[Mineralization of heart valves].

[Mineralization of heart valves]. Mineralization (calcification) of heart valves (mitral, aortic and aortic bioprosthesis) have been analyzed using; histology, x-ray diffraction, infrared spectroscopy, scanning microscopy, atomic absorption and electron microprobe. Obtained results showed the presence of two type of mineralization. First type is represented by grains composed of hydroxyapatite containing admixture of carbonates. This mineralization is seen macroscopically. Second type of mineralization is possible to determine only using chemical methods. It is represented by biological structures containing amount of Ca, P and other elements higher then normal heart valves. This second type of the mineralization conducts to the changes of physical features of the tissue. Both types of calcification develops because of the defects of atomic structure of biological components of heart valves (mainly collagen). These defects show the presence of free atomic bindings i.e. electric potential. Because of this, they are able to react with surrounding free joints, starting calcification. Defects of biological structures of heart valves are the results of infections, mechanical destruction of the valves etc. Calcification may be stopped on different stages of its development: or as secret calcification or may pass to the stage seen as apatite grains.


[In vivo and vitro study of prostaglandins E2 and I2 participation in protective function of antacids on gastric mucosa]. Antacids apart from neutralization of hydrochloric acid possess the gastro-protective properties. In this paper, performed in vivo and in vitro, we studied the effects of antacids (aluminium and magnesium hydroxides) on secretion of PGE2 and 6-keto-PGF1 alpha (a stable metabolite of PGI2) by the gastric mucosa and isolated gastric mucosal cells of rats. We studied protective effects of these drugs on the gastric mucosa and isolated cells as well. It was shown that antacids stimulate generation of PGE2 and PGI2 in the gastric mucosa and protect it against alcohol-induced damage. Indomethacin given prior to antacids in a dose (1 mg/kg) which did not cause any gastric mucosal changes but inhibited generation of both prostaglandins, abolished protective effects of antacids. In comparison with control, surface epithelial cells of the gastric mucosa isolated from the stomachs of rats which were treated with antacids earlier, secreted significantly more PGE2 and PGI2, and were less damaged after incubation with 8% alcohol. Indomethacin inhibited secretion of prostaglandins by isolated surface epithelial cells of the gastric mucosa and abolished protective effects of antacids on these cells. The study confirms both in vivo and in vitro the protective properties of antacids and shows that prostaglandins participate in their action.


[Effect of cadmium on certain factors of lipid metabolism in the aorta and myocardium of rats]. The goal of the research was to examine the effects of cadmium chloride on the levels of selected components of the lipid metabolism in the homogenates of the aorta and the cardiac muscle. Our experiments were carried out on white rats of the Wistar breed subdivided into three experimental groups. Group I were the control animals. The rats of Group II and Group III received the doses of per os, water solution of the cadmium chloride, of 0.88 mg CdCl2 x 2.5H2O per kg of the body weight and 8.8 mg CdCl2 x 2.5H2O per kg of the body weight, respectively, 3 times a week for 3 months. The concentration of total cholesterol was determined in the aorta homogenates and the concentrations of free fatty acids, triglycerides, phospholipids and total cholesterol were determined in the cardiac muscle homogenates. On the basis of our results we found the increase of the total cholesterol concentrations in the aorta homogenates. We also observed the tendency to increase the total cholesterol level in the cardiac muscle homogenates. Such results indicate that atherosclerotic changes of vessels are possible in conclusion of a chronic cadmium poisoning. No changes in the concentrations of the lipid components which are energetically important for the heart were found. Besides, the decrease of the phospholipid concentration resulting from the cadmium chloride poisoning was observed in the cardiac muscle homogenates. That may indicate a change of the activities of the respective enzymatic systems in the cardiac muscle under the influence of cadmium which also causes damages of biological membranes.


[The proliferative activity of myelokaryocytes and the cellular composition of the bone marrow]. Flow cytometry was used to study myelokaryocyte distribution according to the stage of the cellular cycle in 167 bone marrow specimens 94 of which were taken by puncture from hemoblastosis and anemia patients. The results obtained were compared with myelogram data. It has been established that the method provides stable and reliable values, irrespective of cellular composition of the puncture specimens. Basing on the recurrent algorithm of J. H. Fridman's classification, a computer program has been derived that permitted differential diagnosis to be made based on the data of cytometry and myelogram.


[Changes in erythrocyte shape in children treated with chlorpromazine]. Children suffering from schizophrenic psychosis were treated with chlorpromazine for 21 days. Changes in erythrocyte shape were studied by scanning electron microscopy. It was found that the percentage of stomatocytes in sick children was significantly greater than in healthy children. There was no such a difference in case of echinocytes.


[Activity of bronchoalveolar cell population as an indicator of air pollution]. The aim of this study was the evaluation of cytological, immunocytological and cytochemical tests efficiency in describing the pulmonary alveoli cells activity in people chronically exposed to the polluted air. The detailed analysis of bronchoalveolar lavage (BAL) obtained by rinsing of pulmonary alveoli in 36 cases of prolonged exposure to silica and asbestos dust, divided into non-smokers and smokers, was performed. The control were the patients free of any pathological pulmonary symptoms, in this number the inhabitants of Cracow. The BAL cells contribution and activity was evaluated by following methods: routine cytology (the number and percentage of cells), computer cytomorphometry (for assessment macrophage area), nitro-blue-tetrazolium (NBT) reduction test (macrophage activity) and indirect immunofluorescence with use of monoclonal antibodies (macrophage subsets) and FACS-star-PLUS flow cytometer (lymphocyte subsets). In the individuals chronically exposed to the different forms of air pollution we found the changes in number and proportions of bronchoalveolar space cells, the alterations in cell activity (especially pulmonary macrophages) and decrease in CD4/CD8 lymphocyte ratio, that could indicate the apparent disturbances in the local cell resistance. According to our observation there is a synergistic action of tobacco smoking and air pollution. Finally, we may conclude, that BAL, was a non-invasive, repeatable method, useful for monitoring pulmonary changes due to dust exposure.


[Effect of cadmium and lead compounds on behavior of some enzymes in peripheral blood of rats with experimental diabetes]. The aim of these tests was to show whether in an experimental diabetes toxic compounds of the cadmium and lead would intensify changes in the enzymes activity caused by a diabetes itself. The test was carried out on the Wistar breed of rats. After inducing the experimental diabetes animals were given cadmium and lead compounds by searchers directly into their stomachs. The following enzymes the AspAT and the AlAT and the alkaline phosphatase (AP) were indicated among all tested animals. The statistic significant increase of the AspAT and the AlAT and the decrease of the alkaline phosphatase in a blood were documented in the experimental diabetes as well as among animals subjected to the cadmium and lead in comparison with the results secured from the checking group of animals. In comparison to animals with a diabetes itself, in the experimental diabetes the toxic compounds of the cadmium and lead explicitly increased the activity changes of the AlAT and the alkaline phosphatase. On the grounds of the above results it can be assumed that in the diabetic diseases the toxic metals may intensify pathological changes.


[Blood-group systems ABO and RH in the Kenyan population]. The retrospective study was carried out in 38,898 healthy adult blood donors of both sexes, recruited mainly from Nairobi area in Kenya. The percentage proportions of blood groups were: group 0-47.4, group A-26.2, group B-22.0 and group AB-4.4. In all the samples, there were 96.1% Rh (D) positive blood donors. Among these were 0.75% subjects with Rh (D) variant antigen Du positive. Rh (D) negative was only 3.9% among the blood donors. There is a real preponderance of the blood group 0 over the blood groups A, B and especially AB as well as Rh (D) positive over Rh (D) negative. The authors found following frequencies of genes: p(A)0.168, q(B)0.142, r(0)0.690, D positive 0.804, D negative 0.196 and compare their own results with the data of other investigators concerning other Kenyan and African populations.


[Effect of experimental diabetes and thyrotropic hormone on carbohydrate and lipid metabolism in heart and liver of rats]. The purpose of this research was to analyse the change in relationships between the carbohydrate and lipid metabolism parameters in the cardiac muscle and liver in the rats, in which the thyroid gland was induced additionally by use of thyrotropic hormone. The tests were performed on 33 white rats of the Wistar breed that were subdivided into four groups. The first group were reference animals. In the rats of the second group thyroid hyperfunction was induced by use of thyrotropic hormone. In animals of group there diabetes was evoked by use of alloxan. Diabetes and the thyroid hyperfunction the animals in of group four. The levels of glycogen, lactic and pyruvic acids, cholesterol, free fatty acids, phospholipids and triglycerides were determined in the cardiac muscle and liver of all the animals. It was found that the occurrence of both hormonal disorders: experimental diabetes and thyroid hyperfunction noticeably changes metabolism of the cardiac muscle as well as the carbohydrate and lipid metabolism and leads to disorders of carbohydrate metabolism in the liver.


Single, tuberosity-osseointegrated implant support for a tissue-integrated prosthesis. Fixed prosthodontic rehabilitation can be accomplished in partially edentulous patients whose maxillary antrum prohibits successful placement of multiple fixtures. A single posterior fixture is placed in the tuberosity region to support a tissue-integrated prosthesis directly connected to a periodontally sound anterior abutment tooth. The treatment planning considerations and surgical aspects are described, and a case report is used to illustrate the technique.


Occlusal considerations in periodontal prosthetics. The objectives in establishing a physiologic occlusion for periodontal-prosthetic patients are: (1) the minimization of lateral forces on the teeth and (2) the direction of forces along the long axis of the roots. Functional precision of occlusion is not an objective for this type of patient; rather, stability, with freedom of movement, is the goal. This paper gives an in-depth discussion of these objectives and provides an additional look at dental implant therapy and occlusion.


Soft tissue management during implant maintenance. Peri-implant soft tissue problems seen during the maintenance phase of implant therapy include an inadequate zone of keratinized tissue, mobility of grafted tissue, mucosal "pouching," gingival hyperplasia, gingival fistulas, and gingivitis. Techniques to alleviate or reduce these problems include free soft tissue autografts, apically positioned flaps, reduction of tissue thickness by a flap procedure or gingivectomy, and increased attention to the control of inflammation.


Use of a synthetic skin substitute as a physical barrier to enhance healing in human periodontal furcation defects. A study was conducted to evaluate the potential of guided tissue regeneration in the treatment of human molar Class II furcation defects using BioBrane temporary wound dressing as a barrier membrane and to compare the results to those with open debridement. Eight patients, with a total of nine pairs of Class II buccal furcation molar defects, were studied. Prior to surgery, soft tissue measurements, attachment levels, and hard tissue measurements were recorded. These measurements were repeated 4 to 6 weeks after membrane removal. The study revealed no significant difference between results of treatment using the BioBrane membrane and those obtained using open debridement alone, except in the measurement of horizontal open probing attachment, in which BioBrane-treated sites had a significant gain of soft tissue.


The cracked-tooth syndrome: clinical features and case reports. Over a period of 5 months, 18 patients with one or more cracked teeth were treated. Mandibular first molars and maxillary premolars were the teeth most frequently affected. The least affected teeth were mandibular premolars. Predisposing factors for cracked-tooth syndrome are decreased stability (such as caries or poor cavity design) and overloading of the tooth. Treatment involves initial reinforcement and a circumferential cast restoration.


Measurement of enamel thickness in relation to reduction for etched laminate veneers. The etched porcelain laminate veneer is a new conservative treatment that offers a solution to fractured, discolored, and worn anterior teeth. Preparation of enamel should be 0.5 mm to give minimal porcelain thickness and to avoid an overcontoured restoration. At the same time, dentinal exposure is contraindicated, because resin bonds better with enamel than with dentin. One hundred fourteen extracted teeth were measured at the gingival, middle, and incisal thirds. The resulting data reported on labial enamel thickness of anterior teeth may offer guidance in the preparation of laminate veneers.


Modified roll technique for localized alveolar ridge augmentation. A modification of Abram's roll technique is described. A "trap-door" approach is used to reflect and preserve the epithelium that overlies the connective tissue pedicle; the epithelial pedicle is used to cover the donor site. Two case reports illustrate the technique.


[The chemical war in Croatia].

[The chemical war in Croatia]. During the present war against the Republic of Croatia, chemical weapons have been used by the Yugoslav Federal Army (YFA) against both civilians and Croatian Army soldiers. The use of irritants was suspected (Vukovar, Bogdanovci and Vinkovci, October-November, 1991; Solin in the Split area, September, 1991) and proved (Velika Gorica in the Zagreb area, September, 1991; Cakovec, November, 1991) in many cases. The use of psychochemical incapacitating agents (Bilje near Osijek, July, 1991), as well as of psychostimulants in YFA own soldiers (Zadar, August, 1991) has been suspected on clinical findings or laboratory tests. The use of acetylcholnesterase inhibitors was proved in one aggressor's diversion (Zadar, Krusevo, July, 1991). Phosphorus from projectiles and fuming boxes caused poisoning and skin burns due to incineration (Vukovar, November, 1991). YFA used the civilian's fear of chemical and biological weapons, throwing untoxic substances all over the Croatian territory. Great ecocide problems have occurred with massive industry devastation (Sisak, Osijek, October, 1991-January, 1992), with enumerous amounts of toxic substances released into the soil and river aquatoria.


[Pregnancy and labor associated with encephalopathy in neonates during the early neonatal period]. Pregnancy complications, drugs and surgical interventions during pregnancy, fetal growth, medications and interventions during labor, labor complications as well as fetal heart activity during labor in a group of 114 term infants without malformations, but with signs of central nervous system (CNS) damage throughout early neonatal period are compared with paired group of term healthy infants born in the same presentation and mode of delivery. Among prelabor factors only maternal hypertension (found in 16.7% of encephalopathy children versus 0.8% in a control group) was significantly correlated with CNS damage. Fetal growth retardation and long term ritodrine administration were found more frequent in encephalopathy than in healthy group of infants, although statistical significance between the groups could not be demonstrated. A prolonged second stage of labor, high oxytocin dosage, too frequent uterine contractions and vacuum extractions were found significantly correlated with neonatal encephalopathy. CTG pattern during labor was normal in only 28.9% of children, with encepalopathy prepathologic in 46.4% and pathologic in 24.7%. The respective percentages for healthy newborns were: 82.5%, 16.25% and 1.2%. All differences between the groups were statistically significant. Mean duration of prepathologic CTG score in the group of infants with encephalopathy (78.8 minutes) as well as of pathologic score (51.7 minutes) was significantly longer than in healthy infants (23.7 minutes prepathologic and 7 minutes pathologic).(ABSTRACT TRUNCATED AT 250 WORDS)


[Pre-arthrosis of the hip in the adult population]. In order to identify the presence of minor anatomical deformities responsible for the incongruity of the hip joint which causes the degenerative changes, the radiographies of the hips in 332 normal adults were reviewed. The deformities included the acetabular dysplasia and the tilt deformity of the femoral head as the residual condition of epiphyseolysis in adolescence. Using the Wiberg's CE angle acetabular dysplasia was found in 8.6% of cases: the tilt deformity, using the technique by Murray, was confirmed in 9.8%. It is concluded that these minor abnormalities can be recognized from more accurate examination of pelvic radiographies and their presence should indicate the joint incongruity and potential osteoarthritis changes. Earlier recognition of these deformities may permit earlier and simple operative measures and the arrest of the decline of the joint.


[The nucleolar organizer region in malignant non-Hodgkin's lymphoma]. Nucleolar organizer region-associated proteins (AgNORs) have been studied in parafin sections of 15 non-Hodgkin's lymphomas by a silver staining technique. On the basis of the Working Formulation of malignant non-Hodgkin's lymphomas all studied cases were divided into three groups. A statistically significant difference was found between number of AgNORs in the nuclei of low-grade lymphomas (mean 2.654 per nucleus), and also between intermediate-grade (mean 1.588 per nucleus) and high-grade malignant lymphomas. Significant difference was also observed between AgNOR area in high-grade and low-grade malignant lymphomas and between high-grade and intermediate-grade malignant lymphomas. However no statistically significant differences between all three studied groups with regard to the size of nucleus were found. It is suggested that this method can be very useful in the diagnosis of malignant non-Hodgkin's lymphomas.


[The effect of meterological factors on the manifestation of myocardial infarct in the coastal region of central Dalmatia]. The influence of mediterranean climate on the onset of myocardial infarction (MI) was investigated. The study comprised 1306 MI patients from the coastal part of Middle Dalmatia admitted to the two hospitals in Split in 1981-1987 period. Myocardial infarction incidence during south-wind was significantly greater then during north-wind (chi 2 = 5.6; < 0.05) as well as during all non-south-wind days (chi 2 = 11.6; p < 0.001). The coefficients of partial correlation show mild but still significant connection of MI incidence with increased air temperature (rt = 0.064; p < 0.05) and relative humidity (rh = 0.064; p < 0.05). Cross-correlation with shift also revealed mild connection of MI incidence with increased temperature within four days before and on the day of incident (r = 0.023-0.034; p < 0.05). The analysis of synoptical situations in the days with greatest number of MI's (4 to 6) ascertained the characteristics of unstable weather when passing atmospheric front caused a change in the type of weather. The results suggest that coronary patients should stay at home during the south-wind passing atmospheric front, avoid physical stress and take more often antianginal drugs.


[Etiopathogenic characteristics of posterior uveitis in children]. Nine children with acute posterior uveitis were treated for period of 3 years (3.2% of all children treated during that period). The authors speak in favor of the investigation of the HLA-system and the analysis of humoral and cellular immunologic parameters. In this study they present the relationship between these characteristics and the clinical diagnosis. Three of 9 children have with eye diseases associated HLA-B5 and HLA-B12 antigens and grave consequences for the sight of both eyes already as children. The results of immunologic tests in the examined group compared to the control group differ significantly in the total number of lymphocytes, total number of B lymphocytes and serum values of IgG, as well as C3 values of complement component (P < 0.05). Seen in percentage, however, the ratio of T to B lymphocytes, as well as the total number of leukocytes don't show significant differences. We consider that a proper and well-aimed history and complete etiologic detection according to the protocol have contributed to a clearer understanding and better insight into the prognosis of our patients.


[Fractures of the clavicle in neonates]. One hundred and twenty-five newborn infants (6.26%) with clavicular fractures were detected among 1995 neonates seen at the maternity hospital over a period of 16 months. Physical and only exceptionally X-ray examinations were performed. Clinical picture with the subsequent occurrence of callus were pathognomonic signs. The following parameters were taken into consideration for this study: infant's birth weight, sex, risk factors, way of delivery, delivery line, Apgar score, seasonal distribution and complications. Newborn infants with clavicle fracture were infants whose weight was more than 3500 g (3763.36 +/- 360.58 g, chi 2 = 65.605, P < 0.05), most frequently from mothers with the second childbirth (48.8%), babies born in a normal and natural way (58.4%), and in 71. 33% of the cases with some risk factors and Apgar score more than 7. One thousand seven hundred and forty-two out of a total of 1995 neonates had birth weight less than 4000 g and in 92 of these 1742 infants (5.29%) clavicular fractures were found, while in 253 newborn infants with birth weight more than 4000 g, 33 neonates (13.05%) had clavicular fractures. Clavicle fractures were more frequently found among the infants with birth weight more than 4000 g (P < 0.05). Three out of a total number of infants had paresis plexus brachialis, two of which belonged to the group of children with clavicle fractures. This study suggests that the approach to the childbirth conducting should be changed, so that the percentage of clavicle fractures can be reduced or noticed in time by help of more frequent and systematic clinical examinations.(ABSTRACT TRUNCATED AT 250 WORDS)


[Blood pressure in neonates measured by Doppler ultrasound]. In order to provide correct care for newborns it is necessary to determine the arterial pressure, since it is an important physiological indicator of body vitality. We measured blood pressure in 50 healthy, full term infants, born in Zagreb. All blood pressure readings were done by using a Doppler ultrasound. The 4 cm width cuff was used. The mean systolic pressure was 78.76 mmHg (SD +/- 8.6) and the diastolic one 35.78 mmHg (SD +/- 6). The level of systolic pressure was associated with body-mass (r = 0.371; p < 0.01), while sex had no effect on it.


[A Möbitz II atrioventricular block in a healthy male]. The case of a young, asymptomatic and otherwise healthy male with atrioventricular block Möbitz type II is presented. Contrary to the expectations, considering the type of the block, electrophysiologic study revealed only a vagotonic conduction delay in the atrioventricular node. The electrophysiological aspects and clinical significance of such a rare finding are discussed, especially in respect to Möbitz type II atrioventricular block.


[Tuberculosis in systemic connective tissue diseases]. Six female patients who developed tuberculosis during the treatment of connective tissue diseases are presented. Underlying disease--systemic lupus erythematosus, rheumatoid arthritis, and polymyositis--with its numerous immunopathologic processes essentially decreases resistance of the organism to infections. Tuberculosis usually accompanies chronic, exhausting diseases and tends to involve patients with the decreased immunity. The use of glucocorticoids and immunosuppressive agents has been shown to have a significant influence on the suppression of the immune system. Thus, tuberculosis is a dangerous, very often fatal complication in the course and treatment of connective tissue diseases.


[Incidence of skin manifestations of Lyme disease in Croatia]. In the study, the most relevant historical data concerning Lyme-borreliosis are shortly reviewed. The most frequent skin manifestations, i.e. erythema cronicum migrans (ECM), lymphocytoma cutis (LCC) and acrodermatitis chronica atrophicans (ACA) are described. The clinical course of Lyme disease and the chronologic review of the most significant data on the disease are given. The frequency of skin manifestations of Lyme-borreliosis in various areas of Croatia from 1988 to 1989 based on the reports of dermatologists throughout Croatia is presented. According to our results, it can be concluded that skin manifestations of Lyme-borreliosis are much more frequent in the central and western parts of Croatia than elsewhere. The authors hope that the use of a fluorescent method for detecting antibodies to Borrelia burgdorferi since 1989 in the Serologic Laboratory of the Department of Dermatology, Salata, Zagreb will lead to more precise results about this disorder in the future.


Improved life expectancy after coronary artery bypass grafting in elderly. From 1981 to 1990, 204 patients (165 male, 35 female) aged 70 years and older (mean 72.4 +/- 2.4 years [+/- SD], range, 70 to 81 years) underwent isolated coronary artery bypass surgery with an average of 3.8 +/- 1.2 grafts per patient. Seven patients (3.5%) were in NYHA functional class I, 52 (25.5%) were in class II, 1237 (62%) were in class III, and 18 patients (9%) were in class IV preoperatively. The operative mortality (30-day mortality) was 6.8% (14 patients). The NYHA class improved in these patients from a mean preoperative value of 2.8 +/- 0.65 to 1.4 +/- 0.6 postoperatively (p < 0.0001). The actuarial survival (+/- SD) of the entire group was 92 +/- 2% and 86 +/- 4% at 1 and 5 years, respectively, and of the patients surviving operation, excluding those who died in the hospital, it was 98.5 +/- 1.0% and 93 +/- 3.5% at 1 and 5 years, respectively. We concluded that coronary artery bypass grafting in elderly patients can be performed with acceptable operative mortality and good late results.


[Cardiac sarcoidosis verified histologically by endovenous myocardial biopsy]. The female patient with sarcoidosis simultaneously involving the lungs, heart, liver, eyes, skin and lacrimal glands is presented. The diagnosis of this disorder was established by biopsy of the liver and skin as well as by at our institution newly introduced method of endovenous blind-myocardial biopsy. Generalized active sarcoidosis had brought the patient into a very profound cachectic state (body weight 48 kg), but her life was directly endangered by granulomatous inflammation of the myocardium with the development of cardiac decompensation, grade I and II atrioventricular conduction disturbances as well as by transitory and total AV block with frequent arrhythmias. A significant resolution of the disease occurred after the introduction of corticosteroid therapy. However, grade I AV block persisted even after one year of treatment, suggesting that the syndrome has probably proceeded from granulomatous inflammation to fibrosis. Therefore, the patient is still a potential candidate for an electrostimulator.


[Results of treatment in non-Hodgkin's lymphoma in children using the YU-77, YU-84 and YU-87 protocols]. Fifty-eight children with non-Hodgkin's lymphomas (NHL) were treated with three different chemotherapeutic protocols at the Division of Hematology and Oncology, Department of Pediatrics Salata during the period from 1977-1989. Twelve (20%) patients had lymphocytic and 46 (80%) lymphoblastic type of NHL. There was no statistical difference in the incidence of the 1st complete remission induced by different chemotherapeutic protocols (YU-77 86% YU-84 72% and YU-87 81%). However, the 1st relapse occurred in 8% of the patients treated with YU-87 protocol, compared to 30% in those treated with YU-84 and 58% treated with YU-77 (p < 0.01). The probability of 36-month survival was highest in patients treated with the most aggressive chemotherapeutic protocol YU-87 (81%), whereas it was 63% in those treated with YU-84 and 32% treated with YU-77 (p < 0.01). All patients that did not enter the 1st complete remission died during the first year of treatment. The median survival of patients that achieved the 1st complete remission was 28.3 months, while the probability of 36-month survival was 62% (p < 0.001). The survival strongly correlated with the protocol employed and clinical stage, but was independent of the histologic type of NHL.


[The importance of antiviral diagnostic sera]. This paper presents instructions for the control of produced antiviral serum for use in immunofluorescent tests [direct test of fluorescent antibodies (DTFA) and indirect test of fluorescent antibodies (ITFA)] for the detection of viruses from the clinical material of patients. The way of testing nonspecific and specific reactions of antiviral serum which we have presented originates from our own long-standing observations and experiences in the production of antiviral diagnostic serum as well as from observations of other authors.


[Therapeutic systems and drug delivery. 4. The osmotic minipump]. For continuous delivery of substances to conscious experimental animals a miniature osmotic pump was developed. These pumps can be implanted subcutaneously or intraperitoneally. Then with self-powered force (osmosis) substance is released with constant rate over period of 1-4 weeks (model pending). These osmotic minipumps are widely used for investigation of various substances (e. g. anesthetics, anticancer agents, catecholamines, immunomodulators, peptides, steroids). By the means of osmotic minipumps until now more than 300 substances were applied and over 4,000 papers were published on the use of osmotic minipumps in pharmacology, toxicology, oncology, etc.


[Quality control of frozen plasma in 8 blood transfusion centers in the Croatian Republic]. Fresh frozen plasma (FFP) is one of the most frequently used blood components. Its use is continuously increasing, although 50 to 80% of units are not used according to the approved indications. The quality control of FFP was performed in 6 blood transfusion centers. The volume of FFP unit was between 178 and 234 ml. F VIII: C above 0.70 i. u./ml was observed in 40.9 of units. Plasma in 0.9% of units was not sterile and the concentration of total proteins and hemoglobin were within the acceptable range.


[Acute lymphocytic alveolitis in sarcoidosis]. Lymphocytic alveolitis is the characteristic feature of active sarcoidosis. High intensity alveolitis (more than 28% of lymphocytes in bronchoalveolar lavage fluid) implicates, according to some authors, specific, most often poor prognosis. Twenty-seven patients with active pulmonary sarcoidosis were grouped according to the intensity of lymphocytic alveolitis. In the first group, there were 13 patients with high intensity alveolitis (more than 28% of lymphocytes in bronchoalveolar lavage fluid, average 42.8 +/- 12%) and in the second group 14 patients with low intensity alveolitis (less than 28% of lymphocytes in bronchoalveolar lavage fluid, average 13.3 +/- 6.5%). The groups did not differ with regard to sex, chest radiologic stage or the number of relapses. All the patients had pulmonary function tests: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), diffusion capacity (DLCO), and rest and exercise arterial blood oxygen tension. The high intensity alveolitis group had significantly lower FVC (p < 0.01) and FEV1 (p < 0.05) as compared with the low intensity alveolitis group, what indicates that the high intensity alveolitis group of patients had more advanced pulmonary disease and was accordingly more often treated with corticosteroids (69.2%). Nine patients with high intensity alveolitis and ten with low intensity were followed up for 6 months. In the group with high intensity alveolitis there was a statistically significant improvement of DLCO (p < 0.01) what could be explained by a frequent use of corticosteroids in this group. Chest radiogram in the high intensity alveolitis group showed complete clearing in one patient only and incomplete in eight.(ABSTRACT TRUNCATED AT 250 WORDS)


[Evaluation of the potency of the allergen preparation Ambrosia elatior using a skin test and the inhibition radioallergosorbent test]. The total allergenicity of a pollen extract Ambrosia elatior was measured by quantitative prick test applied to the skin of seven highly sensitive patients and by standardized method of RAST-inhibition. Five 10-fold dilutions of the allergen concentration together with histamine hydrochloride 1 mg/ml (H1) were used. The induced wheal diametres for each concentration in per cent of the patient's own histamine wheal, were calculated. There was highly significant correlation (r = 0.9951) between the intensity of IgE mediated skin reactions and the IgE binding molecules in whole pollen extract. The concentration which provides the wheal equivalent to those of H1, found by linear regression analyses, was 54.9 micrograms/ml) in order to inhibit radioallergosorbent test with a pooled serum from the same patients, containing specific IgE antibodies against relevant allergens. Relevant allergen was a disk-allergen W1 (Pharmacia Diagnostics, Uppsala) The quantity of inhibition was proportional with allergen concentration (r = 0.9813). The concentration of 55.9 micrograms/ml, by linear regression analyses elicits inhibition of 50 per cent in RAST. It is concluded that quantitative prick test and histamine estimated skin sensitivity have a good clinical applicability in assessment of releaseability of skin mast cells, and together with RAST inhibition, provides the precise combined method for calibration of an allergenic extract potency.


[Mutagenic changes in medical personnel occupationally exposed to antineoplastic drugs]. Not so long ago the unfavourable influence of antineoplastic drugs on personnel exposed to them was reported. Since then research has been carried out with the aim of clarifying and objectivizing this occupational danger. Agreement was reached on the need for measures of protection at work and regular medical check-ups of personnel exposed to these cancerogenic substances, which can also have a mutagenic and teratogenic effect. This paper presents the possible consequences of the effect of antineoplastic drugs in long-term exposure to low concentrations, and the means of protection from the unfavourable effect of exposure. In our country such means of protection and regular medical check-ups of personnel are not carried out in any oncological department, which is a serious oversight, particularly if we accept the fact that today 70-90% of all carcinomas are due to agents within our environment and diet.


[Transplantation of the peripheral nerves]. The development of microsurgery made possible neurorrhapy of even very tiny peripheral nerves. In case of a transsection of a nerve without a defect or with a minor one up to 15 mm, approximation of stumps can be done directly. Larger defects are bridged with autogenous nerve grafts. In order to avoid this, novel technics like cadaveric allogenous grafts or using veins and small tubes of absorbable materials as a guiding rail have been introduced. For purpose of this degenerated muscle grafts are being also applied.


[Comparative study of respiratory changes in female workers exposed to organic aerosols]. The prevalence of acute and chronic respiratory symptoms and ventilatory capacity were studied in 314 women and 119 men exposed to some organic aerosols. The prevalence of all chronic respiratory symptoms was significantly higher in exposed than in control workers. A large number of exposed workers complained of acute symptoms which develop during work shift. There were statistically significant acute reductions of all ventilatory capacity tests, particularly FEF50 and FEF25. Comparison of measured ventilatory capacity with predicted normal values indicated obstructive ventilatory capacity changes located mostly in smaller airways. Our data suggest that exposure to organic aerosols may contribute to the development of chronic obstructive lung disease.


[Long-term follow-up of related kidney donors after nephrectomy]. From 1973 to July 1990, 183 kidney transplantations were performed at the Transplantation Unit of the Department of Urology--Faculty of Medicine--University of Zagreb. Out of these, 57 were from the living related donors. The research included 50 (88%) living related donors (28 mothers, 12 fathers, 5 brothers and 5 sisters) followed up from 1 to 15 years after donor nephrectomy. The donors' health conditions were evaluated by clinical-laboratory examinations (biochemical tests, renal function tests, urinoculture, ultrasound, isotopic renal studies, arterial blood pressure). In 48 (96%) neither morphological nor functional changes of the urinary system were found. A certain number of donors requested a transfer to less physically strenuous jobs. Except for the grafts functioning well in the recipients, the results also showed that the quality of donors' lives remained unchanged.


[Residual postoperative murmurs in children with congenital heart defects]. Fifty-four children without postoperative complications were admitted to the Department of Pediatrics, University Hospital Rebro, following a complete surgical correction of ventricular septal defect (VSD), atrial septal defect - secundum type (ASD II) and patent ductus arteriosus (PDA) in the period from June, 1989, to February, 1991. Twenty-two patients were treated surgically for VSD, 17 for ASD II and 15 for PDA. There were 23 male and 31 female children. In the early postoperative period, 57% of all the examinees had a murmur with the innocent or functional characteristics. The murmur was significantly more frequent among children with VSD than among children of other groups (ASD II, PDA). Sex, age and hematocrit did not influence this difference. There were 8 anemic children (3 with operated VSD, 4 with ASD II, and 1 with PDA). From this, it may be concluded that anemia also did not cause this difference. However, anemic children represented 50% of the examinees with a murmur among the operated for ASD II and 33% among those treated surgically for PDA. When these anemic children were eliminated, the others operated on for ASD II and PDA probably had the innocent murmurs, since the proportion of examinees with a murmur fits into the incidence of innocent murmurs in the population. The children operated for VSD have had a greater proportion of examinees with a murmur, and most likely, some of these murmurs do not belong to a group of innocent or functional murmurs. Their cause is unknown, as yet (probably, small organic lesion).(ABSTRACT TRUNCATED AT 250 WORDS)


[The effect of cigarette smoking on pulmonary diffusing capacity in asymptomatic smokers]. Ninety-seven subjects of which 72 smokers and 25 nonsmokers attending the Laboratory for Respiratory Functional Diagnostics of the University Hospital for Lung Diseases, Jordanovac, Zagreb were examined. The selection criteria were normal standard spirometric test values (FEV1, FVC, FEV1/FVC) in asymptomatic healthy, young smokers/nonsmokers who showed no signs of hematological, cardiovascular and chronic or acute pulmonary symptoms or diseases (according to a standardized questionnaire), and were not exposed to harmful environmental factors. The single-breath carbon monoxide diffusing capacity was measured in all patients. The results of our study confirm the findings of those authors who report reduced values of DLCO and DL/VA in smokers in comparison with the nonsmokers. A linear value diminution has been noticed in smokers and nonsmokers with increasing age, with the values being much lower in smokers. Our results also demonstrate a significant correlation between DLCO and DL/VA in young healthy smokers vs the duration of smoking and the number of cigarettes smoked per day (p < 0.01). The possibility to detect early reversible damages of lung function in young healthy smokers is an important contribution to the prevention of all diseases in which causal consecutive relation with cigarette smoking is confirmed.


[Developmental and involutional breast disorders]. The majority of benign breast disorders may be classified as developmental and involutive. Mastalgia and breast nodularity represent the greatest groups of these disorders, while epithelial hyperplasia is a complex benign disorder which is most difficult to be evaluated. Sixty women with diagnosis of cyclic mastalgia and 30 with noncyclic breast pain were followed-up. Patients were administered bromocryptine, danazol or a local progestogel. Better treatment results were achieved in cyclic mastalgia than in women with noncyclic mastalgia. One hundred and forty-five biopsies of the benign breast tissue were examined histologically. Nonproliferative forms were found in 66.9% of the women, proliferative without atypia in 29.65%, and proliferative with atypia in 3.45% of the patients. Atypical ductal hyperplasia and atypical lobular hyperplasia increase four-to fivefold the risk for breast cancer. Prophylactic subcutaneous or total mastectomy is not as a rule indicated in atypical epithelial hyperplasia, only regular follow-up is required.


[Epidemiologic and clinical characteristics of anthrax in patients at the University Hospital in Split 1956-1987]. This paper discusses the epidemiological and some clinical characteristics of 61 patients who were diagnosed as having anthrax at the Department of Infectious Diseases, University Hospital Split in the period from January 1, 1956, to December 31, 1987. The pathogenesis of the disease is also reviewed. Clinical diagnosis was confirmed in 36 (59.02%) patients, 32 (52.46%) were diagnosed by microscopic examination of Gram's stained smears and 4 (6.56%) patients by cutaneous lesion fluid culture. In 54 (88.52%) patients the disease presented as a malignant pustule and in 7 (11.48%) as a malignant edema. Only 3 patients had clinical signs of septicemia, but the diagnosis was not confirmed by positive blood cultures in none of these patients. The subjects contracted the infection either by a direct contact with a diseased animal or indirectly by contaminated products of animal origin or by hematophagic insects in approximate ratio 8:2:1. No mode of infection was identified in 27 (44.26%) patients. The male/female and professional/nonprofessional anthrax ratio was 1:1. The majority of children were in the 0-9-year and 30-39-year age groups. Most of the patients were treated with penicillin, and the others with tetracyclines or a combination of antibiotics. Serum was applied in 29 (47.54%) patients. Only one patient died (1.64%). Three different modes of infection are described in the last four treated patients.


[The nail-patella syndrome].

[The nail-patella syndrome]. The nail-patella syndrome (synonym of onychoosteodysplasia) is considered to be an autosomal dominant hereditary disease affecting numerous tissues of ectodermal and mesodermal origin. The changes are mostly found on nails, patellae, eyes and joints. The symptoms of nephropathy are present in 30% to 40% of patients, and renal insufficiency with typical signs of the syndrome in 25% of patients. This report describes a female patient with renal insufficiency on chronic hemodialysis treatment, in whom diagnosis of the nail-patella syndrome has been made at 36 years of age. The incidence of the syndrome has been noted in 11 members of the patient's family, but without clinical signs of nephropathy.


[Auto-reactive anti-B antibodies and hemolysis in patients with type B blood after kidney transplantation from an O blood group donor]. The course and the treatment of the patient M.F., who after kidney transplantation, produced autoreactive antierythrocyte antibodies is described. The patient M.F. was B, Rh positive and the kidney donor was 0, Rh positive. On the 12th posttransplantation day severe hemolysis, anemia and bilirubinemia were observed. Beside anti-A, autoreactive anti-B antibodies were discovered in the B group patient and the direct antiglobulin test (DAT) was positive. The patient was treated with several transfusions of 0 blood group washed red cells, immunosuppressive drugs (Cyclosporin, Methylprednisolone) and with daily plasmaphereses. After the 5th plasmapheresis the serum became clear, autoreactive anti-B antibodies could not be detected in the serum, but DAT was still positive. At that time the function of the graft was adequate. Between 22nd and 30th posttransplantation day DAT became negative. Autoreactive, anti-B antibodies were generated by the donor's lymphocytes, that were transferred with the kidney graft and which continued to synthetize anti-A,B antibodies in the patients' circulation.


[The cochlear implant in patients with sensorineural hearing defects]. Cochlear implants are at the present time the only possibility for rehabilitation of totally deaf people. In this article the pathophysiology of sensoneural hearing impairments, the way of functioning of cochlear implants and indication for their use are presented. The results as well as the differences in rehabilitation effect in prelingual and postlingual deaf are pointed out. The reasons of sometime unexpected good and sometime unexpected poor results are discussed. On the end some unsolved problems in rehabilitation of deaf children with this method are presented.


[Tetracosactide (Synacthen Depot) in patients with multiple sclerosis]. In a group of 292 patients, clinically definite cases of multiple sclerosis, 91 of them were administered Tetracosactrin (Synacthen Depot) during the initial or exacerbation attack of the disease. Two female patients developed typical anaphylaxis during the drug use: the first patient after the twenty-second injection and the second one after the sixth injection. Negativity of the cutaneous test to zinc oxide in these two female patients, increased IgE immunoglobulin concentration and positive RAST to the drug suggested to the feature of immediate allergy conditioned by reagins.


[Blue color vision as a sign of digitalis poisoning]. The paper deals with the course of the illness in a 66 years old male, who had taken an amount of 0.2 mg of medigoxin for an unknown period of time, because of chronic heart failure due to atherosclerotic heart disease and chronic atrial fibrillation. He have had a cholelithiasis also and reduced renal reserve. He was admitted by an emergency admittance because of nausea, vomiting, color vision disturbances: blue colored vision, and with other signs of digitalis toxicity: diffuse abdominal pain, an absolute arrhythmia with a slow ventricular rate, and with a short corrected Q-T interval in an electrocardiogram of 0.315 seconds and with high serum digoxin level reacted 3.8 nmol/L. After stopping of a digitalis treatment, in a period of time of four days, all signs of digitalis toxicity including blue color vision disturbances disappeared. In the paper that rare sign of digitalis toxicity is discussed.


[Neurosurgical treatment of children with spina bifida associated with congenital spinal lipoma in the lumbosacral region]. This paper presents twelve neurosurgically treated children with spina bifida associated with congenital spinal lumbosacral lipoma over a 3-year period. The introduction deals with various types of lipoma, their development, clinical presentation, local findings in children with spinal lipoma, as well as with the significance of neurosurgical treatment. The age span of children with occult spina bifida and spinal lumbosacral lipoma was from 3 months to 2 years, and there were seven girls and five boys. In all the twelve children, a smaller or bigger fatty mass in the lumbosacral area was noticed immediately after birth, gradually increasing in size. Neurologic examination revealed weakness of lower extremities, with somewhat atonic sphincters, in only two of the children. Spinal dysraphism was demonstrated by plain roentgenograms in all the twelve children, while CT-scans, CT-myelography and recently MR-scans, confirmed the diagnosis of spinal lipoma. In all the twelve children the spinal lipoma and the adherences between the lipoma and the low-lying conus or an enlarged filum terminale were removed by the neurosurgical excision. Follow-up of children 6 and more months following the surgery showed improvement of their condition. Spina bifida associated with congenital spinal lumbosacral lipoma is a condition that although benign in histology, can have devastating effects if not surgically corrected early. Children who are asymptomatic at the time of repair will tend to remain asymptomatic. Those who are not repaired early will develop and show subsequent deterioration as time progresses.(ABSTRACT TRUNCATED AT 250 WORDS)


[Therapy of urinary incontinence with the AMS 800 artificial sphincter]. The article deals with the possibility of the therapy of urinary incontinence by means of an artificial sphincter. Indications for the implantation of the artificial sphincter and results obtained after twenty implanted sphincters are shown as well.


[Conservative surgical procedures in transitional cell carcinoma of the kidney and ureter]. Conservative surgical procedure in selected patients with transitional cell carcinoma of upper urinary tract is alternative to radical surgery. Generally, a conservative surgical procedure is indicated in solitary low-stage lesions, particularly impaired renal function and bilaterality. At our Institute, conservative surgical procedure was performed in patients with solitary kidney and significant renal function damage. Survival after conservative and radical surgery was similar, extending the scope of indications for conservative surgical procedure in cases of low-grade low stage tumors.


[Echocardiography in the diagnosis of cardiac sarcoidosis]. This paper deals with echocardiographic changes in the heart in patients with active intrathoracic sarcoidosis. Heart changes were registered with 10 (38%) out of 26 patients, in all radiological stages of sarcoidosis. Out of 16 patients first radiological stage (BHL) was found with 4 (25%), out of 8 patients second radiological stage was found with 4 (25%), and third radiological stage was found with 2 patients. Out of 10 patients with echocardiographic changes in the heart 4 patients (40%) had increased echoes and hypokinesis of the proximal part of interventricle septum, 3 (30%) had significantly reduced diffusive capacity and pulmonary hypertension. Increased echoes of papillary muscles were registered in two cases, one of them with relatively mitral insufficiency. In one case dilatational incipient cardiomyopathy with second stage of relatively mitral insufficiency was found and in one case increased echoes and hypokinesis of the back wall of the left ventricle were registered. Changes in electrocardiogram were found with 5 (19%) patients suffering from pulmonary sarcoidosis.


[Monoclonal antibodies in the diagnosis of breast carcinoma]. The knowledge of immunological reaction against tumor results in using of immunological methods in identification and characterisation of tumor antigens, and also in diagnosis and prognosis of malignant diseases. Identification of tumor antigens by monoclonal antibodies has been an important development in breast cancer research. A number of monoclonal antibodies produced against breast cancer antigens do not detect "tumor-specific" antigens, but, rather, they react with normal or modified tissue antigens which are inappropriately expressed upon malignant cells. The application of several monoclonal antibodies in combination has a potential value in immunohistopathology as diagnostic tools for recognition of small quantities of malignant cells, of premalignant changes, of histological origin of the metastases, or in the development of serum assays for tumor markers. Some of monoclonal antibodies produced against breast cancer antigens, and also attempts of their application in the diagnosis and prognosis of breast cancer, are presented in this review.


[Carnitine: physiologic role, primary and secondary deficiency]. L-carnitine is essential in fatty acids metabolism, it is synthetized endogenically and supplied by nurishment as well. Ninety eight percent of it is stored in skeletal muscles. Its importance in primary deficiency, either systemic encephalomyopathies or isolated myopathies, is out of discussion. In deficiency states, life itself may be threatened. Numerous investigations point to secondary carnitine deficiencies. Favorable substitution effects are published, first of all, in organic acidurias in children, in ischemic heart diseases of adults, in hyperlipoproteinemias, in peripheral vascular disease, in patients on hemodialysis, and in muscle dystrophy. Favorable results are published also in total parenteral nourishment of newborns and adults. L-carnitine may prevent toxic effects of valoproates and antracyclins. The substance is not toxic and is well tolerated. LD50 values are almost like those of amino acids. Meanwhile, inspite of many reports on favorable results in secondary carnitne deficiencies the additional controlled clinical trials should be done, especially in children.


[Cardiomyopathy in children].

[Cardiomyopathy in children]. Cardiomyopathies (CMP) are rare diseases in childhood. There are three different types (dilated, hypertrophic and restrictive). Exact epidemiologic drawing are not well-known, and the numerous nosologic problems still exist. The basic classification distinguishes primary (not well-knows cause) and secondary CMP (cardiac changes have been developed as any influence of the well-known diseases of the cardiovascular system). Dilated forms make 55%, hypertrophic 40% and restrictive only 5% of all CMP. The tendency of this paper is introduce the knowledge of new approaches to cardiomyopathies, the definition of which was taken at 1983. The mean consideration includes etiology and therapeutic approach of different types of CMP. The chapter on dilated CMP was mainly aimed to discuss their development after virus myocarditis, immunologic processes and complicated therapeutic treatment (different in acute, subacute and chronic phase). The purpose of this paper is to call the attention on the CMP in children, as the main problem in pediatric cardiology after congenital heart diseases.


[Oncogenes and growth factors in human epithelial tumors: their importance in diagnosis and prognosis]. The accumulation of the genetic alterations, the activation of oncogenes and the inactivation of tumor suppressor genes, play a critical role in the induction of the malignant tumours. In human solid tumors, oncogenes and growth factors are found at any of the different stages in carcinogenesis. The clinical results of these observations are the demonstration of some relations between activation and expression of the oncogenes and growth factors and clinical features or prognosis. Furthermore, they seem to permit definition of premalignant conditions or populations of high risk of disease.


[Terrorist explosions--medical aspects]. In this paper we present the review of medical and organizational aspects of terroristic explosion as a type of urban disaster. We have focused on consequences of the explosion of unfragmented explosive devices, particularly regarding the type and localization of injuries. The definitions of urban disaster is given and organizational problems in these situations are classified.


[Primary care for adults in Chile: analysis of basic information]. According to national data the Chilean adult population on the average has 2.5 annual ambulatory visits with an increasing trend in the last decade. The figure has significant variation in the diverse geographic regions. Taking pregnant women out, main diseases assisted at the outpatient departments of general consultation include in a 70%, problems usually of the competence of internal medicine specialists. The solving problem capacity in these departments is 80 to 85% which means that 15-20% of the patients needs to be referred to a higher complexity medical care level. According to the National Health Service experience, two-thirds of the primary care level are done by general practitioners and one-third by specialists. A scarce preventive component and a low coverage of chronic disease among adult people and the problems of the primary care in the National Health Service are commented. A new structure of medical care levels is proposed separating a first level with include rural and basic urban outpatient clinics besides low complexity hospitals with general practitioners; a second level with urban general outpatient clinics served with specialists and median complexity hospitals; and a third level with new and specialized ambulatory centers for diagnosis and treatment and hospitals of high and great complexity.


[Is a military hospital needed in the Republic of Croatia?]. The paper is an attempt to answer the question whether the military hospital is necessary or not in such a small country. Some arguments (and contra-arguments) are listed and discussed. Between the others are: (1) the necessity of developing "war" medical skills and knowledge (cannot be developed during peace-time neither in the military nor civil hospitals, and civilian health services are capable to adapt and to fulfill specific war tasks as it was shown in war in Croatia in 1991), (2) the possibility to develop specific, even peculiar, specialties as hyperbaric or space medicine (these are necessary at the airports, navy bases etc, not in military hospitals), (3) specific health needs of the population of soldiers, officers, and their families (as a rule this population is younger and positively selected i. e. healthier than the general population), (4) security reasons (the data are more accessible from the military service in one place than from the scattered civilian health services), (5) privileges in health care for population of soldiers, officers, and their families due to their particular merits (military forces themselves deny this reason; also, separate military health services is not really the privilege due to bureaucracy, and rather narrow choice of services, (6) separate services could be less expensive and more efficient than the civilian one (experiences from the other countries are completely opposite). The conclusion is that, for such expensive parts of health services, as hospital care (spending between 40% and 70% of the total health expenditure), there is the growing need for rational and planned development within the comprehensive and integral healthcare system. Inside such comprehensive system the military hospital does not look like a rational solution.


[The University of Zagreb Medical School and the war in Croatia 1991-1992]. School of Medicine, University of Zagreb (as an institution as well as through the efforts of individual faculty and staff members) has actively participated in all the phases of the war against Croatia: the preparatory phase (1990 and the first half of 1991), the phase of local war (July and August 1991) and the phase of total war (September 1991 to January 1992). In defense preparations, leading faculty members, supervised by the Croatian Government, have: 1. prepared the University hospitals for the case of mass casualties, 2. initiated donation of essential medical supplies and equipment, and 3. prepared the preclinical staff and facilities for research, documentation and information services for Crisis management. On July 11, 1992, Ministry of Health of the Republic of Croatia formed the Medical Headquarters to coordinate the health services in the defense of Croatia. Several faculty members were appointed heads of the following Headquarters divisions: Division of Informatics and Research, Division of Education and Publicity, Division of Toxicology, The Fourth Echelon, Division of Mental Health and Division of Rehabilitation. Assistant lecturers, technicians and students actively joined work in the Division of Donations, which acquired and provided almost all medical supplies used in our battlefields and hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)


[The effect of degree of renal function damage on the levels of serum gastrin and gastric acid secretion]. Fasting serum gastrin concentrations and both basal and maximum-stimulated gastric acid secretory rates have been studied in 225 patients with various degrees of impairment of renal function and 42 healthy subjects. Basal gastrin concentrations in the chronic renal failure (CRF) patients were significantly higher (p < 0.05) than in control subjects. When the glomerular filtration rate (GFR) was used as an index of the degree of renal impairment serum gastrin rose proportionately with the degree of renal failure. Basal (BAO), maximal (MAO) and peak acid output (PAO) in the CRF patients were significantly lower (p < 0.05) than in the control group. Both in the basal condition and during pentagastrin stimulation the CRF patients had low volume of gastric secretion. There was significant positive correlation between basal serum gastrin concentrations and the severity of renal damage. The basal serum gastrin concentration was inversely related to BAO, MAO and PAO in the CRF patients with severe impairment of renal functions. The results indicate that hypergastrinemia in CRF patients might be due to a combined effect of impaired renal catabolism of gastrin and overproduction of gastrin associated with hypochlorhydria. The present findings suggest that in CRF there are some unknown mechanisms that inhibit gastric secretion.


[The sirocco wind increases the onset of paroxysmal atrial fibrillation in patients in the central Dalmatian coastal region]. The influence of weather on the onset of paroxysmal atrial fibrillation (PAF) was studied in 1099 patients who were admitted to the Outpatient Clinic of the Department of Internal Medicine Split during the period 1981-1987. The cumulative frequencies of PAF during bora, sirocco and calm weather were determined. There were 870 bora or sirocco days when the wind lasted at least 8 hours at the velocity exceeding 20 km/h. Thirty two windy days that were neither bora nor sirocco were not studied. The rest of 1654 days were considered as calm weather. The incidence of PAF during 1654 calm days (0.41/day) was significantly different from PAF incidence during 440 days with sirocco (0.50/day, p < .05), but not from the incidence of PAF during 430 days with bora (0.46/day, p < .05). Logistic regression analysis, and control of the patients ages, revealed a significant correlation between type of the wind of various intensities and onset of PAF (chi 2 = 12.73, d.f. = 6, p < .05). The greatest contribution to this correlation was exerted by sirocco in patients over 50 years of age.


[Respiratory function in female workers occupationally exposed to acid air pollution]. Prevalence of respiratory symptoms and ventilatory capacity were studied in 117 female workers exposed to acid fumes and aerosols in pickling industry. Similar prevalence of respiratory symptoms was recorded in three working groups: a) pickling; b) mustard making; c) packing. Significantly higher prevalences of chronic cough (p < 0.05), chest tightness, nasal catarrh and sinusitis (p < 0.01) were found in pickling workers in relation to controls. In all three exposed groups there was a high prevalence of acute symptoms during work shift. Measured FEV1, FEF50 and FEF25 were significantly decreased in comparison to predicted normal values. Pickling workers exposed for more than one year demonstrated significantly larger acute reductions during work shift than those with shorter exposure. Our data suggest that long term exposure to acid fumes and aerosols in industrial environment may cause the development of acute and/or chronic respiratory symptoms and lung function changes.


[The integral civil and military health care system]. The problem of the organization of the army health care system in the Republic of Croatia is very actual. At the beginning of the war, the all fighting formations were covered by the civil health organization. After the Croatian army was organized, the differentiation between civil and army health system has been established. The characteristic of that differentiation was integral system with primary health care and transporting of the wounded persons organized by the army, while the specialistic and hospital care were organized by the civil institutions. In the peaceful future the integral health system must be kept. There is no need for the army hospitals, because only one hundred beds for a year will be enough for the army consisted of about 50,000 persons. The civil hospitals can provide the high quality service with a short-term transporting of the patients. The Government of the Republic of Croatia has decided to establish such integral system which includes the civil hospital care and the civil specialistic out-patient care, while the primary and specific health care are in the organization of the army. This system is less expensive than the full army health system, but is of better quality and includes an easy approach to all health institutions.


[Symptomatic effect of epomediol in patients with cholestasis of pregnancy]. Epomediol is a terpenoid that prevents and reverses cholestasis induced by ethinylestradiol in the rat, apparently by improving liver cell membrane fluidity. Assuming that the pathogenesis of intrahepatic cholestasis of pregnancy (ICP) is related with increased estrogen levels, we studied the effects of epomediol in this disease. Patients hospitalized due to ICP received epomediol 900 mg/day (n = 7), or 1,200 mg/day (n = 4) orally, during 15 days. Biochemical parameters of liver dysfunction (serum bilirubin, bile salts, aminotransferase, alkaline phosphatases) were not modified during nor after epomediol administration. The severity of pruritus was significantly reduced in comparison to pretreatment status, with both doses of epomediol. A greater amelioration of pruritus was observed in patients treated with epomediol 1,200 mg/day than in patients who received 900 mg/day (to 20.7 +/- 6.2, as percent of pre-treatment severity score, versus 48.8 +/- 7.5 respectively; p < 0.05). After epomediol administration was stopped, pruritus relapsed in 6 patients; 3 of them had received the higher drug dose. After delivery, pruritus vanished and liver function tests returned to normal, in all patients. No adverse effects attributable to the drug were observed in the mothers or in their babies. The beneficial effect of epomediol on pruritus in patients with ICP appeared greater in this study than that observed recently in similar patients who received a placebo.


[Risk of chronic oral anticoagulant treatment in elderly patients]. To assess age-related risks of long term anticoagulation, the records of 348 patients followed up at our university hospital outpatient anticoagulation clinic during a seven year period were reviewed. There were 129 patients, under 56 years of age, 144 from 56 to 69 and 75 over 70 years old. The total observation period was 1089 patient-years (3.3 yrs per pt). 64% of the patients had adequate anticoagulation level (prothrombin time < 35%, INR 2.2-4.5) 70 to 100% of the observation period. Prothrombin time was slightly, but significantly higher in the elderly group. During this period 21 patients developed major bleeding complications (1.84/100 pt yrs), 8 of them with fatal intracranial hemorrhages, and 20 embolic complications (1.93/100 pt yrs), 3 of them fatal. No significant differences in the incidence of both bleeding and embolic complications were observed in the three groups. The results of this retrospective follow-up study suggest that long term anticoagulation can be carried out in elderly pts with risk of hemorrhagic and embolic complications similar to those observed in the general population.


[Renal oncocytoma: 4 cases].

[Renal oncocytoma: 4 cases]. Oncocytomas are tumors characterized by cells with an eosinophilic cytoplasm. Renal oncocytomas were described in 1942. Among 46 consecutive patients operated on for renal tumors, oncocytomas were found in 4 (8.7%). In spite of a supposedly benign nature, renal oncocytoma cannot be adequately differentiated from renal adenocarcinoma by imaging techniques. Therefore, we recommend radical surgery as the treatment of choice in these patients.


[Primary hyperparathyroidism caused by a mediastinal adenoma with intermittent hypercalcemia and severe bone disease]. We report the case of a 33-year-old woman who was operated on with the diagnosis of primary hyperparathyroidism (PHP) in 1986. She had bone disease and slight hypercalcemia. Two parathyroid glands were removed with a lack of clinical improvement. Subsequently, the serum calcium levels were normal with occasional slight increases. Depressed phosphorus values and elevated alkaline phosphatases and PTH levels were also present, associated with severe bone involvement and muscular weakness. A second cervical exploration performed in 1989 disclosed only a normal parathyroid gland, which was not removed. In 1990, a thoracic CT scan showed the presence of a 1 cm mediastinal nodule close to the great vessels. A thoracotomy was performed to remove this nodule, which proved to be a parathyroid adenoma. After surgery, the patient presented with a "hungry bone" syndrome, characterized by very low levels of calcium, phosphorus and magnesium, which required enteral and parenteral calcium and magnesium supplements, plus dihydroxyvitamin D. The association of normocalcemia and intermittent hypercalcemia with severe bone disease is very rare, as is the presence of a mediastinal adenoma. This could explain the difficulty in the diagnosis in this case.


[Can we improve primary adult medical care?]. In Chile, primary medical care of adult patients is delivered mostly by young physicians, who work with little or insufficient interaction with their referral centers and with the main teaching hospitals. These physicians have no defined expectancies of a professional career in the field of primary care and they generally recent the lack of a programmed post-graduate education. After 3 to 5 years as general practitioners, some of them may have access to a formal teaching program to become specialists in internal medicine but, as in many other countries, it usually becomes a transit stage leading them to a subspecialty. This position paper adopted most of the proposals raised in a recent meeting, with the participation of universities, scientific and medical organizations, and the Ministry of Health, and modifies some of them. Because financial limitations may hinder the possibility of residency training programs in primary care internal medicine (as established in the USA), primary care of adults is proposed to be organized as a basic medical specialty, with formal teaching activities designed, delivered or supervised by the universities and medical scientific societies, and given as "credits" to be taken along 3 to 5 years. Simultaneously, outpatient care facilities should be improved, in the hospitals and in community units, allowing them to be used in under-graduate and post-graduate teaching programs. General practitioners, focused in adult patients, would receive a new professional status with the stimulus of a specific program of continuing medical education.


[Measles in Chile: a dangerous upsurge]. The monthly incidence of measles in Chile from 1964 to 1991 was analyzed using time series and Fourier's analysis. Epidemic levels are reached at periods of approximately 4 years. Accordingly, a new epidemic may be expected in mid 1992, with a total of approximately 40,000 cases.


[Seroepidemiologic study of measles in 2 populations of children under 10 years of age from the metropolitan area]. Measles antibodies were investigated by direct immunofluorescence in 274 samples from infants and 245 samples of children from 1 to 10 years of age. Antibodies were present in 74% of children under 3 months of age, decreasing to 42% at age 11 months. Positive results were obtained in 60% of children from 1 to 4 years of age, decreasing to 47% from 5 to 10 years of age. Overall, infants had 64% positive tests and children 54%. Accordingly, a greater susceptibility to infection by measles is found in infants above 3 months of age and children from 5 to 10 years of age.


Stimulatory and inhibitory effects of bile salts on rat pancreatic secretion. The effects of various species of bile salts (chenodeoxycholate, deoxycholate, ursodeoxycholate and cholate, and their taurine and glycine conjugates) on pancreatic exocrine secretion were studied in conscious rats with external bile and pancreatic fistulae. For examination of the stimulatory effects of bile salts, bile and pancreatic juice were collected for a basal period of 90 minutes and returned to the intestine, and then solutions of bile salts (60 mmol/L) were infused intraduodenally at a rate of 1 mL/h for 2 hours. For examination of their inhibitory effects, pancreatic secretion was stimulated by exclusion of the bile and pancreatic juice; and then solutions of the bile salts were again infused intraduodenally. Chenodeoxycholate, glycochenodeoxycholate, ursodeoxycholate, deoxycholate, and its conjugates (glycodeoxycholate and taurodeoxycholate) significantly increased the fluid, bicarbonate and protein outputs, and bicarbonate concentration, with decrease in protein concentration. These increases were partially inhibited by infusion of either a cholecystokinin antagonist or secretin antibody. In contrast, cholate, taurocholate, tauroursodeoxycholate, glycoursodeoxycholate, and taurochenodeoxycholate inhibited pancreatic secretion and increase in the plasma cholecystokinin concentration produced by exclusion of bile and pancreatic juice. Thus, some bile salts, including taurocholate and taurochenodeoxycholate (major bile salts in rat bile) inhibited pancreatic secretion and cholecystokinin release, whereas some other bile salts increased pancreatic secretion via cholecystokinin release and secretin release.


Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. A prospective study was performed to verify whether early administration of prednisone could be useful in preventing the development of nephropathy in anaphylactoid purpura. Only patients without signs of nephropathy upon initial presentation entered into the study. A total of 84 patients received delta-prednisone (1 mg/kg per day per os for 2 weeks), and 84 patients did not receive steroids. The patients were followed for 24-36 months. None of the 84 patients treated with steroids and 10 (11.9%) of the 84 control patients developed nephropathy 2-6 weeks after the acute episode. In 2 other patients of the untreated group, signs of renal involvement appeared 2 and 6 years after the acute episode respectively. The difference in the prevalence of nephropathy between the two groups is highly significant (P less than 0.001).


Pregnancy-related mortality in New Jersey, 1975 to 1989. National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women.


A national survey on the practice patterns of anesthesiologist intensivists in the use of muscle relaxants. To determine the practice patterns of anesthesiologist intensivists (with the special certificate of competence in critical care medicine from the American Board of Anesthesiology) in the use of neuromuscular blocking drugs, in the ICU setting. A survey. All anesthesiologists with the special certificate of competence in critical care (n = 374) were selected for this study. Of the 339 who could be contacted and who were still actively practicing, 185 (55%) completed the survey. In the ICU setting, anesthesiologist intensivists most commonly used vecuronium (52%) administered by bolus injection, bolus injection followed by infusion, or by continuous infusion. The most frequent indication for muscle relaxation was facilitation of mechanical ventilation (89%). Neuromuscular blockade was most commonly monitored clinically (55%), with only 34% of respondents using a peripheral nerve stimulator. All respondents indicated the concomitant use of sedatives or narcotics with muscle relaxants. This study was created to address the dearth of information regarding actual usage of muscle relaxants in the ICU setting. The survey population was chosen as one with great familiarity in the use of muscle relaxants. The 55% response rate was significantly greater than the expected response rate for a single mailing survey. In the ICU setting, neuromuscular blocking drugs are most frequently used to facilitate mechanical ventilation. The prevalence of vecuronium use is of interest in light of recent case reports of prolonged neuromuscular blockade after long-term vecuronium administration. The low frequency of peripheral nerve stimulator monitoring during muscle relaxation may contribute, in part, to the problem of prolonged blockade after drug withdrawal. Muscle relaxants are not used in the absence of sedation and/or analgesia by this practitioner population.


Age-related differences in volumes of subcortical nuclei, brain matter, and cerebrospinal fluid in healthy men as measured with magnetic resonance imaging. Magnetic resonance imaging was used to determine the volumes of brain, subcortical gray matter nuclei, and the ventricular and sulcal cerebrospinal fluid in 27 healthy men. Subjects were divided into young (less than 35 years, n = 10) and old (greater than 60 years, n = 17) groups. Volumes were normalized as percent intracranial volume. Older subjects had significantly less brain mass and significantly larger ventricular and peripheral cerebrospinal fluid volumes than the younger men. The caudate and lenticular nuclei were significantly smaller in older than younger men. This significant difference remained when their volumes were expressed as a ratio of cerebral brain matter volume. This cross-sectional study demonstrates age-related atrophy and concurrent dilation of cerebrospinal fluid spaces in healthy subjects. Of brain regions affected, the caudate and lenticular nuclei are significantly more affected by healthy aging than is cerebral brain matter; this may account for some of the motor abnormalities in aging.


Three cases of primary cerebral lymphoma in AIDS patients: detection of Epstein-Barr virus by in situ hybridization and Southern blot technique. Three cases of primary cerebral lymphoma in acquired immunodeficiency syndrome were studied. Tumoral fragments taken at autopsy were frozen and studied by the Southern blot technique (SBT). Other tumoral fragments were fixed in formalin, embedded in paraffin and used for in situ hybridization (ISH) with biotinylated probes for DNA of Epstein-Barr virus (EBV). ISH was positive in each case with a spotty nuclear labelling of certain tumoral cells. SBT evidenced a clonal rearrangement of the immunoglobulin heavy chain gene in each case. In addition, EBV DNA was detected in each frozen fragment with only one restriction pattern, indicating that the EBV- infected cell population was a clonal expansion of a progenitor cell.


A new family of heparin binding growth/differentiation factors: differential expression of the midkine (MK) and HB-GAM genes during mouse development. MK (midkine) and HB-GAM (heparin-binding growth-associated molecule) constitute a new family of heparin-binding growth differentiation factors. The modes of expression of MK and HB-GAM during mouse development were quantitatively examined by mRNA hybridization. The following three distinct patterns of expression were observed in the brain/head region. On the 11th-13th days of gestation, MK was intensely, but HB-GAM relatively weakly expressed; on the 15th-19th days, both MK and HB-GAM expression became weaker; and in the neonatal period, HB-GAM was intensely expressed and MK expression increased slightly. The level of HB-GAM expression was lower than that of MK in the whole embryo on the 11th to 13th days of gestation. HB-GAM mRNA was detected in the kidney of newborn and young mice, where MK was more highly expressed. The identity of the weakly expressed MK and HB-GAM signals was confirmed by means of the polymerase chain reaction in the neonatal brain (MK), the head of 13-day embryos (HB-GAM), and the kidney of 7-day-old mice (HB-GAM). In conclusion, MK and HB-GAM are frequently co-expressed in the same cells and anatomic regions of the fetus or new born mouse, while their modes of expression differ.


Accidental total spinal block: a complication of an epidural test dose. A case is presented of a 36-yr-old parturient who developed a total spinal block after an epidural test dose. After placement of an epidural catheter and confirming negative aspiration for blood or CSF, 3 ml lidocaine 1.5% (45 mg), with 1:200,000 epinephrine (15 micrograms) was injected via the catheter over 30 sec. Within two minutes the patient developed hypotension and extensive sensory and motor block including respiratory paralysis and aphonia. She remained fully conscious and alert and spontaneous respiration recommenced in five minutes. A live healthy infant was delivered by emergency Caesarean section shortly afterwards under general anaesthesia and the mother recovered completely without any untoward sequelae.


Three years' continuous low-dose interferon-alpha treatment of hairy-cell leukaemia: evaluation of response and maintenance dose. Thirty-six HCL patients were treated with 2 x 10(6) U/m2 IFN-alpha-2b three times weekly for 24 months, followed by 12 months of treatment with one of three doses ranging from 0.5 x 10(6) U to 2 x 10(6) U/m2. For most patients the response continued to improve during the whole treatment period, and there were no cases of disease progression during treatment. Patients with disease of short duration before IFN treatment and/or non-splenectomized patients seemed to respond more slowly than others, but there were no differences between patients treated with the different IFN doses. Toxicity was usually WHO grade 1 or 2. The continued improvement in a large number of patients even with very small IFN doses might indicate that only a small number of true complete responses are reached after 24 months of treatment, thus explaining the reported high relapse rate after early discontinuation of treatment. It therefore seems worthwhile--also from a cost/benefit point of view--to test long-term or continuous IFN-alpha treatment at other centres.


Combined effects of a thymic peptide, thymopoietin and myasthenic patient sera in rat myotube culture. We investigated in a rat myotube assay the combined effect of 26 myasthenic (MG) patient sera and a thymic peptide, thymopoietin (Tpo) which had previously been shown to bind Torpedo and human AChR and to compete with alpha-bungarotoxin (alpha-Bgt) binding. Cultures were first exposed to Tpo alone for 3 h (0.3, 7.5, 15 nM), then MG sera (5% final dilution) were added for an additional 18 h. Reduction in the amount of 125I-alpha-Bgt binding sites in the presence of various concentrations of Tpo were similar with control sera and in all the patients with low or undetectable anti-AChR Ab (11 cases). In cultures exposed to Tpo and sera with high anti-AChR Ab titre (15 cases), Tpo and anti-AChR Ab have an additive capacity to reduce the number of alpha-Bgt binding sites. The results are compatible with the hypothesis that anti-AChR Ab and Tpo could impair neuromuscular transmission by complementary mechanisms.


In situ localization of interleukin-6 in normal skin and atrophic cutaneous disease. Interleukin-6 (IL-6) is a multifunctional cytokine that participates in the inflammatory and immune responses. In human skin, keratinocytes produces IL-6, although the in vivo role of this cytokine is unknown. In the present study we investigated the in situ localization of IL-6 in normal epidermis (n = 10) and in a group of skin diseases characterized by epidermal atrophy. Formalin-fixed paraffin-embedded skin biopsies from patients with clinical and histopathological features consistent with localized scleroderma (n = 10), systemic scleroderma (n = 5), lichen sclerosus et atrophicus (n = 9) and balanitis xerotica obliterans (n = 7) were tested using polyclonal antibodies and avidin-biotin-peroxidase immunostaining. We demonstrated the presence of IL-6 in normal epidermis and in atrophic skin diseases. In normal skin there was moderate intercellular and intracellular reactivity detected using a high antibody concentration. In specimens with epidermal atrophy we detected intense cytoplasmic and intercellular immunostaining using a lower antibody concentration. The immunoreactivity was independent of the epidermal thickness. Plasma IL-6, measured by radioimmunoassay, was not elevated in plasma from patients with localized or systemic scleroderma. Increased IL-6 in the epidermis of selected skin diseases suggests that IL-6 may be related to the pathophysiology of dermatologic diseases characterized by epidermal atrophy.


Malignant otitis externa: the therapeutic evolution of a lethal infection. Malignant otitis externa (MOE) is a potentially fatal infection of the external auditory canal caused by Pseudomonas aeruginosa in a majority of cases. Treatment of MOE has changed over the years. Surgical debridement of all infected tissue is no longer considered the treatment of choice and has been replaced by localized surgical debridement supplemented with long-term antimicrobial chemotherapy. The recent availability of the fluoroquinolones and in particular ciprofloxacin has opened up new therapeutic opportunities.


Lineage switch macrophages can present antigen. Recent reports of "lineage switching" from a lymphoid to macrophage phenotype have left unresolved the question of whether such cells are functional macrophages or nonfunctional products of differentiation gone awry. This study demonstrates that several "macrophage-like" cell lines derived from v-Ha-ras-transformed pre-B cells have gained the capacity to effectively present antigen in MHC-restricted fashion. Using an assay involving the cocultivation of putative antigen-presenting cells with chicken ovalbumin (cOVA) and a cOVA-specific T-cell hybridoma, "lineage switch" cell lines were found to present antigen as effectively as macrophage-containing peritoneal exudates. Neither the original pre-B-cell precursors nor B-cell lymphomas derived from them present antigen. Thus, we have demonstrated that these "lineage switch" macrophages are capable of antigen presentation, a mature differentiated function. While gaining macrophage characteristics, these cells have also rearranged their kappa light-chain immunoglobulin locus, suggesting that macrophage differentiation and immunoglobulin rearrangement are not mutually exclusive processes. The existence of both lymphoid and myeloid characteristics in a cell fully capable of antigen presentation suggests greater plasticity in hematopoietic lineage commitment than conventionally thought to be the case.


A new marker on chicken hematopoietic cells is defined by a monoclonal antibody raised against a V beta chain of the human TCR. In this paper, we show that a mouse monoclonal antibody, 111-427, specific for the V beta 5.3 chain of the human T-cell receptor (TCR) for antigen, also reacts with chicken hematopoietic cells. Our data indicate that the majority of 111-427 positive cells among peripheral blood leucocytes (PBL) are thrombocytes. This antibody also recognizes two in vitro cell lines, III-C5, and IL-2-dependent T-cell line and HD11, a macrophage cell line. In addition, erythrocytes and a minor subpopulation of thymus and spleen cells are also stained by the monoclonal antibody (mAb). No specific immunoprecipitation could be detected from 125I radiolabeled cell lysates. By Western blotting techniques, the 111-427 mAb identifies a single band of apparent molecular weight 91 kD, unaffected by reduction, from III-C5 and HD11 cell lysates. This band is absent in negative cell control lysates. On thrombocytes, the apparent molecular weight of the band is shifted to 87 kD. These results indicate that the mAb does not recognize the chicken T-cell receptor for antigen, but a cell surface marker shared primarily between thrombocytes and erythrocytes. This new chicken cell marker is compared to other cell surface markers in avian or mammalian species that present some analogies in their tissue distribution.


Fusion of a scid pre-B cells with a wild type (myeloma) B cell results in correct rearrangement of a V(D)J recombination substrate. Mice with the scid mutation have a defect in the V(D)J recombinase. In order to determine whether the SCID product is normally present in mature B cells that do not have the recombinase activity, scid pre-B cells were fused with myeloma cells. It was found that in the hybrid cells, a rearrangement test gene was correctly joined immediately after fusion. The same test gene was aberrantly rearranged in the scid pre-B cells. Stable hybrids between the scid pre-B and the myeloma cells had lost the expression of RAG-1 and RAG-2 genes, supporting the previous finding of an inhibitor of rearrangement in myeloma cells that acts shortly after fusion. Thus, mature B cells apparently contain the SCID product, the wild type SCID function is not competitively interfered with by products present in scid pre-B cells, and the SCID product seems not to be a target for the recombinase inhibitor.


In vitro growth of thymic tumor cell lines from Xenopus. A spontaneous lymphoid thymus tumor was discovered in a male Xenopus of the MHC ff genotype. The tumor cell can be transplanted in histocompatible larval ff hosts, but not in ff adults unless irradiated (3000 rad). The tumor is rejected by allogeneic hosts. The tumor cells express neither markers of the B-cell lineage nor MHC encoded molecules; they express only markers of the T-cell lineage. Its lymphoid population is clonal as revealed by the existence of a stable rearrangement pattern of the immunoglobulin genes. Cell lines growing continuously in vitro have been derived from the tumor.


Self-reactivity and the expression of memory markers vary independently in MRL-Mp+/+ and MRL-Mp-lpr/lpr mice. MRL-Mp-lpr/lpr mice contain phenotypically abnormal populations of T cells, and exhibit an SLE-like autoimmune disease in which autoantibodies are a prominent feature. We analyzed the phenotype and T-cell receptor V beta expression pattern in CD4+ T cells of this mutant mouse strain to detect abnormalities that could explain the autoimmunity. The CD4+ T cells contain two distinct abnormal populations. One of these expresses B220 and HSA, and in these and other respects closely resembles the accumulating CD4-CD8- population. The other expresses a high level of CD44 (Pgp-1), and a high level of the 16A epitope of CD45, and so resembles post-activation T cells. Both of these cell types are exclusive to MRL-Mp-lpr/lpr. We also identified V beta 5- and V beta 11-positive CD4+ T cells, in both MRL-Mp-lpr/lpr and MRL-Mp-+/+ mice. We conclude that autoimmune T cells can be detected in these mice, but that they are not the cause of the accumulation of abnormal CD4+ and CD4-CD8- cells.


Expression of GATA-3 during lymphocyte differentiation and mouse embryogenesis. The GATA family of C4 zinc-finger transcription factors has been implicated in tissue-specific gene regulation in birds and mammals. One of the members of this family, GATA-3, is reportedly expressed specifically in the T-cell lineage, where it interacts with GATA motifs in the TCR-alpha, TCR-beta, and TCR-delta enhancers, thereby controlling the T-cell phenotype. To evaluate the differentiation control properties of GATA-3, we have now documented its expression pattern during lymphoid differentiation and murine embryogenesis. The onset of GATA-3 expression in the lymphoid lineage was studied in a panel of lymphoid (precursor) cell lines by Northern blot analysis. GATA-3 was uniquely expressed in T-lineage lymphocytes expressing TCR and CD3 genes; it was absent from TCR/CD3 mRNA-negative prothymocytes and from all B-lineage cells. In order to obtain information on the expression of GATA-3 outside the immune system, in situ hybridization was performed on mouse embryos on day 11.5-14.5 of gestation. GATA-3 mRNA was detected in fetal thymus and in erythroid cells. Outside the haemopoietic system, we detected GATA-3 mRNA throughout the central nervous system, in kidney, in the epidermis, lens fibers, the inner ear, whisker follicles, and in the primary palate. These data provide new clues about the potential role of GATA-3 during mouse development, and will aid the interpretation of currently ongoing gene knockout experiments.


Sequences of C mu and the VH1 family in LG7, a clonable strain of Xenopus, homozygous for the immunoglobulin loci. Twenty-eight heavy-chain variable (VH1) region genes and the immunoglobulin (IgM) heavy-chain constant region of an isogenic Xenopus hybrid, X. laevis/X. gilli, LG7, have been sequenced. The LG7 clone represents the first Xenopus hybrid that is homozygous for the IgH locus. The VH1 family was specifically investigated because VH1 genes are used by the antibodies produced during the Xenopus antidinitrophenol (DNP) response, These VH1 germ-line sequences establish a so-called "dictionary" that is available for studying somatic hypermutational mechanisms in immunized frogs.


Lack of peripherally induced tolerance to established skin allografts in immunologically reconstituted scid mice. The mechanism by which the antigen-specific immune system distinguishes between foreign antigens (toward which it mounts an immune response) and self-antigens (of which it is tolerant) is not completely understood. Studies using "superantigens" and transgenic mice have allowed investigations into some of the mechanisms of clonal deletion, anergy, and peripheral tolerance. In the present report, we have attempted to develop a new model system to investigate the possible mechanism(s) of peripheral tolerance to allografts. In this system, skin grafts from C57BL/6J (B6; H-2b) mice are grafted onto T- and B-lymphocyte-deficient C.B-17-scid/scid (H-2d; hereafter referred to as scid) mice. Because of their lack of functional lymphocytes, the scid mice readily accept the allogeneic skin grafts. After the allografts healed, the scid mice were reconstituted with T-cell-deficient fetal liver from coisogeneic C.B-17-+/+ mice or bone marrow from weanling congenitally athymic BALB/c-nu/nu (H-2d; hereafter referred to as nude) mice. Upon immunological reconstitution, the scid mice rejected the established B6 skin allografts, suggesting that an immune system developing in the presence of an intact peripheral skin allograft fails to develop tolerance to the peripheral allograft. This model system may be useful for the study of the mechanisms required for the induction of peripheral tolerance.