Is IVP necessary in children with urinary tract infection? A prospective study was conducted to determine the role of intravenous pyelography (IVP) in detecting the associated urinary tract anomalies in children with urinary tract infection (UTI). A total of 143 cases with confirmed UTI all received renal sonography (RS), voiding cystourethrography (VCUG) and IVP, to evaluate for G-U tract anomaly. Associated G-U tract anomalies were noted in 67 cases (46.85%). No single method was adequate in detecting all abnormalities. Based on the anomalies detected, we proposed and compared two different conditions in which IVP was required. In condition A, in which IVP was performed when abnormal finding were found in RS or VCUG, 67 of 143 cases with UTI (46.85%, 67/143) were required to have IVP, among them 32 cases yielded positive results and 35 cases negative results. Two cases of duplex collecting system (DCS) were found only on IVP would be completely undetected under this proposed condition. However, when IVP was recommended and performed at the time of high grade VUR in VCUG or any abnormality in RS (condition B), 43 of 143 patients (30%, 43/143) with UTI were required to undergo IVP, yielding abnormal findings in 30 cases (70%, 30/43) and normal findings in 13. This would leave four cases of DCS undetected, including the 2 detectable only by IVP plus 2 more that showed low grade VUR on VCUG. However, these 4 cases would not result in progressive renal damage in long-term follow up.(ABSTRACT TRUNCATED AT 250 WORDS)


[The coexistence of vesicoureteral reflux and ureteropelvic junction obstruction in children]. From January 1982 to December 1990, there were 229 cases with 337 ureters having vesicoureteral reflux (VUR). Thirteen of them (3.86%) were also found to have ureteropelvic junction (UPJ) obstruction in the same ureter. They were categorized into three groups based on the therapeutic implications. Group 1 (two ureters) underwent pyeloplasty. Group 2 (two ureters) received both pyeloplasty and reimplantation. The remaining nine ureters having VUR and pseudo-obstruction fell into group 3, and two of them became true UPJ obstruction eventually. We stressed the importance of evaluating upper urinary tract in all refluxed ureters with inappropriately dilated renal pelvis. By doing that we can avoid unnecessary surgery and prevent complications from wrong sequence of operation to a least extent.


[Educational effects of a short-term diabetes camp for children]. A Diabetes camp provides children with fun and educational experience. Seventeen diabetic school children (12 boys and 5 girls) participated in a short-term diabetes camp from April 16 to 17, 1988. Their ages ranged from 8.5 to 13.2 years with an average of 11.3 +/- 1.5 (mean +/- SD) years. The duration of their diabetes varied from 0.05 to 5.3 years with an average of 2.7 +/- 3.3 years. The camp staff consisted of a pediatric endocrinologist, 3 nurses, 4 dietitians, 3 social workers, 4 assistant diabetes educators, and 2 counsellors who were specialized in music and recreational activities. The children's abilities in managing their diabetes were assessed by using a scoring system before and after the camping. Wilcoxon matched-pairs signed-rank tests with significance levels set at p < 0.05 (two-tailed) were conducted to determine whether there were any significant changes in the results from pre- and postcamp assessments. The children showed significant improvement in using glucose-monitoring devices, drawing insulin, injecting insulin, and choosing the right exchange of food with the p values of less than 0.05, 0.01, 0.01, and 0.01 respectively. We concluded that this short-term diabetes camp was educational for school children with diabetes. The campers improved their knowledge and skill in management of diabetes.


Late infantile form metachromatic leukodystrophy: report of one case. Metachromatic leukodystrophy (MLD) is a neurodegenerative disorder with autosomal recessive inheritance, in which cerebroside sulphate (sulphatide) accumulates in the central and peripheral nervous systems due to a deficiency of arylsulphatase A. This article presents a 2-year-old boy who had occasional shortness of breath, horizontal nystagmus and unstable gait for 3 months prior to the entry. He was admitted to our hospital due to shortness of breath, frequent apnea, generalized hypotonia and conscious disturbance. The lumbar puncture, brain CT scan, serum amino acid analysis, urine organic acid assay and nerve conduction velocity of lower extremities all showed negative findings. The electron microscopic finding of muscle elicited lipid deposition. The auditory brainstem response showed bilateral impairment. The routine EEG revealed diffuse slow waves. The brain MRI showed widespread low signals over the white matter of bilateral frontal and parietotemporal areas of the cerebral hemispheres, as well as the white matter of the bilateral cerebellar hemispheres, and the brain stem in the T1-weighted image corresponding the high signals in T2-weighted image. The blood leukocyte lysosomal enzyme activity test revealed arylsulphatase A deficiency. Rapid progressive neurological deterioration was noted since admission. Unfortunately, the patient expired due to respiratory failure in the final.


Essential myoclonus: report of four cases. Four cases of essential myoclonus in childhood are reported. These include three males and one female, whose age-at-onset ranged from 2 months to 16 years. All manifested as involuntary movement of face, neck, or extremities without any known etiology. Only one case has a family history of myoclonus. They showed no other neurological abnormalities. The image or electrophysiological studies of nervous systems were within normal limits except that electromyogram (EMG) showed myoclonic discharge. All were treated by clonazepam with or without valproic acid. No significant effects were noted.


The hypoglossia-hypodactylia syndrome: report of two cases. Two cases of hypoglossia-hypodactylia syndrome are reported. This syndrome is characterized by reduction in the size of tongue, micrognathia and variable limb anomalies. In these present cases, both karyotypes revealed normal. The unrelated parents and siblings are normal. Drug exposure to the mother during pregnancy was negative. Since this syndrome is rare and no previous report in Taiwan. So we report these two cases and review the literature.


Electrophysiologic study and surgical ablation of atrioventricular nodal reentrant tachycardia: report of one case. A 12 years old boy with frequent episodes of palpitation was found, by the electrophysiologic study, to have an atrioventricular (AV) nodal tachycardia. Endocardial mapping during surgery revealed that the earliest retrograde atrial depolarization of the tachycardia occurred at the posterior part of Koch's triangle. Under normothermic cardiopulmonary bypass, perinodal dissection was performed above the tricuspid annulus at the coronary sinus region. The retrograde VA conduction disappeared. Post-surgery the antegrade conduction had a Mobitz type I block which had returned to normal after the fourth month follow-up.


Pyogenic sacroiliitis in children: report of three cases. We report three children who were treated for pyogenic infection of the sacroiliac joint. The disease, usually present in late childhood or adolescence, is uncommon and difficult to assess so that the diagnosis is usually delayed. The three patients were two boys and one girl, aged 14, 15 and 12 years, respectively. A detailed history and physical examination are very important for establishment of the diagnosis. All the three cases presented with typical clinical triad of fever, limping gait and buttock pain. Pelvis compression maneuver, which directly stresses the sacroiliac joint, may aggravate the joint pain and suggest this diagnosis. On physical examination, this test is positive in all our cases. Nuclear scintigraphy is useful for localization of early lesions. For detecting abscess formation, magnetic resonance imaging was performed in two cases and computed tomography in one. In one of the patients, computed tomography failed to demonstrate an iliopsoas abscess formation, which was proved by magnetic resonance imaging later. Staphylococcus aureus was isolated from blood in all three patients. Prompt antibiotic therapy reduces complication and operation is rarely needed. With rapid and appropriate medical treatment, all our patients recovered without an sequelae.


Study on the concentrations of cerebrospinal fluid immunoglobulin G and albumin in children. Concentrations of immunoglobulin G (IgG) and albumin in cerebrospinal fluid (CSF) and serum were measured in 118 "normal" Chinese children from birth to 15 years old to obtain the reference values for the evaluation of the blood-brain barrier (BBB) function. The values of the CSF/serum IgG ratio, CSF/serum albumin ratio and IgG index (IgG ratio/albumin ratio) were then calculated for each subject. A relation was found between the content of IgG in CSF and serum depending on age. The gradual decrease of CSF IgG and IgG ratio during the first 6 months indicated a postnatal impediment of the diffusion of IgG from the blood to the CSF. In the meanwhile the CSF/serum albumin ratio continued to drop until the age of one year. The slower slope of the decrement of the latter ratio further demonstrated the differential permeability of the BBB in favor of the shift of small molecular protein. The change of the protein permeability within the first year of life shows a characteristic of the maturational process of the BBB. Nevertheless, IgG index has no age-dependent variation throughout the childhood period. It remains constant in the absence of inflammation within the central nervous system.


Identification of sex chromosomal abnormalities by fluorescence in situ hybridization. Chromosomes can be specifically stained in metaphase spreads and interphase nuclei by fluorescence in situ hybridization (FISH). Case 1 was a 20 year-old female patient who had chromosomal analysis six years ago because of primary amenorrhea and short stature. Three cell lines were identified: 45, X (20%); 46, X plus an unidentifiable fragment (50%) and 46, X plus an isodicentric X chromosome of short arm fusion (30%). Case 2 was a 6 year-old girl with the problems of clitoromegaly and growth retardation. By use of in situ hybridization with biotinylated X and Y centromere-specific alpha repetitive sequence probes, we were able to identify the marker chromosomes to be X and Y-chromosome originated, respectively. The use of FISH can facilitate clinical cytogenetic diagnosis, and allows fast screening of a large number of metaphases. This technique is applicable to the screening of other types of chromosomal mosaicism as well.


An echocardiographic study on asymptomatic multiple interatrial septal defects in newborns. In a prospective study on the integrity of the interatrial septum in the neonates, multiple interatrial septal defects or openings with shunting were discovered in nine neonates by means of the color flow mapping technique used in their first week of life among 130 Chinese neonates. Eight of the nine neonates had two openings each, and the remaining one had four openings. Thus a total of 20 openings were found in the 9 neonates. Openings located between the tip of the flap valve and the superior limbus of the foramen ovale were classified as "location A openings" (valve-like openings). Those located at the flap valve itself were classified as "location B openings" (fenestrations). Each of the 9 neonates had one opening at location A, eight of them had another opening at location B; one had three openings at location B. Six of the nine neonates were followed up at age of one month, three months and six months by means of color-flow mapping, with a total of six openings at location A and eight openings at location B. Four out of the six openings of location A and seven out of the eight openings at location B closed spontaneously before the age of six months. In conclusion, seven percent (9/130) of these Chinese neonates have multiple interatrial openings. The openings tend to close spontaneously, regardless of their locations.


Extracorporeal shock wave lithotripsy in children: experience with the multifunctional lithotripter MFL 5000. Extracorporeal shock wave lithotripsy (ESWL) has been proved to be an effective method of treating upper urinary tract calculi. However, there is little experience with the use of this approach in pediatric urolithiasis, especially for lower urinary tract calculi. Nine children, aged 1-18 years, were treated here with urolithiasis in the renal pelvis, lower ureter and bladder, using Dornier MFL 5000. A polystyrene plate was used to protect small children from chest damage. Prone position was routinely used to treat lower ureteral and vesical calculi, thus avoiding bony pelvis blockage of shock wave energy. Excellent pulverization was achieved in eight cases; fragmentation in only one case, then required cystolithotripsy for bladder stone fragments three months after ESWL. No patient had melena. Neither hemoptysis nor gastrointestinal complications were seen. Extracorporeal shock wave lithotripsy is a safe and effective method of treating urinary tract calculi in children.


Newborns of Chinese mother with systemic lupus erythematosus (SLE). From January, 1979 to December, 1990, 105 pregnancies of the 87 mothers with systemic lupus erythematosus (SLE) were studied. There were 15 (14.29%) fetal losses. Among the 90 livebirths, 23 (25.5%) were moderately premature; and 1 (1.1%), was extremely premature. All but 2 (2.2%) had an Apgar score more than 7 at 1 minute. There was no neonatal death. Significantly lower birth body weights were noted compared with the matched control group (p = 0.0001). Birth body length and head circumference were not different. Only 1 of the 13 newborns who had been small for gestational age at birth had body weight and length less than the 3rd percentile during follow-up. Three (3.3%) newborns presented as congenital complete atrioventricular block (CCAVB). Their mothers were all positive for SSA (Ro) antibody. One of them obligatorily needed pacemaker implantation. ECG abnormalities including multiple ventricular premature contractions, wandering atrial pacemaker, sinus arrhythmia, and first degree A-V block were detected in another six newborns. Congenital cardiac defect with secundum type atrial septal defect was noted in two newborns (2.2%). Among the 59 mothers who had been tested for SSA antibody, 29 (49.1%) were positive. The incidence of complete A-V block was significantly higher in newborns of mothers with SSA antibody (p < 0.001). On the contrary, the frequency of fetal loss has higher in newborns of mothers without SSA antibody (p = 0.0043).


Inward rectifier and delayed outward potassium currents in isolated guinea-pig ventricular myocytes: maturation and its role in repolarization. In accord with previous reports, we have found that action potentials triggered from isolated mature (> 1 month) guinea-pig ventricular myocytes showed a longer duration than those from the neonate (< 1 day). A whole-cell voltage-clamp technique has been used to identify the postnatal changes of inward rectifier (Ikl) and delayed outward potassium currents (Ik), which may be related to the action potential transition. Our results have shown that the degree of maturation of the neonatal guinea-pig is much advanced, as compared to neonatal rabbits and rats. Slope conductance (1230 +/- 110 pS/pF, n = 10, for neonatal, and 1450 +/- 450 pS/pF, n = 10, for mature guinea-pig, p > 0.05) and the inward rectification occurring over a potential range from -50 to -10 mV were relatively similar between the neonatal and mature guinea-pig myocytes. But, the slope conductance of Ik was significantly greater in neonatal (702 +/- 80 pS/pF, n = 10) guinea-pig myocytes than in the mature (194 +/- 23 pS/pF, n = 10, p < 0.01). Therefore, we suggest that (1) the maturation of Ik appears later than that of Ikl, (2) age-related decrease of the slope conductance of Ik could contribute to an age-related lengthening of the action potential duration.


Neonatal lupus erythematosus with negative anti-Ro and anti-La antibodies: report of one case. Since 1981 when anti-Ro (SS-A) and/or anti-La (SS-B) antibodies were described to be present in infants with neonatal lupus erythematosus (NLE) and their mothers, subsequent studies have demonstrated the almost universal association of NLE with either or both of these autoantibodies. To our best knowledge, three cases of NLE were reported to be negative in anti-Ro (SS-A) and anti-La (SS-B) antibodies. We report one infant born to a mother with systemic lupus erythematosus (SLE). He had neonatal pancytopenia (thrombocytopenia, anemia, and leukopenia) which got resolved after intravenous immunoglobulin (IVIG) administration. Both anti-Ro (SS-A) and anti-La (SS-B) antibodies were not detectable in his serum by immunodiffusion method while other such as RNP (nonspecific, including U1,U2,U3,...,U6), Sm and Scl-70 antibodies were all positive. This mother had all the above antibodies detectable in her serum. After excluding other possibilities, his pancytopenia was most likely to be attributed to neonatal lupus. We suggest that autoantibodies such as RNP and Sm antibodies may play an important role in the pathogenesis of thrombocytopenia of NLE.


Rupture of chordae tendineae in acute rheumatic carditis: report of one case. Acute rheumatic carditis is a rare cause of ruptured chordae tendineae of the mitral valve. Such rupture could result in severe mitral regurgitation and in fatality. Surgical valvuloplasty or valve replacement is usually necessary. A 12-year old boy presented with acute rheumatic carditis, complicated with rupture of the chordae tendineae of the mitral valve leading to intractable congestive heart failure and cardiogenic shock. He was successfully treated by a simple repair of the chordae and by mitral valvuloplasty.


[Haemophilus influenzae cellulitis of the hand: report of one case]. Cellulitis of extremities due to Haemophilus influenzae is rare in children. Only 60 cases of Haemophilus influenzae cellulitis of the extremities have been reported. It usually affects young children between the ages of six and 24 months. The lesion often presents with a red-to-bluish-purple discoloration overlying the involved area. High fever and leukocytosis are commonly found. Culture of needle aspirate and blood with appropriate media is necessary for diagnosis. Early diagnosis is especially important because of associated bacteremia and the subsequent possibility of life-threatening complications such as meningitis. We reported a 8-month-old female infant with Haemophilus influenzae type b cellulitis over the right hand. She was admitted due to high fever and painful swelling of the right hand. Edematous right hand with dusky erythematous skin over the dorsum and swelling of the palm with limitation of range of motion were noted on admission. Smear of needle aspirate revealed gram negative bacilli and beta-lactamase(-) Haemophilus influenzae type b was cultivated in the blood culture. She was successfully treated with ampicillin and discharged with stable condition.


[Pancreatoblastoma: report of one case]. Pancreatoblastoma is an extremely rare pancreatic tumor in childhood, comprising 0.5% of pancreatic non-endocrine tumors. It mostly affects children of under 8 years old without special sexual predilection. Abdominal mass is the dominant clinical feature and abdominal X-ray, sonography, UGI series, CT scan are of assistance in establishing diagnosis. The presence of acinar cells with zymogen granules, squamous metaplasia and endocrine components makes the diagnosis. We report a case of 4-year-old girl, who suffered from abdominal pain for two months. Abdominal mass was found at our OPD and abdominal sonography, UGI series, CT scan all indicated a parapancreatic tumor. AFP was 4700 ng/ml. Laparotomy confirmed a pancreatic tumor and only partial excision was performed due to tumor invasion and adhesion to major vessels. Diagnosis of pancreatoblastoma was made by pathohistology, cytochemical special stains and electronic microscopic examination of the tumor. Neither chemotherapy nor radiotherapy was performed due to family refusal. Then patient followed up at NTUH OPD regularly. Unfortunately patient expired because of the regrowth of residual tumor eight months later.


Ubenimex (Bestatin), an aminopeptidase inhibitor, modulates protein kinase C in K562 cells. Ubenimex (Bestatin) is a potent inhibitor of aminopeptidases (APase) including APase N (EC 3.4.11.2), a widely distributed membrane-bound metalloprotease. Binding of Ubenimex (UBX) to cells has been implicated in a variety of its biological activities, while little evidence has yet been provided as to any subsequent mechanisms of intracellular signal transduction. We now examined the possible involvement of protein kinase C (PKC), a key regulator in transmembrane signaling. Human leukemia K562 cells were cultured in the presence or absence of UBX (1 to 50 micrograms.ml-1, 1 to 72 h), and the subcellular distribution as well as phorbol-12, 13-dibutyrate (PDBu)-induced redistribution of PKC activities were assessed. The membrane-bound enzymatic activity tended to increase in the presence of UBX, while a significant loss of the activity was demonstrable upon subsequent exposure to PDBu (100 nM, 10 min) in both the cytosolic and membrane fractions. Specific binding of [3H]PDBu to intact K562 cells was also down-modulated with UBX concentration- and time-dependently, suggesting loss of PKC enzyme protein on the cell surface. Western blot analysis of the total cell extracts disclosed no appreciable alteration in the amount of PKC protein. APase inhibition with UBX was observable independently of PKC modulation. The present findings were discussed with reference to the possible differential mechanisms of PKC-mediated regulation of cellular responses depending on cell types.


Partial purification of a high molecular weight hepatocyte growth stimulating factor from normal calf serum. A heparin-binding protein, acting as a potent hepatocyte growth stimulating factor (HGSF) was extracted and partially purified from normal calf serum. HGSF stimulated DNA synthesis and proliferation in primary cultures of adult Balb/c mouse hepatocytes and in two liver-derived epithelial cell lines (C6 and C2.8) plated at low cell density in serum-free medium in the absence of epidermal growth factor. HGSF was non-dialyzable in M(r) 50,000 cutoff membranes, and was purified after chromatofocusing on PBE94 resin, (NH4)2SO4 precipitation (80% salt concentration) of the active fractions eluted at pH 5.7, flow chromatography and elution through Sephacryl S300 HR and HA-Ultrogel columns. The hepatotrophic activity was eluted with a protein fraction that was concentrated approximately 40,000 fold over the starting material. The effect was half maximal at approximately 50 ng/ml on adult hepatocytes in primary culture, HGSF had a molecular weight of 90,000-110,000 by gel filtration, was unstable on heat-treatment and was completely inhibited after trypsin digestion and after reduction with dithiothreitol. HGSF did not stimulate growth in Balb/c 3T3 fibroblasts. When injected into partially (40%) hepatectomized Balb/c mice, HGSF increased hepatic DNA synthesis 2 to 4-fold over the background stimulation, at 20 hours after the hepatectomy.


Immunological effects of a single evening subcutaneous injection of low-dose interleukin-2 in association with the pineal hormone melatonin in advanced cancer patients. Recent experiments have shown that a great variety of neurohormones can interact with IL-2 in the modulation of host antitumor immune response. On the basis of these data, a study was started to evaluate the effect of the pineal hormone melatonin (MLT) on IL-2-induced immune changes in cancer. The study included 30 advanced cancer patients. They were randomized to be treated with IL-2 at a dose of 3 million IU subcutaneously twice/daily (8.00 a.m. and 8.00 p.m.) for 6 days/week for 4 weeks, with IL-2 once/daily in the evening, with IL-2 once/daily plus MLT at 10 or at 50 mg/day. MLT was given orally at 8.00 p.m. Both IL-2 given twice daily and IL-2 given once daily and IL-2 given once daily in association with MTL induced a significant increase in mean number of lymphocytes, T lymphocytes, NK cells, CD25-positive cells and eosinophils, whereas the single administration of IL-2 alone was unable to determine a significant rise in the mean number of immune cells. Soluble IL-2 receptor and neopterin increase was significantly higher during IL-2 given twice/daily than during IL-2 plus MLT, while no difference was seen in TNF rise. This study would suggest that a single daily injection of low-dose IL-2 is able to efficiently activate the lymphocyte proliferation in cancer patients when it is given in association with the pineal hormone MLT.


[Orthodontic treatment for orthognathic surgery: indications, possibilities and limitations]. The relation between the maxilla and the mandible can be so discordant that it cannot be corrected with orthodontic treatment only in adults, neither with orthodontic and jaw orthopedic in children. In these cases, only a combination of orthodontic treatment and orthognathic surgery can give the most satisfying results. A careful analysis of all patient records and an accurate planning of all the consecutive procedures should precede this treatment. Nowadays, computer-aided systems can provide substantial help in analysis and planning. In this article, possibilities and limitations of the orthodontic part of these treatments are elaborated.


[Importance of diagnosis in facial pain]. The diagnosis and treatment of facial pain remains a great challenge for oral and maxillofacial surgeons. By taking an exact anamnesis--especially a pain anamnesis--and by starting specific examinations the patient can quickly be recommended to a qualified therapist. The pain syndromes are classified according to the IASP (International Association for the Study of Pain). The pain syndromes the maxillofacial surgeon is most frequently confronted with--idiopathic trigeminal neuralgia, atypical facial pain and the temporomandibular joint--are described. The necessity of a multidisciplinary examination is emphasized and the different diagnostic investigations are illustrated, particularly in the case of myo-arthropathy. Beside the analysis of temporomandibular joint dysfunction, a radiologic examination is performed. In some cases the advise of a neurologist, ophthalmologist or otolaryngologist may be indicated.


Molecular cloning of interferon-gamma inducible genes from a murine pre-B cell leukemia. In the present study, a pre-B cell leukemia L1210-C7, representing a very early stage of the B lineage, was used to characterize the molecular mechanisms exploited by IFN-gamma to modulate B cell activity. A cDNA library was prepared with poly (A)+ RNA from cells stimulated with IFN-gamma and three cDNAs clones complementary to IFN-gamma inducible mRNAs were isolated by differential screening. Of these, the 9.5 cDNA hybridized to a 2.4 kb mRNA not homologous with previously cloned IFN-gamma inducible mRNAs. Furthermore, when compared with RNAs obtained from cells of different origins (fibroblasts and T cells) the 9.5 mRNA appeared to be increased only in cells belonging to the B lineage. Taken as a whole, these results demonstrate that in leukemic pre-B cells IFN-gamma induces the expression of a gene that could be employed as specific cell activation marker.


Effects of granulocyte-macrophage colony stimulating factor on cortisol, growth hormone, prolactin and melatonin in cancer patients (short communication). Several interleukins and interferons have been proven to induce endocrine effects. On the contrary, only few data are available about the possible hormonal activity of hemopoietic growth factors. This study was carried out to evaluate the endocrine influence of GM-CSF in humans. The study included nine head and neck cancer patients, evaluated in basal conditions and after an acute subcutaneous injection of GM-CSF at a dose of 3 mcg/kg b.w., by determining serum levels of cortisol, growth hormone (GH), prolactin (PRL) and melatonin. Both cortisol and GH significantly increased in response to GM-CSF, while PRL, and melatonin were not influenced. This preliminary study shows that hemopoietic growth factors, as well as interleukins, may also play endocrine effects in humans.


[Panoramic dental studies in systematic screening: useful or superfluous?]. In the framework of a programme of systematic screening, a study of dental health of the population was completed on 791 members of the personnel of a service company together with their spouses. This multicenter study was completed in Belgium, by systematic panoramic dental radiography. Dental anomalies were found in 45.8% of the population studied. These 332 positive dental panoramic radiographies reveal on average 2.4 anomalies for each positive case. These anomalies are significantly (p < 0.05) more frequent among older age groups (51% among those over 45 years of age, 39% among those under 35 years). There is no important difference between the sexes, although a non-significant occurrence of anomalies can be observed among men over 45 compared to women of the same age. An active study of pathologies upon a "healthy" population by means of panoramic and clinical dental examination would therefore seem to be of interest.


Peripheral ameloblastoma: case report.

Peripheral ameloblastoma: case report. A case of peripheral ameloblastoma, a rare odontogenic tumour, is presented. This tumour appears to differ from endo-osseous ameloblastoma by the absence of local malignancy. It exhibits a less aggressive and destructive behavior and does not invade the underlying bone. Conservative treatment of the tumour is the treatment of choice.


Comparison between specific IgE measured by RAST, two chemiluminescent assays and skin prick test. Two hundred adult patients referred to a regional outpatient allergy clinic were skin prick tested and their specific IgE against ten inhalant allergens was measured by three different assays: the classical radioallergosorbent assay, Phadebas RAST (P-RAST), (Pharmacia AB, Uppsala, Sweden), the multi-allergosorbent chemiluminescent assay CLA (MAST), (Dome/Hollister-Stier, Miles Ltd., UK), and the immunocheminometric assay, MAGIC LITE SQ Specific IgE (ML), (ALK Laboratorierne, Hørsholm, Denmark). Skin prick test (SPT) was performed with extracts from the same companies. Marked differences between the assays were seen especially in the low range. Specific IgE was detected in 17% of the samples by P-RAST, in 66% by CLA, and in 17% by ML. Frequency distribution of P-RAST and ML measurements showed a peak at zero and a gradual decline towards larger values, whereas distribution for CLA was U-shaped with a peak at zero and another peak close to maximum reactions. Kendall's rank correlation coefficient being 0.80 for P-RAST vs. CLA. Correlation coefficient between measurements of specific IgE and SPT was high for CLA (0.65). Even in the low-level subgroup where IgE was detected by CLA only, a high correlation (0.60) between CLA and SPT was observed. In conclusion marked differences were observed between the three assays for specific IgE measurement. The CLA system seems to be more sensitive than the conventional P-RAST and ML, but further studies should reveal whether this extra sensitivity is clinically useful.


Allergy to heparin. Special problems set by pregnant women. Oral anti-coagulants are always contra-indicated for pregnant women. Only anti-coagulants of the types of heparin or its derivatives may be used. However, some patients have an allergy to heparin. In this article the correct action to make both for diagnosis and prevention is studied. We present 2 observations of heparin-allergic pregnant women with, in the first case an attempted tolerization which failed and in the second case there was success in a second pregnancy with low-molecular weight heparin.


Monitoring of various types of immunotherapy with gramineal pollens. I. Variation of clinical and biochemical parameters. We assessed the clinical effectiveness and adverse effect of various types of immunotherapy on 42 pollinotic patients by monitoring their evolution on administration of Perennial lolium specific extract standardized in protein nitrogen units to 14 of them, the same extract but standardized in biological units (BUs) to another 13, and an extract containing four different pollens standardized in BUs to the remaining 15. For this purpose we measured clinical and medicinal scores, liver and kidney biochemical parameters, skin reactions and circulating immunocomplexes (CICs), both before immunotherapy was started (basal levels) and after 3, 6 and 12 month's treatment. We found no significant differences in clinical effectiveness or the occurrence of any adverse effects on administration of the different immunotherapies after one year's monitoring. We did found gradually decreased reactions to the skin tests, which thus provide a reliable means of monitoring allergen-specific immunotherapy.


Monitoring of various types of immunotherapy with gramineal pollens. II. Variation of humoral immunochemical parameters. We monitored the total and Perennial lolium-specific IgE, IgG, IgM and IgA serum levels of pollinotic patients under three different immunotherapeutic treatments with gramineal pollens over a one-year period. We found statistically significant (p < 0.05) decreases in the total serum IgE levels in successive controls performed after 3, 6 and 12 month's treatment with respect to the basal control levels. The specific IgE levels also decreased gradually throughout the study, while the total serum IgG and IgM levels increased significantly over the first 3 months, and those of IgG continued to increase up to the sixth month. Finally, the total serum IgA levels did not change significantly during the first year of treatment of our pollinotic patients.


[An integrated approach to the psychological features of the asthmatic child]. The work starts from the interrelation that occurs in asthmatic children between physical and psychical aspects. We carry out the experiment on an instructional programme as an efficient method of intervention that on one hand improves the levels of personal, social school and family adaptation and that on the other hand helps to modify the wrong attitudes about the illness, presuming that, in some way, it will be a relief in the physical aspect of the illness. The sample chosen by randomization and stratification from the Allergy Service of the Insular Hospital of Gran Canaria was tested using an experimental and control-placebo with retest design. The children were between nine and eleven years old. The results for the adaptative aspects of the subjects were similar to the ones that Doctors Hernández and Hernández from La Laguna University (Canarias) got through similar studies, though the outcomes were not as successful as we hoped in cognitive/affective and social restriction. About the modification of the more internal aspects of asthmatic problems the programme was successful though we didn't modify some attitudes. We had the improvements that we hoped in some physical aspects as secondary effects but it seems that the programme can have more influence among them.


Skin prick testing with standardized extracts from 3 different manufacturers. A comparative randomized study. The aim of this study was to compare skin reactivity to routine allergen prick test with panels of allergens, supplied by three different manufacturers. The allergens comprised ten aero-allergens commonly used for skin prick test in Northern Europe, and included pollen, dander, house dust mites, and moulds. Two hundred consecutive patients were tested. The methods for standardization of allergen extracts, declaration of allergenic potency, and recommended lancets differed. The equipment were Soluprick SQ (Allergologisk Laboratorium A/S, Denmark) (ALK), Alphatest (Dome/Hollister-Stier, U.K.) (DHS), and Phazet (Pharmacia, Sweden) (PHA). The coefficient of variation for the allergen coated PHA (same lancet was applied twice) was 0.31, and for ALK and DHS allergen extracts 0.13 and 0.18, respectively. The frequencies of patients with positive reactions to the various allergens were generally similar, although DHS appeared to elicit less positive reactions to Timothy, dog, and Dermatophagoides pteronnyssinus. For the individual physician, it may be important to know the allergenic activity of the different allergens in his routine panel compared to the activity in other similar panels.


Alveolar macrophages from AIDS patients spontaneously produce elevated levels of TNF-alpha in vitro. In vitro production of TNF-alpha by alveolar macrophages was investigated in 15 AIDS patients with acute interstitial pneumonia and in 4 patients with asymptomatic HIV infection (anti-HIV+) and was compared to that observed in 6 patients with chronic pulmonary disease and in 5 normal controls (undergoing a fiberoptic bronchoscopy for suspected lung malignancy), all 11 HIV negative. Our results show that unstimulated alveolar macrophages of AIDS and anti-HIV+ patients released much more TNF-alpha than subjects with chronic obstructive pulmonary disease or healthy controls did: this overproduction may play a role in the pathogenesis of lung damage infection and particularly in AIDS patients.


[Acquired atrophic pigmented band-like lesions following Blaschko's lines]. Over a seventeen years period we observed 5 patients presenting with very similar lesions the equivalent of which we could not find in the literature. These were pigmented and more or less atrophic bands which exactly followed Blaschko's lines. The lesions appeared during childhood or adolescence, between the ages of 6 and 20 years and always were unilateral. In all cases they were located on the trunk where they formed a recumbent "S" pattern characteristic of Blaschko's lines. They often started 3 to 6 cm away from the posterior midline and ended precisely on the anterior midline. These bands varied in number and in 3 out of 5 cases they were associated with pigmented atrophic bands or lines on the limbs of the same side. The intensity of pigmentation and atrophy was variable. The lesions were asymptomatic and only caused a cosmetic prejudice. They were perfectly fixed, and during a 2 to 30 years observation period they remained unmodified. The five skin biopsies performed on 3 patients showed no abnormality of the epidermis other than irregular and moderate hyperpigmentation of its deep part. In the dermis, there was no distinct pigment incontinence, no inflammation and no alteration of connective tissue texture; the elastic network was invariably normal. The impression of skin atrophy was not due to true dermal hypoplasia and perhaps corresponded to atrophy of the subcutaneous cellular tissue. No biological disturbance was observed. These lesions can easily be distinguished from epidermic naevi, incontinentia pigmenti and areas of hypoplastic dermis.(ABSTRACT TRUNCATED AT 250 WORDS)


[Persistent photosensitivity: treatment with puvatherapy and prednisolone (corticopuvatherapy)]. Eight patients, six men and two women, had chronic photosensitivity of 2.0 +/- 1.1 years' duration. The clinical and photobiological signs were consistent with a diagnosis of chronic actinic dermatitis syndrome. Photosensitivity was extremely severe, and the minimal erythematous dose (MED) in polychromatic light was dramatically decreased in all eight patients (82 +/- 20 mJ/cm2; range: 25-200 for a normal MED range of 1.000 to 2.000 mJ/cm2). Photopatchtests were positive to phenothiazine in four patients, to fragrance mix and oxybenzone in two patients, to balsam of Peru and musk ambrette in one patient each. Seven patients were treated with corticopuvatherapy. They all were markedly improved after one month of treatment, recovering normal MED and outdoor activities. Corticosteroid therapy was gradually reduced and stopped after 3 months, while puvatherapy was continued for several months. Treatment was withdrawn in three patients. The minimal erythematous dose was monitored after discontinuation of therapy: a progressive decrease of MED was observed, accompanied by a relapse in two of the three patients. This relapse was well controlled by another course of corticopuvatherapy. Four other patients had, after discontinuation of treatment, another course of corticopuvatherapy reinstituted in the early spring. Puvatherapy was stopped at the end of october. One patient did not receive corticopuvatherapy because she was living far from a puvatherapy centre. She was treated with azathioprine for 6 months without improvement, then with azathioprine+prednisolone 20 mg daily during 2 years with slight improvement. Corticopuvatherapy is a very efficient means of treating severe chronic actinic dermatitis.(ABSTRACT TRUNCATED AT 250 WORDS)


[Leg cellulitis caused by Aeromonas hydrophila. Medical treatment]. A case of cellulitis of the leg caused by Aeromonas hydrophila in a cirrhotic patient is reported. The starting point of the infection could not be determined with certainty, but a direct local inoculation during foot-baths was suspected. Because of clinical signs suggestive of erysipelas, the disease was initially treated without success with penicillin G, which raises questions concerning the choice of the initial antibiotic therapy for cellulitis of the leg in immunocompromised patients, pending the bacteriological results. A purely medical treatment (adequate antibiotic therapy) resulted in complete cure of this patient, despite the fact that his lesions were necrotizing.


[Eczema caused by contact allergy to tretinoin]. Skin irritation induced by tretinoin is commonly observed, whereas allergic contact dermatitis to this drug is very rarely found in the literature. We report the case of a 34-year-old man who developed contact dermatitis in areas where a topical tretinoin preparation was applied. Patch tests were positive to tretinoin in low concentration and to isotretinoin. Oral administration of isotretinoin to this patient would carry a risk of systemic complications.


[Balanced facial hydrophilicity of ioversol: a qualitative approach of hydrophilicity]. Chimiotoxicity of iodinated contrast media is essentially due to non specific hydrophobic interactions with biologic proteins and membranes. These hydrophobic interactions depend both on the whole molecular lipophilicity and on the spatial accessibility of lipophilic molecular areas. Measurements of lipophilicity by partition coefficient, partially take into account the spatial localisation of hydrophilic groups around the lipophilic area due to the 1,3,5-triiodo-benzene. These measurements have to be completed by an accurate knowledge of the three-dimensional localisation of hydrophilic groups to improve the biocompatibility of polyiodinated contrast media. The concept of evenly distributed facial hydrophilicity aims to minimize the accessibility to lipophilic area by a localisation of hydrophilic group on each plan of the benzene ring. The molecular structure of ioversol allows to put this concept in concrete form thanks to a tertiary anilide group which imposes on one hydroxy group to be located on each face of the 1,3,5-triiodo-benzene ring, providing facial hydrophilic protection.


[Pharmacotoxicological profile of a non-ionic LOCM at high hydrophilicity: ioversol]. The authors summarize the results of the main preclinical studies conducted to evaluate the tolerance of ioversol (Optiray), a new non ionic Low Osmolality Contrast Medium (LOCM). The various studies conducted by different routes of administration, in a number of animal species and at different dosages led to the conclusion that the product was equivalent or superior to the other non ionic agents used as references. This high inertia towards the biological systems particularly well evidenced in the neurologic tolerance studies has to be relied to the non ionic LOCM character of the agent but also to its highest hydrophilicity in its class and to the good distribution of this hydrophilicity around the molecule. These physiochemical characteristics which differentiate ioversol from the other products of its class make it a promising product for clinical use in humans.


[Double-blind randomized study comparing ioversol 300 versus iopromide 300 abdominal computed tomography (CT scanner)]. The authors compared ioversol 300 and iopromide 300 (ioversol 41 patients, iopromide 38 patients) in a randomized double blind study conducted on 79 patients undergoing abdominal computed tomography (CT) for a variety of indications. Each study was rated as diagnostic or non-diagnostic and the image quality was recorded. All side-effects were recorded. There was no significant difference in image quality and side-effects between both contrasts. In this study, both ioversol and iopromide provided excellent image quality and a low rate of side-effects. The authors conclude that ioversol is a safe and effective non ionic contrast agent for contrast enhanced body CT.


[Ioversol 300 and iopamidol 300 in "whole body" computed tomography. A double-blind clinical trial]. The authors compared ioversol 300 to iopamidol 300 by double blind study in patients undergoing enhanced computed body tomography. There was no significant difference in clinical tolerance and efficacy between the two products. Only minor reactions were recorded in both groups. Contrast media were not considered to be responsible for the poor diagnostic quality of a few explorations. Ioversol 300 appears as a well tolerated and effective contrast medium for computed body tomography.


[Evaluation of diagnostic efficacy and clinical tolerability of ioversol in "whole body" computed tomography in children. A non comparative phase III trial]. An open-label noncomparative clinical study was conducted to evaluate the efficacy and tolerance of ioversol (Optiray 300), a new low-osmolality non ionic contrast medium, in body contrast-enhanced CT scanning in infants and children. Fourty pediatric patients who required contrast-enhanced CT scanning for evaluation of chest, abdominal or pelvic masses participated in the study. The vascular enhancement was judged to be excellent or good in 72.5% of the cases and the CT scans were judged to be diagnostic in 95% of the cases. Ioversol was well tolerated in the study with only two mild adverse reactions (nausea and vomiting, and metallic taste).


[Clinical tolerability of ioversol 300 in brain computed tomography]. Ioversol 300 (Optiray 300) is a new low-osmolality contrast medium. Optiray 300 was used in 92 patients for CT examination of the brain, to assess its clinical tolerance. Adverse reactions, when sensations of heat were neglected, were observed in 15% of the patients. All the adverse reactions, either observed by the radiologist or pointed out by the patient, have spontaneously disappeared without medical treatment and did not require hospitalization. Anaphylactoid phenomena were not observed. Optiray 300 appears as a well suited contrast medium for CT scan of the brain especially in patients with contrast medium high risk.


[Evaluation of efficacy and tolerability of ioversol in intravenous urography. A comparative double-blind study versus iopamidol]. The efficacy and safety of Optiray (ioversol), a new low osmolar non-ionic contrast agent were compared with Iopamiron in a double-blind randomized trial for intravenous pyelography. Concerning the diagnostic efficacy, Optiray 300 was equivalent to Iopamiron 370 for identical injection volumes. Significantly less reinjections were necessary with Optiray. Tolerability was found to be excellent, equivalent to the reference product. Optiray was found to be both well tolerated and of satisfactory diagnostic value.


[Evaluation of clinical tolerability and diagnostic efficacy of ioversol 350 in UIV. A randomized double-blind study of ioversol 350 versus iohexol 350]. The authors evaluated the clinical safety and the efficacy of ioversol compared to the reference contrast medium iohexol, during IVP. The clinical safety has been evaluated by the occurrence of side-effects. The efficacy was appreciated in terms of insufficient, medium, good or excellent. No side-effect was recorded for both contrast media. There was no difference in opacification quality and efficacy between ioversol and iohexol. The authors conclude that ioversol is a safe and effective contrast medium which can be, therefore, particularly recommended for urographic examinations of high risk patients.


Ioversol in intravenous excretory urography. Evaluation of radiographic quality, patient tolerance and safety in four clinical studies. Three randomized, parallel group, double-blind clinical trials (Study A, B and C) and one open-label, noncomparative clinical trial (Study D) were performed in adult patients to evaluate the radiographic quality, patient tolerance and safety of Optiray 300 (ioversol) in intravenous excretory urography. Comparative agents were iohexol (Study A and C) and iopamidol (Study B). Regarding the radiographic quality ioversol provided a statistically significant better ureter opacification (p = 0.029) compared to iohexol (Study A). In comparison to iopamidol (Study B) the mean degree of certainly with respect to the investigator's urogram-based diagnoses was statistically significant higher (p = 0.025) for ioversol. In these two studies the enhancement quality of regions visualized was higher in the ioversol groups than in the control groups. Regions investigated were: parenchyma, calyces, pelvis, ureters and the bladder. Ioversol, iohexol and iopamidol were found to be statistically comparable with regard to safety and patient tolerance. The results of these studies demonstrate that ioversol is an effective, well tolerated and safe contrast agent for intravenous excretory urography.


[Evaluation of efficacy and tolerability of ioversol in intravenous urography]. In an open clinical trial, 100 patients have been injected with ioversol (Optiray 350) during an IVP performed for various indications. This low osmolality contrast medium, which is remarkably hydrophilic, has exhibited a safety of use and image quality which were quite satisfactory.


[Ioversol 300: clinical study in pediatric intravenous urography]. The efficacy and safety of Optiray (Ioversol), a new low osmolar non ionic contrast agent, were evaluated in an open trial for pediatric intravenous urography. At a concentration of 30% iodine, Optiray had a good diagnostic efficacy and was found to be well tolerated.


A double-blind comparative study on the contrast quality, tolerance and safety of ioversol 300 versus iohexol 300 in central venous angiography (C.V. DSA). A prospective, randomised, double-blind study was performed to test the contrast quality, tolerance and safety of ioversol 300 mg/ml (Optiray 300, Mallinckrodt Medical, Inc., St-Louis, USA) versus iohexol 300 mg/ml (Omnipaque 300, Schering AG, Berlin). The study was conducted on 80 patients with peripheral vascular disease, who underwent central venous pelvis-leg angiography. The angiograms in the ioversol group were rated "very good" and "good" in 75.6% of the cases versus 51.3% in the iohexol group. Patient tolerance was nearly identical in both groups. On the 4 point rating scale for pain and heat sensations (1 = none; 4 = severe), the average heat scores were 1.28 for ioversol and 1.44 for iohexol. None of the patients complained of pain when receiving the injection. There were clinically significant changes of blood pressure in 3 patients out of each group and tachycardia in 5 patients in the ioversol group and 9 patients in the iohexol group. Seven out of 80 patients reported mild to moderate side-effects. These were related to the contrast medium in the case of 2 patients in both the ioversol and the iohexol group. All reactions resolved spontaneously or could be controlled by treatment.


[History of microsurgical reconstruction of the mandible]. The history of mandibular reconstruction, initially prosthetic, dates back to Ancient Egypt and China, but developed rapidly and diversified from the 19th century onwards when C. Martin, in 1889 developed his "immediate prosthesis applied to resection of the jaws", while A. Barth, in 1895, performed the first bone grafts. The more recent history of microsurgical reconstruction commenced with free rib transfers in 1977-1978 (Ariyan, Couly). Other microsurgical transfers, either pure bone or composite osteocutaneous, osteoseptal or osteomyocutaneous were then rapidly developed and used with varying degrees of success for mandibular reconstruction: inguinoiliac flap (Talyor and Watson, 1978), dorsopedal flap using the second metatarsal (O'Brien, 1979), forearm flap with the radius (Soutar and Mac Gregor, 1986), lateral brachial flap with humerus (Martin, 1988), free fibular flap (Hidalgo, 1989)... and the story continues.


[Microsurgical reconstruction of the irradiated mandible with deep iliac circumflex flap]. From 1979 to 1988, 30 osteomuscular or osteomyocutaneous free flaps of the iliac crest (revascularized by the deep circumflex pedicle) were used to reconstruct 28 mandibles severely compromised by radiotherapy exceeding 66 Grays. In addition to a perfect graft raising and microsurgical technique, perfect closure of the mucosal plane appears to be an essential factor of success. Over the years, this iliac crest flap appears to improve the radiological appearance of the bone stumps on either side. The procedure therefore appears to be particularly useful in the treatment of advanced radiation osteonecrosis.


[Role of osteocutaneous external brachial flap in the treatment of composite loss of substance of the mandible]. The authors report on their research begun in 1987 on this flap and its uses in reconstruction of composite defects of the horizontal and symphysical parts of the mandible, regardless of the cause of the loss. For treatment of average sized defects (less than 7 centimeters), it is reliable flap, easy to remove and to model by osteotomies, giving a thin skin mobile with bone and the removal of which results in only moderate development of scar tissue at the donor site.


[Osteomuscular serrato-costal free flap: application to mandibular reconstruction]. The serrato-costal free flap provides a large costal flap vascularized by a digitation of the serratus anterior muscle supplied by the dorsal thoracic artery. The flap is easy and rapid to raise with low morbidity. The repair obtained is functionally very satisfactory, but does not allow insertion of an implant. Six cases are reported. The indications of this technique of mandibular reconstruction are discussed.


[Mandibular reconstruction by free transfer of the fibula after cancer excision]. The authors present five cases of mandibular reconstruction using a vascularised fibula free transfer in cases of mandibulectomy for cancer. After giving a short account on the anatomy, they describe the technical details of fibula preparation and its transfer at the recipient site. The clinical observations are described. This recent technique seems to be developing, taking in account the qualities of the fibula: available bone length, possibility of performing osteotomies with preservation of the vascular supply, low morbidity at the level of the donor site, and satisfactory cosmetic and functional results. Despite of one recent failure, this short series seems to confirm the great interest in this type of bone reconstruction.


[Free composite flaps with the fibula and their adaptation to mandibular reconstructive surgery. Apropos of 9 cases]. Although revascularized fibula bone transfers have been used in reconstructive surgery of long bones for about fifteen years, the first reported cases of mandibular reconstruction were only published in 1989 by Hidalgo. The mandible and the fibula actually have very few points in common apart from their respective length and a certain similarity of cross-section. However, free composite flaps including the fibula are adapted to reconstruction of the mandible for several reasons: the length of the bone which can be raised (25 cm) and osteotomized into several fragments; the addition of other components (skin, aponeurosis, muscle, etc.) for skin and/or mucosal repair; the spatial independence of these various elements; the microsurgical qualities of the peroneal artery. This possibility of multidirectional and multiple tissue bony mandibular reconstruction is analysed on the basis of 9 clinical cases: 5 cases of traumatic sequelae of the lower third of the face following gunshot injuries, 2 cases of radiation osteonecrosis, 2 benign bone diseases. The triple bone, integument and vascular adaptation between the fibular donor site and the recipient site must be assessed preoperatively. Due to the quality of the morphological and functional results compared with the limitations of other free composite bone transplants, the authors propose free composite fibular flaps as adapted and adaptable solutions for one-stage reconstruction of extensive mandibular defects (> 10 cm) associated with small or large mucocutaneous lesions.


[Should microsurgical mandibular reconstruction be dissociated?]. Microsurgical transplant has the additional advantage over bone graft of being a composite tissue, resembling the defect it is intended to replace. This applies particularly to the mandible, as the mucocutaneous tissues are intimately applied over the bone. Regardless of the ingenuity of the transplant design and the different variations, none of the flaps used in this series of 37 microsurgical reconstructions was able to validly reconstruct bone and/or mucosa and/or skin in a single operative stage. It very rapidly became apparent that microsurgical reconstruction of the mandible needs to be divided into several stages in order to taken into account the mucosal defect. This choice of a more difficult alternative based on the lack of bone donor sites is compensated by the good tolerance of intestinal transfers to the buccal cavity.


[mandibular reconstruction by free bone flaps with micro-anastomosis. Our current indications]. The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.


[Practically: differential indications of mandibular reconstruction in maxillofacial cancerology]. This study, based on the authors' experience, intends to determine the specific indications of mandibular reconstruction after oncological maxillofacial resections. Mandibular defects without osseous interruption do not necessarily need an osseous reconstruction: the esthetic and functional problems can be resolved using dental osseointegrated implants. On the contrary, mandibular defects with osseous interruption need imperatively an osseous and/or composite reconstruction: the best esthetic and functional results are obtained with an immediate reconstruction by an osseous or osteocutaneous free flap, either from the fibula or the iliac crest. The advantages and the disadvantages of all these reconstruction technics are detailed and largely illustrated.


[No, Mozart was not trigonocephalic].

[No, Mozart was not trigonocephalic]. The precise circumstances of Mozart's death and burial remain unclear at now. In this, the ownership of the skull supposedly belonging to the great musician and deposed at the Salzburg Museum is still a matter of controversy. A comparison between the cephalometric dental and cranial characteristics of this skull and portraits of Mozart, either genuine or reconstituted, has been established. The hypothesis of a trigonocephaly reported initially by Puech and Tichy seems to need modification to the benefit of a regional brachycephaly. On the other hand our study does confirm the great probability for this skull to be Mozart's one.


[Diaphragmatic hernia complicating omentoplasty after thoracic wall excision. Reflections apropos of 2 cases]. The authors relate two case-reports of diaphragmatic hernia occurring after antero-lateral chest-wall resection and repair with an omental flap. Both patients had undergone a prior lung resection for bronchogenic cancer, and the indication for chest-wall resection was parietal neoplastic recurrence. In both patients, the omental flap was brought up to the chest wall defect by a direct transdiaphragmatic route; prosthetic material was note used. The hernia presented once as early post-operative evisceration, and once as proximal obstruction due to gastric herniation. The causes of these two complications are analysed. Omentoplasty was justified twice, since the latissimus dorsi had been severed during the prior thoracotomy. Prosthetic material might have been useful to one of the patients, but not to the second who had undergone pneumonectomy. The transdiaphragmatic passage of the omentoplasty was certainly responsible for the herniae and should be avoided.


[Musculocutaneoplasty by combined flap with tensor of the fascia lata- gluteus medius in trochanteric pressure sores. Apropos of a clinical case]. The authors describe a musculocutaneous flap which can be used in trochanteric pressure sores in paraplegics. Described by Little and Lyons (1983), this reconstructive unit combines the proximal muscular segment of the tensor fasciae latae (TFL) and gluteus medius muscles in a round shaped flap pedicled on the lateral circumflex femoral artery. The anatomical basis of this muscle combination is found in the anastomotic network between the superior gluteal artery which supplies gluteus medius muscle and lateral circumflex femoral artery, the principal vascular pedicle of the TFL muscle. Cutaneous defects of the trochanter and associated osteitis are frequent complications in paraplegic patients which often require ostectomy and coverage of the bony prominence by well vascularised, padded skin. Musculocutaneous flaps are well suited for this purpose and we review various reconstructive units that may be brought into trochanteric defects. Among these, the gluteus medius-TFL flap appears to be an interesting option for, in case of recurrent ulcers, other donor areas are left intact, and the flap itself could give rise to a subsequent "traditional" TFL flap.


Human reciprocal translocations: a new computer system for genetic counseling. A new computer system for genetic counseling in reciprocal translocations is described. This system, namely RCPc (RCP counseling) is a knowledge base extracted from a data base called SCD (Structural Chromosome Data) which contains 1376 families carrying reciprocal translocations. RCPc gives key information for each translocation which allows an evaluation of the risk of unbalance at birth and a prediction of the characteristics of potential unbalances. This information could provide a useful basis for deciding whether a prenatal diagnosis is required and if so, the preferred sampling method i.e. amniocentesis or chorionic villus sampling (CVS).


Population genetics of hereditary hemochromatosis in Saguenay Lac-Saint-Jean (Quebec, Canada). Hereditary hemochromatosis (HH) is an autosomal recessive disorder that has a high prevalence in Caucasian populations. Based on HLA typing in 18 families, the gene frequency was estimated 0.12. The homozygote frequency was 0.014 and the heterozygote frequency was 0.21 in Saguenay Lac-Saint-Jean (SLSJ), a geographically isolated region of northeastern Quebec. The genealogical reconstruction showed that 15 of the 57 obligate carriers of the HH gene could be traced back to a unique ancestor in the 18th century. The mean coefficients of inbreeding and kinship were 17 and 15 times, respectively, higher in the HH group than in three control groups. The values of both coefficients were much higher than those found in other HH populations and in most of the other recessive disorders prevalent in SLSJ.


Deletion 11q23-->qter (Jacobsen syndrome). Report of three new patients. Three unrelated patients with de novo del 11q23-->qter are reported. Clinical features included growth and mental retardation, hypotonia, trigonocephaly, facial dysmorphism with hypertelorism, epicanthal folds, abnormally shaped palpebral fissures, eye globe malformations, depressed nasal bridge, "carp-shaped" mouth, highly arched palate, low set and malformed ears. One patient had congenital heart defect, and reduced platelet count. This syndrome, originally reported by Jacobsen, is now corroborated by more than 35 patients and appears as the most common deletion involving 11q. Since deletion of subband 11q24.1 is critical for full expression of this syndrome, the JBS phenotype could be an example of contiguous gene syndrome.


Seckel syndrome: report of three sibships with the type I primordial dwarfism. Possible linkage with HLA locus. The authors report on five cases of Seckel syndrome type I primordial dwarfism, belonging to three unrelated sibships. Immunological and cytogenetic investigations with DEB test did not evidence immunodeficiency or chromosomal fragility. HLA phenotype studies revealed an identical haplotype in affected sibs: a possible linkage with HLA is therefore suggested. Cranial magnetic resonance was performed in three patients and did not evidence any anomaly. One affected female showed precocious puberty at 7 years of age.


Trisomy of the short arm of chromosome 4: the changing phenotype with age. In this paper the authors describe three patients with trisomy of the short arm of chromosome 4 with special attention to the striking phenotypic changes with age. When they get older the round face with chubby cheeks, deeply-set eyes and broad and flat nasal root with a bulbous nose tip becomes triangular or even long. Postnatal growth retardation is pronounced with short neck and broad, short chest with hyperkyphosis. The moderate to severe mental retardation is associated with almost absence of speech development, severe behavioural problems and poor fine motor development with persisting hypertonia, stiff, unstable gait, joint contractures and seizures.


Is Yq11 the main critical segment in balanced Y;autosome translocations? Balanced Y;Autosome translocations seem to be associated with male infertility whenever the Y breakpoint is located into Yq11 (where the azoospermia factor maps) or near its boundaries. By analogy with the effect on female carriers' fertility of balanced X;Autosome translocations, the band Yq11 emerges as the critical segment. This hypothesis implies that the subjacent mechanism is an impaired expression of the azoospermia factor--either through its physical disruption or via a position effect--rather than a disorder of the sex bivalent inactivation during prophase I.


A 15p+ variant shown to be a t(Y;15) with fluorescence in situ hybridisation. Prenatal diagnosis in two successive pregnancies revealed the karyotype 46,XX,15p+ (pat). Using the Y heterochromatic probe pHY3.4 and fluorescence in situ hybridisation, the variant 15 was identified as a t(Y;15)(q12;p11). Interphase scanning alone would have given a false result in both prenatal assessments and in the phenotypically normal father.


Unbalanced karyotype due to adjacent 1 segregation of t(11;22)(q23.3;q13.2). The 11q;22q translocations, whatever the breakpoints may be, are of particular interest because of their propensity to 3:1 segregation of the chromosomes at meiosis I. Until now, no unbalanced karyotype resulting from 2:2 adjacent segregation was published among offspring of 11q;22q translocation carriers. The authors report the case of an unbalanced karyotype due to adjacent 1 segregation of a maternal translocation (11;22)(q23.3;q13.2). The proband's karyotype was 46,XX,-22,+der(22)(11;22)(q23.3;q13.2)mat. This finding demonstrates that adjacent 1 segregation is possible in t(11;22) with breakpoints at 11q23 and 22q13, and can lead to birth of viable infants.


46,XX/46,XX,del(20)(pter-->p12.2) mosaicism limited to fibroblasts associated with MCA/MR and severe growth deficit. In this report the authors describe an 8-year-old severely mentally retarded girl with facial features resembling the facial dysmorphism seen in patients with Alagille-Watson syndrome, severe growth retardation and a 46,XX/46,XX,del(20)(pter-->p12.2) mosaicism in fibroblasts.


Y aneuploidy: a further case of a male patient with a 48,XYYY karyotype and literature review. An adult male with three Y chromosomes is reported. The patient showed some clinical features similar to those of Klinefelter's syndrome. This case represents the 6th instance described in the literature of a 48,XYYY karyotype without recognizable mosaicism. The authors compare the clinical symptoms with those of the five previously reported cases.


Interstitial deletion and ring chromosome derived from 19q. Proximal 19q trisomy phenotype. A small supernumerary ring chromosome has been found in a boy with overweight, dysmorphic facies and mental retardation. His mother had an interstitial deletion of the long arm of chromosome 19 and the same ring chromosome. By means of fluorescence in situ hybridization the ring chromosome was shown to be derived from the deleted chromosome, after the occurrence of two breaks: one in the centromere region, the other in the q-arm of chromosome 19.


Trisomy 21 mosaicism in two subjects from two generations. In the course of a chromosome fragility investigation on the cancer prone hereditary disorder xeroderma pigmentosum, a low proportion of cells with a 47,XY,+21 karyotype was found in lymphocyte cultures of a patient not showing any Down syndrome symptom. The presence of trisomy 21 mosaicism was demonstrated also in peripheral blood of the healthy father and confirmed by "chromosome painting" that allowed a rapid detection of chromosomes 21 on metaphase cells and interphase nuclei. The trisomic cell line was not detected in fibroblast cultures. The analysis of chromosome 21 heteromorphism indicated that in both subjects the mosaic could result from either a diploid or an aneuploid zygote. Since in the trisomic cell line of the father and the son the extra chromosome 21 seems to be the same, a predisposition toward mitotic errors (non-disjunction or anaphase lagging) may be postulated, leading to the recurrent gain or loss of a specific chromosome 21. In order to test the hypothesis of an abnormal mitotic behaviour of the chromosome 21, we investigated the centromere separation index and the DNA restriction pattern in Southern blots probed with satellite DNA sequences specific for chromosome 21 centromere. Both the approaches did not reveal any peculiar feature that may account for the genetically determined proneness to mitotic error observed in the family.


[Effect of inoculum parameters on the specificity of secondary synthesis in cultures producing novobiocin and mycoheptin]. The impact of the vegetative inoculum parameters on specificity of the secondary synthesis in the cultures producing novobiocin and mycoheptin was studied. During the study the fermentation conditions were varied by using the vegetative inoculum differing in the respiration rate after its transfer to the fermentation medium. To show the decisive role of the inoculum parameters in regulation of the specificity of the secondary synthesis, the dynamics of accumulation of certain metabolites forming from glucose along with the main antibiotic and the activity of the key enzymes of the carbohydrate metabolism during the culture growth in the fermentation media were studied. It was found that the specificity of the secondary synthesis with respect to certain metabolites was defined by the intensity of carbohydrate metabolism, i. e. the ratio of the activity of enzymes of glycolysis and the pentosephosphate pathway. In this regard, the inoculum with the maximum respiration rate in an amount of 10 to 20 per cent promoted the highest productivity of the mycelium by the synthesis of novobiocin and mycoheptin while the rate of accumulation of fatty acids, carbohydrates and phenol compounds (for Streptomyces spheroides) and mycopentene (for Streptoverticillium mycoheptinicum) decreased.


[Effect of rifampicin on the synthesis of antibodies to fraction I of vaccine EV]. Multifactorial analysis was used to study the influence of rifampicin on the dynamics of synthesis of antibodies belonging to IgM and IgG classes in mice immunized by fraction I of the vaccinal strain EV. Equations and quadric surfaces describing individual dynamics of antibody formation within a wide range of antibiotic doses and time of antibody content determination were developed by the experimental data. It was shown that within the range of the doses corresponding to the therapeutic ones in man rifampicin stimulated antibody formation. It had an inhibitory effect on antibody genesis only when used in the doses many times higher than the therapeutic ones.


[Detection of persistent resistance to antibacterial drugs in various strains of Francisella tularensis]. Under natural conditions, the Francisella tularensis strains AE-261 and P-13864 capable of forming the persist type of resistance to antibacterial drugs and being the cause of the infection in laboratory animals not responding to monotherapy with antibiotics were detectable. The antibioticograms of strains AE-261 and P-13864 under the in vitro conditions did not differ from those of the other studied strains responding to the antibiotic therapy. The observed phenomenon could be associated with individual peculiarities of the strains and their phenotypic variation in the host. Combinations of aminoglycoside antibiotics (streptomycin, gentamicin and amikacin) with rifampicin were shown to be highly active in the treatment of general forms of the infection due to such strains. The combined therapy of tularemia was also considered promising because of its high efficacy when the treatment was started at late periods as well as because unlike the monotherapy with the aminoglycoside antibiotics it provided complete elimination of the pathogen from the host.


[Protoplast fusion in Streptomyces fradiae strains producing neomycin and tylosin]. Interspecies fusion of protoplasts of the Streptomyces fradiae strains producing neomycin (an aminoglycoside antibiotic) and tylosin (a macrolide antibiotic) was performed with a view to isolate strains producing novel antibiotics. Fusion of the protoplasts of the neomycin- and tylosin-producing strains labelled by the resistance to monomycin and lincomycin, respectively, caused no formation of stable strains producing antibiotics differing in chromatographic mobility from the antibiotics produced by the initial strains. In fusion of the protoplasts of the unlabelled strains, heat-inactivated protoplasts of the active line of one strain (donor) and native protoplasts of the inactive line of the other strain (recipient) were used. When the neomycin-producing culture was used as a recipient the fusion led to formation of strain 195-34 producing antibiotics of the benzo(a)anthraquinone group. One of these antibiotics, i.e. antibiotic 34-I, proved to be a novel biologically active substance. After regeneration of the protoplasts of the initial strains, no stable strains producing antibiotics differing from neomycin and tylosin were isolated.


[Assessment of the sensitivity of Neisseria meningitidis strains to benzylpenicillin using the disc diffusion method]. The sensitivity of 235 N. meningitidis strains to 5 antibiotics was estimated by the diameter of growth inhibition zones according to the criteria recommended by a Laboratory (Marseilles, France) collaborating with the WHO. All the strains proved to be sensitive to benzylpenicillin when disks containing 10 and 2 IU of the antibiotic were used. The strains were also shown to be sensitive to chloramphenicol and tetracycline. 95.7 and 7.7 per cent of the strains were sensitive to rifampicin and oleandomycin, respectively. When the strain sensitivity was assayed with the disks containing 10 and 2 IU of benzylpenicillin by the more severe criteria recommended by J. Saez-Nieto et al., significant changes were detected: meningococci with relative resistance to benzylpenicillin were detected in various regions of this country and the number of such strains was found to have a tendency to slightly increase.


[Energy metabolism in Staphylococci containing plasmids of resistance to a number of antibiotics]. Activity patterns of membrane-bound enzymes of an antibiotic sensitive strain of Staphylococcus aureus 8325-4 and its variants containing the plasmids of resistance to penicillin, tetracycline, erythromycin and chloramphenicol were studied. It was shown that acquiring of resistance to the above mentioned antibiotics influenced cellular energy metabolism. The resistant strains exhibited an increase in the specific activity of NADN, malate and succinate oxidases, intensification of the ATP-hydrolyzing activity, changes in the activity of definite dehydrogenases and a decrease in the specific content of cytochromes. No changes in the composition of respiration carriers were detected.


[Effect of various adamantane compounds on the reproduction of Sindbis virus. Isolation and properties of a resistant strain]. Rimantadine and its structural analogs, i. e. amide of 1-adamantane carboxylic acid (AACA) and 1-adamantane acetic acid amide, were shown to be able to inhibit reproduction of Sindbis virus in culture Vero cells. AACA had the maximum antiviral activity. Subcultures of the initial sensitive population of Sindbis virus in the presence of AACA led to formation of mutants resistant to AACA as well as to rimantadine, adamantane acetic acid amide and ammonium chloride. The Sindbis virus population was heterogenous in sensitivity to AACA, which was evident from isolation of separate clones with various levels of sensitivity to the above mentioned compounds from the population. It was found that reproduction of the AACA sensitive and resistant strains of Sindbis virus differed: the latent period of the resistant strain was 2 hours longer than that of the sensitive strain. The same effect was observed in the comparative study on synthesis of the virus-specific RNA.


[Comparative effectiveness of various antibiotics in the treatment of patients with meningococcal meningitis]. The results of treating 322 patients with various forms of meningococcal infection accepted to a hospital within a year are presented. The patients were divided into 3 groups by the character of etiotropic therapy. The patients of group I were treated with benzylpenicillin and those of group 2 were treated with levomycetin sodium succinate. Group 3 included the patients, the therapy of whom with the above two antibiotics failed and they were subjected to treatment with cefazolin, cefotaxime, amikacin and other broad spectrum antibiotics. Benzylpenicillin generally proved to be the drug of choice in the antibacterial therapy of meningococcal infection. In comparison to levomycetin (chloramphenicol) it provide more rapid clinical recovery of the patients and normalization of the indices of the cerebrospinal fluid. Only failure of benzylpenicillin therapy was considered as an indication to the broad-spectrum antibiotics to be in the complex treatment of the patients. As additional methods for estimating the efficacy of antibacterial therapy it was recommended to employ calculation of the integral indices of hemograms (the leukocyte index of intoxication and the hematologic index of intoxication).


[Immunochemotherapy of infants in the first year of life with intestinal infections due to opportunistic gram-negative aerobic bacteria]. The clinical and microbiological observations of 50 babies of the 1st year of age with intestinal infections due to opportunistic organisms were made. The babies were treated with antibacterial drugs and an immunoglobulin preparation. It was shown that the combined use of antibacterial and immunological preparations in the treatment of the babies with the intestinal infections caused by opportunistic organisms provided their earlier clinical recovery and lowered the unfavourable effect of the antibacterial drugs on the intestinal microflora.


[Blood cholesterol and mortality].

[Blood cholesterol and mortality]. Mortality rates vary with serum cholesterol levels: the causal nature of this relationship is studied by prospective studies (analysis of associations) and unifactorial primary prevention trials (experimentation to determine causality). In prospective studies all cause mortality is often increased at low and high cholesterol levels because of the inverse relationships of this factor with cardiovascular mortality (positive) and non-cardiovascular mortality (negative). Coronary death increases proportionally to serum cholesterol levels in all populations, including those with low cholesterol levels, in both sexes and at all ages. The relationship with cerebrovascular mortality seems to depend on the clinical feature: increased mortality rate due to cerebral haemorrhage in patients with low serum cholesterol and a positive correlation with cerebral thrombosis. Mortality due to cancers is generally negatively correlated to serum cholesterol levels with a significant increase in mortality in patients with a low serum cholesterol. This relationship often becomes less significant as the time between measurement and death increases. Mortality due to violent causes is not usually related to serum cholesterol. The multitude of possible causes of confusion makes any causal interpretation of data illusory. Experimentation by unifactorial primary prevention trials is essential for any etiological research but none of the trials performed to date was designed to analyse the effect of lowering serum cholesterol on global or coronary mortality.(ABSTRACT TRUNCATED AT 250 WORDS)


[Relations between HDL-cholesterol and cardiovascular diseases]. Many retrospective and prospective epidemiological studies have demonstrated an inverse relationship between HDL-cholesterol and coronary risk. The predictive value of HDL-cholesterol is observed both in asymptomatic subjects and those with a primary vascular event. Several genetic abnormalities may be responsible for low HDL cholesterol (under 100 mg/dl or 0.26 mmol/l) or for a less severe hypoalphalipoproteinaemia. Despite some very low values, these rare causes of HDL deficiency are not all atherogenic and serve to emphasize the complexity of HDL metabolism. The protective role of HDL is explained by a number of mechanisms such as their role in the reverse transport from the peripheral tissues to the liver, their anti-oxidant effect and the increase in prostacyclin levels. The correction of isolated hypoalphalipoproteinaemia by drugs is controversial, but associated hyperlipidaemic states would be an indication to use drugs which increase the HDl-cholesterol the most.


[Role of triglycerides in cardiovascular diseases]. The role of triglycerides in cardiovascular disease is a controversial subject. Despite differences of opinion, present data allow a certain number of conclusions to be drawn. Hyperchylomicronemia is not associated with atherosclerosis, whereas type III hyperlipidemia is very atherogenic. These two abnormalities are, however, rare, and the majority of hypertriglyceridemias are, in practice, associated with increased very low density lipoproteins. Many epidemiological trials do not identify hypertriglyceridemia as an independent risk factor when the cholesterol and, in particular, the HDL cholesterol levels, are taken into consideration. Nevertheless, these results must be interpreted with caution as hypertriglyceridemia represents a very heterogeneous entity which is closely related to many factors which affect coronary risk (hypertension, insulin resistance, sedentarity, and even tobacco consumption). Therefore, hypertriglyceridemia and hypo-HDL-emia may be the result of the same primary abnormality; as the HDL-cholesterol level is more stable, it is the parameter which will be identified as a protective factor in epidemiological trials. The available data is insufficient to affirm that therapeutic lowering of triglycerides is accompanied by a reduced coronary risk because none of the large scale trials were designed to analyse this problem. Despite these epidemiological data, the measurement of serum triglyceride levels remains important in patients with hyperlipidemia.


[Serum cholesterol and cancer. Is there a causal relationship?]. Several studies have reported an inverse relationship between serum cholesterol levels and the risk of cancer, especially of the colon (Seven Countries, Framingham, Chicago studies, London Whitehall Study, Paris prospective study, New Zealand Maori, Honolulu Heart Study, Hypertension Detection and Follow-Up Program, ...). For example, in the Multiple Risk Factor Intervention Trial (361 662 men), the global mortality graph was J-shaped, higher at either side of the 4.6-5.1 mmol/l value of serum cholesterol. This increased mortality with lower serum cholesterol levels was due to increased numbers of death from cancer. However, when the relationship is studied with respect to the time elapsed between the cholesterol measurement and death from cancer, the relative risk of death in the lowest decile with respect to the average of the following deciles, decreases with the period between measurement of the serum cholesterol and time of death. The negative relationship between serum cholesterol and death by cancer, very significant for deaths occurring within the first 5 years, disappeared almost completely for deaths occurring after 5 years. Other trials designed mainly to examine cardiovascular risk, and concerning smaller numbers, have not demonstrated this inverse relationship between serum cholesterol and cancer. This negative relationship between serum cholesterol and cancer must be acknowledged. It is weak and concerns mainly colonic cancer, especially in men in the elderly age groups. Several explanations have been put forward: influence of the combination of factors, competition of risk of death by other causes, chance, alteration of normal biological function of the cell membrane.(ABSTRACT TRUNCATED AT 250 WORDS)


[Is regression of atherosclerosis possible?]. Experimental studies have shown the regression of atherosclerosis in animals given a cholesterol-rich diet and then given a normal diet or hypolipidemic therapy. Despite favourable results of clinical trials of primary prevention modifying the lipid profile, the concept of atherosclerosis regression in man remains very controversial. The methodological approach is difficult: this is based on angiographic data and requires strict standardisation of angiographic views and reliable quantitative techniques of analysis which are available with image processing. Several methodologically acceptable clinical coronary studies have shown not only stabilisation but also regression of atherosclerotic lesions with reductions of about 25% in total cholesterol levels and of about 40% in LDL cholesterol levels. These reductions were obtained either by drugs as in CLAS (Cholesterol Lowering Atherosclerosis Study), FATS (Familial Atherosclerosis Treatment Study) and SCOR (Specialized Center of Research Intervention Trial), by profound modifications in dietary habits as in the Lifestyle Heart Trial, or by surgery (ileo-caecal bypass) as in POSCH (Program On the Surgical Control of the Hyperlipidemias). On the other hand, trials with non-lipid lowering drugs such as the calcium antagonists (INTACT, MHIS) have not shown significant regression of existing atherosclerotic lesions but only a decrease on the number of new lesions. The clinical benefits of these regression studies are difficult to demonstrate given the limited period of observation, relatively small population numbers and the fact that in some cases the subjects were asymptomatic. The decrease in the number of cardiovascular events therefore seems relatively modest and concerns essentially subjects who were symptomatic initially. The clinical repercussion of studies of prevention involving a single lipid factor is probably partially due to the reduction in progression and anatomical regression of the atherosclerotic plaque.(ABSTRACT TRUNCATED AT 250 WORDS)


[Optimal serum cholesterol and efficacy of methods for lowering cholesterolemia]. Analysis of epidemiological studies enables definition of the optimal serum cholesterol level between 2 and 2.2 g/l (5.2 and 5.7 mmol/l). Higher levels are associated with an exponential risk of coronary artery disease: lower levels should be interpreted with caution because of the J-shaped curve of global mortality reported in several trials. In primary prevention, therapeutic trials have clearly shown that a significant reduction in the number of coronary event may be obtained by lowering the serum cholesterol (15 for every 1,000 patients treated). In trials performed to date this benefit has not resulted in any gain in global mortality. In secondary prevention, the benefits of lowering serum cholesterol on the incidence of coronary disease seems identical in terms of relative risk to that observed in primary prevention. Nevertheless, the benefits in terms of absolute risk are much higher because of the high incidence of coronary mortality in a patient population with a previous coronary event. Thus, for 1,000 patients treated, there are 50 less cardiac events and this is reflected in a reduction of global mortality of about 20 for every 1,000 patients treated.


[Should men aged 20 to 30 years with hypercholesterolemia be managed in the same way as older men?]. Serum cholesterol intervention studies have been mainly performed in middle-aged men. Is the extrapolation of these results to men aged 20 to 30 years justified? Atherosclerosis is a process which continues throughout life. It is clear that increased serum cholesterol levels are associated with a higher coronary risk. In addition, serum cholesterol levels increase with age up to 60 years old. Do young men obtain the same benefits from medical intervention as older men? Therapeutic trials have been performed in middle-aged men. The increase in life expectancy associated with a 6.7% lowering of the serum cholesterol by life-long dietary restrictions would only be 4 months in 20 year old subjects at high risk (hypertension, smokers, low HDL cholesterol). With a 20% reduction in serum cholesterol, the gain would be 12 months. There is no reason for not extrapolating acquired data in the over 30s to 20 to 30 year old subjects. Due to the fact that young subjects are exposed to the risk for longer periods, it is advisable to treat their hypercholesterolaemia even more seriously than that of older patients.


[Should hypercholesterolemic women be treated?]. There have been few studies designed to evaluate the problem of hypercholesterolaemia in women despite the fact that, like men, cardiovascular disease is their main cause of death. Serum cholesterol is a risk factor in women, but the increased risk appears at much higher values of serum cholesterol than observed in men. In women, low HDL-cholesterol seems to be the best predictive factor for the occurrence of a coronary event, especially if the triglycerides are raised. The absence of therapeutic data on the treatment of hypercholesterolaemia in women underlines the need for a specific trial to assess the effects of lipid-lowering drugs in this population. The cardiovascular benefits of hormone substitute therapy at the menopause have been reported in several studies and a large scale randomised trial is under way to confirm these results. The benefit of hypercholesterolaemic therapy in women with mild hypercholesterolaemia has not been proved. When the serum cholesterol level is over 3 g/l (7.77 mmol/l), early treatment is advisable.


[Hyperlipidemia in patients over 60 years old]. The management of hyperlipidemia in individuals aged 60 or over is a serious problem, given the frequency of metabolic abnormalities in this age group. The decision to treat must take into account a number of uncertainties. Hypercholesterolemia is a risk factor in the elderly and, in general, its importance varies like the other major risk factors (hypertension and smoking): the relative risk decreases with age but this decrease in relative risk is associated with an increase in the absolute risk because the prevalence of cardiovascular disease greatly increases with age. The serum cholesterol level increases with age but the physiopathological mechanism os this increase is poorly understood (reduction in the number of LDC receptors?). In the over 70s, serum cholesterol levels decrease, probably because of a selection due to the deaths of subjects at higher risk. No therapeutic trials have been performed to evaluate the effects of lowering the serum cholesterol in the over 60s. In addition, strict application of international recommendations in this age group would result in a large number of therapeutic interventions, the value of which would be questionable. Under these conditions, practical clinical advice is based on reasoned extrapolation of epidemiological data obtained in middle-aged men. Treatment should therefore be reserved for sever forms of hyperlipidemia, taking into consideration the life expectancy of the individual.


[The facts about cholesterol (condensed translation and comments of the common declaration of AHA and NHLBI)]. Many epidemiological and experimental studies have confirmed the continuous positive relationship between serum cholesterol levels and coronary risk. Therapeutic trials have demonstrated that the lowering of serum cholesterol by diet or drugs can lower this coronary risk. The benefits have been shown in men and women, the young and old, in those with a high coronary risk due to raised serum cholesterol and LDL and those with only moderately increased risk. In addition, therapeutic interventions on serum cholesterol are cost-effective. These observations more than justify the present national program of lowering the serum cholesterol.


[Comparison of methods for determining the prececal nutrient digestibility and amino acid absorption of swine with ileorectal anastomoses and ileocecal bridge cannulas]. The apparent precaecal nutrient digestibility and amino acid (a.a.) absorption of 10 diets were estimated in pigs with end-to-side ileorectal anastomoses (IRA) as well as with ileocaecal re-entrant cannulae (IZB). The digestibilities of organic matter and crude carbohydrates were significantly higher in IRA pigs than in IZB pigs in two resp. three diets only. There were no practical important differences for the digestibilities of crude protein and crude fat in all diets. Out of the 180 a.a. absorption comparisons only 20 (i.e. 11%) showed differences larger than 5%-units. The absorption rates of several a.a. were lower in IRA than in IZB pigs and of some other a.a. on the contrary. The methionine absorption of five legume diets and one barley + lysine diet were up to 15% resp. 4%-units lower in IRA pigs. Possibly this was due to the activity of microbes in the rectum in connection with a small intake level of protein bound methionine. In order to minimize such a falsification it is proposed to use the end-to-end anastomosis. The deviations in the apparent a.a. absorption between IRA and IZB pigs can be explained partly by differences in the quantity of precaecally excreted endogenous a.a. per 100 g DM intake.


[The use of the mobile bag technique in swine. Determination of the apparent crude protein digestibility and amino acid absorption of feed and rations]. The mobile bag technique (MBT) was used in two ileorectostomized and two intact pigs with duodenal cannulae, in order to estimate the precaecal and total crude protein digestibility and amino acid (lysine, methionine, cystine, threonine, tryptophan) absorption of ten single feedstuffs (field bean, lupin, rapeseed meal, fish meal, barley, wheat) and three diets. For each feed 36 bags were applied per animal. After a peptic predigestion in vitro, application of the bags through the duodenal cannula into the intestine and their passage through the gut, the residues remaining in the bags were pooled to collective samples and just as the original feed material analysed on dry matter, nitrogen and amino acids. The directly determined MBT-digestibilities (BV) and the values obtained by regressive calculations (BVb) have been compared with apparent digestibilities (sV) conducted from conventional digestion experiments. 74 per cent of all BV data was higher than the corresponding sV values. Similarities of BV with sV showed in 58 per cent, those of BVb with sV only in 17 per cent. In all cases differences of > +/- 4 digestibility units showed. Checking additivity of diet-BV by means of calculations from the BV of their single ingredients did not generally lead to the same results as the directly estimated diet-BV; in some cases the results were contrary. Therefore the use of MBT for mixed feed diets has to be further investigated. For single feedstuffs the MBT can be used successfully as a rapid and simple technique when regressive calculations are employed.


[The use of the mobile bag technique in swine. 2. Determination of the apparent and true crude protein digestibility of 15N-labeled feed]. In a series of experiments in two ileo-rectostomized pigs the precaecal apparent and true digestibilities for crude protein of seven 15N-labelled feedstuffs were studied using the mobile bag technique. True digestibility values of crude protein calculated with the help of isotope dilution were 4-14 units higher than the corresponding apparent digestibility values. This is caused by the infiltration of the bag residues with endogenous unlabelled nitrogen. In dependence on the kind of feedstuff the endogenous N portion in the bags amounted to 25-70% of the total N. In addition, the contamination is influenced by differences between the animals (mean 4-7%) and by different treatments of bags after gut passage (3-10%).