The in vitro perifused rat ovary: II. Role of oxygen tension in the whole and quartered ovary. In vitro perifusion of whole ovaries raises questions about tissue viability and its effects on the observed ovarian steroid secretion. To assess effects of tissue degeneration, whole and quartered ovaries from pregnant mare serum gonadotropin (PMSG-) treated immature rats were perifused for 8 h, employing various levels of pO2. Histological examination of both the whole and quartered ovary showed signs of degeneration in centrally located follicles but not in follicles located near the surface. However, basal and gonadotropin-stimulated (luteinizing hormone plus follicle stimulating hormone) secretion of estradiol, testosterone and progesterone were not significantly different in the whole ovary whether in the presence of high or low pO2 (n = 8; p > 0.05). Similarly, although the quartered ovary secreted greater amounts of steroids than did the whole ovaries (p < 0.05, n = 8), pO2 levels did not affect the steroid output. We conclude that during in vitro perifusion, minimal oxygen supply is sufficient for ovarian steroidogenesis to proceed. In addition, although quartered ovaries displayed some evidence of tissue degeneration, they were more responsive in terms of steroid output per mg ovary than were whole ovaries.


Progesterone administration by nasal spray in menopausal women: comparison between two different spray formulations. The aim of the study was to compare the bioavailability of progesterone dissolved in almond oil or dimethicone, and administered by nasal spray. Twenty healthy menopausal women were randomly allocated to treatment by four doses of intranasal spray either of a progesterone solution in almond oil, 2 mg/0.1 ml, corresponding to a total dose of approximately 11 mg of progesterone, or a progesterone solution in dimethicone 5 mg/0.1 ml corresponding to a total dose of approximately 28 mg of progesterone. Circulating progesterone levels were calculated at various time intervals following administration. The formulation with almond oil yielded a maximum progesterone concentration (Cmax of 3.75 ng/ml at Tmax = 60 min, and the area under the curve (AUC0-720) value was 1481.6 +/- 343. The formulation with dimethicone yielded a mean Cmax of 1.049 ng/ml at Tmax = 30 min; the AUC0-720 value was 302.06 +/- 37.5. Therefore, bioavailability of progesterone dissolved in almond oil proved to be largely superior compared to the solution in dimethicone. The crucial role of the carrier in the spray formulations is discussed; in addition to ensuring clinical safety, it must have good solubility for progesterone, be fluid enough to enable efficient 'spraying' and also must allow progesterone to be absorbed through the nasal mucosa.


High density lipoprotein concentration is increased during the ovulatory phase of the menstrual cycle in healthy young women. This study aimed to examine the relation between sex steroid hormone fluctuations during the menstrual cycle and serum lipoproteins and their constituents. Serum was obtained in the early follicular, preovulatory, and midluteal phases from 18 young women. Ovulation was confirmed by estrogen and progesterone assays. High density lipoprotein cholesterol (HDL-C) was found to increase by 16% in the preovulatory phase, in comparison to the early follicular phase. Serum apolipoprotein-AI (Apo-AI) was elevated in the preovulatory and mid-luteal phases (14% and 19%, respectively) in comparison to the early follicular phase. Total cholesterol, triglycerides, very low, and low density lipoprotein-cholesterol (VLDL-C and LDL-C) and apolipoprotein-B (Apo-B) serum levels did not change throughout the cycle. In the mid-luteal phase, the Apo-AI/HDL-C ratio was higher than in the other two phases, suggesting altered HDL composition during this phase. These results suggest that endogenous progesterone, unlike some synthetic progestogens, does not negate the beneficial effect of estrogen on serum lipoproteins.


The effect of somatostatin analog octreotide (Sandostatin) on luteinizing hormone and ovarian steroids in insulin-dependent diabetic women without residual insulin secretion. In order to determine whether the inhibitory effect of octreotide on luteinizing hormone (LH) secretion and ovarian steroids observed in women with polycystic ovaries (PCO) is a direct or indirect action of the analog, we have investigated the effect of 7 days of octreotide on LH, follicle stimulating hormone (FSH) and ovarian steroids in nine insulin-dependent diabetic women without residual insulin secreting, as in these patients a possibly confusing inhibitory effect of octreotide on endogenous insulin production is excluded. LH and FSH pulsatility over 4 h and hormonal responses (LH, FSH, estradiol, testosterone and androstenedione) to a single subcutaneous injection of buserelin were measured before and after 7 days' treatment with octreotide 100 micrograms subcutaneously twice a day. Octreotide failed to induce a significant reduction in either serum gonadotropin or ovarian steroid levels, although there was a general tendency of hormonal responses to buserelin to be lower with the analog. The effect of octreotide on LH secretion seems to be in correlation with the pretreatment levels which are, in turn, at least determined partly by endogenous insulin secretion. Thus, the results of the present study support the view that insulin has an important influence on LH secretion.


Multiple serum marker assay in the diagnosis of endometriosis. Serum levels of CA-125, CA-15-3 and TAG-72 were measured in 81 patients with endometriosis, diagnosed by laparoscopy, and staged according to the Revised American Fertility Society, and in 31 control subjects. The values of CA-125 and CA-15-3 were also determined in peritoneal fluid. The aim of the present study was to evaluate the clinical usefulness of these various markers in the diagnosis of endometriosis by using them either by themselves or combined. High serum levels of CA-125 were found in 43 of 81 patients with endometriosis (53%) and in five of 38 control subjects (13%). The values of serum CA-125 progressively increased in relation to the severity of the disease. High serum values of CA-15-3 and TAG-72 were also found in patients with endometriosis, but with a similar incidence also in control patients. High CA-125 and CA-15-3 values in peritoneal fluid were found in all patients investigated. These results suggest that measurement of serum CA-15-3 and TAG-72 in addition to CA-125, does not provide any advantage for the diagnosis of endometriosis.


GnRH agonist analog therapy in advanced/recurrent granulosa cell tumors: further evidence of a role of inhibin in monitoring response to treatment. Five patients with advanced ovarian granulosa cell malignancies resistant to cytotoxic chemotherapy were treated with monthly subcutaneous injections of long-acting gonadotropin releasing hormone (GnRH) agonist analog. One partial response and one stabilization of the disease were observed. In three patients, the tumor continued to progress. Treatment response was monitored with serum inhibin assay. Four patients had high serum inhibin concentrations at the beginning of GnRH analog treatment, while one patient had an inhibin-negative tumor. In three of four patients, serum inhibin remained relatively constant, or decreased during the first 3 months of therapy. It subsequently increased, in parallel with clinical deterioration. Further clinical trials with GnRH analogs are warranted in this malignancy in which serum inhibin appeared to be a clinically valuable tumor marker.


Vaginal progesterone administration in physiological doses normalizes raised luteinizing hormone levels in patients with polycystic ovarian syndrome. A raised luteinizing hormone (LH) level is a typical finding in the polycystic ovarian syndrome (PCOS). This inappropriate elevation of LH is thought to interfere with normal follicular development and ovulation. The resulting chronic anovulation is associated with the absence of the luteal phase increase in secretion of progesterone and inhibin. Progesterone can exert both a positive and negative feedback action on LH secretion, but inhibition is thought to occur following prolonged exposure to progesterone. Therefore, the aim of this study was to see if exogenously administered progesterone in physiological doses would normalize circulating LH concentrations in patients with PCOS. Vaginal progesterone was administered twice daily in a dose of 100 mg, at 12 h intervals, to ten women with PCOS. Serum samples were taken on alternate days for radioimmunoassay of follicle stimulating hormone (FSH), LH, estradiol, progesterone and inhibin. To determine the effect of progesterone on LH secretory dynamics in PCOS, LH pulse studies were carried out prior to treatment, and on day 10 of progesterone administration in four of the ten subjects. Mean serum progesterone concentrations reached 51 nmol/l by 4 days after exogenous progesterone treatment, and remained in the mid-luteal phase range, as established in 12 normal cycles, during the use of the vaginal suppository. The mean serum LH concentration had fallen significantly (p < or = 0.01) after 8 days of treatment, and continued to fall progressively until the end of progesterone administration. Serum LH concentrations had fallen into the normal follicular phase range by 14 days (mean 5.5, range 3.4-10.9 IU/l; normal follicular phase range 1.8-10.0 IU/l).(ABSTRACT TRUNCATED AT 250 WORDS)


The value of an electronic microcomputerized basal body temperature measurement device (Bioself) in in vitro fertilization cycles. The Bioself 110 electronic basal body temperature (BBT) measurement device was employed in 18 women undergoing in vitro fertilization (IVF). This microcomputer-operated device records, charts and accurately analyzes the mean temperature measurements. These temperature recordings were used in addition to transvaginal ovarian sonography and serum estradiol and progesterone levels. The BBT rise correlated significantly (p < 0.0002) with progesterone elevation following human chorionic gonadotropin (hCG) administration. It is suggested that this electronic device may be used as an additional tool in the detection of premature progesterone secretion in IVF cycles.


Urinary and amniotic epidermal growth factor during normal and abnormal pregnancies. A comparison based upon umbilical Doppler velocimetry. Fetal growth retardation is associated with abnormal umbilical flow velocity. We have begun a systematic study of growth factors and their relationship to this specific pattern of growth retardation. Using a specific double-antibody epidermal growth factor (EGF) 125I-radioimmunoassay, we studied urinary EGF in normal pregnancy from 5 to 42 weeks of gestation, and amniotic fluid EGF from 18 to 24 weeks. EGF levels increased from early pregnancy until 21-28 weeks, when they declined to a level at term similar to non-pregnant controls and first-trimester pregnancy levels. There was no significant difference in urinary EGF levels between women delivering appropriate-for-gestational-age (AGA) infants, and those delivering small-for-gestational-age infants (SGA). We conclude that the urinary EGF is not different in the SGA pregnancy from normal pregnancy.


The human first-term placenta in vitro: regulation of hCG secretion by GnRH and its antagonist. Gonadotropin releasing hormone (GnRH) has been proposed to play a role in the regulation of human chorionic gonadotropin (hCG) release from the human placenta. To test this assumption, we utilized an in vitro perifusion system, together with cultures of placental explants, to investigate short- and long-term effects of GnRH and its respective antagonist on the hCG secretion from the early human placenta. Tissue slices of human placenta (100 mg), obtained from first-trimester terminations of pregnancies, were continuously perifused and the effluent collected in fractions of 2-20 min. After initial perifusion periods of 30-40 min, either GnRH, a GnRH antagonist (SB-75; Asta Pharma, Frankfurt, Germany) or both compounds at equimolar concentrations were added to the perifusion medium at final concentration of 10(-4)-10(-8) mol/l). Administration was effected either continuously or intermittently in 10-min pulses. Further, 50-mg pieces of placental tissue explants were cultured in tissue culture plates for up to 6 days. During the perifusions, hCG (determined by enzymeimmunoassay) was found to be released spontaneously in a pulsatile fashion. Pulse amplitudes and frequencies of this episodic hCG secretion were increased in response to GnRH, but not affected by GnRH antagonist. Also, GnRH stimulated the hCG secretion during cultures of placental explants. When pharmacological doses of GnRH (10(-4) mol/l) were utilized, this stimulatory effect of GnRH was no longer evident, while perifusion with medium containing GnRH antagonist at identical concentrations stimulated the hCG secretion, indicating an intrinsic agonistic activity of the antagonist.(ABSTRACT TRUNCATED AT 250 WORDS)


Regulation of the low affinity receptor for nerve growth factor, p75NGFR, in the olfactory system of neonatal and adult rat. Using MAb192, a monoclonal antibody to the rat low affinity receptor for nerve growth factor (p75NGFR), we determined the expression of p75NGFR in rat neonatal and adult olfactory system. In neonates and adults, we observed discrete p75NGFR-immunoreactivity (p75NGFR-ir) in the glomerular layer of the main olfactory bulb. The intensity and organization of glomerular p75NGFR-ir increased with age. This was in keeping with the general ontogeny of the main olfactory bulb. Generally, granule cells, mitral cells and periglomerular cells of the main olfactory bulb were not specifically stained. However, in early neonates, granule cells close to the lateral olfactory tract exhibited p75NGFR-ir. Additional specific staining was found in the olfactory receptor neurons of neonatal and adult olfactory neuroepithelium, the olfactory fascicles and in the glomeruli of the accessory olfactory bulb. The intensity, but not the organization, of specific staining in the accessory olfactory bulb increased as the animal matured. We believe that p75NGFR-ir in the olfactory system is associated with its unique capacity to regenerate its peripheral input to the main olfactory bulb. The presence of p75NGFR-ir in the accessory olfactory bulb would suggest a broader role for this protein. Here we discuss the implications of these findings with regards to nerve growth factor, other trophic molecules, and their receptors. The data presented provide a foundation for studies involving manipulation of regenerative phenomena while monitoring the expression of neurotrophic factors and their receptors.


Immunofluorescent labeling of tight junctions in the rat brain and spinal cord. Tight junctions may play an important role in maintaining the integrity of the blood-brain barrier. These junctions can be individually visualized using electron microscopy but no current technique is able to provide a more global picture of the presence and density of tight junctions in central nervous system tissue. We used an antibody that recognizes a high molecular weight protein (ZO-1) associated with tight junctions, to identify these specialized junctions within the rat brain and spinal cord. Immunofluorescent labeling showed a network of tight junctions between cells in the brain vasculature, leptomeninges and choroid plexus, and between tanycytes lining the floor of the third ventricle and the central canal of the spinal cord. Anti-ZO-1 labeled the majority of cells associated with the blood-brain barrier and may prove a useful marker, possibly in conjunction with functional dye studies, in evaluating the anatomical and functional integrity of the blood-brain barrier.


Neuritogenesis on collagen substrates. Involvement of integrin-like matrix receptors in retinal fibre outgrowth on collagen. Extracellular matrix molecules such as laminin, fibronectin and collagen promote neurite outgrowth in vitro. We have investigated the capacity of hydrated gels of collagen types I-III and monomeric collagen types I-VI on plastic surfaces to support neuritogenesis. The attachment and survival of explants from the day 6 chick embryo were studied and neurite outgrowth measured as mean elongation rate and maximal neurite length. Collagen types I and III, both as three-dimensional gels or as native monomers supported neuritogenesis equal to or better than laminin. Collagen type V also supported neurite out-growth although less effectively. Collagen types II, IV and VI, as well as denatured collagens of all types tested, did not support outgrowth. The monoclonal anti-beta 1 integrin antibody (CSAT), as well as rabbit polyclonal antibodies directed to the integrin beta 1-chain, effectively inhibited neurite outgrowth on permissive collagenous substrata, indicating that collagen-binding integrins were involved in the neuritogenesis. These beta 1-integrins were independent of Arg-Gly-Asp (RGD) since neurite formation proceeded in the presence of synthetic RGD-containing peptides. Fluorescence immunohistochemistry revealed the presence of the integrin beta 1-chain on the outgrowing neurites. The results suggest a possible function of collagen and collagen-binding integrins in the development of the visual system.


Recovery of vestibular function in young guinea pigs after streptomycin treatment. Glutamate decarboxylase activity and nystagmus response assessment. Fifty-day streptomycin (STP) treatment in guinea pigs causes specific vestibular hair cell (VHC) types I and II (HCI; HCII) degeneration, depletion of glutamate decarboxylase (GAD) and a gradual disappearance of postrotatory nystagmus response (PRNR), which is a sign of vestibular function alteration. In order to look for a possible spontaneous reversibility and its time course guinea pigs receiving 300 mg/kg STP daily were monitored for PRNR and vestibular GAD loss. Once PRNR was lost, STP was interrupted and the animal was allowed to recover; at the time that PRNR was completely reestablished, vestibular GAD was measured. PRNR was lost within 22-25 days of STP treatment. Vestibular GAD showed a loss that, with time of treatment, gave two slopes: a fast decrement (45% in 20 days) and a slow one (40% in the remaining 30). Stopping of the STP treatment after 22-25 days and animal recovery resulted in the return of both PRNR and GAD activity 22 days after STP stoppage. These results suggest two STP-susceptible GAD-containing VHC populations, one more sensitive than the other, possibly HCI followed by hair cell II (HCII). As hypothetic HCI loss and PRNR disappearance is simultaneous, the important role of the former for vestibular function could be inferred. Interruption of STP treatment after PRNR loss results in a long range restoration of both GAD activity and vestibular function, and thus recovery of HCI, the first evidence of its occurrence in a mammalian vestibule, could be suggested. The intimate mechanism of this recovery remains to be seen.


NMDA receptor levels in chronically depolarized long-term neonatal rat neocortical explants. The levels of the N-methyl-D-aspartate subclass of glutamate receptor were determined in organotypic neocortical explants chronically exposed to a growth medium containing 25 mM potassium (K25). Explants exposed to 25 mM potassium for 2-3 weeks evinced significantly less binding of the non-competitive N-methyl-D-aspartate receptor-associated channel antagonist 125I-MK801 than did age-matched controls. Surprisingly, cultures that were returned to control growth medium for a further 2 or 7 days showed even less binding of the ligand. The Kd values of binding were not affected and were similar to those of fresh postnatal cortex. The maximum number of binding sites did not vary between postnatal day 6 and 14 days in vitro control cultures, but were significantly less than those measured at postnatal day 20 (comparable age: 14 days in vitro). Several conclusions can be drawn from these findings: (i) the density of the N-methyl-D-aspartate subclass glutamate receptor does not attain in vivo levels under the present culturing conditions, but remains at those levels associated with the stage of development at which the tissue was brought into culture, (ii) chronic depolarization results in a drastic reduction in N-methyl-D-aspartate receptor density, which is not compensated for after the return to normal growth conditions, (iii) depolarization selectively inhibits cellular maturation of the neocortex (but not survival, as shown previously), including neurotransmitter receptor production and/or insertion into membranes or assembly.


Neonatal prazosin exposure reduces ovarian weight and estrogen receptor binding in adult female rats. Exposure of estrogen treated adult female guinea pigs to the alpha-1 antagonist prazosin has been shown to reduce levels of estrogen binding in the hypothalamus and preoptic area. To further investigate this interaction between the noradrenergic and neuroendocrine axes, newborn female rat pups received an s.c. implant of prazosin (0.0125 mg/day for 5 days) or placebo. In adulthood, subjects were sacrificed by perfusion with DMSO on the morning of proestrous. Tissue analysis of the medial preoptic area, corticomedial amygdala, and mediobassal hypothalamus revealed that cytosolic estrogen binding was significantly reduced in all three areas for the prazosin treated group as compared to controls. Ovarian weight was also significantly reduced in the prazosin treated group, although uterine weight was unaffected. Interestingly, prazosin treated females showed a post-pubertal increase in body weight characteristic of ovariectomized females, while controls showed no such increase. These results support the existence of a significant developmental interaction between the noradrenergic system and the neuroendocrine axis as measured by ovarian weight and estrogen binding in the brain.


Distribution of cholinergic neurons in the chick spinal cord during embryonic development. Comparison of ChAT immunocytochemistry with AChE histochemistry. The location of cholinergic neurons was studied during the development of the chick embryo spinal cord. A comparison between choline acetyltransferase (ChAT) immunocytochemistry and acetylcholinesterase (AChE) histochemistry was performed. ChAT-positive neurons could be detected only from embryonic day 9 (E9) onwards by the FITC technique and from E12 onwards by the PAP technique. These neurons were located mainly in the medial and lateral motor columns in the ventral horn of the gray matter and some of them were observed in the intermediate region of the spinal cord. AChE-containing cell bodies were much more numerous than the ChAT immunoreactive ones and were distributed in the ventral horn of the gray matter, the intermediate gray region and mostly off the apical part of the dorsal horn. ChAT should provide a reliable and specific marker for cholinergic neurons.


[Angiographic diagnosis of intracranial aneurysms: study of the experience of the neuroradiology service at the Egas Moniz Hospital]. In this work, 139 intra-cranial aneurysms diagnosed at the Egas Moniz Hospital were studied, from 1980 to the first quarter of 1992. The nature of this type of lesions was discussed, and aneurysms were defined as an abnormal and segmental dilatation of an intracranial artery wall. A statistical study was performed, including 67 cases after selection, corresponding to 71 aneurysms. Of these, 39% originated from the anterior cerebral artery, 37% from the carotid siphon, 18% from the middle cerebral artery and 6% were found in the vertebro-basilar system. The observed topographic incidence of the symptomatic aneurysms was compared with neuropathology data. The results obtained with the hypothesis test for a proportion are suggestive of an increased incidence of symptoms for the aneurysms of the anterior cerebral artery, with a significance level alpha = 0.05.


[Neuroradiology in the physiopathologic diagnosis of subarachnoid hemorrhage--cerebral aneurysm]. The clinical importance of the cerebral aneurismatic lesion in well known. In Portugal we still do not have reliable statistics regarding the occurrence of the subarachnoid hemorrhage, however we can make a comparison through Kassel's and Drake's studies where they refer that annually 28,000 North-Americans suffer from subarachnoid hemorrhage attributed to the rupture of the cerebral aneurysm. This is a clinical situation that needs to be analyzed, more so because if it is not diagnosed and treated in time, it can cause a high level of morbidity and mortality. From 1984 to 1990, the authors studied 208 clinical cases of in-patients at the Santa Maria Hospital who had been diagnosed as having subarachnoid hemorrhage-cerebral aneurysm. They analyzed 172 cranium-encephalic Tomographies and 190 cerebral Angiographies. They found levels that overlapped the series already published with respect to the location of the lesion, dimensions and age groups involved. They tried to relate the presence aneurysm in the willis arterial circle with the occurrence of locoregional anatomic variants that were detected in 51% of the patients with aneurysm of the anterior communicating artery and in 33% of the cases in the posterior communicating artery. The high occurrence of serious forms of tomodensitrometric presentation should also be emphasized. As a matter of fact, 42.6% of the patients studied were grouped in degree IV of the Fisher Scale. This result translates the effort that is still required towards an early clinical and imaging diagnosis of warning hemorrhage to avoid or prevent a catastrophic hemorrhage recurrence.


Tumor necrosis factor in solid tumors: increased blood levels in the metastatic disease. TNF, a cytokine produced by macrophages, is able either to exert an antitumor activity, or to determine severe clinical complications, such as cachexia and septic shock. Increased blood levels of TNF have been described in cancer patients. The present study was performed to better define TNF secretion in patients with solid tumors. The study included 48 cancer patients (lung cancer: 22; colon cancer: 11; breast cancer: 10; renal cancer: 5), and among them 27 showed distant organ metastases. TNF serum levels were measured by IRMA method. The control group comprised 40 healthy subjects. TNF levels were also evaluated in relation to those of SIL-2R, whose increase seems to be associated with an unfavorable prognosis in cancer. High levels of TNF were seen in 27/48 (56%) patients. Mean levels of TNF were significantly higher in cancer patients than in controls. Moreover, within the cancer group, TNF mean values were significantly higher in metastatic patients than in those without metastases; the highest levels were observed in patients with visceral lesions as dominant metastasis sites. Finally, patients with high TNF concentrations showed significantly higher mean levels of SIL-2R than those with normal values. This study shows that the neoplastic metastatic disease is associated with an exaggerated TNF secretion.


Percutaneous placement of inferior vena cava filters. Pulmonary embolism is a serious and difficult problem. Many approaches for the prevention of recurrent pulmonary embolism have been tried. Percutaneous placement of inferior vena cava filters is an easy, safe, available and well established procedure for the prevention of pulmonary embolism. The authors review the indications for use of IVC filters, and they review the main filters available in terms of ease of use, the physical characteristics, the technique of introduction, the efficacy and morbidity, and the potential complications associated with their use. Insertion of IVC filters by percutaneous approach was successfully performed in 6 patients with recurrent pulmonary embolism. Following the intervention procedure without complication there were no further pulmonary emboli.


[Value of percutaneous nephrostomy in nephrology]. Percutaneous Nephrostomy (P.N.) has been traditionally used by Urologists. The authors seek to demonstrate the interest of its mastering by members of Nephrology teams, by reviewing 27 cases of unilateral or bilateral P.N. performed in a Nephrology unit from 1983 to 1991. The single most frequent indication for P.N. was Acute or Chronic Renal Insufficiency of obstructive etiology (21 cases), followed by infected Hydronephrosis (4), assessment of residual function of an obstructed Kidney (1) and renal colic in a pregnant woman (1). There were no major complications of the procedure. P.N. allowed correction of metabolic derangements and of infections, enabling the definitive etiologic solution to take place in a clearly favourable clinical context.


Interferon-gamma (r-IFN-gamma) induced activation of alveolar macrophages (AM) from anergic patients with chronic obstructive pulmonary disease (COPD). Forty-six anergic patients (37 males and 9 females, age range 55-79 yr) were selected from ninety-one patients suffering from COPD due to frequent exacerbations and impaired delayed cutaneous reactivity (43.9%). The phenotype of circulating lymphocytes, their proliferative response to a panel of polyclonal T-cell activators and the candidacidal activity (CA) of circulating PMNs (polymorphonuclear cells) were measured. In 13 patients presenting a defective CA of circulating PMNs, the in vitro response of alveolar macrophage CA to r-IFN-gamma was also determined. We found: 1) a significant reduction in the CL response to PHA in COPD patients vs controls; 2) a low PMN-CA in 23 (57%) COPD patients; 3) a non-significant difference in phenotype analysis in patients and controls; 4) lower CA of AMs in COPD patients than in controls; 5) restoration in vitro of CA by r-IFN-gamma in the group of anergic COPD patients presenting depressed CA. We conclude that a defective cell-mediated immunity could be the basis of the enhanced susceptibility to infectious exacerbations in many COPD patients and that, in vitro, it could be reversed by r-IFN-gamma treatment.


In vitro antitumor effect of LAK cells and alpha interferon in combination on tumor cell lines. In vitro antitumor effects of LAK cells and alpha-2b-Interferon (IFN) either alone or in combination were evaluated on NK resistant (K562) and NK sensitive (Namalwa, Raji) cell lines. Tumor cells were incubated with LAK cells for 4, 8 and 24 hours at a LAK: tumor cell ratio of 1:1, 10:1, 100:1, or with IFN for 48 and 96 h at the concentrations of 100, 1000, 10,000, 100,000 IU/ml. A clonogenic assay was utilised to enumerate residual cells after in vitro treatment. A positive correlation was found between tumor cell killing and effector: target ratio, IFN of 100:1 incubated for 4 h, and 100 IU/ml of IFN incubated for 48 h were further chosen. A synergistic effect was found when IFN was incubated before LAK cells or contemporarily, but not when IFN was incubated after LAK cells. These findings demonstrate that an additive or a synergistic effect in vitro can be obtained by adding the two agents in different sequences and suggest that a potential utility of LAK cells and IFN in vivo should be tested in clinical trials.


[Radiologic manifestations of AIDS in the thorax]. In AIDS, pulmonary involvement is the main cause of morbidity and death. In this article the author makes a short report of the illness and a review of its radiological pulmonary images, in what concerns infections, tumoral, non-infections and non-tumoral pathology. Finally, the author proposes a radiological follow-up of great interest for the early diagnosis and treatment of the illness.


Rapid high level production and purification of recombinant murine and human interferons alpha from Escherichia coli. The availability of large quantities of pure interferon alpha (IFN-alpha) subtypes for in vivo studies has often proved difficult. This paper presents details on the use of the commercially available pGEX expression system for the production and purification of milligram (mg) quantities of recombinant Murine (Mu) and Human (Hu) IFNs-alpha-1 in Escherichia coli. Initially a fusion product is made which can be rapidly purified on a glutathione-sepharose 4B affinity matrix. Biologically active IFN-alpha can then be released from the matrix by cleavage with the restriction protease activated factor X (FXa+7,++). Routine yields of the final products were in the range of 0.5 to 2.0 mg/l of original culture.


[Research in psychogeriatrics. Various theoretical and methodologic aspects]. The rapid increase in individuals aged 65 years old and more in the general population has directed attention to geriatrics, a medical specialty concerned with the study, prevention and treatment of pathological conditions in the aged. Among these conditions, frequent psychiatric disturbances occur and therefore it is widely recognized the increasing role of psychogeriatrics. A comprehensive review of theoretical and methodological issues related with research in psychogeriatrics is presented. In a short introduction, the state of the art in some main areas is analyzed. It is pointed out that controversial and unsolved problems still influence the ongoing research in this field. The use of different theoretical models is discussed, taking into consideration their specific scope and drawbacks. Psychopathological phenomena in the elderly are under the influence of a variety of etiologic and pathogenic factors and the conclusion arises that an adequate conceptual framework can be provided by systemic and multifactorial models. However, in order to preserve their explicatory power, they require valid and reliable definitions of all variables involved--not only independent and dependent variables, but also mediating variables--as well as clear hypothesis on their relationships. Different approaches for the fulfillment of these requirements are discussed.


[Gastric carcinoid associated with pernicious anemia]. A clinical case of a patient with pernicious anaemia and a carcinoid tumor of the gastric fundus is described. In the context of the case the relationship between pernicious anaemia, achlorhydria, atrophic gastritis and gastric carcinoid is discussed. The gastric neuroendocrine tumours and their structural and functional characteristics were reviewed in an attempt to clarify the nomenclature and the diagnostic and therapeutic approach in these situations.


[Primary hyperparathyroidism].

[Primary hyperparathyroidism]. Primary hyperparathyroidism due to a solitary adenoma of the right inferior parathyroid gland was diagnosed in a 60 year old female, presenting a 4 year complaint of progressive disabling bone and joint pain. The diagnostic follow-up used in this case, including the imaging techniques, the clinical features and the medical and surgical management are presented and discussed.


[William Harvey: his life and work (2)]. William Harvey's biography is briefly summarized in this essay. The author shows a bird's-eye view of the 16th and the 17th centuries, with regard to the transformations which occurred in science, and narrates Harvey's life. A short description is given of his precursors and their ideas. His most important works are analysed, as well as contemporary scientists' reactions to them. Special emphasis was laid on the discovery of the blood circulation.


Effects of various growth factors on a chondrocyte differentiation model. We developed a new 4-dimensional differentiation model of growth-cartilage cells (temporally and spatially regulated). composed of a high-density suspension culture of rabbit costal chondrocytes. In this system, fibroblast growth factor (FGF) or transforming growth factor-beta (TGF beta) stimulated proliferation and matrix synthesis, but reversibly inhibited terminal differentiation-induction of alkaline phosphatase (Alpase) activity, type X collagen synthesis and subsequent calcification. When parathyroid hormone (PTH) was added to the differentiation model, both the induction of Alpase and calcium uptake were reversibly suppressed. In contrast, calcitonin (CT) stimulated Alpase activity and calcium uptake dose-dependently. Bone morphogenetic protein (BMP) strongly stimulated DNA synthesis of chondrocytes in the presence of FGF and induced rapid maturation of chondrocytes at a growing stage. Moreover, BMP stimulated Alpase activity in multilayered chondrocytes at the calcifying stage.


Potential role of HBGF (FGF) and TGF-beta on prostate growth. We review in this paper the role of heparin-binding growth factor (HBGF*) or fibroblast growth factor (FGF*), rat prostate cancer cells produce TGF-beta, IGF-II* and OGF*. Of these growth factors, TGF-beta and unknown labile factor with 19 kDa are the most probable candidates responsible for osteoblastic bony metastasis of prostate cancer. In vitro experiments suggest that TGF-beta modulates cell detachment of prostate cancer cells together with nutritional factors. HBGF-dependent growth of the prostate tumor epithelial cells is free from inhibition by TGF-beta, whereas normal prostate epithelial cells are sensitive to TGF-beta inhibition. Transfection experiments suggest that HBGF-2 (basic FGF) might be closely related to the malignant growth of prostate cancer, in addition to tumor angiogenesis.


Animal prostate carcinoma models: limited potential for vertebral metastasis. Several methods for induction of rat prostate carcinomas are now available. The induced adenocarcinomas, which develop normally in the lateral and/or dorsal prostate, are invasive and can form distant metastases. Metastatic sites include the abdominal cavity, liver, lung, and/or lymph nodes but, as yet, bone metastasis of prostate cancers in experimental animals has not been reported, despite its being very common in man. Anatomical and hemodynamic differences seem to be account for this lack of bone metastasis.


Analysis of bone metastasis of prostatic adenocarcinoma in 137 autopsy cases. Metastatic frequency to various organ sites in 137 autopsy cases with histologically confirmed prostatic adenocarcinoma was examined retrospectively. Bone lymph node metastases were observed in 81% and 82.5% of the cases, respectively. Lung and liver metastases were noted in 46.7% and 30.7% of the cases respectively. Statistical analysis of the inter-relation among metastases to the bones, lymph nodes, lungs and liver revealed that 83.2% of cases with lymph node metastasis also had bone metastasis. Sixty out of 64 cases with lung metastasis also presented with bone metastasis. There was a significant correlation of metastases between bones and lymph nodes, bones and lungs, and lymph nodes and lungs. Although approximately 88% of cases with liver metastasis also had bone metastasis, this relationship was not statistically significant. there was a statistically significant relationship between lung metastasis and specific sites of bone metastases, i.e. vertebrae, ribs, and sternum. Using the Cochran-Mantel-Haenszel statistical method, we found that the metastatic combination between lung and bone was significantly related in cases with or without lymph node metastasis. These observations suggest that the Batson's vertebral system might play an important role in the metastatic spread of prostatic adenocarcinoma either to the bones or lungs.


Flow cytometric analysis of prostatic carcinoma with and without bone marrow metastasis. We have analyzed 68 prostates obtained at autopsy, for DNA ploidy by means of flow cytometry from patients who had clinical prostatic carcinoma with (29 cases) and without (39 cases) bone marrow metastasis. Flow cytometric analysis revealed 42 diploid cases and 26 aneuploid cases in a total of 68 cases. Among the 26 cases of aneuploidy, 4 cases were tetraploid aneuploid and 22 cases were not tetraploid aneuploid. The highest incidence for the aneuploidy was found in stage D2 disease (19/29, 65.5%), while the highest incidence for diploid was seen in stage B disease (23/25, 92.0%). The correlation between ploidy and bone marrow metastasis was significant (P < 0.01). We thus reconfirm that flow cytometric analysis of paraffin embedded tissue is useful for prognostic evaluation of prostatic carcinoma.


Bone marrow MRI in prostate cancer.

Bone marrow MRI in prostate cancer. Normal bone marrow MRI has a distinct pattern with STIR pulse sequence MRI. The central low signal intensity area corresponds to fatty marrow. The red marrow is distributed in the peripheral portion of the vertebrae and shows a high signal intensity. Prostatic cancer metastases to the bone marrow revealed a high signal intensity with STIR. Prior to the appearance of an abnormal scintigram and radiograph, MRI was able to depict an abnormality.


Bone mineral density for patients with bone metastasis of prostate cancer: a preliminary report. Patients with prostate cancer frequently have osseous metastases which are qualitatively assessed with bone scannings. We have studied the quantitative evaluation of skeletal diseases by measuring bone mineral density (BMD) in the lumbar vertebrae and radius. Forty-four patients with prostate cancer, nine with non-prostatic urogenital cancer and 90 controls were entered in this study. Among the patients with prostate cancer, the values of BMD in the lumbar vertebrae were significantly higher in patients with osseous metastasis than in those without metastasis, whereas the values of BMD in the radius were insignificantly different. Most of the patients with high levels of BMD in the lumbar vertebrae had osseous metastatic disease with no relationship between BMD in the lumbar vertebrae and the radius. The values of BMD in the lumbar vertebrae where hot spot scans were observed were related to X-ray findings. The alterations of BMD levels in the lumbar vertebrae were quantitatively evaluable as responses to androgen deprivation therapy. Measurement of BMD is useful for the accurate diagnosis of osteosclerotic lesions. BMD measurements of the lumbar vertebrae compared with those in the radius were variable in individuals.


The usefulness of serum acid phosphatase in monitoring patients with advanced prostate carcinoma. The usefulness of serum acid phosphatase (SAP) in monitoring patients with advanced prostate carcinoma has been questioned. We reviewed a series of 59 patients with stage D2 prostate carcinoma. All patients had extended follow-up through at least one clinical relapse, or death. Responses to a variety of therapies were characterized as absent, subjective, or objective. All patients with an elevated pre-treatment SAP that fell to normal following therapy had prolonged survivals and improved prognoses. Conversely, all patients with an elevated SAP which did not normalize following therapy had poorer survivals. Among 36 objective responses to therapy, the SAP was elevated prior to or simultaneous with disease progression in 33 (93% sensitivity). In each ease where the pretreatment SAP normalized following therapy, any subsequent elevation in SAP above normal was always associated with clinical evidence of disease progression (100% specificity). Changes in SAP following therapy correlate well with both disease regression and disease progression in patients with advanced prostatic carcinoma.


Clinical study of bone-related relapse in prostate carcinoma. Prostate carcinoma is usually highly responsive to initial endocrine therapy. However, when relapse occurs, the subsequent clinical course is very poor. In this study, we tried to reveal the clinical aspects of bone-related relapse in 392 patients who received endocrine therapy for prostate carcinoma. In 17 stage B patients who had relapsed, 76% experienced relapse within 4 years following the start of treatment, 76% within 3 years in 27 stage C patients, and 71% within 2.5 years found in 45 stage D patients. Pre-treatment levels of serum enzymes and initial response of the primary lesion and of serum enzymes failed to predict relapse. The Gleason sum tended to be correlated with relapse. In particular, patients with a Gleason sum of 9-10 had a lower non-relapse rate during the follow-up period than patients with lower sums. With the recent use of more sophisticated measurements of PSA and/or PAP, the reduction rate or interval to normalization of the markers must be more relevant to predicting relapse.


Analysis of survival of prostate cancer patients in Japan and the U.S.A. The prognosis of U.S.A. patients with prostate cancer based on reports from the American College of Surgeons and Roswell Park Cancer Institute was compared with that of Japanese in Nagasaki and Gunma. There was more than a 10% difference in survival rate between the two countries. Several clinical parameters were analyzed to determine the basis for this difference. In general, stage distribution, metastatic sites, bone pain and alkaline phosphatase in the USA patients with Stage D disease were more severe than in the Japanese patients. Moreover the prostate cancer death rate in the USA was higher than that in Japan. However, only the distribution of pathological grade in the USA was better than that in Japan. From these results, it is difficult to conclude that prostate cancer in the USA is more aggressive than in Japan. The possibility of selection bias in these studies is discussed.


Surgical treatment of metastatic tumors of long bones and the spine. We have operated on 42 patients with bone metastasis from various primary tumors over the past fourteen years. The number of operated cases of metastasis secondary to thyroid and breast carcinoma was especially high, since patients with such types of cancer have prolonged life expectancies in general. The sites of these operation were as follows: 27 in the spine, 12 in the femur, 2 in the tibia, and 1 in the humerus.


Hormone therapy of prostatic bone metastases. When present at diagnosis or when developing in the course of disease, the presence of bone metastases from prostate cancer is generally considered an indication to begin endocrine therapy, as this is clearly the most effective form of treatment for this problem. Endocrine therapy can stop progression of prostate cancer in 80-85% of cases. Endocrine therapy can relieve pain, prevent pathologic fractures, and prevent neurologic complications from bone metastases from prostate cancer. Rarely, bone scans may become normal after the start of endocrine therapy, but partial improvement or stabilization of bone scans are more commonly seen. While endocrine therapy has been the first line of treatment of metastatic prostate cancer for the past 50 years, the recent development of newer forms of endocrine therapy have increased the options in the past few years. In addition to orchiectomy and estrogens, newer alternatives include inhibitors of androgen synthesis, the class of agents termed "antiandrogens", and luteinizing hormone releasing-hormone (LHRH) analogues either alone or in combination. Orchiectomy causes a prompt fall in serum testosterone and is regarded by many as the "standard" form of endocrine therapy, but there is concern about the psychologic impact of surgery. Estrogens are being used less frequently today because of their real or potential side-effects, including cardiovascular and thromboembolic complications. The development of analogues of LHRH has resulted in another major choice for endocrine therapy, and one which is therapeutically equivalent to orchiectomy or estrogens. Since LHRH analogues may cause an early rise or "flare" in serum testosterone before it drops to castrate level, these agents should not be given alone to patients with severe pain or neurologic problems. The newly available antiandrogen flutamide can block the "flare", and may also improve survival when used with LHRH analogues or orchiectomy, especially when disease is less advanced. Not all studies of "combination therapy" support this conclusion. However, the use of flutamide is increasing significantly in the United States. Both the LHRH analogues and flutamide are fairly safe, but they are very expensive. Their use, in combination, is likely to become a progressively more common form of initial endocrine therapy in the future. The growing application of prostate specific antigen (PSA) as a tumor marker for prostate cancer has made the difficulty in interpreting changes in bone scans a much less critical problem in determining response to endocrine or other forms of therapy for advanced prostate cancer.


Role of the vertebral venous system in metastatic spread of cancer cells to the bone. Bromodeoxyuridine (BrdU) labeled human prostatic cancer cells, PC-3, and murine osteosarcoma cells, POS-1 were injected into the tail veins of male mice under concomitant temporal occlusion of inferior vena cava. Five minutes after release of the venous occlusion, animals were sacrificed and various tissues, organs and the vertebral bones were examined immunohistochemically using an application of BrdU-anti-BrdU methods. Obvious BrdU labeled tumor cells, isolated or clumped, were demonstrated within the venous channels along the vertebral column, the epidural venous channels around spinal nervous tissues, in the bone marrow of lumbo-sacral vertebrae and intra- and peri-prostatic venous channels. The results suggest that a blockade of short duration of venous flow at the inferior vena cava can result in the bypassing of tumor cells through the vena cava to the vertebral venous system, which has a close connection with the peri-prostatic venous plexus. Thus, the vertebral venous system may play an important role in the metastasis of prostatic carcinoma to bone. In addition this experimental procedure is a very valuable model for studying mechanisms and prevention of bone metastases from prostatic carcinoma.


Clinical significance of the vertebral vein in prostate cancer metastasis. A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread in the axial skeleton and pelvis were different between the groups. The differences in the distribution of bony metastases between prostate and lung are explained by the role of Batson's vertebral venous plexus. We developed an animal model of spinal bone metastasis to prove this route. As suspension of tumor cells was injected into the tail vein of mice with vena caval occlusion. This procedure reproducibly resulted in metastatic tumor growth in the lumbar region of the vertebral column. The prevalence of spinal bone metastasis is attributed to passage of tumor cells via the vertebral venous plexus.


Treatment of anejaculation with electroejaculation. Male infertility caused by anejaculation is common after spinal cord injury (SCI) and following retroperitoneal lymph node dissection (RPLND) for testicular cancer. Other conditions sometimes associated with neurogenic ejaculation loss are diabetes mellitus, multiple sclerosis, extensive pelvic surgery and adult myelodysplasia. Primary absence of ejaculation also has been described. Few treatment options exist for these patients, if they wish to father a child. With electroejaculation (EEJ), or the low-current stimulation of the ejaculatory organs via a rectal probe, emission of semen can be initiated in these men. In non-SCI-patients EEJ requires general anaesthesia. The collected semen is washed and the motile sperm fraction isolated before artificial insemination (AI) of the partner. At the University of Michigan 198 men have been treated between 1986 and December 1991. An ejaculate could be obtained from nearly all patients. A major obstacle to success is the severe asthenozoospermia and the poor functional quality of the obtained sperm samples. This can be caused by the EEJ-technique itself, as well as by the long anejaculatory status. A semen sample with at least 10 million progressively motile sperm cells, useful for AI, was obtained in 75% of the SCI men and in 87% of the men following RPLND. In the couples wishing insemination, 49 pregnancies were induced, accounting for an overall pregnancy rate of 35% per couple. Thirty five healthy babies have been born. Only three complications were encountered. At Hannover Medical School only few patients have been stimulated to date. We could obtain an adequate sperm sample for AI from all of them. No complications were seen. As the first couple has just entered the phase of AI with husband sperm, an analysis of these results would be premature. Electroejaculation combined with artificial insemination is an efficient and safe treatment of male infertility due to neurogenic anejaculation.


[Urinary bilharziasis].

[Urinary bilharziasis]. A short account is given of present views on urinary schistosomiasis or bilharziasis. The incidence of infections is increasing in endemic areas of Africa and the near east, as a consequence of irrigation programs and hydroelectric power development. Urinary schistosomiasis is a disease of children and young adults. The serious consequences, obstructive uropathy due to more or less irreversible ureteral lesions, and cancer of the bladder, less directly related to the infection, appear but later in life. Diagnosis is still based on parasitology and serology but ultrasonography has proven to be an important means to evaluate the extent of lesions of the urinary tract, especially in developing countries. Praziquantel was a major development in the medical treatment and cures easily the infection. Some irreversible consequences have however to be treated surgically. Schistosomiasis is still an important cause of morbidity and mortality in medically backward endemic countries. The control of the disease aims at reducing morbidity and mortality, consequences of the infection, rather than to avoid infection itself. It is based on mass treatment of school age children, together with focal molluscacides at places where people have contacts with water. Vaccination will be available in the near future and will be a welcome addition to other control measures, but will not be able to interrupt transmission on its own. Only economic development will solve in the long term this social African problem.


[Conservative treatment of urogenital fistula following gynecological surgery: the value of fibrin glue]. Ureteric and bladder vaginal fistulas are recognized complications of gynaecologic surgery. We report on 4 cases of fistulas (2 uretero-vaginal and 2 vesico-vaginal) successfully treated by urinary drainage associated with plugging of fistula with fibrin sealant. Efficiency of conservative treatments is directly related to early application. Mechanical and biological properties of fibrin sealant explain its possible role in recovery, without increasing risk of viral transmission.


[Youssef syndrome].

[Youssef syndrome]. Youssef's syndrome is a vesico-uterine fistula through the uterine isthmus, with periodic hematuria, or menouria, and an absence of vaginal bleeding or urinary leaks. The sphincteric mechanism of the uterine isthmus could explain this symptoms, quite unusual for a urogenital fistula. Diagnosis can be achieved by cystography and hysterography. Surgical closure of the fistula is the usual treatment, but uterus can be preserved if patient wishes further pregnancy.


[Ureteral risk in celioscopic surgery].

[Ureteral risk in celioscopic surgery]. In recent years, there has been a significant improvement in laparoscopic surgery which had led to more and more frequent use of this technic in various cases. As a consequence, the ureteral injury which have been a less common iatrogenic pathologic up to know is likely to be more and more frequent in the years to come. The authors present 2 cases of 28 and 36 years old patients. In both cases the laparoscopy was indicated for gynecologic pathology. The healing ureteral occurred in those cases during a revealing postoperative peritonitis. Treatment consisted in healing up the lesion by ureteral stent. Treatment and evolution of this injury are discussed.


[The role of neoadjuvant treatment prior to radical prostatectomy]. Preoperative hormonal therapy has been recently advocated, but remain controversial. The aim purpose is to achieve downstaging, downgrading and improvement of the surgical results. In the last 80 patients undergoing radical retropubic prostatectomy, 28 had preoperative androgen deprivation, for a period ranging from 2 to 12 months with a mean treatment time of 3 months. Medical castration was obtained with total androgen deprivation. Return to normal value of PSA level in 90% cases and to undetectable level (< 0.25) in 39% of cases, expressing probably reduction of the tumor activity. Total prostatic volume is reduced by 30-50% after three months of treatment. The operative procedure was facilitated by an easier dissection, reducing operative time and blood loss. Recovery of postoperative continence was achieved in a significantly shorter period of time (3 months) as compared with the untreated patients (9 months). Immediate continence was obtained in 70% of patients treated preoperatively. No tumor was found in one specimen but no change was observed in the histological grading of the tumor in all the patients. This present study indicates the interest of a large scale randomized study, in order to show the real benefits of neoadjuvant hormonal treatment in prostate cancer patients.


Neo-adjuvant hormonotherapy does not facilitate radical prostatectomy. Sixty-eight patients who underwent radical prostatectomy without or after neo-adjuvant hormonotherapy for B2 or C stage prostate cancer were evaluated as concerned to the ease of the surgical procedure. Although it is difficult to assess this parameter, we experienced more difficulties and blood loss was higher in patients who had preoperative hormonal deprivation. Ongoing randomized trials could demonstrate an oncological benefit of neo-adjuvant hormonotherapy before radical prostatectomy. This eventual benefit will have to be balanced against an increased surgical difficulty.


[Partial cystectomy: and alternative to radical cystectomy? Apropos of a series of 75 patients]. From a retrospective series of 75 patients, we try to determine the place of this treatment with respect to bladder urothelial cancer. Of our 75 patients the breakdown of tumours according to their stage is the following: PTA: 16 (21.3%) PT1: 12 (16%) PT2: 21 (28%) PT3 A: 15 (20%) PT3 B: 7 (9.3%) PT4: 4 (5.4%) 47 patients benefited from a complete check up of tumoural spread which is negative in any case. In 28 cases, an uretero-vesical reimplantation was necessary for carcinologic reasons. None of the patients benefited from chemotherapy and/or radiotherapy in pre or post-operative period. Mortality was 4% (3 cases) and morbidity 8% (6 cases)- Sixty two Patients were followed-up at 5 years. The results are expressed according to different carcinologic parameters. The overall rate of recurrence is 61.2% (38/62). The actuarial survival corrected at 5 years, all stages and grades included, is 53.2% (32/62). There was no recurrence in 18 patients (29%) and 29 patients preserved their bladder. The advantages of partial cystectomy are obvious: Its mortality and morbidity are weak. It also preserves the sexual function and mainly avoids resorting to urinary derivations. As a principle these indications apply to a small percentage of invasive tumours T2-T3 A located in the mobile part of the bladder that is unifocal and of small size (< 4 cms).


[Intestinal implantation of an artificial sphincter]. In order to restore anal sphincteric function, artificial AMS sphincter was used with his 3 components: the peri-intestinal cuff giving anal sphincter tone, the pump used for active opening and the pressure regulating balloon. In the same fashion a continent valve may be created on an intestinal segment as a part of a reconstructed bladder. In this case the pump may be replace by a subcutaneous port allowing fluid injection to adjust volume and pressure in the cuff. Two patients with fecal incontinence related to sequela of a high imperforate anus syndrome were implanted. Follow-up is greater than 1 year with normal continence in the day for the first case (degree 2) and continence day and night in the second case. Artificial valve has been implanted in seven cases of neobladder pouch (or related situations), with in 4 cases very good results and in 3 cases a failure (Follow-up 3-36 months).


Subgroup differences in educational placement for deaf and hard of hearing students. This study presents crosstabulations of educational placement variables by selected demographic characteristics and reports the different patterns of educational placement for subgroups of the deaf and hard of hearing population. Type of school, amount of academic integration with hearing students, and the number of deaf or hard of hearing students attending the same school building were considered as dependent variables in the analysis. Degree of hearing loss, age, ethnic and racial background, and additional handicap status were considered as independent variables. Data from the 1990-1991 Annual Survey of Hearing Impaired Children and Youth were analyzed. Results indicate that subgroups defined by each of these variables differ markedly with regard to patterns of educational placement. The importance of paying attention to subgroup statistics, as opposed to global population statistics, in the formulation of educational policy is discussed.


The receptive communication abilities of deaf students under oral, manual, and combined methods. Two groups of severely and profoundly deaf students aged 10 to 17 years were tested on their abilities to choose, from a set of four pictures, the one matching a sentence presented on videotape under 11 different communication conditions. The communication conditions involved individual and combined presentations of lipreading, listening, fingerspelling, and signed English. Severely deaf students scored higher than profoundly deaf students under all conditions except those that involved signed English, where the profoundly deaf group scored as high as the severely deaf group. All the students scored higher under conditions that involved audition, including lipreading plus audition, than under audition alone. The discussion of the results highlights methodological problems that made it difficult to interpret some previous studies in this area. Practical implications of the results for both oral education of the deaf and simultaneous communication are also discussed.


Combining cognitive learning theory and computer assisted instruction for deaf learners. This study investigated the effects of implementing cognitive learning theory principles in computer assisted instruction of educational psychology concepts. A total of 19 preservice deaf teachers participated in the study. We used a pre-post design to measure the learning and attitude changes of the teachers. The results of the analysis of pretests and posttests of cognitive outcomes indicated that significant learning occurred as a result of the computer-based instruction. Also, the majority of the students reacted positively to the quality of the lessons. The results also suggest that applying an appropriate theoretical framework to the design of instruction offers an avenue for meaningfully addressing the appropriate use of technology.


Using video resumes to teach deaf college students job search skills and improve their communication. For several years the National Technical Institute for the Deaf (NTID) at the Rochester Institute of Technology has offered a course that focuses on preparing video resumes. Professionals from the Instructional Television Department and the National Center of Employment for the Deaf have collaborated with communication instructors to develop this option for NTID students. This paper describes the instruction and evaluation process from the perspective of NTID instructors, students, and other technical professionals. Employers who have hired NTID students and those who have no familiarity with deaf employees also participated in the evaluation. Their comments give valuable insights into the often different perspectives of deafness between those who have worked with deaf employees and those who lack such experience. Video resumes were found to be a viable tool in the job search, and the process of preparing the video was found to be a stimulating and rewarding experience for the participating students.


Partnering to run a community-based program for deaf-blind young adults. Community-based programs that assist deaf-blind young adults with living skills can be a cost effective alternative to institutional care. Their unique medical, psychosocial training, and daily living needs require services and support from a variety of agencies and providers. The elements and concepts necessary to conduct a program 24 hours a day for young adults who are deaf and blind includes sound management, realistic staff expectations for clients, developmentally appropriate activities, family participation in planning accessible medical and psychological services, and close collaboration with universities and community organizations. Management must also be sensitive to the emotional concerns of the staff and provide ongoing opportunities for supervision and training.


Reforming teacher education: a model program for preparing teachers of deaf children. Recent literature is replete with the concerns of general educators that students majoring in elementary and pre-primary education do not acquire sufficient content and liberal arts matter as a part of their knowledge base. Educators in undergraduate teacher preparation programs in deafness have expressed the same concerns. This article describes how the Program in Education of Deaf Children at the University of North Carolina at Greensboro added courses in a second major and in liberal arts to expand the knowledge base of prospective teachers of deaf and hard of hearing children.


A survey of the appropriateness of instructional language materials used with deaf students. A questionnaire survey was conducted of the instructional language materials used by educators in programs for deaf and hard of hearing students. The results indicated that over half (51%) of the materials used are not developed specifically for use with deaf students. The majority of the respondents (67%) cited problems finding age- and interest-appropriate materials. Dissatisfaction with current language materials was one reason many educators (60%) made their own materials. Their comments emphasized the need to develop language materials and assessment tools specifically for deaf and hard of hearing students.


A national survey of educational preparation programs for early intervention specialists. To examine the status of preprofessional education in early intervention, we conducted a nationwide survey of college and university programs offering degrees in education of the deaf. Curriculum content and practicum experiences with infants and toddlers and their families were examined, as well as general comments and recommendations of program directors. Additional information was sought from programs offering specializations at the preschool level to determine whether they had CED affiliation, and if so, whether they were certified in the areas of parent-infant education or early childhood education. The findings are discussed in the context of Public Law 99-457 and the growing emphasis on family centered early intervention.


Improved pregnancy outcome in epileptic women in the last decade: relationship to maternal anticonvulsant therapy. The prevalence of abnormal pregnancy outcomes in the offspring of 103 epileptic women, followed prospectively during pregnancy between 1982 and 1989, was compared with that in the previous study of 119 pregnancies by Dansky et al from the same institution. Our results have shown a significant decrease in the prevalence of major malformations, as compared with the previous study: 8.8% vs 24.1% (P < 0.01). Monotherapy was more frequent and the mean number of drugs used during pregnancy was significantly smaller in the present study. Phenytoin, phenobarbital and primidone were prescribed less frequently in the present study, whereas carbamazepine and valproic acid were used more frequently. Plasma levels of valproic acid during pregnancy were higher in mothers of malformed babies. In the present study, plasma folate levels were significantly higher, and more patients were taking folate supplements during pregnancy. In conclusion, the type and number of drugs used during pregnancy, as well as the plasma concentrations and serum folate levels, may determine the frequency of abnormal outcomes.


Stroke in neonates with cardiac right-to-left shunt. Neonatal focal cerebral arterial infarction has been rarely reported in the literature, in contrast to the watershed infarctions, which are common entities among asphyxiated infants. In neonatal postmortem series, thromboembolism was the commonest cause of cerebral arterial occlusion; the source of emboli was associated to different risk factors. Our four cases are the first alive patients reported with congenital heart disease and right-to-left shunt, who suffered a cerebral infarct with its clinical neurological correlates in the neonatal period. We assume that the most probable mechanism was paradoxical embolism, once pulmonary filter is obviated as a result of the altered hemodynamics in these patients. Our data demonstrate the value of ultrasound scanning for assessment of focal cerebral ischemic lesions. Thus, although abnormal neurological signs in this particular group of infants could be attributed to hypoxemia or specific treatments as prostaglandins, we suggest routine cerebral ultrasounds in neonates with congenital heart disease and neurological disabilities, as early complications could be not so infrequent.


Ferritin, creatine kinase, and neopterin in subacute sclerosing panencephalitis. To study the disease process in the brain in subacute sclerosing panencephalitis (SSPE), sequential changes in ferritin, creatine kinase (CK), and neopterin in the cerebrospinal fluid (CSF) of two patients with SSPE were compared with the changes in the clinical signs and symptoms and the findings by magnetic resonance imaging (MRI). On the basis of changes in various substances in the CSF, especially ferritin, CK and neopterin, we concluded that the high-intensity area in MRI might be evidence of local inflammation and the resulting cell damage. Ferritin, CK and neopterin seemed to be biochemical markers in patients with SSPE for detection of the extent of lesions, and their measurement may provide information useful for evaluation of the therapeutic response.


Down syndrome complicated by brain tumors: case report and review of the literature. This report concerns a 24-year-old male patient with Down syndrome, complicated by a benign but true neoplastic lesion of a differentiated papilloma of the choroid plexus which simultaneously displayed a dysgenetic character. A review of the literature revealed a lack of single case reports of Down syndrome with brain tumors, which may reflect chance occurrence; however, the brain tumors in Down syndrome patients are characterized by their dysontogenetic or dysgenetic character.


Deficiency in complex II of the respiratory chain, presenting as a leukodystrophy in two sisters with Leigh syndrome. We report 2 sisters with a degenerative neurological disorder presenting clinically as a leukodystrophy. CT scan and MRI demonstrated small symmetrical foci of necrosis in the substentia nigra and in the basal ganglia typical of Leigh syndrome and diffuse cerebral white matter abnormalities. In these patients a deficiency in complex II of the respiratory chain was demonstrated in isolated mitochondria from muscle, as well as in fibroblasts and lymphocytes.


Improvement of clinical and MRI findings in a boy with adrenoleukodystrophy by dietary erucic acid therapy. A 5-year-old boy with adrenoleukodystrophy, with clinical symptoms of visual, mental and motor disturbances which progressed rapidly, was treated with Lorenzo's oil consisting 1 volume of glyceryl trierucate and 4 volumes of glyceryl trioleate. Five months after initiation of this therapy, ability to swallow was enhanced and T2-weighted magnetic resonance imaging of the brain revealed regression of high intensity area of the parieto-occipital white matter.


A case with nocturnal paroxysmal unilateral dystonia and interictal right frontal epileptic EEG focus: a lateralized variant of nocturnal paroxysmal dystonia? We report here a patient with frequent nocturnal attacks, characterized by paroxysmal dystonic posturing of the left arm and contraction of the lower face, lasting 20-30 seconds. The attacks occurred in clusters of up to 20 spasms during the NREM stage of sleep. Interictal EEG showed clear-cut epileptic discharges in the right frontal region. Repeated ictal video-EEG recordings revealed only arousal pattern immediately before and during seizures except in those which evolved to left sided clonic hemiconvulsions. The dystonic attacks here described share many features of nocturnal paroxysmal dystonia (NPD) of Lugaresi and Cirignotta in common, including nocturnal periodic occurrence, absence of ictal EEG changes during attacks, and favorable response to CBZ, except for their unilateral nature. It was assumed that our case may be a lateralized variant of NPD and would further support the hypothesis that NPD is one particular form of frontal lobe epilepsy.


Hydrocephalus due to acute aqueductal stenosis following mumps infection: report of a case and review of the literature. An acquired form of hydrocephalus due to aqueductal stenosis developing as a sequela of mumps virus infection of the central nervous system is presented. Percutaneous third ventriculostomy and interventriculostomy (aqueduct cannulation) were performed using a flexible fiberoptic ventriculoscope. The aqueduct was blocked with amorphous material but was cleared with the scope. This is the first case of a fulminant phase of mumps ventriculitis leading to aqueductal stenosis, which has been treated using a ventriculoscope for the first time.


Congenital muscular dystrophy of a non-Fukuyama type with white matter hyperlucency on CT scan. The term "congenital muscular dystrophy (CMD)" is used for a group of diseases with heterogeneous clinical and cranial CT scan manifestations. Recently, a distinct subtype, characterized by white matter hyperlucency on CT scan but normal or nearly normal intellectual function, has been recognized in Western peoples and has even been named "occidental-type cerebromuscular dystrophy." Here, we described two Chinese siblings with this type of CMD.


Elevated fibrinopeptide A (FPA) in patients with Lesch-Nyhan syndrome. The detection of elevated fibrinopeptide A (FPA) level in a patient with the Lesch-Nyhan syndrome complicated with cerebral infarction prompted us to examine FPA level in 3 other patients with the syndrome. FPA level significantly increased in all patients. Fibrinopeptide B beta 15-42 (FPB beta 15-42) level was increased in two, and both beta-thromboglobulin (beta TG) and platelet factor 4 (PF4) levels were elevated in one patient. These results suggest coagulation abnormalities in patients with Lesch-Nyhan syndrome.


Early infantile epileptic encephalopathy: a case associated with hemimegalencephaly. The authors report a case of early infantile epileptic encephalopathy (EIEE) associated with hemimegalencephaly. The etiological factors in previously published cases of EIEE are reviewed and attention is focused on the high proportion of cases associated with neuronal migration disorders. We suggest that idiopathic cases of EIEE would be due to such disorders.


Analysis of diffusional broadening of vesicular packets of catecholamines released from biological cells during exocytosis. Secretion of catecholamines is observed as a series of current spikes when measured at the surface of a bovine adrenal medullary cell in culture with a carbon-fiber microelectrode operated in the amperometric mode. Prior work has shown that these spikes are due to detection of concentrated packets of catecholamines which are released from individual vesicles after their fusion with the cell membrane, a process known as exocytosis. The shape of the individual current spikes, detected with a 5-microns spacing between the hemispherical cell and the electrode, has been compared to the shape generated by a theoretical model. The model consists of an instantaneous point source of material on a surface which subsequently diffuses to a disk that consumes the emitted material. The pertinent diffusion conditions have been evaluated with finite difference and random walk digital simulations. The two methods give identical results when the point source is located on a plane. The more realistic simulation geometry, emission from a hemispherical surface, was evaluated with the random walk method. The simulations allow a set of criteria to be established to evaluate diffusion-controlled broadening of spike shape. The broad range of spike widths observed experimentally and their individual shapes measured with 5-microns cell-electrode spacing are consistent with diffusion from point sources randomly distributed across a hemispherical surface. The data can be described with the diffusion coefficient for catecholamines in free solution. The model enables evaluation of signal-to-noise losses and correction for diffusional losses which are dependent on electrode radius.(ABSTRACT TRUNCATED AT 250 WORDS)


World Health Organization international intercalibration study on dioxins and furans in human milk and blood. Under the sponsorship of the World Health Organization (WHO), an interlaboratory calibration on the analysis of PCDD/PCDFs in human milk and blood was carried out which included 19 laboratories from 14 countries. The study design involved the analysis of three samples of each matrix in triplicate. Selected samples were spiked with native standards of certain 2,3,7,8-substituted congeners at concentrations known only to WHO staff. The study design resulted in approximately 4000 individual pieces of PCDD/PCDF data generated by a variety of analytical methods, at various concentrations, and by laboratories of widely different experience. This was, by considerable margin, the largest study which allowed for the direct comparison of laboratory and method performance. The results of statistical analysis of this data base addresses the effect on data quality of clean up methods, instrumental methods, analyte concentration, laboratory QA programs, and laboratory experience. The study has shown that the laboratory is the single most important determinant of data precision and accuracy. The method of analyte enrichment (sample clean up), analyte measurement [gas chromatography/mass spectrometry (GC/MS) protocol], and analyte concentration have weaker correlations with data quality.


Combined effect of coulombic and van der Waals interactions in the chromatography of proteins. We have recently proposed a theoretical framework for the effect of the eluting salt ionic strength of the eluent on the retention factor of proteins in ion-exchange chromatography of proteins. It is based on the solution of the linearized Poisson-Boltzmann equation for two oppositely charged planar surfaces in contact with a salt solution and describes the coulombic interaction between the protein and the oppositely charged stationary-phase surface. At sufficiently high salt concentrations in the mobile phase van der Waals interactions between the protein and the stationary phase become important. In this work we consider the effect of salt on the combined coulombic and van der Waals interactions by combining the electrostatic theory with the theory for van der Waals interactions. The combined theory describes the retention of proteins as a function of eluting salt concentration over a wide salt concentration range. The protein molecules are, according to the proposed theory, held in a diffuse layer close to the stationary phase and are not in a distinct layer, which is assumed in the traditional thermodynamic interpretation of the capacity factor. For this reason, we also examine the thermodynamic interpretation of the capacity factor when it is due to distant dependent interactions.


Improvements in the computerized analysis of 2D INADEQUATE spectra. The carbon skeleton of a molecule can be determined by using the powerful 2D INADEQUATE experiment, but the method suffers from very poor sensitivity at natural carbon-13 abundance. A computer program, described previously, has been significantly improved in its ability to recognize AB spectral patterns corresponding to carbon-carbon bonds which makes it possible to evaluate reliably spectra with rms S/N ratio as low as 2.5, i.e., nearly 1 order of magnitude below the level required for routine manual interpretation. Application of the INADEQUATE experiment to samples containing as little as 20 mumol of a compound of interest is now possible. The method is described in detail and critically evaluated by means of examples and simulations.


Applications of the improved computerized analysis of 2D INADEQUATE spectra. This paper illustrates the use of the program CCBond to determine the carbon skeletons of bioorganic molecules in low concentration samples. Discussed is the structure elucidation of bistramide A, a compound extracted from a Fijian Lissoclinum sp. and cholesterol in 71- and 20-mumol samples, respectively. The detection limit of the automated bond extraction is shown to be dramatically improved compared to the manual interpretation of 2D INADEQUATE spectra.


Stable films of cationic surfactants and phthalocyaninetetrasulfonate catalysts. Films made from cationic surfactants and well-retained redox catalysts were investigated. Full loading of metal phthalocyaninetetrasulfonates (MPcTS4-) into water-insoluble dialkyldimethylammonium surfactants by ion exchange from aqueous solutions yielded coatings on electrodes that retain these catalyst ions for 1-2 weeks in electrolyte solutions. In contrast, partly loaded films lost most MPcTS4- ions in a few hours. All films showed gel-to-liquid crystal phase transitions at temperatures characteristic of surfactant bilayers. Cross-sectional views by SEM showed layers of 0.1-0.2 micron, as well as some disordered regions. Each larger layer is probably made up of stacks of many molecular bilayers. Retention of MPcTS4- ions seems related to their dimerization. Dimers of MPcTS4- associated with ammonium head groups may crosslink adjacent surfactant bilayers. The MPcTS4- ions that enhance stability in these films are also good redox catalysts.


[Caudal epidural anesthesia during surgery of the lower extremities in traumatology and orthopedics]. One hundred and forty operations and eleven manipulations on all the segments of the lower extremities have been performed under caudal epidural anesthesia, i.e. by forming in the caudal canal a dense infiltrate using lidocaine or trimecaine solutions prepared on hypotonic solvent supplemented by microdoses of adrenalin and calcium chloride.


[Nasogastric intubation of the small intestine in relation to the anesthesiologist and the resuscitation specialist]. The experience of the use of single and prolonged nasogastric intubation of the small intestine in 286 urgent patients in Arkhangelsk clinical hospital No. I has been reviewed and the peculiarities and drawbacks of the technique have been assessed from the point of view of the anesthesiologist and intensive care specialist. A special technique of respiratory airway protection during intestinal intubation is described and recommendations on intensive care as well as control over tubing location and patency in the postoperative period that can adequately prevent potential complications are outlined.


[The effect of exogenously administered ATP on the postischemic restoration of myocardial function]. The effect of ATP (24 x 10(-6) M) on the contractility of the isolated hearts has been studied. It has been shown that ATP infusions improved postischemic hemodynamics. The favourable effect of ATP was based on the retention of diastolic properties and compliance of the left ventricle. The percent of postischemic reduction in the force and rate of contractions was analogous to the results in the control group, but the hearts on ATP performed a greater volume of work and demonstrated higher functional reserve.


[Monitoring and computer control of the status of the central and regional hemodynamics in patients with diffuse forms of peritonitis]. Changes in basic central and regional hemodynamic parameters have been studied in 46 patients with diffuse peritonitis using an automated system of constant intensive circulation monitoring. It has been established that the type of circulation did not reflect the severity of the condition in patients with peritonitis, but a characteristic combination of central hemodynamic parameters makes it possible to assess compensatory reserves within each circulation type, as well as to identify unfavourable hemodynamic tendencies. Analysis of changes in the circulation parameters in the course of peritonitis development is necessary to predict the course of the disease and its outcome. There was a considerable difference in circulation parameters patterns of patients who recovered and died of the disease. The principal differences manifested on day 2 postoperatively. Abdominal hemodynamic changes are specific and characterize the severity of peritonitis beginning from the first day of observation.


[The choice of anesthesia during abdominal delivery in patients with severe forms of late pregnancy toxemias]. Sixty eight anesthesia procedures during abdominal delivery in patients with late toxemia of pregnancy have been analysed. In 32 cases the diagnosis was preeclampsia, in 8 cases--eclampsia, in 28 cases III degree nephropathy. Depending on the variant and method of anesthesia the subjects were divided into 3 clinical groups. Group I comprised 31 women to whom cesarean section was performed under general endotracheal anesthesia. In group II (24 pregnant women) analgesia was achieved by prolonged epidural anesthesia (PEA). In group III (13 patients) a combination of PEA and superficial endotracheal anesthesia was used. Analysis of the anesthesia techniques in patients with severe late toxemia of pregnancy has established that in endotracheal anesthesia it is sometimes impossible to block completely pathological and operation-induced nociceptive pulsation. PEA has a good analgetic effect but ensures no neuroautonomous protection, and upon discontinuation of action of the local anesthetic there is a danger of the onset of the convulsion syndrome and signs of preeclampsia or eclampsia. Taking into account the advantages and disadvantages of endotracheal anesthesia and PEA, a technique based on the combination of both variants has been selected, which ensures optimal anesthesiological protection in abdominal delivery.


[The tolerance to exogenous energy substrates in the post aggression period in children]. Pharmacokinetic parameters of glucose and fatty emulsion elimination from the vascular bed have been studied using prolonged glucose-fat tolerance test. Forty-four children have been examined upon various aggressive interventions. Surgical intervention or mechanical trauma have been regarded as an aggressive factor. It has been established that children in the post aggression period are characterized by a pronounced increase of exogenous fatty emulsion tolerance and a reduction of glucose tolerance. The most marked changes in the elimination of basic energy substrates are observed in the first three days after the aggression.


[Early prognostic signs of disorders of the regional pulmonary circulation in the dynamics of hemorrhagic shock and in the post-resuscitation period]. The earliest significant unfavourable signs of shock are as follows: an increase in total pulmonary resistance, reduced pulmonary blood flow and tachypnea. Ventilation-perfusion disturbances in the lungs precede the onset of circulation decompensation, which in the pulmonary flow manifests as enhanced pulmonary blood content and elevated pressure in the pulmonary artery. Pulmonary flow damage in the early postresuscitation period is to a great extent predetermined by the degree of circulation disturbances in the lungs, developing during hypotension period, the leading among them being congestive processes in the lungs (increased blood content, hypertension) which progressed in case of unfavourable outcome of resuscitation and reduction of the microvascular bed.


[The pathogenesis and correction of disorders of the heart rhythm in the early post-resuscitation period]. The frequency and nature of heart rhythm disturbances have been studied in experiments on random-bred male rats who survived 4- and 6-min clinical deaths of acute blood loss. Using correlation analysis it has been shown that the leading pathogenetic arrhythmogenic factors are: catecholamine excess, as well as excess of free fatty acids, lipid peroxidation products, lactate and Ca-ATPase inhibition. The efficacy of preventive (gutimin, inderal, oxipiridin-6, isoptin) and therapeutic (carnozin, creatinphosphate) use of the drugs affecting pathogenetic mechanisms of heart arrhythmias and thus stabilizing bioelectrical heart activity in the early postresuscitation period has been observed.


[General anesthesia, hormones and hemodynamics during the excision of tumors of the posterior cranial fossa]. The levels of tropic and peripheral hormones (ACTH, TSH, STH, T3, T4, hydrocortisone, insulin) have been assessed in 74 patients, aged 16 to 64 years, operated on for posterior cranial fossa tumors. Depending on the basic anesthesia component the patients were divided into 3 groups: patients on halothane anesthesia, patients on anesthesia with azeotropic mixture, patients on neuroleptanalgesia. Three hemodynamic variants in the course of operation and postoperative period have been established: patients with normal blood pressure, heart rate, stroke volume; patients with elevated and high blood pressure; patients with unstable hemodynamics. It has been found that general halothane and azeotropic mixture anesthesia is associated with marked changes in intraoperative endocrine function. Endocrine function is changed on the 3rd and 7th day postoperatively due to surgical brain trauma.


[Late potentials of the heart ventricles and a method of spectral mapping for evaluating the action of dalargin in intensive therapy]. The data of 114 examinations of 38 patients with respiratory failure of different genesis have been presented. The method used was that of averaging the ECG signal with analysis of late ventricular potentials and parameters of spectral mapping, as well as analysis of the R-R intervals. The patients were examined initially, 30-45 min after intravenous injection of 1 mg dalargin and 16-20 hours later. The results have shown that there were differences in the changes of a number of basic characteristics of the QRS complex spectrum. In 18 cases (21%) signs of late potentials have been recorded, 14 of them (78%) in the group with decreased total spectral density. A shift of extremums by the beginning of QRS was observed. Statistical and spectral characteristics of the R-R intervals changed in one direction. It has been shown that dalargin has a complex effect on electrophysiological myocardial properties. The use of the method of ECG signal averaging and its different modifications broadens considerably the quality of evaluation of the drug effect in the heart. The technique of spectral-time mapping simplifies the diagnosis of late potentials and elucidates their inner structure.


[The choice of a method of general anesthesia for patients with cancer of the abdominal cavity]. Two variants of anesthesiological management have been used in 135 patients with gastrointestinal tumors. The first variant was intubation anesthesia with N2O+O2, ketamine or sodium hydroxybutyrate combined with classical neuroleptanalgesia technique. Pentamine was used to potentiate protection. This anesthesia technique was used in patients under 50 who had no concomitant diseases. The second variant was used in patients over 50 with concomitant diseases. In these cases combined prolonged epidural anesthesia was accompanied in the intraoperative period with intubation anesthesia with controlled lung ventilation using N2O+O2 and additional administration of promedol and droperidol. The second variant of anesthesia not only ensured a safe intraoperative period but also optimized the management of patients in the postoperative period.


[The effect of a nitroglycerin infusion on the hemodynamics, extravascular lung water and gas exchange in patients with adult respiratory distress syndrome]. Nine patients with adult respiratory distress syndrome, stage III, secondary to diffuse peritonitis have been examined. The patients were subject to pulmonary artery and aorta catheterization. Cardiac output, extravascular water in the lungs, the extent of pulmonary shunting were determined; pulmonary artery and aortic pressure were measured. O2 transport parameters, pulmonary capillary pressure (Pc), pressure gradient (Pc-COP) were calculated and arterial and venous blood gases as well as colloid-osmotic pressure (COP) were analysed. Selective hypotension in the pulmonary circulation was performed using an infusion of nitroglycerin solution. Despite differences in the response of patients with ARDS to nitroglycerin, when the drug was injected with optimal positive end-expiratory pressure, it promoted an increase in O2 delivery, normalization of pulmonary hemodynamics and a decrease in extravascular pulmonary water.


[The hemodynamic effects of ketamine anesthesia in children with congenital heart diseases]. One hundred and thirty five children have been examined after surgery for congenital heart valve defects performed under ketamine anesthesia. It has been established that ketamine anesthesia has no considerable effect on the preload and cardiac pump function. Different hemodynamic changes have been observed in systemic and pulmonary circulation: the afterload of the left ventricle increases, while the afterload of the right ventricle decreases, which causes an increase in the heart performance (and energy consumption) in the first case and their reduction in the second case. In ketamine anesthesia myocardial contractility is enhanced and relaxation is deteriorated, and the tone of arterial vessels in the kidneys, bulbar conjunctiva, and skeletal muscles is increased. A spasm in the vessels of the conjunctiva is observed even when small drug doses are used. This may be accounted for by calcium accumulation in the muscular cells, noradrenaline hyperproduction, enhanced sensitivity of sympathomimetic receptors to circulating endogenous catecholamines.


[Opioid inhibition of oxytocin release from the posterior lobe of the hypophysis and its significance for obstetrical anesthesiology]. The review of literature presents modern experimental and clinical data on opioid inhibition of oxytocin release from posterior hypophysis lobe during pregnancy and in childbirth. The impact of various narcotic analgesics on oxytocin secretion, myometrium contractility and the condition of the fetus and newborn has been assessed. The data on oxytocin blood plasma level are of importance in the clinical practice for selecting the most suitable anesthesia technique during physiological and pathological labour, especially when modern narcotic analgesics (morphine, promedol, fentanyl, tramadol, etc.) are used.


Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals. Concern is increasing regarding the risk of transmission of blood-borne pathogens by means of improperly reprocessed medical devices. On-site surveys of policies and practices were performed in 18 reprocessing areas in eight randomly selected hospitals in Massachusetts to assess current practices for reprocessing of flexible fiberoptic endoscopes. Manufacturers' and internal written protocols, were reviewed, employees were interviewed, and procedures were observed. Reprocessing included high-level disinfection in 17 of 18 areas, with 16 areas using 2% glutaraldehyde; ethylene oxide gas sterilization was used in one area. Considerable interhospital and intrahospital variability was found in high-level disinfection procedures, including equipment, contact time (range 10 to 45 minutes), disinfectant testing, and rinsing. Disinfection of internal channels was inadequate in three areas, recommended sterilization of biopsy forceps was not performed in five, and written protocols were unavailable in three. Ad hoc deviation from established written or verbal protocols occurred in eight areas during reprocessing of flexible fiberoptic endoscopes from patients known to have AIDS; ethylene oxide sterilization was used in seven areas and a separate device was used in one. Interviews with personnel revealed that lack of knowledge of high-level disinfection contributed to the discrepancies between policy and practice. We conclude that reprocessing of flexible fiberoptic endoscopes is inconsistent and potentially ineffective. Knowledge that a flexible fiberoptic endoscope was used for a patient with AIDS influences practice.


[The use of trakrium during surgical interventions in children]. Nondepolarizing shortly acting myorelaxant trakrium (0.5 mg/kg) during surgical interventions in children makes it possible to perform tracheal intubation 1.5 min later and to maintain optimal myoplegia at various stages of the operation by bolus injections in doses making up 1/2-1/3 of the initial one or by non-stop infusion at a rate of 0.008 mg/kg per min. Trakrium may be used along with arduan administered at the end of the operation. Trakrium administration is accompanied by the recovery of adequate respiration 25-30 min after discontinuation of administration. Trakrium has no unfavourable effect on hemodynamics and ensures retention of the myocardial reserve capacities.