[Correlation between sequential changes in angiographical findings and clinical deteriorations during management for dural AVM of the cavernous region]. The authors treated five patients with dural arteriovenous malformation of the cavernous region (DAVM) by cervical compression procedure as the initial treatment. In four of five patients clinical symptoms were aggravated during that period. The period between the beginning of cervical compression and the deterioration of clinical symptoms ranged from 11 to 20 days. In three of four patients, the angiography examined at the time of deteriorations confirmed the same amount of A-V shunt flow and otherwise the remarkable decrease of the draining pathway compared to the findings of the angiogram performed before the management. The angiography examined at the time of the remission of the symptoms showed the increase of the draining pathway in two patients and the resolution of the DAVM in another. These findings indicate that clinical courses of the DAVM and the amount of the draining pathway correlate to each other and that cervical compression procedure may occlude the important draining pathway of the DAVM.


Functional determinants of bone structure: beyond Wolff's law of bone transformation. Frost has suggested that functional loading controls bone mass and form as a thermostat controls temperature--by homeostatic regulation (i.e., by negative feedback). Yet, the literature contains many results that appear incompatible with the "mechanostat" hypothesis. We propose that a different type of regulation--epigenetic--is important in many aspects of bone adaptation. Epigenetic regulation, as we describe it, involves positive feedback loops and promotes differentiation as it forces elements of a system to choose between two extreme levels called attractors. Our review of bone adaptation data suggests that lamellar bone formation is regulated homeostatically, whereas the formation of woven-fibered bone or fracture callus is regulated epigenetically, that is, woven bone formation is brought about by a positive feedback loop that stimulates osteoblasts to a state of greater individual activity. This positive feedback loop may involve transforming growth factor beta (TGF beta), for which autocrine induction has been demonstrated in vivo, as well as other factors, including insulin-like growth factor (IGF) and prostaglandin E2 (PGE2). The importance of this model is that it provides a mechanism for many unexplained nonlinear events that have been observed in bone adaptation experiments. Furthermore, it provides insights into the genesis of woven bone, which is a critical step in the process of bone healing and regeneration.


Characteristic localization of carbohydrates in osteoclasts by lectin cytochemistry. Lectin cytochemistry was performed to clarify the process of glycosylation and the localization of glycocalyx in osteoclasts. Microslicer sections of decalcified rat tibiae were incubated in the presence of HRP-conjugated lectins (Con A, PNA, MPA, WGA, UEA-1). Lectin reactions in cell organelles revealed that glucose (Glc) and mannose (Man) are transferred to carbohydrate chains in nuclear envelopes, rough endoplasmic reticuli, and the cis and medial sides of the Golgi apparatus. N-acetylgalactosamine (GalNAc), N-acetylglucosamine (GlcNAc), and/or N-acetylneuraminic acic (NANA) residues are transferred, in turn, in the Golgi apparatus. Lectin reactions detected in lysosomal structures suggest that some sugar residues are incorporated into carbohydrate chains of hydrolytic enzymes, such as acid phosphatase and arylsulfatase. Others would be transported to plasma membranes as glycocalyx. PNA and MPA reactions were most evident on ruffled borders of osteoclasts. On the other hand, cement-line-like structures on bone surfaces displayed Con A, MPA, and WGA positive reactions. The following factors suggest that osteoclasts actively metabolize sugar: characteristic localization of glycocalyx in osteoclasts reflect the polarity of osteoclasts, and carbohydrate complexes in cement-line-like structures seem to play an important role in the coupling phenomenon in bone tissue.


Structural changes in rat bone subjected to long-term, in vivo mechanical loading. Woven bone formation is commonly observed when grossly altered loading conditions are imposed upon living bone tissue. The fate of this woven bone with time has not been fully characterized. In this study, rats underwent daily bending of the right tibia for a period of 3 to 14 weeks. New bone was formed in the region of maximum bending stresses on the right tibiae of all rats that underwent daily loading. The new bone was at first poorly mineralized with disorganized collagen structure. With time, the new bone consolidated into a well mineralized primary bone structure similar in appearance to pre-existing nonlamellar bone within the tibial cortex. Using the data from this study and previous studies, we were able to outline the sequence of events that occur during bone adaptation in the rat tibia loading model. Explosive new woven bone formation began to occur five days after the initial four-point bending session, and the amount of woven bone reached a peak after about 15 days. After the third week the new bone began to consolidate. Rapid mineralization occurred during the third and fourth weeks, with less rapid mineralization occurring for several weeks thereafter. After the 14 weeks, the new bone was fully mineralized, and new bone formation had stopped.


The effect of fluoride treatment on bone mineral crystals in the rat. In order to investigate the effect of fluoride on bone mineral crystals, we gave groups of female rats 8 mM NaF/L water and distilled water to control groups. The rats were sacrificed at six weeks, three months, and six months. The fluor content of the bone was determined by neutron activation. X-ray diffraction showed no difference in bone crystal size/strain with fluoride treatment. Fourier transform Infrared Spectroscopy (FTIR) showed an increased crystallinity in fluoride-fed animals, which seems to be associated with a decrease of labile phosphate environment. Three carbonate bands have been found in fluoridated and normal bone samples. The distribution of carbonate ions on type A and B sites is strongly affected by fluoride. Type A carbonate is always present in bone, but decreases with increasing bone fluoride content. A carbonate band found at 866 cm-1 may correspond to a fluoride interaction with type B carbonate ions. Lastly, phosphate bands have been found to be shifted towards high wave number, which is probably related to the change in unit cell size induced by the fluoride ion. All these changes induced by fluoride reduce the solubility of bone crystals by direct incorporation of fluoride ions in the apatite lattice and by decreasing the labile phosphate environments.


Osteoporotic fractures: an unusual presentation of haemochromatosis. The association of haemochromatosis and osteoporosis is well established, but it is unclear whether this is due to iron overload, hypogonadism, liver disease, or diabetes mellitus. We describe a young eugonadal male patient with osteoporotic fractures as a presenting feature of haemochromatosis, suggesting that factors other than hypogonadism contribute to osteoporosis.


Impaired bone activity in aged rats: alterations at the cellular and molecular levels. We have used a model of rapid bone induction and resorption in rats initiated by the removal of bone marrow to define age-associated deficits. Here we report the sequential expression of various genes implicated in the formation and removal of bone following marrow ablation. Significant increases in alkaline phosphatase and procollagen alpha 1(I) mRNA were observed by day 5, and of osteocalcin and osteopontin by day 6. At their peak, these mRNA levels were elevated three- to eight-fold and correlated with histological evidence of bone formation. No change in collagen II mRNA was observed, indicating that there was no cartilage phase. Collagenase activity increased 10-fold at day 9 and coincided with the beginning of bone resorption. Actin mRNA, a reference gene marker, remained at constant levels. Comparison of the response between adult (6 mo.) and old (24 mo.) rats showed the same temporal pattern, but a lower expression of bone-related genes in older rats. Histological examination also showed that the bone volume and osteoblast number at day 6 were significantly lower in old rats. Furthermore, the percentage of mineralized bone was greatly reduced in the aged rat. This model system is currently being used to evaluate the effectiveness of interventions to up-regulate the bone activity in senescent rats.


Do different fluorochrome labels give equivalent histomorphometric information? Substances that bind calcium are given to determine where and how fast bone is forming. Several vital dyes are used (tetracycline, calcein, alizarin, xylenol), but it is not known whether the histomorphometric results they provide are equivalent. This work tests whether different fluorochrome labels give the same results when they are quantitatively measured. Twelve-week-old rats (n = 58) were divided into six groups and given double labels IP of calcein, tetracycline HCl, alizarin complexone, or xylenol using a 1-7-1 scheme. Two other groups received either calcein followed by tetracycline, or tetracycline followed by calcein. Our results show that (a) tetracycline hydrochloride leads to a significant underestimation of mineralizing surface when given as the second label, probably because of its weak fluorescence; (b) there were no differences among any of the non-tetracycline labels for any of the histomorphometric measurements; (c) there was no evidence of osteoblast suppression with any label; and (d) there was no evidence that tetracycline caused increased osteoblast resting periods.


Synthesis of pyrimidine derivatives of amino acids using pig liver esterase and pancreas lipase. The parent methyl ester of the N-1 substituted 5-chloropyrimidinone is hydrolysed by pig liver esterase to the corresponding carboxylic acid. The acid chloride was made with PCl5 in toluene, and coupling with benzyl and methyl esters of selected L-amino acids to the corresponding amides was done in dichloromethane in the presence of triethylamine. The benzyl and methyl ester protecting groups were hydrolysed with pancreas lipase or esterase in a pH-stat to yield the corresponding carboxylic acids.


Tetrin polypeptides are colocalized in the cortex of Tetrahymena. There is a complex system of 2- to 5-nm filaments in the oral apparatus of Tetrahymena. Four major subunit proteins, called tetrins, have been isolated from the filaments. These proteins, showing apparent molecular weights in polyacrylamide gels of 79-89 kDa, will assemble in vitro into 2- to 5-nm filaments. Tetrin filaments in vivo show different packing arrangements in different regions of the oral apparatus. We sought to determine the distributions of tetrin polypeptides within the complex oral structure by obtaining monoclonal antibodies specific for individual tetrins, then mapping their distributions within the oral apparatus using standard fluorescence microscopy, confocal laser scanning fluorescence microscopy, and electron microscopy. The results indicate that the four tetrin polypeptides are colocalized everywhere within the oral apparatus of Tetrahymena. Tetrin-binding proteins or specific nucleating structures may need to be invoked to explain the complex organization of the tetrin network. The 16 monoclonal antibodies obtained were also used to search for evidence of immunological relationships between tetrin and cytoskeletal proteins in multicellular organisms. None was found.


The impact of agency policies and protocols on breastfeeding. Health care agency policies and protocols exert a considerable effect on the initiation and continuation of breastfeeding. Supportive practices, protocols, policies, and philosophies are outlined, and the most prevalent nonsupportive practices are described. Other agency factors affecting the support of breastfeeding, such as diagnostic procedures and medical and surgical interventions, are discussed.


Supporting breastfeeding: how to implement agency change. Health care agency policies and protocols that negatively influence breastfeeding initiation and continuance can be changed to provide a supportive milieu for breastfeeding mothers and their infants. This change must be systematic and purposeful to be effective. Agency personnel must become aware of the need for change and be guided by a credible change agent through a process of goal-setting, assessing the present, educating staff, educating consumers, assessing and documenting care, and evaluating results. Outcome and continuing evaluation can be measured against the WHO/UNICEF's (World Health Organization and United Nations International Children's Emergency Fund) "Ten Steps to Successful Breastfeeding."


Distribution of viral RNA molecules during the adenovirus type 5 infectious cycle in HeLa cells. Viral RNA was localized ultrastructurally by in situ hybridization with a biotinylated viral DNA probe and colloidal gold label in HeLa cells during infection with adenovirus type 5. Transcription was monitored by high-resolution autoradiography after short pulses with tritiated uridine. At the earliest stage of virus-induced nuclear transformation, viral RNA was restricted to the small compact fibrillar "early replicative sites" which we had previously demonstrated to be the site of viral DNA replication (Puvion-Dutilleul and Puvion, 1990b). Protease-DNase-treated sections revealed that these fibrillar masses rapidly enlarged and gave rise to a juxtaposed loose fibrillogranular structure devoid of viral RNA. Subsequently, the function of the compact fibrillar zones changed to become the sites of accumulation of single-stranded (ss) viral DNA molecules, and the contiguous new fibrillogranular zones (previously named the peripheral replicative zones, Puvion-Dutilleul and Puvion, 1990a) became not only the centers of replicating viral double-stranded DNA but also the only sites of viral RNA molecules including the elongating RNA transcripts. Pulse-chase experiments revealed an unexpected accumulation of RNA molecules in these extranucleolar regions of infected nuclei.


Breastfeeding success and failure: implications for nurses. Breastfeeding is a relationship and a method of communication. Breastfeeding success or failure is a personally defined experience that is based on a woman's individual perceptions and self-definition. This article discusses various aspects of relationship and communication as they relate to the breastfeeding experience and the effect of connections and disconnections in the mother-infant and mother-nurse relationships. The major goal of the nursing care is to support and encourage a "growth fostering" relationship that is based on mutuality and empathy, regardless of the duration of the breastfeeding experience.


A nuclear magnetic resonance imaging technique designed for studies of water in plant leaves. A new imaging technique is described which uses nuclear magnetic resonance (NMR) to create a water profile of plant leaves. The water profile shows the average distribution of water as a function of depth into a leaf along a line perpendicular to the leaf surface; it can be used to measure the thickness of cell layers and the quantity of water in each layer. Two-dimensional NMR methods were used to avoid chemical shift distortion which degrades the resolution in leaf images made by conventional NMR techniques; image resolution was improved further by deconvolution analysis. To illustrate its application, the technique was used to follow changes in the internal structure of developing leaves.


Promoting breastfeeding success: an overview of basic management. The management of breastfeeding can have a powerful effect on its outcome. To promote success, the nurse must use strategies that are based on an understanding of lactation and the breastfeeding infant. The nurse also must guard against strategies that, although intended to be helpful, sabotage the delicate breastfeeding relationship. Success-promoting and sabotaging strategies are discussed.


The three-dimensional structure of trypsin-treated Staphylococcus aureus alpha-toxin. Trypsin treatment of staphylococcal alpha-toxin cleaves the molecule into two roughly equally sized parts, which results in inactivation of the toxin. Tetragonal arrays of oligomers, closely resembling the native ones, can however be formed on lipid layers. From tilted views of negatively stained crystals a 3D structure to 23 A resolution has been determined by electron microscopy and image processing. On comparison with the 3D structure of the native alpha-toxin (Olofsson et al., J. Mol. Biol. 214, 299-306, 1990) the subdomains are more separated, confirming the differences found when comparing the projection maps (Olofsson et al., J. Struct. Biol. 106, 199-204, 1991). The tryptic cleavage takes place in a postulated hinge region. The results are consistent with the hypothesis that the conformational change required for inducing the membrane permeabilizing property takes place in this region. Furthermore, we present a refined projection map at approximately 10 A resolution based on the analysis of a large number of crystals using unbending methods.


Structure of paracrystalline arrays on outer membranes of rat-liver and rat-heart mitochondria. Crystalline arrays are induced in outer membranes of rat-liver and rat-heart mitochondria by phosphotungstate and silicotungstate. The basic structure of the arrays has been determined by correlation averaging of electron microscopic images of side views of tubular arrays and en face views of planar arrays. The arrays consist of rows of bilobed projecting subunits and are similar (in lattice parameters and projected subunit dimensions) to periodic arrays of ion transport ATPases, e.g., arrays of Ca(2+)-ATPase induced by vanadate in sarcoplasmic reticulum. Hexokinase-labeled colloidal gold particles do not specifically decorate the arrays, suggesting that the hexokinase receptor (VDAC channel) is not a component of the arrays.


The breastfeeding dyad: early assessment, documentation, and intervention. The early postpartum period is a critical time for the establishment of lactation. Although newborns are well equipped with reflexes that enhance breastfeeding, many aspects of the experience can be assisted by the knowledge and skills of clinicians. To prevent negative outcomes for mothers and infants, it is essential that the clinician make an accurate assessment of breastfeeding technique and milk intake by the infant. An understanding of the mechanics of milk transfer serves as a foundation for developing interventions to be applied to the common breastfeeding challenges (including difficult latch-on, nipple trauma, and lack of nutritive suckling) that can jeopardize effective breastfeeding.


The use of field emission in-lens scanning electron microscopy to study the steps of assembly of the nuclear envelope in vitro. At mitosis the nuclear envelope (NE) is disassembled to allow chromosome separation. In telophase it is reassembled as the chromosomes decondense. Cell-free extracts of Xenopus eggs have been used extensively to study assembly of the NE and the nuclear pore complexes (NPCs), providing several models for the steps involved. The NE is a surface structure which in cell-free extracts is easily exposed. It is appropriate, therefore, to use a surface imaging technique to study NE dynamics. Field emission in-lens scanning electron microscopy (FEISEM) provides the opportunity to image surfaces, directly, and to visualise details of structures such as the NPC. Here we show the feasibility and value of FEISEM to study the steps of NE formation. Nuclei have been assembled in vitro and fixed at different time points during assembly, followed by conductive staining, platinum coating, and visualisation by FEISEM. Changes on the nuclear surface with time are shown. Details of the surface of chromatin and the cytoplasmic face of NPC structure are demonstrated without the need to isolate the structures from the nucleus.


Medication use in the breastfeeding mother. Historically, the risks associated with drugs in breast milk were not a major clinical concern. The small percentage of infants who were breastfed and the low use of drugs in postpartum women stimulated little interest in studying medication use in the breastfeeding mother. However, explosive growth in the number of new pharmacologic agents, concerns over environmental contaminants, and a significant increase in breastfeeding, dramatically altered the interest in this clinical issue. Providers of health care to women and children often are asked to advise breastfeeding women on the choice and risks of a particular medication. However, medical professionals too often simply discourage breastfeeding when this situation arises. This short review examines factors that determine whether a drug that enters breast milk poses a risk to the breastfeeding infant. A series of questions and practical decisions are presented that should enable nurses and other health care providers to more effectively address the issue of medication use in a breastfeeding woman.


Insufficient milk supply syndrome.

Insufficient milk supply syndrome. Insufficient milk supply syndrome is a complex phenomenon and a major reason reported by mothers worldwide for early termination of breastfeeding. A review of the literature suggests possible explanations for insufficient milk but fails to indicate conclusively why it is such a problem. Nursing management of real and perceived insufficient milk syndrome (IMS) is an important part of encouraging breastfeeding success.


Breastfeeding and jaundice: cause for concern? Jaundice occurs in 50-75% of newborn infants and is noted to occur more frequently and with greater severity in breastfed infants. However, despite years of investigation of this common problem, many aspects of neonatal jaundice in healthy breastfed infants remain unexplained. Knowledge of the types, pattern, and causes of jaundice in healthy breastfed neonates is reviewed, and the potential effect of treatment options is discussed. Practices and interventions used by health care professionals that may decrease the duration of breastfeeding and increase the incidence and severity of jaundice experienced by newborns also are explored.


Visualization of myosin helices in sections of rapidly frozen relaxed tarantula muscle. Tarantula leg muscles in the relaxed state were rapidly frozen against a copper block cooled with liquid helium. Thin longitudinal sections of freeze-substituted specimens, both live and skinned, clearly showed the helical tracks of crossbridges on the surface of the myosin filaments, which are not preserved by conventional fixation. Fourier transforms of selected filaments showed a myosin layer line pattern, similar to that observed in X-ray diffraction patterns of intact tarantula muscle, extending to the sixth order of the 43.5 nm X-ray repeat. The phases of corresponding reflections were similar on the two sides of the meridian on the first layer line, and the crossbridge arrangement showed a line of mirror symmetry running down the center of the filament. These observations show that the number of helices (N) is even, in agreement with N = 4 determined from image analysis of negatively stained, isolated tarantula filaments (Crowther et al., J. Mol. Biol. 184, 429-439, 1985). Filtered images showed clear detail of the crossbridge helices and were similar to filtered images of negatively stained, isolated thick filaments. Thus, rapid freezing combined with freeze-substitution preserves the crossbridges in a three-dimensional arrangement approximating that occurring in vivo.


Breastfeeding the premature infant.

Breastfeeding the premature infant. Breastfeeding the premature infant is both possible and desirable. Premature infants derive benefits from breast milk that they can not receive from formula. Nutritional issues look at the components of breast milk as they relate to brain growth and development and disease protection in the acute setting and later in childhood. Recommendations for clinical practice are provided, as are information on expressing and collecting milk, breastfeeding readiness, putting the infant to breast, and discharge planning.


Breastfeeding the infant with a cleft defect. Infants with cleft defects should be assisted to feed at the breast whenever a mother chooses this as the method of feeding. This is an ideal choice for such infants because it encourages normal, physiologic muscular involvement of the mouth and face, it benefits speech development, and it provides protection against upper respiratory infections, particularly otitis media. Successful breastfeeding helps normalize the infant to the family. Unfortunately, the attitude that infants with cleft defects cannot be breastfed often has been the first and most consistent response that the parents and families receive from their health care providers. Health care professionals must provide interventions to facilitate breastfeeding and thus normalize and empower these infants. The first days of life are extremely important for imprinting and learning what position works best.


Breastfeeding the neurologically impaired infant. Care of neurologically impaired infants usually is complex and challenging. Mothers of these infants who want to breastfeed should be supported, given sound information, and assisted to set realistic expectations. The health care team can provide guidance while continuously assessing the infant's status. When and if the infant will feed from the breast cannot be predicted, but the lactation consultant and other members of the health care team should support the mother to do what she can and wants to do for her infant.


The slow-gaining breastfeeding infant.

The slow-gaining breastfeeding infant. Several options are outlined for caring for the slow-gaining breastfed infant when the goal is to continue breastfeeding. A review of pertinent causative factors and simple management solutions are included. Infants with organic causes of slow weight gain can safely be breastfed by using a feeding tube device at the breast. Other feeding options can be explored with the parents, but safety, comfort of the infant, energy conservation, the parents' emotional and time capabilities, and long-term ability to maintain lactation must be considered. A careful follow-up plan is outlined, mostly for encouragement until the problem is corrected and the infant weans himself from the feeding tube if supplementation was required.


Breastfeeding more than one: multiples and tandem breastfeeding. The concurrent breastfeeding of two or more infants is associated with multiple births or non-twin siblings, which sometimes is referred to as tandem breastfeeding. In these situations, the "supply and demand" production principle of lactation is a compensatory mechanism. It ensures the availability of adequate amounts of human milk, no matter how many infants are breastfeeding. A lack of time for the increased number of breastfeedings, physical and emotional difficulties associated with caring for more than one infant, and a lack of social support generally are greater hindrances than an inability on the part of the mother's body to produce milk for all infants. The nurse helps by explaining the process of milk production adaptability and sharing intervention strategies to help the mother minimize the obstacles to breastfeeding more than one.


Breastfeeding and the chemically dependent woman. Chemical dependence in pregnant and postpartum women is an issue of concern for perinatal nurses. Special concerns arise when a chemically dependent woman chooses to breastfeed her infant. This article discusses the effects of the most common drugs of abuse on lactation and the neonate and criteria for and benefits of breastfeeding for this population.


Breastfeeding after breast surgical procedure or breast cancer. As more older women bear and breastfeed children, an increasing number will have lactation risk factors, such as a cosmetic or diagnostic breast surgical procedure or breast radiation therapy after breast cancer. The chief risk of breast operation can be attributed to periareolar breast incisions, which sever milk ducts and disrupt innervation, whereas radiation therapy causes diffuse damage, including atrophy of the lobules. Prenatal recognition of women at risk, early intervention to maximize milk yield, and close medical follow-up should permit accurate assessment of lactation potential and the tailoring of a plan of care that allows for satisfying breastfeeding without compromising an infant's nutritional well-being.


Breastfeeding during maternal or infant illness. The continuation of breastfeeding during a hospital stay is not only possible, it can be beneficial for both the mother and the infant. The ill mother avoids breast engorgement and possible mastitis; the infant of an ill mother continues to receive, in breast milk, antibodies to the mother's illness. Through breast milk, an ill infant receives antibodies to his illness, liquids, and an easily digested, nourishing food. In addition, the physical and emotional comfort the mother and infant give each other eases the job of the nurse who cares for them. Hospital policies that take a woman's lactational status into account and encourage breastfeeding should be the accepted standard.


Diets and eating disorders: implications for the breastfeeding mother. Although research is inconclusive or lacking, breastfeeding women who are on special diets or who have eating disorders are in need of nutritional counseling. This article provides information about the dietary risks of breastfeeding women, particularly those on weight-loss diets and vegetarian diets, and breastfeeding women who have anorexia or bulimia. Recommendations for dietary guidance are given based on information available about breastfeeding and maternal nutrition. Additional research is needed to determine the effect of the lactating woman's nutrition on her health and the health of her child.


Maternal employment and breastfeeding.

Maternal employment and breastfeeding. A high percentage of mothers return to work during their infant's first year of life. Recent studies indicate that mothers who return to work early and for more than 20 hours a week wean earlier, on the average, than other women. However, within employment subcategories, women vary widely in breastfeeding duration. Studies done in England and Minnesota indicate that variables from Ajzen and Fishbein's Behavioral Intention Model (BIM) can be helpful in explaining some of the variations in length of breastfeeding that are not explained by work-related variables. The variables in this model are motivational in nature. Clinicians can apply research to practice by assessing selected factors that have been demonstrated to predict breastfeeding duration, eg, breastfeeding knowledge, work-related variables, and motivational variables. Then interventions can be focused on gaps in a woman's knowledge or motivational system and on what she needs to know to return to work and breastfeed.


The father's role in breastfeeding.

The father's role in breastfeeding. The father plays an important role in breastfeeding, and the nurse can encourage fathers to become participants in the care of their breastfeeding infants. This article presents a whimsical overview of how a father can participate in this most important relationship through supporting and assisting the mother and developing comforting skills for the infant.


Cultural sensitivity in the promotion of breastfeeding. Despite the efforts of health care providers, the problem of low and decreasing breastfeeding rates among low-income women and women of color persists. Failure to make progress in this crucial area makes it essential to develop new strategies and models for culturally appropriate promotion of breastfeeding. Sensitive cultural assessment helps to gather information regarding cultural characteristics that may affect clients' behaviors. Strategies for the promotion of breastfeeding should be based on an awareness of the sociocultural barriers to breastfeeding in a particular community. General approaches for assessing and overcoming cultural barriers are addressed.


A strategy for promoting breastfeeding among economically disadvantaged women and adolescents. Best Start is an innovative social marketing approach to promote breastfeeding among low-income women. Focus group interviews were used to identify the determinants of infant-feeding decisions and the most effective strategies for encouraging women to breastfeed. Motivations and perceived barriers related to breastfeeding and social network influences on feeding choice are discussed. The findings were used to design a multifaceted breastfeeding promotion campaign aimed at new mothers, family members, health professionals, and the community at large.


The lactation consultant: part of the health care team. The role of the lactation consultant in the health care team is examined, as is the need for specialized breastfeeding assistance by consumers within the childbearing cycle. An overview of certification for lactation consultants is reviewed. Differentiation of the roles of perinatal nurses and lactation consultants related to breastfeeding assistance is identified. The role of health care providers in breastfeeding advocacy is addressed.


Stereoselective binding and activity of oxotremorine analogs at muscarinic receptors in rat brain. The activities of the enantiomers of BM-5 were examined to measure muscarinic cholinergic selectivity in the central nervous system. Autoradiographic studies assessed the ability of each enantiomer to inhibit the binding of [3H]-(R)-quinuclidinyl benzilate ([3H]-(R)-QNB) to muscarinic receptors in the rat brain. (+)-(R)-BM-5 inhibited [3H]-(R)-QNB binding to rat brain sections at concentrations below 1.0 microM, while 100-fold higher concentrations of (-)-(S)-BM-5 were required for comparable levels of inhibition. Analysis of the autoradiograms indicated that both stereoisomers had a similar distribution of high affinity binding sites. Each enantiomer displayed higher affinity for muscarinic receptors in the superior colliculi and lower affinity for receptors in the cerebral cortex and hippocampus. (+)-(R)-BM-5 and oxotremorine inhibited adenylyl cyclase activity in the cerebral cortex with efficacies comparable to that for acetylcholine. (+)-(R)-BM-5 was 26-fold more potent than (-)-(S)-BM-5 in inhibiting adenylyl cyclase. Oxotremorine-M and carbamylcholine stimulated phosphoinositide turnover in the cerebral cortex. Oxotremorine had lower activity and (+)-(R)-BM-5 was essentially inactive at comparable concentrations. The difference in activity of the two enantiomers indicates a remarkable stereochemical selectivity for muscarinic receptors. The stereoselectivity index is comparable for both the autoradiographic assays (48) and measures of adenylyl cyclase activity (26) in the cerebral cortex.


Cytochrome P-455 nm complex formation in the metabolism of phenylalkylamines. XII. Enantioselectivity and temperature dependence in microsomes and reconstituted cytochrome P-450 systems from rat liver. Formation of metabolic intermediate (MI) complexes was studied with the enantiomers of amphetamine, 1-phenyl-2-pentanamine, N-hydroxyamphetamine, and 2-nitroso-1-phenylpropane (the C-nitroso analogue of amphetamine). Three different enzyme systems were used; liver microsomes from phenobarbital pretreated rats and two reconstituted systems containing the P450 2B1 and P450 2C11 forms of cytochrome P-450. Enantioselective complex formation in microsomes was shown for the amines and the nitroso compound, but not for the hydroxylamine. The highly purified P450 2B1 system formed the MI complex with all substrates tested, and the enantioselectivity observed with the microsomal system was reproduced. In the P450 2C11 system the nitroso compounds were completely inactive, whereas the enantiomers of N-hydroxyamphetamine still produced the complex at a high rate. Changes in temperature were shown to affect (R)-2-nitroso-1-phenylpropane more than its enantiomer. Both enantiomers showed biphasic Arrhenius plots for MI complex formation in microsomes (breaks around 22 degrees C), but the activation energies of the (R)-isomer were about five times higher than those of the (S)-isomer. A theory is presented which suggests different modes of interaction with the active site of P-450 to account for the different behaviour of the various substrates.


Enantioselectivity in the induction of peroxisome proliferation by 2-ethylhexanoic acid. The stereoselectivity of the peroxisome proliferation potency of 2-ethylhexanoic acid (2-EHA), a metabolite of the plasticizer di-(2-ethylhexyl) adipate, was investigated in vitro. The enantiomers of 2-EHA were prepared via the semipreparative HPLC resolution of their diastereoisomeric (+)-(R)-1-phenylethylamine derivatives and the subsequent hydrolytic cleavage. Monolayers of hepatocytes were incubated 3 days with solution of (-)-(R), (+)-(S), and (+/-)-2-EHA. The peroxisome proliferation potency was measured by means of determination of the peroxisomal palmitoyl coenzyme A oxidation. The theoretical induction component due to each enantiomer were calculated from the experimental data considering the enantiomeric purities of the acids. The (+)-(S)-enantiomer was found to be the most potent inducer e.g., the eutomer, while the (-)-(R) was the distomer. The eudismic ratio was about 1.6 and the racemic mixture exhibited an intermediary potency. These results, obtained in vitro in conditions avoiding confounding factors such as pharmacokinetics, suggest that the peroxisome proliferation induced by 2-ethylhexanoic acid is a stereoselective phenomenon.


Enantioselective pharmacodynamics of the nonsteroidal antiinflammatory drug ketoprofen: in vitro inhibition of human platelet cyclooxygenase activity. The pharmacological activity of ketoprofen enantiomers was investigated in humans by an in vitro method. The antiplatelet effect of ketoprofen was assessed by measuring the inhibition of platelet thromboxane B2 (TXB2) generation during the controlled clotting of whole blood obtained from each of four healthy volunteers. Ketoprofen was added separately to whole blood as a range of concentrations of (1) predominantly (S)-ketoprofen, (2) racemic ketoprofen, and (3) predominantly (R)-ketoprofen. (S)-Ketoprofen was found to be solely active at inhibiting human platelet TXB2 production; (R)-ketoprofen was devoid of such activity and did not modify the potency of its optical antipode. A relationship between the percentage inhibition of TXB2 generation and the unbound concentration of (S)-ketoprofen in serum was modelled according to a sigmoidal Emax equation. The mean (+/- SD) serum unbound concentration of (S)-ketoprofen required to inhibit platelet TXB2 generation by 50% (EC50) was 0.320 (+/- 0.062) ng/ml. This value for ketoprofen is considerably lower than previously reported values for (S)-ibuprofen and (S)-naproxen.


Measurement of the (R)- and (S)-isomers of warfarin in patients undergoing anticoagulant therapy. An achiral/chiral high-performance liquid chromatographic system for the analysis of total warfarin together with the (R)- and (S)-enantiomers in clinical samples has been developed. The achiral analysis is achieved using a C8 column, which is coupled to a chiral stationary phase, alpha 1-acid glycoprotein (AGP), thereby allowing for analysis of warfarin isomers without interfering serum peaks. A 0.015 M phosphate buffer mobile phase with 15% v/v propan-2-ol (pH 7.0) was used on the C8/AGP system. UV analysis at 308 nm was used for quantitation of total warfarin on the C8 column and fluorescence (excitation 300 nm, emission 390 nm) detection was employed for isomer quantitation on the AGP. Retention time of total warfarin on the C8 column was 5.95 min, while that of the (S)- and (R)-warfarin on the AGP column was 10.38 and 12.69 min, respectively. Peak resolution of the warfarin isomers was 1.64. All serum samples were subjected to solid-phase extraction. Data from two patients in a single dose study indicate that a two-compartmental model could represent the warfarin concentration-time data with enterohepatic circulation. In some patients studied during steady state therapy, concentrations of (S)-warfarin were greater than (R)-warfarin indicating that the clearance of the former is slower in these patients.


Discrimination in resolving systems: ephedrine-mandelic acid. Resolution of mandelic acid with (-)-(1R,2S)-ephedrine in water and ethanol produces intermediate diastereomeric salts with greatly disparate solubilities and melting points. Single crystal X-ray analysis of the less (L) and more (M) soluble (-)-ephedrinium mandelates (I, II) shows crystal structures which are isosteric, each crystallizing in the monoclinic system, space group C2. Protonated ephedrines occupy the same relative positions in the L- and M-salts, and mandelates are in the same general locations. Hydrogen bonds link alternating protonated ephedrine nitrogens and mandelate carboxylate oxygens in each salt forming columns of ions. The helical H-bonded chain winds down the crystallographic 2-fold screw axis. Additional H-bonds form between 2-fold related mandelates in the L-salt. Mixed crystals, containing both mandelate isomers, (2R)- and (2S)-mandelates, are obtained from the resolving system partly depleted of the L-salt. A specimen with nearly equal amounts of the mandelates (III) is also isosteric with the commensurate structures. I (294K), L-salt: a = 18.160(7), b = 6.538(2), c = 13.898(4) A, beta = 92.02(3) degrees, V = 1649.1(9) A3; IIa (294K), M-salt: a = 17.978(11), b = 7.164(4), c = 13.574(6)A, beta = 96.41(4) degrees, V = 1737.3(16) A3; IIb (223K), M-salt: a = 17.805(8), b = 7.115(2), c = 13.50(5) A, beta = 96.89(3) degrees, V = 1697.9(15) A3; III (294K), mixed-salt: a = 18.184(22), b = 6.792(7), c = 13.808(19) A, beta = 93.74(10) degrees, V = 1701.7(35) A3.


Direct coupled column separation and determination of the diastereomeric glucuronides of almokalant, a new class III antiarrhythmic drug, in human urine. A reversed-phase coupled column separation (CCS) system for the analysis of two diastereomeric glucuronides of almokalant, a new class III antiarrhythmic drug, in human urine is described. After direct injection of urine samples (50 microliters) the glucuronides were isolated by complex formation on a terbium(III) loaded strong cation exchanger at alkaline pH. The solutes were eluted from the precolumn by an acidic mobile phase, enriched and separated on Hypercarb (porous graphitic carbon) as analytical column with 0.1 M acetic acid pH 2.8 and 30% acetonitrile as mobile phase. The calibration graph was linear (r2 = 0.9999) and the detection limits were in the low picomole (UV) or femtomole (fluorescence) range. Optimization of the analytical column revealed that elution order and selectivity for the glucuronides were dependent on the buffer agent and temperature used. By appropriate choice of mobile phase conditions all four diastereomers could be separated.


Indirect chiral separation and analyses in human biological fluids of the stereoisomers of a thienothiopyran-2-sulfonamide (TRUSOPT), a novel carbonic anhydrase inhibitor with two chiral centers in the molecule. The indirect chiral separation of the four stereoisomers (1)-(4) of a novel carbonic anhydrase inhibitor with two chiral centers in the molecule is reported. The method is based on chemical derivatization of the secondary amino group of the inhibitor with chiral isocyanate, formation of diastereomeric urea derivatives, each with three chiral centers in the molecule, and their separation under nonchiral HPLC conditions. The attempts to separate racemic mixture (1) + (2) from its diastereomeric counterpart (3) + (4) under nonchiral conditions, and to separate enantiomers (1) and (2) directly on a chiral stationary phase (CSP) are also reported. The indirect method was utilized for the assessment of an in vivo inversion of configuration at either one or both chiral centers of the molecule of (1). Analyses of selected whole blood and urine samples from human subjects after multiple bilateral topical ocular dosing with (1) did not reveal the presence of any of the three possible stereoisomers (2)-(4) of (1) indicating that the inversion of configuration at neither one nor two chiral centers of (1) occurs in vivo.


Growth of Salmonella and competing flora in five commercial Rappaport-Vassiliadis (RV)-media. Growth of 18 Salmonella strains belonging to 11 serotypes and the bacterial flora of deep-frozen broiler carcasses was examined in five commercial Rappaport-Vassiliadis (RV) media. Growth was measured by an automated turbidometer (Bioscreen). Significant differences in performance between the media investigated were observed. The unequal performances were ascribed to differences in the concentration of magnesium chloride (MgCl2) and the type of peptone used.


Survival of hog cholera virus (HCV) in sausage meat products (Italian salami). Survival of hog cholera virus (HCV) was determined in several sausage meat products (Italian salami) prepared with meats from experimentally infected hogs slaughtered at the peak of disease. Meats were processed following the technology applied by the main factories of the typical Italian production. The survival of HCV was assessed through inoculation in both PK 15 cell monolayers and fully susceptible piglets. In all types of sausages examined HCV was detected up to 75 days of curing by piglet inoculation. This technique was much more sensitive than use of cell culture.


Ropy slime-producing lactic acid bacteria contamination at meat processing plants. At three Finnish meat processing plants the processing rooms, meat trimmings and carcasses were examined for the presence of ropy slime-producing lactic acid bacteria. Bacterial isolates similar to ropy slime-producing lactobacilli strains able to produce ropy slime on meat products, were recovered from the processing rooms and meat trimmings, indicating that these rooms and raw materials are a source of contamination for ropy bacteria. The ability to produce ropy slime would appear to be a common characteristic of lactobacilli, since altogether 10 different ropy lactobacilli groups were isolated in this study.


Inhibition of PCR by components of food samples, microbial diagnostic assays and DNA-extraction solutions. We have tested the influence on the polymerase chain reaction (PCR) of a large number of compounds found in food, in media used for selective propagation of food-borne pathogens or in DNA-extraction methods. PCR was found to be sensitive to large volumes of complex food samples containing high amounts of fat and protein, however, an extraction procedure based on treatment with hot NaOH/SDS reduced the effect significantly. Some culture media (Fraser, MLEB, MRB and Rappaport) interfered with the analysis and for most of the media it was possible to assign the inhibitory effect to one or more individual components. Several compounds (detergents, lysozyme, NaOH, alcohols, EDGA, EGTA) used in DNA extraction procedures were found to have some inhibitory effect. The inhibitory effects need to be taken into consideration when designing new tests.


Detection of Clostridium perfringens enterotoxin gene by the polymerase chain reaction amplification procedure. The polymerase chain reaction (PCR) procedure was evaluated to see if it is a simple and rapid method to detect Clostridium perfringens enterotoxin gene. The method, involving the use of two synthesised primers and gene amplification by the PCR procedure, detects a DNA fragment of 364 base pairs of C. perfringens enterotoxin gene by gel electrophoresis. The enterotoxin gene of strains was detected by use of purified chromosomal DNA. The supernatant of sporulating cultures in a sporulating medium was able to be used as template DNA. Template DNA can be obtained by merely culturing the strain in DS medium, a sporulating medium, for 48 h at 37 degrees C. All C. perfringens strains showing positive results in the PCR procedure were demonstrated to produce enterotoxin by a conventional method and all strains showing negative results were enterotoxin negative. To detect the enterotoxin gene in stool specimens by the PCR procedure, the specimen was heat-treated for 10 min at 90 degrees C and cultured in a sporulating medium, the supernatant of which was used as template DNA. From the stool specimens showing positive results in the PCR procedure by this method, enterotoxigenic C. perfringens was isolated from the heat-treated specimens. Thus, it is possible to detect enterotoxigenic C. perfringens in stools without isolation of the organism.


Application of pyrolysis mass spectrometry to the investigation of outbreaks of food poisoning and non-gastrointestinal infection associated with Bacillus species and Clostridium perfringens. Eighteen isolates of Bacillus species and 15 of Clostridium perfringens, all of which had been associated with outbreaks of either food poisoning or non-gastrointestinal infection (NGI), were examined for relatedness by pyrolysis mass spectrometry (PyMS). The PyMS-analysis correctly clustered all the groups of epidemiologically related isolates of both genera, and distinguished all the single, epidemiologically unrelated isolates of the same species. PyMS is a simple, rapid and inexpensive technique which can provide useful and accurate inter-strain comparisons within both the Bacillus and Clostridium genera in complete accord with conventional serological typing results.


Effect of tomato juice addition on the growth and activity of Lactobacillus acidophilus. Addition of tomato juice to skimmed milk stimulated the growth of Lactobacillus acidophilus. It resulted in higher viable counts, shorter generation time and improved sugar utilization with more acid produced and lower pH for the strains tested. Varying results were obtained for the five strains examined.


Study of surface yeast flora of Roquefort cheese. The change in yeast flora on the surface of two batches of Roquefort cheese was monitored over a period of 6 months. 401 isolates were determined and their technological properties were investigated. The main species isolated were: Debaryomyces hansenii and its non sporulating form Candida famata, Kluyveromyces lactis and its non sporulating form Candida sphaerica and Candida species. The species Debaryomyces hansenii inoculated on the surface of the cheese in one of the batches just before the salting phase was abundant throughout the ripening phases but never exceeded 50% of the yeast count. About 80% of the isolates of each species were resistant to 15% (w/v) of sodium chloride. Most of the species were able to assimilate lactose and lactic acid. 50-90% of the isolates of each species were able to hydrolyze rapeseed oil and glycerol tributyrate. Ten isolates among 401 hydrolyzed gelatin. Most of them were able to assimilate cadaverine, histamine, putrescine and tyramine.


Increased activity of lymph node cells in thermal injury. While trauma-induced suppression of T-cell responses is well documented, only few studies address lymphocyte activation. The aim of this study was to investigate the functional activity of lymph node cells in rats subjected to scald injury, proliferative activity, cytokine production, and responsiveness to exogenously added cytokines was evaluated in cells from lymph nodes draining burned tissue and from distant, nondraining lymph node cells. Results presented clearly show that lymph node cells in scalded rats are activated in vivo although the extent of proliferation and pattern of cytokine production differ: a) proliferative activity was elevated both in draining and distant lymph nodes, but was more pronounced in cells from lymph nodes draining the injured region; b) increased production of IL-2, and particularly IL-1 and IL-6 was found and coincides well with peak of proliferative activity of draining lymph node cells; IL-2 production by distant lymph node cells remained unchanged, IL-1 and IL-6 production was significantly increased coinciding with increased proliferation; c) increased responsiveness to exogenously supplied cytokines was found in draining lymph node cells, while it remained unchanged in nondraining lymph node cells. Early activation of lymphocytes demonstrated in our experiments could be one of the previously unrecognized consequences of trauma-induced immunosuppression.


Effect of human thyroglobulin on the production of platelet activating factor from peripheral blood mononuclear cells from patients with autoimmune thyroid diseases. Platelet activating factor (PAF), a phospholipid mediator, has been found to play a role in immune reactions, as well as in many pathophysiological alterations in certain disorders. To determine whether there might be a potential role of PAF in the development of autoimmune thyroid diseases (AITD) we have measured in vitro production of PAF by cultures of pokeweed mitogen-stimulated peripheral blood mononuclear cells (PBMC) obtained from 13 patients with Hashimoto's thyroiditis (HT) and 22 patients with Graves' disease (GD), as well as 18 normal control subjects. Similarly, the levels of PAF in cultures of PBMC after relevant [human thyroglobulin (Tg) and human thyroperoxidase (TPO)] antigenic stimulation in the same preparations were measured by a RIA kit. The basal values of PAF were significantly higher in the PBMC preparations from HT patients than in other two groups. In HT preparations, but not in controls, Tg antigen significantly increased the production of PAF. In GD preparations the response to Tg antigen was also present, but the release of PAF did not reach the levels in control group of preparations. Significantly lower values of PAF production were found in preparations from hyperthyroid GD when compared to the results of preparations from GD patients who were euthyroid and to the results of normal control preparations. The type of treatment and chronicity of disease may also have played some role in these findings, since those treated with radioactive iodine had lower values than those patients who became euthyroid using only antithyroid drugs.(ABSTRACT TRUNCATED AT 250 WORDS)


Ontogeny of lymphocyte activating factors in conventional and germfree rats. Immune regulatory cytokines have previously been demonstrated outside the immune system in, e.g., the skin, testis, and brain, and suggested to serve as barrier site defence mediators. We have recently demonstrated constitutive production of an interleukin-1 (IL-1)-like factor(s) in the proximal gastrointestinal tract, liver, and placenta of adult rats. In the present study we have investigated the developmental production of IL-1-like factors in these tissues in conventional rats and in rats raised under germfree conditions. Slight IL-1 bioactivity was detected at a gestational age of 18 days in the skin and esophagus, and on day 19 significant amounts were detected in the skin, tongue, esophagus, and stomach. The activity was maximal at gestational day 20-21, and stationary at all later time-points. The placenta and liver contained high amounts of IL-1 activity throughout fetal life. The brain showed a transient appearance of IL-1 bioactivity at a gestational age of 19-21 days, but no activity at later time-points. Germfree rats showed no significant difference in the ontogeny or amounts of IL-1 bioactivity compared to conventional rats. It can be concluded that the IL-1 bioactivity appears at a definite time point in all measured tissues in fetal life and that exposure to microbial antigens does not seem to influence its production. As the investigated tissues show a high proliferation rate, it is tempting to suggest that the detected IL-1 (-like factors) might have an alternate function in these tissues, e.g., to serve as growth factors.


Immunological characterization of pulmonary intravascular macrophages. Pulmonary intravascular macrophages (PIMs) are lung macrophages found apposed to the endothelium of pulmonary capillaries. In many species, they are responsible for the clearance of blood-borne particulates and pathogens; however, little else is known about their roles as immunologic effector cells. We compared PIMs with pulmonary alveolar macrophages (PAMs) to determine the relative immunological activities of these two cell populations. Our results suggested that both populations possess similar phagocytic and bactericidal activities. In assays measuring cytotoxicity, PIMs were more cytotoxic than PAMs against virally infected target cells; however, differences between these macrophage populations were not as marked when noninfected targets were used. LPS-stimulated PIMs produced more T-cell proliferative cytokines than PAMs, and both populations of nonstimulated macrophages produced similar amounts of the cytokines. In contrast, PAMs produced more TNF alpha and NO2- than PIMs when both populations were stimulated with LPS; however, nonstimulated PAMs and PIMs produced similar amounts of TNF alpha and NO2. These data suggest that bovine PIMs are immunologically active. Differences between the degrees of activity of PIMs and PAMs indicate that these macrophage populations may have different roles in lung surveillance.


Characterization of the mucosal immune response to 2-acetylaminofluorene-protein conjugates. Many environmental carcinogens gain access to the body only after traversing a mucosal surface. Due to their small size, most carcinogens are not recognized by the immune system and pass unhindered from the external to the internal environment. In previous studies, we demonstrated that secretory IgA directed against the carcinogen 2-acetylaminofluorene (AAF) can be elicited by covalently coupling AAF to the mucosal immunogen cholera toxin (CT). Rabbit intestines receiving secretions containing secretory IgA anti-AAF demonstrated a marked reduction in transmucosal absorption of carcinogen from the intestinal lumen to the mesenteric blood supply. In actively immune animals, however, recent data suggests that the disposition of luminal carcinogen may be influenced by the relative abundance of serum versus mucosally-based immunoglobulins. Our objective was to quantify the amount and isotype distribution of antibodies produced in response to AAF-carrier protein conjugates administered via different routes; using traditional parenteral carrier proteins and routes of administration, compared to mucosal carrier proteins and routes of administration. Administration of AAF-cholera toxin conjugates to isolated ileal (Thiry-Vella) loops in rabbits elicited a vigorous sIgA anti-AAF response in ileal secretions, with low levels of serum or intestinal IgG, or serum-based IgA produced concomitantly. All parenteral immunization protocols generated extremely high titers of serum IgG anti-AAF, with only moderate levels of sIgA produced concomitantly, even when mucosal boosting followed parenteral priming. When AAF-CT mucosal boosts were administered after intraperitoneal priming, a dramatic rise in serum, not secretory IgA was observed.


Diminished immunoglobulin synthesis after stimulation of mononuclear cells from periodontal disease tissue. Gingival mononuclear cells from patients with adult periodontitis were cultured to determine the potential for IgG production. All samples (N = 27) showed IgG synthesis. Some samples demonstrated IgG synthetic activity over the entire period in culture, often with maximum synthesis after 8 days. Other samples showed IgG synthesis during the first half of the culture period and then little detectable production for the remainder. Cells were either untreated or treated with one of several different known mitogens during the culture period. Total IgG synthesis by peripheral blood lymphocytes was enhanced in the presence of pokeweed mitogen, E. coli lipopolysaccharide and killed. A. actinomycetemcomitans. In contrast, IgG synthesis by gingival cells in the presence of these same additives was significantly reduced when compared to gingival cell synthesis in the absence of mitogens; suggesting the presence of suppression in this system. These differences in responsiveness may be attributable to the unique combination of T cells found in the gingival tissues of patients with periodontal diseases. The patterns of IgG synthesis by gingival cells were different from those of peripheral blood cells from the same patient. This finding verified the distinctiveness of local immunoregulatory mechanisms in periodontal disease tissue from those found systemically.


Peyer's patches and mesenteric lymph nodes are the sites of first appearance of IgE bearing B lymphocytes and hapten specific IgE antibody forming cells in BPO-KLH sensitized mice. Antigen specific IgE responses originate in gut associated lymphoid tissue (GALT) of mice sensitized with benzylpenicilloyl-keyhole limpet hemocyanin (BPO-KLH) in alum, regardless of the route (intraperitoneal [i.p.], oral [gavage], subcutaneous [s.c.], intramuscular [i.m.] or intravenous [i.v.]) used for immunization. When BALB/c mice were injected i.p. with BPO-KLH (10 micrograms) in alum, B lymphocytes bearing membrane bound IgE (sIgE+B cells) first appeared simultaneously in Peyer's patches (PP) and mesenteric lymph node (MLN) on day 8. BPO specific IgE antibody forming cells (AFC) also appeared in PP on day 8, but were not found in MLN until day 10. On day 8, no sIgE+B cells or IgE AFC were found in bone marrow (BM) or other lymphoid organs. The appearance of sIgE+B cells and IgE AFC in PP and MLN was transient; these cells were no longer detected in PP on days 14 and 24, respectively, or in MLN on days 14 and 36, respectively. sIgE+B cells and IgE AFC did not appear in spleen until day 12, where they were detected through day 70. Although sIgE+B cells were never found in BM, IgE AFC appeared in BM on day 18, where they were detected through day 70. No sIgE+B cells or IgE AFC were found in other lymph nodes (OLN) on days 0-70. Boosting did not induce the reappearance of sIgE+B cells or IgE AFC in PP, the reappearance of sIgE+B cells in MLN, the appearance of sIgE+B cells in BM, or the appearance of sIgE+B cells or IgE AFC in OLN.(ABSTRACT TRUNCATED AT 250 WORDS)


T cell functions of IL-2-activated tumor-infiltrating lymphocytes from renal cell carcinoma. Renal cell carcinoma (RCC) is one of the few cancers partially sensitive to biotherapy. However, involvement of T cell immunity in host-defense against autologous tumor cells remains unclear. This manuscript investigated T cell functions of interleukin-2 (IL-2)-activated tumor-infiltrating lymphocytes (TILs) from human RCCs by studying their oligoclonality, cytotoxicity, and cytokine production. IL-2-activated RCC-TILs from 17 of 33 cases (52%) (p < 0.01 vs. IL-2-activated patients' peripheral blood mononuclear cells, PBMC) displayed oligoclonal expansion as determined by seven different monoclonal antibodies (mAbs) to T cell receptor (TCR) V alpha or beta regions after 2 to 5 weeks in culture. By comparison, IL-2-activated PBMC from only 1 of 15 healthy donors (7%), 3 of 23 patients (13%), and IL-2-activated lymphocytes from nontumorous kidney from 1 of 8 (12.5%) cases (V beta 5.1) did. Specifically, IL-2-activated RCC-TILs showed oligoclonal expansion of V alpha 2+ cells (8/33 cases, p < 0.05 vs. IL-2-activated patient's PBMC), V beta 5.1+ cells (6/33), V beta 8+ cells (4/33), V beta 12+ cells (4/33), and V beta 6.7+ cells (2/33). Oligoclonal expansion of plural TCR V regions was observed in 6 of 33 cases. IL-2-activated RCC-TILs from 4 of 16 cases produced higher levels of interferon-gamma (IFN-gamma) in culture with autologous tumor cells than with allogeneic tumor cells. Those from 11 of 16 cases did not produce IFN-gamma in response to autologous tumor cells, and the remaining case produced it in a major histocompatibility complex (MHC)-nonrestricted manner. IL-2-activated RCC-TILs with oligoclonal expansion in 4 of 5 cases showed IFN-gamma production in response to the corresponding anti-TCR V region mAb as well as anti-CD3 mAb. IL-2 and IL-4 were not detected in any cases tested. IL-2-activated RCC-TILs displayed cytotoxicity relatively restricted to autologous tumor cells in only 1 of the 16 cases evaluated, MHC-nonrestricted cytotoxicity in 12 cases, NK activity in one case and no cytotoxicity in two cases. In summary, IL-2-activated RCC-TILs demonstrated the oligoclonality in approximately half of the cases (17 of 33, 52%), but rarely displayed either autologous tumor-specific-IFN-gamma production (4 of 16 cases) or -cytotoxicity (1 of 16 cases).


A nurse-led 'stop smoking' initiative.

A nurse-led 'stop smoking' initiative. A one-week smoking awareness initiative and subsequent audit in a general practice are described. All patients attending morning surgery during the study period were offered the opportunity to discuss smoking habits at a smoking awareness clinic: 84 smokers attended. They were interviewed by the practice preventive care nurse who took a smoking history, monitored carbon monoxide (CO Hb) levels and offered a follow-up appointment. CO Hb provided immediate feedback on the effect of smoking and patients who smoked 20 or more cigarettes per day had an average CO Hb of 16.1 per cent. Fifteen per cent of smokers made a commitment to stop smoking and agreed to attend follow-up clinics. A random sample (50) of attenders at the initial Smoking Awareness Clinic (84) were followed up by questionnaire six months later. There were 29 replies (58 per cent); 19 patients (65 per cent) found the visit to the clinic helpful, 14 (48 per cent) reduced the number of cigarettes they smoked, and 11 (38 per cent) altered some other aspect of their lifestyle, of whom four modified their diet and four increased exercise. Five patients claimed they had given up smoking.


Fluoride: spanning the health divide.

Fluoride: spanning the health divide. This article describes the causes and prevention of tooth decay, with particular emphasis on the role of fluoride. Focusing on the North West of England, social class differences in the prevalence of tooth decay, and hence the need for water fluoridation, are discussed. Finally, the role of non-dental health professionals in dental health promotion is outlined.


Appropriate use of HRT post-menopause.

Appropriate use of HRT post-menopause. The last decade has seen a dramatic increase in the use of, and interest in, hormone replacement therapy (HRT) in the United Kingdom, with its undoubted benefits in relieving distressing symptoms associated with the menopause, protecting the skeleton and preventing ischaemic heart disease. Recent studies, however, suggest that compliance with therapy tends to be poor. In this article, the author examines some of the reasons why the drop-out rate is so high in women who start hormone replacement therapy, and suggests there are three broad areas in which there is need for improvement: more counselling of patients, dispelling unrealistic expectations which some women may have of HRT and, most importantly, the need for the individualization of therapy to suit the woman's requirements.


Recurrent cranial polyneuropathy.

Recurrent cranial polyneuropathy. General considerations on recurrent cranial polyneuropathy are made. In addition, a study carried out in 42 patients with recurrent cranial polyneuropathy (RCP) permitted the assessment of some parameters closely related to age, sex and evolution in order to elaborate an etiopathologic hypothesis. Female cases prevailed (31 females, 11 males); the interval between two episodes varied from 1 month to 39 years. 117 episodes were found (from 2 to 8 episodes in one patient). Immune, vascular and entrapment aspects are discussed.


Outcome in ischaemic stroke: carotid versus vertebro-basilar territory. Clinical study and laboratory investigations were performed in 166 carotid ischaemic stroke (CIS) patients and 64 vertebro-basilar ischaemic stroke (VBIS) patients. The study revealed some features of VBIS: significant male predominance (p < 0.001), better outcome (for modified Rankin Scale (MRS)) (p < 0.01), significant number of different triggering factors (p < 0.001). Nonsignificant differences in mortality were found in both groups (p > 0.05). Myocardial infarction was an important associated cause of death.


Calcium blockers in ischemic stroke.

Calcium blockers in ischemic stroke. The study investigated the evolution of 72-nifedipine treated cases with ischemic stroke. Dipyridamole was administered to 72 controls. Subjects showed clinical improvement, thus calcium blockers can constitute a therapy alternative. A good influence of nifedipine was remarked in blood pressure.


Mutant p53 oncogene expression in keratoacanthoma and squamous cell carcinoma. The tumour suppressor gene p53, located on the short arm of chromosome 17, encodes for a nuclear protein which regulates cell proliferation by inhibiting cells entering S-phase. p53 mutations are alleged to be the commonest genetic abnormality in human cancer. We studied mutant p53 oncoprotein expression, using PAb1801 monoclonal antibody immunohistochemistry, in 25 'ideal' keratoacanthomas and 26 well-, 19 moderately and 18 poorly differentiated squamous cell carcinomas of the skin. While there was a highly significant trend in the proportion of p53 oncoprotein-positive lesions from keratoacanthomas to poorly differentiated squamous cell carcinomas (chi 2 = 17.13, df = 1, exact P = 0.00003), p53 expression was inadequate for distinguishing keratoacanthoma from well-differentiated squamous cell carcinoma (chi 2 = 2.55, df = 1, exact P = 0.18; corresponding to a sensitivity of 0.84 and a specificity of only 0.36).


Density and morphology of Langerhans cells in basal cell carcinomas of the face and trunk. We investigated the density and morphology of Langerhans cells in epidermal sheets of basal cell carcinomas in chronically sun-exposed skin (face) and less exposed skin (trunk) of 65 patients. Langerhans cells in perilesional and control skin at the same anatomical sites as the tumours were also examined. Two markers (ATPase and OKT6) were used in a parallel fashion to identify Langerhans cells. The density of the cells was reduced, and their morphology was changed in epidermis overlying tumours of both the face and trunk. These alterations were confined to tumour areas, as Langerhans cells in perilesional skin were normal when compared with control skin at both anatomical sites. Results with both markers were the same.


A novel tissue preservation medium for immunoperoxidase staining of skin biopsies. The requirement for unfixed tissue is a major drawback in the use of immunohistochemistry for the diagnosis of inflammatory and neoplastic disease. We describe the use of a novel gel transport medium (U.K. Patent No. WO 90/07703, international patent applications pending) to preserve unfixed skin biopsies from allergic contact dermatitis reactions for 1 week prior to frozen section and immunohistochemistry for leucocyte antigens. The medium can be used with biopsies up to 6 mm3 and does not require any alteration in the usual frozen section or immunohistochemical staining procedures. The results show a subjective improvement in both morphology and staining quality. We believe this to be due to improved cutting of the sections and reduced background staining of collagen. This transport medium should be of considerable benefit to the provision of a clinical service, because it allows tissue for immunohistochemical examination to be taken at locations distant from the pathology laboratory.


Statistical study of lethal stroke.

Statistical study of lethal stroke. Deceased cases with cerebral infarction and hemorrhage constituted the subjects of the present study. They were divided into two groups: 127 cases in group 1 (1954-1959) and 427 cases in group 2 (1977-1982). The purpose of the study was to compare clinical data to evidence any statistical difference between groups. No statistically significant difference was noticed, except the increase of age mean in both diagnoses due to the overall increase of age mean of the population (2.5-10 yrs).


Interleukin 1 immunoreactivity in sebaceous glands. Interleukin 1 (IL-1) immunoreactivity in sebaceous glands was studied in paraffin sections of normal human skin. A panel of antibodies against IL-1 alpha and beta was tested using an immunoperoxidase labelling method. All the antibodies showed a similar specific labelling pattern: both glandular and ductal cells were immunoreactive for both IL-1 alpha and beta, provided optimal tissue fixation was used.


Rat hair follicle growth in vitro.

Rat hair follicle growth in vitro. Pelage hair follicles were isolated by gentle microdissection from 8-12-day-old rats, and maintained in supplemented Williams E medium. Length measurements made on freshly isolated hair follicles, and at 24-h intervals, showed a significant increase in hair follicle length over 48 h, after which time no further significant increase in length was observed. Photomicrographs of maintained follicles showed that this increase in hair follicle length could be attributed to the production of a keratinized hair shaft. Histology and [methyl-3H] thymidine autoradiography of freshly isolated hair follicles showed the dermal papilla to be elongated, with thymidine uptake located predominantly in the matrix cells of the hair follicle bulb adjacent to the dermal papilla. This pattern remained unaltered for the first 48 h of maintenance, but after 72 h the dermal papilla had rounded into a tight ball of cells, with very little thymidine uptake occurring in the adjacent matrix cells. On maintenance, fetal calf serum (FCS), epidermal growth factor (EGF) and 12-o-tetradecanoyl phorbol 13-acetate (TPA) all significantly stimulated [methyl-3H] thymidine and [U-14C] leucine uptake, but inhibited hair follicle elongation. Insulin-like growth factor-1 (IGF-1) had no significant effect on rates of hair follicle elongation and [methyl-3H] thymidine uptake, but significantly stimulated rates of [U-14C] leucine uptake. Transforming growth factor-beta 1 (TGF-beta 1) significantly inhibited both the rate of [methyl-3H] thymidine uptake and hair follicle elongation.


DERMIS: a computer system for assisting primary-care physicians with dermatological diagnosis. DERMIS is a computerized skin disease diagnostic prompting system which has been derived from the prospective study of 5203 cases. It has been designed for use by non-dermatologists such as general practitioners. The program produces a list of reasonable diagnoses based on probabilities calculated using Bayes' theorem. Out of 221 precise diagnoses made by the dermatologist in the clinic, 42 groupings were created to encompass the most common or important diseases encountered in general practice. Four 'remainder' or 'send to specialist' groups were included for the 13% of uncommon conditions. The program, when tested by 'one out' analysis on the original cases, placed the correct diagnosis first on 76% of occasions, and within the first three on 95% of occasions. In 76 of 125 cases randomly selected from the data base, a request for diagnostic assistance had been made by the referring general practitioner. It has been estimated that in 54 of these 76 cases the DERMIS system could have provided differential advice with the correct diagnosis appearing at the top of the list. The system has been written in MUMPS and runs on an IBM-compatible desk-top computer. The software allows real time data entry. Arrangements are in hand for performing clinical trials of the system in general practice. If current performance is maintained, and the response to the system's output is favourable, then DERMIS might well enhance performance in medical decision making for the benefit of patients, medical services and budget holders.


The influence of food on 8-methoxypsoralen serum concentration and minimal phototoxic dose. Ten adult volunteers were given three oral doses of 0.46-0.56 mg/kg body weight of 8-methoxypsoralen (8-MOP) in a liquid formulation under fasting conditions, and after ingestion of a low-fat or fat-rich breakfast. 8-MOP serum levels and photosensitivity were measured 0.5-4 h after drug ingestion. The 1-h 8-MOP serum levels and photosensitivity were significantly higher in fasting conditions than after ingestion of a low-fat or fat-rich meal (intra-individual median difference in photosensitivity 7.5 J/cm2). On 12 of 20 occasions when the drug was taken after food ingestion, the 1-h 8-MOP serum concentration was below 30 ng/ml. A survey of 43 out-patients undergoing regular PUVA treatment showed that the frequency of erythemal reactions was significantly higher when 8-MOP was ingested with a > 50% smaller quantity of food than usual (P < 0.005). This study demonstrated food-induced variations in 8-MOP photosensitivity both in an experimental situation and in an out-patient survey. In order to optimize the therapeutic effect of PUVA, the quantity of food taken before 8-MOP should remain constant, and the timing of UVA irradiation should be adjusted according to the preceding food intake.


Therapy of alopecia areata with diphencyprone. The properties of diphencyprone (DPC), its possible mechanism of action in the therapy of alopecia areata (AA), and its side-effects are summarized. The results of our own study of treatment in 45 patients with AA, with a mean treatment duration of 72 (15-146) weeks, are presented, and compared with the results of previous studies. We suggest that, in future, therapy protocols should define entry criteria and therapy results more precisely, and include follow-up assessments to establish the length of remission. In view of the low response rates and short lengths of remission, the indications for DPC therapy should be set more rigorously.


Restrictive dermopathy: a disorder of fibroblasts. Restrictive dermopathy is a rare, lethal genodermatosis, characterized by a thin, tightly adherent skin which causes a dysmorphic facies, arthrogryposis and respiratory insufficiency. The recorded cases to date show a remarkable phenotypic similarity. Thinning of the dermis and the arrangement of collagen in parallel bundles appear to be constant findings. We have found many dead and degenerating fibroblasts in the dermis on ultrastructural examination, and have demonstrated their poor growth in vitro. Studies of collagen from a skin sample showed a marked increase in mature cross-links, indicating a decrease in skin collagen turnover. These findings suggest a primary disorder of fibroblasts, and may explain the apparent arrest in growth and differentiation of the skin which appears to be important in the pathogenesis of this rare condition.


Diffuse primary cutaneous amyloidosis.

Diffuse primary cutaneous amyloidosis. A case of extensive primary cutaneous amyloidosis exhibiting both macular and lichenoid lesions is reported. Lesions were arranged in a distinctive linear pattern covering much of the trunk and limbs, in places following Blaschko's lines. The coexistence of macular and lichenoid lesions suggests that this is an unusual variant of biphasic cutaneous amyloidosis.


Acquired tufted angioma showing spontaneous regression. We report a 62-year-old woman with acquired tufted angioma. Several scattered reddish nodules were present on the neck and upper chest. During a follow-up period of 6 months, some of the lesions showed transient spontaneous regression and one disappeared completely. Electron microscopy revealed that a few tumour cells contained Weibel-Palade bodies in their cytoplasm.


Do pigmented naevi in albinism provide evidence of tyrosinase positivity? We investigated a 4-year-old Japanese boy with oculocutaneous albinism who had a solitary pigmented mole measuring 5 mm in diameter on his back. An electron microscopic tyrosine incubation test and a DOPA reaction test clearly demonstrated the presence of tyrosinase activity in the patient's hypopigmented skin. The presence of tyrosinase activity was confirmed by tests on hair bulb samples. Histopathological evidence showed that the mole was a typical compound cellular naevus with melanin pigmentation. Although no reports to date have focused on the relationship between pigmented naevi in albinism and tyrosinase activity, our findings suggest that the occurrence of pigmented naevi in an albino may indicate the presence of tyrosinase activity.


Ganglioglioma in children. A review of 32 cases at the University of Florida. The entity ganglioglioma in children seems to be an increasingly more common tumor. Most of these lesions are pathologically and clinically benign but have a pathological and clinical continuum in their behavior. Gross total resection, especially involving the lesions in the supratentorial compartment, is often curative. The most common symptom, seizures, in this group of lesions, can often be alleviated with removal of the tumor. This may be enhanced with the use of corticography at the initial surgery. The group of lesions located in the brainstem are more difficult to control and may require multiple operations and other therapies including radiation and chemotherapy for optimum outcome. Malignant lesions in the ganglioglioma series are rare and optimum therapy for these tumors is not well defined at this time. Pathologically, this group of tumors needs better definition for designing the best therapy. We are planning a survey both retrospectively and prospectively with flow cytometry and the use of various makers such as the K167 proliferation antigen to better define potential biological behavior. Clearly, a broader discussion with the patient and family is indicated when one of these tumors is discovered and operated.


The halo vest apparatus: essentials for patient management. Cervical spine trauma or disease, regardless of its cause, warrants prompt diagnosis and treatment. The halo vest apparatus is an external fixation device which is used extensively in the management of these individuals. Since patient management may pose some difficulties, expert knowledge is essential. In this paper we describe our experiences in the management of this challenging group of patients. Our discussion will focus on management techniques and strategies which include hygiene, activity, mobility and emergency procedures.


The Glasgow Coma Scale: a critical look. Today much of our knowledge about a patient's level of consciousness is given to us by his or her score on the Glasgow Coma Scale (GCS). Since its development at the University of Glasgow in 1974, it has been widely adopted, become an integral component of the hourly "neuro assessment", and is typically incorporated into the graphic assessment portion of the patient's medical record. Once the information has been documented, the pure data itself is lost as the documented form takes on an interpretative meaning or a reality that is different from the clinical state experienced by the patient. The formation of this "new" reality occurs in two separate phases: in the completion of the scale and in its reading. There are various factors or forces that affect the completion and use of the scale. These are important as they are not visible in the scale itself; however, their effects are evident in the coma score obtained. These forces include the design of the GCS and the manner in which the tool is taught and used. The purpose of this paper is to discuss these factors and to delineate how they create a reality that may not accurately depict the patient's level of consciousness.


The cardiopulmonary complications of aneurysmal subarachnoid hemorrhage: current trends in management. It is well established that excessive sympathetic activity, resulting in the development of cardiopulmonary complications, commonly occurs in patients who have suffered aneurysmal subarachnoid haemorrhage. Cardiac dysfunction and neurogenic pulmonary edema are life threatening conditions that have serious implications with regard to patient outcome. The purpose of this article is to familiarize the neuroscience practitioner with the effects of subarachnoid haemorrhage on the heart and lungs and to provide an update in terms of current medical and nursing management trends. It is vital that these patients receive aggressive therapy including definitive surgical treatment of the aneurysm, vigilant monitoring for cardiopulmonary complications and prompt medical and nursing intervention should they occur. A brief review of the anatomy and physiology of the sympathetic division of the autonomic nervous system will be presented. In addition, the theories that have been proposed to explain the underlying pathogenesis will be introduced. Medical and nursing management strategies will also be addressed.


Functional hemispherectomy.

Functional hemispherectomy. Complete hemispherectomies were performed throughout the 1950's and early 1960's for the treatment of medically refractory seizures associated with hemiplegia. In 1964 a study published by Laine, Pruvet and Ossen reported a late post operative complication; superficial cerebral hemosiderosis. This, with its associated neurological deterioration, hydrocephalus, and at times death, led to disfavor with the procedure. It was replaced by the subtotal hemispherectomy which effectively eliminated the late complication of superficial cerebral hemosiderosis but was less successful in controlling seizures. Results decreased from 85% showing improved seizure tendency to 68%. Dissatisfied with these results, a hybrid operation was designed by Dr. Rasmussen and Dr. Villemure known as functional hemispherectomy. Removing less cortical tissue but disconnecting the remaining tissue provided a functionally complete but anatomically incomplete removal. Patients, having undergone this surgery, have obtained the same degree of seizure reduction without any of the late complications of the complete hemispherectomy. Our presentation will discuss the preoperative, operative and post-operative course of these patients. Criteria for surgery will be reviewed. A description of the surgical procedure will be included so that one can understand why the complications of aseptic meningitis, hydrocephalus, cerebral hemosiderosis and altered motor function will or will not occur postoperatively. Concerns of family and patient will be addressed throughout the presentation.


Functional electrical stimulation (FES) systems for restoration of motor function of paralyzed muscles--versatile systems and a portable system. Multichannel functional electrical stimulation (FES) systems were developed to restore the motor functions of the paralyzed muscles, i.e. two kinds of versatile systems for laboratory use and a practical portable system were developed. The first microcomputer-based FES system was composed of an 8 bit microcomputer (PC-8801mkII) with a voice recognition board and 30 stimulation outputs, in which the voice commands were used for selecting a motion pattern, and for executing (start), (hold), (restart) and (stop) commands. In combination with the voice commands, a proportional control command detected from a head angle sensor was used for volitional control of motion. The second microcomputer-based FES system was composed of a 16 bit microcomputer (PC-9801 UV or compatible) with flexible control capabilities (e.g. respiratory sensors) for volitional control and with 64 stimulation outputs. An originally designed practical portable FES system was 89 x 145 x 31 mm in dimension and 380 g in weight. This paper describes the system configurations, the control methods of these FES systems and three examples of the clinical applications of the FES systems.


A simple and practical method for evaluating overall measurement error of joint moments obtained by a force plate and a position sensing device. Joint moments are now widely used in the field of gait analysis and sports biomechanics. They are usually calculated from the data obtained by a force plate and a position sensing device. Although separate assessment of the measurement error of a force plate and a position sensing device is possible, it can give only the worst case estimate of the joint moments. A simple and practical method is presented here which can give an estimate of the overall error of the combined system. The basic principle of this method is that if a lumped load is applied to a point where the joint center is supposed to be located and the moment is calculated about this point, then the moment should be zero. Thus, the deviation of the calculated moment from zero will give an estimate of the overall error. Examples of experimental data of a joint moment measuring system are given to validate this method. Various factors which contribute to the overall error are discussed and a method of reducing it by software compensation is presented.


Modelling exercise-induced pulmonary hemorrhage in racing thoroughbreds. Exercise-induced pulmonary hemorrhage (EIPH) affects a large portion of racing thoroughbred horses. Sites of hemorrhage and causal mechanisms remain unestablished. Our mathematical model was constructed to test the hypothesis that EIPH could be caused by a combination of respiratory and circulatory mechanical factors occurring during exercise. Various physiological data for respiration, blood circulation and exercise were incorporated into the model. Results show that inhalation pressure drops across airway resistances become great enough during exercise to cause rupture of capillaries for both bronchial and pulmonary systems.


Data compression of electrocardiograms for long-time digital recording in IC memory. To realize a digital recorder capable of long-time recording of electrocardiograms (ECGs) in IC memories, the methods of data compression were studied and the accuracy of reconstructed ECGs from the compressed ones was evaluated. Concretely, the variant of MSAPA was used as a data compression algorithm in order to store ECGs in IC memories for 12-24 h. The fabricated digital recorder used an 8 bit CPU with the function of data compression and was capable of operating in real time at a sampling rate of 200 Hz. With bit compression, 24 samples of American Heart Association ECGs were compressed to an average value of 16.8% under the condition of an error limit of 30 microV (120 microV in QRS); the average maximum recording time in 1 Mbyte IC memories was 8.5 h. In a comparison of the reproduction accuracy and errors produced by a small analog tape recorder with those produced by the digital method, the digital system was shown to be superior to the analog system.


On the intracranial pressure-volume curve. The intracranial pressure-volume curve is considered and a new mathematical model proposed to describe it. Researchers and clinicians currently use an exponential curve to describe the increase in intracranial pressure following a rapid increase in the fluid volume in the cranial vault. It is argued in this paper that a form of logarithmic curve, derived from elementary physical principles, can also be used. An upper limit to the extra volume is an intrinsic feature of the model and the argument does not require a variable compliance to be associated with the system.


The head louse in Sierra Leone: an epidemiological study among school children, in the Njala area. A survey of five primary schools in the Njala area, Sierra Leone showed that Pediculus humanus capitis infestation is wide-spread. The overall prevalence was 6.8% among 1007 school children examined. Infestation rates varied between schools from 1.4% to 14.6% and the prevalence of infestation increased with age, from 3.1% among class I children to 10.2% among class IV and decreased to 4.9% among class VI children. Females had a higher infestation rate (8.3%) than their male counterparts (5.4%). The infestation rate was higher' in children whose fathers were Farmers (9.4%) followed by Traders (7.8%), Artisans (6.5%) and Professionals who had the lowest infestation rate of (5.8%). Sharing of beds, beddings and combs had a significant effect (P < 0.01) on the rate of infestation. The infestation was light, therefore, impetigo was minimal. Overcrowding at home is the main factor facilitating the transmission of the infestation from one head to another among these children.


More enlightenment on the essence of applying Fisher's Exact test when testing for statistical significance using small sample data presented in a 2 x 2 table. The paper illustrates the inconsistent behaviour of the Chi-Square test when applied onto 2 x 2 tables involving independent samples and a small overall sample size. The appropriateness of applying this test to a given 2 x 2 table was judged by the degree of agreement between the probability associated with a value of Chi-Square for that table and that obtained by direct application of Fisher's Exact Test. Data from two different studies were used for the illustration. For one of the tables, the two tests led to divergent conclusions about the Null Hypothesis (H degrees) being tested; and the two probabilities were found to differ quite significantly. When the same procedures were repeated for the data in another 2 x 2 table (also involving a small sample size) the two tests led to the same conclusion about Ho; and in this latter case, the two probabilities were approximately equal: thus implying good approximate accuracy of the Chi-Square test relative to the Exact Test. To avoid these unantisipated variations of results from the Chi-Square test when it is applied onto 2 x 2 tables involving small sample sizes, Fisher's Exact Test is further recommended as a definitive test, always to be resorted to for fourfold tables involving small sample sizes and independent samples.


Primary post-partum haemorrhage at a university hospital in Nigeria. Two hundred and four cases of primary postpartum haemorrhage were compared with the same number of normal post-partum mothers, during a period of two years at a University Hospital in Ilorin, Nigeria. Majority of the women (71%) who suffered from primary post-partum haemorrhage were in the age group 15 to 29 years, and there was no difference in the age distribution between the study and the control groups. Primary post-partum haemorrhage occurred more in the primipara and grand-multipara compared with the control and the differences is statistically significant. Atony of the uterus was the commonest cause of post-partum haemorrhage and this was attributed to mismanagement of labour. Many of the women with post-partum haemorrhage had vaginal delivery but the difference in the mode of delivery between the study and the control groups was statistically significant. Anaemia and hypovolaemic shock were the two commonest avoidable complications and the preventable measures and the need for further investigations of cases of primary post-partum haemorrhage are highlighted.


Antibiotic susceptibility patterns and plasmid profile of Helicobacter isolates from Nigeria. Antibiotic susceptibility testing and plasmid screening of 50 local isolates of Campylobacter coli and Campylobacter jejuni were done. All isolates were sensitive to ofloxacin but were resistant to ampicillin, cloxacillin, penicillin, streptomycin and aztreonam. A large number of isolates were sensitive to nalidixic acid (96%), ceftriaxone (96%) and chloramphenicol (86%). It is noteworthy that nine (18%) of the isolates were resistant to each of erythromycin, 15 (30%) were found to harbour plasmid DNA ranging in sizes from 2.0 to 45 megadalton. Resistance to tetracycline in one isolate was associated with the carriage of a 45-megadalton plasmid.


Bacteriological investigation of infected root canals in Benin City, Nigeria. Possible viable bacteria were isolated and determined through culture based on paper point inoculation from infected root canals of 50 patients who presented for endodontic therapy at the school of Dentistry, University of Benin Teaching Hospital and Central Hospital, Benin City. Eighty-one strains of bacteria were isolated from 50 patients. The bacterial isolates were Streptococcus species, (51), Klebsiella species (17), E. coll (5), Staphylococcus aureus (3), Micrococcus species (2), Neisseria spp. (2) and Lactobacillus. The isolation of Klebsiella spp from the study is particularly interesting, constituting 21% of all the isolated bacteria. The implications of these findings in root canal infections are presented.


Male breast carcinoma in eastern Nigeria--a 13 year study. A 13 year review of carcinoma of the male breast in an African Population is presented. Its incidence, Clinical presentation, diagnosis and modalities of treatment are critically analysed. The literature is reviewed and such topical issues as risk factors, prognostic indices and modern concepts on the possible aetiological mechanisms of development of human breast cancer are discussed. Finally suggestions are offered on possible strategies to improve the bleak survival rate.


Renovascular hypertension in a newborn: necessity of assessing blood pressure routinely. A 7-day old neonate presented with heart failure secondary to severe hypertension. The hypertension was discovered on day 9 of life. Control of his hypertension was a difficult problem eventually requiring continuous intravenous sodium nitroprusside therapy, and ultimately a nephrectomy. The nephrectomized specimen revealed renal artery stenosis, renal artery thrombosis and renal vein thrombosis. His eventual outcome was excellent.


Disseminated cutaneous sporotrichosis associated with anergic immuno-suppression due to miliary tuberculosis. A 52-years-old policeman suffering from tuberculous meningitis, developed pseudo-umbilicated nodular skin lesions which increased rapidly in size during the course of his illness. Histology revealed cutaneous sporotrichosis. Human immuno-deficiency virus infection was excluded by absence of history of exposure and repeated negative serological test for HIV antibodies. The tuberculin test was also negative. Anti-tuberculous therapy failed to prevent a fatal outcome 3 months after admission to hospital. The possibility that the usually presentation of disseminated cutaneous sporotrichosis was an opportunistic infection facilitated by immuno-deficiency accompanying anergy of miliary tuberculosis is discussed.


Neurological complication following tetanus toxoid immunization. A case report. A 33-year-old Nigeria male developed fever, malaise, headache, muscle weakness and polyneurutis 24 hours after administration of tetanus toxoid. These manifestations however cleared within 72 hours. No other identifiable agents or predisposing factors were identified to explain this phenomenon.