In vitro postantibiotic effect of roxithromycin and erythromycin against gram-positive cocci. A persistent suppression of bacterial growth following a brief exposure to an antibiotic (postantibiotic effect [PAE]) has been described for a variety of antibiotics and microorganisms. Data concerning PAE have not yet been demonstrated in Taiwan. In this study, the PAEs of erythromycin (EM) and roxithromycin (RXM) against 4 strains of Staphylococcus aureus, 3 of Streptococcus pyogenes and 1 of Streptococcus pneumoniae were tested. Dilution method was used for removal of drugs. Two controls, one free of drug and one in 1/1000 of the original drug concentrations were used. The results showed that the PAE lasted longer in strains of S. aureus (RXM 1.7-2.1 h; EM 1.7-2.1 h) and S. pyogenes (RXM 1.7-3.0 h; EM 1.9-2.9 h) than those in S. pneumoniae (RXM 0.6-1.6 h; EM 0.8-1.4 h). There was no difference of PAE between RXM and EM against each bacterial strain tested.


[Aortoiliac surgery after renal transplantation. Authors' experience and review of the literature]. Eighteen patients who had undergone renal transplantation three months to 25 years earlier were operated on for treatment of complicated aortoiliac atherosclerosis: nine had aneurysms (of which one was leaking) and nine had stenotic or obstructive lesions. Except for the first patient, operated on in 1973, in whom the kidney was protected by general hypothermia, no special measure was used to protect the kidneys in the other 17 patients. A transient increase in creatininemia occurred in the majority of cases during postoperative period. All patients had regained renal function identical to the preoperative state in less than 10 days. Three patients had significant improvement of renal function which lasted in the long term follow-up. Such improvement was a result of correction of a lesion that was impairing renal blood flow. Results obtained in this series show that protection of the transplant during aortic surgery is not necessary, provided an adequate surgical technique is used. This technique is described: it avoids the complex methods employed in several previously reported cases and appears to be a safe procedure.


[Pseudomyxoma of the peritoneum. Apropos of 4 cases]. Peritoneal pseudomyxoma is a rare disease (400 published cases). In 60% of all cases, an ovarian tumor is the cause of the disease. The second cause is appendicular mucocele. We report about four personal cases after a longer time lapse. No clinical or biological sign is specific. Ultrasonography associated to CT may allow establishing the preoperative diagnosis. Peritoneal pseudomyxoma has several main features: it is insidious, recurrent, obstinate and severe. Recent work has shown that peritoneal pseudomyxoma is secondary to malignant mucosecretory tumors, mainly of ovarian (cystadenocarcinoma) or appendicular origin, with intraperitoneal cell implants. Surgery is the only treatment with proven effectiveness. The effectiveness of chemotherapy and radiation therapy has not been established.


[Primary colonic linitis plastica. Apropos of 3 new cases]. Primary linitis plastica of the colon is unfrequent. Since Laufmann and Saphir's first cases in 1951, less than 50 cases have been described, to which our three new cases now add. The intramural origin with late involvement of the mucosa delays the onset of clinical signs, and accounts for the rarity of overt bleeding and for the frequent failure of biopsy. The radiological appearance is that a tubular colic narrowing without ulceration or intraluminal process. Endoscopy shows regular, centered stenosis with few modifications of the mucosa. The clinicopathological diagnosis is primarily microscopic: presence of isolate mucosecretory neoplastic cells infiltrating the whole wall of the colon without destroying it. Because of its potential for local invasion and of its centripetal extension, linits is often detected only at the equivalent of stage C (Astler-Coller). The prognosis is poor, with survival averaging 1 year after the onset of the first clinical signs.


[Aberrant biliary ducts and cysto-hepatic ducts. A comprehensive study]. Though very different, aberrant bile ducts and cysto-hepatic ducts are often confused. Aberrant bile ducts are abnormal ducts which do not drain any segment or sector of the liver. They are filled of bile counter-flow and can be injured not only in the gallbladder bed, but also elsewhere on the surface of the liver. Cysto-hepatic ducts are normal ducts, draining segment or sector of the liver, but because of an embryologic sliding, their branching is on the gallbladder or on the cystic duct. All these ducts can be injured during cholecystectomy, and it would be of importance to recognize the true type of duct one has to deal with, by radiologic explorations. The management is different as aberrant bile ducts need only to be ligated, instead, the cysto-hepatic ducts may require a reimplantation in the common bile duct or Roux en y loop. We discuss all these problems on the basis of 1200 traditional cholecystectomies where 1 aberrant bile duct, 3 cysto-hepatic ducts, and 3 external biliary fistulas were encountered.


[Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment]. Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks.


[Repair of hernia by a prosthetic dacron plug. Experience with 600 cases]. In some cases of inguinal hernia and of recurrence, the hernial gap can be selectively filled with a plug made of tull or dacron. In our opinion, the merit of this technique is that it limits incisions, detachments and structures of muscular and aponeurotic structures. Thus the operation is particularly non-traumatic and well tolerated by patients, who are discharged after 30 to 40 minutes and can often resume work on the very same day.


[Ileo-sigmoid knot. 16 cases].

[Ileo-sigmoid knot. 16 cases]. A retrospective study of 16 cases of ileo sigmoid knot, treated at Treichville Hospital in Abidjan Côte-d'Ivoire, is reported by the authors between 1970 and 1989. This pathology is not so seldom and concerned 14 men and 2 women from 14 years old to 61 years old with an average of 42 years. The more precise description of the physiopathology of this occlusion allows to classify this pathology as an independent entity from the other types of volvulus. The physiopathologic knowledge described allow a more precise diagnostic approach and a better codified therapeutic attitude.


[Analysis of stress in the knee using the finite element method]. The increase in the number of the studies of the stress around the anatomic prosthesis by the finite element method incited the authors' work. Our purpose was to study the methodology of a technic with simple cases. The finite element method is a method of calculation which allow the calculation of the displacement under the stresses of each element that we created in the structure. Before this calculation, we needed to define the exact geometry of the structure, the elementary properties of the material and the conditions of the experimentation, particularly the strains that exist in the structure. Three simple examples are given: an osteosynthesis plate with an hole, a knee model that Maquet studied with the photoelasticimetry method and a bidimensional knee model. The results are traduced by different colours or by coloured ligns. The conclusion is to warn the orthopaedic surgeons to look carefully what model is behind the pretty coloured results.


[Experimental study of the thermic effect on bone at 60 degrees C, as applied to bone allograft]. Bone reconstruction methods increasingly often require using bank bone. These massive bone fragments can be taken only from dead subjects or those in irreversible coma. Surgical sterility of the samples does not always guarantee the absence of an HIV infection, for which seroconversion often occurs very late. B. Spire's work has shown the effectiveness of a 30-minute heat treatment at 56 degrees C to inactivate HIV in blood products. Our study has therefore evaluated the effectiveness of a heat treatment method for bone to inactivate HIV on one hand, and the mechanical and histologic consequences of this treatment on rabbit bone. All bone fragments in this study were frozen at -80 degrees C to reproduce the same conditions of use as in current bone banks. Heating deep-frozen fragments of spongious tissue and of bone marrow from seropositive subjects in a 60 degrees C humid heat allowed confirming thermal sterilization of HIV, but a greater number of case is required to support this technique, as well as a verification with cortical bone. Thermal sterilization of bone allografts does not alter the mechanical properties nor the possibilities of bone regrowth in allografts. Application to human bone allografts should be confirmed by a greater number of cases, but it appears as a simple means to suppress the current disadvantage of late seroconversion control.


[A nail for progressive lengthening. An animal experiment with a 2-year follow-up]. The elongation nail was experimented on 10 pure-breed Romanov ewes aged 9 to 12 month-old. It was implanted in a randomly chosen femur, the other femur being used as a control. After a superior and lateral approach to the femur, drilling and initial distraction averaging 26 mm, the nail was inserted and locked at both ends. Lengthening began at D1 by alternate inward and outward rotation maneuvers exerted on the pelvic limb. One ewe presented an intraoperative hip dislocation, another one unlocked the upper lock, with secondary shortening. The other 8 ewes underwent successful lengthening without apparently suffering (63-mm gain, i.e. 37% at the end of lengthening). Two ewes died at 9 months and their femura presented with a space remaining to fill smaller than 3 mm. Five of the other 6 ewes were followed up for an average of 10 months after bone healing and nail removal, over a total follow-up of 2 years. The femur is modified all over its diaphysis and widened at the level of the regenerated tissue, where cortical bone is thinner but has a normal lamellar appearance. Bone marrow is replaced by trabecular bone filled with fatty marrow. The pathology study of the last of the 6 ewes followed up for 2 years showed a bridge between both sites of incipient regeneration, indicating bone healing. The final gain as compared to the non-operated side is 27%. Progressive lengthening can be performed with an internal fixator in animals. The clinical trial in progress with allow evaluating this technique and establishing its field of application.


[Experimental study on a skin substitute. Artificial dermis epidermised by human keratinocytes]. In patients with third-degree burns, plastic surgeons must meet emergent requirements for skin coverage. Conventional autografts do not provide enough substance to cover these patients, hence the interest of skin substitutes. The aim of our work is to achieve epidermization of an artificial dermis with a technique of culture of human keratocytes, thus producing in vitro a dermoepidermal skin substitute akin to normal skin, and to implant it in nude mice. Human keratocytes are grown in a definite medium (MCDB 153) on an artificial dermis based on type I and III collagen and glycosaminoglycans, and cross-linked with chitosan. Human keratocytes from thin skin were seeded on the artificial dermis after a last passage in culture fials. Cell density and the number of days in vitro were varied on patches of artificial dermis. After culture, the patches were transferred on nude mice. These were sacrificed on the 7th or 14th day. Cell recolonization of the artificial dermis was then studied, as well as the growth of the epidermis on deep-frozen histologic sections. Primary cultures on an artificial dermis did not show production of a satisfactory epidermis. In some animals grafted with artificial dermis epidermized in a secondary culture, we observed a structure similar to that of normal skin. This work allowed outlining the problems to slove and contemplating the solutions required to develop a total artificial skin.


[Assessment of difficulties in mental representation of visual stimuli in anorexic patients]. The aim of this research is to assess the mental representation associated to visual stimuli for anorexic patients. Two studies are described. The first one is a systematic observation of food representation for five patients within a 3-month period. The disruptive factors, mainly related to food visual aspect decrease with time. Consequently, a second experiment was carried out. Two groups were compared as far as the food mental representation related to visual food stimuli is concerned: a group of anorexic patients and a group of control subjects selected according to sex, age, and educational standard. The results show the existence of habituation process as there is a decrease of disruptions concerning the mental representation of food color, texture and shape. This result must be confirmed on a larger sample.


[Prospective study of psychiatric and pedagogic evaluation of the adolescent service of the Student Health Foundation of France. Methodology and preliminary results]. The present prospective study, with a five-year follow-up, presents an extensive psychiatric and educational assessment of an adolescent population (N = 30) in the age range 14-20, suffering from several psychiatric disorders, though apt to follow a normal academic program. The residential settings where the study took place provide both psychiatric and schooling facilities. In this environment, what is the effectiveness of long-term hospitalization? Are there any criteria for predicting results? After discharge, could social adjustments difficulties be prevented? Assessment instruments are described and the results of one preliminary study are presented. The actual data seems to confirm the impact of the special treatment facilities combining schooling and psychiatric settings on the long term outcome of adolescents.


[Crisis intervention: assessment process and long-term follow-up of patients]. The aim of this work, which was performed in a Crisis Centre in Geneva, Switzerland, was to study the relationship between a patient's long-term follow-up and the range of the patient's difficulties as assessed during screening by a clinician. Out of the 78 patients who were referred to the Centre during a two-month period in 1985, 31 were followed-up during a complete crisis intervention program. All these patients with severe symptoms would have been hospitalized if they had not been transferred to this program. The clinician's opinion of these patients' difficulties was obtained by using a questionnaire containing open-response questions. The data obtained was then subjected to specific content analysis. The patients' clinical state, diagnosis and changes during therapy were also assessed, using various questionnaires. Our results show that there is a negative correlation between the number or range of difficulties attributed and noted by the clinician and the long-term evolution of the patient, especially after two years. This relationship is dependent on the number, not the type of difficulties noted. Thus, although it is not possible to generalize these results, we have shown that it is possible to study parameters involved in the process of a psychotherapeutic-type treatment, using a questionnaire. We have also shown that crisis intervention can be considered as an especially interesting analogue of the early steps of psychotherapy, spread over a longer period. This is an aspect which is rarely studied.


[Post-traumatic dementia].

[Post-traumatic dementia]. On the basis of a retrospective study concerning 63 cases of normal pressure hydrocephalus, the author examines the characteristics of patients with a traumatic aetiology who were not ameliorated by a ventricular derivation. Four of these patients suffering from a post-traumatic dementia are described. Reviewing the literature, several topics concerning post-traumatic dementia are considered: incidence, time delay before diagnosis, variation of pictures, aetiopathogenic explanations, medico-legal problems encountered with Alzheimer's of Pick's diseases. Finally the differential diagnostic characteristics between the curable and incurable forms of post-traumatic dementia syndromes are discussed.


[Prognostic value of various classifications of acute delusional episodes]. A population of 56 cases of acute delusional disorders classified Bouffées délirantes by Pichot's diagnostic criteria is studied. Diagnostic methodology is described. Prognostic factors are assessed from individual variables, using a logistic linear regression model giving the probability of a favourable outcome. These prognostic factors are then adjusted considering gender.


Effects of convulsant ligands of the GABA-benzodiazepine receptor complex in conflict and learning tasks in mice. A systematic study of the effects of convulsants acting at the GABA-benzodiazepine receptor complex was undertaken in mice to estimate their potential anxiogenic effects and/or performance enhancing effects in learning and memory tasks. Anxiogenic effects were assessed in a conflict task where lever presses delivered both a food pellet and a mild electric foot shock. Effects on learning were assessed through analysis of habituation to a new environment. The convulsant agents pentylenetetrazol (PTZ) and picrotoxin (PX), both acting through the GABA-benzodiazepine receptor complex, and strychnine, a convulsant acting through the glycine transmission were used. Our data show that non convulsive doses of PTZ (25 mg/kg) and PX (0.85 mg/kg), but not of strychnine (0.8 mg/kg), are anxiogenic in the conflict model. At lower doses PTZ (10 mg/kg) and PX (0.3 mg/kg), but not strychnine (0.1 to 0.6 mg/kg), enhance performance in the habituation model. Our results contribute to the validation of the idea that small decreases in GABAergic transmission are accompanied by improvement of learning whereas medium decreases induce anxiogenic effects.


[Genetic polymorphism and metabolism of tricyclic antidepressants]. Steady state plasma concentration of orally administered tricyclic antidepressants varies markedly between individuals. This is partly explained by a recent notion: pharmacogenetic, as interindividual differences in the capacity of the liver to extract and metabolize them. Different studies indicate that N-dimethylation and 10-hydroxylation of tricyclic antidepressants are regulated by different enzymatic mechanisms. The 10-hydroxylation is under the same genetic control as hydroxylation of debrisoquin or demethylation of dextromethorphan. They are metabolized by the same cytochrome P450 isoenzyme. Monogenic control has been described for debrisoquin 4-hydroxylation and for dextromethorphan O-demethylation. The ratio between debrisoquin and 4-hydroxydebrisoquin or dextromethorphan and dextromethorphan O demethylated, in urine, after a single oral dose is bimodally distributed. A correlation between most of tricyclic antidepressants plasma concentration and metabolic ratio of debrisoquin or dextromethorphan has been demonstrated. Currently, the posology for a drug is established without taking into account slow-hydroxylator phenotype which is more exposed to adverse reactions.


[SPECT and depressive pseudo-dementia. A case report]. The SPECT (Single Photon Emission Computed Tomography), a new advance in medical imagery, allows the measure of cerebral blood flow and could be of interest in studying mental disorders. We report here a case of pseudo-dementia for which a SPECT has been performed before and after treatment. Mrs V., a 49 years old female, has been suffering from a dementia-like syndrome for several months. She is divorced, has two children, lives with a boy-friend, and has been working in a factory for 25 years. The first psychiatric disorders began three years ago with a gradual apragmatism and muteness. A neuroleptic treatment gave no result. One year later, without any reason, Mrs V. recovered a normal way of life. Nevertheless, from time to time, she had some periods of subexcitation. Few months later, she relapsed in her previous state of apragmatism and muteness. During a new hospitalization, neuroleptic treatment is tried again without any success. Mrs V. is then referred to us for medical screening of a dementia syndrome. In the Unit, it is difficult to communicate with her; she looks sad or amimic and has motor stereotypies (like rubbing her feet continuously against the floor). She has polidypsia and glutonny. Neurologic examination is normal, as well as EEG, X Scan, Nuclear Magnetic Resonance. The Folstein Mini Mental State score is 9/30.(ABSTRACT TRUNCATED AT 250 WORDS)


[Triatoma infestation in the San Luis del Palmar Department of Corrientes Province, Argentina]. The purpose of this study was to determine domestic and peridomestic infestation of Triatominae, Trypanosoma cruzi infection rates, and the prevalence of human seroreactivity in rural areas of the Department of San Luis del Palmar, Corrientes, Argentina (Fig. 1). The study took place from April 1986 to May 1989. The Department of San Luis del Palmar covers an area of 2551 km2 and is part of the Neotropical biogeographic region, Chacoan Dominion and Province. The climate is of the subhumid type. The mean annual temperature is 21.6 degrees C. Some localities were chosen because of the presence of triatominae. Households were carefully examined and classified according to their building materials. A 0.2% solution of tetrametrine was sprayed in all possible hiding places to dislodge bugs, which were collected by capture/hour/man methods. A survey to determine the socioeconomical, sanitary, and cultural conditions of house-dwellers was carried out. The same method was used to examine peridomiciles and total demolition was carried out in the positive ones. Fecal examination was carried out to verify the presence of T. cruzi in collected insects and observed at 400X. Human blood was obtained through venipuncture. The serum was kept in a freezer until examined. Serologic studies included indirect hemagglutination test (IHAT) and indirect immunofluorescence antibody test (IFAT). Positive titer for IHAT and IFAT was 1/64. Seroreactives were those that had two positive assays. The whole data obtained was analyzed by chi 2 tests. From one hundred households studied, 80% belonged to huts and 20% to houses. Mud walls were predominant in huts while brick walls were predominant in houses.(ABSTRACT TRUNCATED AT 250 WORDS)


[Cerebral embolism of cardiac origin].

[Cerebral embolism of cardiac origin]. We reviewed 538 charts of patients hospitalized with acute ischemic strokes between 1983 and 1991. The inclusion criteria for cardioembolism were: 1) sudden onset and maximal neurological focal deficit from the beginning, 2) brain CT showing an ischemic infarct, hemorrhagic infarct, or multiple infarcts, 3) cardioembolic sources demonstrated by echocardiography or heart catheterization, and 4) absence of stenotic-occlusive cerebrovascular disease. Sixty-nine patients (12.8%) filled the criteria for cardiogenic brain embolism. Cardiac sources were: 1) nonvalvular atrial fibrillation in 20 patients (29.0%), 2) rheumatic heart disease in 14 (20.3%), 3) nonischemic dilated cardiomyopathy in 13 (18.8%). Nine of these (69%) had cardiac involvement due to Chagas' disease, 4) ischemic heart disease in 11 (15.9%), and 5) other less common conditions such as bacterial endocarditis, mitral valve, and congenital heart malformation in 11 (15.9). Transient ischemic attacks preceding stroke occurred in 11 patients (15.9%), six patients had previous strokes, and 14 patients (20.3%) had silent infarcts. Early recurrence of embolism (three initial weeks) occurred in 5 patients (7.2%), and 28.6% of the patients had hemorrhagic transformation within this period. Taken together, our figures show that, although they are well in line with the current literature, nonischemic dilated cardiomyopathy is one of the main causes of cerebral embolism in our community. This reflects the presence of a regional factor, namely Chagas' disease.


Relative importance of urinary sulfate and net acid excretion as determinants of calciuria in normal subjects. In normal subjects fed western-mixed diets, in the fasting state, 39.6% of the variance of calciuria is accounted for by net acid excretion and 4% by sulfaturia. In the postprandial period, net acid accounts for 6.9% and sulfaturia for 11.8% of the variance of calciuria. As expected, after a load of ammonium chloride, net acid excretion exceeded the importance of sulfaturia (36.2% vs. 8.4%) and the opposite was observed after DL-methionine load (1.5% and 46.2%). A group of normal subjects fed vegetarian diets was also investigated. The excretion of the three variables measured were significantly reduced in this group when compared with that of the former group. In the fasting state the variance of calciuria was accounted mainly by net acid excretion (85.7%). In the postprandial state net acid (4.9%) and sulfate (2.2%) had much less importance as determinants of calciuria. It is concluded that in spite of their metabolic relationship, net acid and sulfate excretions are independent determinants of calciuria. The relative importance of each variable changes as a function of metabolic circumstances.


[Intermediate-density lipoproteins and liver lipase in postmenopausal women]. In order to evaluate atherogenic lipoproteins in post-menopause, we studied 73 healthy women, 49 to 65 years old (Post-menopausal Group), with 1 to 10 years of amenorrhea and body mass index below 27 Kg/m2, and 20 young women (Control Group). We have determined plasma cholesterol concentration in the lipoproteins of intermediate density in addition to the classical lipoprotein parameters: total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and fractionation of lipoproteins by electrophoresis. In 63 women from the Post-menopausal Group and 16 from the Control Group we studied the activity of hepatic lipase. Among these patients we selected at random 25 post-menopausal women and 13 controls to add measurements of triglycerides in the lipoproteins of intermediate density. Table 1 shows that the average plasma concentration of total cholesterol in the Post-menopausal Group was higher than that of the Controls (p < 0.001). The same was found for LDL-cholesterol (p < 0.001) and for triglycerides (p < 0.001) whereas the average concentration of HDL-cholesterol did not show significant differences. The Post-menopausal Group had high values of plasma lipoproteins of intermediate density, even with normal phenotypes (Table 2). Cholesterol but also triglycerides (Fig. 1) were responsible for this increase. A triglyceride rich lipoprotein subspecies of intermediate density was predominant in 73% of Post-menopausal women vs 23% of the Controls (p < 0.01, Table 3). No differences in hepatic lipase activity were seen between the two groups (Table 4), and non statistic correlation between the enzyme activity and IDL-triglycerides or HDL-cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)


Epidemic model of HIV infection and AIDS in Argentina. Status in 1990 and predictive estimates. The purpose of this paper was to evaluate the prevalence of HIV infection and AIDS in Argentina, to study the dynamics of the spread of HIV and to predict the future course by means of an epidemic model. The model was constructed using differential equations to describe the interactions between members of the various groups at risk. The functional form of the solutions was used in a back calculation procedure using data from cohort studies which were done in other countries (U.S.A. and France) together with data of AIDS cases reported to the National AIDS Program, to determine the time evolution of HIV-infection in each of the groups at risk defined. Results show that HIV was introduced in Argentina during the early 80's and affected persons of the homosexual/bisexual group in a first stage. In April 1990 it was estimated that there were a total of 34,131 HIV-infected persons. Intravenous drug users (IVDU) represented 39.5%, homosexual/bisexual men 47.6% and heterosexual adults 11%. It is estimated that in December 1992 there will be 107,946 HIV-infected persons where heterosexuals contribute with more than 20% of that value. AIDS cases predicted for the same period are 4130, with 1958 among homosexual/bisexual, 1483 among IVDU, 449 in heterosexual adults, 153 in children under 4 years old and 87 among hemophiliacs or patients with blood coagulation disorders. By the end of 1994 the model predicts more than 200,000 HIV infected persons with an important proportion of heterosexual adults and more than 12,000 AIDS cases. The values of this period must be considered as a future possible scenario if the present spread conditions are preserved. Infection among heterosexual adults is at the present time in a first and exponential phase of spread and dominated by transmission from IVDU group and bisexual men. It is concluded that the future course of AIDS epidemic in Argentina may be particularly influenced by changes in the heterosexual behavior particularly in those with a higher degree of exposure to HIV-infection.


[Tamoxifen as the primary treatment for breast cancer in elderly patients]. A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57% had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43% had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67% there was a clinical objective response (RC: 14%, RP: 53%), and 33% had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81% are still alive, and 14% died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.


[Cardiovascular effects of ketamine anesthesia in rats treated with enalapril and propranolol]. It is well-known that ketamine (Kt) anaesthesia produces a rise in blood pressure and heart rate in man. These cardiostimulatory effects were adscribed to several factors such as: a) increased sympathetic nervous system activity by direct stimulation of central nervous structures, b) increased catecholamine release from the peripheral sympathetic system, c) high plasmatic renin levels. However, the quantitative participation of these mechanisms in the cardiovascular effects of this anaesthetic agent is unknown. While some authors have shown a major rise in serum renin activity in experimental anaesthesia, others have been unable to confirm these results. The present study was undertaken to assess if the cardiostimulatory effects of Kt anaesthesia were due to an activation of renin-angiotensin system or to increased sympathetic activity. In consequence we used rats treated with enalapril (an angiotensin-converting enzyme inhibitor) or propranolol prior to anaesthetic procedures. Thirty male Wistar and six spontaneously hypertensive rats (SHR) weighing 240-300 g were used in all the experiments. The rats were randomly grouped into six groups. I- Non-anaesthetized rats, II- Anaesthetized rats (trained in the experimental procedures), III- Anaesthetized rats (without training), IV- Anaesthetized rats previously treated with enalapril, V- Anaesthetized rats pretreated with propranolol, VI- SHR treated with enalapril. The rats of groups IV and VI received enalapril p.o. for three weeks (25 mg/Kg body wt). The animals of group V were submitted to acute beta-adrenergic blockade. Propranolol dose: 10 mg/Kg body wt, was given i.p. 15 min before Kt anaesthesia. Blood pressure and heart rate were measured with a sphygmomanometer and photoelectric sensors and recorded.(ABSTRACT TRUNCATED AT 250 WORDS)


Vaccine strategies against schistosomiasis. Schistosomiasis, the second major parasitic disease in the world after malaria affects at least 200 million people, 500 million being exposed to the risk of infection. It is widely agreed that a vaccine strategy which could lead to the induction of effector mechanisms reducing the level of reinfection and ideally parasite fecundity would deeply affect the incidence of pathological manifestations as well as the parasite transmission potentialities. Extensive studies performed in the rat model have allowed the identification of novel effector mechanisms involving IgE antibodies and various inflammatory cell populations (eosinophils, macrophages and platelets) whereas regulation of immune response by blocking antibodies has been evidenced. Recent epidemiological studies have now entirely confirmed in human populations the role of IgE antibodies in the acquisition of resistance and the association of IgG4 blocking antibodies with increased susceptibility. On the basis of these concepts, several schistosome target proteins have been identified and their encoding genes cloned. One of them, a schistosome glutathione S-transferase (Sm 28 GST) appears as a promising vaccine candidate. Immunization experiments have shown that two complementary goals can be achieved: (a) a partial but significant reduction of the worm population (up to 60% in rats); (b) a significant reduction of parasite fecundity (up to 70% in mice and 85% in cattle) and egg viability (up to 80%). At least two distinct immunological mechanisms account for these two effects. IgE antibodies appear as a major humoral component of acquired resistance whereas IgA antibodies appear as a major humoral factor affecting parasite fecundity.(ABSTRACT TRUNCATED AT 250 WORDS)


Immunoregulatory mechanisms and Chagas' disease. During the course of experimental Chagas' disease, several immune disorders occur. In the acute phase, T and B cell polyclonal activation is associated to immunosuppression. At the chronic stage, T cells--of the TH2 subset--participate to the pathology characteristic of Chagas' disease. Data obtained after infection of BALB/Xid mice suggest that polyclonal activation may be dependent on B1 (CD5) cell-activation. Moreover, these mice fail to develop the pathological features of the chronic infection. Control of lymphokine secretion might play a key role in the clinical status of Chagas' disease.


Immunopathology of American cutaneous leishmaniasis. American mucocutaneous leishmaniasis is a granulomatous disease clinically characterized by ulcerated skin lesions that can regress spontaneously. A small percentage of the affected individuals can however develop a severe destruction of the nasal, oral, pharyngeal and/or laryngeal mucous membranes many years after the healing of the primary lesion. The human immune response to the infection and the possible mechanisms underlying the pathogenesis of the disease, determining either the self-healing or the development of chronic and destructive mucosal lesions, are discussed.


Coevolution of hosts and microorganisms: an analysis of the involvement of cytokines in host-parasite interactions. Parasites may employ particular strategies of eluding an immune response by taking advantage of those mechanisms that normally guarantee immunological self-tolerance. Much in the way as it occurs during the establishment of self-tolerance, live pathogens may induce clonal deletion, functional inactivation (anergy) and immunosuppression. At this latter level, it appears that certain pathogens produce immunosuppressive cytokine-like mediators or provoke the host to secrete cytokines that will compromise the anti-parasite immune response. It appears that immune responses that preferentially involve T helper 1 cells (secretors of interleukin-2-and interferon-gamma) tend to be protective, whereas T helper 2 cells (secretors of IL-4, IL-5, IL-6, and IL-10), a population that antagonizes T helper cells, mediate disease susceptibility and are involved in immunopathological reactions. Cytokines produced by T helper 2 cells mediate many symptoms of infection, including eosinophilia, mastocytosis, hyperimmunoglobulinemia, and elevated IgE levels. Administration of IL-2 and IFN-gamma has beneficial effects in many infections mediated by viruses, bacteria, and protozoa. The use of live vaccinia virus might be an avenue for the treatment of or the vaccination against infection. We have found that a vaccinia virus expressing the gene for human IL-2, though attenuated, precipitates autoimmune disease in immunodeficient, athymic mice. Thus, although T helper 1 cytokines may have desired immunostimulatory properties, they also may lead to unwarranted autoaggressive responses.


Milky spots reaction to schistosomal mansoni infection. Milky spots (MS), considered by the authors as a Coelomatic Lympho-myelopoietic Organ (CLMO), present a strong reactivity during experimental schistosomal mansoni infection, characterized by an increase of lymphocytes, macrophages, plasmocytes, mast cells, neutrophils and expression of eosinophil metaplasia. Intraperitoneal injection of purified Schistosoma mansoni (Sm) eggs provoked a rise in the number and size of MS, which developed the sessile marginal and pedunculated types. The authors conclude that egg antigens are, at least partially, responsible for MS reactivity during Sm infection.


Modern immunological approaches to assess malaria transmission and immunity and to diagnose plasmodial infection. The present paper reviews our recent data concerning the use of immunological methods employing monoclonal antibodies and synthetic peptides to study malaria transmission and immunity and to diagnose plasmodial infection. As concerns malaria transmission, we studied the main vectors of human malaria and the plasmodial species transmitted in endemic areas of Rondônia state, Brazil. The natural infection of anopheline was evaluated by immunoradiometric assay (IRMA) using monoclonal antibodies to an immunodominant sporozoite surface antigen (CS protein) demonstrated to be species specific. Our results showed that among six species of Anopheles found infected, An. darlingi was the main vector transmitting Plasmodium falciparum and P. vivax malaria in the immediate vicinity of houses. In order to assess the level of anti-CS antibodies we studied, by IRMA using the synthetic peptide corresponding to the repetitive epitope of the sporozoite CS protein, sera of individuals living in the same areas where the entomological survey has been performed. In this assay the prevalence of anti-CS antibodies was very low and did not reflect the malaria transmission rate in the studied areas. In relation to malaria diagnosis, a monoclonal antibody specific to an epitope of a 50 kDa exoantigen, the major component of supernatant collected at the time of schizont rupture, was used as a probe for the detection of P. falciparum antigens. This assay seemed to be more sensitive than parasitological examination for malaria diagnosis since it was able to detect plasmodial antigens in both symptomatic and asymptomatic individuals with negative thick blood smear at different intervals after a last parasitologically confirmed attack of malaria.


Diagnostic markers in schistosomiasis.

Diagnostic markers in schistosomiasis. In the present paper a brief overview will be given of the recent progress and trends in assaying diagnostic markers in schistosomiasis; only markers of the humoral immunological system and biochemical markers will be discussed, as markers for cellular immunological reactivity will be discussed by other authors. The following diagnostic markers will be reviewed: markers for infection, markers for immunity and markers for morbidity.


Human B19 parvovirus infection: an example of multiple pathogenic effects determined by differences in host susceptibility. B19 infection offers some general lessons about human viruses and their possible effects on the human host, as follows: (1) Ubiquitous apparently benign viruses may have severe effects on a compromised host. The virus may be invariable but the host can have diverse susceptibilities. (2) B19 and some other human viruses (though for none is the evidence so clear as for B19) have narrowly targetted effects. The host cell of B19 is a specialised progenitor of mature red cells: impairment of the function of this cell by B19 may cause profound anaemia. (3) The 'normal' host response to B19 may also cause disease, though this is self limiting. (4) The effects of malfunction of the virus' target cell are exacerbated when the immune response is impaired by congenital or acquired immunodeficiency, immunosuppressive therapy or, in the case of the fetus, developmental immaturity that allows the virus to persist.


Recent advances and prospective researches on molecular epidemiology of dengue viruses. The determination of amino acid changes in the envelope protein by direct sequencing of either genomic RNA or PCR-amplified cDNA fragments provides useful informations for assessing the genetic variability and the geographic distribution of the actually most widespread dengue-2 serotype. The possible link of variations in the envelope protein-gene and virus virulence is discussed.


Virulence and the immune response in malaria. Many factors determine the virulence of a malaria infection. These include host innate resistance mechanisms and, with Plasmodium falciparum, the ability to cytoadhere to endothelial cells, form rosettes, and induce release of cytokines. The effect on virulence of acquired immune responses can be determined by Class I and Class II MHC-antigens; levels of immunological responsiveness may be determined too in other ways. The structure of parasite surface antigens and their great diversity modulate the immune response and influence parasite survival and hence virulence, and transmission to the vector.


Mechanisms of immune protection in the asexual blood stage infection by Plasmodium falciparum: analysis by in vitro and ex-vivo assays. Mechanisms of immune protection against the asexual blood stage infection by Plasmodium falciparum are reviewed. Recent studies of two independent lines of research developed at the Institut Pasteur, in humans and primate infections clearly indicate an obligatory interaction of antibodies and effector cells to express the anti-parasitic effect.


T lymphocytes and iron overload: novel correlations of possible significance to the biology of the immunological system. This paper is written in the context of our changing perception of the immunological system as a system with possible biological roles exceeding the prevailing view of a system concerned principally with the defense against external pathogens. The view discussed here relates the immunological system inextricably to the metabolism of iron, the circulation of the blood and the resolution of the evolutionary paradox created by oxygen and iron. Indirect evidence for this inextricable relationship between the two systems can be derived from the discrepancy between the theoretical quasi-impossibility of the existence of an iron deficiency state in the adult and the reality of the WHO numbers of people in the world with iron deficiency anemia. With the mounting evidence that TNF, IL-1, and T lymphocyte cytokines affect hemopoiesis and iron metabolism it is possible that the reported discrepancy is a reflection of that inextricable interdependence between the two systems in the face of infection. Further direct evidence for a relationship between T cell subset numbers and iron metabolism is presented from the results of a study of T cell populations in patients with hereditary hemochromatosis. The recent finding of a correlation between low CD8+ lymphocyte numbers, liver damage associated with HCV positivity and severity of iron overload in beta-thalassemia major patients (unpublished data of RW Grady, P. Giardina, M. Hilgartner) concludes this review.


V-region-related and -unrelated immunosuppression accompanying infections. This paper discusses current evidence for the relationship between polyclonal lymphocyte activation, specific immunosuppression with decreased resistance, and autoimmune pathology, that are all often found associated with infections by a variety of virus, bacteria and parasites. The central question of class determination of immune effector activities is considered in the context of the cellular targets for nonspecific mitogenic activities associated with infection. A model is presented to integrate these findings: mitogens produced by the microorganism or the infected cells are preferentially active on CD5 B cells; the resulting over-production of IL-10 will tend to bias all immune activities into a Th2-mode of effector functions, with high titers of polyclonal antibodies and little or no production of gamma IFN and other "inflammatory" lymphokines that often mediate resistance. In turn, these conditions allow for parasite persistence and the corresponding long-term disregulation of self-directed immune reactivities, resulting in autoimmunity in the chronic phase. This model would predict that selective immunization with the mitogenic principles involved in deregulation, could stand better chances than strategies of vaccination based on immunopotentiation against other, functionally neutral antigenic epitopes. It is argued, however, that the complexity of immune responses and their regulation, together with our ignorance on the genetic controls of class-determination, offer poor prospects for a scientifically-based, rational development of vaccines in the near future. It is suggested that empirically-based and technologically developed vaccines might succeed, while basic scientific approaches are reinforced and given the time to provide a better understanding of those processes.


Trypanosoma cruzi recognition by macrophages and muscle cells: perspectives after a 15-year study. Macrophages and muscle cells are the main targets for invasion of Trypanosoma cruzi. Ultrastructural studies of this phenomenon in vitro showed that invasion occurs by endocytosis, with attachment and internalization being mediated by different components capable of recognizing epi- or trypomastigotes (TRY). A parasitophorus vacuole was formed in both cell types, thereafter fusing with lysosomes. Then, the mechanism of T. cruzi invasion of host cells (HC) is essentially similar (during a primary infection in the absence of a specific immune response), regardless of whether the target cell is a professional or a non-professional phagocytic cell. Using sugars, lectins, glycosidases, proteinases and proteinase inhibitors, we observed that the relative balance between exposed sialic acid and galactose/N-acetyl galactosamine (GAL) residues on the TRY surface, determines the parasite's capacity to invade HC, and that lectin-mediated phagocytosis with GAL specificity is important for internalization of T. cruzi into macrophages. On the other hand, GAL on the surface of heart muscle cells participate on TRY adhesion. TRY need to process proteolytically both the HC and their own surface, to expose the necessary ligands and receptors that allow binding to, and internalization in the host cell. The diverse range of molecular mechanisms which the parasite could use to invade the host cell may correspond to differences in the available "receptors" on the surface of each specific cell type. Acute phase components, with lectin or proteinase inhibitory activities (alpha-macroglobulins), may also be involved in T. cruzi-host cell interaction.


Host tissue destruction by Entamoeba histolytica: molecules mediating adhesion, cytolysis, and proteolysis. Entamoeba histolytica, the protozoan parasite causing human amoebiasis, has recently been found to comprise two genetically distinct forms, potentially pathogenic and constitutively nonpathogenic ones. Host tissue destruction by pathogenic forms is believed to result from cell functions mediated by a lectin-type adherence receptor, a pore-forming peptide involved in host cell lysis, and abundant expression of cysteine proteinase(s). Isolation and molecular cloning of these amoeba products have provided the tools for structural analyses and manipulations of cell functions including comparisons between pathogenic and nonpathogenic forms.


Pseudomonas aeruginosa adhesion to normal and injured respiratory mucosa. Human nasal polyps in outgrowth culture were used to study the adhesion of Pseudomonas aeruginosa to respiratory cells. By transmission electron microscopy, bacteria associated with ciliated cells were identified trapped at the extremities of cilia, usually as aggregates of several bacterial cells. They were never seen at the interciliary spaces or attached along cilia. Bacteria were also seen to adhere avidly to migrating cells of the periphery of the outgrowth culture. Using a model of repair of wounded respiratory epithelial cells in culture, we observed that the adhesion of P. aeruginosa to migrating cells of the edges of the repairing wounds was significantly higher than the adhesion to non-migrating cells and that adherent bacteria were surrounded by a fibronectin-containing fibrillar material. The secretion of extracellular matrix components is involved in the process of epithelium repair following injury. To investigate the molecular basis of P. aeruginosa adhesion to migrating cells, bacteria were treated with a fibronectin solution before their incubation with the respiratory cells. P. aeruginosa treatment by fibronectin significantly increased their adhesion to migrating cells. Accordingly, we hypothesize that during cell migration, fibronectin secreted by epithelial cells may favour P. aeruginosa adhesion by establishing a bridge between the bacteria and the epithelial cell receptors. Such a mechanism may represent a critical step for P. aeruginosa infection of healing injured epithelium.


Effects of azadirachtin on Rhodnius prolixus: immunity and Trypanosoma interaction. The effects of azadirachtin, a tetranortriterpenoid from the neem tree Azadirachta indica J., on both immunity and Trypanosoma cruzi interaction within Rhodnius prolixus and other triatomines, were presented. Given through a blood meal, azadirachtin affected the immune reactivity as shown by a significant reduction in numbers of hemocytes and consequently nodule formation following challenge with Enterobacter cloacae beta 12, reduction in ability to produce antibacterial activities in the hemolymph when injected with bacteria, and decreased ability to destroy the infection caused by inoculation of E. cloacae cells. A single dose of azadirachtin was able to block the development of T. cruzi in R. prolixus if given through the meal at different intervals, together with, before or after parasite infection. Similarly, these results were observed with different triatomine species and different strains of T. cruzi. Azadirachtin induced a permanent resistance of the vector against reinfection with T. cruzi. The significance of these data is discussed in relation to the general mode of azadirachtin action in insects.


Is the thymus a target organ in infectious diseases? The thymus is a central lymphoid organ, in which T cell precursors differentiate and generate most of the so-called T cell repertoire. Along with a variety of acute infectious diseases, we and others determined important changes in both microenvironmental and lymphoid compartments of the organ. For example, one major and common feature observed in acute viral, bacterial and parasitic diseases, is a depletion of cortical thymocytes, mostly those bearing the CD4-CD8 double positive phenotype. This occurs simultaneously to the relative enrichment in medullary CD4 or CD8 single positive cells, expressing high densities of the CD3 complex. Additionally we noticed a variety of changes in the thymic microenvironment (and particularly its epithelial component), comprising abnormal location of thymic epithelial cell subsets as well has a denser Ia-bearing cellular network. Moreover, the extracellular matrix network was altered with an intralobular increase of basement membrane proteins that positively correlated with the degree of thymocyte death. Lastly, anti-thymic cell antibodies were detected in both human and animal models of infectious diseases, and in some of them a phenomenon of molecular mimicry could be evidenced. Taken together, the data reviewed herein clearly show that the thymus should be regarded as a target in infectious diseases.


Human schistosomiasis mansoni: studies on in vitro granuloma modulation. Infection with Schistosoma mansoni induces humoral and T cell mediated responses and leads to a delayed hypersensitivity that results in granulomatous inflammatory disease around the parasite eggs. Regulation of these responses resulting in a reduction in this anti-egg inflammatory disease is apparently determined by idiotypic repertoires of the patient, associated with genetic background and multiple external factors. We have previously reported on idiotype/anti-idiotype-receptor interactions in clinical human schistosomiasis. These findings support a hypothesis that anti-SEA cross-reactive idiotypes develop in some patients during the course of a chronic infection and participate in regulation of anti-SEA cellular immune responses. We report here on experiments which extend those observations to the regulation of granulomatous hypersensitivity measured by an in vitro granuloma model. T cells from chronic intestinal schistosomiasis patients were stimulated in vitro with anti-SEA idiotypes and assayed in an autologous in vitro granuloma assay for modulation of granuloma formation. These anti-SEA idiotype reactive T cells were capable of regulating autologous in vitro granuloma formation. Both CD4 and CD8 T cells could be activated to regulate granuloma formation. This regulatory activity, initiated with stimulatory anti-SEA idiotypic antibodies, was antigenically specific and was dependent on the presence of intact (F(ab')2) immunoglobulin molecules. The ability to elicit this regulatory activity appears to be dose dependent and is more easily demonstrated in chronically infected intestinal patients or SEA sensitized individuals.(ABSTRACT TRUNCATED AT 250 WORDS)


Dual function of eosinophils in pathogenesis and protective immunity against parasites. The functional duality of eosinophils, involved in a protective response or in pathogenesis is illustrated in various parasitic infections. In schistosomiasis, eosinophils have been shown to mediate schistosomula killing, in the presence of antibodies. The association of eosinophil-dependent cytotoxic antibody isotypes with resistance of reinfection (IgE and IgA antibodies), whereas in vitro blocking antibody isotypes (IgG4, IgM) were detected in susceptible subjects, suggested a participation of eosinophils in antibody-dependent protective response. However eosinophils could participate to granuloma formation and consequently to the pathological reactions during schistosomiasis. Activation of eosinophils by antibodies, leading to release of granule proteins have been studied in patients with filariasis. Eosinophil peroxidase, EPO was released after IgE-dependent activation whereas Eosinophil Cationic Protein, ECP, was released after IgG- and IgA-dependent activation of eosinophils, results suggesting a process of differential release of mediators. Interactions between eosinophils and interleukins, and specially IL-5 are discussed. Whereas a receptor for IL-5 has been characterized on human eosinophils, recent studies have shown that eosinophils expressed the messenger RNA encoding IL-5. These results associated to data showing the synthesis of other cytokines indicate that eosinophils are not only the source of cytotoxic mediators involved in the effector phase of immunity but also of growth and regulatory factors, participating to immunoregulation.


Immunity to intracellular bacteria.

Immunity to intracellular bacteria. Immunity to intracellular bacteria including Mycobacterium tuberculosis, Mycobacterium leprae, and Listeria monocytogenes depends on specific T cells. Evidence to be described suggests that CD4 alpha/beta T cells, CD8 alpha/beta T cells and gamma/delta T cells which interact with each other and with macrophages contribute to acquired resistance against as well as pathogenesis of intracellular bacterial infections.


Evolving views of viral evolution: towards an evolutionary biology of viruses. Despite considerable interest in viral evolution, at least among virologists, viruses are rarely considered from the same evolutionary vantage point as other organisms. Early work of necessity emphasized phenotype and phenotypic variation (and therefore arguably was more oriented towards the broader biological and ecological perspectives). More recent work (essentially since the development of molecular evolution in the 1960's but beginning earlier) has concentrated on genotypic variation, with less clarity about the significance of such variations. Other aspects of evolutionary theory, especially considerations of natural selection and of evolutionary constraints, have not widely been applied to viruses, and an evolutionary framework for virology has long been lacking. This becomes apparent in considering 'emerging' viruses, which have often been treated on an ad hoc basis. It was often felt that, because previously unrecognized viruses are involved, mechanisms of viral emergence must mirror the unpredictability of mutations in the viral genome. However, most examples of viral emergence are independent of mutation, at least initially, and are often pre-existing viruses in changed circumstances ('viral traffic'). This conclusion also readily follows from ordinary Darwinian premises, which would require that, like other living species, 'new' organisms are descended only from existing species. In this respect, from a Darwinian perspective, viruses would appear to resemble other organisms.


Koch's postulates and the etiology of AIDS: an historical perspective. This paper examines the debate over the human immunodeficiency virus (HIV) as the cause of acquired immunodeficiency syndrome (AIDS) from an historical perspective. The changing criteria for proving the link between putative pathological agents and diseases are discussed, beginning with Robert Koch's research on anthrax in the late nineteenth century. Various versions of 'Koch's postulates' are analyzed in relation to the necessity and sufficiency arguments of logical reasoning. In addition, alterations to Koch's postulates are delineated, specifically those required by the discovery of rickettsiae and viruses in the early twentieth century and by the immunological testing developed after mid-century to demonstrate the links between elusive viral agents and two diseases, hepatitis B and infectious mononucleosis. From this perspective, an examination of the AIDS debate is constructed. Molecular biologist Peter Duesberg's argument that HIV is not the cause of AIDS is analyzed in light of his contention that a version of Koch's postulates has not been satisfied. Additional research findings through 1990 relating to the etiology of AIDS are also noted.


[The vaccine metaphor. From inoculation to vaccination]. The episodes of cowpox inoculation (1798) and rabies preventive treatment (1885) are celebrated as the landmark of modern medicine. Paradoxically, these two advances have been accomplished without any theoretical breakthrough in the understanding of immunity. Going further, they were made possible by a long past of empirical procedures among which smallpox inoculation played an outstanding role. The paper explores the paradox of 'Immunization without Immunology' and Pasteur's reconstruction of the past, through his successful use of a metaphor. 'Vaccine', originally linked to the jennerian method, was meant by Pasteur to designate a general program of virus attenuation. The paper investigates the scientific factors accounting for why viruses played such a leading role in immunization. The longlasting immunity, the easy transmission from man to man characteristic of smallpox allowing in vivo experimentation, may explain how crude procedures of early immunizers shaped scientific ideologies and strategies of public health and family initiated modern 'vaccinology'.


Pandora's box and the history of the respiratory viruses: a case study of serendipity in research. As fastidious human parasites, the respiratory viruses other than influenza viruses have been among the last of the human viruses to be isolated. Their recognition has been dependent upon the evolving technology of cell culture and equally upon a series of fortuitous observations by astute investigators. Adenoviruses were discovered independently by two different groups of scientists, one utilizing explantation of ostensibly normal human tissues and the other recovering virus directly from epidemics of acute disease. In other studies, a technique developed for detection of influenza virus in cell culture led to the discovery of other hemagglutinating viruses, now known as parainfluenza viruses. From such shreds of laboratory evidence, the structural and molecular characteristics of these diverse viruses have been defined, and each in turn has been retrospectively linked to a legacy of previously described clinical syndromes and epidemic patterns. Thus, neither technology or human imagination alone is sufficient for scientific advance, but, when combined, are the essence of scientific discovery.


[A functional explanation of normative prescriptive-evaluative judgments and the concept of "evolutionary ethics"]. Neodarwinian ethology, today above all represented by sociobiology, is conceived of by responsible exponents as a descriptive and explanatory theory that cannot include any normative declarations. Still other, indeed notable, authors belonging to the discipline in question, either underhand or frankly employ prescriptive or evaluative judgments, or they claim (what is not an insight of natural science) that it is impossible to provide a rational foundation for prescriptive or evaluative judgments. (Michael Ruse and Edward O. Wilson even assert the latter without relinquishing the former.) Several functional explanations of normative validity claims advanced by Michael Ruse, Edward O. Wilson, Donald T. Campbell, Florian von Schilcher and Neil Tennant are designed to show that prescriptive or evaluative judgments cannot be justified. The reasonableness of this move is, however, dubious, because it implies strategies of raising oneself into a privileged status or of rendering the position of oneself immune from criticism by shifting it among the objects of the theory. Then Wilson's concept of 'evolutionary ethics' is thoroughly--and critically--analyzed. The suspicion that Wilson's fallacies in the transition from biological facts to moral norms are of exemplary nature is finally examined on the basis of tenets advanced by Herbert Spencer, Wolfgang Wickler, and Hans Mohr.


[Doppler study in the management of intrauterine growth retardation]. Forty-four pregnancies with clinical and sonographic diagnosis of intrauterine growth retardation (IUGR) were prospectively studied. A Doppler examination of arcuate and umbilical arteries, fetal descending aorta and medial cerebral artery was done. The results of the Doppler interrogation determined three groups. The first with normal Doppler had the higher birth weight the lesser ponderal deficit and the lesser percent of newborns below the fifth centile. No morbimortality was found in this group. The second group with a mild abnormal Doppler, had a morbidity of 18.8%, and no mortality was found. The third group had the most abnormal Doppler and, showed a perinatal morbidity rate of 28.6% and mortality 42.9%. In our series, the Doppler examination was able to identify among the pregnancies with clinical and sonographic diagnosis of IUGR those with the highest risk of morbimortality (sensibility 100%, specificity 77.8%, positive examination predictive value 50% and negative examination predictive value 100%).


[The effect of tocolytic drugs on oxytocin-induced uterine contractility in vitro]. The results obtained demonstrate that the blockers of calcium channels effectively inhibit uterine contractions induced by oxytocin. Its effects depends on the doses administered and is comparable to those of ritodrine and of magnesium sulphate. A channel of potassium, dependent on calcium was also identified and this channel was activated by oxytocin.


[Bilateral renal agenesis: a 10-year experience]. Bilateral renal agenesis (BRA) is an uniformly lethal malformation occurring in 0.1-0.3/1000 births. This condition is associated with severe oligohydramnios, intrauterine growth retardation (IUGR), extra-renal anomalies, and malpresentation. The aim of this study was to present our experience with 10 cases of BRA seen in a 10-year period. In only one case the prenatal diagnosis was made. Therefore, the clinician was faced with a high-risk pregnancy: 70% of cases presented with malpresentation, oligohydramnios, and severe IUGR. This explain the high rate of cesarean section (40%) and the neonatal intensive care offered to these neonates. The principal methods to improve the prenatal diagnosis of this condition are discussed.


[The usefulness and importance of functional progesterone and estrogen tests in the study of amenorrheas]. One hundred and eighty-two patients who complained of amenorrhea were tested with progesterone and oestrogen. The results are correlated with the diagnosis of the causes. The etiology is related with hypothalamic, hypophysiary, ovarian and/or uterine origins and dysfunction.


[The herpes simplex virus and immunoglobulins in the amniotic fluid in pregnant women with genital herpes and a follow-up over several years: 3 clinical cases]. The presence of herpes simplex virus and immunoglobulin in the amniotic fluid in three pregnant women with herpetic genital virus are investigated. The mothers and their children are followed for several years.


[General and ethnic factors associated with the duration of lactation amenorrhea]. 114 women in fully nursing, were studied, according to the length of lactational amenorrhea and their relation with general characteristics and ethnic group. Of the 114 mothers, 66 (58%) recovery their menses before the 6th postpartum month. The length of lactation was 100.7 +/- 5.2 and 277.9 +/- 10.5 days, for those mothers who were with menses and amenorrhea until the 6th postpartum month, respectively. A group of Mapuche women had a higher length of lactational amenorrhea and we found differences in the frequency of suckling episodes at night. This study corroborate, that short length of lactational amenorrhea is a condition highly frequent in Chilean population and it does not have a relation the nursing pattern in general population. However, the difference in the length of lactational amenorrhea in specific ethnic group, can include some general or behavioral factors of breast-feeding.


[Non-Hodgkin's lymphoma and pregnancy].

[Non-Hodgkin's lymphoma and pregnancy]. The coexistence of non-Hodgkin lymphoma and pregnancy is extraordinarily rare. A clinical case is presented and also the description of the epidemiology, the clinical features, the diagnostic methods and the staging. The current guidelines for its managements are analyzed.


[The sexuality of adolescents from 14 to 19 in a given population]. A study by a survey about sexuality in adolescents was performed in 218, subjects aged 14-19 years with the aim of knowing the level of sexual intercourse practice, the degree of sexual information and the use of contraceptive methods and history of pregnancy by age and sex. In the analysis made it was found that 51% of the sample have sexual intercourse since early adolescents. The majority has information about contraceptive methods. Only 66% of adolescents who have sexual intercourse is protected against impregnation or infections; 38 have no protection at all. The most effective contraceptive methods for this group such as condom or diaphragm are not known or not used by them. 61% of young people who has sexual intercourse had a history of pregnancy, most of them having given birth to a child in first place, followed by uterine curettage and as a result they left school and a few began to work. The family doctor and the nurse must provide sexual education to the family due to the relation they have with their population.


[The work of the nurse in administering cytostatics to the leukemic child]. This study consisted in the observation of the technique of administration of antineoplastic drugs to children in the Department of Hematology and Oncology at "Pedro Borrás Astorga" Pediatric Hospital during January and February, 1989. A number of 50 techniques from which 96% were correct and only two (4%) were incorrect since there was a chemical phlebitis in the site of the venous puncture, was observed. It was proved that nursing staff is well trained for the development of this technique which requires maximal scientific skills to avoid complications in these patients. Adverse reactions shown by the patients with the administration of different antineoplastic drugs do not differ from what has been found in the literature.


[Hepatic coma. The nursing care].

[Hepatic coma. The nursing care]. The hepatic coma is an entity tending to occur as a complication of severe hepatic diseases and in which the recognition of symptoms and signs by the personnel caring for those patients is essential for the early detection of this condition. A review of the literature is made making emphasis on the pathogenesis, clinical picture and the trigger factors of the hepatic coma. The nursing care for patients with hepatic coma are described; stressing that the nursing diagnosis of the first signs Ia essential for the prognosis and the clinical course of these patients. It is pointed out how health education in these patients is oriented to maintain and improve their health condition, to have a better response to the treatment and to avoid a relapse in prone patients.


Urban planning in metropolitan areas of Asia: the challenge of accomodating the informal sector. One paradox in the recent pattern of urbanization in Asia is 'metropolisation' and 'informalization'. This is paradoxical since growth and development of a metropolis is expected to reduce its traditional or informal sector. From available evidence, this paper shows that metropolisation in Asia, instead of reducing the size of informal sector, is rather providing new impetus to its growth. After revealing the nature and content of these growth patterns, the paper argues the case for making changes in the urban planning paradigms for accommodation of the informal sector in metropolitan development. The concurrent expansion of a metropolis and the informal sector within it will not appear paradoxical, the author believes, once the traditional urban planning paradigms of land use, zoning, and standards, mostly evolved from the Western experience of urban-industrial development, are modified in light of the socio-economic realities of the Asian metropolises. The huge population base of the respective countries relative to capital and other material resources, and vast qualitative change in the production structure of urban metropolitan economies have made the presence of the informal sector rather functionally relevant in the very heart of their metropolises. The paper provides some directions, citing examples from several cities, as to how to make the necessary accommodation. The paper further contends that mere physical accommodation by legal acceptance and provisions will not be enough. The other major direction of change in urban planning ought to be for integrating the physical, economic, and social dimensions of planning for ensuring better quality of life for all instead of a small proportion of people.


The group work of the workshop.

The group work of the workshop. The project aims at determining how aging influences nutritional status (as determined by measurements and indicators from clinical evaluation, anthropometric, laboratory, and biophysical tests) in a Chronic degenerative disease burden; 5) Use of drugs and medications (both Western and traditional) and 6) physical activity as the direct mediators of nutritional status of the elderly. A chain of causal determinants of each of the six mediators was developed. The primary target population is composed of persons from 60 to 75 years of age who are migrants to the metropolis from the same rural province. They share the same religious practices and ethic heritage in common and are free living (non-institutionalized) in the community. We shall enroll, in a stratified randomized manner (stratified for danger, urban community, and existence of participating second generation relative), 400 elderly persons in two groups: Group 1A: 100 males and 100 females who migrated more than 40 years earlier from the province to the metropolis; Group 1B: 100 males and 100 females who migrated less than 20 years earlier from the province to the metropolis. In a "controlled cross-sectional survey" format these represent two exposure groups: long-residency and short residency. A secondary contrast group will be gender specific, second generation relatives (sons or nephews for older men; daughters or nieces for older women), 400 in all, ie, one for each first generation (elderly) subject. They will range from 25 to 42 years of age and will also be living in low-income peri-urban communities of the metropolis. The tests from the overall battery of measurement indicators, appropriate to young adults, will be applied. The primary contrast is G1A vs G1B, aggregated or deseggregated by gender, using 1) relative risk based on long vs short urban exposure and 2) conventional parametric and non-parametric intergroup comparisons. The secondary contrast is within individual generation pairs (father-son, uncle-nephew; mother-daughter, aunt-nice) using conventional parametric or non-parametric tests for dependent variables.


The nutritional situation in metropolitan Kuala Lumpur, with focus on squatters. Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.


Nutrition situation in metropolitan Jakarta. Jakarta is the capital and biggest city of Indonesia with a total population of 10 million. The National Census Office revealed a rapid increase in population through 1985 to 1990. This rapid increase has brought many devastating effects on various aspects of life such as housing, food stock and food production, health and environmental conditions, education, socio-economic and cultural life and political stability. All of these factors contribute to malnutrition in the city as well as in the country as a whole. Data obtained from the Municipal Health Offices showed an unsatisfactory health status having a crude birth rate (CBR) of 2.80%; crude death rate (CDR) of 0.68%; and family size of 5.5. Undernutrition among under-five children still is alarming with a prevalence of 27.91%. Anemia also afflicts a great number of pregnant mothers (70%) and preschool children (38.6%). Nutrition problems are worst in urban areas with their high population density; moderate and severe PEM is 5.63% in urban areas compared with 3.7% moderate PEM and no PEM in rural areas. Jakarta is experiencing rapid urbanization. The presence of slums, air and water pollution in city is a paramount factor leading to poor environmental conditions. The existing health system cannot keep pace with the increasing occurrence of infectious diseases brought about by these unfavorable conditions. Unemployment and underemployment as well as rising costs of foodstuffs cause inadequate food availability at the household level. Due to the grinding poverty experienced by the low socio-economic groups, female workers occupy almost one-third of Indonesia's labor force, hence inadequate care is given to children. All these are factors aggravating the nutritional problems in the country.


Nutrition situation in metro Manila.

Nutrition situation in metro Manila. Summarizing the general characteristics of food consumption pattern and dietary status of the country's central urban region, the following are brought to focus: Metro Manila as compared to all urban and rural areas consumes less cereal grains but more sugars and fats and oils; consumes more of the high quality protein foods such as meat, poultry, eggs, milk and dried beans; and consumes less of fruits and vegetables. Availability and affordability of foods in the respective sectors could have affected to a large extent the magnitude of consumption differences. Although urban households had the advantage of a more varied and quantitatively higher food consumption, their nutrient intake was not really very different from rural households. Metro Manila still had a 13.7 percent calorie gap in its intake in 1987, and intake of ascorbic acid was notably lower than the rural sector. However, intake of thiamin and riboflavin as well as fat was appreciably higher in the metropolis. Briefly identifying the trends in food consumption with reference to six survey year periods from 1974 to 1987 (excluding 1984 and 1985), Metro Manila diet disclosed the following: increasing trend for sugars and syrups as well as dried beans, nuts and seeds and decreasing trend for cereal products, fruits and vegetables and condiments and others. There was a decrease in overall food consumption among Metro Manila households during the economic crisis that transpired in 1984 and 1985. However, there was a steady consumption of rice which was under price control, and a significant increase in the intake of some food items particularly green leafy and yellow vegetables which were among the cheapest food items available in Metro Manila markets. Some food adjustments were evidently resorted to during the period of economic dislocation showing the resiliency of the urban population. Metro Manila has been apparently drawing inordinately large amounts of the food supply from the rest of the country. There is therefore an "urban bias" of food supply to Metro Manila, that is, there is a much higher demand capacity for Metro Manila to draw food supply because of its higher income level and bigger population. The impact of this situation in terms of nutrition and food supply in the rural areas should be carefully examined so as not to put the rural areas in extreme disadvantage. FNRI nutrition surveys have shown that dietary energy inadequacy remains rampant in Metro Manila, while protein continues to be a marginal problem.(ABSTRACT TRUNCATED AT 400 WORDS)


Nutrition and the environmental situation in Bangkok. Bangkok, the capital of Thailand, is a large city of about six million people. According to the rapid growth of economy, Bangkok faces to the problems of urbanization and industrialization. Non-communicable disease such as cardiovascular diseases, cancers are the leading causes of death. There is a trend of increasing air pollution in the congested areas and industrialized zones, with the increase over the ambient air quality standard involving suspended particulate matter. Other public health problems include the sanitation of restaurants, the quality of drinking water and coloring agents in food, drug addiction especially in young males. Poor hygiene in drug injection is one of the major causes of HIV transmission. AIDS, originally our imported disease, needs urgent prevention by health education and counseling. Improvements in government and non-government health care resources are still needed. A good cooperative city health plan serves a practical purpose, especially for the solution of the air and water pollution in Bangkok. However, pilot operational research on nutrition, health and environment in relation to city health planning needs to be discussed further for more effective implementation.


City studies on nutrition: Bangalore, India. The size of urban population in developing Asian countries grows at a faster rate than in the developed West. Urban cities in India are being crushed by the onslaught of population growth, migration of rural poor and industrialization, the urbanization in turn inducing social and economic changes. During the decade 1972-81, India's population grew by 25%, urban population by over 40% and that of Bangalore city by 76%. The 1991 Census records the population of Bangalore city at 4.1 million, though the decennial growth rate seems to have begun to decline. The current sex ratio is 900 females to 1000 males with nearly 50% of the population literate and the density of population at 2200 per km2. With the rapidly expanding "conurbation" (continuous urbanization), the number of slum settlements have increased with Bangalore having recorded the highest annual growth rate of 27.4% in its slum population accounting for more than 10% of the share of its population in the slums within the corporation limits. 29% of the population in urban areas in the State is under the poverty line and the percentage under the poverty line may be higher in the city. In this situation the nutrition of the mother and child is most vulnerable. The incidence of low birth weight recorded in a Government Hospital in Bangalore was between 30-40% and the IMR at 47/1000 births. Incidence of child mortality was 5% for children under 1 year and 3% for preschool children. The percent distribution of PEM in preschool children was 41, 31 and 1 for Gomez Grades I, II and III respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Physical exercise. The results in hypertensive patients of area 30 of the Policlínico Docente Lawson]. Systematic physical training influences upon a series of changes which occurs in the body, not only improves the cardiovascular functioning, but every organ and system, it increases the functional capacity of the individual, reduces tension due to stress and controls arterial tension figures. Regarding the aforementioned aspects, a study in 50 patients representing 100% of hypertensive subjects involved in a physical exercise program without any other associated disease is made with the aim of determining the influence of systematic physical activity upon the treatment of arterial hypertension. Results show that in most of the patients who previously had high tension values, hypertension was controlled or improved by systematic physical training and the use of drugs was also reduced or eliminated.


Nutritional situation of Dhaka.

Nutritional situation of Dhaka. The paper presents the nutritional situation of Dhaka. Dhaka is the capital city of Bangladesh with an area of 414 square Km. The population size of Dhaka city is about 7 millions of which nearly 3 millions live in the slums. Socio-economic and socio-cultural situation has been discussed. In the pre-school children, protein-energy malnutrition (PEM) appeared to be a serious problems. A high rate of advanced vitamin A deficiency along with severe PEM has been demonstrated. A recent survey showed that slum children below five years of age had higher prevalence of acute (11%) and chronic (50%) malnutrition. This paper also discussed the nutritional status of school children and pregnant women. A national nutrition survey revealed that average energy intake by the industrial laborers was only 74% of the daily requirement. To date no data is available on the nutritional situation of the adolescent and elderly people. Poverty, lack of knowledge, illnesses, lack of sufficient services and socio-cultural barriers are the major causes of nutritional problem. There are several Government and Non-Government organizations in Dhaka city working for improving community health and nutritional status through a number of interventions; such as health and nutrition education, vitamin A capsule distribution, immunization, growth monitoring and feeding through rehabilitation centers. A positive impact of vitamin A oral dosing has been demonstrated and improved nutritional status by nutrition education and feeding through the centers have been reported. Community participation and sustainability of the program have also been discussed.


[The prevalence of infertility and the importance of nursing work in this field]. A survey in the health area of "Héroes del Moncada" Polyclinics in Plaza de la Revolución municipality from Havana City was carried out by means of a multistage sampling in which 352 women in reproductive age (15-49 years old) were randomly chosen. A questionnaire designed by the World Health Organization for this kind of investigation was applied and a work of information and orientation was carried out for the infertile women. Prevalence of infertility in this health area was moderate and was found in 9.1% of the total number of women studied (12.1% of married women). Primary infertility was found in 0.6% of the total number of the women studied (12.1% of married women) and secondary infertility was found in 8.5% (11.3% of married women). A 43.8% of infertile women wanted to be pregnant what inversely correlated with the age and the number of children. The efficacy of the educational work of nursing was evidenced because 85.7% of infertile women who wanted to be pregnant attended the specialized consultation after the interview by the nurse. It is recommended to increase the nursing activity in the field of human reproduction.


Nutritional situation of Beijing residents. Beijing is the capital of China with the population of 10.32 million in 1990 and the area of 1687.8 km2. It is the economic and cultural center of the country. Since the founding of new China, the development of Beijing city has been very fast. The gross national product (GNP) of Beijing in 1988 is 2.78 times the average GNP of the whole country. The sanitary institution has increased 71 times from 1949 to 1989. The prevalence of infectious diseases decreased significantly. The infant mortality is 11.6 per thousand approaching the figure of developed countries. The main food products increased rapidly. The grain, meat and egg increased from 100.7 kg and 0.48 kg per capita per year in 1949 to 217.1 kg and 20.17 kg in 1988 respectively. The food consumption of residents have been increasing consistently with the increasing of food production in Beijing. The food available in Beijing is well both in quantity and in quality. The results of the nutritional survey in 1985 showed that the daily average energy intake was 2549 kcal per capita. The average protein intake was 70g per person per day. The fat intake as the percentage of the total energy was 25.7. The average nutrients intake of Beijing residents meets the Chinese RDA basically. The nutritional status of people living in the city is good in general. But there are still some nutritional problem exist. Zn and Fe deficiencies anemia are common in infants and children along with the decreasing rate of breast feeding. Riboflavin, Zn and Ca intakes are inadequate in a lot of adults and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)


Urban nutritional problems of Korea.

Urban nutritional problems of Korea. Rapid economic development resulted in urbanization of Korea, since 1960s. Seoul is the center of politics, finance, education and culture of Korea. Mostly young people have migrated to large cities, such as Seoul and Pusan. For instance, the population in Seoul city was 2.5 million in 1960 but increased to 10 million in 1990. Presently, total population of Seoul and Pusan, second largest city, composed of approximately 50% of whole national population. The economic distribution among urban people became extremely uneven creating a large gap between low and high income group. As a consequence, both under and over nutritional problems coexist. According to the national nutrition survey data, animal food, such as meat, fish and dairy products have been consumed about 6 times more, and cereal consumption was far less in higher income group. In terms of nutrients intake, 28% of total caloric intake comes from lipids and 15-17% of total caloric intake from protein. This was found in higher income group, while low income group consumed more than 80% of total caloric intake from carbohydrate. The trends of major causes of death in Korea have changed. The degenerative diseases, cerebral disorder, high blood pressure became leading cause of death in recent years. Malignant neoplasm and diabetes followed second leading cause of death in Korea. Undernutrition and nutritional insufficiencies, anemia and low growth rate continue to exist among low income group. According to the annual death rate by age group, the age between 34-54 was the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)


Nutrition related resource use in urban areas. Current social organization of cities is unable to respond to increases in the population fast enough to ensure adequate physical and social functioning of all inhabitants. New social structures in the organization of cities is changing the situation of disadvantaged and malnourished people by changing their access to resources. Resources include a number of non-economic ones that can contribute to improve health and nutritional status. The use of these resources depends on individual choices by people. The nature of basic needs predisposes these choices to include ones that are economically irrational and an inefficient use of resources from economic standpoints. The combination of restricted access to resources and inherent inefficiencies in their use determine the health and nutritional situation of people. Indicators of change in the number of choices and the elasticities of benefits associated with them would recognise both the non-competitive and the market aspects of the new urban social organization. Indicators of the number and type of choices available to people, associated with the nutritional and health benefits derived from those choices may be tools for use in urban planning to support new initiatives for groups in fast growing areas where malnutrition is prevalent.


Social problems and health in urbanization. One of the main characteristics of urbanization in Asia is the very rapid increase in population movement from rural to urban centers. This phenomenon has led to changing population structure, its composition and lifestyles in the cities and its fringes. As a consequent of population pressure on urban system and infrastructure, compounded by the nature of the composition of the in-migrant population, the urban concentrates are faced with several social and socio-economic problems. Although there has been a lot of interests among researchers to study the causes and effects or urbanization, there is a vacuum in the area of health implications. Planners and administrators usually give priority to the physical aspects of the urban and urbanities. Social problems and health implications thereof receives very little attention either at the level of administration or research. This paper therefore is a brave attempt to focus and draw some attention to this neglected area by looking at selected social problems and the health consequences.


[Critical approach to emergency care in consultation psychiatry]. 36 patients consecutively admitted in medical and surgical wards of Reims' University Hospital, and referred to the Psychiatric Emergency Unit, were assessed for their psychiatric morbidity (DMS-III-R, axis I) and their psychiatric dangerousness. Approximately one third of the patients didn't suffer from any mental disorder and belonged to the area of psychological medicine. One third showed reactional disorders, were dangerous and were then admitted in a psychiatric department. The risks of the development of liaison psychiatry are discussed by authors--for example, the hardly admitted concept of psychiatric emergency is in danger of losing value.


Supracondylar fractures of the humerus in children. We undertook a retrospective study of 39 children with displaced supracondylar fractures treated by delayed closed reduction with fluoroscopic guidance. After 3-5 days of side-arm traction, swelling had usually diminished sufficiently to allow the elbow to be safely hyperflexed to stabilize the fracture after elective closed reduction. This method yielded 92% good or excellent results. There were no vascular problems or Volkmann's contractures.


[Contribution of pilots to the folder of anxiety]. Anxiety crises sometimes exhibited inflight by professional pilots, mostly fighter pilots in our experience, do not qualify as psychiatric pathology. Here, it is to be understood as the study of mental disorders associated with the profession of pilot. Beyond circumstances or events implied in the onset of disorders, occupational psychopathology takes into account the background of the occupational motivation and the mental dynamics of adaptation to the job requirements.


[Young arsonists, psychopathology and follow-up aspects]. Relatively infrequent (2% of offences in France) the arson behavior (1989, 11,149 acts with an elucidation of 35%) is highly diffused as recent events have shown (forest fire, shops, cars in suburbs). A population of 30 young firesetters, under 25 years shows a great frequency of social parental failure with weak intellectual and scholar levels, but with less obvious pathologic states. Since 1981, the non referring to a criminal court show that this delinquency is linked with other offences. Educational care and psychotherapeutic sid allow a possible evolution to avoid backsliding.


Genetic discrimination and the law.

Genetic discrimination and the law. The use of genetic tests can lead to genetic discrimination, discrimination based solely on the nature of an individual's genotype. Instances of the discriminatory uses of genetic tests by employers and insurance companies have already been reported. The recently enacted Americans with Disabilities Act of 1990 (ADA), together with other federal and state laws, can be used to combat some forms of this discrimination. In this article we define and characterize genetic discrimination, discuss the applicability of the various relevant federal and state laws, including the ADA, in the areas of employment and insurance discrimination, explore the limitations of these laws, and, finally, suggest some means of overcoming these limitations.