Perforated-patch method reveals extracellular ATP-induced K+ conductance in dissociated rat nucleus solitarii neurons. Extracellular adenosine 5'-triphosphate (ATP)-induced responses were investigated in acutely dissociated rat nucleus tractus solitarii (NTS) neurons, using nystatin perforated-patch and conventional whole-cell patch-clamp recordings. Extracellular application of ATP could evoke the inward currents with both methods. An additional outward current was observed only with the perforated patch method. The outward current resulted in an increase of K+ conductance which was activated by Ca2+ influx through the ATP receptor-channel complex.


Induction of c-Fos immunoreactivity in the rat forebrain by conditioned and unconditioned aversive stimuli. The protein product of the c-fos proto-oncogene was immunocytochemically localized in forebrain regions of adult male Lewis rats subjected to a physically aversive footshock stimulus or a Pavlovian-conditioned, non-aversive, auditory stimulus. Animals receiving the conditioned stimulus were first conditioned by repeatedly pairing electric footshock, the unconditioned stimulus (US), with an auditory cue, the conditioned stimulus (CS). These animals were later tested with the CS in the absence of the US, a procedure which, like footshock itself, suppresses immune function. In animals exposed to the conditioned or unconditioned stressor, c-Fos was strongly expressed in cells of the paraventricular nuclei (PVN) of the hypothalamus, some of which contain corticotropin-releasing hormone (CRH), and other forebrain areas directly associated with autonomic function, the ventral lateral septal nuclei (LSV), the medial amygdaloid nuclei (AME), the sensorimotor cortex, the basal ganglia and thalamic nuclei. Control animals exhibited very little or no c-Fos in the above areas. The identified forebrain nuclei can now be targeted for further study aimed at elucidating their role in stress-induced immune alteration.


Androgen receptor immunoreactivity in intact and castrate guinea pig using antipeptide antibodies. We developed and used antibodies to an androgen receptor (AR)-specific synthetic peptide (amino acids 201-222 of the human androgen receptor) to localize AR in the brain and peripheral tissues of intact and castrate adult male guinea pigs. Immunoreactivity was localized to the nucleus of epithelial and stromal cells in the prostate of intact animals. Immunostaining was abolished in the prostate 4 days following castration. Androgen receptor immunoreactivity was found in brain nuclei known to be involved in reproductive and other androgen-dependent behaviors, including the preoptic area, medial basal hypothalamus, and anterior pituitary gland. Castration had no effect on the distribution or intensity of AR immunostaining in the brain. These data indicate a differential regulation of AR in the brain compared to peripheral tissues.


D-fenfluramine effects on hypothalamic monoamine activities and their hormonal correlates. In order to test the hypothesis that the anorectic effects of D-fenfluramine involve mediation by increased serotonin (5-HT) activity we examined the effects of acute and chronic D-fenfluramine on the hypothalamic activities of 5-HT as well as the other major monoamine neurotransmitters noradrenaline (NA) and dopamine (DA). Precise and specific gas chromatograph/mass spectrometer analyses of NA, 5-HT and DA and their primary metabolites dihydroxphenylethyleneglycol (DHPG), 5-hydroxyindolacetic acid (5-HIAA) and dihydroxyphenylacetic acid (DOPAC), respectively, were made in combination with analysis of the hormonal correlates of the monoamines, glucose and adrenocorticotropin for NA, thyroid-stimulating hormone for 5-HT and prolactin for DA. Acute D-fenfluramine increased NA, while reducing 5-HT, functional activity. Chronic and acute after chronic, D-fenfluramine decreased both NA and 5-HT functional activity. The effect of acute D-fenfluramine on the DA system is consistent with a post-synaptic blockade which is compensated for by chronic treatment. Since chronic D-fenfluramine acted to depress noradrenergic tone, a further study was undertaken which showed that chronic D-fenfluramine does not impair the ability noradrenergic/sympathetic system to respond to stress. The results indicate that D-fenfluramine may not exert its anorectic and weight loss effects via serotonergic agonism and involvement of the NA and/or DA systems is likely.


Excitotoxin paraventricular nucleus lesions: stress and endocrine reactivity and oxytocin mRNA levels. Electrolytic lesion of the paraventricular nucleus (PVN) of the hypothalamus blocks the tachycardia response to stress. The current study examined the effects of chemical lesion of PVN parvocellular neurons on the cardiovascular and endocrine responses to stress and on the content of hypothalamic oxytocin (OT) mRNA levels. Acute footshock stress increased heart rate in both ibotenic acid lesion and control groups of animals; however, the tachycardia was significantly lower in animals with a PVN lesion than the controls. Lesion of the PVN also attenuated the increase in plasma OT induced by stress, 4-fold in the lesion group versus 20-fold for the controls. There was not a generalized decrease in hormonal responsiveness since the OT response to an osmotic challenge was exaggerated in the lesion group. There was no difference between the groups in the arterial pressure and vasopressin responses to acute stress. Neurotoxin lesions of the PVN also resulted in significant depletions of VP and OT in all levels of the spinal cord and decreased OT levels in the dorsal brainstem. Ibotenic acid lesions of the PVN resulted in no significant changes in OT mRNA in the PVN, SON and PP. In addition, the 48-h dehydration resulted in a significant increase in plasma OT and OT mRNA in the PVN. These data indicate that the parvocellular neurons of the PVN play a role in integration of cardiovascular and endocrine responses to both stressful and osmotic stimuli and provide further evidence that parvocellular OT and VP neurons project to the brainstem and spinal cord.


[Use of a disposable peroperative autotransfusion device in uncomplicated vascular surgery]. We used a simple single process to recover total blood during surgery. All the process stands on a low burdensome jib and does not require additional staff in theater. Its cost is low. The indications concern all surgical operations enduring low or mean bleeding, except in septic and cancer surgery. It may be used in emergencies, even in war surgery with an incorporated source of depression.


[Postoperative autotransfusion in total hip and knee prostheses]. The Solcotrans orthopaedic system was used post-operatively in one hundred patients. The following findings were made concerning the blood collected: absence of bacterial contamination; reduction of cellular elements; destruction of clotting factors; increased free haemoglobin. Clinical observation and biological checks established the absence of any disturbance of coagulation and of renal function due to the transfusion of haemolyzed blood. Only blood collected during the first ten hours postoperatively was retransfused. No attempt was made to correct the state of haemodilution considered of benefit in the prevention of thrombo-embolism. In 90% of the cases transfusion of homologous blood in the postoperative phase was avoided. The method seems appropriate in orthopaedic surgery when postoperative bleeding is expected but should be used cautiously in re-interventions. It is to be avoided in malignancies and septic cases. Since the writing of this paper three hundred more cases were done without incident.


[The value and limitations of autotransfusion in traumatology]. 29 autotransfusions were realised in severe cases of trauma (20% of a sample of 143 traumatic emergencies). The recovery of haemothorax blood as well as the peroperative collection by a Cell Saver allowed the retransfusion of 1989 +/- 1,838 ml (225-7070 ml) of autologous blood, amounting to 56% of the average blood loss. A total of 69% of the patients received homologous blood. Eight patients (where the haemorrhage amounted to 143% of the blood volume) showed some coagulation troubles. Autotransfusion assures the immediate availability of blood while reducing the immunological and viral transfusion risks. Therefore haemothorax autotransfusion should be used systematically. Peroperative recollection by a cell-separator works well but is technically more tedious.


[Delayed autologous transfusion in prosthetic surgery of the hip and knee]. Blood sparing methods used during hip or knee prosthesis implantation or change in 360 patients during the years 1990-1992 were evaluated. For delayed transfusion of autologous blood the main counter-indication was unstable cardiovascular condition. Such cases being excluded, the method was used in 64.2% of all cases. No homologous blood was needed in 68.9% of patients. This result was obtained in 55% of the cases by delayed transfusion of autologous blood and in 13.9% by peroperative normovolaemic haemodilution.


[Methods of reducing peroperative bleeding]. The reduction of bleeding during surgery can be aimed at for two reasons: to facilitate the operation by providing a bloodless field and/or to avoid blood loss requiring compensation by transfusion. These aims can be reached by reducing blood pressure or by acting on blood-clotting. For inducing hypotension sodium nitroprussiate and isoflurane are mainly used. Complex and precise monitoring is required for patient safety. Two drugs have been used to diminish bleeding: desmopressin and aprotinin. With the latter an important reduction (40 to 50%) of the blood loss has been achieved.


[The transfusion card: value, limitations]. The transfusion-sheet is an important document which appears first in the French legislation on May 1985 the 17. Its aim is to keep a close watch over transfusion of red blood cells, platelet concentrates and fresh frozen plasma and also immunohematologic evolution of data for every patient. In spite of its importance for everyone in charge of transfusion practice (physicians, biologists, transfusion center,...), a lot of problems may be observed in the strict and complete updating of the document. Informatisation of all the steps of the medical and biological practice appears of crucial interest to perfect its use.


[Use of Cell Saver 4 in traumatology. Apropos of 9 cases]. During a recent seven mouth period of time, patients with intrathoracic and intraabdominal injury had recovery of shed blood utilizing a Haemonetics Cell Saver. Blood is suctioned from the surgical field or with tube thoracostomy. Autotransfusion is sufficient for four patients; five others patients need blood transfusion, for intraoperative or postoperative hemorrhage. However, the decrease of transfusion requirement is evident, and autotransfusion is equivalent to 8.6 concentrated red cells units for each patient, as 2.6 homologous bank blood concentrated red cell units. The difficulties are nurse training, and cost (to be compared with homologous bank blood cost); but autotransfusion with Haemonetics Cell Saver 4 is sizeable part of transfusion therapy of acute trauma.


[A comparative study in children of 3 anesthetic techniques using plethysmography, pulse oximetry and the level of postoperative pain]. This study compares three techniques of anesthesia on the ground of the course of plethysmography, pulse oximetry and evaluation of postoperative pain in 75 pediatric patients divided into 3 groups. Results show that combined anesthesia, intravenous and regional anesthesia, has a less desaturation incidence, a better development of plethysmography and a positive reply to postoperative pain.


[Blood saving in bone prosthetic surgery. Apropos of 426 cases]. Perioperative blood salvage during hip and knee prosthetic surgery have been evaluated in a series of 345 patients who underwent a total of 426 surgical procedures. In 85 per cent of the cases, no additional homologous transfusion was required. In the patients who benefited from autotransfusion the quantity of bank blood transfused was 10 times less than in patients who were not autotransfused.


[Considerations on the monitoring of soda lime. Consideration technique]. The choice of ethyl violet as a pH indicator in soda lime is not the best. Color change happens too late because pH alteration of the surface of soda lime is slower than in the core of the canister. Clinical and comparative measurement of wall temperature of two in series canisters is a good precaution. If the down stream canister is warmer than the upstream one, you must change the latter.


[Auriculo-ventricular conduction disorder following a continuous administration of propofol. Apropos of a case]. A case is reported of atrioventricular conduction trouble (Möbitz I block) during propofol-fentanyl anaesthesia in a healthy 22 year old patient. All troubles disappeared after IV atropine and isoflurane administration instead of propofol infusion.


[Postoperative rhabdomyolysis following surgery of a pheochromocytoma]. The authors reports one case of post operative rhabdomyolysis after surgery of pheochromocytomas. The diagnosis of rhabdomyolysis suspected on acute renal failure was confirmed on the increase of CPK and myoglobin blood levels. The findings on physical examination were normal. In this particular case, the operative position seems not implicated in the genesis of this rhabdomyolysis. Nevertheless, the long duration of surgery (4 h) is the major factor encountered in this pathology. Evolution was satisfactory after three haemodialysis sessions.


[Pocket informatics in anesthesia].

[Pocket informatics in anesthesia]. A simple, easy to use and inexpensive computerized system could optimize the evaluation of anaesthetic activities. Full processing of information remains our ideal but its difficulties and cost make it hardly possible yet. On the other hand, each anaesthetist can use, for example, a pocket Psion Computer which allows to register 15 items for each anaesthesia. All data are subsequently transferred to a Macintosh central computer. However this activity recording cannot be a substitute for the medical anaesthesia chart which remains essential.


Technique of ocular regional anesthesia. Regional anaesthesia by retrobulbar injection by the anaesthetist is recommended for day care ophthalmic surgery. Patient management and anaesthetic technique are detailed. The preferred anaesthetic is 2% lidocaine with hyaluronidase and adrenaline added. Fine, sharp pointed needles are recommended.


[Interpleural anesthesia].

[Interpleural anesthesia]. In 1986, Reiestad and Strömskag introduced interpleural postoperative analgesia with local anaesthetic solutions. The aim of this review was to describe the physiological mechanisms, indications and limits of this new mechanisms, indications and limits of this new technic. Interpleural analgesia has been successfully used for pain relief after cholecystectomy by subcostal incision. Nevertheless, the potential side-effects of this technic and the reduction of the postoperative pain with the use of coelioscopic approach discard interpleural analgesia. After thoracotomy, if this technic seemed to be simple by visual placement of the catheter tips by the surgeon, most of the studies failed to demonstrate reduction of postoperative pain. Finally, interpleural analgesia has recently been shown to be effective in the management in various chronic pain syndromes of the upper abdomen (pancreatitis...) and thorax (postherpetic neuralgia, upper extremity reflex sympathetic dystrophy). The efficacy of this technic for long-term chronic pain involves the blockade of the sympathetic chain of the injected side.


[Patient-controlled analgesia by the peridural route and classical methods of analgesia]. Patient controlled analgesia was developed to compare drug effects. Later its psychological implications were studied. Drug administration by intravenous or epidural injection has been used. The latter provides relief with much smaller doses. Simultaneous use of opioids and anti-inflammatory drugs enhances the analgesic effects. For pain relief in childbirth, opioids need to be combined with local anaesthetics for best results. Little has been achieved by patient controlled analgesia in the treatment of chronic pain.


[Intracerebral morphine therapy in cancer patients]. An overview of recent studies concerning opioids and their pharmacokinetics is presented. In the light of these findings it is shown that intracerebral administration may be justified. The authors experience with 63 cases is detailed: all cancer patients in the final stage. Initial dosage by the intraventricular route was 500 to 700 microgram-day but in one case twice daily injections of 1.200 microgram were needed. The dosage needed doubled over the observation period of 2 to 3 months. The mean length of survival was 75 days. Among complications nausea and vomiting were observed in 15 to 35% of the cases, sweating and pruritus in 15%, urinary retention in 15 to 20%. In some cases euphoria, motor excitement and hallucinations occurred. Chronic constipation was present in all cases. Two cases of meningitis were successfully treated by antibiotics. Pain relief was judged excellent or good in 75% of the cases. In 20% other analgesics had to be added to the treatment. In 5% the method failed.


[Trans-sacral extradural anesthesia in pediatrics]. Between 1988 and 1991 1,714 extradural anaesthesias by the transsacral or lumbosacral route have been performed. The anesthetic has always been mepivacaine 1%. Puncture between sacral vertebrae was practiced in 1,308 cases and by the lumbosacral approach in 406. Anaesthesia was for urogenital surgery in the majority of cases but also for orthopedic, abdominal and thoracic surgery. There have been 12 failures (0.7%) and a total of failures and complications was registered numbering 42 or 2.47%. No serious complication occurred.


[Intrathecal morphine therapy in children with cancer]. Five children with cancer pain were given continuous intrathecal morphine or fentanyl infusion associated with bupivacaine 0.25% without epinephrine. The morphine daily dose varied from 0.1 mg.kg-1 to 1 mg.kg-1, the maximum daily dose of fentanyl was 0.1 mg.kg-1 associated with the same dose of intravenous fentanyl, and the maximum daily dose of bupivacaine was 1 mg.kg-1. Intrathecal treatment was started after oral and epidural morphine treatment had failed. The children were at home, under the care of several nurses and physicians. A satisfactory analgesia was achieved until demise occurred. In all children, urinary retention was the only side effect of the therapy. Therefore, intrathecal opioid and bupivacaine may be indicated after oral morphine therapy has failed in children with advanced cancer refractory pain.


[Spinal pain].

[Spinal pain]. Three hundred and nine patients complaining of cervical, dorsal or lumbar pain or sciatica were explored by digital subtraction epidurography then treated with local steroids. This treatment was very efficient with 5% failure. Only 19% of the herniated discs required surgery.


[The neurostimulator in loco-regional anesthesia]. The physiological basis of neurostimulation is recalled and its use for the placement of needles for neural blockade described. After an account of available equipment, the author gives his reasons for preferring some of it. Based on experience gained with more than ten thousand cases, a protocol for using neurostimulation to insure close placement of needles to the nerves to be blocked. The advantages and disadvantages of available needles are stated. The indication for the use of neurostimulation in the practice of infiltration anaesthesia are enumerated and its advantages stressed. Finally its limitations and complications are presented.


[Spinal administration of analgesic substances in the treatment of chronic pain]. The various forms of chronic pain conditions are described and related to recent knowledge of their neurophysiology. The pharmacology and mode of action of substances used for pain relief by intrathecal, subdural or peridural injection is presented. The modalities of their application, the results obtained and the complications encountered are detailed.


[Physiopathology of combined peridural and general anesthesia]. General anaesthesia alters self-regulation of arterial pressure by lowering the sympathetic tone to his baseline level. More important is the sympathetic stimulation before general anaesthesia, more important will be the decrease in arterial pressure after induction. Epidural anaesthesia always leads to a sympathetic blockade. The extent and the speed of appearance of this blockade condition the magnitude of the decrease of arterial pressure. So, general anaesthesia and epidural anaesthesia both modifying deeply the autonomic nervous system, their association can only be performed on hemodynamically stable patients for a non hemorrhagic surgery. Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the epidural anaesthesia and on the cardiovascular condition of the patient. However, although the combined use of the two techniques is attractive, it does not seem to improve cardiovascular nor respiratory morbidities in high risk patients compared with classical general anaesthesia. Nevertheless, the high value of epidural analgesia may improve the postoperative course.


[Pharmacokinetics of local anesthetics in children]. Anatomical and physiological differences between children and adults may induce changes in absorption, distribution and elimination of local anesthetics throughout life. Absorption is faster and the Cmax may be higher in children than in adults. In addition, the volume of distribution is larger, and the Cmax is lower and the terminal half-life is longer in children than in adults. The low level of albumin and alpha-1-acid-glycoprotein until 6 months of life, may result in an increase in free fraction of drugs, as it has been demonstrated for bupivacaine. In clinical practice, the decrease in protein binding in infants may lead to careful use before the age of 6 months. It seems preferable to use drugs with moderate protein binding and high hepatic extraction ratio such as lidocaine; the repeated injection of epidural bupivacaine should be careful used because of the longer terminal half-life; maximum dosage regimens are for lidocaine 10 mg.kg-1 and for bupivacaine 2.5 mg.kg-1.


[Complementing loco-regional anesthesia in children]. An accomplishment to loco-regional anesthesia. Yes! but dependent on the age of the child; rather mild general anesthesia than progressive sedation. This should not lead to the neglect of certain basic principles: a faultless technique including the highest security standards without neglecting the psychological aspect. Use of these technique as means of outpatient treatment will be the future outlook.


Characterisation of Rhizobium isolates by amplification of DNA polymorphisms using random primers. The use of single random primers, selected in the absence of target sequence information, has been shown to be effective in producing DNA amplifications that provide fingerprints which are unique to individual organisms. DNA amplification by random priming was applied to the DNA from isolates of Rhizobium leguminosarum biovar trifolii. Amplification products were produced using a number of primers, and the resulting fingerprints allowed strain differentiation. However, the effectiveness of primers was dependent upon length and GC content. It was also possible to amplify DNA directly from cells in culture and in nodule tissue. Lysis of these cells was achieved simply through heat applied in the initial DNA denaturation stage of the thermal reaction. The ability to produce varied amplification patterns from different Rhizobium isolates, especially directly from nodules, gives this method potential for use in examining genetic structures and relationships in Rhizobium populations.


Incorporation of cysteine by Borrelia burgdorferi and Borrelia hermsii. The growth rate of Borrelia burgdorferi and Borrelia hermsii in BSK II medium prepared with cysteine-free or cysteine-containing (0.185-5.92 mM) CMRL 1066 medium was studied. In media with cysteine-free CMRL 1066, growth of borreliae was detectable, although it was reduced by approximately 80%. Bacterial growth was maximal when the concentration of cysteine in CMRL 1066 reached 1.48 mM, which represents the standard cysteine concentrations of the medium; higher concentrations inhibited the growth of borreliae. Cysteine incorporation, measured by the uptake of radiolabeled cysteine, showed that cysteine enters B. burgdorferi and B. hermsii cells by passive diffusion. Labeling studies of borreliae with [35S]cysteine indicated that B. burgdorferi has several cysteine-containing proteins, including ones at 22, 30 (OspA), and 34 kDa (OspB), whereas B. hermsii showed only two [35S]cysteine-incorporating proteins, at 22 and 24 kDa, which were exposed onto the outer cell surface. In addition, most of the cysteine-incorporating proteins could be biosynthetically radiolabeled when bacterial cells were grown in vitro with [3H]palmitate, and the differences in cysteine incorporation observed between B. burgdorferi and B. hermsii were found to be correlated with differences in lipoproteins.


Expression of the 4-chlorobenzoate dehalogenase genes from Pseudomonas sp.-CBS3 in Escherichia coli and identification of the gene translation products. The genes encoding the 4-chlorobenzoate dehalogenase of Pseudomonas sp. strain CBS3 were, in an earlier study, cloned in Escherichia coli DH1 with the cosmid vector pPSA843 and then mobilized to the 4-chlorobenzoate dehalogenase minus strain Pseudomonas putida KT2440. In this paper we report on the expression of 4-chlorobenzoate dehalogenase in these clones and on the polypeptide composition of the active enzyme. The dehalogenase activity in whole cells suspended in 3.2 mM 4-chlorobenzoate (30 degrees C) was determined to be approximately 27 units (micromoles 4-hydroxybenzoate produced per minute) per 100 g of E. coli-pPSA843 cells and approximately 28 units per 100 g of P. putida-pPSA843 cells. Dehalogenase activity in fresh cellular extracts (pH 7.4, 30 degrees C) prepared from the E. coli and P. putida clones was unstable and at least 20-fold lower than that observed with the whole cells. The polypeptide components of the dehalogenase were identified by selective expression of the cloned dehalogenase genes and analysis of the gene translation products. Analysis of dehalogenase activity in omega insertion mutants and deletion mutants circumscribed the dehalogenase genes to a 4.8-kilobase (4.8 kb) stretch of the 9.5-kb DNA fragment. Selective expression of the dehalogenase genes from a cloned 4.8-kb DNA fragment in a maxicell system revealed a 30-kDa polypeptide as one of the components of the dehalogenase system. Selective expression of the dehalogenase genes using the T7 polymerase promoter system revealed the 30-kDa polypeptide and 57- and 16-kDa polypeptide products. Determination of which of the three polypeptides were translated in deletion mutants provided the relative positions of the encoding genes on a single DNA strand and the direction in which they are transcribed.


Antimicrobial activity of 2-aminophenoxazin-3-one under anaerobic conditions. Potential toxicity of 2-aminophenoxazin-3-one to 20 bacterial species and two fungi and its inactivation under anaerobic conditions were investigated. Minimum inhibitory concentration for cellulolytic bacteria was in the range of 50-100 micrograms.mL-1, but at 100 micrograms.mL-1 of 2-aminophenoxazin-3-one, there was no effect on the growth of any of the noncellulolytic bacteria. Four noncellulolytic bacterial strains showed no inhibition of growth, even at 200 micrograms.mL-1 of this compound. Under anaerobic conditions and in the presence of cysteine, the long wavelength absorption band of this compound slowly shifted from about 434 to 320 nm, and its inhibitory effect on RNA synthesis was relieved after one-half of a generation time in cultures of cellulolytic ruminal bacteria. A similar shift of absorption band was observed in rumen fluid filtered through a 0.22-microns Millipore filter. It was concluded that protonation of 2-aminophenoxazin-3-one under anaerobic conditions present in the rumen would considerably reduce its potential toxicity to cellulolytic bacteria.


Detection of enterotoxigenicity of Staphylococcus aureus strains: a comparative use of the modified Ouchterlony precipitation test, reversed passive latex agglutination test, and avidin-biotin ELISA. The avidin-biotin enzyme-linked immunosorbent assay (ELISA), reversed passive latex agglutination (RPLA) test, and the modified Ouchterlony precipitation test (MOPT) were compared in detecting enterotoxin production by Staphylococcus aureus strains. A total of 1015 strains isolated from human beings, animals, and foods were tested for staphylococcal enterotoxins A (SEA), B (SEB), and C (SEC). Of these, 495 (48.8%), 467 (46.0%), and 204 (20.1%) were classified as enterotoxigenic by the ELISA, RPLA test, and MOPT, respectively. The difference in the number of strains classified as enterotoxigenic by the ELISA and RPLA test was not significant (P > or = 0.05; chi 2), but both tests detected significantly (P < 0.001; chi 2) more enterotoxigenic strains than the MOPT. The combined use of the three assay systems classified 258 (25.4%), 278 (27.4%), and 263 (25.9%) of 1015 strains tested as positive for SEA, SEB, and SEC, respectively. However, the three systems were all positive in only 29.1% of SEA-producing strains, 32.0% of SEB-producing strains, and 25.1% of SEC-producing strains. The MOPT was negative when the corresponding ELISA and RPLA test were positive (46.9% for SEA, 43.5% for SEB, and 40% for SEC); the RPLA test was negative when the corresponding ELISA was positive (10.5% for SEA, 15.5% for SEB, and 25.5% for SEC); and the ELISA was negative when the RPLA test was positive (13.6% for SEA, 9.0% for SEB, and 9.5% for SEC). All factors considered, the RPLA test appears most suitable for quantitatively screening large numbers of strains for staphylococcal enterotoxins.


Yeasts associated with Drosophila in tropical forests of Rio de Janeiro, Brazil. The distribution and diversity of yeast species vectored by and from the crop of eight species groups of Drosophila is described for two rain forest sites and an urban wooded area in Rio de Janeiro, Brazil. The typical forest Drosophila groups guarani, tripunctata, and willistoni showed a higher diversity of yeasts than the cosmopolitan melanogaster species group, suggesting different strategies of utilization of substrates. Apiculate yeasts, including Kloeckera apis, Kloeckera javanica, and Kloeckera japonica, were the prevalent species. Geotrichum spp. and Candida citea were also frequent isolates in the forest sites. Similarities between the yeasts from the external surfaces and crops of Drosophila suggested that the feeding substrates were the main source of the yeasts vectored by these flies. Most of the yeasts were strong fermenters and assimilated few compounds, usually sucrose, cellobiose, and glycerol. This indicated a preference of the flies for food sources such as fruits. Some yeasts were primarily isolated from one group of Drosophila; for example, Kloeckera javanica from the melanogaster group, Debaryomyces vanrijiae var. yarrowii from the tripunctata group, and Kluyveromyces delphensis from the willistoni group. These associations and differences in the yeast communities among the fly groups suggested a differentiation of diets and specialization of the yeast-Drosophila association in the tropical forests.


Thiamine secretion in yeast.

Thiamine secretion in yeast. To isolate thiamine excretors and (or) overproducers, 188 cultures belonging to nine yeast and three fungal genera were screened. Nine excreted thiamine as determined by both the presence of cross-feeding zones on a thiamine-free agar medium seeded with a thiamine-requiring yeast strain and by the direct detection of excreted thiamine on agar plates. Several of these cultures produced several-fold more intracellular thiamine than the general culture population. Thiamine-requiring strains of Saccharomyces cerevisiae and S. uvarum (carlsbergensis) were identified and were tentatively assigned to 10 complementation groups.


The thermostable direct hemolysin of Vibrio parahaemolyticus is a pore-forming toxin. The hemolytic mechanism of thermostable direct hemolysin (TDH), a possible virulence factor of Vibrio parahaemolyticus, was studied. We demonstrated that TDH acts as a "pore-forming toxin" in temperature-dependent and -independent steps. The first temperature-dependent step requires only about 1-2 min incubation at 37 degrees C and makes a "pore" with a functional diameter of approximately 2 nm. The pore size was deduced from the molecular diameter of the colloidal inhibitory polysaccharides. The formation of the pores on TDH-treated erythrocyte membranes was also demonstrated by electron microscopic examination. The second step, which is a temperature-independent lytic step, causes the erythrocytes to swell owing to a colloidal osmotic influx of water via the "pores" into cells, resulting in erythrocyte lysis (or rupture) owing to increased intracellular pressure.


Specificity of the microimmunofluorescence assay for the serodiagnosis of Chlamydia pneumoniae infections. Chlamydia pneumoniae infections are mostly confirmed using an indirect microimmunofluorescence test for which potential cross-reactions between antigens from different chlamydial species are not well documented. Using this assay, 928 sera (507 subjects) submitted for Chlamydia pneumoniae serology were tested for specific IgM and IgG to this bacteria using the TW-183 antigen. IgM and IgG reactivities to Chlamydia trachomatis serotypes C, D, E, and L2 and Chlamydia psittaci strain 6BC antigens were also tested. A sample was interpreted as positive only when evenly fluorescent elementary bodies were observed. Twenty-five subjects (4.9%) showed serological evidence of recent Chlamydia pneumoniae infection (IgM positive and (or) IgG seroconversion); 11 of them also showed serological evidence of recent infection with at least one other chlamydial species. Specificity was 50 and 63% for IgM and IgG detection, respectively. These results suggest that mixed or temporally related infections might occur, or, more likely, that some Chlamydia pneumoniae IgM or IgG reactivities might be due to heterotypic antibodies.


Prolonged survival of Bordetella pertussis in a simple buffer after nasopharyngeal secretion aspiration. A simple method for recovery of Bordetella pertussis is described using phosphate-buffered saline containing a casein hydrolysate for transporting secretions collected by nasopharyngeal aspirate. Bordetella pertussis was reisolated from 92% of clinical specimens held at 4 degrees C for 1 week and from all specimens held at -20 degrees C. This method will facilitate the centralization of laboratory facilities for the diagnosis of pertussis.


Disparate efficacy of tobramycin on Ca(2+)-, Mg(2+)-, and HEPES-treated Pseudomonas aeruginosa biofilms. Mucoid exopolysaccharide (MEP) obtained from Pseudomonas aeruginosa 579 was suspended in 10 mM N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES) pH 7.2 containing 0.1-10.0 mM of CaCl2.2H2O or MgCl2.4H2O. MEP treated with HEPES or < 5.0 mM of the Ca2+ or Mg2+ salts remained soluble and bound tobramycin in an equilibrium dialysis bioassay. MEP treated with 5.0 or 10.0 mM of the Ca2+ or Mg2+ salts did not bind tobramycin. Five and 10 mM Ca(2+)-treated MEP precipitated but Mg(2+)-treated MEP did not. Pseudomonas aeruginosa 579 biofilms formed using a defined growth medium having < 1 mM Ca2+ or Mg2+ were treated for 1 h with 10 mM HEPES +/- 5.0 mM CaCl2.2H2O or MgCl2.4H2O, prior to an 8-h exposure to HEPES, or the defined growth medium, +/- 125 micrograms/mL of tobramycin. The tobramycin kill kinetics for the HEPES-, Mg(2+)-, and Ca(2+)-treated biofilms were similar and gradual from T = 0-6 h. The viability of the HEPES- and Mg(2+)-treated populations declined sharply (from 6 to 8 h). Bacteria dispersed from the MEP in control biofilms at 0 and 8 h did not grow in the presence of 7.81 micrograms/mL of tobramycin. Thus, binding of tobramycin of P. aeruginosa 579 MEP may not be as influential to the impediment of tobramycin diffusion as is the steric hindrance imposed by the Ca2+ condensation of the polymer.


Pharmacokinetic evaluation of ceftiofur in serum, tissue chamber fluid and bronchial secretions from healthy beef-bred calves. Ceftiofur is a new broad spectrum cephalosporin marketed for the treatment of acute bovine respiratory disease. In this investigation ceftiofur was administered by intramuscular injection, at 24 h intervals, to healthy beef-bred calves for four days at dosages of 2.2 and 4.4 mg/kg of body weight, with 4 wk intervals between dosing regimens. Serum, tissue chamber fluid (TCF), and bronchial secretion (BS) concentrations of ceftiofur were measured by microbiological assay after the first and fourth dose of each dosing regimen. Peak serum concentrations (Cmax) of 8.8 micrograms/mL and 17.3 micrograms/mL were obtained approximately 2 h (Tmax), the time of mean peak concentration) after single injections of 2.2 mg/kg and 4.4 mg/kg, respectively. The Cmax was increased approximately twofold following multiple doses of 2.2 mg/kg (Cmax = 13.1 micrograms/mL) and 4.4 mg/kg (Cmax = 24.1 micrograms/mL). Ceftiofur accumulated slowly into TCF and peak concentrations were found to be approximately 14% of those observed in serum after the first dose and approximately 24% after multiple dosing. Concentrations of ceftiofur in BS were obtained rapidly with peak concentrations reaching 45% of the serum Cmax after the first dose. After multiple dosing the Cmax for BS was approximately 25% of the serum Cmax. This study found that both the 2.2 mg/kg and 4.4 mg/kg dosing regimens resulted in continuous serum, TCF and BS concentrations of ceftiofur that exceeded the minimal concentration required to inhibit the bacteria most frequently isolated from calves with acute bovine respiratory disease.


A cohort study of coagulase negative staphylococcal mastitis in selected dairy herds in Prince Edward Island. The epidemiology and importance of coagulase negative staphylococcal (CNS) mastitis in Prince Edward Island had not been documented. To investigate this, a cohort of 84 cows at seven farms were quarter sampled eight times over a lactation, commencing with samples taken prior to drying off in the previous lactation. Thirteen species of CNS were isolated. The quarter prevalence of CNS mastitis varied from 4.8% to 6.4% in the first five months of lactation and increased to 14.2 to 16.6% in the last four months of lactation. The geometric mean somatic cell counts (SCC) for quarters infected with CNS and uninfected quarters were 90 x 10(3) and 64 x 10(3) respectively (difference significant at p > 0.005). The two month new infection risk of CNS was 9.0% while the two month elimination risk was 74.4%. Infection with CNS did not alter the risk of subsequent infection with Staphylococcus aureus. The results from this project support the classification of CNS as a minor pathogen in mastitis control programs.


Effects of bovine leukemia virus infection on production and reproduction in dairy cattle. The purpose of this study was to determine the effects of bovine leukemia virus (BLV) infection on production, reproduction and longevity in dairy cattle. The study population was a commercial Holstein dairy herd of approximately 400 milking cows. Cattle were tested for antibodies to BLV at least annually for three years and when culled. Four groups of culled cows were compared: seronegative cows (n = 79), seropositive cows without lymphocytosis (n = 176), seropositive cows with lymphocytosis (> or = 9,000 lymphocytes/microliter) (n = 74), and seropositive cows with lymphosarcoma (n = 29). Seropositive groups of cows were bred more times and had longer calving intervals than seronegative cows. The seropositive groups had greater 305-day ME (mature equivalent) FCM (3.5% fat-corrected milk) per lactation and were older when culled than seronegative cows. However, the percent fat per lactation was greater in seronegative cows. In the last complete lactation, differences in 305-day ME FCM, days open and cull age between groups were reduced and none were significant (p > 0.05). In the cull lactation, only cows with lymphocytosis had reduced milk production relative to seronegative cows, although this difference was not significant. After adjustment for initial production and reproductive values, only seropositive nonlymphocytotic cows were culled at a significantly older age than seronegative cattle. Lymphocytotic cows were culled four months younger on average than nonlymphocytotic seropositive cows. Hence, BLV infected cows had greater milk production on average than uninfected cows. Adverse effects of BLV infection were primarily limited to lymphocytotic cows which were culled earlier and had reduced milk production in the cull lactation.


Immune response of pigs to parenteral vaccination with an aromatic-dependent mutant of Salmonella typhimurium. Cellular and humoral immune responses to parenteral vaccination with an aromatic-defined (aroA) Salmonella typhimurium and to oral challenge with the S. typhimurium parent strain were examined in pigs. The effectiveness of aroA S. typhimurium vaccination for prevention of clinical disease following challenge was also evaluated. A split litter model was utilized and analysis of variance was by least squares. The statistical model accounted for the effects of vaccination and litter. Parenteral vaccination of pigs with the aroA mutant induced a significant O-polysaccharide (O-ps) specific lymphocyte blastogenic response as well as a significant antibody response to O-ps, lipopolysaccharide and killed bacteria. The aroA strain was avirulent in pigs, was not shed in the feces and significantly reduced the severity of diarrhea following oral challenge.


Antibody avidity in swine lymphocyte antigen-defined miniature pigs. Antibody avidity to hen egg white lysozyme (HEWL) was measured by thiocyanate ion elution enzyme-linked immunosorbent assay (ELISA) in swine lymphocyte antigen (SLA) defined miniature pigs. Serum antibody avidity was evaluated on day 14 and 30 after primary (day 0) and secondary (day 14) immunizations in eight to ten week old miniature pigs previously typed for swine lymphocyte antigen genotype. The effect of SLA genotype, litter, and gender on anti-HEWL antibody avidity was determined by least squares. Antibody avidity varied amongst individuals. Antibody avidity maturation was observed as a mean rise in antibody avidity from primary response (0.89 +/- 0.64) to secondary response (1.23 +/- 0.54) (p < 0.0005). Overall, SLA genotype did not significantly influence antibody avidity or avidity maturation, but pigs of dd genotype had greater avidity maturation between primary and secondary responses than other genotypes. Litter effects significantly affected antibody avidity and maturation.


Streptomycin-resistant Escherichia coli as a marker of vulvovestibular contamination of endometrial culture swabs in the mare. To investigate the vulvovestibular contamination of endometrial culture swabs in the mare, a liquid culture of a streptomycin-resistant strain of Escherichia coli was applied to the vulvovestibular area of mares and used as a marker of contamination of endometrial culture swabs. Prior to taking endometrial swabs, the perineal area was washed with soap, rinsed with water, and dried. Endometrial culture swabs were taken from mares that were in anestrus or diestrus and from mares that were in estrus. When a manual transvaginal swabbing technique was used, 22 of 24 endometrial swab specimens from 12 mares were contaminated with the experimental bacterial strain; culture of only one endometrial swab yielded more than nine colonies. When a speculum approach was employed, three of 12 swab specimens from 12 mares yielded between one and three colonies. The stage of cycle had no effect on the extent of contamination, but the proportion of positive cultures was significantly smaller when swabs were taken via a vaginal speculum approach, compared to a manual transvaginal approach. Complete preclusion of vulvovestibular contamination of endometrial swab specimens was not achieved; however, fewer than ten colonies can be expected even in mares in which the vulvovestibular area has been thoroughly contaminated with a broth culture, provided that the perineal area is adequately cleaned prior to swabbing.


Ultrastructure and molecular characterization of Fusobacterium necrophorum biovars. The ultrastructural features and molecular components of 18 strains of Fusobacterium necrophorum biovars A, AB and B, isolated from animal and human infections, were examined by electron microscopy, multilocus enzyme electrophoresis (MEE) and by sodium dodecyl sulfate-gradient polyacrylamide gel electrophoresis (SDS-PAGE). High resolution scanning electron microscopy revealed that the strains possessed a convoluted surface pattern. Transmission electron microscopy showed that all strains possessed a cell wall structure typical of gram-negative bacteria. Bleb formation was not uncommon. Numerous extracellular materials, resembling lipopolysaccharide (LPS) fragments, surrounded cells of both human strains and biovar B animal strains. Biovar A field strains revealed capsules as stained by ruthenium red whereas a stock culture strain showed the capsule only when immunostabilized with hyperimmune serum. Starch gel electrophoresis showed all strains to possess adenyl kinase, glutamate dehydrogenases and lactate dehydrogenase; each enzyme migrated uniformly (monomorphic) among the strains and represented an electrotype. However, SDS-PAGE indicated differences in the protein profiles between all of the strains; the most distinctly different was a human isolate (FN 606). Silver staining to detect LPS showed extensive "ladder" patterns among the majority of biovar A strains but not in the animal biovar B strains. Immunoblotting of LPS with a rabbit antiserum prepared against phenol extracted LPS from a biovar A animal isolate (LA 19) suggested marked variability in the LPS antigens among the isolates studied.


Measurement of the cytotoxic effects of different strains of Mycoplasma equigenitalium on the equine uterine tube using a calmodulin assay. The cytopathic effects induced by five strains of Mycoplasma equigenitalium for cells of equine uterine tube explants were tested by measuring changes in cellular and extracellular concentrations of calmodulin (CaM). Calmodulin concentrations in samples of total homogenate (TH) and total homogenate supernates (THS) of the infected equine uterine tube explants were significantly lower than respective measurements on noninfected controls. In tissue culture medium fractions (TCM) of some infected explants, CaM concentrations were significantly higher than noninfected controls (p > 0.95). The results suggest that M. equigenitalium colonization on ciliated cells of the equine uterine tube can affect the permeability of the cell membrane leading to leakage or release of CaM during cell breakdown. Measurement of CaM concentrations in samples of TH revealed significant differences in the cytotoxic effects induced by different strains of M. equigenitalium on the equine uterine tube (EUT). The data suggests that some strains of M. equigenitalium may have a role in reproductive failure in the mare. In addition comparisons of the means of the concentrations of CaM in samples of TH or THS in EUT explants from four mares in the follicular and four in the luteal phase of the estrous cycle were found to be not significantly different.


Effect of oral administration of sulfadiazine and trimethoprim in combination on thyroid function in dogs. The effect of oral administration of sulfadiazine and trimethoprim in combination on serum concentrations of thyroxine (T4), triiodothyronine (T3) and free thyroxine (fT4) and the thyroid hormone response to thyrotropin administration was assessed. Six dogs were administered sulfadiazine (12.5 mg/kg) and trimethoprim (2.5 mg/kg) orally for 28 days; six untreated dogs acted as controls. Serum T4, T3 and fT4 were determined weekly during and for four weeks after treatment. Thyrotropin response tests were performed prior to treatment, after four weeks of treatment and three weeks after stopping treatment. There were no significant differences in mean serum T4, T3 or fT4 concentrations between treated and control groups at any time during the study. Mean concentration of serum T4 over time did not differ significantly from baseline concentration in either group. Significant differences in the mean serum T3 and fT4 concentrations occurred at several time points in treatment and control groups, and were apparently unrelated to treatment. Significant differences in the T4 or T3 response to thyrotropin administration within or between groups were not present. Serum T3 and fT4 concentrations fluctuate in normal dogs. Administration of sulfadiazine and trimethoprim in combination does not affect tests of thyroid function in the dog.


Approaches for genetic purity testing of live recombinant viral vaccines using a human adenovirus:rabies model. A two part purity testing regimen for genetically engineered live viral vaccines is described using a human adenovirus 5: rabies glycoprotein gene recombinant as a model vaccine. Initially, restriction endonuclease analysis of the recombinant viral genome verified the integrity of the recombinant construct and identified the vector genome. The second stage employed the polymerase chain reaction to facilitate a more detailed study of the target rabies glycoprotein cassette. The size of the target region was predicted from known nucleic acid sequence information and compared to that obtained after electrophoresis with molecular weight standards. Digestion of the polymerase chain reaction product with a second restriction endonuclease cleaved the target into a number of small fragments. Resolution of the fragments by gel electrophoresis allowed analysis of the target region alone, verifying its identity and integrity.


Bovine platelets retain functional activity in the presence of penicillin G. It has been reported that antibiotics of the penicillin family impair the functional response of human, canine and lapine platelets to a broad range of agonists. In contrast, we have shown that the bovine platelet retained full functional responses to stimulation by adenosine diphosphate (ADP) or platelet activating factor (PAF) following administration of penicillin G to clinically normal cattle at 20,000 IU/kg for three days. The aggregation response to collagen was transiently reduced to approximately 50% of pretreatment values, but only while the drug was detectable in the circulation. When penicillin was added to platelet rich plasma suspensions, ADP-induced aggregation was similar to that of the control untreated platelets, while the PAF-induced aggregation response was reduced by not more than 25%. Only collagen-induced aggregation exhibited a modest dose-dependent inhibitory response in the presence of penicillin. It is postulated that the relative insensitivity of the bovine platelet to penicillin may be related to differences in postreceptor biochemical events compared to the human platelet.


Alkaline phosphatase isoenzymes in feline serum using an agarose gel alkaline phosphatase kit method. Total serum alkaline phosphatase (ALP) activity is the product of the combined activity of isoenzymes from a number of tissue sources. In this study, a commercially available kit for electrophoretic separation of ALP isoenzymes in an agarose gel was used to separate ALP isoenzymes in feline tissue extracts and serum. Five separate bands of ALP activity were identified. These bands were numbered 1 to 5 with band 1 having the most anodal migration. The tissue of origin corresponding to the migration position of the isoenzymes are as follows: Band 3 was the liver isoenzyme, band 4 was the bone isoenzyme and ALP isoenzymes of both intestine and kidney migrate in the position labelled band 5. Band 1 appears to be related to albumin and does not represent true ALP activity. The tissue source of band 2 (a and b) was not identified. Serum ALP activity of mature, healthy cats is primarily of liver origin. Immature cats (< 1 year of age) have a greater proportion of the bone isoenzyme in the serum.


A study of repair cartilage from osteochondrotic humeral condyles of swine: preliminary report. A total of 16 animals, including 12 lame and four normal boars, were used. All lame boars had severe osteochondrotic humeral condyles in which repair cartilage tissues originating from subchondral bone were observed. Quantitative chemical studies of repair cartilage and normal cartilage were carried out using humeral condyles from four selected animals (two lame and two normal boars, respectively). The repair cartilage contained a higher concentration of collagen and lower concentration of proteoglycan than did the normal cartilage, consistent with the light microscopic observation of fibrous and fibrocartilaginous tissues in the repair cartilage. The proportion of proteoglycan extractable with 4M-guanidine hydrochloride was less in the repair cartilage than the normal cartilage. The proportion of proteoglycan that can interact with hyaluronic acid was also less than normal in the repair cartilage.


Sex does not influence serum osteocalcin levels in standardbred horses of different ages. The influence of sex on serum osteocalcin levels was studied in 99 Standardbred horses, 52 males and 47 females. The age varied between the day of birth and five years old. A significant inverse correlation (r = -0.87, p < 0.01) was observed between serum osteocalcin level and the age of the animal. Sex did not influence serum osteocalcin level (p > 0.05). When the subjects were divided into five age groups of six months or less, 6 to 18, 18 to 24, 24 to 36 and between 36 and 60 months, no significant influence of sex was noted. A predictive model for serum osteocalcin levels (y = 52.19 - 0.026 age in days, r2 = 0.76) for Standardbred horses aged between the day of birth and five years is described.


The use of an implantable central venous (Hickman) catheter for long-term venous access in dogs undergoing bone marrow transplantation. Methods were developed for the insertion and maintenance of long-term central venous catheters in dogs in order to provide reliable venous access during bone marrow transplantation. Single-lumen, 9.6 Fr Hickman catheters with a VitaCuff were used. The catheter was inserted into the jugular vein via a surgical cut-down, and tunnelled subcutaneously to exit over the thoracic spine. Fluoroscopic guidance was necessary to ensure proper positioning of the catheter tip in the right atrium. The catheter was secured at the venous entrance site with a grommet and at the cutaneous exit site with a finger-cuff suture. The exit site was bandaged; dressings were changed daily. Five dogs were studied. Catheter insertion and maintenance techniques were developed using two dogs. For the other three dogs, which developed 7 wk of profound myelosuppression induced by total body irradiation, the catheters were used for blood sampling and infusions of antibiotics, fluids, and blood products. For these three dogs there were 261 total catheter-days. Complete catheter obstruction did not occur. Partial obstruction (inability to withdraw blood) occurred for 13 days with one catheter. The tip of this catheter was in the cranial vena cava. One irradiated dog had a staphylococcal exit site infection for several days after catheter insertion, which resolved with antibiotic therapy. Infections of the subcutaneous tunnel, and catheter associated bacteremia, were not identified. Infectious and hemorrhagic complications of myelosuppression were less severe than in six other dogs where intermittent venipuncture was used for vascular access during radiation induced myelosuppression. In conclusion, long-term central venous catheterization is feasible in dogs during profound myelosuppression and markedly facilitates patient management.


The assessment of dimensions relevant to adult reciprocal attachment. The development and potential clinical uses of the Adult Attachment Dimensions Questionnaire is described. The seven scales of the Adult Attachment Dimensions Questionnaire relate to the aspects of a relationship formed to promote and maintain security. The underlying theory is founded on John Bowlby's work on the attachment behavioural system. The empirical validation was accomplished through three studies involving a clinical group and a non clinical group in a hospital setting and respondents to a community survey. Psychometric validation included measures of internal reliability, test-retest reliability, and construct validity through factor analysis. The resultant 35 item questionnaire should be useful to both clinicians and researchers interested in the characterization of the attachment system for adults.


[An inventory for the evaluation of dangerousness in mental patients]. The authors of the article propose an inventory for the systematic assessment of the dangerousness of psychiatric patients. This clinical tool is qualitative and is helpful in a case-by-case approach. The prediction of violent behaviour is discussed; quantitative and qualitative research perspectives are also mentioned.


Risk and protective factors affecting children in foster care: a pilot study of the role of siblings. A retrospective chart review of 115 siblings (from 48 families) simultaneously taken into the care of a Children's Aid Society was conducted. These children were a very neglected group at great risk of developing mental illness. There was a significant correlation between the number of symptoms the child had while in the receiving home and the time spent in foster care. Protective factors correlated with fewer symptoms at home but not while the child was in care. Being in care resulted in better performance at school, fewer symptoms and involvement in more extracurricular activities. High risk children made up their losses. While in foster care, 53% were eventually separated from their siblings. Children were more likely to be separated from their siblings if they were older, their father was physically ill or their parents were separated. Children who were separated from their siblings had more risk factors and placements while in care. However, they had fewer symptoms and better school performance while they were in foster care and fewer symptoms at discharge than the siblings who stayed together.


Cognitive-behavioural treatment of panic disorder during pregnancy and lactation. The treatment of panic disorder during pregnancy and lactation poses special problems. It is important that both the practitioner and patient consider a number of issues to find the most appropriate treatment for the patient. New cognitive-behavioural treatment options often circumvent the problems of pharmacotherapy for pregnant or lactating women while providing therapeutic benefits which are at least equivalent.


Psychiatric disorders in adopted children: a profile from the Ontario Child Health Study. Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.


A preliminary report on the discrepancy between clinical and test evaluations of competence. This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.


Assessing psychopathology in Korean immigrants: some preliminary results on the SCL-90. The goal of this study was to respond to a pressing need for translated versions of existing measurement scales that can reliably and validly rate degree of psychopathology among various groups of Asian immigrants. Specifically, the study investigated the cross-cultural utility of the Symptom Checklist-90 (SCL-90) by examining scores of community and patient samples of Korean immigrants and comparing them with norms for Americans and for Koreans living in Korea. Several analyses were also performed to establish the cross-cultural utility of the SCL-90. First, the reliability of the Korean version of SCL-90 was compatible with that of the original scale. Second, the scores of patient samples were unequivocally escalated compared with the scores of community samples within each population (Koreans, Korean immigrants and Americans), providing a partial confirmation of the concurrent validity of the SCL-90. Third, the cross-cultural validity of the scale was assessed by examining the scores of the patient samples. As expected, both symptom profiles and symptom levels were virtually invariant in the three patient samples. However, results of the study were clear in demonstrating that the SCL-90 scores of the community sample of Korean immigrants were substantially higher than the community norms of both North American and Korean samples.


[Narcosis under barbiturates: mutism].

[Narcosis under barbiturates: mutism]. The authors review the history and current uses of the amytal interview. This technique was quite popular over 50 years ago when it began, but has been ignored for the past ten years. A clinical case of mutism is described in this research to illustrate the usefulness of the amytal interview. In this particular case, the narcosis has permitted the uncovering of delusions and consequently the administration of the appropriate treatment.


Behavioural disturbances in the demented elderly: phenomenology, pharmacotherapy and behavioural management. Behavioural disturbances in the demented elderly cause a significant amount of distress both to the patients and their caregivers. This article first summarizes the phenomenology associated with these disturbances. It then deals with the pharmacological methods of reducing these disturbances. Finally, it deals with some of the more recent advances in combining the insights of behavioural modification with those of neuropsychology in finding non pharmacological methods of reducing problematic behaviours. It is stressed that a combination of the two approaches is most likely to be required, and most likely to be successful, in the individual case.


Screening psychiatric patients for Axis II disorders. This study examined the usefulness of the SCID-PQ on a sample of 82 inpatients as a screening measure for Axis II disorders. The SCID-PQ proved effective (i.e., resulted in a very low false negatives and moderate false positives) in screening for seven of the 11 DSM-III-R personality disorders. Of the four remaining disorders, minor modifications were suggested which resulted in improved classification rates for dependent and schizoid personality disorders.


Pyridoxine, ascorbic acid and thiamine in Alzheimer and comparison subjects. We compared the intake and functional levels of vitamins B6, C and B1 in 15 pairs of Alzheimer's disease and normal subjects. These were similar in both groups, except that B1 had lower functional values for the subjects with Alzheimer's disease. This suggests that it is unlikely that B6 or C could be used in the treatment of Alzheimer's disease. The role of B1 needs further exploration.


[Gallstones: a choice of treatments].

[Gallstones: a choice of treatments]. This article presents a profile of the 20-year evolution in the treatment of gallbladder stones. The author herself works in a modern hepato-biliary and pancreatic surgical department of Hospital Saint-Luc in Montreal. The role of the gallbladder, its pathophysiology and the symptoms of gallbladder syndrome are explained. The main objective of the article is to inform the nurse that, along with traditional surgical treatment, other treatments, non-surgical as well as surgical, do exist. The general public is aware of new methods such as laparoscopic cholecystectomy. This surgical procedure is explained along with other choices of treatment.


[Positive results from light therapy].

[Positive results from light therapy]. In their original May 1991 article, (this journal), the authors described the guidelines for, and results of, implementation of artificial light therapy in a Sherbrooke Hospital psychiatric unit for the treatment of seasonal affective disorder. In the present article, the authors describe an evaluation conducted to determine if there were specific aspects relating to the client or the therapy that had a direct influence on the results, and if it was necessary to develop new guidelines or parameters to guide future administration of treatments. They also wanted to obtain a typical portrait of their clients. Eighteen clients were treated on an outpatient basis during the winter of 1990-91. All but two completed their treatment programs and took part in the evaluation. The majority of the clients identified were women (94 per cent); 56 per cent were unmarried; and of those of working age, all were regularly employed except one. The greatest majority of clients had no social activities, 69 per cent had a history of psychiatric problems and 44 per cent were taking anti-depressants. Because of the artificial light therapy, improvement was noted in their level of energy, social activities, sleep, appetite and emotional state.


[Family intervention according to Roy. Planning, execution and evaluation]. Last month, the author presented the first two steps necessary in the development of a nursing care plan. This care plan utilized Sister Callista Roy's conceptual model and was designed to evaluate the family system. The readers became familiar with the Joly family, whose family system was evaluated (this included Diane and Jessie). Analysis of the collected data identified two nursing diagnoses and the author explained the way that nursing diagnosis is derived. The first identified nursing diagnosis revealed a threat to the beneficiary, the second diagnosis revealed a threat to the family system. This second article is devoted to the three other steps involved in the development of a nursing care plan that will assist the nurse in developing a systematic strategy in caring for this type of family. The planning step consists of the identification of objectives for care. These objectives must be specific, measurable and realistic as well as able to answer the question: "What changes are intended for this family?" Suggestions are offered for objective development. Once the objectives are finalized, the nurse chooses pertinent and realistic interventions that permit her/him, as well as Diane, to attain the identified objectives. The nurse's interventions are centred around stimuli that are increased, decreased or maintained by the goal of modifying or reinforcing observed behaviors. In the care plan example developed for the Joly family, the identified interventions are not all inclusive and serve as suggestions. During the course of the interventions the nurse must constantly readjust and adapt the interventions to fit with changing needs.(ABSTRACT TRUNCATED AT 250 WORDS)


Management of sodium abnormalities in patients with CNS disease. The CNS plays an integral role in the neuroendocrine regulation of sodium and water homeostasis. Therefore, disturbances of this function are common in patients with CNS disease. The body's sodium and water content are tightly regulated in order to maintain normal osmolality and intravascular volume. Complex neural, humoral, and renal mechanisms integrate information regarding osmolality, intravascular volume, blood pressure, and intake of sodium and water. They act to modify intake and excretion of sodium and water and vascular tone. Most sodium abnormalities in patients with CNS disease result from altered water excretion secondary to disturbed release of antidiuretic hormone (ADH). Insufficient release is seen with lesions in or near the optic chiasm and pituitary gland and results in diabetes insipidus (DI). DI is common following surgery or trauma in this region and care must be exercised in treating these patients because of the potentially variable and transient nature of the disturbance. The syndrome of inappropriate release of ADH is seen in a wide variety of CNS disorders and produces a dilutional hyponatremia. Symptomatic hyponatremia should be managed aggressively with diuretics and hypertonic saline followed by fluid restriction. However, very rapid correction or overcorrection should be avoided. In some patients, especially those with acute subarachnoid hemorrhage, disturbed sodium regulation appears to contribute to hyponatremia. Patients with subarachnoid hemorrhage and hyponatremia should not be fluid restricted, because of the risk of exacerbating vasospasm, but treated with large volumes of isotonic saline.


Coadministration of vigabatrin and valproate in children with refractory epilepsy. The effects of adding vigabatrin (GVG) to the antiepileptic regimens of 16 children with refractory epilepsy have been studied. One-half of the regimens included sodium valproate (VPA). Parameters studied were seizure reduction, platelet GABA-T activity, and steady-state plasma concentrations (CSS) of GVG and VPA. Add-on GVG reduced the seizure frequency both in patients receiving VPA (from 42.9 to 4.5 seizures/month, p < 0.01) and in those without VPA (from 60.0 to 31.7 seizures/month, p < 0.05). GVG also reduced GABA-T activity in both groups (from 19.4 to 5.4, p < 0.001 and from 8.3 to 4.5 pmol/min/mg of protein, p < 0.05, respectively). Seizure reduction and GABA-T inhibition were greater in patients taking VPA than in those who were not. In patients receiving VPA, no significant changes were observed in VPA CSS values before and after the addition of GVG. On the other hand, no differences were found in GVG CSS values between patients with and without VPA. It is concluded that the coadministration of GVG to valproate reduces the frequency of seizures in refractory epileptic children and does not affect the steady-state plasma concentrations of either drug. Therefore, their association could be useful in clinical practice.


Effect of propranolol in head tremor: quantitative study following single-dose and sustained drug administration. The effect of the beta-adrenoceptor antagonist propranolol has been investigated in nine patients suffering from isolated (six patients) or prominent (three patients) essential tremor of the head. In a double-blind, placebo-controlled study the tremorolytic efficacy of propranolol has been assessed by a quantitative accelerometric method after a single oral dose (120 mg) and following 2 weeks of sustained treatment with two different dosage regimens of the drug (120 and 240 mg daily). As compared with placebo, a significant reduction in tremor magnitude was found following a single oral dose but not on sustained administration of the beta-blocker at either dosage. The results suggest that the efficacy of sustained propranolol on isolated or prominent essential head tremor is less predictable and satisfactory than expected on the basis of the single-dose response, as compared with hand tremor.


The clinical efficacy of single morning doses of levodopa methyl ester: dispersible Madopar and Sinemet plus in Parkinson disease. For many patients with Parkinson disease and levodopa-related motor fluctuations, the latency to onset of action of a single dose of a levodopa preparation may be both long and variable. In an effort to find a more rapidly acting and reliable preparation of levodopa, we therefore studied the efficacy of single doses of an oral solution of 250 mg of levodopa methyl ester (ME) with benserazide, 50 mg and of a molar equivalent dose of dispersible Madopar (DM) (50/200) in 13 patients in the fasting state after overnight drug withdrawal. The response of seven of these patients was compared to that after two Sinemet 25/100. The latency to "on" was equally fast with ME and DM, and significantly faster than after standard Sinemet. The duration of "on" was similar with all three. Because of this more rapid relief of "off" periods, both ME and DM offer a potential clinical advantage over standard preparations of levodopa.


No effect of chronic bromocriptine therapy on levodopa pharmacokinetics in patients with Parkinson's disease. We studied the effect of chronic bromocriptine cotherapy on levodopa kinetics in seven patients with Parkinson's disease who were receiving levodopa therapy. Plasma levodopa concentrations were measured after a standard oral levodopa fasting dose over a 5-hour period, on two different sessions, without and with bromocriptine at a fixed daily dose of 15 mg. We found no statistically significant difference in the rate and extent of levodopa absorption between the two treatments, with minimal intrasubject variability. Our observations suggest that chronic bromocriptine cotherapy is unlikely to affect the plasma levodopa pharmacokinetics under standardized intake conditions or to contribute to a less predictable pattern of drug plasma concentrations.


Tolerability of oral dextromethorphan in patients with a history of brain ischemia. Twelve patients with a history of cerebral ischemia were randomized to treatment with the N-methyl-D-aspartate antagonist dextromethorphan (60 or 90 mg p.o. q.i.d.) or placebo for 2 weeks in a randomized, safety study. Neuropsychological testing did not detect evidence of cognitive dysfunction; however, side effects including lightheadedness, drowsiness, nausea, decreased coordination, and unsteady gait were reported by several patients while taking dextromethorphan.


Therapeutic interventions to reduce rates of hospitalization and death in patients with heart failure: new clinical evidence. The high prevalence and poor prognosis of heart failure are a major concern. Hospitalization for heart failure accounts for a major proportion of health-care expenditure. A number of large clinical trials have been initiated to assess therapeutic strategies to improve prognosis for patients with this condition. Results from one of the largest and most recently completed of such studies, the Studies of Left Ventricular Dysfunction (SOLVD) trial, demonstrate that addition of the long-acting angiotensin-converting enzyme (ACE) inhibitor, enalapril to conventional therapy with diuretics and digoxin is associated with reduced rates of mortality and hospitalization for heart failure. Activation of the renin-angiotensin-aldosterone system (RAAS) appears to play an important role in the pathogenesis of this condition. The effects of treatment with this ACE inhibitor may be related to the degree of RAAS suppression it affords.


Long-term magnesium supplementation in essential hypertension. The main objective of this clinical trial was to evaluate the effects of magnesium pidolate (15 mmol/day) on blood pressure at rest and during sympathetic stimulation induced by cold, isometric and tilt test; peripheral blood flow has been evaluated by strain-gauge plethysmography. Fourteen mild to moderate hypertensives (8 males, 6 females, age range 40-60 years) were randomly given magnesium or placebo in a double-blind parallel clinical trial for 6 months. In the actively treated group magnesium urinary excretion increased from 5.3 +/- 2 to 7.7 +/- 2 mmol/24 h, and serum magnesium changed from 0.9 +/- 0.1 to 1.0 +/- 0.2 mmol/l. On magnesium, BP changed at rest from 156/97 +/- 12/4 to 149/90 +/- 8/3 mm Hg, during cold pressor test from 169/105 +/- 9/6 to 174/105 +/- 15/4, during isometric exercise from 170/107 +/- 13/9 to 170/105 +/- 20/6, and during tilt test from 149/96 +/- 11/6 to 153/96 +/- 17/7 mm Hg. Similar changes were observed in the placebo group. Peripheral resistances were 14.7 +/- 4 and 9.8 +/- 2 PRU before and after magnesium, respectively. These data indicate that long-term magnesium pidolate supplementation does not affect blood pressure at rest and during sympathetic stimulation, despite a slight, nonsignificant reduction in forearm peripheral resistance.


Facilitated recovery of cardiac performance by triiodothyronine following a transient ischemic insult. Reperfusion following a transient ischemic insult has been shown to result in a delayed recovery of myocardial function. A reduction in plasma triiodothyronine (T3) has been reported in these acute cardiovascular challenges. To test whether the replacement of T3 can facilitate the recovery of myocardial function following a transient regional ischemia, we investigated cardiac performance for 3 h after a 15-min, left anterior descending coronary artery occlusion in a canine model. Three groups of dogs were studied: I--control (n = 10); II--receiving T3 (0.25 micrograms/kg i.v. and 0.25 micrograms/kg/h for 3 h, n = 9), and III--receiving T3 (0.25 micrograms/kg i.v. and 0.5 micrograms/kg/h for 3 h, n = 9). Three hours following reperfusion, the T3 level in blood was significantly decreased in group I. Concomitantly, local segmental shortening was reduced from preocclusion control levels in group I (15.2 to 5.1%, p < 0.05), but recovered in both treated groups. The endsystolic elastance (Ees) and the external work (EW) efficiency (EW/PVA) in group I were depressed from preocclusion control (Ees = 95.5 +/- 0.8%; EW/PVA = 90.2 +/- 1.8%, both p < 0.05), the effective arterial elastance (Ea) and ventriculoarterial coupling (Ea/Ees) in group I were still elevated from preocclusion control (Ea = 122.5 +/- 5.1%; Ea/Ees = 128.3 +/- 5.3%, both p < 0.05). But these measures of global cardiac performance in the treated groups recovered following reperfusion, and the extent of recovery was dose dependent. These data suggest that T3 facilitates recovery of the stunned myocardium by improvement in local and global contractile function, in ventriculoarterial coupling, and in the energy efficiency.


Occurrence of chest pain more than 24 hours after hospital admission in acute myocardial infarction and its relation to prognosis. In 857 consecutive patients with acute myocardial infarction (AMI), the occurrence of chest pain more than 24 h after hospital admission is described and related to death or reinfarction during one year of follow-up. Prolonged chest pain was observed in 333 patients (39%). In this group 15% died and 7% developed reinfarction during the first month as compared with 10% (p < 0.05) and 2% (p < 0.01) respectively in patients without prolonged pain. However, during one year of follow-up mortality did not differ significantly between patients with (27%) and without (24%) prolonged pain. The 1-year reinfarction rate was similar in the two groups (18% and 14%, respectively; NS). We conclude that AMI patients with prolonged chest pain have a particularly high mortality during the first month. However, during a longer follow-up the prognosis is similar in patients with and without prolonged chest pain.


Transesophageal echocardiographic findings in partial and complete papillary muscle rupture complicating acute myocardial infarction. Papillary muscle rupture occurred in two patients with recent inferior myocardial infarction. In one case with partial rupture transesophageal echocardiography in the standard four-chamber view did not visualize the rupture and in the second case with complete rupture it provided incomplete diagnostic information. A not previously described transgastric longitudinal scanning of the left ventricle provided complete delineation of the lesion and it was of great value in the diagnosis and management of this potentially lethal complication. Both patients were operated upon and had a favourable outcome.


Comparison between end-systolic pressure-volume and end-systolic wall stress in determining left ventricular contractility with increased afterload. This study compared end-systolic pressure-volume relationship (P/V) versus wall stress index (WS) as a tool for the evaluation of ventricular contractile state during upright isometric exercise. Both indices of contractility exhibit significant (p < 0.001) increase during exercise compared to resting values. The correlation coefficients for the two indices of contractility were r = -0.45 for exercise and r = -0.70 for rest. Both were significant at the p < 0.01 level. The correlation of the difference scores between rest and exercise as computed by both indices was low (-0.20) and insignificant. These data suggest that changes in contractility from rest to exercise as measured by one index do not reflect the pattern of individual differences that are measured by means of the other index. However, from a reliability point of view, it seems appropriate to prefer the use of P/V index over the WS index in order to determine contractile state.


Diastolic perfusion time and exercise posture in coronary artery disease patients: correlation with ST segment changes. The relationship between either heart rate or diastolic time and ST segment depression has been evaluated during supine and upright exercise in 16 coronary artery disease patients. Diastolic perfusion time and ST segment depression were related by a linear regression, which was independent of exercise posture. The entity of ST segment depression was greater during supine than in upright exercise for the same heart rate. The assessment of the relationship between heart rate and diastolic perfusion time during two exercises showed that at the same heart rate, diastolic perfusion time was shorter in supine posture. In conclusion, the greater entity of ST segment depression induced by supine rather than upright exercise might be explained by the effect of supine posture on diastolic perfusion time.


Influence of age and sex on left ventricular anatomy and function in normals. Using digitized M-mode echograms, we evaluated the influence of sex on age-related changes of left ventricular (LV) anatomy and function in a normal population (75 males and 75 females, subdivided in age groups for each decade from 20 to 70 years). Aging is accompanied with an increase in septal and wall thickness in both males and females and in LV diameter only in males, with a progressive increase of LV mass more pronounced in males than in females. As regards LV function we found a progressive slowing of relaxation in females and of both contraction and relaxation in males, not related to changes in LV mass.


[The importance of the Czech Medical Society yesterday and today]. Fourteen physicians headed by Jan Evangelista Purkynĕ signed the proposed by-laws of the Czech medical society in october 1861. Emperor's approval was received 26th june 1862 and in july Purkynĕ was elected the first president. The same illuminated personalities were the founders of the Casopis lékarů ceských--the Czech medical Journal which has remained the most important Czech periodical until the present time. The aims of the Society were to cultivate medical science and promote Czech language in medicine. Weekly scientific sessions, medical periodical and publication of monographs related to medicine were the means how to achieve the aims. The Czech Medical Society became soon the centre of medical science in Bohemia. Its members were among the foremost fighters for the use of Czech language in Charles university and their relentless effort helped much to the establishment of the Czech Univerzity in 1882 and Czech medical faculty a year later. In subsequent years the Society was also involved in professional problems related to social health insurance, medical fees, ethical problems and other relevant questions such as the establishment of medical chambers. The activity of the Czech medical Society was never interrupted during its 130 years of existence, although there were several difficult periods in its life, mainly during the first and second world war and also in the past 40 years. In spite of the atomization of medicine the Czech medical Society has been continuing its eminent mission to create communication and establish close links between the medical science and practical medicine by systematically bringing new knowledge in medicine and biology to general physicians and by putting together physicians, surgeons and basic scientists. The task for the future is seen in optimal transfer of new knowledge and ideas from scientists to practicians and vice versa; and to take care of the highest possible moral and ethical standard required for humane medicine. Tradition and achievements of our teachers is binding and we are looking forward to better future in united Europe.


[130 years of the Czech Medical Society in Prague]. The author reminds that 130 years ago the Czech Medical Society in Prague was founded. He mentions the difficulties which proceeded this historically important event during the Austrian monarche where the leading language was German and all attempts to introduce Czech into public life were impossible. The author mentions the names of those with the greatest merits as regards the foundation of the Society: J. E. Purkynĕ, B. Eiselt, J. Podlipský and E. Grégr who achieved after repeated attempts that the foundation of the Society was granted and its activities were started in July 1862. The first elected chairman was Jan Evangelista Purkynĕ. The author mentions briefly also the activities of the Society during the German occupation and subsequent years. If in 1862, the time of foundation, the Society had only 150 members, at present it has 1500 members and is not only the oldest but also the largest medical society in this country.


[Lipoperoxides and atherosclerosis].

[Lipoperoxides and atherosclerosis]. The theory of the pathogenetic role of lipoperoxides in atherosclerosis and thrombosis is very topical at present. It unifies the theory on the role of free oxygen radicals with the theory of damage of the vascular wall and with the theory of impaired lipid metabolism. It makes possible also a new interpretation of known risk factors. It is also based on the most recent results of molecular biology (role of monocytes-macrophages).


A new balloon-expandable tantalum stent (Strecker-Stent) for the biliary system: preliminary experience. Placement of a balloon-expandable metallic stent (Strecker-Stent) for biliary drainage has been attempted in 30 patients. The stent was successfully implanted in 22 patients; in the remaining 8 patients, dilatation of the biliary stricture prior to stent placement was inadequate and delivery of the Strecker-Stent was, therefore, not possible. Insufficient balloon dilatation was related to the rigid nature of the stricture and to pain experienced during dilatation. During 2-9 months follow-up, 3 of 21 patients (14%) presented with reocclusion of the stented bile ducts. In all other patients, biliary drainage remains adequate. No major complications related to stent placement were observed.


[Blood platelets, lipid peroxidation and antioxidants]. The paper reviews published data on the products of platelet lipid peroxidation, their role in blood coagulation as other physiological and pathological processes. The authors discuss the significance of anti-oxidants (selenium, glutathione peroxidase, reduced glutathione and vitamin E) in removing excessive hydroperoxides and thus in the control of platelet functional activity. Changes in platelet arachidonic acid metabolites and in antioxidants were found in a number of pathological conditions such as diabetes mellitus and cardiovascular diseases.


[Incidence and changes in mitral regurgitation in balloon valvotomy of the mitral valve. A color Doppler study]. The objective of the work was a detailed examination of the incidence and changes of mitral regurgitation (MR) in conjunction with percutaneous transluminal valvotomy of the mitral valve (VMCH). Using coloured Doppler mapping, the authors examined a total of 40 patients before and in the course of one week after VMCH. They assessed the number of regurgitation jets the site of their development, the timing and haemodynamic impact of MR. Knowing the site of development of MR, the authors were able to assess whether the regurgitation after VMCH persisted, developed de novo or disappeared. The total number of mitral regurgitation increased after VMCH from 38 to 51 (increase by 34%, p < 0.05) with a significant rise of the number of double regurgitation jets (4 before as compared with 12 after VMCH, p < 0.05). Before VMCH the authors recorded a holocystic MR in 53%, after VMCH in 86% of the patients (p < 0.01). While before VMCH almost half the regurgitation jets originated in the central portion of the valve, after VMCH MR originated mainly from the area of commissures (48% regurgitation jets before, 79% after VMCH, p < 0.01). Only in 33% of MR after VMCH persisting regurgitation was involved, almost half (47%) of 38 regurgitation jets present before VMCH, disappeared after valvulotomy. MR displays a considerable variability. This may be one of the reasons why prediction of the development and severity of MR after PTMV is difficult.


Metallic stents in benign biliary strictures: three-year follow-up. Eighteen patients with recurrent benign biliary strictures (BBS) were selected for metallic stents placement because they failed to respond to percutaneous balloon dilatation. None were candidates for surgical corrections. We used "Z" single or double stents in 17 cases and a Wallstent in 1 case. After more than 3 years of follow-up (average period 37 months, range 30-41 months), 10 patients (55.5%) were asymptomatic without signs of bile stasis; 5 patients (27.7%) had recurrence of symptoms and were eventually retreated; and 3 patients (16.6%) died, 2 of obstructive jaundice and liver failure and 1 of metastatic gastric cancer. Recurrence was due to stent occlusion by tissue ingrowth in 3 cases, stent migration in 1 case, and an inflammatory lesion of the papilla of Vater in another case, with patency of the metallic stent. The overall patency rate, at 3-year follow-up was 68.7%. In our series, the main factor determining long-term patency of metallic stents has been reactive tissue ingrowth. Nevertheless, long-term results obtained with metallic stents in recurrent benign biliary strictures should be considered satisfactory. In selected patients, metallic stents may represent the only long-term treatment available for maintaining bile flow.


[Comparison of the properties of spot and ring electrodes in transesophageal cardiac pacing]. The authors compare diagnostic oesophageal pacing of the left atrium by a ring and spot electrode using poles with an area of 20 mm2 oriented towards the left atrium. The examination was made in 15 volunteers, aged 37 +/- 5 years (range 28-43 years). In different depths of the oesophagus the threshold of stimulation was assessed (PS) and the threshold of perception of stimulation (PV) of the left atrium. At each of the examined levels the amplitude of waves A and V was determined as well as the A/V ratio. The change from a ring to a spot electrode reduces the PS from 12.2 +/- 2:3 (8.0-15.0 O) mA to 8.0 +/- 1.3 (6.0-10.0) mA. When the spot electrode is used, the difference between PS and PV is markedly reduced; one third of the examined subjects can be stimulated without subjective perception. The amplitude of the A wave recorded by means of the spot electrode was not reduced, as compared with the ring electrode and the optimal A/V ratio above 2:1 was recorded by the spot electrode on a longer section of the oesophagus. Evidence was also provided that the lowest PS is 3-4 cm beneath the site of recording of the maximum amplitude of wave A.


[Changes in liver histones in rats after single, continuous and combined irradiation with gamma rays]. The authors examined the concentration and total contents of histones and the relative ratio of different fractions of histones in the liver of rats after a single (6 Gy), continuous (total dose 1.4 Gy cumulated at rate of 0.1 Gy per day) and combined continuous and single irradiation with gamma rays. The most extensive changes of histones were revealed after combination of continuous and single irradiation. Continuous irradiation did not lead to activation of reparative mechanisms which would mitigate the response to the subsequent single irradiation. The summation of effects is apparent from the fact that in the liver, contrary to organs with active cellular proliferation, irradiation with small doses does not increase the resistance to the subsequent irradiation, on the contrary, cumulation of damage was observed.


Role of the Gianturco expandable metal stent in the management of tracheobronchial obstruction. This paper reports our experience in treating localized airway obstruction with expandable metal stents. Nine patients were treated for malignant obstruction and 6 for benign obstruction. The main indications for treatment were imminent asphyxia, breathlessness and/or repeated chest infections. All but 2 patients had received other treatments before referral. Seven patients with malignant obstruction had extrinsically compressed airways and all derived a sustained symptomatic improvement. Two patients with recurrent tracheal obstruction caused by intraluminal tumor gained lasting relief with the use of a covered expandable metal stent. All 6 patients with benign strictures were improved, although 2 developed recurrent obstruction caused by granulation tissue growing within and beyond the stent. It is concluded that the expandable metal stent provides an effective and noninvasive method of relieving large airway obstruction. As the long-term tissue tolerance to this type of stent is not known, caution is advised in the management of benign strictures. In patients with malignant obstruction, however, the expandable metal stent would appear to have considerable potential as a palliative treatment.


[Hydrocortisone decreases blood flow in bones in sham-operated and oophorectomized female rats]. In an experiment on 38 75-day-old female rats--sham-operated or oophorectomized (OOX)--the authors assessed the effect of hydrocortisone administration (0.01% in the diet for four weeks) on the blood flow in the tibia and distal end of the femur (uptake of 85Sr microparticles). In the tibia they assessed also the density (according to the Archimed principle) and the weight of ashes per volume unit of bone. OOX increases significantly local circulation in both bones. After hydrocortisone these values are significantly lower in sham-operated and OOX rats as compared with controls and also significantly lower in the group OOX+hydrocortisone, as compared with group OOX. The density and weight of ashes from the tibia are not affected by hydrocortisone; the minute volume of the heart per 100 g body weight of rats is not altered in any group. The mechanism of the described hydrocortisone effects on circulation is not known. In the discussion the authors indicate possible associations of blood flow and the osteoblast and prostaglandin function in bony tissue.


A comparative study of the schizontocidal efficacy and safety of artemether versus chloroquine in uncomplicated malaria. Forty-seven patients with uncomplicated falciparum malaria were randomly assigned to receive either artemether (n = 24), 9.6 mg/kg body weight intramuscularly over five days or chloroquine (n = 23), 25 mg/kg body weight orally. Patients were kept in hospital for seven days followed by review on days 14, 21 and 28. Five patients on chloroquine were withdrawn before day seven due to treatment failure. Of the remaining patients, parasite clearance time was 33.0 +/- 13.6 hours for the artemether group and 63.3 +/- 14.7 hours for patients on chloroquine (p < 0.001). No significant difference was recorded in fever clearance time between the two groups of patients. Recrudescence rate for patients on artemether was 14.3 pc compared to 57.1 pc for the chloroquine group (p < 0.05). No major adverse events were recorded for either treatment group although five patients on artemether had a transient spike of temperature after clearance of parasitaemia. In conclusion, our study has shown that no major adverse events were experienced by patients on artemether and the rate of parasite clearance for the artemether group was superior to that of patients on chloroquine.