Atomic force microscopy of uncoated plasmid DNA: nanometer resolution with only nanogram amounts of sample. Reproducible, high-contrast, nanometer-resolution AFM images of uncoated plasmid DNA can be obtained with nanogram quantities of DNA with the help of two advances in sample preparation: (1) Heating a DNA solution at 35 degrees C for 10 to 20 minutes before deposition on mica helps separate and spread the DNA, and (2) Using 5 microliter drops of the heated DNA solution in the concentration range of 2 to 10 nanogram/microliter in contact with a specially prepared mica surface for 5 to 10 minutes gives optimal coverage with only nanograms of DNA.


Cation-dependence of the self-association behavior of guanylyl-(3'-5')-guanosine. The aggregation behavior of guanylyl-(3'-5')-guanosine, GpG, in the form of the tetramethylammonium (TMA), Li, Na, and K salts in aqueous solution has been investigated by NMR and FTIR techniques. The salts were prepared by a cation-exchange method. The ability of the cations to induce aggregate formation is TMA+ < Li+ < Na+ < K+, where TMA+ has only a weakly promoting action and K+ has a very strong effect. Three types of aggregates have been observed: (a) small aggregates which are in rapid exchange with respect to the NMR time scale; (b) intermediate-sized aggregates which are slow to exchange; (c) very large aggregates which can only be observed by FTIR. In all cases the aggregated species are held together by base stacking and guanine-guanine hydrogen bonding. A stoichiometry of 2 GpG per K+ has been determined by a 1H NMR titration of TMAGpG with KCl. Models have been proposed for the various-sized species. These include stacked dimers, stacked tetramers (similar to G-tetrads), and species in which K+ ion bridges between phosphates in separate tetramers.


Zidovudine-resistant and -sensitive HIV-1 isolates from patients on drug therapy: in vitro studies evaluating level of replication-competent viruses and cytopathogenicity. To compare biological properties of zidovudine-resistant variants of HIV-1 isolated from subjects on long-term drug therapy with drug-sensitive parental isolates obtained from the same patients before initiation of treatment. Clinical HIV-1 strains were isolated following co-incubation of patient peripheral blood mononuclear cells with mitogen-stimulated umbilical cord blood lymphocytes. Drug resistance was evaluated by infecting MT-4 cells pretreated with zidovudine and maintained under drug pressure. The drug-resistant phenotype remained stable, following many viral replication cycles in the absence of zidovudine. Drug-resistant variants contained fewer replication-competent viruses but were more cytopathogenic than their corresponding zidovudine-sensitive parental strains. These results suggest that drug-resistant strains possess biological properties that may differ from those of drug-sensitive variants of HIV-1.


Infection of cultured human adrenal cells by different strains of HIV. To determine whether human adrenal cells can be infected by HIV. Cultured human fetal adrenal cells and the SW13 human adrenocortical carcinoma cell line were inoculated with several HIV-1 and HIV-2 strains. Virus replication was detected by viral core antigen enzyme-linked immunosorbent and reverse transcriptase assays. CD4 expression was measured by Northern blot and polymerase chain reaction procedures. HIV infection of these adrenal cells was detected and was most evident after cocultivation of the inoculated cells with peripheral blood mononuclear cells. Infection does not involve the CD4 molecule, which is not expressed by these adrenal cells. The relative level of HIV replication depended on the viral strain used. Virus production occurred best in cells that maintained evidence of adrenal cell function. Infection did not appear to disturb steroidogenesis measured in the cells. These observations indicate that human adrenal cells are susceptible to HIV infection, and provide further evidence of the polytropic nature of the virus.


Immunization in children with HIV seropositivity at birth: antibody response to polio vaccine and tetanus toxoid. To evaluate the humoral response to routine childhood immunization of HIV-infected children. Response rate, antibody titres and persistence after polio and tetanus vaccination were compared in 72 children with HIV seropositivity at birth and divided according to HIV infection status as determined by clinical and laboratory tests. Polio antibodies were titred in a microneutralization test (positive titres, > or = 1:4), and antibody to tetanus toxoid with a passive haemagglutination method (protective titres, > or = 1:1024). The response rates to polio and tetanus vaccination (> 80 and > 75%) were similar in the HIV-infected and non-infected children, as were antibody levels. In the subgroup with sera obtained some months after the last dose of vaccine, polio antibody levels decreased in all four HIV-infected and in three of the seven non-infected children; protective tetanus antitoxin levels were detected in three of the six infected and in all three non-infected children. This study demonstrates the ability of children with HIV infection to respond adequately to the two vaccines considered, although tetanus antitoxin levels were inferior, compared with those in the seroreverted children. The unsatisfactory antibody levels observed in the admittedly few HIV-positive children studied some months after the last vaccination could be the result of a lower initial protective level and not necessarily an expression of severely impaired immunocompetence. The administration of booster doses in addition to the traditional immunization schedule could be useful in children with HIV infection.


Eflornithine versus cotrimoxazole in the treatment of Pneumocystis carinii pneumonia in AIDS patients. To compare cotrimoxazole and eflornithine as primary treatment for first-episode Pneumocystis carinii pneumonia (PCP). Prospective open-labelled study. Patients were randomized to eflornithine (400 mg/kg daily, as a continuous intravenous infusion) or cotrimoxazole (3.84 g twice daily, intravenously) for 14 days. Only 39% of patients treated with eflornithine (20 out of 51) and 40% of those given cotrimoxazole (nine out of 47) successfully completed therapy. Although 12 out of the 36 patients with confirmed PCP were treated successfully with eflornithine, significantly more patients were withdrawn from the eflornithine group because of therapy failure (25 out of 51 versus 10 out of 47, P = 0.007). This significant difference persisted in patients in whom a diagnosis of PCP was confirmed histologically (19 out of 33 versus seven out of 27, P = 0.03). Significantly more patients were withdrawn from cotrimoxazole because of serious drug-related side-effects (38 versus 12%, P = 0.005). Eflornithine (400 mg/kg daily) is less effective than cotrimoxazole (7.68 g daily) as treatment for first-episode PCP. Eflornithine does have activity against P. carinii in humans.


HIV infection and breast-feeding: policy implications through a decision analysis model. (1) To develop a comprehensive decision analysis model to compare mortality associated with HIV transmission from breast-feeding with the mortality from not breast-feeding in different populations and (2) to perform sensitivity analyses to illustrate critical boundaries for guiding research and policy. Using a decision tree, mortality rates were estimated for all children, children born to mothers infected during pregnancy, and children born to mothers who were uninfected at delivery. Given various assumptions about child mortality rates, relative risks of mortality among children who are not breast-fed compared with those who are (R), rates of HIV transmission from breast-feeding, HIV prevalence, and HIV incidence, scenarios were created and sensitivity analysis used to delineate critical boundaries. Our model shows that only in situations where R is approximately < or = 1.5 and HIV incidence/prevalence is high (prevalence > 10%, incidence > 5%) would universal breast-feeding result in equal or higher mortality compared with non-breast-feeding. Among populations in many developing countries, where there is a high relative risk of mortality if breast-feeding is not practiced, if R > 3, overall mortality is almost always lower among children who are breast-fed, even by HIV-infected mothers. In situations where maternal HIV status is known, the decision whether to breast-feed is largely dependent on the magnitude of additional mortality risk if the child is not breast-fed. The model illustrates the importance of distinguishing between population and individual recommendations. Based on available data, the model supports current World Health Organization and Centers for Disease Control recommendations on HIV infection and breast-feeding. Given the importance of breast-feeding and the global impact of HIV infection, more research is needed, especially to clarify the range of HIV transmission rates from breast-feeding and to expand specific assessments of relative risks for different areas of the world.


Estimating the incubation period of paediatric AIDS in Rwanda. To estimate the distribution of the incubation period of paediatric AIDS in Rwanda. Data were collected between February 1984 and December 1990 at the Centre Hospitalier de Kigali (CHK), the capital city of Rwanda, Central Africa. We used a sample of 685 AIDS cases registered consecutively in the Department of Paediatrics of the CHK, in which the proportion of perinatally acquired HIV-1 infection was estimated to be 98.6%. We performed both non-parametric and parametric analyses. The methods of estimation were adapted to truncated data, using essentially the same methods as Auger et al. in their analysis of data from the New York City and the New York State AIDS case registries in 1988. We found that a double Weibull model fitted the data very well and that the risk of developing AIDS was high for subjects under 18 months of age, but lower for older subjects. Our results were qualitatively similar to those of Auger et al.. There were quantitative differences between the two studies, but it was not possible to compare median survival periods. Parameters such as median or mean survival times cannot be validly estimated using only data from registers because these data exclude infected subjects who have not yet developed AIDS.


The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. To determine the prevalence of HIV-1 infection and to identify the most important risk factors for infection. A cross-sectional population survey carried out in 1990 and 1991 in Mwanza Region, Tanzania. Adults aged 15-54 years were selected from the region (population, 2 million) by stratified random cluster sampling: 2434 from 20 rural villages, 1157 from 20 roadside settlements and 1554 from 20 urban wards. Risk factor information was obtained from interviews. All sera were tested for HIV-1 antibodies using enzyme-linked immunosorbent assay (ELISA); sera non-negative on ELISA were also tested by Western blot. The response rate was 81%. HIV-1 infection was 1.5 times more common in women than in men; 2.5% of the adult population in rural villages, 7.3% in roadside settlements and 11.8% in town were infected. HIV-1 infection occurred mostly in women aged 15-34 years and men aged 25-44 years. It was associated with being separated or widowed, multiple sex partners, presence of syphilis antibodies, history of genital discharge or genital ulcer, travel to Mwanza town, and receiving injections during the previous 12 months, but not with male circumcision. This study confirms that HIV-1 infection in this region in East Africa is more common in women than in men. The results are consistent with the spread of HIV-1 infection along the main roads. There is no evidence that lack of circumcision is a risk factor in this population.


No seroconversions among steady sex partners of methadone-maintained HIV-1-seropositive injecting drug users in New York City. To assess the incidence of heterosexual HIV-1 transmission from seropositive methadone-maintained injecting drug users (IDU) to their seronegative, non-IDU steady sex partners. A prospective, longitudinal study. HIV-1-seropositive IDU and their HIV-1-seronegative, non-IDU steady sex partners were recruited from six methadone-maintenance clinics in the New York City boroughs of Brooklyn and Manhattan. Between December 1988 and October 1991, 60 research participants were recruited [30 methadone-maintained, HIV-1-seropositive IDU (index subjects) and their non-IDU HIV-1-seronegative steady partners]. Baseline and follow-up (every 3-4 months) data included a structured questionnaire and blood testing for HIV infection and CD4+ cell subsets. Demographic characteristics of the 30 steady sex partners were evaluated as follows: sex (22 women, eight men); age (mean, 32 years; range, 21-55 years) and race (African-American, 13; Hispanic, 13; other, 4). The average duration of relationship between index subject and partner at study entry was 7.5 years (range, 4 months to 19.4 years). At entry, 27 of the 30 partners reported no or intermittent use of condoms with the index subject during a typical 12-month period. Follow-up data (median follow-up, 298 days; range, 85-992 days) were available for 22 partners. Of these, 15 reported no or intermittent condom use. For a total study observation time of 23 person-years, there were no seroconversions. The upper 95% confidence interval for the observed seroconversion rate of 0% is 13%. These results suggest that the likelihood of heterosexual HIV-1 transmission from seropositive methadone-maintained IDU to their seronegative, non-IDU steady sex partners is low.


Seroprevalence of HIV infection in rural South Africa. To establish the prevalence of HIV infection in rural South Africa and to investigate demographic factors that influence this prevalence. An anonymous HIV seroprevalence survey was performed in conjunction with a population-based malaria surveillance programme. The rural area of northern Natal/KwaZulu, South Africa. A total of 5023 black African participants were recruited by malaria surveillance agents during house-to-house visits; each house in an endemic malaria area is visited approximately once every 6 weeks. Participants included 4044 healthy and 979 febrile individuals (i.e., suspected of having malaria). HIV-1 and HIV-2 serological status, degree of mobility, age and sex. Sixty of the 5023 blood specimens were confirmed to be HIV-1-antibody-positive by Western blot, an overall prevalence of 1.2% (95% confidence interval, 0.9-1.5). None of the specimens was positive for HIV-2 antibodies. After adjusting for age, presence of fever and migrancy, women had a 3.2-fold higher prevalence of HIV-1 infection than men. HIV-1 infection was approximately three times more common among subjects who had changed their place of residence recently (2.9 versus 1.0%, P < 0.01). The prevalence of HIV-1 infection is higher among women than men resident in rural Natal/KwaZulu, South Africa. This is at least in part the result of oscillatory migration, particularly of men who work in urban areas but have families and homes in rural areas. Migration is associated with a higher prevalence of HIV-1 infection, suggesting that improving social conditions so that families are not separated and become settled in their communities is one way to help reduce the spread of HIV-1.


Comparative study of some factors affecting enumeration of moulds using dilution plate techniques. The influence of dilution plating technique, nature of diluent, culture media and incubation period on the enumeration of moulds have been studied. Three new culture media containing Auramine, Gentian Violet and Malachite Green respectively have been induced in this study. No significant differences were observed between results obtained after 3, 5 and 7 days of incubation. Significantly higher recoveries were obtained using the surface-spread method than pour plate method. Using the first technique no effect of diluent was observed, and among the different culture media studied higher counts were obtained with medium containing Auramine.


[Detection of Bacillus larvae in mixed populations of bacterial spores from larval remains]. An accurate laboratory technique for the detection of Bacillus larvae from larval remains of Apis mellifera with mixed bacterial spore populations was developed. The incorporation of nalidixic acid to the culture medium (3 micrograms/ml) was a satisfactory procedure for the separation of Bacillus larvae strains from Bacillus alvei motile colonies.


Microbial corrosion of stainless steel.

Microbial corrosion of stainless steel. Stainless steel, developed because of their greater resistance to corrosion in different aggressive environments, have proved to be affected, however, by various processes and types of corrosion. Some of these types of corrosion, mainly pitting, is activated and developed in the presence of microorganisms, which acting in an isolated or symbiotic way, according to their adaptation to the environment, create a favorable situation for the corrosion of these steel. The microorganisms that are involved, mainly bacteria of both the aerobic and anaerobic type, modify the environment where the stainless steel is found, creating crevices, differential aeration zones or a more aggressive environment with the presence of metabolites. In these circumstances, a local break of the passive and passivating layer is produced, which is proper to these types of steel and impedes the repassivation that is more favorable to corrosion. In the study and research of these types of microbiologically influenced corrosion are found electrochemical techniques, since corrosion is fundamentally an electrochemical process, and microbiological techniques for the identification, culture, and evaluation of the microorganisms involved in the process, as well as in the laboratory or field study of microorganism-metal pairs. Microstructural characterization studies of stainless steel have also been considered important, since it is known that the microstructure of steel can substantially modify their behavior when faced with corrosion. As for surface analysis studies, it is known that corrosion is a process that is generated on and progresses from the surface. The ways of dealing with microbiologically influenced corrosion must necessarily include biocides, which are not always usable or successful, the design of industrial equipment or components that do not favor the adherence of microorganisms, using microstructures in steel less sensitive to corrosion, or protecting the materials.


Thiobacillus ferrooxidans detection using immunoelectron microscopy. A specific, fast and very sensitive immunoelectron microscopy method was developed to morphologically and serologically distinguish different cultures of iron oxidizers. Bacteria isolated from the acidic waters of "Matahambre" and "Mina Delita" mines (Cuba) were characterized. An antiserum specific to Thiobacillus ferrooxidans did not react with other bacteria also present in the acidic waters of mine drainage. Our results suggest the occurrence of some strains of Thiobacillus ferrooxidans, Thiobacillus thiooxidans and Leptospirillum ferrooxidans in these waters.


[Biomass of Rhizopus oligosporus as an adsorbent for metal ions]. The effect of different parameters on the adsorption of metal ions by Rhizopus oligosporus has been studied. The uranium sorption by dried biomass was rapid, reaching in 5 min around 95.% of the binding capacity. The uranium-binding capacity of the culture showed an inverse relation to the growth kinetic. The relationship between sorption and equilibrium concentration was similar to an adsorption isotherm. Using the Langmuir model, a maximum sorption capacity of 0.52 mmoles uranium/g dry biomass and an affinity constant of 101 l/mmol uranium at pH 4.15 were determined. The best capacity of the biomass to bind ions (UO2(2+), Cu2+, Cd2+ and Zn2+) was best at pH 4.5-5.5. By using hydrochloric acid as eluant a 18% uranium removal of the biomass-bound ions was obtained at pH 1.0. The presence of other cations inhibited uranium-binding in the following order: Cu2+ > Cd2+ > Zn2+ > Mg2+ > Ca2+.


Meeting the challenge of infection: a case study. Infection is the most critical complication of cancer. A case study is presented that describes an adolescent with acute lymphocytic leukemia. He experienced multiple complications due to infection. Both new and standard therapies were required for the treatment and prevention of infections. A discussion of the rationale for various aspects of his care is presented.


The use of venous access devices in pediatric oncology nursing practice. Venous access devices have been in use since 1973 and have made a tremendous impact on care of children with malignancies to facilitate the delivery of complex medical care and minimize the trauma associated with cancer therapy. During the past 20 years the variety and complexity of available devices has resulted in an increased demand for technical knowledge and expertise to prevent complications and assure safe use. This article reviews the various devices, complications and implications for nursing practice, and recommendations for pediatric nursing regarding patient/parent self-care and developmental safety issues.


Premedicating children for painful invasive procedures. Children with cancer experience a great deal of anxiety concerning their treatment and invasive tests such as bone marrow aspirations (BMAs) and lumbar punctures (LPs). Responses of pain, fear, and anxiety are well documented and may cause regression, developmental delay, sleeping and eating problems, nausea and vomiting, nightmares, and depression. Diagnostic and treatment procedures need not cause such adverse effects if sufficient pharmacological sedation, analgesia, and anesthesia are used. However, studies show that inappropriate interventions such as underdosing and limited use of medications occur because of certain myths, beliefs, and lack of pharmacological knowledge on the part of health professionals. Studies that specifically address premedication for painful procedures in children with cancer have shown that only a small percentage of children receive premedications and that there is no clear consensus or standard for either drugs or dosages. The issue of premedicating children before procedures remains controversial and deserves further investigation. This study explored the attitudes and perceptions of oncology physicians and nurses concerning medicating children before procedures. Findings showed that most pediatric oncology specialists medicate their patients before invasive procedures and that the most common premedications used are Versed; Demerol, Phenergan, Thorazine; chloral hydrate; Ativan; fentanyl; Demerol; and Xylocaine. Most pediatric oncology specialists believe that premedication is necessary for children for BMAs and LPs.


Comparing the perception of support by parents of children with cancer and by health professionals. Childhood cancer is considered one of the greatest challenges a family can face. Some families cope well with it; others do not. The presence of social support, both perceived and actual, as well as the individuals with whom parents interact, may determine how well a family copes. The purpose of this pilot study was to describe how parents of children with cancer perceive support and the types of things parents found supportive while their child was hospitalized. Parents' perceptions of support were compared with those of the health professionals involved in the care of these children. The primary way the parents perceived support was any activity that met their affective needs. Health professionals faltered when asked to define support, but most said that it meant "being available." Caring and educational activities were the two ways the professionals could offer support to the families, yet parents rarely mentioned teaching as a supportive activity. Parents and health professionals defined aspects of support similarly, but there was minimal congruity between them in listing which people were considered supportive to the parents. In conclusion, health professionals and parents have similar ideas about what support is, but at best, the professionals' predictions concerning who is supportive in a given case appear random and may be biased. This study suggests that new ways of assessing support needs for these families are needed.


Accuracy and precision in protein structure analysis: restrained least-squares refinement of the structure of poplar plastocyanin at 1.33 A resolution. The structure of the electron-transfer protein, plastocyanin (99 amino acids, one Cu atom, 10,500 Da) from poplar leaves, has been refined at 1.33 A resolution to a residual R = 0.15. The space group is orthorhombic, P2(1)2(1)2(1), a = 29.60 (1), b = 46.86 (3), c = 57.60 (3) A. The 14,303 reflections used in the refinement were obtained from a data set recorded on a four-circle diffractometer with radiation from a sealed fine-focus tube, combined with a data set measured on oscillation films exposed at the DESY synchrotron. The final model comprises 1442 (738 non-H) protein atoms, one Cu atom and 110 solvent molecules. Nine residues are described as disordered. The root-mean-square deviation from ideal bond lengths is 0.016 A and the root-mean-square difference between the positions of the C alpha atoms in this refined model and in the structure previously refined at 1.6 A resolution is 0.11 A. The effects of manual model adjustment, resolution, choice of standard values for geometrical parameters, inclusion of H atoms and inclusion of anomalous-scattering corrections on the copper-site geometry have been explored. The final values of the Cu-ligand bond lengths are: Cu--N(His37) 1.91, Cu--S(Cys84) 2.07, Cu--N(His87) 2.06, Cu--S(Met92) 2.82 A.


Structures of secocubane and nortwistbrendane derivatives. (I): 4,7-Dichloro-1-cyano-N-isopropyltetracyclo-[4.2.0.0(2,5).0(3,8)] octane-4-carboxamide, C13H14Cl2N2O, M(r) = 285.17, orthorhombic, Fdd2, a = 34.012 (1), b = 15.791 (2), c = 10.899(1)A, Z = 16, D chi = 1.29 g cm-3, Cu K alpha (lambda = 1.5418 A), mu = 39.2 cm-1, F(000) = 2368, T = 293 K, 1504 reflections with I > 3 sigma(I), R = 0.042. (II): 4,7-Dichloro-N-isopropyl-10-oxo-9-oxatetracyclo [4.4.0.0(2,5).0(3,8)]decane-4-carboxamide, C13H15Cl2NO3, M(r) = 304.17, monoclinic, P2(1)/a, a = 9.902(2), b = 9.381(2), c = 15.174(2) A, beta = 103.25(1) degrees, Z = 4, D chi = 1.47 g cm-3, Cu K alpha (lambda = 1.5418 A), mu = 43.1 cm-1, F(000) = 632, 2107 reflections with I > 3 sigma(I), R = 0.036. (I) represents the first crystallographic example of a secocubane. The nonbonded distances (C4...C7) are 2.742 (5) and 2.717(3) A in (I) and (II). C--C distances in the cage portions of the molecules are typical of cubanes.


Oligonucleotide separations with capillary gel electrophoresis. Capillary Electrophoresis with polyacrylamide gel filled columns offers a fast and automated alternative to slab gel electrophoresis for the analysis of biopolymers. The principle of operation of CE in general, the operation conditions for the analysis of synthetic oligonucleotides and practical examples are described.


Few aspects of bacterial colonies in the stomach during the treatment with acidoinhibitors. On this paper are stated the reasons why a prolonged gastric-acid inhibition causes bacterial and/or mycotic colonizations in the stomach. Instead, the surgical operations, that now became obsolete, are only casual occasions of intragastric colonizations. This paper ends with some rules to be followed in order to avoid risks connected to a pH increase, and with a short hint to two important vitamins (i.e. Vitamin C and Vitamin E) for the complementary treatment of ulcerous patients.


Evaluation of some 4-aryl-3-arylamino-5-imino-1,2,4-thiadiazolidines as potential anticonvulsant and analgesic compounds. A series of 4-aryl-3-arylamino-5-imino-1,2,4-thiadiazolidines (1a-k) and 4-aryl-3-arylamino-5-oxo-1,2,4-thiadiazolidines (2a-k) were evaluated for their anticonvulsant and analgesic activity. Substitution of p-methoxy group (1g) in the aryl ring resulted in more active compounds than the standard drug phenytoin in the MES test, whereas in the chemoshock test the compounds were found inactive. In the analgesic test most of the compounds exhibited analgesic activity with particular reference to p-Br (1k) and m-Cl (1i) substitutions which were most potent in this series.


Novel pyrazolo [4,3-e] [1,4] diazepin-5,8-diones. The synthesis of some pyrazolo [4,3-e] [1,4] diazepin-5,8-diones has been accomplished starting from the readily available 1-ethyl-3-methyl-4-nitro-5-pyrazolecarbonylchloride and the appropriate alpha-aminoesthers, 2a, b, c. The catalytic reduction of the obtained 3a, b, c gave the products 4a, b, c which were, in turn, cyclized into the title compounds 5a, b, c. The intermediates of type 3 and 4 and the pyrazolo-diazepin-diones 5 were tested in vitro for their antimicrobial activity.


A non-antibiotic antimicrobial mixture (C31G): evaluation of the antimicrobial efficiency of C31G on vaginal cultures. Minimum inhibitory concentrations and the effective period for cidal concentrations of an amphoteric surfactant mixture (C31G) were determined on 13 microorganisms (common bacteria, strains ATCC, and fungi) by microtiter dilution procedure. Also the antimicrobial efficiency of this composition (C31G) was evaluated on 105 culture samples which were obtained from (Turkish) patients having vaginal infections. E. coli was found to be the most frequently observed microorganism (45.45%) in these samples and C31G was determined to be active on microorganisms obtained from vagina at low concentrations in a short time.


Approach to the sterilization with gamma rays of a drug. Note I: Treatment technique and effects at zero time. Authors, considering a possible use of the sterilizing treatment with gamma rays for the productive process of a drug, performed a series of practical treatment tests. To this purpose, they used a single molecule, stable in time and with an easy analytical approach. The examined active principle is the injectable salt of acetylcarnitine chloride. For tests, they used irradiating doses by 2.5-5.0-7.5 Mrads in order to point out the process possible effects. The treatment, even at highest dosages, did not show damages to the molecule that could prevent from going on with the investigation.


Rate-limiting components and reaction steps in complement-mediated haemolysis. The aims of this study were to identify the rate-limiting components and reaction steps in the integrated activation sequence of the alternative (AP) and classical (CP) pathways of the complement (C) system. In an initial correlation analysis we found that the haemolysis rate in AP was correlated with the concentrations of C5 and IgM. In CP, the haemolysis rate was correlated with the concentrations of C2-C6, factors I and B, and IgM. In order to identify the rate-limiting components, we added single, purified C components and IgM to pooled, normal human serum and measured the resultant change in the haemolysis rate. We found that a large number of different components, rather than a single one, were rate-limiting in AP and CP. In reconstitution experiments we found that in CP the rate-limiting reaction steps are the activation of C4 and C2. In AP we cannot identify the rate-limiting step precisely, but can only state that it is at the C3 activation step or earlier.


Comparison of detection speed and yield in agitated and non-agitated aerobic blood culture bottles. The influence of agitation on detection speed and yield was evaluated in 7,033 paired, identical aerobic blood culture bottles (Media Department, Statens Seruminstitut, Copenhagen, Denmark). One bottle was agitated and the other was incubated stationary. Of a total of 943 organisms isolated in aerobic blood culture bottles, 74% were clinically significant. No difference in the total yield of significant organisms was observed between agitated and non-agitated bottles. In the evaluation of detection speed, only cultures where organisms were isolated from both bottles, but at different times, were included, to ensure that no other factors influenced the result. Staphylococci, Pseudomonas spp., and Candida spp. were detected significantly faster in agitated bottles, on average 0.5-1 day earlier (p < 0.05), and in the majority of the cases within the first incubation day. These species are frequently found and are important causes of severe generalized infections, especially in immunocompromised patients, where early detection is of great importance. The detection principle in agitated bottles in our system, darkening of blood, proved to be an easy, reliable, and fast method to detect positive aerobic blood cultures, which could probably lead to increased automation.


Comparison of the effects of methoxysuccinyl-Ala-Ala-Pro-Val-chloromethyl ketone-inhibited neutrophil elastase with the effects of its naturally occurring mutationally inactivated homologue (HBP) on fibroblasts and monocytes in vitro. The mature neutrophils in the circulation contain, besides the different proteases known for a long time, a recently discovered proteolytically inactive elastase homologue (HBP/CAP37/azurocidin). This homologue, which we have named HBP due to its strong affinity to heparin, is a chemoattractant for monocytes and has been shown to induce reversible detachment and contraction when added to monolayers of endothelial cells or fibroblasts. HBP may therefore play a pivotal role in leukocyte migration in response to inflammation. In this report a comparison of CH3O-Suc-Ala-Ala-Pro-Val-CH2Cl-inhibited elastase with HBP, its naturally occurring homologue selectively mutated in active serine and histidine, reveals that homotypic aggregation of monocytes and contraction of fibroblasts is specific for HBP. HBP induces thrombospondin secretion from monocytes four times as efficiently as the inhibited elastase, and the same molecule was found unable to compete for a specific saturable binding of HBP to monocytes with an apparent KD of 3 x 10(-8)M.


Superficial perineal leiomyosarcoma in an adolescent female and a review of the literature including vulvar leiomyosarcomas. Superficial perineal leiomyosarcomas are rare, with only three previously reported examples. We encountered a superficial (deep subcutaneous) perineal leiomyosarcoma in a 17-year-old female. At follow-up two years after a wide excision, there were no signs of recurrence. The tumour was well differentiated and showed immunoreactivity for alpha-smooth muscle actin and desmin. A review of the literature on superficial leiomyosarcomas indicates that superficial perineal leiomyosarcomas may be more aggressive than superficial leiomyosarcomas in general. As the presented tumour occurred in a female, it was compared with vulvar leiomyosarcomas.


Primary non-Hodgkin's lymphoma of the breast (PLB): a clinicopathological study of seven cases. Seven cases of PLB in females were reviewed. Six cases involved the breast alone (stage 1E), whereas one case also involved the ipsilateral lymph nodes (stage 2E). None had B symptoms. The age range was 37-70 years (mean 52 years). The clinical course was indistinguishable from that of breast carcinomas, though the tumors were relatively large and the duration of symptoms was relatively short. Histologically, all cases were non-Hodgkin's B-cell lymphomas, comprising five cases of diffuse centroblastic type, one case of diffuse centroblastic-centrocytoid type and one case of follicular centroblastic-centrocytic type, according to the updated Kiel classification, corresponding to six cases of the diffuse large cell type and one case of the follicular mixed, small cleaved and large cell type, according to the modified International Working Formulation (IWF). None of the cases was a lymphoma of mucosa-associated lymphoid tissue (MALT). The mammary glandular tissue outside the tumor showed ductectasia in four cases. Changes resembling fibrous disease of the breast were seen in four cases, too. The inflammatory infiltration in all these cases was mainly composed of T cells. At the time of diagnosis, all patients were receiving cytoreductive treatment. The mean follow-up time was 34 months (range 5-79 months). At present, six of the patients are alive and well.


Remnant kidney pathology after five-sixth nephrectomy in rat. I. A biochemical and morphological study. In Wistar male rats, hypertension was induced by 5/6 nephrectomy (5/6N). Body weight, blood pressure measurements, morphological and biochemical changes were followed (at four weekly intervals) for 12 weeks after 5/6N. Renal function was assessed by daily total urinary protein (TUP), plasma creatinine concentration [(Cr)p] and creatinine clearance rate. Plasma renin concentration (PRC), aldosterone concentration and erythrocyte content of sodium [Na]E and potassium [K]E were also investigated. Significant increases in systolic blood pressure (SBP), TUP, [(Cr)p] and [Na]E occurred after 4, 8, and 12 weeks of 5/6N. Progressive glomerulosclerosis (GSC), tubular atrophy and interstitial fibrosis were observed. Positive correlations were found between GSC and SBP and TUP. Positive correlations were also found between SBP and [Na]E and [(Cr)P]. PRC was not increased and showed no correlation with SBP. It is concluded that 5/6N produced hypertension associated with a series of morphological and biochemical alterations in kidney structure and function. In this model, mechanisms other than the renin-angiotensin system may be involved.


Fetal antigen 2: an amniotic protein identified as the aminopropeptide of the alpha 1 chain of human procollagen type I. Fetal antigen (FA2) was purified from second trimester human amniotic fluid by immunospecific chromatography, gel filtration and reversed-phase chromatography. Gel filtration revealed two molecular forms of FA2 eluting at volumes corresponding to an M(r) of approximately 100 kDa and 30 kDa. SDS-PAGE analysis gave an M(r) = 27 kDa under reducing and non-reducing conditions for both forms, whereas the exact M(r) determined by mass spectrometry was 14,343 +/- 3 Da. FA2 was N-terminally blocked and after tryptic digestion the amino acid composition and sequences of the peptides showed identity with the aminopropeptide of the alpha 1 chain of human procollagen type I as determined by nucleotide sequences. After oxidative procedures normally employed for radio-iodination (iodogen and chloramine-T), FA2 lost its immunoreactivity. An antigen which cross-reacted with polyclonal rabbit anti-human FA2 was demonstrated in fetal calf serum. Gel filtration with analysis of fractions by inhibition ELISA showed that the bovine homologue was present in the same molecular forms as those in human amniotic fluid, and immunohistochemical analysis with anti-human FA2 showed that its distribution in bovine skin was identical to that of FA2 in human skin. FA2 is a circulating form of the aminopropeptide of the alpha 1 chain of procollagen type I, and this is the first description of its isolation and structural characterization in humans.


Immunohistology of skin and rectum biopsies in bone marrow transplant recipients. We have studied histological and immunohistological specimens of 39 skin biopsies from 21, and 30 rectal biopsies from 17 bone marrow transplant recipients. The biopsies were taken before transplantation, during acute and chronic graft-versus-host disease (GVHD), and at times with no GVHD. In biopsies taken during cutaneous aGVHD grade I to III, epithelial changes were seen in 16/23 biopsies. The cutaneous infiltrates during aGVHD consisted of CD2-, CD4-, CD8- and FMC-33-positive cells both in the epithelium and in the dermis. CD57-positive NK cells were also detected in most biopsies. During chronic GVHD the cutaneous cellular infiltrates were similar to those seen in moderate aGVHD, i.e. both CD4- and CD8-positive lymphoid cells were present. When the biopsy was taken after the beginning of corticosteroid treatment for aGVHD, or at times when the patient did not have GVHD symptoms, the cellular infiltrates were considerably smaller in the dermis. During clinical intestinal aGVHD mucosal epithelial changes were relatively uncommon; instead, increased numbers of both CD4- and CD8-positive lymphocytes in the lamina propria (LP) were seen in 11/13 samples. During chronic GVHD the number of CD4-positive cells exceeded that of CD8-positive cells in the LP, and the large lymphoid infiltrates also reached the muscularis mucosae. In rectal biopsies the differences were not so prominent because most of the pretransplant biopsies showed CD2-, CD4-, CD8- and CD57-positive lymphocytes both in the lamina propria and epithelium.


Cell kinetics of the rat corneal epithelium. In the rat corneal epithelium the mitotic rate (MR) is almost equal throughout the epithelium in the morning (Haaskjold et al. 1988). The labelling index (LI) shows a marked reduction in the central cornea, which could suggest a lack of uptake of tritiated thymidine via the salvage pathway (Haaskjold et al. 1989). In the present study we have used [3H]deoxycytidine, and [3H]thymidine after prior treatment with a methotrexate regimen to elucidate this discrepancy. Deoxycytidine is incorporated into DNA independent of thymidine kinase, while methotrexate, which depletes the cells of reduced folates, makes the cells completely dependent on the salvage pathway. With both techniques the same pattern of labelling was observed, confirming that in the morning the ratio between the MR and the LI differs throughout the cornea. Based on previous observations, an analysis of the MR/LI ratio during 24 h was performed, showing that these parameters were strongly correlated. This suggests that there may be different circadian variations in the cell proliferation parameters throughout the corneal epithelium. The methotrexate regimen may be a useful tool to investigate the salvage pathway.


Binding of human IgA to HCl-extracted c protein from group B streptococci (GBS). The c beta protein of group B streptococci obtained by HCl extraction appears as a ladder-like pattern in SDS-PAGE when detected by a rabbit anti-c beta serum, and a similar picture is seen when the crude extract is incubated with human IgA and an anti-human IgA conjugate. Affinity-purified c beta antigen and IgA receptors from GBS gave identical pictures in Western blots using rabbit anti-c beta serum. Both the c beta antigen and the IgA receptor are exposed on the surface of GBS as demonstrated by immunofluorescence.


[Contents of daily reports and nursing practice in 2 homes for the aged]. Many patients in homes for the aged become progressively more disabled and thus constant reevaluation of all their nursing care needs is required. The patients' basic human needs, as well as those related to their diseases, have to be met. The aim of this study was to describe the contents of daily reports in two homes for the aged. The data was collected by tape-recording nursing staff's reports for four weeks period on two wards. The data was analysed by using content analysis. The contents were divided into messages. The results show that most of the discussions concerned daily activities and medical care. Some of the discussions fell within the categories of "patients' opinions" and "mood". Information was situation related. Patient's holistic care or supporting the patient's initiativeness in his daily activities were seldom discussed. The impression given on the nursing practice was task orientated and routinized.


[Patients' need for information in self-dialysis]. The purpose of the study was to examine self-dialysis patients' need for information at different stages of the dialytic treatment, to find out the most efficient method to give information and to examine the patient's idea of the best communicator. The data were collected by the theme interview of 30 patients performing self-dialysis. Content analysis was the method used in analysing the data and in the presentation of the results both qualitative and quantitative representations are used. The self-dialysis patients felt that they needed information on the cause of their basic disorder. Of the information given before the dialytic treatment they were most interested in the technical and nutritional aspects of the treatment. During the dialytic treatment, information was wanted on hygiene, as well as further information on the technical and nutritional aspects. Information on the post-transplantation treatment was found especially important. The patients wanted the information mainly to be told to them by the physician, only during treatment the information was wanted from the nurse.


[Ambulatory surgery unit. One year's experience of the otorhinolaryngology service]. Surgery practice is no longer defined by the number of days of stay but for its results without regard to whether it has been performed under in-patients or outpatient basis. Due to this fact and others suck as the increase in population and shortage of surgical resources, the improve in technics, and new concepts in anesthetics, we developed and out patient surgery unit in our hospital. We describe our experience in the design development and follow-up of this unit. The sticss in set on ensuring patient's safety and comfort in order to make this procedure more attractive than in patient's ones. Finally we explored the significance of data available, its pros and cons.


[Influence of the contralateral acoustic stimulation on the acoustic otoemissions: response modulation by the efferent olivocochlear system]. We have correlated in 16 patients (32 ears), the modifications de EOEs before and after sound stimulation of the contralateral ear. The recording of the EOEs has been performed in a sound proof room with ILO 88 from Otodynamics Ltd., the analysis has been made with the ILO 88 V.3.5 software. We have tried to study the modulator rol of the medial efferent coclear system on the external ciliated cells. In the results we observe a decrease of the amplitude in the EOEs when the contralateralmears is stimulated a white noise, in relation with the nonstimulation situation. When pures tones are used contralateral stimulation the decrease in the EOEs amplitude takes place in the same frequency spectrum as the pure tone used.


[Vascular microinvasion in laryngeal epidermoid carcinoma]. Microvascular invasion by carcinoma cells is one of the first steps for the potential development of metástasis. The presence of squamous cell carcinoma within capillaries and/or venules in the immediate vicinity of primary lesions of the oral cavity and oropharynx may be related to regional lymph node metastasis. To evaluate this possibility in laryngeal carcinomas we have reviewed the histopathologic features of 48 cases of this type of tumor with simultaneous surgical treatment of the primary neoplasms and the neck. In our opinion the histologic finding of such invasion is not pathognomonic for establishment of regional metástasis in epidermoid carcinoma of the larynx.


[Congenital paralysis of the vocal cords: a review of 14 cases]. Were performed 220 direct laryngoscopys and bronchoscopys, from 1981 to 1990, in newborns and infants that showed as a main finding: stridor, voice change or aspiration syndromes. Fourteen (20.28%) of the 69 congenital laryngeal anomalies were vocal cord paralysis: 13 (92.8%) unilateral paralysis and 1 (7.2%) bilateral paralysis. Eleven (84.6%) of the 13 unilateral paralysis were left and 2 (15.4%) were right. The vocal cord position was noted to be median or paramedian in 13 (92.8%) patients. The etiology was idiopathic in 11 (78.5%) of the cases. The bilateral paralysis required tracheotomy and in the unilateral paralysis wasn't necessary it.


[ORL manifestations in HIV patients. Report of 156 cases]. The study of 156 cases HIV infected patients put forward the high incidence of ENT manifestations in these cases. Cervical lymph nodes are an habitual manifestation of the disease. They appear as a host reaction versus viral infection and often they are the expression of opportunistic infection, Kaposi Sarcoma or lymphoma. They also have prognostic significance. We think that the lowe incidence of Kaposi Sarcoma in our report (comparing with other authors rates) is due to the fact that there is a smaller population of homosexuals in our environment.


[Synchronous carcinomas of the upper aerodigestive tract: a diagnostic and therapeutic problem]. Patients with epithelial cancer of the upper aerodigestive tract are at increased risk of a new epithelial cancer developing in the same upper aerodigestive tract, in the oesophagus, or in the lung. We studied the cases seen at our Hospital in the last seven years. The clinical characteristics, the diagnosis and the treatment of 38 patients with synchronic epithelial cancer of the upper aerodigestive tract, oesophagus and lung, were reviewed.


[Collagen diseases and their manifestations in the head and neck region]. We carried out a clinical study on the manifestations of various connective tissue pathologies of the head and neck. The need to suspect the presence of these pathological entities from non-specific ENT symptoms and performing early diagnoses of cochleovestibular diseases on the basis of a clinical and examination protocol is emphasized.


[Study of the facial nerve motor pathway with the transcranial cerebral magnetic stimulation technique]. Transcranial magnetic stimulation method permits the study of the facial nerve in all its aspects (motor cortex-alpha moto-neurone-facial muscle) in an non invasive and painless way. We studied 12 patients using two levels of stimuli, the first was at an occipital level and the second at the primary motor cortex in the frontal lobe. We compared the results of this technique with those obtained by electric stimulation of the nerve.


[Nystagmic response after bithermal caloric stimulation in elderly subjects: latency, culmination, and finalization]. We analysed the nystagmic response poscaloric stimulation in 38 healthy elderly persons. Latence, culmination, lasting, central nystagmic frequency and interaural difference are analysed. We establish the normal pattern for the nystagmic response.


[Endogenous peroxidase activity of the laryngeal epithelium: experimental study]. Twenty vocal cords were studied. The used animals were rabbits. Beta-blockers and beta-stimulants were perfused by the jugular vein. Variations in endogenous peroxidase were observed in electron microscopy. The activity of endogenous peroxidase can be used according to our results as tracer of the autonomic innervation of the vocal cord.


[Lateral pharyngeal phlegmon following nasotracheal intubation]. We present a case of lateropharyngeal abscess, which was caused by the undermucous dissection of the lateral wall of the nasopharynx in the moment to make a nasotracheal intubation in a patient with long-term intubation. In the International Literature none other case of this complication have previously been reported and we things that is suitable his publication and the revision of this anesthetic method and their repercussions in the field ORL.


[Congenital cystic adenomatoid malformation of lung]. In the differential diagnosis of the bronchial aspiration syndrome of foreign bodies, we must place the congenital malformations among the rare causes that can simulated it. In this work, we present a case in which bronchoscopy was indicated because the existence of intrabronchial foreign body was suspected.


[ORL manifestations of Wegener's disease]. Wegener's disease is characterized by necrotizing granulomatous vasculitis. The localized form involves the upper and lower respiratory tract, in the generalized form, the kidneys are also involved. In this paper, three cases of Wegener granulomatosis with otorhinolaryngological symptoms are reported. Frequently the presentation of this disease occurs in the ears, nose and throat, we think that the knowledge of this granulomatosis by the otorhinolaryngologist is necessary.


Use made by patients of chronic disease surveillance consultations in general practice. A prospective, observational study of chronic disease surveillance consultations over a six-month period was performed in one semi-rural general practice in order to determine the content of the consultations, including incidental items not relevant to the chronic disease. At least one incidental item was recorded during 43% of consultations. There was substantial clinical content in these items: 23% of items required a prescription to be issued and 7% referral to a specialist. It is concluded that chronic disease surveillance consultations in general practice are frequently extended by patients who are anxious to discuss issues which may not be relevant to their chronic diseases. General practitioners must be sensitive to such patient expectations when they instigate chronic disease management clinics.


Provision of health promotion clinics in relation to population need: another example of the inverse care law? The new contract encourages health promotion in general practice. The aim of this study was to explore the pattern of provision of health promotion clinics across one family health services authority and to relate this to possible indicators of health need in the practice population. Single-handed practices were less likely to be running health promotion clinics. The proportion of practices running clinics increased with increasing numbers of partners. Practices located in wards where the standardized mortality ratio was greater than 100, and practices receiving deprivation payments were less likely to be offering health promotion clinics. This was explained by the presence of most single-handed practitioners in deprived, historically unhealthy wards. If effective, health promotion clinics will have tended to benefit populations in Bedfordshire at lower risk of ill-health. Other shortcomings of the clinic-based health promotion model are discussed.


Prevalence of eating disorders in three Cambridge general practices: hidden and conspicuous morbidity. The aims of this study were to investigate the prevalence of anorexia nervosa, bulimia nervosa and partial syndromes in women general practice attenders to establish the relative proportions of 'conspicuous' and 'hidden' morbidity. A consecutive series of 540 women patients aged 16-35 years attending their family doctor were screened using a specially devised questionnaire, the weight and dietary practices survey. A total of 115 patients were selected for further assessment and of these 101 patients were interviewed using a standardized diagnostic interview for DSM III-R eating disorders. The prevalence of anorexia nervosa was 0.2% (one case), of bulimia nervosa 1.5% (eight cases) and of partial syndrome bulimia nervosa 5.4% (29 cases). Half of the cases of bulimia nervosa had not been identified by the general practitioner and two of these patients had been referred to specialists for treatment of secondary complications of the eating disorder. Hidden cases of bulimia nervosa or partial syndromes are relatively common in general practice. Certain key questions could be used by general practitioners in order to identify women with eating disorders.


Mothers' attitudes to and experience of breast feeding: a primary care study. This study investigated the attitudes to breast feeding of women registered with 24 general practitioners in Nottingham. A total of 514 women were interviewed in the antenatal period and then followed up at six weeks and six months after the birth of their child. Seventy per cent of the women planned to breast feed their baby, 23% planned to bottle feed and 7% were undecided. Only 26 women changed their plans. Although 73% of the women interviewed began breast feeding, this had fallen to 49% by six weeks and 26% by six months. Logistic regression analysis showed that multiparae who had bottle fed or stopped breast feeding their previous child during the first six weeks were 5.15 times more likely to stop breast feeding in the first six weeks, than those who had breast fed their previous child for six weeks or more. Primiparae in social classes 3M, 4 or 5 or who were unemployed were 3.68 times more likely to stop than women in higher social classes, while those who said they had considered bottle feeding were 2.40 times more likely to stop. Most women gave an inadequate milk supply as a reason for stopping, but sore nipples were also a problem in the first six weeks. Of all the women who had started breast feeding 46% felt they did not have enough milk at some stage and despite the finding that 49% of those who sought advice from a health professional were advised to feed more often, 42% said they had been advised to give bottle feeds.(ABSTRACT TRUNCATED AT 250 WORDS)


Assessment of the otoscopic skills of general practitioners and medical students: is there room for improvement? Ear, nose and throat problems are common in general practice, yet undergraduate and postgraduate teaching in the subject is variable and often sparse. The assumption that direct experience in otoscopy in practice will compensate for inadequate previous tuition was tested by assessing a group of 53 general practitioners and 59 medical students. Confidence in otoscopy was assessed using a visual analogue scale and skill was assessed by clinical examination of four ears. Otoscopy was divided into identifying the tympanic membrane, distinguishing a normal from an abnormal membrane and identifying specific features of the membrane. The medical students and general practitioners were comparable in both confidence and skill for all parameters except skill in identification of specific features of the tympanic membrane, in which the students' ability was greater (Student's t-test, P < 0.01). In both groups the percentage of false negative observations was reassuringly low--for students the mean was 3.0%; and for general practitioners 4.3%. There is room for improvement in general practitioner's training in otoscopy. Supervised tuition is essential and cannot be compensated for by unsupervised experience. More involvement with ear, nose and throat problems in vocational training or attendance at continuing education courses is suggested.


Prescription of diuretic drugs and monitoring of long-term use in one general practice. A cross-sectional survey of the prescription and monitoring of diuretic drugs for long-term use was performed in a Nottinghamshire training practice, which has 7619 patients. It was found that 330 patients were long-term users of diuretic drugs, with 79% of these patients aged 60 years or over. Twenty three different diuretic drugs were prescribed with a total cost of 13,643 pounds per year. A few drugs accounted for a disproportionate amount of the total cost, with combination diuretic drugs being particularly expensive. The most common indications for the prescription of diuretic drugs were hypertension and congestive cardiac failure. General practitioners initiated the prescribing of diuretic drugs in 87% of cases, with only a small proportion being prescribed by hospital doctors. One third of the patients had no record of urea and electrolyte levels in their notes after commencing treatment with a diuretic drug. On the basis of these findings recommendations are made for the initiation and monitoring of the long-term use of diuretic drugs.


Computerized health information in The Netherlands: a registration network of family practices. A registration network of family practices (Registratienet Huisartspraktijken) has recently been established in the Netherlands. Forty two general practitioners in 15 practices, with a patient population of 80,000 people, are using a general practice health information system to establish a central computerized anonymous database containing certain patient characteristics and all relevant health problems. By September 1990 patient characteristics and problem lists for 32,972 patients had been entered and a total of 94,476 health problems had been identified. The database has been set up primarily as a sampling frame, allowing researchers to identify patients with particular health problems. The database can also provide descriptive data on prevalence and incidence rates, fulfil a monitoring function and provide data for practice audit, medical education and health management.


Attitudes towards and use of general practitioner services among homosexual men with HIV infection or AIDS. In a study of 263 homosexual men positive for the human immunodeficiency virus (HIV), it was found that 87% were registered with a general practitioner and of these, 55% said that the general practitioner knew their HIV status. Of the 104 men who had experienced symptoms, 39% had consulted the general practitioner for HIV-related advice. A total of 49% of those who were not registered used a specialist outpatient clinic for all their medical needs. Of those who were registered and whose general practitioner was aware of their HIV status but who did not consult their doctor, 72% used a specialist outpatient clinic. Reasons for not consulting the general practitioner included fears of breach of confidentiality and lack of confidence in the general practitioner's understanding of HIV. Fifteen per cent of the sample continued to see a general practitioner who was unaware of their HIV status, for non-HIV related advice. The needs of patients must be taken into account when planning more integrated hospital and community care for those with HIV infection or the acquired immune deficiency syndrome (AIDS).


Outpatient clinic referrals and their outcome. A cohort of 392 patients referred to six outpatient clinics by general practitioners during 1987 with diagnoses of rheumatoid arthritis, osteoarthritis, peripheral vascular disease, psoriasis or eczema, were studied from the time of their first attendance until up to two years later. Six consultant clinics were studied in the three specialties: rheumatology, vascular surgery and dermatology. For each specialty a clinic in both a teaching hospital and a district general hospital were included. The cohort members were predominantly middle-aged or elderly people, with a greater proportion of women, except at the vascular surgery clinic where 65% of patients were men. The 392 patients made a total of 936 visits (median two, range one-eight) during the study period; 91 patients were still attending up to two years after the first visit. Patients referred by their general practitioner for therapy were less likely to be discharged than those referred for other reasons. The principal reason for continuing attendance as perceived by patients, general practitioners and hospital doctors was the necessity for consultant supervision, although agreement was far from complete in individual cases. Junior staff tended to see a higher proportion of patients at follow-up visits than did consultants, and were found to have lower discharge rates than consultants. Analyses of data showed that at the first visit, diagnosis, disease severity and the grade of doctor seeing the patient in the clinic was significantly associated with patient discharge at the P < 0.05 level of significance. Patients considered that their visits had produced improvement in their condition in 38% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)


Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Evidence from one practice and from the literature suggest that approximately half of most common chronic disorders are undetected, that half of those detected are not treated, and that half of those treated are not controlled: the 'rule of halves'. Workload in primary care would increase by at least 12% if all common and important chronic disorders were fully diagnosed, treated and followed up; the accompanying effects on prescribing costs would be complex, but not necessarily inflationary. The relationship between these data and the new general practitioner contract is discussed.


Hormone replacement therapy and breast cancer, endometrial cancer and cardiovascular disease: risks and benefits. The relatively restricted use of hormone replacement therapy in the United Kingdom has frequently been noted. It is possible that low prescribing rates may, in part, be due to the difficulty in interpreting the wealth of research evidence relating to the risks and benefits of hormone replacement therapy. Conflicting conclusions from research can cause considerable uncertainty and confusion. This paper reviews the evidence relating to hormone replacement therapy and the risks of breast cancer, endometrial cancer and cardiovascular disease and discusses the issues which require critical assessment. This should add to the information base available to general practitioners and thus assist in decision-making in the context of uncertainty.


Psychological aspects of miscarriage: attitudes of the primary health care team. A questionnaire surveying the attitudes of general practitioners, health visitors, community midwives and district nurses towards the psychological aspects of miscarriage was distributed to a random sample of 50 staff in each professional group. The response rate was 78%. A large majority of all staff surveyed (76%) agreed that miscarriage is frequently associated with significant psychological distress and 90% agreed that women should be routinely encouraged to explore and discuss their feelings following such an event. Overall, health visitors and community midwives were seen to be the most appropriate members of the primary health care team to offer such counselling. The gap between perceived need and provision of care for women who have had a miscarriage is highlighted, and ways of narrowing this are discussed.


Psychological sequelae of miscarriage: a controlled study using the general health questionnaire and the hospital anxiety and depression scale. This study was carried out to assess whether psychiatric morbidity after a miscarriage is higher than that associated with early pregnancy. A total of 60 consecutive women admitted to a Swansea hospital with a miscarriage were compared with 62 consecutive women who attended an antenatal clinic at the same hospital, using the 28-item general health questionnaire and the hospital anxiety and depression scale. These were completed both at initial contact and six weeks later. Women who had had a miscarriage were found to be significantly more anxious and scored higher on the subscale for severe depression than the pregnant women, both at initial assessment and six weeks later. At the six week assessment more somatic symptoms were also experienced by the group who had had a miscarriage. This study highlights the psychological disturbance associated with miscarriage. The primary health care team and hospital staff need to take this into consideration when organizing follow up for women who have had a miscarriage.


Effect of a human immunodeficiency virus protease inhibitor on human monocyte function. Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS). Encoded by the HIV genome are several precursor proteins that undergo proteolytic cleavage to yield functional proteins. The env precursor protein is cleaved by a cellular protease. The gag precursor protein of HIV (p55), however, is cleaved by a virally encoded aspartate protease (HIV Protease). Cleavage of p55 is required for viral maturation and infectivity. There are also several host cell aspartate proteases that serve important homeostatic functions. Cathepsins D and E are lysosomal aspartate proteases which are believed to play an important role in macrophage function, and it has been suggested that inhibition of these enzymes by an HIV protease inhibitor may exacerbate immunosuppression in AIDS patients. We have studied the effect of SK&F 107461 (a hydroxyethylene dipeptide isostere inhibitor of HIV protease), on various host defense functions of human monocytes. Pepstatin A (an inhibitor of most aspartate proteases) and leupeptin (an inhibitor of serine and cysteine proteases) were included as controls. Although less potent than the prototypic aspartate protease inhibitor pepstatin, SK&F 107461 inhibited partially purified cathepsin D in vitro. However, in cell-based assays, SK&F 107461 had no effect on the degradation of hemoglobin, antigen processing of the protein antigen streptokinase, or secretion of 17-kD IL-1 beta by monocytes at concentrations which inhibit maturation of intracellular virus in HIV infected monocytes. Furthermore, SK&F 107461 had no effect on constitutive candidacidal activity. In contrast, leupeptin and pepstatin A partially inhibited accessory cell function of monocytes in the proliferative response to the recall antigen streptokinase. In addition, leupeptin partially inhibited degradation of hemoglobin.(ABSTRACT TRUNCATED AT 250 WORDS)


A novel transgenic mouse model for the in vivo evaluation of anti-human immunodeficiency virus type 1 drugs. We have developed a binary transgenic mouse system that allows easy in vivo evaluation of new anti-human immunodeficiency virus type 1 (HIV-1) drugs or therapies specifically designed to target the viral transactivator protein (TAT) or long terminal repeat (LTR) functions. This approach consists of a simple genetic cross between an "activator" transgenic mouse expressing the HIV-1-tat gene exclusively to T lymphocytes and a "target" transgenic mouse bearing a silent reporter gene whose expression is under the control of the HIV-1-LTR. As expected, most of the target transgenic animals did not express the reporter gene; on the contrary, all the double-transgenic mice bearing both the activator and target transgenes strongly expressed the TAT-induced reporter gene. The choice of a secreted human alpha 1-antitrypsin variant (alpha 1-AT) as reporter gene readily permits in a single animal the quantitative determination of the plasma level of alpha 1-AT protein before and after anti-LTR or anti-TAT treatments. Such mice may be valuable as new laboratory models for the in vivo evaluation of agents with potential anti-HIV-1 activity.


Diagrammatization of codon usage in 339 human immunodeficiency virus proteins and its biological implication. The occurrence frequencies of bases A (adenine), C (cytosine, G (guanine), and T (thymine) occurring in the 1st, 2nd, and 3rd codon positions in the codon usage table of viral genes for the 339 human immunodeficiency virus (HIV) proteins compiled recently have been calculated and diagrammatized. For comparison, the corresponding diagrammatic representations for the 2681 human proteins from the codon usage table for primate genes are also presented. The analyzed results based on these characteristic diagrams indicate that considerably similar features have been found between HIV and human proteins for the 1st and 2nd codon positions; i.e., they are all occupied predominantly by purine, especially base A. However, a significant difference in the 3rd codon position between HIV and human proteins has been observed; i.e., human proteins are of high C + G content and low A + G content in the 3rd codon position, whereas the case is just the opposite for HIV proteins. The biological implication of such a duality on the codon bias of HIV against human proteins is discussed. It is suggested that the 1st and 2nd codon positions can be termed as the structure-determining position, and the 3rd codon position termed as the species-determining position. The diagrammatic representation and analysis method described here possess a great potential for the study of molecular evolution from the viewpoint of the genetic code for which data have been accumulated rapidly and will continue to grow at a much faster pace.


Regulatory elements in the human immunodeficiency virus type 1 long terminal repeat LTR (HIV-1) responsive to steroid hormone stimulation. Within the long terminal repeat (LTR) of the human immunodeficiency virus type 1 (HIV-1) provirus there exists a steroid hormone-responsive element corresponding to the TGTTCT sequence identified as the glucocorticoid receptor binding element within the LTR of mouse mammary tumor virus. We have used an LTR(HIV-1)-chloramphenicol acetyl transferase (CAT) plasmid construct to transfect infected H9V3 and noninfected H9 cells. Four hours before harvest the cells were divided into two parts and half was treated with hydrocortisone (10(-7) M). The cells were harvested and washed, and the CAT activity was measured. In eight repeat experiments an increased expression of the CAT gene has consistently been observed in H9V3 cells in response to the glucocorticoid but no significant effect of the steroid was observed in noninfected cells. Double transfection of LTR(HIV-1)-TAT and LTR(HIV-1)-CAT into noninfected H9 cells results in a cell population in which the CAT gene was responsive to glucocorticoid stimulation. A time course and dose response for the steroid effect have been determined and the binding of steroid receptor fo the LTR-DNA characterized by gel retardation experiments.


Heterogeneous expression and coordinate regulation of endogenous retroviral sequences in human peripheral blood mononuclear cells. This study examines the expression of human endogenous retroviral or retroviral-like (ERV) sequences in peripheral blood mononuclear cells (PBMC). Probes to 12 human ERV were used in Northern analyses of 38 patients with autoimmune muscle diseases and 31 blood donor controls. All patients and controls expressed multiple classes of ERV RNA. This expression was quite heterogenous: for each of the nine ERV classes for which expression was detected, some individuals showed high RNA levels whereas others showed low levels. ERV expression was independent of disease and autoantibody production. Statistical analysis of densitometric data indicated that expression of several classes of ERV was coordinately regulated. ERV expression in individual patients showed coordinate fluctuations with time. These studies demonstrate the heterogeneity and coordinate regulation of human ERV expression. To evaluate whether ERV expression might be affected by lymphocyte activation, PBMC were cultured with or without lymphocyte mitogens before RNA extraction. These studies demonstrated complex changes in ERV expression after lymphocyte activation. Murine ERV have several immunoregulatory activities. If human ERV have analogous effects, their heterogeneous expression and association with lymphocyte activation may have important biologic consequences.


Stable expression of the human immunodeficiency virus type 1 envelope glycoprotein in transfected L cells. An SV40-based expression vector was used to generate CD4-negative murine L cell lines which stably expressed the human immunodeficiency virus envelope glycoprotein (env). Despite the presence of abundant intracellular envelope glycoprotein, the expression of env gp120/41 was not detected on the cell surface. Pulse-chase studies showed that the majority of the gp120 detected at the end of a 20-h chase was in the culture medium. Therefore gp120 was shed and/or secreted from these cells. Transfected L cells (H-2k) served as targets for specific lysis by CTL raised against vaccinia virus-encoded env gp160. The discrepancy in relative levels of intracellular versus surface expression of env was probably due to the highly inefficient processing of newly synthesized gp160, as well as the apparent instability of the gp120/41 complex in the transfected cell lines. Digestion of immunoprecipitated gp120 and gp160 with endoglycosidase H and peptide N-glycosidase F revealed that the envelope glycoprotein in transfected L cells possessed both high mannose and complex N-glycans, analogous to the posttranslational modification of the mature envelope glycoprotein in infected T cells. These studies indicate that the relatively inefficient processing of env gp160 occurs in the absence of CD4, and that the stable surface expression of envelope gp120/41 complex may require additional factors not present in transfected cells.


Strong association of simian immunodeficiency virus (SIVagm) envelope glycoprotein heterodimers: possible role in receptor-mediated activation. Soluble forms of a human cell-surface molecule expressed on T lymphocytes (CD4) neutralize diverse strains of both human (HIV) and simian (SIV) immunodeficiency viruses through the induction of envelope shedding and direct competition with cellular CD4 for virus binding. However, we have previously shown that sCD4 enhances infection of simian immunodeficiency viruses from African green monkeys (SIVagm) and have theorized that this enhancement is due to the induction of conformational changes leading to viral fusion (receptor-mediated activation). In this report, we compared the relative association of the envelope glycoproteins of SIVagm with HIV type 1 (HIV-1) in order to determine if a more stable association of SIVagm envelope glycoproteins might account for the differential effects of sCD4 on the infectious process. Monospecific antisera to each of the SIVagm glycoproteins were generated and used to detect stable heterodimers by radioimmunoprecipitation. Standard solubilization buffers containing both ionic and nonionic detergents or saturating concentrations of sCD4 failed to disrupt SIVagm gp120 interactions with the transmembrane protein, gp36, whereas HIV-1 heterodimers were easily dissociated. Higher concentrations of SDS (1%) were necessary to disrupt the SIVagm envelope complexes demonstrating the existence of strong noncovalent interactions between these membrane glycoproteins. In addition, morphometric analysis by electron microscopy revealed that the linear density of SIVagm spikes was stable and resisted shedding when virus was incubated with sCD4 whereas a significant decrease in linear spike density was noted for HIV-1. Based on our original hypothesis, the strong association of SIVagm glycoprotein spikes during soluble receptor binding may allow for highly stable conformational intermediates important for viral fusion, while neutralization of HIV-1 by sCD4 results from less stable envelope associations.


Simian immunodeficiency virus (SIVsm) infection of cynomolgus monkeys: effects on follicular dendritic cells in lymphoid tissue. We studied follicles in sections of lymph nodes and spleen from cynomolgus monkeys (Macaca fascicularis) after infection with simian immunodeficiency virus (SIVsm), by (immuno)histology and (immunogold) electron microscopy. Also isolated follicular dendritic cells (FDC) were investigated. Histology showed ranged from follicular hyperplasia to follicle fragmentation. FDC showed desmin and vimentin, characteristic of mesenchymal cells. Except for two animals who got experimental chemotherapy in the first postinfection period, the cells expressed SIV gag p28 protein. Electron microscopy showed SIVsm-like particles in the germinal centers. A number of cell types in the germinal center, including FDC, showed tubuloreticular structures, indicative of alpha-interferon synthesis during an antiviral response. In immunogold electron microscopy, SIV p28 label was observed on the surface of FDC, on SIVsm-like particles, and in the cytoplasm of macrophages. A relatively high density of CD8-positive cells (T cytotoxic-suppressor phenotype) was observed around and in germinal centers, especially areas depleted of FDC. Cells immunoreactive for serine esterase granzyme-B, a protein occurring in granules of cytotoxic cells, occurred around germinal centers, but not in germinal centers at areas where FDC and SIV p28 label localized. This argues against a role of cytotoxic T cells in mediating follicle destruction.


Changes in the reactivity and neutralizing activity of a type-specific neutralizing monoclonal antibody induced by interaction of soluble CD4 with gp120. Antibodies directed against the third hypervariable loop-domain (V3 loop) of human immunodeficiency virus type 1 (HIV-1) gp120 inhibit the infection by HIV-1 in a type-specific manner without interfering with the binding of gp120 to CD4. Previous studies demonstrated that soluble CD4 (sCD4) induced the dissociation of gp120 with gp41 and caused conformational changes within the envelope oligomer. We report changes in the binding and neutralizing activity of a monoclonal antibody against the V3 loop after sCD4 binding to gp120. Flow cytometry revealed that a type-specific neutralizing monoclonal antibody against V3 loop of HTLV-IIIB, 0.5 beta, reacted with HTLV-IIIMN-infected cells after exposure to sCD4. When the sCD4-treated HTLV-IIIMN infected cells were analyzed by two-color flow cytometry, most of the CD4-bearing cells were 0.5 beta-positive, indicating that this reactivity of 0.5 beta was associated with the binding of sCD4 to the infected cells. To determine the cross-neutralization by 0.5 beta after exposure to sCD4, HTLV-IIIMN viruses pretreated with sCD4 were used to infect susceptible target cells. The addition of 0.5 beta significantly reduced the p24 antigen production (66.1 +/- 5.9 pg/ml) compared with a control murine IgG (221.3 +/- 15.3 pg/ml). In contrast, no significant reduction in the p24 antigen production was observed by adding the HTLV-IIIMN neutralizing monoclonal antibody, mu 5.5, (209.9 +/- 15.0 pg/ml). Taken together, these results suggest that sCD4/gp120 binding could induce conformational/antigenic changes within the V3 loop that result in the induction of cross-reactivity and cross-neutralizing activity of a type-specific monoclonal antibody.


Expression of human CD4 in transgenic mice does not confer sensitivity to human immunodeficiency virus infection. Transfection of the human CD4 molecule into mouse cells does not confer susceptibility to human immunodeficiency virus type 1 (HIV-1) infection. Expression of the human CD4 molecule in transgenic mice was seen to offer some new possibilities. However, transgenic mouse T cells expressing either the human CD4 receptor, or a hybrid human/mouse CD4 receptor alone or in conjunction with human major histocompatibility complex class I molecules, were refractory to in vitro HIV-1 infection. In addition, no infection was observed after in vivo HIV inoculation to mice of these various transgenic lines. Injection of recombinant gp160 viral protein to the transgenic mice did not alter their T and B cell populations. The existence of a dominant block in mouse cells that prevents HIV entry is discussed.


[Cancer of the esophagus (I): its epidemiological, clinical and diagnostic assessment according to histological type]. From 1975 to 1991, sixty-eight patients were treated with surgery for esophageal cancer at the Clínica Universitaria de Navarra. This study involves an analysis of epidemiologic and predisposing risk factors in relation with the histologic type of tumor: epidermoid carcinoma vs. adenocarcinoma. The difference in mean age of males (60.5 yrs.) as compared with that of females (48.7 yrs.) was statistically significant (p < 0.05). Likewise, the mean age of patients with epidermoid carcinoma (57.8 yrs.) was significant lower (p < 0.01) as compared with that of those with adenocarcinoma (66.3 yrs.). Smoking and alcoholism were common in the group of patients with epidermoid carcinoma, while Barrett's esophagus and hiatal hernia were frequently seen in patients with adenocarcinoma. Dysphagia was the most frequent symptom both at the start of disease (75%) and with the diagnosis established (96.7%). There was no significant difference in the symptomatology of patients with one type of tumor or the other. The efficacy of ancillary diagnostic procedures such as barium swallow, esophagoscopy, computerized tomography and biopsy were likewise assessed. The most frequent site of tumor was at the middle third, with majority of patients being at clinical stage 1-2 of disease at the time of diagnosis.


[Cancer of the esophagus (II): the results of surgery, anatomicopathological study and patient survival]. We present a retrospective study of 68 esophageal cancer patients treated with surgery between 1975 and 1991. Results showed a resectability of 73.5% with the most frequent surgical approach being a Lewis esophagectomy. The mean hospitalization time was 24.7 days with a postoperative mortality of 7.3%. Other complications included anastomotic leakage, wound infection, sepsis and pulmonary disorders. Over-all survival at 3 years was 17.3%, reaching 24% in resected patients. Survival according to lymph node involvement was 13.4% for lymph node positive patients and 34.5% for node negative patients. According to histopathologic stage, survival rates were 34.6% and 8.59% for early and advanced tumor respectively, the difference being statistically significant using the Mantel-Haenszel test.


[Is the introduction and realization of the Japanese system of staging and surgical treatment for stomach cancer possible in Spain?]. Discrepancies in the five-year survival rates after treatment of gastric cancer between the West and the East have been attributed to differences in the biological behavior of the tumor or in the incidence of early cancer. Alternatively, the better staging system and the national standardization of the diagnosis and treatment used in the East may explain their findings. Poor definition of stages and curability, scarce interest in standardization of techniques, and lack of basic information in many pathological reports are frequent in Western countries. Between May 1988 and April 1991 a prospective study on a consecutive series of 89 patients diagnosed of gastric carcinoma in the Hospital "Príncipe de Asturias" using the directions given by the Japanese Research Society for Gastric Cancer has been made. Our results support the use of the Japanese system in a General Hospital of our country and confirm its accuracy in defining the type of surgery performed, the later being its main advantage over the TNM staging system.


[A cellular proliferation study in patients with colorectal cancer, solitary, synchronous and with polyps]. Colonic carcinogenesis is probably related to a disturbance in cell proliferation of the colonic mucosa. The present study was designed to determine whether patients with adenomatous polyps of the colon, which have a tendency to develop synchronous malignancies of the colon, have any disturbance in mucosal cell proliferation. Using flow cytometry the proliferative index, and the S and G2M phases of normal mucosa and tumoral tissue of patients with colorectal cancer (synchronous, alone, or associated with adenomatous polyps) were studied. No differences were found between the there groups of study at the level of proliferation pattern of normal mucosa. Our findings do not support the development of synchronous or metachronous colon cancer in patients with polyps on the basis of different patterns of cell proliferation.


[Biliary complications in the follow-up of 54 orthotopic liver transplant patients]. We analyze the biliary tract complications after 54 orthotopic liver transplantation in 49 patients during a 2-year period. Biliary tract reconstruction was achieved by a choledochocholedochostomy over a t-tube in 47 cases and by a Roux-en-Y choledochojejunostomy in 7 cases (2 sclerosing cholangitis, 4 retransplants and 1 secondary biliary cirrhosis). The t-tube was removed between the 12-16 postoperative week in all cases except in two patients (2 and 3 postoperative week). There was not intraoperative mortality. During the first postoperative month 8 patients died (16.3%) none of them because a biliary complications. The one year actuarial survival of patients was 74.6%. During the (first three postoperative months) we observed 5 patients with a bile leak (biloma). In 3 cases the ultrasonographic drainage was effective and in two cases a surgical drainage was necessary. After the 3rd postoperative month, four patients developed a biliary peritonitis after t-tube removal and a reoperation was required in all cases. Finally, 1 patient suffered a hilar biloma cavity due to hepatic artery thrombosis. We stress the low incidence of reoperations due to early biliary complications (2 cases) and the high incidence of biliary peritonitis after t-tube removal.


[The accidents and complications of laparoscopy. A review of 8,915 cases]. Complications occurring in 8,915 laparoscopies done during 1957-1991 are analyzed. Complications were classified as major or minor, according to the need of surgical intervention for their management, and also in relation to pneumoperitoneum, introduction of the laparoscope, during the examination or after laparoscopy. The total number of major accidents was 54 (0.60%). Half of them as a consequence of the instrumentation or of liver biopsy. There were 442 minor complications (4.96%). Mortality included 10 patients (0.11%) as a sequel of uncontrolled haemorrhage, 5 of them after liver biopsy. The complications of laparoscopy cannot be ignored; as all invasive techniques it may have a risk, even in the most expert hands. Half of the major accidents and of the mortality were due to complications from liver biopsy.


[Gastric metastasis of melanoma].

[Gastric metastasis of melanoma]. The authors report a case of gastric metastases from a melanoma three years after the removal of the original tumour located at the front side of the left leg. The metastases was diagnosed because of asymptomatic iron deficiency anemia.


[Deficiency polyneuropathy secondary to immunoproliferative disease of the small intestine]. We report a new case of immunoproliferative small intestinal disease with neurological involvement expressed as deficiency polyneuropathy. In spite of non identifiable plasmatic paraprotein, the use of immunohistochemical techniques showed the characteristic proliferation in the intestinal mucosa of plasma cells with a prevalence of IgA cells, which define this disease.


[Collagenous colitis as a cause of acute diarrhea]. Collagenous colitis is a newly recognized entity presenting clinically as chronic watery diarrhea and histologically by a thickened subepithelial collagenous band in colonic biopsies. We report the case of a middle aged woman affected of acute diarrhea in whom, after ruling out its main etiologies, the diagnosis of collagenous colitis was made.


[Retroperitoneal lipoma (with areas of myxoid degeneration)]. Retroperitoneal tumors of lipomatous origin are usually liposarcomas. Only a minority of adipose tumors of the retroperitoneum show histological criteria of benignity. We present the case of a 52-year-old woman, diagnosed of a retroperitoneal lipoma with areas of myxoid degeneration. The tumor involved the left kidney and was resected completely.


[Idiopathic sclerosing peritonitis (ISP). A report of a new case and a review of the literature]. Idiopathic sclerosing peritonitis (I.S.P.) is a rare disease, in which the small bowel is encased in a fibrous capsule, with symptoms and signs of intestinal obstruction. A new case of I.S.P. in a 42-year-old man who underwent laparotomy and was reoperated for intestinal obstruction is presented. A jejunal fistula with a favorable outcome occurred in this case. The literature about this entity is reviewed, and 16 cases are collected. This condition is being reported more and more commonly and requires further research to elucidate its unknown mechanism.


[Trauma surgery, a multidisciplinary responsibility]. Our efforts within trauma-care have to include accident-prevention, the organization of a functioning rescue-chain as well as a pluridisciplinary care of the trauma-patient. This is of special importance within the given Swiss hospital structure. For the treatment of injuries of the locomotor-system general-and orthopaedic surgeons need to cooperate. Additional training and experience in traumatology are therefore important for both specialties.


[Shoulder dislocation and periarthrosis humeroscapularis]. 1232 injuries involving shoulder luxations in 1984 were investigated on the basis of the insurance dossier. 1/3 of the injured persons have sequelae: 10.5% habitual tendency to luxation, 9% peritendinitis, 2% omarthritis and 2% a shoulder instability. 1/5 in each case still experience pain and restricted movement. The 108 cases where peritendinitis has occurred following shoulder luxations are shown divided up according to various symptoms. Peritendinitis ankylosis or frozen shoulder represents the major share in almost half of the cases. Various characteristics, complications and risk factors for the possibility of contracting peritendinitis following shoulder luxation are being worked out. In conclusion, the insurance-relevant parameters for peritendinitis after shoulder luxation are shown: in cases with peritendinitis, integrity compensation was awarded 12 times more frequently than in cases without peritendinitis; in the case of shoulder luxation with peritendinitis, the entire insurance benefits were 10 times higher than in cases without peritendinitis.


[Clinical and radiologic long-term follow-up of Eden-Lang operation in habitual anterior shoulder dislocation]. The incidence of degenerative arthritis after Eden-Lange procedure is judged differently in literature, recently high rates of degenerative arthritis have been reported. 37 patients and the same number of shoulder joints have been evaluated clinically and radiologically after an average follow-up time of 14.9 years. Overall results can be considered as good. Recurrence of dislocation occurred only in one case. Most frequently we observed a limitation of external rotation and overhead performance in sports. The frequency of degenerative arthritis was 17%, clearly less than mentioned elsewhere. The Eden-Lange procedure still can be recommended as a treatment for recurrent anterior shoulder dislocation except for patients with high expectations in physical overhead activities.


[Chronic posterior shoulder dislocation]. The posterior dislocation of the shoulder is frequently unrecognized for many days, months or even years after the initial accident. After the presentation of its clinical and radiological features, as the different ways of its treatment, some cases will illustrate this entity, too frequently missed or wrongly treated.


[Hook plate (so-called Balser plate) or tension banding with the Bosworth screw in complete acromioclavicular dislocation and clavicular fracture]. With both treatments good results are achieved. In cases treated with the hook-plate mobilisation and load putting are earlier possible. These patients are sooner back to work. The costs for the hook-plate are higher. To take out the hook-plate a second hospitalisation is necessary.


[Extended surgical indications in combined shoulder girdle fracture]. The combination of an ipsilateral clavicule and scapula fracture causes a double instability of the shoulder. In opposite to an isolated clavicule or scapula fracture this injury should be treated operatively. Diagnosis of the scapula fracture in polytrauma can be difficult. If there is a clinical or radiologic suspicion, the indication for a CT scan is given. Osteosynthesis with plates from separated approaches, first the scapula from dorsal then the calvicule from ventral has proven good. The nervus suprascapularis must be treated carefully and, if necessary, liberated from the fracture. The optimal treatment of this injury is not always possible in polytraumatised patient.


[Treatment of subcapital humerus fracture with the Prévot nail]. Displaced subcapital fractures of the humerus are difficult to manage due to the specific anatomical and biological conditions in the proximal humerus. With respect to the fracture type and extent of displacement of the humeral head and the tuberosities the concepts for treatment remain controversial. A large spectrum of recommendations for the treatment of unstable subcapital fractures are known ranging from conservative treatment, open reduction and internal fixation using different implants to the primary prosthetic replacement of the humeral head. Recent results from basic research emphasize the importance of sound tissue viability for undisturbed fracture healing and influence today's strategies in fracture management. Minimal exposure of the fracture area, indirect reduction techniques and a minimal but optimal biomechanical use of implants can help to avoid some of the possible (and partially iatrogenic) complications. Fixation of subcapital humeral fractures by intramedullary pinning seems to provide sufficient stability without damaging the vascularity of the fracture fragments leaving intact in addition the soft tissues around the shoulder. The treatment of proximal humeral fractures by the use of Prévotnails is presented in this paper and some possible problems of the method are discussed.


[Fractures of the proximal humerus. Classification and treatment principles]. The therapeutical strategy for fractures of proximal humerus is pointed out both by Neer's and by AO classification. Thus closed functional treatment is indicated in case of all undislocated or minimally displaced fractures. Conservative management is indicated for all reducible fractures as well. Severe and irreducible bone lesions i.e. three and four part fractures with or without dislocation are to be handled primarily by operation. Dislocated fractures require an emergency procedure. The operative strategy has to be suitable for the type of fracture. Stable T-plate osteosynthesis is preferred for simple fractures (i. e. Type A2 or A3 according to the AO classification). Serious bifocal and articular bone lesions are sufficiently managed by minimal internal fixation (osteosynthesis) especially in regard to the biological aspects. The sincere contact of bone fragments accompanied by sufficient anatomical axis should be the aim of the operative strategy. Manifold expedients for reduction like temporarily applied Steinmann pins are necessary. Larger lesions of spongiosa can mostly be substituted by autoclaved spongiosa transfer. As minimal osteosynthesis led rarely to necrosis of the humeral head it is preferred especially in case of severe fractures. According to our therapeutical draft head preserving procedure had the priority to primary humeral prosthetic arthroplasty.