Alzheimer's disease or plaque disease? Two cases at the frontier of a definition. Atypical dementias confront the adequacy of current diagnostic concepts. The two patients with atypical dementia syndromes described here shared common postmortem features of numerous neocortical neuritic (senile) plaques and microvascular amyloid, sparing of hippocampus and substantia nigra, and the virtual absence of neurofibrillary tangles. Microscopically, the two differed only by the presence of a few subcortical Lewy bodies in case 1. These similar morphologic features were associated with dramatically different clinical presentations. In the first patient, visual hallucinations, Capgras' syndrome, cognitive slowing, myoclonus, parkinsonism, and primitive reflexes evolved over 3 years. Memory and language were relatively spared. In the second, dysphagia, nonfluent aphasia, hypophonia, motor perseveration, and a severe disorder of attention developed during this 18-month illness. At autopsy, an unrecognized colon malignancy was found. Despite high neuritic plaque counts in cortex, neither the clinical nor the pathologic criteria for Alzheimer's disease adequately describe either case. The cases will be examined first as clinical, then as neuropathologic, entities. From this approach, we conclude that a specific clinical dementia syndrome may be expressed by several neuropathologic "diseases" and that a variety of clinical syndromes may represent a single neuropathologic diagnosis. This strategy identifies a conceptual dichotomy between Alzheimer's syndrome and postmortem Alzheimer's disease. Meticulous clinical and neuropathologic observation is essential in advancing an understanding of the relationship between the two.


To drive or not to drive: preliminary results from road testing of patients with dementia. There has been considerable debate about whether driving privileges should be revoked from patients with a diagnosis of dementia and whether highway safety policies should come under closer scrutiny for all elderly. Two case studies are reported of patients with a diagnosis of probable Alzheimer's disease who participated in a pilot project to assess driving. Subjects underwent neurologic and neuropsychological evaluation. Caregivers were included in psychosocial assessments. Patients participated in a specially designed driving evaluation, including an actual road test. Although both patients had mild-to-moderate cognitive impairment on standard tests, one of the patients was deemed safe to drive on the road test while the other was not. These preliminary results suggest that driving skill may not be predictable solely on the basis of the office examination. A road competency test provides a more objective and direct measure on which to base a decision of such important consequence. Implications for public policy and the role for healthcare providers in this process are discussed.


Successful treatment with pimozide of Capgras syndrome in an elderly male. A case of Capgras syndrome in a 67-year-old man who failed to improve on haloperidol, but responded to pimozide, is described. The patient's paranoid delusions abated with 8 mg per day of pimozide. We believe pimozide's established benefit in the treatment of delusional disorders warrants its consideration in alleviating other delusions, including "the delusion of doubles."


The SKT neuropsychological test battery. The SKT is a brief neuropsychological test battery that includes nine performance subtests that define two independent factors of memory and attention deficit. It requires no more than 15 minutes to administer and has five parallel forms. Developed in Germany, it has been used successfully to document improved performance of patients in trials of antidementia drugs in that country. This article addresses factor structure and scoring, dementia profile classification, reliability, and validity data. The SKT appears to hold promise for efficient assessment of objective performance changes to supplement clinical evaluations of therapeutic efficacy of new drugs for treatment of senile dementia.


Induction of TH1 and TH2 responses: a key role for the 'natural' immune response? What pushes a T-cell response towards a predominantly TH1 or TH2 phenotype? Several factors have been proposed, including the properties of antigens, dose of antigen, site of exposure and ongoing immune response in the host. Here, Sergio Romagnani presents new evidence to indicate a determining role for the 'natural' immune response, including NK cells and cells of the mast cell/basophil lineage, in the subsequent 'specific' T-cell response.


Pattern of use of antidepressants in long-term care facilities for the elderly. Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.


Immunotoxins: the power and the glory.

Immunotoxins: the power and the glory. Immunotoxins are hybrid proteins in which the potent cytocidal action of a toxin is harnessed for the selective destruction of target cells by attachment to a specific monoclonal antibody (mAb) or growth factor. This brief article describes the latest advances in the molecular and cellular biology, pharmacology and clinical evaluation of immunotoxins, as discussed at a recent meeting.


Limitation of the Mini-Mental State Examination for the detection of amnesia. The present study demonstrates the limitation of the Mini-Mental State Examination (MMSE) for detecting the amnestic syndrome. Although neuropsychological testing yielded severe memory deficits in all of the 11 amnesic patients tested, six of the patients obtained total MMSE scores above the standard cutoff score of 24. Further, only six patients completely failed the MMSE recall item, and three patients performed errorlessly on this item. Results from one postencephalitic patient are presented in detail. She performed the serial sevens task very quickly and subsequently recalled all three of the to-be-remembered words. Her performance on other memory tests confirmed that a longer retention interval than that provided by the MMSE is necessary to elicit her memory disorder.


Eosinophils 1992.

Eosinophils 1992. This report from a recent meeting* highlights some of the key developments in eosinophil research and assesses their impact on current views of the role of eosinophils in inflammation. Considerable progress has been made in defining the structure, constituents and properties of eosinophils in vitro and these new insights into eosinophil biology are summarized. A new era is beginning in which the roles of eosinophils can be assessed and defined in vivo.


The association of normal-pressure hydrocephalus with obstructive sleep apnea. This report describes a 70-year-old man with obstructive sleep apnea who deteriorated rapidly when nasal continuous positive airway pressure was begun. The patient was found to have normal-pressure hydrocephalus, which was possibly exacerbated by the nasal continuous positive airway pressure. A review of the literature indicates several significant associations between apnea, normal-pressure hydrocephalus, and increased intracranial pressure and suggests that the association of obstructive sleep apnea and hydrocephalus might not be rare. Implications for diagnosis and treatment are discussed.


The developmental relationship between NK cells and T cells. NK cells and T cells share many features, suggesting that they have a common origin. Here, Lewis Lanier and colleagues describe recent studies of fetal ontogeny and thymic development that provide support for this hypothesis, and propose an integrated scheme for NK-cell and T-cell development.


Immunoglobulins did not arise in evolution to fight infection. The complex interactions between B and T cells in response to external antigens are the major focus of contemporary immunology. Here, John Stewart argues that they may be relatively late evolutionary developments, due to the redeployment of a system invented for other reasons. He suggests that the system of variable region molecules (VRM) arose, at the time of the first vertebrates, by an endogenous, self-organizing process; this primordial VRM system instituted a molecular ecology, a function so important that from then on no vertebrate has been able to do without it.


Mechanisms of self tolerance.

Mechanisms of self tolerance. The redundancy of biological systems minimizes the probability that isolated molecular and cellular defects entail deleterious consequences. This notion also applies to the establishment and maintenance of tolerance to self antigens. Thus, immune homeostasis is attributed to multiple distinct safety valves that are connected in series and intervene at defined control points of the life cycle of the developing lymphocyte to guarantee the physical elimination, functional inactivation, or regulated inhibition of self-reactive, potentially autoaggressive, B and T cells.


Diseases associated with HTLV-I: virus, IL-2 receptor dysregulation and redox regulation. HTLV-I, the etiological agent in adult T-cell leukemia, has also been strongly implicated in a number of non-neoplastic T-cell-associated diseases. Here, Junji Yodoi and Takashi Uchiyama review these associations and focus on the emerging concepts of IL-2R dysregulation and redox regulation by adult T-cell leukemia-derived factor in the pathogenesis of HTLV-I-related diseases.


Insect defensins: inducible antibacterial peptides. In response to bacterial challenge or trauma, insects produce a battery of bactericidal or bacteriostatic molecules with a broad spectrum of activity against Gram-positive and/or Gram-negative bacteria; most are small-sized cationic peptides. This review focuses on insect defensins, a large group of inducible antibacterial peptides that are present both in ancient and recent insect orders. This immune response of insects shares many of the characteristics of the mammalian acute phase response.


The size of the mature membrane receptor for follicle-stimulating hormone is larger than that predicted from its cDNA. A 240 kDa protein isolated from bovine calf testis has been shown to have properties characteristic of an FSH receptor. However, rat testis FSH receptor has, on the basis of cloning experiments, been found to have a much lower molecular mass of 75 kDa (peptide only). To examine this point, the size of the FSH receptor in membranes obtained from cultured Sertoli cells of immature rats was determined after polyacrylamide gel electrophoresis under non-reducing conditions, followed by transfer to polyvinylidene difluoride membranes and direct identification of the FSH receptor by ligand blot analysis utilizing radioiodinated human FSH. In this system, the rat Sertoli cell membrane FSH receptor also showed a molecular mass of 240 kDa. Bovine testis contains LH and FSH receptors. We compared the sizes of FSH and LH receptors present in the same bovine testis membrane preparation by ligand blot analysis. The FSH receptor again showed a molecular mass of 240 kDa, whereas the LH receptor showed a molecular mass of 90 kDa. The latter value is similar to that deduced by cloning techniques (75 kDa, peptide only). The evidence seems to suggest that, whereas the molecular mass deduced for the LH receptor on the basis of its cDNA is similar to that of the mature membrane receptor, the size of the FSH membrane receptor is considerably different from that deduced on the basis of its cDNA, presumably as a result of post-translational processing. The marked difference in size between mature FSH (240 kDa) and LH (90 kDa) receptors may reflect significant structural differences of importance with regard to mechanisms of signal transduction.


Design and synthesis of heterofunctional V1a-selective vasopressin receptor ligands with lysine at position 9. A peptide analogue of [8-arginine]vasopressin (AVP) with Lys substituted for Gly at position 9 ([d(CH2)5Tyr(Me)2LysNH2(9)]AVP; ALVP) has been synthesized as a precursor for the production of heterofunctional vasopressin receptor ligands. Three heterofunctional ligands have been prepared by attaching biotin and a photoreactive cross-linker capable of iodination, either alone or in combination, to the epsilon-amino group of Lys at position 9 in ALVP. The binding characteristics of these novel ligands have been determined at the V1a and V2 vasopressin receptors by employing membrane preparations of rat liver and kidney respectively. All of the analogues synthesized during the course of this study bound selectively, and with high affinity, to the V1a vasopressin receptor subtype. Our results demonstrate that the strategies described in this paper provide a convenient means of synthesizing heterofunctional vasopressin receptor ligands with preservation of subtype-specific, high affinity binding characteristics. These parameters establish the potential value of the analogues as probes for investigating V1a receptor structure and function.


Hormonal control of insulin-like growth factor-II gene expression in the rat liver. IGF-II in the rat is an embryonic/fetal growth factor. Transcription of its gene falls abruptly in the liver at about 18-20 days postnatally. In an attempt to elucidate the mechanisms controlling this phenomenon, we used Northern analysis to investigate the effect of corticosterone and thyroid hormones (tri-iodothyronine and tetra-iodothyronine) on hepatic IGF-II mRNA levels. The administration of either corticosterone or tri-iodothyronine to 8-day-old pups resulted in a significant decrease in IGF-II mRNA when the animals were examined on day 12 of life. Adrenalectomy, thyroidectomy or adrenalectomy combined with thyroidectomy were, however, without effect. Our results indicate that glucocorticoid and thyroid hormones are not the exclusive regulators of IGF-II gene transcription in the rat liver, but participate in this process, which appears to involve multifactorial interactions.


Regulation of steady-state follistatin mRNA levels in rat granulosa cells in vitro. The regulation of steady-state follistatin mRNA levels by different pituitary hormones and peptide factors was examined in granulosa cell cultures derived from diethylstilboestrol-treated immature rats. Cytosolic RNA from cell cultures was prepared by lysis and equal amounts of RNA from all samples were analysed with a solution-hybridization assay using a 32P-labelled antisense probe corresponding to a part of exon 5 together with a part of the 5' end of exon 6 of the rat follistatin gene. In addition, a specific 35S-labelled probe for cyclophilin was used as an internal standard. The results show that 5 micrograms FSH/l for 24 to 72 h stimulated steady-state follistatin mRNA levels, reaching levels 18.5-fold higher than controls. LH (0.2-100 micrograms/l) had only minor effects on follistatin mRNA levels in FSH-primed granulosa cells and prolactin, GH and IGF-I did not show any significant effects. Activin raised basal as well as FSH-stimulated steady-state follistatin mRNA levels up to ten- and twofold above controls respectively, whereas epidermal growth factor was found to inhibit FSH-stimulated follistatin mRNA levels in a dose-dependent manner. It is concluded that follistatin mRNA levels in granulosa cells are regulated by FSH rather than LH, and that the stimulation by FSH can be inhibited by epidermal growth factor but enhanced by activin. Activin alone was also capable of stimulating follistatin mRNA.


Extra-pancreatic expression of the rat islet amyloid polypeptide (amylin) gene. Messenger RNA for rat islet amyloid polypeptide (IAPP) has been identified not only in the pancreas but also, in lesser amounts, in preparations from the stomach and dorsal root ganglia. In the stomach, insulin mRNA was not detectable, ruling out possible contamination by pancreatic tissue. Because IAPP and calcitonin gene-related peptide (CGRP) are related and CGRP is present in both stomach and dorsal root ganglia, it was possible that 'IAPP' signals were in fact due to cross-hybridization with CGRP mRNA. A second IAPP probe was constructed which does not cross-react. This probe also detected mRNA in both tissues, confirming the expression of IAPP in both tissues. The regional distribution of IAPP mRNA in the stomach did not parallel that of gastrin mRNA. IAPP mRNA was present in the antrum, centrum and pylorus and, like gastrin, the highest amounts were in the pylorus. However, the ratio between the pylorus and centrum was 3.6:1 for IAPP and 156:1 for gastrin. The effects of dietary manipulation were determined; a period of 48 h of starvation reduced pancreatic IAPP mRNA by approximately 60%, whereas in the stomach there was no significant reduction. If the action of IAPP was hormonal, pancreas and stomach would not be acting in concert. A paracrine role for gastric IAPP therefore seems more likely.


Membrane permeability to K+ and the control of aldosterone synthesis: effects of valinomycin and cromakalim in bovine adrenocortical cells. Stimulation of aldosterone synthesis by angiotensin II (AII) is associated with depolarization of the cell membrane. Since the potential difference of adrenocortical cells is dependent on membrane permeability to potassium ions, the effects of agents which hyperpolarize the cell (by increasing permeability to K+) on the control of aldosterone synthesis were investigated further. Basal and AII-stimulated aldosterone synthesis was increased by 20-70% in cells incubated with 1 or 10 nM of the potassium ionophore valinomycin; higher concentrations markedly inhibited AII-stimulated synthesis. Cromakalim, a potential antihypertensive drug which facilitates the opening of K+ channels in smooth muscle cells, stimulated basal aldosterone synthesis at 2 microM but had no effect at 40 microM. AII-stimulated aldosterone synthesis was not affected by cromakalim except at 40 microM, which was inhibitory. The inhibitory effects of cromakalim, unlike those of valinomycin, were not reversible. Aldosterone synthesis from added hydroxycholesterol and pregnenolone (but not from deoxycorticosterone and corticosterone) was significantly inhibited by 40 microM cromakalim. Potassium efflux from cells preloaded with 43K was unaffected by low concentrations of valinomycin, but was markedly increased by concentrations which inhibited AII-stimulated aldosterone production. Small decreases and increases in 43K efflux, caused by 1 and 40 microM cromakalim respectively, corresponded with increases and decreases in basal aldosterone production; cromakalim did not affect 43K efflux from AII-stimulated cells. We suggest that increasing adrenocortical cell membrane permeability to K+ reduces steroidogenesis, but that valinomycin and cromakalim have other actions which complicate the relationship between 43K efflux and aldosterone production. Cromakalim appears to inhibit 21-hydroxylase activity in the biosynthetic pathway and may also affect 3 beta-hydroxysteroid dehydrogenase activity.


Microheterogeneity of pituitary follicle-stimulating hormone in male rats: differential effects of the chronic androgen deprivation induced by castration or androgen blockade. Testicular androgens are known to influence not only the secretion but also the bioactivity and molecular composition of pituitary FSH. In the present study, we investigated the effects of chronic androgen blockade and castration on the molecular heterogeneity of the gonadotrophin. Groups of male adult rats (five animals per group) received one of the following treatments: vehicle, the non-steroidal anti-androgens casodex (20 mg/kg per day) or flutamide (20 mg/kg per day), or castration. After 8 weeks, the animals were killed and individual pituitary homogenates fractionated by isoelectric focusing (IEF) on sucrose density gradients in the pH range 2.5-8. FSH was measured by radioimmunoassay (RIA) in the individual fractions and by invitro bioassay (Sertoli cell aromatase bioassay) in pools of fractions which were combined according to pH intervals of 0.5 units. Bioactive and immunoreactive FSH were also measured in sera and unfractionated pituitary extracts. Testosterone and inhibin were assayed in sera by RIA. A significant increase in serum immunoreactive and bioactive FSH was demonstrated in flutamide-treated and castrated animals, whereas the pituitary content of bioactive FSH remained unchanged in the four groups. Serum testosterone and inhibin were undetectable in castrated animals and significantly increased in those treated with flutamide. By RIA, the IEF profiles of the flutamide-treated and castrated rats showed a significant reduction of the FSH isoforms with 3.5 < pI < 4, with a significant increase in the isoforms with pI > 4 only in the castrated group.(ABSTRACT TRUNCATED AT 250 WORDS)


[Measurement of mediators in drug allergies. Preliminary study]. Drug allergy is still a region where diagnosis remains difficult. It relies on clinical history, sometimes skin tests and lymphoblast transformation tests, though only when the antigen is soluble. Provocation tests may, if there is a doubt, prove the involvement of the drug. It may be made objective by the measurement of mediators: ECD and tryptase, thus showing the involvement of eosinophils and mastocytes. Should change in these mediators be associated with a syndromic reaction or is it on its own, a diagnostic factor? A complementary study with a reference group, on a sufficient number of patients has allowed, with the assistance of a statistical analysis, better objectivity from the results.


[Occupational asthma caused by isocyanates]. The aim of our study is to find whether the percentage of RAST positives to isocyanates within a company is a reflection of the exposure of the workers. Specific IgE was sought in 199 workers from ten companies where isocyanates were used. Twenty of them were followed for some time (june 87 to september 90). A non-exposed reference group was used for comparison. Measurements were made by the Pharmacia RAST-ELISA Method. In some cases, controls were made by RAST-RIA and CAPS ELISA/RIA. Results show that the proportion of positive RAST varies from one organisation to another and is probably a measure of the type and intensity of the exposure; the improvement of the working conditions to reduce the ambient concentration reduces, in time, the proportion of positive RAST; there were no positive RAST in the reference group; the conditions of taking and storage of blood samples before analysis influences the result. In conclusion, measurement of specific IgE may be an useful alternative to measurement of ambient concentration for following workers exposed to isocyanates.


[Measurement of specific IgE (sIgE) using the MATRIX technique]. In this study, on 34 subjects, the technique for measurement of sIgE by the MATRIX technique has been compared with the reference of CAP RAST, skin tests and clinical history. The two techniques of CAP RAST and MATRIX are judged to be comparable (correlation percentage 88.2%). The results obtained with four allergens [D. pteronyssinus, Timothy grass (Phleum pratense), cat and dog] done separately confirm the reliability of the technique. The study was completed by a comparison of the advantage and disadvantages of CAP RAST and MATRIX. This shows that the manipulation time is much reduced, but with a longer delay time and high reagent cost. In contrast, it has the enormous advantage of using a standardised range of allergens.


Combined treatment of allergic rhinitis with terfenadine and nimesulide, a non-steroidal antiinflammatory drug. Thirty patient with allergic rhinitis sensitized to Parietaria pollen were enrolled in a double-blind clinical trial in order to evaluate whether the addition of nimesulide, a non-steroidal antiinflammatory drug, to standard antihistamine therapy may improve symptom relief. Patients were randomly divided in two groups: one was given terfenadine (120 mg/day) and nimesulide (200 mg/day), the other was given terfenadine (120 mg/day) and placebo. Both treatments lasted 30 days. Clinical efficacy was assessed by physical examination on 1st, 15th, 30th day of treatment, daily self-evaluation of symptom score, and patient's overall judgement at the end of the trial. The group receiving terfenadine + nimesulide reported a significant lower symptom score and gave a better overall evaluation than the group receiving terfenadine + placebo. These results suggest that the addition of nimesulide to antihistamine treatment may be useful to achieve a better relief of symptoms in allergic rhinitis.


Plasma osteocalcin concentrations in cows around parturition. The influence of a regular versus a very short dry period. Plasma Ca, P, Mg and OC concentrations were compared between 2 groups of Holstein cows around 2nd calving. Thirteen cows were milked until their daily milk production was lower than 2 kg, which occurred 4 d before parturition. The control group (8 cows) was normally dried 8 weeks before the expected time of calving. Apart from the week following the initiation of the dry period where plasma OC concentrations were significantly lower in dried cows than in the control group (which would indicate lower bone remodeling in dried cows), no significant difference concerning Ca, P, Mg and OC concentrations were observed between the 2 groups of cows. This indicates that the only lack of 1 8-week-long dry period probably has no major immediate effect upon Ca and bone metabolism in young dairy cows given a convenient Ca and P daily intake. Nevertheless, the lack of the dried period might protect the cow against parturient hypocalcemia: the decrease in plasma Ca and P concentrations observed 12 h after calving was less intense in non-dried cows than in controls.


Degradation of maize stem by two rumen fungal species, Piromyces communis and Caecomyces communis, in pure cultures or in association with cellulolytic bacteria. Two species of rumen fungi, Piromyces (Piromonas) communis FL and Caecomyces (Sphaeromonas) communis FG10, were cultured alone or in association with the cellulolytic bacteria Ruminococcus flavefaciens or Fibrobacter succinogenes on maize stem. A kinetic study of the degradation of the substrate was then made. After 48 h of culture, all non-lignified tissues observed by scanning electron microscopy disappeared with P communis and degradation was as complete as that observed in the rumen. In contrast, C communis degraded little of the plant cell walls. The ability of P communis to more rapidly degrade maize stem was probably due to the presence of filamentous rhizoids. The extent of dry matter loss after 8 days of incubation was practically the same in all the monocultures and in the 4 cocultures. However, the rate of degradation was faster in the bacterial than in the fungal monocultures and the co-cultures. No metabolic interaction was observed.


Follicular dynamics, plasma metabolites, hormones and insulin-like growth factor I (IGF-I) in lactating cows with positive or negative energy balance during the preovulatory period. The effect of dietary energy balance (EB) on growth of ovarian follicles was tested. Cows (n = 9) were fed a high energy diet (HE diet; positive EB; n = 4) or switched to a low energy diet (LE diet; negative EB; n = 5) during the preovulatory period. Non-esterified fatty acids (NEFA) were greater in cows fed the LE diet. Concentrations of luteinizing hormone (LH) were similar in HE and LE cows. However, the growth of preovulatory follicles in cows fed the LE diet was 50% that of cows fed the HE diet. Insulin-like growth factor-I (IGF-I) in plasma was less in LE-fed cows compared with HE-fed cows, and plasma IGF-I was positively correlated to estrogen: progesterone ratio in follicular fluid of dominant follicles. In summary, slower follicular growth in cows fed an LE diet occurred despite normal plasma LH and coincided with reduced IGF-I and elevated NEFA in plasma.


Feeding behavior in rats on a complete diet containing Concanavalin A. Canavalia ensiformis is a tropical legume which could be used in animal feeding. However, it contains a lectin, Concanavalin A (Con A) which is harmful to animals. When rats are presented with a diet containing Con A, rejection of the food appears very soon after the beginning of ingestion. In order to examine this rejection phenomenon 3 studies were carried out. The rejection was found not to be due to a neophobic response, nor could it be attributed to a conditioned taste aversion. The gastric intubation study suggested the hypothesis that it could be the binding of the lectin to the glycosylated molecules from the gut membrane which impaired absorption and hence food intake.


[In vitro simulation of rabbit cecal fermentation in a semi- continuous flow fermentor. I. Role of food substrate pretreatment]. A Rusitec semi-continuous flow fermentor was used to study the influence of enzyme pretreatment of food substrates on the fermentation profile over a 2-week period following inoculation with rabbit caecal contents. Three types of substrate were examined: 1) homogenized commercial rabbit feed; 2) the solid remains of this feed after digestion with alpha-amylase for 24 h; and 3) substrate 2 digested for 4 h with pepsin (double enzyme treatment). One of a pair of nylon pouches containing 15 g substrate was replaced each day, thus producing a uniform 48-h fermentation. Fermentation of the untreated feed (1) for 5-6 days produced a fermentation profile quite different from that obtained in vivo in the rabbit caecum: propionic acid accounted for over 35% of total volatile fatty acid (VFA), and butyric acid for about 15%. Amylase digestion (2) gave a stable ferment profile closer to the in vivo profile, except that propionic and butyric acids were similar at 15% of total VFA. Digestion with both amylase and pepsin (3) produced a stable fermentation profile very close to the in vivo profile: C2 > 60%, C3 < 11% and 17% < C4 < 21%. The rate at which membrane constituents (acid detergent fibre, ADF) were lost in 48 h was similar to the digestibility coefficient measured in vivo by others for the same basic feed. Lastly, there was a high percentage (about 5%) of volatile C5 fatty acids; this could be due to the discontinuous fermentor input of one pouch per 24 h. Thus, feed pretreated with both amylase and pepsin simulates, in vitro, rabbit caecal fermentation in a semi-continuous Rusitec type fermentor.


[In vivo study of cecal fermentation activity in the rabbit. Completion and validation of a new technique for cecal cannulation]. A new technique for caecal cannulation in adult rabbit was validated in order to perform in vivo studies of caecal fermentation under a physiological status. The cannulation did not modify the digestibility of the diet, and it was possible to collect digesta (10 g fresh matter) after a few minutes without stress for animals only 10 days post-surgery. Volatile fatty acid (VFA) (60 mM/l) and ammonia (11 mM/l) concentration of caecal digesta collected in vivo was not different from that obtained from slaughtered rabbits. VFA measurements were reproducible (CV = 6.8%) and were not dependent on the daily collection frequency (1-5/day). Caecal VFA level in the starved rabbit was very low (23 mM/l) while the butyrate/propionate rate was the inverse (C4/C3 = 0.6). Five h after feeding, the in vivo VFA level reached 96 mM/l and the butyrate proportion (12%) over-reached those of propionate (3.5%). The caecal fermentations of a 7-week-old rabbit differed from those of an adult by a higher VFA level and by a greater post-feeding variation in the fermentation pattern.


Influence of the method of forage conservation on feeding behaviour, intake and characteristics of reticulo-rumen content, in sheep fed ad libitum. The influence of silage conservation methods on eating behaviour and the characteristics of reticulo-rumen contents was studied in sheep by comparing 3 forages, a silage without additive (WAS), one with additive (FAS) and hay (H), prepared from the same cut green forage. The sheep were rumen fistulated. WAS was very badly and FAS poorly preserved while the hay was dried under favourable conditions. The forages were fed ad libitum and the dry matter (DM) intake was 1,054, 1,241 and 1,469 g/day for WAS, FAS and H respectively. There was a single feeding in the morning. At the main meal, DM intake was 270, 317 and 388 g/day and ingestion rate 4.76, 4.56 and 4.16 g of DM/min for WAS, FAS and H respectively. There was slight recovery in ingestion around 16-19 h with hay and FAS but not with WAS. With hay, rumination lasted much longer than with the silages and began sooner after the end of the main meal. In contrast, overall rumination efficiency was the same for hay and FAS. There were fewer contractions of the reticulo-rumen with both WAS and hay. The amounts of reticulo-rumen contents were comparable for the 2 silages and higher for hay. The amounts of NH3 in the contents were the same with WAS and hay but greater with FAS. With WAS, contents were richer in butyric, valeric and caproic acids. The DM turnover rate of the contents was the same for FAS and hay and lower, but not significantly, for WAS. Accordingly, with silage, satiety seems to be rapidly reached but there was no evidence that organoleptic factors were involved. There were no problems with the digestion rate of silages. However, the factors limiting silage intake persisted throughout the diurnal cycle, and reticulo-rumen fill was affected. The more poorly preserved the silage the more these factors reduced the duration and volume of the meals, or both.


Ultrastructural study of sex inversion in a protogynous hermaphrodite, Epinephelus microdon (Teleostei, Serranidae). Sex inversion of Epinephelus microdon, a protogynous hermaphrodite was studied using light and electron microscopic criteria. The sex changes takes place within ex-ovarian lamellae in which, in addition to spermatogonia, numerous primordial germ cells (PGCs) were detected. These undifferentiated and bipotential early germ cells are involved, as well as spermatogonia, in the building up of the testis.


Update on immunotherapy for recurrent pregnancy loss. Results of recent, randomized, placebo-controlled clinical trials have raised questions about the efficacy of immunotherapy for recurrent spontaneous abortion (RSA). Most of the clinical trials have shown a 70% successful pregnancy rate with immunotherapy. The controversy comes from variations in success rates in the control populations, which have ranged from 29% to 76%. Explanations for these variations includes small sample sizes and heterogeneity by the populations studied as well as cointervention by the placebo. A meta-analysis has been proposed to investigate these explanations. Because the trials have largely used husband's leukocytes for immunization, alternative forms of immunotherapy have been sought. Two treatments that have been proposed but have not completed testing a randomized, placebo-controlled trials are intravenous immunoglobulin (IVIG) and immunization with seminal plasma. A safe and efficacious method is needed to treat recurrent spontaneous abortion; it is hoped that results of proposed studies will answer this controversy.


Association between infertility and spontaneous abortion. Women experiencing recurrent spontaneous abortion have a higher frequency of infertility than that expected in the general population. To further define the relationships between infertility and spontaneous abortion, the obstetrical histories of 43 women with unexplained secondary infertility were evaluated for the frequency of spontaneous abortion. Of the 88 pregnancies studied, 39 (44%) resulted in spontaneous abortion. Women with unexplained secondary infertility experienced a three-fold increase (P less than 0.0001) in the frequency of spontaneous abortions and half the number of live births (P less than 0.0001) compared with the general population. We conclude that the association between infertility and spontaneous abortion includes a higher frequency of spontaneous abortion among infertile couples as well as a higher prevalence of infertility among recurrent spontaneous aborters compared with the general population.


Evaluation of immunological infertility. To evaluate the frequency with which immunological factors are associated with infertility, 92 couples with unexplained infertility were studied by using assays to detect anti-sperm antibodies (ASA), human leukocyte antigen tissue types (HLA), lymphocytotoxic antibodies (LCA), and inhibitors of mixed lymphocyte culture (MLC) and mouse blastocyst assay (MBA). Seventy-three of the women had blood assayed for antiphospholipid antibodies (APA). The frequencies of APA, ASA, LCA, inhibitors of MLC and MBA, as well as HLA associations previously reported to be related to infertility (B locus blanks, single DQ locus in offspring, greater than 1 DR sharing between mates) among 92 infertile couples were compared with those observed among 41 fertile control couples. No significant differences in the frequencies of APA, ASA, MBA, and HLA associations between fertile and infertile couples were observed. Fertile couples demonstrated the presence of wife anti-husband LCA and MLC inhibitors more frequently than did infertile couples (51% vs. 8%, P = 0.0001 and 29% vs. 4%, P = 0.002, respectively). While APA, ASA, HLA tissue typing, LCA, and MLC and MBA have been previously reported as being markers of autoimmune and alloimmune responses relating to reproductive outcome, the current data suggest that more specific markers are necessary to diagnose immunological components of infertility.


Sera from preeclamptic women specifically activate human umbilical vein endothelial cells in vitro: morphological and biochemical evidence. Endothelial cell dysfunction could explain many of the pathophysiological changes observed in preeclampsia. Markers of endothelial cell activation including increased circulating Von Willebrand factor (VWF) and cellular fibronectin (cFN) antedate clinically evident disease. We have therefore proposed that alteration of endothelial cell function by circulating agent(s) produced by the placenta initiates the clinical syndrome. This hypothesis predicts that there are a factor(s) in the blood of women with preeclampsia that are capable of altering endothelial cell function. We and others have examined in vitro interactions of maternal serum and endothelial cells to test this hypothesis. Our initial report indicating increased release of [51Cr]chromate from human umbilical vein endothelial cells (HUVE) suggested a lethal, lytic effect of serum from preeclamptic women. However, more specific indicators of endothelial cell structure and function do not support such a nonspecific effect. The morphology of HUVE was minimally altered after exposure to sera of preeclamptic women, and the entry of propidium iodide entry into cells, a sensitive indicator of membrane integrity, also was not increased. These findings, in combination with the increased expression of mRNA for platelet-derived growth factor (PDGF), suggest endothelial cell activation rather than cell death in response to sera from preeclamptic women. Comparison of the effects of endotoxin and sera from preeclamptic women also supports the specificity of this response. Whereas endotoxin strikingly increased VWF on the surface of HUVE and tissue factor activity in conditioned media while minimally increasing cFN, preeclamptic sera increased cFN but had no demonstrable effect on VWF or tissue factor activity.(ABSTRACT TRUNCATED AT 250 WORDS)


New concepts in ovarian regulation: an immune insight. The purpose of the ovary is to produce eggs. In the human, oocyte production occurs cyclically at monthly intervals. The control of egg production is provided by both the endocrine and immune systems. Successful oocyte production is the result of sophisticated communication between the two systems. These interactions allow adaptive processes necessary for continuation of the species.


Sperm antibodies.

Sperm antibodies. Anti-sperm antibodies (ASA) occur in 1% to 30% of infertile couples. Mechanisms by which ASA impair fertility include prevention of fertilization by decreasing acrosome reaction and/or zona pellucida binding, and postfertilization effects. Treatment for ASA involves assisted reproductive technologies.


Interleukin-1 alpha and interleukin-1 beta in preterm and term human parturition. Interleukin-1 (IL-1) has been implicated in the mechanism of human parturition in the setting of infection. The purpose of this study was to determine the effect of labor (term and preterm) and microbial invasion of the amniotic cavity on amniotic fluid (AF) concentrations IL-1 alpha and IL-1 beta. AF was retrieved by transabdominal amniocentesis from the following groups of women: midtrimester genetic amniocentesis (16 to 18 wk) (N = 15), preterm labor with intact membranes (21 to 36 wk) with or without infection (N = 72), preterm premature rupture of membranes (PROM) (N = 88), and term not in labor or in active labor with or without infection (N = 58). AF was cultured for aerobic and anaerobic bacteria as well as Mycoplasmas. IL-1 was measured with a commercially available immunoassay validated for AF (sensitivity: IL-1 alpha, 157 pg/ml; IL-1 beta, 50 pg/ml). All women at midtrimester had undetectable AF IL-1 alpha and IL-1 beta. Among women in preterm labor with positive AF cultures, IL-1 alpha and IL-1 beta were detectable in the AF in 86.6% (13/15) and 100% (15/15), respectively. In contrast, all women with negative AF cultures without labor (N = 36) had undetectable AF IL-1 alpha concentrations and 52.7% (19/36) had undetectable AF IL-1 beta concentrations. Histopathological chorioamnionitis was present in 92.8% (13/14) of patients who had positive AF cultures and detectable IL-1 in the AF. IL-1 was significantly higher in patients with preterm PROM, labor, and positive AF cultures than in the other subgroups of patients with preterm PROM.(ABSTRACT TRUNCATED AT 250 WORDS)


Characterization of the anti-cancer activity of transferrin-adriamycin conjugates. The anthracycline anti-cancer drug adriamycin (Adr) was coupled to human transferrin (Trf) by using a glutaraldehyde technique. The effect of Trf-Adr conjugates and unconjugated Adr on human cells was determined by using normal peripheral blood mononuclear cells and chronic myelogenous K562 cells. Cytotoxicity was determined by using an assay that measures the conversion of a tetrazolium salt (MTT) into a purple product (formazan) by mitochondrial dehydrogenases in viable cells. We found that free Adr at a concentration of 1 x 10(-7) had little effect on K562 cells, while Trf-Adr conjugates inhibited 75% of cellular activity. When normal peripheral blood mononuclear cells were tested against Trf-Adr conjugates, the 50% inhibitory concentration was found to be 1.4-1.7 x 10(-6) M, at which concentration greater than 85% of K562 cells were inhibited. Interactions of Trf-Adr conjugates with plasma membrane energy-producing systems are the proposed mechanisms of cytotoxicity.


Danazol suppresses both spontaneous and activated human lymphocyte-mediated cytotoxicity. Danazol is an effective drug in the treatment of endometriosis. Previous reports suggest that it can act by influencing the immune system. Thus, in this study we evaluated whether danazol is able to affect the expression of natural and activated cytotoxicity by human peripheral blood lymphocytes (PBL). A cytotoxicity assay by 51Cr release was performed to determine the effect of danazol on lymphocyte cytotoxic response toward an erythroleukemic cell line (K562). A significant suppression of spontaneous cytotoxicity was observed when lymphocytes were pretreated for 18 h with danazol at the concentration of 5 x 10(-6) M. In addition, danazol could significantly inhibit both IL-2- and INF alpha-activated cytotoxicity at the concentration of 10(-5) M. Following 18 h exposure to danazol, PBL were able to completely recover their spontaneous but not activated cytotoxic potential upon further in vitro incubation (18 h) in absence of the drug. The biological significance of danazol as an inhibitor of immune function under experimentally defined conditions is discussed in relation to its possible role in vivo.


Proto-oncogenes and germ-cell differentiation. Oncogenes are identified functionally by their ability to induce neoplastic transformation of susceptible cells. The first oncogenes to be characterized were isolated from acutely transforming retroviruses. Subsequently, it was determined that the retroviral oncogenes were formed from normal, progenitor genes. These cellular homologs of the viral oncogenes are termed proto-oncogenes. The derivation of oncogenes from proto-oncogenes is the consequence of mutations that remove regulatory constraints from the proto-oncogene. The ability of oncogenes to induce transformation implies that proto-oncogenes may function in growth and differentiation pathways in normal cells. Although many proto-oncogenes have been defined, the normal physiological function of most is not known. Studies of proto-oncogene expression during normal gametogenesis have determined that some genes are expressed in a stage-specific manner. The use of germ cells to provide homogeneous and defined normal cell populations facilitates identifying the roles proto-oncogenes have in regulating cell growth and differentiation.


In vitro sperm capacitation to treat antisperm antibodies bound to the sperm surface. Our objective was to study antisperm antibody bound to the acrosome region during in vitro capacitation and to determine whether acrosome-antibody free sperm can be obtained from previously acrosome-antibody-coated sperm. The spermatozoa from a selected series of 14 patients were tested for sperm antibodies bound to the sperm surface using d-IBT and focusing on the acrosome positivity. The tests were carried out before the incubation and after 3, 6, 9, and 12 h of incubation in Tyrode's solution with 0.5% human serum albumin as the capacitation medium. Tests to evaluate acrosome region, sperm motion parameters, and zonae binding ability were carried out. In this way we were able to evaluate sperm function during capacitation protocol. The patients were 14 subjects selected according to good seminal characteristics, good post-rise sperm parameters, and high percentage of ASA bound to the sperm surface. In all cases the results showed that antisperm antibodies bound to the acrosome region were shed prior to the acrosome reaction. During sperm capacitation in human a modification, migration, or shedding of plasma membrane molecules takes place. The presence of antibodies in such an important area of the sperm head could certainly interfere in the fertilization process. Our data indicate that in vitro capacitation could provide an in vitro therapy capable of eluting antibodies from the acrosome region.


The effect of peritoneal macrophage-derived factor(s) on ovarian progesterone secretion and LH receptors: the role of calcium. Macrophages and their secretory products, cytokines, play an integral role in many reproductive processes. In this study we examined the effect of conditioned media from cultured human peritoneal macrophages on progesterone production by granulosa cells and the role of calcium in this process. Macrophages were pretreated with various concentrations of a calcium channel blocker (verapamil) or a calcium ionophore (A23187). Macrophage-conditioned media (MCM) or cell-free media that contained calcium channel modifiers were added at three dose levels to cultured porcine granulosa cells. Progesterone production and LH receptor content were determined. Macrophage-conditioned media alone elevated basal progesterone production, but significantly attenuated granulosa cell LH receptor content. These effects were neither potentiated nor suppressed by pretreating macrophages with verapamil. However, production of the LH receptor lowering factor(s) appeared to be suppressed by calcium ionophore. We conclude that (1) one or more factors produced by macrophages have a net stimulatory effect on basal progesterone production and these factor(s) may not be calcium-dependent and (2) macrophage-derived secretory products reduce granulosa cell LH receptor content. The production of these factor(s) may be calcium-dependent.


A rat cytotrophoblast antigen defined by a monoclonal antibody. A monoclonal antibody that recognizes specifically a cytotrophoblast antigen was obtained. The monoclonal antibody 22H6 was tested on rat choriocarcinoma (in vivo, in vitro), normal placenta, ectoplacental cone, blastocysts, and several normal organs. The antigen was detected on frozen sections and on tissue culture by indirect immunofluorescence. The monoclonal antibody 22H6 reacts with the cytotrophoblasts of rat choriocarcinoma. The giant cells do not display a positive reaction. It is not expressed on other tumors than choriocarcinoma. In adult rats the only cells revealing a positive reaction are the hepatocytes and the epithelial cells lining the small intestine. In the pregnant rat, the antigen is expressed on the cytotrophoblasts of the junctional zone in the placenta, but not on the giant cells. The mab reacts only with the small trophoblast cells of the ectoplacental cone, but not with trophectoderm of blastocyst. The mab has an IgG2b isotype and is not cytotoxic for choriocarcinoma cells in a complement-dependent cytotoxicity test. The described monoclonal antibody is to our knowledge the only known marker of rat benign and malignant cytotrophoblast.


Supplementation of breastfed infants: does continuing education for nurses make a difference? Supplementation of breastfed newborns in the first few days of life is a common practice that interferes with the establishment of lactation and is related to early cessation of breastfeeding. Quality assurance audit results at a large maternity hospital led to the development of a continuing education program to increase nurses' knowledge of breastfeeding and thereby reduce supplementation. An integrated quality assurance and research methodology was selected to analyze the impact of the education and yield results that would be more generalizable and interest a wider audience. Findings revealed no change in supplementation behavior occurred following a four-week education program. Only 33 percent of newborns in the study were unsupplemented during their hospital stay. Formula was the most often used supplement. Continuing education alone was not effective in changing behavior. As shown in the literature, post-course reinforcement of behavior needs to be built into the cost of the program to implement and sustain desired changes.


Breastfeeding knowledge of hospital staff in rural maternity units in Ireland. Knowledge of breastfeeding is necessary for health workers to adequately assist breastfeeding mothers. This paper examines the level of knowledge concerning breastfeeding in three rural maternity units in Ireland. Health workers responding to a self-report questionnaire felt that they had adequate knowledge, but their answers to the questions did not always bear this out. Health workers felt more staff training in breastfeeding would help to improve breastfeeding rates. Thirty-four percent of respondents had never attended continuing education on infant feeding topics. Manufacturers of artificial infant formula were the main source of continuing education information. The knowledge level of obstetricians did not appear to affect breastfeeding rates. Pediatricians' breastfeeding knowledge was good, but they had little input in the care of healthy babies. Rising breastfeeding rates were found in the unit where midwives were more recently qualified and had higher knowledge scores. The need exists for more breastfeeding education in all the units examined, ideally provided by a staff member with current lactation training.


Nurses' knowledge of breastfeeding in a clinical setting. Most obstetrical nurses subscribe to the "breast is best" theory. This project examined the current knowledge base of a sample of nurses and their practices relating to breastfeeding in three clinical settings. These study findings reveal that many nurses need to update their knowledge of those practices found to encourage successful breastfeeding. Only seven of 16 questions were answered correctly by more than 50 percent of the nurses surveyed. Areas of adequate knowledge included positioning, breastfeeding frequency, infant suckling patterns, and the importance of night feedings. Areas of inadequate knowledge included timing of the baby at the breast, milk production, use of glucose water, and the use of nipple shields.


Breastmilk oversupply despite retained placental fragment. In clients experiencing oversupply, lactation consultants should question more closely the frequency of milk ejection reflexes and whether the mother is experiencing them only during breastfeeding or frequently, even while not nursing. If the mother is still experiencing vaginal bleeding, even if she is producing large quantities of milk, she should be encouraged to talk with her health care provider about having a sonogram in order to rule out the possibility of a retained placental fragment.


Intractable complex partial seizure: correlation of magnetic resonance imaging with pathology and electroencephalography. We prospectively analyzed MR studies of 32 patients with intractable complex partial seizures, who later underwent resection of EEG-proven seizure foci. Twenty-seven patients were imaged at 1.5, 4 at 0.35, and 1 at 0.5 Tesla. Correlation was obtained on all patients with EEG and surgical pathology. Of 19 patients with mesial temporal sclerosis (MTS), 13 exhibited an MR abnormality at the site of pathology as determined by EEG and surgery. Abnormalities included increased (8) or decreased (1) signal intensity, distortion of gray-white interface (1) and temporal lobe atrophy (3). Six patients had no abnormalities at the site of the diseased focus. MR was more sensitive in patients with other structural lesions which included tumor, encephalitis, polymicrogyria, cryptic vascular malformation, and tuberous sclerosis. Prior studies indicate some usefulness of MR in intractable seizure patients, but many report relative insensitivity of MR in defining an abnormality (as low as 11%). Our results demonstrate the usefulness of high-resolution thin-section multiplanar MR using cardiac gating or flow compensation techniques in this patient population.


Single photon imaging computed tomography (SPECT) for localization of epileptogenic focus in patients with intractable complex partial seizures. Interictal and ictal HIPDM-SPECT brain scans were obtained in 38 patients who eventually underwent temporal lobectomy for treatment of medically intractable complex partial seizures (CPS). Interictal studies revealed decreased regional cerebral perfusion (rCP) in the temporal lobe corresponding to the eventual site of surgery in 76% of the patients. Similarly, ictal studies demonstrated increased rCP in 91% of the patients. Of the 33 patients who had both interictal and ictal SPECT studies, 23 (70%) showed increased rCP in the ictal state and decreased rCP in the interictal state in the same temporal lobe which was subsequently removed. The SPECT scans were particularly helpful in providing confirmatory evidence for localization and in deciding to undertake temporal lobectomy in 16 patients whose EEG studies had provided less secure localization. Our experience suggests that interictal and ictal SPECT brain imaging can be easily obtained and provides reliable localizing information in the epileptic patients being considered for temporal lobectomy.


Natural history of drug resistant seizures: clinical aspects. In an effort to determine the long-term efficacy of surgical therapy for epilepsy, a control group of patients was identified. Both the surgically treated and non-surgical groups were evaluated before and after 5- or 10-year follow-ups for seizure frequency in the preceding 2 years. To date 39 patients have had bona fide partial seizures, with or without secondary generalization, and EEGs with focal epileptiform patterns. Prior to first evaluation, these patients had had seizures for an average of 10 years and were treated with an average of 54 AEDs with documented therapeutic serum levels in most; one-third of the patients participated in experimental studies. After treatment for another 5 years with an average of 2.5 AEDs or 10 years with an average of 4.0 AEDs, no one was seizure free. Fifteen percent had a 75% decrease in seizure frequency and 85% continued to have no significant improvement in seizure control. Thus despite vigorous treatment, these patients who might have been considered surgical candidates continued to have uncontrolled seizures.


Subdural electrodes in the presurgical evaluation for surgery of epilepsy. This article gives first an overview of the advantages and disadvantages of electrodes of progressively greater invasiveness used in the evaluation of patients who are candidates for surgery of epilepsy. The following sections discuss the design of subdural electrodes, their clinical indications, and the relative advantages and disadvantages of subdural electrodes when compared with other invasive techniques.


Different approaches to resective epilepsy surgery: standard and tailored. Intra-operative approaches to resective surgery for medically intractable epilepsy, especially cases involving temporal lobes, vary from anatomically standardized operations to those tailored to the location of epileptogenic zones and eloquent areas in individual subjects. The choice of approaches seems to depend on different views of the variability in epileptogenic zones and eloquent areas and on the reliability of identifying these areas intraoperatively, including the value of interictal epileptic activity. Evidence relating to these issues is reviewed. Although the choice of an intra-operative approach has a major effect on the risks and costs of the evaluation for epilepsy surgery, with higher risks and costs for approaches using standard operations or extra-operative recording, no controlled study has compared the approaches. Indeed, the reported outcome for optimal candidates for each approach is nearly identical, providing little justification for use of approaches with higher risks and costs in all patients.


Temporal resections in the surgical treatment of epilepsy. Cortico-amygdalo-hippocampectomy in our experience remains the surgical procedure of choice for the treatment of temporal lobe epilepsy. It allows removal of an ample amount of epileptogenic tissue, provides excellent exposure for the mesial structures and is not accompanied by significant intellectual deficit. It takes into account the fact that temporal seizures usually arise in the limbic structures but quickly recruit the whole anterior cortex in most instances. Selective amygdalo-hippocampectomy is an alternative approach when a clear mesiobasal limbic focus has been repeatedly demonstrated by intracranial recording.


Uncontrolled epilepsy in children.

Uncontrolled epilepsy in children. Intractable seizures in any age indicates (1) the continued presence of an unacceptable quantity of seizures despite reasonable medical and social management or (2) seizure eradication at the expense of medication toxicity. The incidence of seizures deemed unacceptable depends on their nature, the patient's life-style, physiological and social consequences of uncontrolled seizures, and the promise of surgical alleviation. The true value of surgery should increase as candidates and surgical sites can be more accurately selected, the necessary (and unnecessary) diagnostic tests better identified, and all aspects of its effects objectively evaluated in follow-up.


Assessment of surgical outcome.

Assessment of surgical outcome. Evaluation of outcome of epilepsy surgery is complex because of several factors. Epilepsy is itself a heterogeneous disorder. Different epilepsy centers encounter different referral mixes of patients. Institutions employ various methods for pre-operative evaluation and widely varying surgical techniques. Clear definitions of surgical success and reliable scales for its measurement are lacking. Few data are acquired prospectively and maintained in a format allowing inter-institutional collation of results. A better representation of surgical outcome could in the future be served by adherence to 4 principles: collection of common data in standard formats; comparison of like, rather than disparate, populations; maintenance of quantitative data in raw form; and measurement of outcome along several dimensions or scales. Psychosocial issues have been underemphasized in most prior analyses of outcome.


The natural history of drug resistant epilepsy: epidemiologic considerations. Approximately 160,000 United States residents will be evaluated for newly identified unproved seizures in 1990. While the majority will have a favorable prognosis and more than 50% will ultimately be able to discontinue medication, about 10,000 will fall into the category 'intractable'. There are well established predictors for seizure remission and for successful withdrawal of medications, including seizure type, etiology, age at onset, neurologic status, and family history. There are few studies which have evaluated predictors for poor outcome, in part because of difficulties with definition. Predictors of poor outcome are not necessarily the converse of predictors of good outcome. Identification of such factors is important to allow earlier referral of patients destined to meet criteria for intractable to allow alternative therapies to be instituted.


Drug treatment of uncontrolled seizures. The success of AED therapy for epileptic seizures varies according to epilepsy and seizure type. The outcome is excellent in the idiopathic generalized epilepsies, poor in the secondary generalized epilepsies and intermediate for the partial epilepsies. For this latter group, a table of outcome is described in Table I. Overall, approximately 70% of patients can be reasonably managed using one AED, although several may need to be tried before considering monotherapy to be a failure. Of the 30% unsatisfactorily managed by monotherapy, approximately another one-third can be adequately managed given a combination of two drugs. Combinations of more than two drugs provide little if any additional benefit. Evidence that such combinations have efficacy is inferred from the observation of seizure exacerbation when one drug is removed purposely to elicit seizures during evaluation for possible epilepsy surgery. The remaining patients are often considered for trial of an investigational drug although prospects for important improvement are very small even with use of agents shown to be effective and introduced for treatment of epilepsy. Thus, 15% of patients may conservatively be considered for surgical therapy. This would not suggest that all such patients are appropriate candidates from other aspects, but at least they can be considered to have failed all reasonable drug therapy.


Presurgical EEG investigation in frontal lobe epilepsy. Poor localization of the interictal epileptic abnormality and the rather unreliable EEG localization of ictal onsets in patients with frontal lobe epilepsy may be due to some of the following factors: (1) high risk of EEG sampling error, (2) early seizure spread within and outside the frontal lobe, (3) widespread distribution of the epileptogenic brain tissue responsible for the patient's habitual seizures, and (4) secondary bilateral synchrony and secondary epileptogenesis. The relevance of these factors in the preoperative investigation of patients with frontal lobe epilepsy was studied in: (a) 34 adult patients (mean age: 25 years) who became and persisted seizure free after restrictive surgical removal of the anterofrontal region, the parasagittal region convexity or the fronto-opercular area; (b) 12 patients in whom the pre-operative EEG investigation with extracranial electrodes failed to localize the site of seizure onset, leading to further investigation with depth electrodes.


Intractable epilepsy in adults.

Intractable epilepsy in adults. Intractable epilepsy can be defined as seizures which have not been completely controlled with AEDs 1 year after onset despite accurate diagnosis and carefully monitored treatment. Once intractable, there is a low probability of remission. Predictors of intractability include the presence of partial seizures, structural abnormalities on imaging studies, and abnormalities on the neurological examinations. If a person continues to have seizures in spite of adequate treatment with AEDs, surgical options should be considered.


Use of psychological and neuropsychological variables in selection of patients for epilepsy surgery. Cortical resection surgery for epilepsy is costly, involves risk, and does not result in significant seizure relief in a number of patients. Therefore, it is important to develop methods which will as accurately as possible identify in advance those persons who will or will not be helped by this procedure. From a review of the literature and from a presentation of original data, it is concluded that psychological/neuropsychological variables are valid predictors of cessation of seizures following surgery but that they are only infrequently used. A multidisciplinary, multivariate statistical approach, using EEG findings and psychological/neuropsychological variables in combination, provides the most accurate predictions which are superior to those derived from using either EEG variables or psychological/neuropsychological variables alone. This approach also avoids much of the predictive instability encountered when single variables are evaluated. Since psychological/neuropsychological variables are obtained at low cost and are non-invasive, further evaluation of their role as predictors of seizure relief following surgery is needed.


Neuropsychological techniques in the identification of epileptic foci. Neuropsychological evaluation contributes towards identification of a seizure focus through assessment of function. Tests sample widely among cognitive abilities, usually contrasting language and visuospatial competence. In patients with a temporal-lobe focus, evaluation of memory is crucial and ideally should comprise a variety of tasks tapping different aspects of learning and memory. As a means of predicting and preventing severe postoperative memory impairment, memory is further tested in many cases with the intracarotid sodium amytal (IAP) procedure; hippocampus will be spared in patients who fail IAP memory tests. Performance after temporal lobectomy on three basic memory tests was evaluated in patients who had failed pre-operative IAP memory tests compared to those who had passed. Those who had failed performed significantly worse, confirming fragility of memory function in cases who have been identified as at risk by the IAP procedure.


Identification of the epileptic focus: magnetic resonance imaging. Magnetic resonance imaging (MRI) is the most sensitive and specific structural imaging technique available to demonstrate focal epileptogenic lesions in patients with intractable partial epilepsy. MRI may be useful in the selection of candidates for surgical treatment of epilepsy. The studies may also assist in the implantation of depth electrodes and in the stereotactic resection of epileptogenic lesions. More recent applications of this neuroimaging modality in the surgical treatment of epilepsy include pre-operative hippocampal formation of volume measurements and postoperative quantitative determinations of cortical resections.


The electrical status epilepticus syndrome. The authors review the clinical and electroencephalographic features of electrical status epilepticus during slow sleep (ESES) in children. The major points of debate regard the nosology and diagnosis of ESES. The relationship between ESES and the neuropsychological impairment is emphasized. It is concluded that ESES is a separate electro-clinical entity which deserves individual categorization.


Benign myoclonic epilepsy of infancy: electroclinical symptomatology and differential diagnosis from the other types of generalized epilepsy of infancy. Benign myoclonic epilepsy in infancy (BME) is characterized by the occurrence of brief myoclonic attacks in normal infants aged 4 months to 3 years. There is no prior personal history, although in some patients 1 or 2 isolated febrile convulsions may occur prior to the onset of myoclonias. A family history of epilepsy or febrile convulsions is present in 30% of cases. Myoclonic attacks are short and mild, they involve mainly the head and upper limbs. The psychomotor development continues normally after the onset of seizures. The EEG shows a normal background activity and generalized spike-wave or polyspike-wave discharges associated with the myoclonias. These abnormalities are activated by drowsiness and during the first stages of sleep. A clinical and EEG photosensitivity is present in one-third of the patients. Myoclonias can be easily controlled by valproate monotherapy. Rare grand mal seizures can occur during adolescence, after withdrawal of drug treatment. The psychomotor evolution is good if treatment is started early. When myoclonias begin during the first year of life, the diagnoses of cryptogenic infantile spasms and of non-epileptic benign infantile myoclonus must be eliminated. In cases with a later onset, the following diagnoses can usually be easily discarded: cryptogenic Lennox-Gastaut syndrome, myoclonic-astatic epilepsy and unclassified epilepsies with the association of myoclonias and other types of seizures.


The therapy of benign myoclonic epilepsy in infants. The authors report the results of treatment of 14 patients (10 male, 4 female, average age 20.3 years) with benign myoclonic epilepsy. Valproate monotherapy led to control of seizures in 10 cases, and to a distinct reduction of seizure frequency in 3 cases. Thrombocytopenia was the only side-effect encountered in this study.


Myoclonic-astatic epilepsy.

Myoclonic-astatic epilepsy. Myoclonic-astatic epilepsy (MAE) belongs to the group of epilepsies with primarily generalized seizures as absence epilepsies, and juvenile myoclonic epilepsy, as well as infantile and juvenile idiopathic epilepsy with generalized tonic-clonic seizures. Like these types of epilepsy, MAE is polygenically determined with little non-genetic variability. The disease is characterized by the following criteria: genetic predisposition (high incidence of seizures and/or genetic EEG patterns in relatives); mostly normal development and no neurological deficits before onset; primarily generalized myoclonic, astatic or myoclonic-astatic seizures, short absences and mostly generalized tonic-clonic seizures; no tonic seizures or tonic drop attacks during daytime (except for some rare cases with a most unfavourable course); generalized EEG patterns (spikes and waves, photosensitivity, 4-7/sec rhythms), no multifocal EEG abnormalities (but often pseudofoci). There is a partial overlap with other 'syndromes', such as benign and severe myoclonic epilepsy in infants (Dravet et al., 1985a, b), myoclonic epilepsy of infancy and early childhood (Aicardi and others). In differential diagnosis the Lennox-Gastaut syndrome in its stricter sense has to be considered, and also atypical benign partial epilepsy or pseudo-Lennox syndrome. Discussion is presented of possible pitfalls in the classical syndromic approach to classifying epilepsies of early childhood, and of the advantages of a neurobiological view for understanding the immense variability of clinical manifestations of epilepsy.


Behavioural and developmental aspects of primary generalized myoclonic-astatic epilepsy. The evolution of psychomotor development and behaviour was studied in 15 children with primary generalized myoclonic-astatic epilepsy and with developmental status adequate for age at final examination at school age following a mean follow-up period of 8.5 years. Temporary arrest of mental and motor development in 4 children was related to high seizure frequency or, in 3, to non-convulsive status. Different types of behavioural abnormalities were documented frequently during the course of the disorder; they were significantly related to active seizure periods and to a lesser extent to anticonvulsant medication. Persistent behavioural abnormalities were noted in 5 children. Hyperkinesia, short attention span and emotional lability were the most frequent complaints. None of the children needed special care and those followed-up until school age were seizure-free, without medication and in classes appropriate for their age. At initial examination the high probability of a favourable prognosis may be anticipated in children with normal development before seizure onset, lack of gross brain pathology and with strong indications (family history and/or EEG criteria) for a genetic predisposition. Nevertheless, repeated systematic re-evaluation for early recognition of possible developmental and/or behavioural deviances throughout the course of illness are recommended.


Comparison of the EEG background activity of epileptic children and children with migraine. The EEG background activity was investigated in the interictal EEGs of 19 children with migraine and of 88 patients with epilepsy of idiopathic origin in the third year of treatment. The control group consisted of 96 healthy children matched for age. Spectral analysis was performed, and parameters of the relative power within the conventional frequency bands were compared with norm data. The means of parameters representing the background activity of migraine as well as of epileptic patients significantly differed (slowing) from those of healthy controls. No significant differences were found between the main groups of migraine and epileptic patients. In comparing the subgroups of epileptic as well as of migraine patients, the composition of the background activity in migraine patients without aura differed the least from the controls. While the background activity in epileptics (especially those with an unfavourable course) showed a moderate slowing, a high degree of slowing was observed in patients with migraine accompagnée.


Rolandic epilepsy: clinical and electroencephalographic features. Benign rolandic epilepsy (BRE) is a common seizure disorder confined solely to children. The disorder is marked clinically by nocturnal generalized tonic-clonic seizures and diurnal seizures consisting of simple partial seizures consisting of brief unilateral facial clonic activity, dysphasia, and drooling. The EEG abnormalities are unique, consisting of generally high amplitude, centrotemporal spikes that are activated by sleep. The seizures typically begin in the first decade and almost always stop by age 16 years. The seizures are usually infrequent although clusters of seizures do occur. When the physician elects to treat, the seizures are usually easily controlled.


The neurophysiological features of benign partial epilepsy with rolandic spikes. SEPs were performed in 44 children with benign partial epilepsy with rolandic spikes (BERS). High-amplitude mid- or long-latency SEPs were recorded in 17 patients (38%). These giant responses showed normal latency values but reached an exceedingly high amplitude (up to 200 microV). They showed the same reactivity characteristic of normal long-latency SEPs. In a 3-year follow-up study, the giant responses were shown to disappear in some patients and to shift from side to side in others. Our study demonstrates that giant SEPs are relatively common in BERS and give further support to the concept of a functional nature of rolandic foci.


Contribution to the genetics of rolandic epilepsy: waking and sleep EEGs in siblings. Waking and sleep EEGs were recorded in 69 siblings of 43 patients with rolandic spikes. 36 suffered from rolandic epilepsy, 7 from other diseases or symptoms (headaches, migraine, learning problems). At least one sibling with epileptic activity was found in 51.16% of the patients. Taking the 69 siblings as a basis, in 26 (37.68%) epileptic activity was recorded. Benign spike foci were recorded in only 4 siblings, generalized spike-wave complexes were seen in 22. Most epileptic activity was recorded in the age group of 5-12 years (54.3%). Nearly one-half (17.4%) was recorded exclusively in sleep, predominantly in sleep stage C (88%). Siblings of patients with (40%) and without seizures (37.5%) showed approximately the same rate, likewise siblings with (40%) and without seizures (34.8%). An autosomal-dominant mode of inheritance is assumed, but a multifactorial mode is also discussed.


Benign rolandic epilepsy of childhood: topographic EEG analysis. Topographic EEG investigation with instant voltage mapping showed maximal negativity of 'rolandic' spikes over central or midtemporal electrodes with spread to parietal or upper frontal areas, and a dipole distribution (centrotemporal negativity, frontal positivity). There was no correlation of spike amplitude or duration with spread to adjacent areas. No other focal abnormalities, such as focal slowing, occurred. Spike activity was pronounced during light sleep and was often associated with generalized spike-wave activity, and thus was a sign of functional disturbance rather than the sequelae of brain damage. A review of the literature indicates that this pattern is helpful in differentiating this from focal abnormalities due to brain lesions.


Is rolandic discharge a hallmark of benign partial epilepsy of childhood? A longitudinal study was conducted in 89 children with partial seizures who had rolandic discharges on their interictal EEGs. The clinical characteristics and seizure prognosis were compared in children without an organic background (idiopathic) and in children with an organic background (symptomatic). Since rolandic discharges and sylvian seizures were found in the symptomatic children and their seizure outcome was favorable, it is likely that they are symptomatologically close to benign childhood epilepsy with centrotemporal spikes. Some of the symptomatic patients may have had complex partial seizures, although rolandic discharges were the principal EEG finding. Their seizure prognosis was as unfavorable as that of the patients with other symptomatic partial epilepsies. The rolandic discharges disappear in an age-related manner in idiopathic patients, but tend to persist in the symptomatic ones. The presence of rolandic discharges was not considered a hallmark of a benign outcome. Instead, the presence of sylvian seizures heralds a benign outcome of partial epilepsies regardless of whether they are idiopathic or symptomatic.


The prognosis of benign localized epilepsy in early childhood. Onset of seizures during early childhood is a not infrequent possibility in benign partial (localization-related) epilepsy (BPEC) when all these syndromes and not only benign partial epilepsy with centrotemporal spikes are considered. In patients followed up for long periods of time, temporal changes in the EEG often make impossible a distribution into discrete syndromes. The electroclinical patterns overlap and the determining factor is not the location but the morphology of the sharp waves. A complete remission is observed in all patients, with rolandic and/or extrarolandic foci. In rare patients, seizures occur during adolescence or later and an early onset is a possible risk factor for such an outcome. It is not a relapse of BPEC but another epileptic syndrome, usually a generalized idiopathic epilepsy. BPEC may be considered as a risk factor for late epilepsy. Patients with an early onset of BPEC tend to have a longer active period of epilepsy and a higher total number of seizures, whatever is the EEG pattern. But neither frequent seizures nor a long seizure period impair the children's abilities. Nonetheless, when BPEC begins in early childhood, the patient is prone to experience frequent seizures during several years. Drug therapy is advisable more often than in BPEC with a later onset.


Profile of the paediatric burn patient in a Canadian burn centre. Five hundred and eighty-three children (0-18 years old), consisting of 33.4 per cent of all burn inpatients, were admitted to the University of Alberta Hospitals over an 11-year period (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4 per cent of burns occurred in children less than 4 years of age, with males predominating in every age group (P less than 0.001). Children had smaller burns, a higher incidence of scalds, less inhalation injuries and a lower mortality compared to adult burn patients admitted over the same time period (P less than 0.05). There was a low incidence of confirmed child abuse by burns (1.4 per cent). High-risk environments identified were the home (74.6 per cent of burns) and recreational settings (12.4 per cent of burns), mainly occurring around campfires. Native children were overrepresented in the burn population compared to the general population by a factor of approximately 10:1. Scald prevention, high-risk environments (home and recreational), high-risk populations (male and natives) and unsafe practices with flammable liquids (petrol in particular) should be emphasized in paediatric burn prevention programmes.


Environmental conditions for treatment of burned patients by the exposure method. The influence of the thermal environment on evaporation and heat loss from patients with severe burns treated by exposure has been studied. Simple heat transfer equations can be used to predict changes resulting from alterations in environmental conditions and these have been tested using phantoms. The method relies upon the derivation of surface diffusion resistances to describe the moisture properties of burn wounds. Clinical measurements revealed wide variations in evaporation rates and diffusion resistances for different wounds. Evaporation rates changed by less than 30 per cent during the first 5-6 days following injury, after which evaporation from partial skin thickness wounds gradually fell whereas that from full skin thickness wounds tended to remain higher. Raising ambient temperature can compensate for increased evaporation heat losses. Patients can be treated at ambient temperatures of 32-35 degrees C in the intensive care room with a specially designed airflow system. However, raising the temperatures of standard wards with no special airflow or temperature control facilities often caused patients to sweat, further increasing heat loss.


Metabolic abnormalities of mitochondrial redox potential in postburn multiple system organ failure. Forty-five burn patients underwent sequential assays for plasma acetoacetate and beta-hydroxybutyrate concentrations as well as plasma amino acid levels. Those patients who went on to develop multiple system organ failure were noted to have a decrease in their acetoacetate concentration with time, whereas there was no change in those patients who failed to develop multiple system organ failure. The plasma concentration of beta-hydroxybutyrate was not altered by multiple system organ failure. In addition, the plasma acetoacetate/beta-hydroxybutyrate ratio was found to be directly related to the plasma concentration of branched chain amino acids and inversely related to the concentration of aromatic amino acids.


Survival in major burn injuries treated by one bathing in cerium nitrate. Sixty-four patients aged 16-74 years with total body surface area burns (TBSA) ranging from 30 to 90 per cent, were given one bathing in 0.04 M cerium nitrate within 4 h of admission to hospital. Of 21 patients aged 16-30 years, one died (aged 28 with 90 per cent TBSA), and of those aged 31-74 years, two died, one (aged 50 years with 55 per cent TBSA) had multiple internal injuries, the other (aged 51 years with 55 per cent TBSA) had a pulmonary embolism at day 19. Two risk scores, developed from data on 11,200 burn patients treated by standard methods (Roi et al. 1983), were applied to the analysis of risk for 59 patients for whom both total burn surface (TB) and full thickness (FT) areas had been recorded. About 20 patients bore risk of 0.8 or greater on the FT scale and 1.0 on the TB scale, yet instead of 80 per cent deaths among these, only two died. No FT assessment had been made on the multiple injury death whose TB risk score was 0.66. Such survival results in high-risk patients should encourage the use of cerium nitrate for treating serious burn injury.


The progress of hypertrophic scars monitored by ultrasound measurements of thickness. Ultrasound scanning was used to measure the thickness of hypertrophic scars following burn injury. Scarred areas on patients receiving pressure therapy were monitored at regular intervals from the initial healing, through the hypertrophic stage, to maturation of the scars. The data, collected over a period of 30 months, allowed a comparison of scar development in children and adults and a comparison of the response at different anatomical sites. Measurements made on individual patients could be related to factors affecting the progress of their hypertrophic areas and provided a useful backup to visual assessment during pressure garment therapy.


DuoDERM hydroactive dressing versus silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns. The study compared DuoDERM Burn Pack Hydroactive Dressings (DHD) with silver sulphadiazine/Bactigras dressings (SSD/Bactigras) in the outpatient management of small partial skin thickness burns. Forty-eight patients were entered into the study, and randomly allocated into either the DHD or SSD/Bactigras group. Burn wounds were followed until complete re-epithelialization occurred. There were no statistical differences between the groups, either with respect to their composition or characteristics of healing in days, and patients' subjective responses to treatment. However, application was easier in the DHD group (93 per cent), compared with 71 per cent in the SSD/Bactigras group (P = 0.0009), and the SSD/Bactigras were easier to remove (96 per cent) versus DHD (66 per cent, P = 0.0004). Furthermore, the DHD group had significantly less dressing changes; a mean of three changes per subject in the DHD group compared with eight in the SSD/Bactigras group (P = 0.117). Two burn wounds became infected in the DHD group, and one in the SSD/Bactigras group. In this study both modalities were found to be equally suitable and effective for small partial skin thickness burns.


Management of thermal injury in pregnancy--an analysis of 16 patients. Sixteen patients at various stages of pregnancy suffered burns covering between 10 and 80 per cent of the body surface area. This review highlights the management problems of these patients during the first, second and third trimesters. Only two mothers (both with 80 per cent TBSA burns) died. There were five fetal deaths, three of them intrauterine.


Microskin autograft with pigskin xenograft overlay: a preliminary report of studies on patients. Split-thickness pigskin graft (STPSG) was used to replace allograft skin for microskin grafting in 16 patients, nine of whom were burn patients, five suffered from traumatic defects and two from diabetic ulcers. The expansion ratios used in these patients ranged from 8:1 to 12:1. The STPSG preparation described was found to be safe for clinical application. The autogenous donor skin was excised from the inguinal area, and the donor site was primarily closed. There were no instances of donor site morbidity. The majority of the STPSG overlays adhered to the wound firmly. Histological examination showed that the microskin grafts proliferated actively immediately beneath the STPSG overlay. The time for the wound to be fully resurfaced varied from 13 to 21 days depending on the expansion ratio employed. There were only two episodes of pseudomonas infection and no further grafting was required in any of the patients. In this study the pigskin xenograft was found to provide a suitable environment for the epithelialization of microskin autografts. When allograft is not available, this is an alternative way of ensuring successful microskin grafting.


X-plasty for repair of burn contractures. Release of skin contractures across a joint surface by X-incision is presented. The method is particularly suitable for severe and moderate contractures. Resultant long lateral flaps lead to good coverage of the flexor surface of the joint. This prevents recurrence of contracture even in growing children. The method is suitable for any joint.


Burns following cigarette lighter fluid abuse. Seven patients with burns associated with butane cigarette lighter fluid abuse, in a group setting within an enclosed space, are presented. In all patients there was a reluctance to admit that butane vapour was in use as an intoxicant immediately prior to the injury. It is obvious from the circumstances of these injuries that the hazardous nature of cigarette lighter fluid is not fully appreciated. Since the resultant injuries are usually minor (all patients recovered spontaneously with conservative management, the hospital stay averaging 2 days), it is probable that many more occur, but do not present to accident departments as the victims are wary of repercussions should they admit to intoxicant vapour abuse. In view of the medical sequelae that can follow butane inhalation, burns unit staff should be aware of the problems, their recognition and treatment.


Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit. To assess the sites, incidence, and bacteriology of infections in intensive care burn patients, a prospective survey of all admissions to a tertiary care institution burn unit was carried out over a 12-month period. One hundred and sixteen patients were admitted, 106 with a diagnosis of thermal burns. Forty patients developed 90 infections. Only two deaths occurred, one in a patient with sepsis. In order of frequency, pneumonia, burn infection, UTI and primary bacteraemia were most common. Staphylococcal species accounted for a majority of infections at all body sites except UTI (47 per cent of all infections, including 11 of 14 bacteraemic infections). Staph. aureus sepsis was more common in those carrying the organism on admission. Strain typing of paired admission and subsequent clinical isolates in 19 patients with Staph. aureus sepsis indicated that eight (42 per cent) became infected with a strain they carried on admission. Further reductions in septic complications of burns in our center would be best directed at staphylococcal species, particularly Staph. aureus. Both eradication of carrier state, and prevention of acquisition of Staph. aureus strains could be explored.


Primary pressure grafts in early reconstruction of deep facial burns. The face is an area of great cosmetic importance where the repair of deep burns is particularly delicate, as both appearance and function must be taken into account. In order to improve the aesthetic prognosis of full skin thickness facial burns, a primary pressure graft technique was used in eight patients. Early excision was carried out during postburn day 3 and after good-quality granulation tissue was obtained around day 10, a full skin thickness graft was applied. Pressure was applied to the graft and maintained for 10 days. The grafts took successfully in all patients with very satisfactory cosmetic results. This is an original technique as it replaces burned tissue at a very early stage with tissue which is normal in thickness and quality.


Phosphorous pentachloride chemical burn--a slowly healing injury. A 51-year-old chemical engineer sustained phosphorous pentachloride partial skin thickness burns over 20 per cent of his body surface area. Although macroscopically and microscopically the wound seemed to be superficial, the course of clinical healing of this injury was very slow and painful. Retrospectively this burn should have been treated by early excision and grafting.


Bilateral metastatic endophthalmitis as a complication of major burns. Metastatic infection of the eye is a rare complication of burns. The following report describes a patient with endophthalmitis occurring as a complication of major burns. The diagnostic difficulties that arose are discussed and the recommended treatment outlined.


[Determination of the active constituent in Veronicastrum sibiricum (L.) Pennell]. The anti-inflammatory and analgesic constituent isoferulic acid was quantitatively analyzed by means of TLC-SM. The content is 0.09%.


[Kinetics of pharmacologic effects of radix Aconiti Lateralis Preparata and sini decoction]. In the study of analgesic action of Radix Aconiti Lateralis Preparata and Sini Decoction hot-plate method was used and the time-effect relationship was determined. The biological half-lives were 11.05 h and 6.84 h respectively. In the study of the effect on inflammation induced by egg white in the ankle joints of rats, the method of complement ED50 was used. The residual rates of the dosages after an interval of 6 hours were 0.60 and 0.69, and the biological half-lives were 8.11 h and 11.35 h respectively.


[Inhibitory effects of the extract of pilose antler on monoamine oxidase in aged mice]. It was demonstrated that the water extract of Pilose Antler (WEPA) showed a higher inhibitory effect on MAO-B activities in the liver and brain tissues of aged mice, but nearly no effect on NAO-A. WEPA could significantly increase the contents of 5-HT, NE and DA in the brain tissues of aged mice. In vitro experiments revealed that the inhibition of WEPA on MAO-B was competitive, but on MAO-A was of mixed-type.


[Effects of ginseng volatile oil on cytochemical components of SGC-823 gastric carcinoma in cell culture]. After 24, 48 and 72 hours' treatment of cells of SGC-823 gastric carcinoma in cell cultures with ginseng volatile oil, glycogen, succinate dehydrogenase and DNA in single cells were measured quantitatively with MPV2 microscope photometer. The results show that the inhibition of cancer cell growth by ginseng volatile oil may be due to the action of metabolism of DNA, carbohydrates and energy.


[Review of improving the technology of processing Chinese herbal medicines]. In this paper, the present situation of processing technology for Chinese herbal medicines is expounded in all aspects. Careful processing, overall developing and comprehensive utilization are put forward as improving ways, in the hope of providing a scientific basis for carrying forward the traditional processing techniques for Chinese herbal medicines in producing areas and putting the resources to full and rational use.


[Discussion on criteria for appraising the endanger threatening rare medicinal plants]. This paper deals with the criteria for appraising the endanger threatening rare medicinal plants. A preliminary evaluating method is presented.


[Production layout of endemic and superior Chinese medicinal materials in Sichuan]. In this paper, the climatic ecological adaptabilities of 15 kinds of genuine Chinese medicinal materials in Sichuan are quantitatively illustrated by means of Fuzzy sets and some tentative ideas about their rational production layout are advanced for the first time.


[Scanning electron microscopic identification of hairs on surface of fruits and seeds of Chinese medicinal plants]. A comparative identification of hairs on surfaces of fruits and seeds of some Chinese medicines has been made, and a key to 13 kinds of hairs has been compiled. According to the characters of hairs, it is possible to identify some Chinese drugs in powder form.


[Effect of moisture and temperature on seed viability of Fritillaria thunbergii Miq]. This paper deals with the effect of two moisture levels (9.2%, 16.7%) and three temperature levels (15, 25, 35 degrees C) on seed viability of Fritillaria thunbergii. The results show that moisture and temperature have significant effects on seed viability.


[Determination of sugar components in wild and cultured sclerotia of Grifola umbellata (pers. ex Fr.) Pilat at different ages]. Our determination indicates that in both wild and cultured sclerotia of Grifola umbellata the contents of reducing sugar decrease with the growing years; the contents of Polysaccharide peak in the second year of growth; the contents of protein increase with the growing years; the contents of fat reaches maximum in the first year of growth; in cultured sclerotia ergosterol becomes highest in contents when the plant is two years old, while in wild sclerotia it remains lowest.


[Volatile oil in Ephedra sinica Stapf. and its processed products by GC-MS]. This paper deals with the changes in contents and chemical composition in the volatile oil of Ephedra sinica before and after processing. The results indicate that after processing, the more the substances of low boiling point, the higher their contents and vice versa. The changes are particularly obvious in yellow-fried Ephedra sinica.


[Saponins in fruits pedicels of Panax notoginseng (Burk.). F.H. Chen]. Six saponins were isolated from the fruit pedicels of Panax notoginseng for the first time. They were identified as ginsenoside-Rc, -Rb3, -Re, notoginsenoside-Fe, -R1 and gypenoside IX by chemical and spectroscopic analysis.