and comparison with internationally published reports. An examination strategy is devised, with estimation of its effectiveness in the follow-up and after-care.


Ultrasonographic screening of neonatal adrenal apoplexy. A total of 1785 newborns were subjected in the course of 14 months to ultrasonographic screening. Adrenal bleeding among those born via caesarean section has not been recorded. Among 1490 born via vagina there were 14 (0.94%) with adrenal apoplexy and 80 were delivered with clavicular fracture (5.37%). There were 13 with unilateral bleeding. Hormone examination applied to one infant with bilateral bleeding confirmed adrenal insufficiency which normalized after three months. In the aetiology of neonatal adrenal apoplexy the dominant causative role is attributed to birth trauma.


Differential diagnosis of adrenal tumour and upper pole renal tumour by I-131 cholesterol adrenocortical scintigraphy. A 27-year-old housewife with right hypochondralgia was admitted for treatment of a huge right adrenal or upper pole renal tumour. The tumour measured 10 x 8 x 8 cm and was hypovascular. The main blood supply derived from the right adrenal artery which originated from the abdominal aorta just proximal to the right renal artery. Although several diagnostic imaging studies suggested that the tumour arose from the right adrenal gland, the bilateral adrenal glands were equally visualized on I-131 cholesterol adrenocortical scintigraphy. After surgery and pathological examination, the tumour proved to be a renal cell cancer, while the right adrenal gland was intact. This case demonstrates that adrenocortical scintigraphy is useful in the differentiation of adrenal and renal tumours when a large tumour occupies the upper pole of the kidney or adrenal gland.


Renal cell carcinoma in chronic renal failure without dialysis treatment. We report a case of renal cell carcinoma in chronic renal failure without dialysis treatment. The literature is reviewed, and the relationship between renal cell carcinoma and uraemia is discussed.


Urinary infection and stone formation as complications of Gil-Vernet's antireflux procedure. The authors describe two cases of urinary infection and stone formation as late complications of Gil-Vernet's antireflux treatment. The immediate cause of these complications was the migration to the mucosal surface of the nonabsorbable sutures employed in this technique.


Recurrence of superficial bladder tumours after transurethral resection. From 1979 to January 1990, 48 patients with newly diagnosed superficial bladder tumours were treated by transurethral resection (TUR) at Toyama Medical and Pharmaceutical University Hospital. The relationship between tumour recurrence and the stage, grade, number, or size of the tumours was investigated. The 1-, 2-, 3-, 4- and 5-year non-recurrence rates were 72%, 63%, 47%, 40%, and 40%, respectively. Non-recurrence rate for pTa tumours was significantly higher than that for pT1 tumours (p < 0.05). There was no relationship between tumour grade and recurrence. The rate of recurrence of multiple tumours was higher than that of single ones. There was no difference in non-recurrence rate between tumours smaller than 1 cm and those of 1 cm or larger. Non-recurrence rate in the instillation therapy group was significantly higher than in the non-instillation group (p < 0.05). It was concluded that patients with multiple or high-stage tumours have the risk of a high rate of recurrence and that intravesical chemotherapy is effective in preventing local recurrence in some patients.


The influence of bilateral orchiectomy on volume changes of the prostate in men with advanced prostatic cancer--the predictive value. The changes of prostatic volume were evaluated in 84 men with adenocarcinoma of the prostate treated by bilateral orchiectomy. In every case the greatest volume decrease was observed during the first month after castration. In 56 patients (66.6%), where the response to orchiectomy was better, the reduction of prostatic volume was considerably greater and diminished more rapidly than in the remaining 28 patients (33.3%), where the reaction to the treatment was worse.


Germ cell neoplasms in three intersex patients with 46,XY karyotype. This report presents 3 cases with gonadoblastoma mixed with other germ cell tumours in intersex patients, all with a 46,XY karyotype. One 11-year-old patient was a true hermaphrodite, the others, aged 13 and 18, respectively, had both gonadal dysgenesis. Different clinical courses have been noted. Two patients had gonadoblastoma combined with dysgerminoma; in one of them a teratoma was also found. In the third case gonadoblastoma was transformed into teratocarcinoma. The malignant degeneration was more serious in the 2 pubertal patients. Thus, we recommend early and prophylactic gonadectomy.


Primary malignant melanoma of the scrotum. The authors describe a rare case of primary scrotal neoplasm. The necessity of a prompt diagnosis is emphasized.


Meatal advancement and glanuloplasty: a report on 25 cases. We report on 25 children who underwent repair of distal hypospadias with the meatal advancement and glanuloplasty technique. The principles of this operation were safe and there were no complications. Meatal advancement and glanuloplasty proved to be a successful and reliable procedure in the properly selected child with distal hypospadias.


Ultrasonic changes in primary gouty nephropathy. Investigations were carried out in a total of 60 patients with gouty nephropathy (GN), chronic glomerulonephritis (CGN) and chronic pyelonephritis (CPN), respectively. The aim of the study was to compare ultrasonic changes in the three diseases.


Continuous arteriovenous haemodialysis and haemofiltration in intensive care acute renal failure patients. CAVHD and CAVH were compared regarding uraemic control in 13 critically ill intensive care patients with acute renal failure (ARF). Patients' mean age was 60 years. Pretreatment blood urea range was 17-56 mmol/l (33-56 mmol/l in 70% of the patients). All patients received vasopressor drugs, and 92% were on artificial mechanical respiration. From the results of this study both modalities gave adequate uraemic control. There was a notable decrease in the urea and creatinine levels with CAVHD more than with CAVH. There was no statistically significant difference between the two modalities in the urea clearance. However, a significant difference (P < 0.05) in creatinine was obtained with CAVHD. Our results suggest that CAVHD is a useful alternative to CAVH in ARF especially when the blood urea level is > 30 mmol/l. However, a higher dialysate flow rate (e.g. 25 ml/min) should be used if the urea level is more than 40 mmol/l. CAVH should be reserved for ARF patients in whom fluid overload is a major problem.


Candida peritonitis: successful treatment with CAPD in two patients. The authors treated seven patients with CAPD between September 1986 and December 1990. In two of them Candida peritonitis was observed. The pathogen proved to be Candida albicans in both cases. The traditional antimycotic treatment resulted in a temporary improvement in both patients; complete healing was only achieved after removal of the Tenckhoff catheter. Subsequently both patients were put to haemodialysis. Successful renal transplantation was performed two weeks and three months, respectively, after removal of the catheter. The authors' experience supports the opinion that removal of the Tenckhoff catheter constitutes the most important move in the management of Candida peritonitis.


Effect of haemodialysate and its peptide fractions on lactate dehydrogenase activity in erythrocytes from healthy subjects and patients with end-stage renal disease. The effect of haemodialysate and its 3 peptide fractions on lactate dehydrogenase activity in erythrocytes was studied in patients treated by repeated haemodialysis for end-stage renal disease and in healthy subjects. Erythrocytes from dialyzed patients showed significantly lower LDH activity than those from healthy subjects. After a 3-h incubation with haemodialysate (675 and 450 micrograms protein/ml), or its peptide fraction III (270 and 190 micrograms protein/ml), a significant inhibition of LDH activity was observed. On the other hand, neither haemodialysate nor its peptide fractions inhibited LDH activity in red blood cells from patients with end-stage renal disease treated by repeated haemodialysis.


Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations. Arthrodesis of the hip is thought to achieve satisfactory clinical and functional results in the adult despite the loss of articular mobility involved (Santori et al., 1986; Russel, 1987; Weber, 1987). Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and knees due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires further intervention. Surgery on these joints may yield satisfactory short-term results, but these will not last if the arthrodesed hip is not converted to total hip arthroplasty either prior to or at the same time as such operations.


Hip deformity and dislocation in spina bifida. A group of 118 patients with spina bifida treated between 1960 and 1988 was reviewed with a focus on the problem of hip deformity and dislocation. Deformity can be avoided by physical therapy and correct posture. Hip dislocation often occurs in cases of high or mid-lumbar lesions; at lower levels subluxation is more common. In choosing appropriate treatment, the most important consideration is the patient's true functional potential. If the patient is either not ambulatory or severely impaired, his or her condition will not be exacerbated by a dislocated hip.


Thigh pain in cementless hip replacement. Clinical and radiographic correlations. The authors analyse a series of 35 Rippen System cementless hip joint prostheses implanted in 32 patients from May 1987 to September 1988. Certain radiographic parameters were studied in an attempt to find a correlation with the clinical results. Special attention was paid to the high incidence of thigh pain, attempting to identify the cause through radiographic study of the bone-implant interface. Even when analyzed using Kappa statistics, the correlation between the clinical and radiographic findings was purely incidental. In agreement with the literature, the authors identify some elements which should be investigated further such as primary temporary fixation of the stem, reduction of micromotion, and biocompatibility of the materials.


Rotator cuff tears. Results of surgical repair. A prospective study was done on 73 patients who underwent surgical repair of a rotator cuff tear. The patients were divided into four groups according to the active shoulder flexion and the trophism of the rotator cuff muscles: group A--range of motion > 100 degrees; group B--ROM 60-100 degrees; group C--ROM < 60 degrees; group D--ROM < 100 degrees and significant muscle hypotrophy. The rotator cuff tears were classified into four groups at surgery according to size: grade I measured < 2 cm; grade II measured 2-4 cm, grade III measured > 4 cm but was reparable; and grade IV was irreparable. The results were evaluated after an average follow-up of 2.3 years and correlated to several factors including the preoperative clinical assessment, the size of the lesion, the type of lesion (tear or detachment), and the mechanism of injury (traumatic or atraumatic). Seventy-three percent of the cases had satisfactory results. The preoperative clinical assessment and the size of the tear were the most important indicators of the final outcome. The proportion of satisfactory results underwent a progressive decline from group A (88%) to group D (14%) and from grades I and II (88% and 89%, respectively) to grade III (56%) and grade IV (none). Rotator cuff repair is almost always successful in patients with more than 60 degrees of active arm flexion and either small or medium-size tears. Less than two-thirds of the patients with major tears and less than 60 degrees of motion achieve satisfactory results. Failure is highly probable in irreparable tears and in the presence of significant hypotrophy of the rotator cuff muscles.


Static-dynamic intramedullary nailing (SDIN) in diaphyseal and metaphyseal lower limb fractures. The authors report their experience with the Grosse-Kempf nail in treatment of diaphyseal and metaphyseal fractures of the femur and tibia. The biological and biomechanical preconditions of the method as well as several details of the surgical technique are discussed, and the results of 70 procedures performed from 1986 to 1989 are evaluated. The outcomes are quite positive and confirm other reports in the literature.


Treatment of slipped capital femoral epiphysis: evaluation of the results of extracapsular epiphysiodesis and open reduction-epiphysiodesis. The authors review 26 patients who underwent either "in situ" extracapsular epiphysiodesis or intracapsular reduction followed by epiphysiodesis for slipped capital femoral epiphysis (SCFE). A total of 32 operations were performed. In the first group (chronic grade II SCFE), no complications occurred in the 16 operations and the results were excellent in all cases. In the second group (chronic grade II and III SCFE and acute-on-chronic SCFE), in 16 operations we observed four cases of avascular necrosis, two of which accompanied by chondrolysis. Three of these were in cases of acute-on-chronic SCFE. The results confirm that the cases of acute-on-chronic SCFE have the worst prognosis and a much higher risk of avascular necrosis and/or chondrolysis than purely chronic SCFE. Early diagnosis of ischemic complications make it possible to maintain the spherical shape of the femoral head and good joint function. The results are considerably better than in untreated cases.


The ultrastructure of peripheral neurofibroma: the role of mast cells and their interaction with perineurial cells. The authors analyze the ultrastructure of mast cells and perineurial cells when both are present in neurofibroma of the nerve sheath. Samples of pathologic tissue taken from three patients with neurofibroma of a peripheral nerve sheath were analyzed by light and transmission electron microscopy. The observations document the characteristics of the tumor cells (Schwann cells and perineurial cells) as well as the presence of numerous mast cells, typically in close contact with the perineurial cells and never with the Schwann cells. Many electron-dense vesicles were found between the cells; these vesicles are created when the cell membrane of the mast cell buds, and then they come into contact with the adjacent perineurial cell. Endocytosis vesicles are often present in the cytoplasm of perineurial cells. Analysis of these observations led the authors to assume the existence of a metabolic interaction between the two cell type in contact with each other and an active role of the mast cells in the evolution of the tumor. The following two theories are plausible: either the mast cells actively stimulate tumor growth, or they alter the phenotype of the tumor cell. These findings could have interesting clinical applications. The use of treatment protocols which inhibit mast cell activity could, in theory, stop either the proliferation of the neurofibroma or its malignant transformation.


Bone scan features in spontaneous knee pain. In 21 patients with "spontaneous" knee pain, 99mTc-MDP bone scan was found to be more sensitive than clinical and radiographic examination in detecting alterations of the joint components. These alterations were shown by increased radionuclide uptake in the compartments where pain was present, which was most commonly the medial femorotibial compartment, although the femoropatellar compartment was also frequently affected. The authors conclude that bone scan should be the first imaging study performed on the knee in order to establish if further tests are necessary.


External callus development on ultrasound and its mechanical correlation. The authors compare the variations in the ultrasonographic and radiographic images with the strain gage values in long bone fractures treated by external fixation. The three test parameters were applied during the entire healing process of 239 fractures. There is a direct correlation between ultrasonographic changes and the calcification of the periosteal callus; there is also a correlation between the morphologic development visible on ultrasound and the stage of the callus. The strain gage values recorded were consistent with these variations.


Primitive synovial chondromatosis of the hip joint. Primitive synovial chondromatosis of the hip is quite rare. Through the presentation of four new cases, the authors discuss the pathologic and clinical features of this disease and evaluate the performance of imaging studies, emphasizing the value of CT scan for confirmation of radiographic findings. The indication for surgical treatment is analyzed for each stage of the disease.


Kinematic and isokinetic evaluation of patients with flat foot. In recent years research into joint physiology and biomechanics of movement has employed high-technology instruments to quantify the parameters which determine whether the behavior of a joint or kinematic chain is normal or pathologic. Motion analysis, featuring evaluation of both kinematics and the foot-ground reaction, enables us to measure the temporal and quantitative events of normal and pathologic gaits. The use of motion analysis in the study of flat foot has confirmed the ability to discriminate between "normal" and pathologic. Analysis of these themes has enabled us to follow the temporal evolution of the quantitative parameters both before and after treatment, which can be either surgical or conservative. Evaluation of the kinematic changes and the foot-ground reaction also provides information about the quality and effectiveness of the corrective treatment. For instance, the change in the subtalar alignment following application of an endo-orthotic implant can be targeted for validation by motion analysis. All of the joints comprised in the kinematic chain of the lower limb work together to achieve a symmetrical, rhythmic, and most of all harmonic gait.


Early diagnosis of deep vein thrombosis following total hip replacement using impedance plethysmography: advantages and limitations of this approach. Early diagnosis of deep vein thrombosis (DVT) following total hip replacement is of fundamental importance given the particularly high incidence of thromboembolic complications and the limited effectiveness of available preventive measures. The authors report the results of postoperative monitoring of the lower limbs using impedance plethysmography (IPG). The validity of the computerized plethysmograph used in this study has been confirmed by previous clinical studies, in which this instrument demonstrated high sensitivity and specificity of diagnosis of deep vein thrombosis in the symptomatic patient. In the present study, however, the instrument is applied to a group of mostly asymptomatic patients, many of whom have non-occlusive DVT. One hundred thirty-two patients underwent IPG both one the day before surgery and on the seventh day after surgery. The postoperative IPG was positive in seven asymptomatic patients (5.3%). Proximal DVT was confirmed by phlebography in five patients (3.7%) and found to be absent in two patients (false positives: 1.5%), for a positive predictive value of 71%. IPG also found proximal DVT to be absent in three patients with postoperative signs and/or symptoms compatible with a thrombotic complication in the lower limbs. The character of the study did not permit collection of data as to IPG sensitivity in the asymptomatic patient, which is presumably quite lower than in the symptomatic patient. Therefore, phlebography remains the most reliable test for diagnosis of asymptomatic DVT. However, systematic monitoring by phlebography is not feasible for logistic, economic, and ethical reasons. Postoperative use of IPG may at least partially reduce the risks connected with thromboembolic complications.


Ultrasound for early diagnosis of hip dysplasia. Over the past several years ultrasound has become the main means of early diagnosis of hip dysplasia. The success of this diagnostic test lies in the fact that it is non-invasive, can be performed at a very early age, and can be repeated. Moreover, it has made a more modern nosographic approach to this disorder possible, especially regarding correct orthopedic treatment. The results of the first 1500 patients (3000 hips) examined with ultrasound confirm the validity of our classification, which is based on both anatomical and clinical criteria. When performed correctly, ultrasound examination permits early diagnosis, precise anatomical differentiation, and monitoring of the progress of conservative treatment especially in cases of congenital dislocation treated with the Hoffmann-Pipino harness.


Morphological aspects of the synovial membrane and femoral epiphyseal cartilage in experimentally induced chronic anemia. The authors describe the microscopic and ultrastructural changes in the synovial membrane and femoral growth cartilage in experimentally induced chronic anemia. The reiterated anoxic stimulus is responsible for premature morphologic changes which become progressively worse and then appear to stabilize after 30 days. The series of events at the completion of the experiment are characterized by the following: 1) villous hyperplasia-hypertrophy with an increase of the secretory vesicles of type B synoviocytes in the intima and lymphoplasmacellular infiltrates in the sub-intima of the synovial membrane with fragmentation of the bony trabeculae, 2) areas of premature closure of the growth cartilage, 3) irregularity of the profile, thickness, and structure of the articular cartilage. The authors propose a biologic correlation between the above osteoarticular changes and the typical features of certain disorders of this anatomical region (hemopathies, Legg-Calvé-Perthes disease).


A case of rupture of the deep tendon of the third palmar interosseous muscle. The authors present a case of traumatic subcutaneous rupture of the deep tendon of the third palmar interosseous muscle. This injury is characterized primarily by the abduction of the little finger. Surgical fixation of the proximal loose end of the tendon to the base of the proximal phalanx yields excellent clinical and functional results.


Effect of different fractions of methanolic extract of the seeds of Dolichos biflorus on some microorganisms. Extracts from different parts of plants (1) including seeds are reported to act upon pathogenic microorganisms. A few active principles were isolated. The present preliminary report shows significant role of the seeds of Dolichos biflorus (Linn), locally known as Kulthi, against some test organisms using different fractions of defatted seed extracts with methanol.


In vitro evaluation of three topical antimycotics against ring-worm fungi singly and in combination. Three antimycotic drugs, viz., Miconazole nitrate, Econazole nitrate and ciclopirox olamine were tested singly and in combination of miconazole nitrate and Econazole nitrate, Miconazole nitrate and Ciclopirox olamine, and Econazole nitrate and Ciclopirox olamine to evaluate in vitro efficacy against Trichophyton mentagrophytes and Macrosporum nanum. The best efficacy was shown by Ciclopirox olamine (MIC 0.78 microgram/ml) and a combination of Miconazole nitrate and Econazole nitrate (MIC 0.78 microgram/ml).


Screening and identification of antibiotic producing strains of Streptomyces. About 450 actinomycetes were isolated from nearly 100 soil samples collected from different parts of West Bengal. The isolates were screened on the basis of their inhibitory effect against test organisms. Finally two potent antibiotic producers were chosen having maximum inhibitory effect on both gram positive and gram negative test bacteria. On the basis of morphological, structural, physiological and biochemical characters, the two potent antibiotic producers were identified as Streptomyces violaceus-niger and S. antibioticus.


In vitro evaluation of lingering antimycotic effect of 2% miconazole nitrate cream (citaderm) on human skin. An evaluation of lingering antimycotic effect of miconazole nitrate cream 2% was evaluated on the skin of 20-healthy subjects (16 male and 4 female) after a single dose of application. The test spots were covered with bandage. The tape strippings were taken at various intervals of time from the test area, and applied on the agar surface which was priorly inoculated with Trichophyton mentagrophytes isolated from a patient with the symptoms of onychomycosis. The lingering effect of miconazole nitrate was determined by the degree of inhibition of growth of the fungus under the tape. The test drug showed lingering effect from 36 to 48 hours.


Production of carbohydrases by Sclerotium rolfsii. Coproduction of alpha-amylase, beta-amylase, amyloglucosidase, cellulase, xylanase, pectinase and beta-galactosidase by Sclerotium rolfsii was studied on various polysaccharides. Starch induced alpha-amylase, beta-amylase, amyloglucosidase and beta galactosidase; cellulose induced cellulase, xylanase, pectinase and beta-galactosidase; and pectin induced pectinase and beta-galactosidase. None of the enzymes studied except beta-galactosidase were induced on xylan. Group controlled mechanism for production of carbohydrases by Sclerotium rolfsii is suggested.


Osteopathic graduate medical education.

Osteopathic graduate medical education. Osteopathic graduate medical education is still in transition. The AOA Department of Education will continue to monitor and report on the impact of these changes.


Four approaches to using patients to teach and evaluate clinical skills of residents, interns, and students. As osteopathic medical educators look for ways to enhance their training programs in a fiscally responsible manner, previously underused training methods deserve a second look. This article presents four ways that patients can serve as teachers and evaluators of residents' and students' clinical skills.


Special considerations for HIV infection in women. This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.


Effects of blood contamination on equine peritoneal fluid analysis. Peritoneal fluid and blood was collected from 8 healthy adult horses. Four 1-ml aliquots of peritoneal fluid from each horse were then contaminated with 0 ml (normal), 0.05 ml (1 drop), 0.10 ml (2 drops), and 0.20 ml (4 drops) of blood from the same horse. Samples were analyzed for RBC count, nucleated blood cell count, total protein concentration, and nucleated cell differential count. Statistical analysis revealed no significant changes in nucleated cell number, nucleated cell differential, or total protein concentration in peritoneal samples contaminated with blood. The RBC count significantly increased with blood contamination. It was concluded that up to 17% blood contamination of peritoneal fluid in clinically normal horses did not significantly alter interpretation of the nucleated cell count or protein concentration.


Production, characterization, and applications of a murine monoclonal antibody to dog erythrocyte antigen 1.1. A murine IgM monoclonal antibody, which recognizes dog erythrocyte antigen (DEA) 1.1, has been produced. The antibody correctly identified canine RBC possessing DEA 1.1 in a panel of RBC typed by an independent laboratory. Reactivity of the monoclonal antibody was compared with canine anti-DEA 1.1 antiserum with 163 RBC samples from 145 dogs. Results of agglutination tests with the 2 reagents were in agreement for all samples. A card agglutination test that uses the monoclonal antibody with blood is described. A monoclonal antibody-based test should facilitate blood typing for DEA 1.1 in clinical practice.