Volatile fatty acids, lactic acid, and pH in the stools of breast-fed and bottle-fed infants. We measured fecal pH, volatile fatty acids (VFA), and lactic acid concentrations in 67 healthy infants ranging in age from 1 to 5 months. The babies were divided into five groups according to their diet: group 1: human milk, with subgroups of 1 month of age (n = 8), and 2-5 months (n = 12); group 2: formula milk, with subgroups of 1 month of age (n = 9) and 2-5 months (n = 10); group 3: cow's milk, one group of 2-5 months of age (n = 12); group 4: human milk supplemented with formula milk, 2-5 months of age (n = 8); and group 5: human milk supplemented with cow's milk, 2-5 months of age (n = 8). Fecal VFA concentration and pH of bottle-fed infants (groups 2 and 3) were significantly higher and lactic acid concentrations significantly lower than those of the breast-fed group. Groups 4 and 5 showed significantly higher pH and propionic acid concentration, and lower lactic acid concentration than Group 1 did. There were no significant differences in the data on pH, VFA, and lactic acid concentrations between the feces of formula and cow's milk groups. On the other hand, the addition of formula or cow's milk to the human milk was sufficient to alter the profile of VFA, the pH, and the lactic acid concentration of breast-fed infants stools. Low pH, low VFA, and high lactic acid concentrations make the colonic content of breast-fed babies an environment favorable for Bifidobacteria growth, and this is probably the main protective factor against gastrointestinal infections.


Efficient assimilation of lactose carbon in premature infants. Previous studies have shown that there is minimal fecal excretion of carbohydrate energy in premature infants with high breath H2 concentrations, implying that the colon plays an important role in salvaging lactose energy. The present study extends this work by using a stable isotope method for serial assessment of lactose carbon excretion. Thus, in nine premature infants (30-32 weeks of gestation and 11-36 days of age), we conducted 23 longitudinal studies of breath hydrogen concentration and the cumulative fecal excretion of 13C derived from a single dose of [D-1-13C]lactose. The ranges of values (mean +/- SD) for breath hydrogen concentration and lactose absorption were respectively 4-440 ppm/5% CO2 (92 +/- 100) and 82-100% tracer dose (98.4 +/- 3.9). In 21 studies, lactose carbon excretion was less than 2% of the dose. There was a significant correlation between postnatal age and breath hydrogen concentration (R = 0.48; p = 0.02). These studies suggest that colonic fermentation activity is adequate for efficient colonic salvage of lactose even during the second week of life.


Developmental changes in lactase-phlorizin hydrolase precursor isoforms in the rat. The purpose of this study was to determine whether the developmental decline in lactase specific activity (mumol/min/g protein) in the rat was associated with (a) changes in the relative quantities of immunoisolated precursor and mature forms of the enzyme purified by SDS-PAGE and/or (b) immunohistologic changes in the jejunal mucosa. We studied 10- and 16-day-old suckling rat pups, 22-day-old weaned rat pups, and adult female rats (nongravid, pregnant, and lactating). Lactase activity was three- to fourfold higher in 10-day-old pups than in adult rats. Lactase activity was 27% greater in lactating compared with nongravid or pregnant rats. Three molecular forms of the enzyme that migrated identically in all animals were observed on SDS-polyacrylamide gels stained with Coomassie blue: 140-kDa (mature brush border form), 200-kDa, and 220-kDa (apparent precursor forms). There was a striking difference in the proportions of the three polypeptides at different ages that was unrelated to animal status, i.e., pregnant or lactating. As the animals aged, the relative amount of the 140-kDa band declined from 86 +/- 1.1% of the total immunoprecipitated lactase in 10-day old suckling pups to 68 +/- 0.7% in adults. Simultaneously, the relative concentration of the 200-kDa band rose from 1.7 +/- 0.4% in the 10-day-old to 19 +/- 0.6% in adults. The relative concentration of the 220-kDa polypeptide did not change as a function of age.(ABSTRACT TRUNCATED AT 250 WORDS)


Iron absorption and incorporation into red blood cells by very low birth weight infants: studies with the stable isotope 58Fe. Measurements of iron absorption and incorporation into RBCs were obtained with the stable isotope 58Fe, administered as a reference dose, in 11 premature infants with birth weights between 780 and 1,520 g and gestational ages between 24 and 33 weeks. Each study included a timed stool and urine collection, nasogastric tube administration of a single dose of about 228 micrograms of 58Fe/kg of body weight (as FeSO4, with 10 mg/kg of vitamin C) between feedings, and blood samples before 58Fe (day 1) and then 2 weeks (day 15) later. Gastrointestinal absorption of the 58Fe dose as measured by fecal isotope balance was 41.6 +/- 17.6% (mean +/- SD). However, only 12.0 +/- 9.6% of the 58Fe dose (28.7 +/- 22.3% of the absorbed 58Fe dose) was incorporated into RBCs on day 15. 58Fe absorption and 58Fe incorporation into RBCs on day 15 were significantly correlated with the hemoglobin concentration and reticulocyte count on day 1. Transfusion history did not affect 58Fe absorption or 58Fe incorporation into RBCs. We conclude that concurrent measurement of 58Fe absorption with fecal monitoring and of 58Fe incorporation into RBCs permits a better understanding of the fate of iron ingested by premature infants than either measurement alone.


Surfactant-like material in the antral gastric mucosa of children. It has been proposed that the hydrophobicity of the gastric mucosa is due to surfactant-like material (SLM), mainly composed of phospholipid, adsorbed to the mucosal surface. Biochemical and physiological studies have been performed in different mammals but morphological data on children are lacking. In the present work, the presence of SLM on the antral gastric mucosa of children has been studied by electron microscopy. The results demonstrate that SLM is present and shows two different forms, lamellar bodies and lamellar layers. In the mucosae without endoscopic, histologic, and ultrastructural alterations we have found SLM when the tannic acid method has been used but not when the tissue has been fixed only in glutaraldehyde. Our results suggest that in children with ultrastructural alterations of the epithelium, the amount of gastric SLM is increased in respect to children with a normal mucosa and that the amount of SLM on the surface of the gastric antral mucosa is modified in pathologic conditions.


Low bone mineral content in summer-born compared with winter-born infants. Possible seasonal differences in newborn bone mineral content (BMC) have not been studied. Adult studies show seasonal variations with lower BMC in winter versus summer. Assuming that BMC variations may relate in part to vitamin D status, we hypothesized that newborn BMC would be lower in winter than summer. BMC of one third distal radius was measured in 55 healthy term newborns using a single beam photon absorptiometer [coefficient of variation (CV) for phantom standard 2.1%]. Infants were enrolled during summer (July-September, 1988) and winter (January-March, 1989) for a longitudinal nutrition study. Contrary to our hypothesis, there was a 12% lower BMC in summer versus winter (mean +/- SD 75.94 +/- 17.42 vs. 86.55 +/- 17.54 mg/cm, respectively; p = 0.035). The difference remained significant after controlling for possible race and gender effects (p = 0.02). We conclude that BMC is lower in summer- compared with winter-born infants. Since any seasonal effects on fetal bone are presumably related to effects through the mother, we speculate that if maternal vitamin D status influences fetal bone mineralization, the effect (possible sunshine deprivation in winter) may operate especially in early pregnancy, thus resulting in lower BMC, evident at birth in summer.


Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhoea and persistent diarrhoea syndrome. Zinc has been shown to enhance intestinal mucosal repair in patients suffering from acrodermatitis enteropathica; but the impact on mucosal integrity during acute (AD) or persistent (PD) diarrhoea is unknown. One hundred eleven children with AD and 190 with PD aged between 3 and 24 months received, randomly and blind to the investigators, either an elemental zinc supplement of 5 mg/kg body wt/day or placebo in multivitamin syrup for 2 weeks while intestinal permeability and, biochemical and anthropometric markers were serially monitored. The permeability test was administered as an oral dose of 5 g lactulose/l g mannitol in a 20-ml solution followed by a 5-h urine collection. The ratio of the urinary probe sugars was correlated to clinical, biochemical, and microbiological parameters. At presentation, lactulose excretion was increased and mannitol excretion decreased in both AD and PD as compared with age-matched asymptomatic children. The lactulose/mannitol ratio (L/M) was higher in subjects with mucosal invasive pathogens (rotavirus and enteropathogenic Escherichia coli) compared with children excreting Vibrio cholera and enterotoxigenic E. coli. Two-week zinc supplementation significantly reduced lactulose excretion in both AD and PD, whereas the change in mannitol excretion and L/M was similar between study groups in both studies. Changes in lactulose excretion were significantly influenced by zinc supplementation in children with E. coli, Shigella sp., and Campylobacter jejuni stool isolates. The greatest reduction in total lactulose excretion was seen in supplemented children who on presentation were lighter (wt/age less than 80%), thinner (wt/ht less than 85%), and undernourished [middle upper arm circumference (MUAC) less than 12.5 cm] or with hypozincaemia (less than 14 mumol/L).(ABSTRACT TRUNCATED AT 250 WORDS)


Gastric emptying using three different formulas in infants with gastroesophageal reflux. The role of delayed gastric emptying (GE) in the pathogenesis of gastroesophageal reflux (GER) in infants is controversial at present. GE has been shown to be altered by the composition and osmolality of the feedings. This prospective study was undertaken to assess the changes in the GE and the percentage of time GER was detected by scintigraphy using three different formulas on consecutive days in infants with GER. Twenty-eight infants under 1 year of age diagnosed to have GER by extended intraesophageal pH monitoring (pH being less than 4.0 for greater than 5% of the duration of the test), underwent scintigraphy on three consecutive days using the same volume per single feeding of a casein-predominant, soy, or a whey-hydrolysate formula in a randomized order. The formulas were isocaloric. Gastric emptying and percentage of GER into the esophagus were estimated for 60 min following these feedings. Mean GER percent during the study was 20.39, 17.68, and 16.34 on casein-predominant, soy, and whey-hydrolysate formulas, respectively, and was not significantly different. Mean values of GE were 39.7%, 44.6%, and 48.5% on casein, soy, and whey formula, respectively. No significant difference in GE was also observed between casein-predominant and soy formula. However, a significant difference was observed (p less than 0.05) on GE between casein-predominant and whey-hydrolysate feedings. Our data suggest that formula selection may be important in the treatment of conditions associated with delayed gastric emptying.


ELISA method for quantitative measurement of IgA and IgG specific anti-gliadin antibodies. In this study we describe the application of an enzyme-linked immunosorbent assay (ELISA) for the measurement of anti-alpha-gliadin antibodies (AGA) in absolute units (microgram protein/ml). Enriched samples of IgA and IgG AGA were obtained by means of protein A chromatography after immunoaffinity purification of pooled sera from untreated celiac patients. No cross-reactivity with other food antigens (beta-lactalbumin, soya proteins, ovalbumin) was detected. The quantitative evaluation of protein content in IgA and IgG AGA samples obtained by immunoaffinity chromatography, was performed by means of ELISA sandwich method using a reference curve obtained with pure standard human immunoglobulins. Scalar concentrations of purified IgA and IgG were then used to obtain a reference standard curve by means of an ELISA method. Such standard curve was utilized for titrating AGA in 214 sample sera. The minimal detectable concentration of IgA and IgG AGA was 0.02 micrograms/ml. The reproducibility of within- and between-assay resulted very good for IgA-AGA and acceptable for IgG-AGA. The method here described seems to be satisfactory not only for quantitative diagnostic purposes in routine screenings but also in epidemiological studies. Moreover, it can constitute a suitable way to solve practical problems of quality control of AGA ELISA assay.


Postnatal development of liver and exocrine pancreas in polycythemic newborn infants. In 35 newborn infants appropriate for gestational age the influence of neonatal polycythemia (venous hematocrit greater than 60% measured between the second and fourth hour of life) on development of enterohepatic circulation of bile acids, activities of pancreatic enzymes in duodenal juice, and the effects of hemodilution were studied during the second week of life. A significant correlation was found between the initial hematocrit and both the bile acid concentration in serum and lipase and trypsin activity in duodenal juice. Of 35 infants, 10 were not treated with hemodilution due to asymptomatic polycythemia; they had the highest concentration of serum bile acids associated with the lowest lipase and trypsin activity in duodenal juice. However, the 25 infants treated with hemodilution also showed serum bile acid concentrations and lipase and trypsin activity in duodenal juice out of the normal range when compared to normocythemic infants. These data indicate that, during the first days of life, polycythemia results in a delayed postnatal development of enterohepatic circulation of bile acids and exocrine pancreas functions independently from the occurrence of clinical symptoms. Thus, it can be concluded that, on the first day of life, all polycythemic infants should be treated with hemodilution. Moreover, the nutritional management of these infants must also account for the limited functional capacity of the gastrointestinal tract.


Theory-driven research in pediatric psychology: a little bit on why and how. Introduces a Special Issue, covering two published issues (5 and 6) of this journal, on theory-driven research in pediatric psychology. A rationale for conducting research from a conceptual basis is presented. It is emphasized that science is primarily an intellectual activity, demonstrated in the form of theory building, testing, and reformulation. Furthermore, it is argued theory serves as a planning and communication aide for scientific pursuit. The process and components of theory-driven research are then highlighted. Theoretical constructs, theoretical and empirical definitions of constructs, and the use of variables are discussed. A definition of scientific theory is offered. Theory testing is distinguished from post hoc theorizing. Differences in the scope of theories are noted. Connections between theory and hypothesis testing and research design are addressed, especially for nonexperimental or correlational research.


A longitudinal analysis of adherence and health status in childhood diabetes. Applied structural equation modeling to a longitudinal data set of 193 youngsters with insulin-dependent diabetes mellitus assessed on two occasions, an average of 1.65 years apart. Six adherence constructs, Injection, Exercise, Diet Type, Testing-Eating Frequency, Calories Consumed, and Concentrated Sweets, were quantified from 24-hr recall interviews conducted with mother and child. Glycemic control was indexed by glycosylated hemoglobin (HA1C); lipid metabolism was indexed by fasting triglyceride levels (TRIG). The relationship of each adherence construct to metabolic control was tested separately. Patient age and disease duration served as exogenous variables in all models. Testing-Eating Frequency was associated with HA1C and Injection was associated with TRIG; in both cases better adherence was associated with better metabolic control. However, the standardized regression weights and variance accounted for were small. Patient age was a predictor of both adherence and metabolic control; older youngsters were less adherent and were in worse metabolic control. Inspection of models for younger versus older children suggested that age-homogeneous models improved prediction, but adherence and metabolic control linkages remained weak. Suggestions for refining the model are provided.


Comparing social learning and family systems correlates of adaptation in youths with IDDM. Evaluated social learning and family systems theoretical models to determine (a) whether illness-specific family relations (based on social learning theory) and general family behaviors (based on family systems theory) relate uniquely to the youths' illness-specific and psychosocial adaptation, and (b) whether these types of family relations covary or whether they represent distinct aspects of family functioning. Participants included 95 youths with insulin-dependent diabetes mellitus (IDDM) and their parents. Positive and supportive family relations (illness-specific family support, general family affection, general family adaptability) as well as conflictual and nonsupportive relations (i.e., illness-specific family nonsupport, general family conflict) were assessed. Results suggest that both illness-specific and general family relations uniquely predict the youths' dietary adherence and general psychosocial adaptation. Because illness-specific and general family relations also covary, broad-based models that include both types of family functioning seem warranted.


Stress, coping, and family functioning in the psychological adjustment of mothers of children and adolescents with cystic fibrosis. Assessed the role of illness parameters, demographic parameters, and hypothesized psychosocial/mediational processes in the psychological adjustment of 68 mothers of children and adolescents (7-17 years of age) with cystic fibrosis. Together the illness and demographic parameters accounted for only 13-15% of the variance in maternal adjustment. However, the hypothesized mediational processes accounted for 35-40% increment in the variance in maternal adjustment. More specifically, maternal adjustment was associated with lower levels of perceived daily stress, less use of palliative coping methods, and family functioning characterized by high levels of supportiveness.


Stress, appraisal, and coping in mothers of disabled and nondisabled children. The cognitive-behavioral model of stress and coping provided the framework for this study of mothers of physically disabled children (n = 69) and mothers of nondisabled children (n = 63). The first aim was to test for differences between groups in responses to stressful parenting events. As hypothesized, mothers of disabled children reported higher levels of depressive symptomatology. Differences in psychological distress and health status approached significance. The second aim was to explore the mediating influences of coping strategies and cognitive appraisals. As predicted, emotion-focused coping was related to increased psychological distress in mothers of disabled children whereas problem-focused coping was associated with decreased distress. Both relationships were significant even after controlling for differences in type of parenting stressor. Hierarchical regressions showed that 58 and 25% of the variance in psychological distress was explained by the independent variables; however, the predictors were different for the two groups of mothers. Factors that may explain the differential effectiveness of coping and appraisal, and clinical implications of this study are discussed.


Social class and parenting children with mild and moderate mental retardation. Based on Kohn's (1977) and Gecas' (1979) theories of social class and parenting values, the role of socioeconomic status (SES) as a determinant of parenting attitudes and behaviors and as a moderator of problems associated with raising children with handicaps was evaluated among 171 families raising a child with mild or moderate mental retardation. Self-report measures assessed mothers' and fathers' attitudes regarding control, independence, and closeness within the family, and parental and family problems. Supportive, aversive, and controlling parent-child interactions were observed in the home. As expected, higher SES was associated with parental attitudes and behaviors related to fostering independent initiative in the family, and lower SES parents exhibited relatively more controlling and negative behaviors. However, regardless of SES, controlling parental behaviors also were responsive to the level of functioning of the child with mental retardation. Consistent with an hypothesis about violations of SES-related values, negative and controlling interactions with the child were more highly correlated with the parents' reports of parental and family problems for upper SES as opposed to lower SES parents. Several models of SES and family adaptation are discussed.


Applying stigma theory to epilepsy: a test of a conceptual model. Tested a theoretical model that sought to explain the association of stigma to self-esteem among adolescents with epilepsy. The model depicted hypothesized relationships among several characteristics of epilepsy (seizure type, seizure frequency, and duration of epilepsy), perceived stigma, management of disclosure, and self-esteem. Subjects were 64 adolescents 12 to 20 years old with idiopathic epilepsy. In a hierarchical multiple regression analysis, variables were entered into the equation in the order specified a priori by the model. Results showed that the data supported some hypotheses tested in the model: (a) Seizure type and seizure frequency predicted low self-esteem, and (b) the belief that epilepsy is stigmatizing predicted low self-esteem. However, several relationships of major theoretical significance were not realized. Explanations for why some aspects of stigma theory were not supported by the data are offered.


Inhibitory effect of melanin on the interaction of Fonsecaea pedrosoi with mammalian cells in vitro. Conidial forms of Fonsecaea pedrosoi, grown under conditions where melanin was or was not synthesized, were allowed to interact with normal and cytochalasin treated macrophages. Melanin-free conidia were more infective to the macrophages. Treatment of macrophages with either cytochalasin B or D before the interaction decreased, but did not totally prevent their infection by the fungi. This inhibitory effect was higher (approximately 90%) if F. pedrosoi was grown under conditions where melanin was not synthesized. When melanin-containing conidia were used, the inhibitory effect of the cytochalasin on the infection was lower (approximately 50%). At least two mechanisms of infection of the host cell were observed: typical phagocytosis and another process in which the fungi played a more active role. Infection by F.pedrosoi was also observed in the non-professional phagocytic MDCK epithelial cell line. Two types of cytoplasmic vacuoles which contained parasites were seen in thin sections of host cells infected with F.pedrosoi: a 'tight' type and a 'loose' type. At least 200 conidia-containing vacuoles were analysed by transmission electron microscopy. The 'tight' type was observed in 75% of the vacuoles of non-treated macrophages, suggesting an association with classical phagocytosis. On the other hand, the 'loose' type vacuole was seen in 75% of the vacuoles present in cytochalasin treated macrophages and seemed to be related to induced phagocytosis or active penetration by the fungi.


Determination of plasma (1-->3)-beta-D-glucan: a new diagnostic aid to deep mycosis. We present additional evidence that plasma from patients with deep-seated mycoses contains (1-->3)-beta-D-glucan. Digestion of such samples with endo-(1-->3)-beta-D-glucanase completely abolished the ability of the plasma to activate factor-G, a horseshoe crab coagulation enzyme that is extremely sensitive to this polysaccharide. Measurement of plasma (1-->3)-beta-D-glucan is a promising method for the diagnosis of deep-seated mycoses and for monitoring the response of these infections to antifungal therapy.


Immunoblotting analysis of sera from patients with candidal vaginitis and healthy females. Antigenic components of Candida albicans were extracted from whole cells with a buffer containing SDS and 2-mercaptoethanol, and separated by SDS-polyacrylamide gel electrophoresis. The components reactive with IgG, IgA, IgM and IgE antibodies in sera from patients with (14 subjects) and without (15 subjects) C. albicans in the vagina, and from healthy females (34 subjects), were investigated by immunoblotting using immunoglobulin class-specific antibodies. Many components reacted with IgG and IgA in all sera tested; the major antigens that reacted strongly with the sera were 67, 62, 29 and 25 kDa components. Several components were observed which reacted with IgM in 63% of the sera; the 67, 62 and 25 kDa components that reacted with IgG and IgA also reacted with IgM. No components reacting with IgE were detected in any of the sera. No striking differences in antibody binding profiles to whole cell antigens were detected among the C. albicans positive and negative patients or the healthy subjects. On the other hand, IgG against extracellular proteinase was more frequently detected in the C. albicans positive patients than in the C. albicans negative group or the healthy subjects. This may suggest that vaginal infection with C. albicans contributes to a rise in anti-proteinase antibody levels.


Microsporum gypseum complex in man and animals. Twenty-eight strains of the Microsporum gypseum complex isolated from humans and animals were studied. The perfect form was found for 25 of the isolates. Nannizzia incurvata was the species most frequently involved in human pathology, while Nannizzia gypsea was most frequently found on animal lesions. Nannizzia fulva was rarely involved pathologically and Nannizzia corniculata was not isolated during this study. It is surprising to note that this species was not found even though most of our strains (22/28) came from Africa. Reliable methods are not available for differentiating among the anamorphs, which are commonly called M. gypseum, Microsporum fulvum or Microsporum boullardii. The Sabouraud medium conventionally used for medical mycology makes almost no distinction among them. We found that the species could be easily distinguished by colonial and microscopic features when grown on Takashio medium. When strains are atypical, sexual reproduction remains the reference technique but, in most cases, Takashio medium makes it possible to avoid this long drawn-out procedure.


Cryptococcal peritonitis in a CAPD patient. A 50-year-old diabetic woman with end-stage renal disease, who had been on continuous ambulatory peritoneal dialysis for 8 months, developed peritonitis caused by Cryptococcus neoformans var. neoformans. The patient was completely asymptomatic and infection was confirmed by detection of budding yeast cells in Gram-stained smears of turbid peritoneal fluid. The infection was cleared after intravenous fluconazole with delayed removal of the catheter. Fluconazole may be a suitable alternative drug in treating cryptococcal peritonitis.


Activation of human complement system in paracoccidioidomycosis. Plasma samples of 14 patients with paracoccidioidomycosis were analysed for components that represent activation of the complement system. Most patients (12/13) showed significant titres of complement-fixing antibodies and 14/14 had increased C4d/C4 ratios. There was no conclusive correlation between these two immunological indices, however. Factor B values of patients were similar to normal donors and fragment Ba was not detected in any of the patients. These results indicate a classical complement pathway activation in the plasma of patients with paracoccidioidomycosis.


A microfermentation test for the rapid identification of yeasts. The accuracy and speed of a microfermentation test (MFT), developed as a supplementary aid to other yeast identification systems, were compared with the conventional fermentation method in identifying 15 yeast species. The MFT significantly reduced the incubation period required to obtain a definitive identification. The method is easy to perform and the media and space requirements are minimal.


Re-evaluation of the synonymy between Keratinomyces ceretanicus and Trichophyton ajelloi. In 1987, Keratinomyces ceretanicus was reduced to synonymy with Trichophyton ajelloi based on mating between the putative ex-type culture, ATCC 58594, and minus mating strains of Arthroderma uncinatum. Although we confirm that ATCC 58594 produces fertile ascomata when mated with A. uncinatum, we demonstrate that this strain is not representative of the type of K. ceretanicus and conclude that K. ceretanicus should be maintained as a separate taxon.


Burns associated with the use of microwave ovens. This article reviews published reports of conventional and radiation burns associated with the use of microwave ovens. Conventional food burns can result from the ingestion of microwave heated food because consumers may overlook the differential temperature gradients within foods and between the food and the container. There are reports of accidental radiation injury associated with the use of microwave ovens, but they are difficult to evaluate because these reports lack definitive clinical data and verification of the actual radiation exposures. Only one study has provided useful insight into the clinical features of microwave radiation burns compared to conventional burns.


Endophthalmitis following pediatric intraocular surgery for congenital cataracts and congenital glaucoma. The incidence of endophthalmitis following pediatric anterior segment surgery is currently unknown. The paucity of reports of this entity has led some observers to recommend simultaneous bilateral surgery for congenital cataracts or glaucoma. In this study, we surveyed over 500 pediatric ophthalmologists and glaucoma specialists concerning their knowledge of, or involvement with, endophthalmitis following pediatric intraocular surgery. Seventeen cases of endophthalmitis were documented to occur out of 24,000 reported surgical cases. This results in an incidence estimate of 0.071%, or 7 cases per 10,000, which is similar to that recently reported following adult extracapsular cataract extraction. The presence of infection was diagnosed by the 3rd postoperative day in 82% of cases. An organism was documented by culture in 65% of cases. The organism was gram positive in all cases. Visual outcome was generally poor with 65% having no light perception. The presence of possible concurrent risk factors for postoperative endophthalmitis, including nasolacrimal duct obstruction and upper respiratory infection, was noted in 8 of the 17 cases.


Congenital double elevator palsy: vertical saccadic velocity utilizing the scleral search coil technique. Four patients with congenital double elevator palsy were studied who had clinically brisk elevation of the affected eye from downgaze to the midline position of rest, but severely limited or absent elevation above primary position. Forced duction tests were negative and Bell's phenomenon was present preoperatively in all patients. To clarify why upgaze saccades clinically seemed intact below but not above midline, vertical saccadic velocities were measured using the scleral search coil technique. The tracings of three cases suggest sufficient superior rectus function to generate a normal upward saccadic trajectory. A supranuclear lesion is the most likely etiology of the inability to elevate the eye well above primary position in these three patients. In a fourth patient, the reduced ability to elevate the affected eye above primary position is caused by a superior rectus paresis with decreased upward saccadic velocities. We suggest at least three distinct groups of patients present clinically as double elevator palsy: primary inferior rectus restriction, primary superior rectus paresis or palsy, and congenital supranuclear elevation deficiency.


Surgery in the prism adaptation study: accuracy and dose response. Prism Adaptation Study Research Group. Three hundred twenty-two patients underwent strabismus surgery for acquired esotropia according to a rigid protocol in the Prism Adaptation Study (PAS). This report describes the PAS surgical technique and the methods used to evaluate and assure adherence to the surgical protocol. We present analyses of the discrepancies between the amount of recession surgery planned by the surgeon and the amount of recession estimated by the masked graders from documentary photographs. In 74% of patients, the total discrepancy (combined from both medial rectus operations) was 1 mm or less. There was a distinct trend for masked graders to estimate larger recession amounts than were dictated by the protocol and claimed to be done by the surgeon. In 24% of patients, the masked graders estimated that the recession was more than 1 mm greater than that claimed by the surgeon, while in 2%, the graders estimated that the surgery was more than 1 mm less than planned. Of the 74 patients for whom the graders' estimated total recession was more than 1 mm greater than the amount planned by the surgeon, 88% were successful. Of the six patients for whom the graders' estimated total recession was more than 1 mm less than the amount planned by the surgeon, five (83%) were successful. We propose new surgical tables for patients with acquired esotropia. Enhanced amounts of recession appear to be necessary to decrease the rate of undercorrection for each group of patients.


A mydriatic eye-drop combination without systemic effects for premature infants: a prospective double-blind study. Eye drops used for diagnostic mydriasis may produce systemic side effects in preterm infants. Studies on the pupil dilating and systemic effect of various mydriatic agents yielded conflicting results. We conducted a prospective randomized double-blind study on the systemic effect of two mydriatic eye-drop combinations. Thirty-nine preterm infants were randomly assigned to two groups. An eye-drop combination of 2.5% phenylephrine and 0.5% tropicamide (group D) was compared with the combination of 0.5% cyclopentolate and 0.5% tropicamide (group F). Either eye-drop combination was followed by 0.5% tropicamide given 20 minutes later. Heart rate (HR) and the systolic, mean, and diastolic blood pressure (BP) were recorded before and after eye-drop instillation and after ophthalmoscopy. A control session with NaCl eye drops was added for each infant. A significant increase of BP and HR peak values was observed within 7 to 10 minutes after the cyclopentolate/tropicamide combination only. On the other hand, the mydriatic effect of the phenylephrine/tropicamide combination was significantly superior to that of the cyclopentolate/tropicamide combination. We recommend the combination of 2.5% phenylephrine and 0.5% tropicamide to achieve a sufficient diagnostic mydriasis without systemic side effects in preterm infants.


Hypertropia following trochlear trauma.

Hypertropia following trochlear trauma. Hypertropia following trauma to the trochlea is rare. The more widely recognized response of the trochlea to trauma is hypotropia or acquired Brown syndrome. We observed three cases of hypertropia following penetrating trauma to the trochlea. Each had computerized tomography and/or magnetic resonance imaging to assist in the understanding of the mechanism of the observed superior oblique dysfunction. The clinical course of these cases was variable. Awareness of the damaged trochlea's capacity to respond as a hypertropic as well as a hypotropic syndrome will allow for improved management of these unusual patients.


Intraoperative succinylcholine and the postoperative eye alignment. In 99 patients undergoing strabismus surgery, an intravenous bolus of succinylcholine (Sch) was given after completion of the strabismus procedure. Reliable data were obtained in 53 patients. The interlimbal distance measured at 60 seconds after injection (VR60) was compared to the interlimbal distance at 1 and 6 weeks postoperatively, to evaluate the correlation between the drug-induced eye position under anesthesia and the awake-eye alignment postoperatively. Correlations were highest in patients undergoing symmetric recessions of the medial or lateral recti in primary horizontal strabismus. Confidence intervals of 0.8 to 1.2 were noted for both the esotropia and exotropia groups. Two patients experienced Sch-related complications of masseter spasm and prolonged apnea. Although infrequent, the potential gravity of the complications from Sch use and the currently enjoyed high rate of success in primary strabismus surgery suggest that these formulas not be used clinically. Nonetheless, the high correlations between the drug-induced and awake ocular position provide further support to the premise that the Sch sensitive fibers provide an important motor component to the awake eye position.


Atropine cycloplegia: how many instillations does one need? Atropine is accepted generally as the most efficient cycloplegic agent. Although it is considered a relatively safe drug, toxic local and systemic side effects do occur. The recommended regimen for atropine cycloplegia has been 7 to 10 applications within 3 to 4 days. We compared the cycloplegic effect of four instillations of atropine drops to the effect of eight instillations. The results showed that the cycloplegia obtained after eight instillations was not greater than after four instillations.


Ocular findings of incontinentia pigmenti in a male infant with Klinefelter syndrome. A male infant with Klinefelter karyotype (47, XXY) manifested both the typical dermatologic findings of the X-linked dominant disorder incontinentia pigmenti (Bloch-Sulzberger syndrome) and ocular findings including retinal pigmentary changes, peripheral retinal avascularity, and preretinal fibrovascular proliferation. To our knowledge, this is the first reported case of incontinentia pigmenti with this specific abnormal genotype manifesting ocular findings.


Oculocutaneous albinism: variable expressivity of nystagmus in a sibship. Traditionally, the diagnosis of ocular or oculocutaneous albinism (OCA) is based on a constellation of features including the presence of nystagmus associated with iris transillumination defects, hypopigmentation of the fundus, and hypoplasia of the fovea and optic nerve head. Nystagmus is the most frequent ocular sign for the ascertainment of albinism particularly in individuals who have lightly-pigmented parents. We report two siblings, a male and female, with minimal, if any, pigmentation of skin and hair, iris transillumination defects, blond fundi, and hypoplasia of the foveae and optic nerve heads who were discordant for nystagmus; the diagnosis of OCA was based on the clinical findings. These siblings presumably have the same genetic hypopigmentation defect and demonstrate that nystagmus is not a consistent finding in OCA and may not be an absolute criterion for diagnosis.


Ocular torsion-direct measurement with indirect ophthalmoscope and protractor. Objective measurement of the optic nerve head (ONH)-foveal angle, representing the torsional status of 40 eyes in 20 normal patients, was performed by fundus photography and compared to a method utilizing an indirect ophthalmoscope and protractor described herein. Photography established a mean ONH-foveal angle of 7.03 degrees (SD 2.94 degrees). Comparison with the indirect/protractor method revealed a mean difference of 1.10 degrees (SD 0.99) with a range of 0 degrees to 4 degrees between methods. The indirect/protractor method seems to provide a rapid, inexpensive, and accurate method of determining the degree of ocular torsion when compared to the fundus photograph method which requires greater patient cooperation and investment in time and equipment. The ONH-foveal angle varies widely among normal individuals (0 degrees to 16 degrees). Variation between left and right eyes of the same individual was not significant (1.15 degrees, SD 1.39 degrees), and if greater than 4 degrees, probably represents cyclovertical muscle dysfunction or restrictive orbitopathy. The converse, however, may not always be true as individuals with less than 4 degrees difference between eyes may have cyclovertical muscle imbalance.


Sclerocornea and interstitial deletion of the short arm of chromosome 6--(46XY del[6] [p22 p24]). The interstitial deletion of the short arm of chromosome (6)--46 XY del (6) (p22.3 p24) is unrecorded. The ophthalmic findings in a dysmorphic infant included peripheral sclerocornea and epicanthal folds with upslanting palpebral fissures. We present a short review of sclerocornea and the ophthalmic findings of infants with anomalies of chromosome 6. Our findings provide further evidence that genes influencing the development of the anterior segment are located on the distal portion of the short arm of chromosome 6.


Changes in eyelid position accompanying vertical rectus muscle surgery and prevention of lower lid retraction with adjustable surgery. Whether or not eyelid position changes are caused by vertical rectus muscle surgery is controversial and poorly understood. We reviewed pre- and postoperative photographs of patients who underwent recession or resection of one or more vertical rectus muscles in a 10-year period. A change in eyelid position occurred frequently with vertical rectus muscle surgery. With superior rectus recession, 91% of the patients developed upper lid retraction. With inferior rectus recession, 94% of patients developed lower lid retraction. With inferior rectus resection, every patient developed lower lid advancement with accompanying flattening. We describe an adjustable surgical technique to prevent lower lid retraction associated with inferior rectus recession. The technique involves a separate adjustable suspension of the lower eyelid retractors from the inferior rectus insertion at the time of strabismus surgery. The lid position can then be adjusted separately at the time of muscle adjustment. After an average 2 1/2-month follow up, no statistically significant lid retraction could be measured in six patients who underwent the adjustable lid suspension, while statistically significant retraction (P < .01) developed in a group of nine patients who had inferior rectus recession alone. This technique did not limit the success of the strabismus surgery.


Recognized scleral perforation during eye muscle surgery: incidence and sequelae. Inadvertent perforation of the sclera is a widely recognized complication of eye muscle surgery. In the 1960s and 1970s, it was estimated to occur in 9% to 12% of patients operated. Fortunately, dreaded vision-threatening sequelae have been much less common. To better define the occurrence and sequelae of this complication, we sent a questionnaire to all 342 members of the American Association for Pediatric Ophthalmology and Strabismus. Scleral perforations, defined to include known retinal damage, occurred in 728 of nearly 554,000 eye muscle procedures performed by 223 surgeons. Perforations were two times more common with residents or fellows operating. They occurred not only during muscle reattachment (633 cases), but also during muscle disinsertion (24 cases), muscle dissection (6 cases), passage of traction sutures beneath the lateral rectus (5 cases), and preplacement of muscle sutures (5 cases). Many other perforations may have been unrecognized and uncounted. Visual loss was uncommon, occurring in only nine patients. Fourteen retinal detachments included four cases with partial and two with total loss of vision. Only three cases of endophthalmitis occurred, one resulting in partial visual loss and two in total visual loss. Techniques suggested by respondent surgeons to avoid perforations are discussed.


The surgical treatment of traumatic Brown syndrome. We present the results of surgical treatment in 13 patients who attended Moorfields Eye Hospital with traumatic Brown syndrome between 1975 and 1990. The average age was 34 years (range, 18 to 46 years), and in 12 cases the cause was a road traffic accident. Diplopia was the indication for surgery in all cases. Most patients had two surgical procedures; but in two patients, three were required. The outcome was assessed both subjectively and objectively. Objective assessment was by analysis of the preoperative and postoperative fields of binocular single vision and Hess charts which were available for 11 patients. The Hess charts were analyzed using a new scoring system. At final follow up, subjective improvement had occurred in 7 patients, 3 patients reported no improvement, and 3 patients thought their symptoms were worse. The field of binocular single vision improved in 8 patients and was worse in 3 patients. The Hess chart improved in 8 patients and was worse in 3 patients. The management of this difficult condition is discussed.


Hypertensive retinopathy: a cause of decreased visual acuity in children. Hypertensive retinopathy may present atypically in children. Delays in diagnosis may result in permanent visual loss, as demonstrated in three cases we saw.


Synthetic polypeptide sleeve for strabismus surgery. A synthetic polypentapeptide sleeve was placed around the superior rectus muscle of five New Zealand white rabbits in hopes of preventing postoperative fibrous scarring. Two forms of the polypentapeptide were used. No significant inflammation or scarring occurred with either form of the polypentapeptide when compared to controls. One form elicited a fibrous membrane surrounding the sleeve within 2 weeks. The other elicited no such reaction after 2 months. The latter form of the polypentapeptide may be useful in preventing scarring following strabismus surgery.


Visual hand display (VHD) as an introductory procedure for measuring vision in infants and young children with visual impairment. We developed the Visual Hand Display (VHD) to measure vision in visually impaired infants and young children. The VHD is a circular fabric mitten, which is held easily by inserting the hand between the two surfaces. Black-and-white stripes are attached to one surface, 25, 15, 10, 4, and 2 mm per stripe. The VHD acuity is determined by the shortest test distance and the smallest stripes that the patient can detect. The VHD acuities were compared with preferential looking (PL) staircase acuities in 130 patients (53 males, 77 females; age range, 2 to 13 years; median, 21.0 months). Of these, 107 (82.3%) had various degrees of retinopathy of prematurity. The correlation between the VHD and the PL acuities was high (R2 = 0.849). PL acuities were better than the VHD acuities in 98/130 patients (75.4%), with an average difference of 0.51 (SD = 0.70) octave. The visual acuity differences were more pronounced in subjects with slight visual impairment and much less in subjects with severe visual impairment. The VHD seems to be an effective introductory method to evaluate visual acuity in severely visually impaired infants and young children. This method also would be effective with severely mentally and physically disabled patients who cannot undergo PL testing.


Refractive error changes following strabismus surgery. Several uncontrolled, retrospective studies have suggested that permanent changes in refractive error can be seen following strabismus surgery. We prospectively enrolled 68 patients undergoing strabismus surgery for evaluation of pre- and postoperative cycloplegic refraction. In addition, the adult patients had computerized corneal topography recorded using the Corneal Modeling System, (Computed Anatomy, Inc, New York, NY). Pre- and postoperative refractions were compared using spherical equivalent and meridional equivalent (90- and 180-degree meridian). We found no significant change in the spherical equivalent between the pre- and postoperative measurements. However, a significant increase in the astigmatic power at 180 degrees (meridional equivalent at 180 degrees) was detected in both pediatric and adult patients. We did not observe any qualitative change in the corneal topography pre- and postoperatively. The change in astigmatic power at 180 degrees is equivalent to additional plus-cylinder correction at 90 degrees and was persistent throughout the 4-month postoperative period.


Levodopa and childhood amblyopia.

Levodopa and childhood amblyopia. A pilot study was undertaken to address the tolerance and efficacy of levodopa/carbidopa treatment for amblyopia in older amblyopic children who failed to respond to conventional occlusion therapy. Five amblyopic children, between the ages of 7 and 12 years, and two normal adults were given between 100 mg/25 mg and 400 mg/100 mg of levodopa/carbidopa, respectively, depending on body weight. A symptoms questionnaire was completed, with temperature, respiration, heart rate, and blood pressure taken periodically to assess tolerance. Blood samples were taken, via a heparin well, to assess the pharmacokinetics of levodopa, dopamine, noradrenaline, and DOPAC. Snellen visual acuity, contrast sensitivity, stereo acuity, and pattern VERs were measured periodically to assess efficacy. The results revealed a high prevalence of side effects including emesis and nausea (four of seven subjects). Pharmacokinetics revealed that maximum serum levels of levodopa occurred 30 minutes to 1 hour after drug ingestion and decreased by 50% after 2 to 4 hours. One hour after drug ingestion, Snellen visual acuity temporarily improved from an average of 20/159 to 20/83 in the amblyopic eyes. Contrast sensitivity and pattern VERs (10-minute checks) temporarily improved in both dominant and amblyopic eyes, whereas visual function remained stable in normal eyes. The improvements in visual function started to decrease 5 hours after drug ingestion. The results are discussed in the context of developing a therapeutic trial of levodopa/carbidopa for childhood amblyopia.


An evaluation of abdominal staging procedures performed in pediatric patients with advanced Hodgkin's disease: a report from the Childrens Cancer Study Group. Forty-nine children and adolescents underwent staging laparotomy in the course of a cooperative group (CCG) study of advanced Hodgkin's disease (HD). The purpose of the study was to evaluate the toxicity of a regimen of 12 cycles of doxorubicin, bleomycin, vinblastine, and imidazole carboxamide (ABVD) plus 2,100 cGy regional irradiation in patients with stage III-IV disease. Review of the biopsies and specimens from these 49 laparotomies identified distinct patterns of abdominal involvement and permitted an evaluation of the importance of different aspects of the staging procedure and an assessment of the value of non-invasive techniques in determining the extent of abdominal disease. The major observations from these studies were: (1) computed tomography (CT) and gallium 67 scans (GA) were specific (few false positives), but not sensitive, indicators of abdominal disease; (2) negative findings at laparotomy in 29 patients permitted a contraction of the abdominal radiation fields with no subsequent abdominal recurrence in these patients; (3) in five patients, stage IV status was established only by laparotomy and open hepatic biopsy; (4) all patients with lower abdominal or pelvic involvement also had upper abdominal node or splenic involvement; (5) involvement of splenic hilar nodes was a sensitive predictor of splenic involvement; (6) disease in the inferior paraaortic nodes accurately predicted the presence of more distal disease, ie, in the iliac or pelvic node groups; and (7) in a limited experience, transposition of the ovaries protected ovarian function from the effects of pelvic irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)


Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia. We present our experience with 92 Broviac central venous catheters inserted into 84 infants over a 31-month period. Our technique specifies placement in the neonatal intensive care unit under local anesthesia, with insertion to the inferior vena caval-atrial junction via the saphenous or femoral vein, with a subcutaneous tunnel to an exist site on the anterior thigh. We conclude this technique to be safe, efficient, convenient, cost-effective, and minimally uncomfortable to the infant, with no increase in morbidity or mortality in comparison to previously described methods.


Proximal and distal cannulation of the internal jugular vein for ECMO in a primate. Extracorporeal membrane oxygenation (ECMO) is lifesaving for infants with severe respiratory distress but is complicated by severe intracranial hemorrhage in 10% to 30% of patients. Intracranial venous hypertension, as a result of ligation of the internal jugular vein (IJV), has been hypothesized as a contributing factor to cerebral edema and subsequent hemorrhage. Accessory cephalad IJV cannulation may serve as a means of additional venous drainage to the pump as well as protection against intracranial venous hypertension. Proximal and distal cannulation of the IJV were studied in a primate model. The parameters monitored included sagittal sinus, right and left ventricular pressures as well as venous pressure in the ECMO circuit. The cephalad venous cannula was clamped and unclamped at 30-minute intervals. There was no significant difference in sagittal sinus or intracranial pressures during periods of cephalad cannula clamping or unclamping. Venous return was augmented when the cephalad cannula was unclamped. Cephalad cannulation has no demonstrable protective effect on intracranial, subarachnoid or venous pressures but does improve venous return to the ECMO circuit. It is concluded that cephalad venous cannulation is not necessary in all cases and should be reserved for those patients requiring additional venous drainage to support pump flow.


Congenital diaphragmatic hernia in an era of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization: a prognostic and management classification. In November 1987 we began to practice delayed repair of acutely symptomatic congenital diaphragmatic hernia (CDH) following medical and/or extracorporeal membrane oxygenation (ECMO) stabilization. We reviewed 23 consecutive patients with CDH symptomatic at birth treated over the ensuing 2 1/2 years. The mean age at admission, age at repair, and interval from admission to repair were 4.9, 37.0, and 32.6 hours, respectively. Overall survival was 52% (12/23). ECMO was used in 14 patients with 7 survivors (50%); 4 of these patients underwent repair prior to ECMO and 10 while on ECMO. The patients were retrospectively grouped into three classes based on postductal arterial blood gas (ABG) response to conventional medical management: class A (n = 8), able to achieve and sustain adequate oxygenation (PO2 greater than 60 mm Hg) and hyperventilation (PCO2 less than 40 mm Hg); class B (n = 10), unable to sustain adequate oxygenation (PO2 less than 60 mm Hg) but able to be hyperventilated (PCO2 less than 40 mm Hg); and class C (n = 5), unable to be oxygenated (PO2 less than 60 mm Hg) or hyperventilated (PCO2 greater than 40 mm Hg). The interval from admission to repair was 13.6, 53.5, and 25.4 hours for classes A, B, and C, respectively. Two class A (25%), nine class B (90%), and three class C patients (60%) were placed on ECMO. Survival rates were 88%, 50%, and 0% for classes A, B, and C, respectively. We propose the following management protocol. Class A patients are stable and can be repaired at any convenient point after admission without prerepair ECMO; few will need it afterward.(ABSTRACT TRUNCATED AT 250 WORDS)


Is the phakic eye normal in monocular pediatric aphakia? This retrospective review of 97 pediatric patients who underwent monocular surgery for congenital or developmental cataracts studied the incidence of abnormalities in the contralateral phakic eye. Fifty-nine percent of patients had a normal phakic eye. However, 40 patients showed at least one abnormality in the phakic eye: reduced vision (21%), nystagmus (19%), cataract (15%), iris heterochromia (9%), myopia (6%), microphthalmos (6%), pupillary miosis (2%), congenital glaucoma (2%), optic nerve abnormality (2%), aniridia (1%), and corneal opacity (1%). Not all abnormalities were detected at the time of diagnosis of the contralateral cataract. The more significant findings of reduced vision and nystagmus in the phakic eye were usually detected postoperatively, often several months after the optimum time for treatment of pediatric cataracts. We suggest that monocular cataract surgery not be delayed. This will allow the best vision to be obtained for the aphakic eye, as the "sound eye" may not always be normal in monocular pediatric aphakia.


Major surgical intervention during extracorporeal membrane oxygenation. Of 135 patients treated with extracorporeal membrane oxygenation (ECMO) between January 1987 and December 1989, 19 (14.0%) patients underwent surgical procedures while on ECMO. Thirteen (68%) patients had operations related to hemorrhage, including cannula site (6), mediastinal (1), hemoperitoneum (3), and hemothorax (3). Six of 13 patients required repetitive operations for bleeding; 4 of 6 died. Six (35%) patients had operations for congenital pathology including patent ductus (PDA) ligation (2), repair of transposition of the great vessels (2), repair of coarctation (1), and repair of congenital diaphragmatic hernia (3). One patient had multiple simultaneous procedures performed. Of these 6 patients, 4 were decannulated immediately and 2 were decannulated within 28 hours following surgery without any bleeding complications. Fifteen of 19 patients were operated on in the neonatal intensive care unit. The 4 remaining patients required transport on ECMO to the surgical suite. Thirteen of the 19 patients requiring surgical intervention on ECMO survived. In the 13 survivors, the mean time to decannulation postoperative was 45 hours, and in those that died it was 90 hours. Our experience suggests that surgical intervention while on ECMO is technically feasible with the best results achieved when rapid discontinuation of ECMO can be accomplished postoperatively. Due to this fact major surgical intervention should be postponed if possible until near the conclusion of the ECMO therapy.


Elevated levels of endotoxin, oxygen-derived free radicals, and cytokines during extracorporeal membrane oxygenation. It has been demonstrated that the initiation of extracorporeal membrane oxygenation (ECMO) is associated with an increase in the circulating plasma levels of inflammatory mediators. We have expanded the study of these substances to include measurements of complement activation, prostaglandin production, endotoxin appearance, oxygen-derived free radical generation, and cytokine release before, during, and after ECMO. A reproducible second phase of complement activity and prostaglandin synthesis was associated with the appearance of detectable circulating endotoxin (0.04 U/mL pre-ECMO to 0.07 U/mL at 36 hours, P less than .05). Oxygen-derived free radical activity also increased (2 ng/mL to 3 ng/mL at 36 hours, P less than .05), as did plasma levels of tumor necrosis factor (40 pg/mL to 70 pg/mL at 36 hours, nonsurvivor group: P less than .05). Interleukin-1 was elevated above normal, but there were no significant variations noted during the time period studied. Small amounts of interleukin-6 were also detected in the occasional patient. None of these mediators differed significantly between survivors and nonsurvivors. These data indicate that ECMO is associated with a previously undescribed, endotoxin-related, generalized inflammatory state after 36 hours of support. The pulmonary, renal, and cardiac dysfunctions documented with prolonged bypass can all be related to a classic sepsis syndrome.


Biliovenous fistula in children after blunt liver trauma: proposal for a simple surgical treatment. Biliovenous fistula (BVF) with subsequent leakage of bile into the venous system is a rare but serious complication of blunt liver trauma. Nine cases have been reported since 1975. Surgical therapy is indicated; however, there are still controversies as to which operative method should be applied. Based on experience gained in adult surgery, resection of the BVF together with necrotic liver tissue is also recommended in children. We describe both an organ-saving and technically simple method that was applied in two male patients, 2 and 10 years old, respectively, suffering from BVF. After debridement and tamponade of a necrotic cavity of the liver, drainage was carried out. This prevented bilious leak into the venous system. Based on the case history of these two patients, management of BVF fistula will be described. Pathophysiology of bilhemia and the drainage effect will be discussed in light of a review of the literature.


Splenic autotransplantation provides protection against fatal sepsis in young but not in old rats. Splenectomy increases the risk of contracting infections with high mortality. Thus, splenic tissue should be repaired orthotopically whenever possible. If all attempts fail, splenic autotransplantation might be a suitable method for splenic salvage. The protective function of such transplants in adults has been questioned, leading to a decreased frequency of splenic autotransplantations. However, the regeneration of splenic tissue is better in the young organism than in the old, suggesting that the protection provided by regenerated splenic tissue might be more reliable in children than in adults. In addition, children are at a higher risk in the case of overwhelming postsplenectomy sepsis. The protection warranted by regenerated splenic tissue after autotransplantation at different ages was examined using a highly standardized animal model. Sham operation, splenectomy, and splenic autotransplantation were performed on adult, weanling, and newborn rats, and Streptococcus pneumoniae was applied intranasally 9 months after the operation. After pneumococcal challenge about 80% of the splenectomized animals in the different age groups died of infection, whereas only 20% of the sham operated rats died. Regenerated splenic tissue resulting from splenic autotransplantation performed on adult or weanling rats demonstrated no protective function. However, in newborn rats with transplanted splenic tissue, both survival rate and survival time were increased significantly. Determination of lymphocyte subsets in the blood did not allow the protective role of splenic transplants to be predicted. This study indicates that disappointing results of splenic autotransplantation in adult patients should not lead to false pessimism about the role of this operation in children.


Correlation between extrinsic nerve fibers and synapses in the muscle layers of bowels affected by Hirschsprung's disease. The aim of this study is to clarify any correlation between nerve terminals (synapses) and proliferating extrinsic nerve fibers in the muscle layers of bowels affected by Hirschsprung's disease (HD). Synapses and extrinsic nerve fibers in the muscle layers of bowels of 10 patients with HD and 8 comparable controls were labeled with monoclonal antibody (MAb) 171B5 and acetylcholinesterase (AChE), respectively. In the control a rich and even distribution of synapses, representing neuromuscular junctions, was seen in the muscle layers, together with dense clusters of synapses in the adjacent myenteric plexuses; proliferation of extrinsic nerve fibers was not seen. In the transitional oligoganglionic segment of HD, many synapses were present in the myenteric plexus, but a few synapses in the muscle layers; there was a gradual increase of extrinsic nerve fibers from proximal to distal. In the narrow aganglionic segment very few synapses were seen in the muscle layers; proliferating nerve fibers and bundles were prominent. We conclude that the muscle layers of bowels affected by HD were almost denervated despite presence of intrinsic nervous elements in the oligoganglionic segment and proliferating extrinsic nerve fibers in the aganglionic segment.


Meconium ileus-like condition in Chinese neonates. Between January 1985 and May 1990, 16 neonates were treated for meconium ileus (MI) at this hospital. All babies were born to Chinese couples. Seven of them were premature, but none of them weighed less than 1,000 g. Eight patients underwent operations either because of mistaken diagnosis, as ileal atresia or long-segment Hirschsprung's disease, or because of complicated MI, including two meconium peritonitis and one associated with ileal atresia. Gastrograffin enema was successful in management of eight uncomplicated MI. The albumin content in the meconium of the last nine cases, including four complicated cases, ranged from 9.2 to 93.3 mg/g dry meconium. Usually, albumin is not present in normal meconium. All cases received sweat test, which were negative. Three patients died in the follow-up period. Sepsis of unknown origin, multiple congenital anomalies, and severe metabolic problems were the causes of death. The other 13 patients are doing well. They have exhibited no pulmonary or digestive problems during their follow-up period, which ranged from 11 months to 5 years. They are healthy and receive regular diets. Growth and development are appropriate for their age groups.


Colonoscopic polypectomy in children.

Colonoscopic polypectomy in children. Between January 1984 and July 1990, a total of 129 colonoscopic snare polypectomies were performed during 77 sessions on 74 patients aged 2 to 12 years. Bleeding per rectum (mean duration, 10 months) was the chief presenting symptom and was present in all of these patients. In 89% of patients polypectomy was carried out without using general anesthesia. Ninety-six percent of patients had juvenile polyps. Two patients had familial polyposis coli and one patient had a solitary adenomatous polyp. The majority (98; 80%) of the polyps were located in the rectosigmoid region. Four patients developed complications, one needing emergency operation. There were no deaths in the series. It is concluded that colonoscopic snare polypectomy is a simple, effective, and safe procedure for treating colorectal polyps in children.


Tracheoesophageal fistula associated with perforated Meckel's diverticulum. Neonates with esophageal atresia and tracheoesophageal fistula (TEF) may present with respiratory distress. Intubation and mechanical ventilation may force air from the tracheobronchial tree, through a distal fistula and into the gastrointestinal tract. We present a newborn with TEF who became moribund during mechanical ventilation. High ventilator pressures transmitted via the TEF caused over distention of the gastrointestinal tract and perforation of a Meckel's diverticulum.


Congenital diaphragmatic hernia presenting due to gastrointestinal complications. Congenital diaphragmatic hernia (CDH) presents beyond the first hours of life in 10% to 20% of cases. Presenting symptoms may be quite nonspecific, and are often gastrointestinal rather than respiratory in origin. We have recently had experience with five such cases, one in a newborn and four in older children. All presented with symptoms related to gastrointestinal complications of their diaphragmatic defect. In the newborn, gastric perforation had occurred, a complication of this anomaly not previously reported. The chest radiograph showed loops of bowel in the chest in all cases, allowing correct preoperative diagnoses. Urgent operative intervention was undertaken in each case with good results and no long-term morbidity. The risk of intestinal strangulation in the late-presenting CDH patient warrants emergent surgical management, which should be rewarded by uniform survival with few complications. Although preoperative stabilization may decrease the severity of pulmonary vasospasm in the newborn with respiratory failure, delay may increase the risk of bowel infarction in the older child presenting with gastrointestinal symptoms.


Granulomatous peritonitis by ascaris.

Granulomatous peritonitis by ascaris. The granulomatous peritonitis by ascaris (GPA) is a rare complication of intestinal ascariasis due to the perforation of the digestive tract by the adult worm, which deposits its ova in free peritoneum; therefore, provoking an intense granulomatous inflammatory reaction. We report a case of an 8-year-old boy with GPA, emphasizing the clinical and diagnostical aspects and the therapeutics procedures.


Retroperitoneal alimentary tract duplications detected in utero. The prenatal diagnosis of numerous congenital anomalies has become routine. The prenatal diagnosis of cystic lesions of the retroperitoneum can be due to a variety of renal, gastrointestinal, or adrenal lesions. This finding demands aggressive postnatal follow-up to rule out the possibility of cystic adrenal neuroblastoma. We report the first cases of retroperitoneal cystic masses diagnosed in utero that ultimately proved to be enteric duplications. Therefore, the differential diagnosis of cystic masses of the retroperitoneum found prenatally should be expanded to include enteric duplication cysts.


Necrosis of the ileum in a diabetic adolescent. A 17-year-old boy with insulin-dependent diabetes mellitus developed ketoacidosis and transitory shock. After resolution of his metabolic imbalance, he developed an acute abdomen prompting exploratory surgery. A section of necrotic ileum was found and resected.


Tubular duplication of the hindgut with genitourinary anomalies. Hindgut duplication including the colon and rectum as well as the genital and urinary organs are extremely rare. Only a few cases are noted in the medical literature. In this report, a newborn with exstrophy of the urinary bladder, double vagina and uterus, double anus, and complete duplication of rectum and colon with malrotation is presented.


Single-system cecoureterocele.

Single-system cecoureterocele. A rare case of single system cecoureterocele associated with ipsilateral dysplastic kidney in a 4-year-old girl is reported. The preoperative radiological and endoscopic investigations identified ureterocele but not its cecal extension. The latter was diagnosed only during the transvesical surgery. Complete cure of her symptoms was achieved following staged procedures comprising of right ipsilateral nephroureterectomy followed by combined transvesical and transurethral deroofing of the cecoureterocele, excision of ureteric stump and its extension in the bladder and repair of the detrusor. This is the second case report in English language literature of single-system cecoureterocele.


Removal of a multicystic half of a horseshoe kidney: significance of preoperative evaluation in identifying abnormal surgical anatomy. A rare case of multicystic dysplasia in half of a horseshoe kidney is presented. Proper evaluation led to a modified surgical approach necessary for adequate exposure, division of the isthmus, and removal of the diseased component. Considerations applicable to the treatment of multicystic dysplasia and renal fusion are discussed. The surgical anatomy of horseshoe kidney is reviewed.


Prepregnancy care and prevention of birth defects. Birth defects and disturbances in growth and development need an increasing attention in perinatal medicine. It is remarkable that so little attention has been paid to the pathogenesis of malformations in the literature in an approach to find aspects of prevention. Primary prevention of birth defects is an important public health issue as malformations have important consequences both for society and the individuals concerned. Prepregnancy care as a logical precursor to antenatal care, offers risk-assessment, advice and occasionally treatment before pregnancy, in order to avoid congenital malformations. It is therefore that we started a research program with emphasis on primary prevention of congenital malformations. In this respect medication, maternal nutritional status, diabetes mellitus and neural tube defects are discussed.


Vibro-acoustic stimulation in high-risk pregnancies; maternal perception of fetal movements, fetal heart rate and fetal outcome. Maternal perception of fetal movement in response to vibro-acoustic stimulation was compared with antenatal fetal heart rate monitoring as a test of fetal well-being in a population of gravidae with high-risk pregnancies (n = 517), admitted to the high-risk ward at Danderyd Hospital, Karolinska Institutet; a total of 2,015 tests were performed. The sensitivity and the specificity of the test compared to the fetal heart rate tracing was 81% and 89% respectively. If the test was performed within 24 hours of delivery, its predictive value for fetal asphyxia (i.e. a 5-minute Apgar score < 7) was 14% (7/49). Ten per cent of the patients felt no fetal movement in response to stimulation (irrespective of gestational age). In five cases where fetal heart rate tracings were pathological, stimulation nonetheless produced fetal movement and fetal outcome was good. Pathological heart rate tracings and no fetal movement in response to stimulation were present in 30 cases (out of 251 with no fetal movements at stimulation), in seven of which the infants had 5-minute Apgar scores < 7. Although many patients underwent repeated vibro-acoustic stimulation, there was no evidence of fetal habituation to the test. On 24 occasions (i.e. 1.2%), the patient denied vibro-acoustic stimulation, mostly because of previous discomfort due to vigorous fetal response. Where resources are limited, maternal perception of fetal movements in response to vibro-acoustic stimulation might be a useful alternative for preliminary screening of high-risk pregnancies.


Acoustic stimulation as a diagnostic test: comparison with oxytocin challenge test. The usefulness of an acoustic stimulation test as a marker of fetal well-being was evaluated in a randomized controlled study of 121 pregnant women exhibiting a non-reactive fetal non-stress test at term. The women were randomly divided into two groups; those in the first group (n = 62) underwent an acoustic stimulation test immediately prior to an oxytocin challenge test, while those in the second (n = 59) underwent an oxytocin challenge test only. Fetal response to the acoustic stimulation was non-reactive in 22.5% of the women tested in the first group. The incidence of abnormal oxytocin challenge test among the women who were previously subjected to an acoustic stimulation was somewhat lower than among those who did not (14.5% vs. 23.7%), but the difference was not significant. In the prediction of an abnormal oxytocin challenge test, a non-reactive acoustic stimulation test had a sensitivity of 100%, a positive predictive value of 64% and a specificity of 91%. As a single test for the prediction of fetal distress in labor (n = 62), the acoustic stimulation test had a specificity and a positive predictive value similar to those of the oxytocin challenge test (n = 121), and its sensitivity was even higher (88% vs. 71%). We conclude that the acoustic stimulation test is at least as reliable as the oxytocin challenge test in the evaluation of fetal well-being in women exhibiting a non-reactive non-stress test at term.


Disseminated herpes simplex infection in a twin: the role of the "stat" autopsy in immediate therapeutic intervention for survival of multiple birth neonates. Multiple birth neonates are unique in sharing similar intrauterine, and commonly the extrauterine, environments. The development of an infectious disease in one infant during the perinatal period assumes special significance in this setting, and the other siblings are often at high risk for a similar disease. Under these circumstances it is important to make a rapid etiologic diagnosis to provide appropriate therapeutic intervention. The immediate, or "stat", autopsy is a diagnostic modality involving the use of multiple procedures for the rapid diagnosis of perinatal infection which may be lifesaving in the setting of multiple birth neonates. This report describes the use of the "stat" autopsy to diagnose a fatal case of disseminated herpes simplex infection in a twin, which lead to the immediate treatment of the surviving sibling with appropriate antiviral medication.


The effect of prenatal administration of dexamethasone and ritodrine on cord blood cortisol and glucose concentrations in premature infants with respiratory distress syndrome. The influence of maternal dexamethasone and ritodrine administration during pregnancy on cord blood cortisol and capillary serum glucose concentrations and on the incidence of respiratory distress syndrome (RDS) was studied in 30 premature infants (gestational age 27-36 weeks), and compared with a matched control group of 37 premature infants where no such medications were administered. RDS occurred less often in the treated group of infants (13.3%) than in the controls (35.1%, p < 0.01). The healthy treated infants had a significantly lower mean umbilical cord plasma cortisol concentration (5.5 +/- 1.8 ug/dl, mean +/- SD) than that observed in the controls (11.2 +/- 3.9 ug/dl, p < 0.01). Mean cord plasma cortisol concentrations increased with duration of pregnancy. No significant difference in the capillary serum glucose at 30 minutes post-delivery was found between the healthy, RDS, treated and non-treated infants. No adverse effects of steroid and ritodrine therapy were observed.


Oro-naso-pharyngeal suction at birth: effects on respiratory adaptation of normal term vaginally born infants. The effect of oro-naso-pharyngeal suction at birth on pulmonary mechanics is described in a random assigned controlled study of 40 normal term vaginally born infants. Twenty cases had their oro-naso-pharynx suctioned immediately after birth (S Group), whereas 20 were not suctioned in the neonatal period (NS Group). A computerized pneumotachographic system (MECVENT) was used for the assessment of respiratory mechanics (Dynamic Compliance (C. Dyn.) and Total Pulmonary Resistance (R) in inspiration and expiration at 10, 30 and 120 minutes after birth. In both groups the C. Dyn increased during the study period whereas the R decreased, mainly in the initial 30 minutes. No significant differences were observed between S and NS groups for any of the parameters of respiratory mechanics. The results obtained in this study provide no physiological basis to recommend routine airway suction at birth in normal, term, vaginally born infants.


Umbilical artery blood flow velocity waveforms in twin pregnancies. To detect discordant fetal growth in twin pregnancies and assess a possible role for Doppler ultrasound measurements of blood flow velocity waveforms in umbilical arteries in such cases, 32 twin pregnancies were examined on 125 occasions. The last examination was within 14 days of delivery. There was postpartum death of one pair of twins with the twin transfusion syndrome. Birthweight was appropriate for gestational age in 15 twin pairs, both infants were small for gestational age (SGA) in 5, and one of the infants was SGA in 12 twin pairs. The correlation coefficient of RI difference at the last examination and percentage birth weight difference in twin pairs was 0.68. Cutoff points for the delta RI and weight difference were established. The sensitivity of delta RI (0.1) was 77.8%; specificity, 95.8%; positive predictive value, 87.5%; and negative predictive value, 92.0%.


Severe localised pulmonary interstitial emphysema--decompression by selective bronchial intubation. We report three infants (26-28 weeks gestational age) in whom selective bronchial intubation was associated with successful decompression of severe localised pulmonary interstitial emphysema, uniquely in two cases this involved intubation of the left main bronchus. Pulmonary interstitial emphysema did not recur despite maintenance of selective intubation for only 48 hours or less in all three cases.


Intestinal obstruction and perforation following sucralfate administration in a very low birth weight infant. A case of intestinal obstruction and perforation following sucralfate administration in a very low birth weight infant is reported. Potential adverse effects of using sucralfate for prophylaxis of stress ulcer in premature babies are discussed.


Reliability and validity of the Coolidge Axis II Inventory: a new inventory for the assessment of personality disorders. This group of studies describes the development of a 200 item, self-report, 4-point true-false inventory (Coolidge Axis II Inventory [CATI]) to assess personality disorders according to the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). The 13 personality disorder scales of the CATI had a mean test-retest reliability of .90 and a median internal consistency (Cronbach's alpha) of .76. There was a 50% concordance rate with clinician's diagnosis for 24 personality disordered patients. The median concurrent validity (raw score sums) between the CATI and the Millon Clinical Multiaxial Inventory-II for the 13 personality disorder scales was .58. Preliminary studies also support the reliability and validity of Depression, Anxiety, and Brain Dysfunction scales.


Classification of adult attachment: an integrative taxonomy from attachment and psychoanalytic theories. Developmental and psychoanalytic theorists have focused increasingly on empirically determined early childhood antecedents of adult attachments, with several resulting taxonomic models. This article suggests a theoretically based and clinically based model of attachment consistent with both psychoanalytic and attachment theories, resulting in an integrative taxonomy of four adult attachment styles: dependent, avoidant, hostile, and resistant-ambivalent. These styles reflect behavioral manifestations of dependence and anger, as derived from the interaction of primitive relational drives, defenses, and interpersonal experience. In addition to theoretical construction, brief clinical examples are presented to facilitate discussion of the model.


The evaluation of truthfulness in alleged sex offenders' self-reports: 16PF and MMPI validity scales. The evaluation of response bias (i.e., minimization or exaggeration) is central to forensic psychological evaluations. Yet few studies have assessed forensic samples to investigate the ability of psychological tests to detect response bias. We studied the relationship between the Sixteen Personality Factors Questionnaire (16PF) and the Minnesota Multiphasic Personality Inventory (MMPI) validity scales for 65 alleged sex offenders and assessed the effects of different cutoff scores for the 16PF validity scales. Results indicate consistent significant correlations between the validity scales of the 16PF and the MMPI for measures of minimization and exaggeration. use of a priori cutoff scores resulted in the classification of our sample in proportions parallel to those found in previous research for the 16PF Fake-Good scale but not the Fake-Bad scale. Our results indicate that 16PF validity scales are useful, but interpretations must take into account different base rates of response bias between sex offenders and the general population.


The Rorschach test for predicting suicide among depressed adolescent inpatients. With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.


Personality in panic disorder with agoraphobia: a Rorschach study. In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses such as avoidance, repression, denial, and reaction formation against dependency needs. These defenses are thought to lead to a greatly impoverished affective life. The Rorschach Comprehensive System was used to assess the personality features of avoidance, restricted affective life, and reaction formation against dependency needs. We found evidence for the presence of a highly avoidant information-processing style (86% of protocols had lambda [L] greater than .99) and a constricted affective life (low weighted sum color [WSumC] and low affective ratio [Afr]). Our results were consistent with the hypothesis of reaction formation against dependency needs (low food content [Fd]). Findings are discussed in light of studies that found a high incidence of avoidant personality disorder in PDA patients.


The response of African Americans to the Rorschach: a review of the research. Studies exploring the performance of African Americans on the Rorschach were reviewed. The review revealed the limited number of studies done in this area of study, as well as the fact that the research paradigm for all of this research has been limited to comparing the Rorschach performance of African Americans to that of Whites. However, no one has offered a rationale for such a research paradigm. Without a scientific reason to expect personality to be a function of race, another research design was recommended, one that explores the effect of a variety of aspects of living conditions on the development of the personality of African Americans.


Toward the clarification of the construct of depersonalization and its association with affective and cognitive dysfunctions. Little consensus or systematic research exists regarding the symptoms that constitute depersonalization and its association with affective and perceptual dysfunctions. A scale was constructed to measure depersonalization experiences reported in the literature and four items representing psychotic symptoms. Five factors representing different types of depersonalization emerged: Inauthenticity, Self-Negation, Self-Objectification, Derealization, and Body Detachment. Based on the factors, scales were constructed; these scales have internal consistency ranging from .78 to .84. Each of these factor scales was factorially distinguishable from psychosis and correlated between .48 and .58 with the Jackson and Messick (1972) Feelings of Unreality Scale, suggesting divergent and convergent validity. Inauthenticity, the most frequent and pervasive form of depersonalization experience, was best predicted by a cognitive style featuring intense, critical examination of self and others. In contrast, Self-Objectification was best predicted by thought disorganization and perceptual distortion and was experienced somewhat infrequently by relatively few subjects. All forms of depersonalization were associated with depression, except Inauthenticity.


Hypotensive effect of a phosphorus-containing novel angiotensin converting enzyme inhibitor, (S)-1-[6-amino-2[[hydroxy(4-phenylbutyl)phosphinyl] oxy]-1-oxohexyl]-L-proline (SQ 29,852) in conscious hypertensive dogs. The hypotensive efficacy of (S)-1-[6-amino-2[[hydroxy(4-phenylbutyl) phosphinyl]oxy]-1-oxohexyl]-L-proline (SQ 29,852), a phosphorus-containing novel angiotensin converting enzyme inhibitor (ACEI) was examined in conscious two-kidney, one-clip Goldblatt hypertensive dogs. The acute hypotensive effect of SQ 29 852 was compared with that of captopril or enalapril at 3 mg/kg, p.o., for each, and the potencies were ranked as follows, enalapril greater than SQ 29,852 greater than captopril. On the other hand, the hypotension caused by repetitive dosing with SQ 29,852 (3 mg/kg, p.o./d for 7 d followed by another 7-d treatment with 10 mg/kg, p.o./d) was somewhat more marked than that by enalapril at the same dosage. Blood urea nitrogen (BUN) increased in all the animals given enalapril, while that in all of the SQ 29,852-treated animals did not increase. These results indicate that SQ 29,852 is a potent, and long-lasting ACEI with a possible low incidence of side effects.


Activation of the complement system by (1----3)-beta-D-glucans having different degrees of branching and different ultrastructures. Activation of the alternative (APC) and classical (CPC) pathways of complement by fungal (1----3)-beta-D-glucans having different degrees of branching (DB) and different conformations were examined by using human serum and plasma. The glucans used in this study were curdlan (no branch; 0/1), grifolan (one branch in every third main chain unit; 1/3), schizophyllan (1/3), SSG (1/2), and OL-2(2/3). Triple or single helix conformer of these glucans were prepared by heating at 150 degrees C or dissolution in sodium hydroxide. Activation of APC by these glucans were dependent on incubation time, concentration, molecular weight, and DB. Interestingly, the triple helix conformer of all glucans tested activated APC stronger than a single helix one. The activity of branched glucans in plasma was weaker than those in serum. On the other hand, in the case of CPC, a single helix conformer activated CPC stronger than a triple helix one, and the activity was dependent on DB. Activation of CPC by a single helix conformer was thought to be dependent on the binding of beta-glucan to immunoglobulin in serum, because the complex was clearly detected by gel permeation chromatography only in the case of single helix one. From these results, it appears that the different conformers were recognized by the host complement systems in different ways. (1----3)-beta-D-Glucan is one of the major constituents of fungal cell wall and is thought to be clearly recognized by the host immune systems.(ABSTRACT TRUNCATED AT 250 WORDS)


Clinical management of boric acid ingestion: pharmacokinetic assessment of efficacy of hemodialysis for treatment of acute boric acid poisoning. Seven hours after suicidal ingestion of about 21 g of boric acid, a 26-year-old female admitted to our hospital in a state of slightly impaired consciousness, with frequent vomiting, shivering, fever and skin flush. Immediately, gastric lavage, followed by administration of activated charcoal and laxative (MgSO4), was performed. In order to ensure her urination, fluid infusion therapy was conducted with the aid of diuretics (furosemide). Since the serum concentrations of boric acid was very high, hemodialysis was carried out twice during the first 39 h. She responded well to the above mentioned treatment and was discharged 12 d post-admission without any sequelae. The concentrations of boric acid in serum and urine were measured in appropriate intervals with our modified Miyamoto's method, and the pharmacokinetics of boric acid were analyzed. The concentration of boric acid in serum and urine at the beginning of treatment was 465 micrograms/ml and 3.40 mg/ml, respectively. The half-life of boric acid in serum was 13.46 h, whereas it was shortened to 3.76 h during hemodialysis. The total body clearance was 0.99 l/h, while it increased to 3.53 l/h by hemodialysis. The additional removal of boric acid by hemodialysis was estimated to be about 5 g. It was concluded that the hemodialysis was very useful in the treatment of boric acid poisoning, because it accelerated the elimination of boric acid about four times faster than with conventional treatment.


Brain and cerebrospinal fluid distributions of metoprolol in rats. The distribution of metoprolol tartrate (MPL) into the brain and cerebrospinal fluid (CSF) from plasma was determined at 2 different steady-state plasma concentrations (2 and 20 nmol/ml) and following intravenous bolus administration (100 nmol/kg) in rats. Under steady-state condition, no difference in the brain and CSF distributions of MPL was observed between 2 different plasma MPL concentrations, and the value of brain- or CSF-to-plasma partition coefficients were 5.7 and 1.5, respectively. Following intravenous administration, MPL distributed into CSF very rapidly and its initial uptake phase was not detected. On the other hand, MPL distribution into the brain was relatively slow with the uptake phase. Thus, the brain uptake of MPL from the plasma was pharmacokinetically analyzed using a modified 2-compartment model and deconvolution method, whereas the CSF distribution of MPL was not adequate for kinetic analysis because of the lack of uptake phase. The analysis of brain uptake of MPL by both compartment model and deconvolution gave the same results and the calculated brain Kp value of MPL was almost comparable with that of observed Kp value under steady-state plasma concentration. The distribution of MPL into CSF was considered mainly depending on the pH difference between the plasma and CSF, and the mutual transfer of MPL between CSF and the brain tissue was considered to be negligible from an in vitro study.


Inducible resistance to a 16-membered macrolide, mycinamicin, in Staphylococcus aureus resistant to 14-membered macrolides and streptogramin B antibiotics. Staphylococcus aureus 8325(pEP2104), a transductant derived from S. aureus PM2104 isolated clinically in Hungary (L. Janosi, and E. Ban, Acta Microbiol. Acad. Sci. Hung., 29: 187-200, 1982), exhibited an inducible resistance to the 14-membered macrolides [erythromycin (EM) and oleandomycin (OL)] and streptogramin B (MKM-B) antibiotics, but not to the 16-membered macrolides and lincosamides. This resistance was referred to as PMS-resistance phenotype (L. Jánosi, Y. Nakajima, and H. Hashimoto, Microbiol. Immunol., 34: 723-735, 1990). In addition to EM, OL, and MKM-B, however, the strain was recently and first observed to have inducible resistance to mycinamicin, a 16-membered ring macrolide. Thereby, we propose that the reference stated just above as PMS-resistance has to be extended to such 16-membered macrolides as mycinamicin. An optimum concentration of erythromycin or oleandomycin for induction of PMS-resistance was 1.35 mu g/ml in the strain 8325(pEP2104). The concentration was about 30 times as great as that (0.05 mu g/ml) required for induction of well-known co-resistance to macrolide-lincosamide-streptogramin B antibiotics in S. aureus ISP447.


Food restriction enhances melatonin effects on the pituitary-gonadal axis in female rats. The effects of melatonin (25 micrograms s.c. daily in the late afternoon for 10 days) on the ovarian morphometry and the gonadotropin secretion were investigated in food-restricted rats and rats fed ad libitum. In food-restricted rats melatonin produced the significant decrease of the surface area of the ovary and of zona granulosa. Moreover, melatonin treatment of food-restricted rats resulted in significant diminishment of the relative areas of Graafian follicles and zona granulosa estimated in relation to the ovary cross-sectional surface area. On the other hand, melatonin did not produce significant alterations of the morphometric indices of the ovary in rats fed ad libitum. Melatonin administration was found to inhibit the effects of gonadoliberin on gonadotropin release in food-restricted but not in normally-fed rats. These findings suggest that food restriction sensitizes the pituitary-ovarian axis to antigonadotropic melatonin action.


Melatonin inhibits mammary gland development in female mice. The objective of this study was to determine whether melatonin (aMT) influences the postnatal development of the mammary gland parenchyma in female mice from the time of weaning to adulthood. Twenty-one-day-old female BALBc mice were treated with daily subcutaneous injections of aMT (200 micrograms) or diluent, 3 hr before the onset of darkness (photoperiod LD 12:12). At 3, 5, 7, 9, 11, and 13 weeks of age, batches of 20 animals (ten controls and ten aMT-treated) were sacrificed and the second pair of mammary glands were dissected to evaluate their degree of development. Melatonin decreased body weight gain from 2 weeks before until 2 weeks after the onset of puberty. Treatment with aMT also resulted in a lower DNA content and smaller area of the mammary gland from the time of puberty until the end of the study. In aMT-treated mice the phase of highly positive allometric growth began 2 weeks later, but ended at the same time as in controls (11th week of life). Finally, aMT decreased the development of terminal, lateral, and alveolar buds while it increased the number of terminal ducts per gland. We conclude that pharmacological doses of aMT (1) reduce body weight gain at the peripuberal age; (2) partially inhibit postnatal mammary gland development by reducing the number of epithelial structures representing sites of growth and increasing that of structures representing the final state of ductal growth in virgin animals; (3) delay the onset of the shorten the phase of rapid mammary growth occurring in early postpuberal age.