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8042611 | The use and limitations of the INR system. | This study was undertaken to answer some practical questions physicians and medical directors of clinical laboratories face when they contemplate replacing their high international sensitivity index (ISI) thromboplastins with low ISI ones and using international normalized ratio (INR) in place of prothrombin time ratio (PTR) for monitoring warfarin therapy. To the question of whether low-ISI thromboplastins would produce a prolonged PT on normal patients, the answer is probably no. To the question of the extent of normalization of disparate PTs, determined by high and low ISI thromboplastins, of patients on oral anticoagulants upon the conversion of PTR to INR, the answer is a mixed one. For those whose PTs were 14-20 sec, conversion of PTR to INR would markedly, but not completely, normalize the PTR values. In other words, there would be a lessening of disparity of the PTR after the conversion. For patients whose PTs were > 20 sec, conversion of PTR to INR could even widen the disparity seen with the PTR. Finally, when PTs were assayed on different coagulation devices with the same reagent, highly congenial results were obtained. |
8042610 | Langerhans cell histiocytosis: lack of a viral etiology. | Langerhans cell histiocytosis (LCH) is an enigmatic histiocytic proliferative disorder of unknown etiology that affects children primarily. We have investigated the possibility that viruses are etiological or that they have a "triggering effect" in LCH. Sensitive in situ hybridization and polymerase chain reaction (PCR) techniques were used in 56 cases of LCH. We sought and failed to find evidence of genomes for adenovirus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, human herpesvirus type 6, human immunodeficiency virus, human T-cell leukemia virus types I and II, and parvovirus. Although some probes hybridized to tissues from several cases, PCR failed to confirm the presence of viral genome in any. We conclude that there is no evidence that these viruses are associated with LCH. |
8042609 | Thrombomodulin: a marker for endothelial damage during orthotopic liver transplantation. | Thrombomodulin is a surface protein of vascular endothelial cells. A smaller form of thrombomodulin in blood and urine, the soluble (s)thrombomodulin, appears to be derived from injured endothelial cells or to be proteolytically cleaved from thrombomodulin by proteases. Several in vitro and in vivo studies have suggested (s)thrombomodulin as a marker of endothelial damage. In orthotopic liver transplantation, platelet and leukocyte activation as well as prothrombin activation are suspected of being caused by damaged endothelial cells in the graft liver. We determined (s)thrombomodulin antigen as well as thrombin-antithrombin III complexes, protein C, and antithrombin III activities in the course of 23 orthotopic liver transplantations. Samples were taken at 7 different time-points intraoperatively, as well as out of the perfusate released from the graft liver vein during the flushing procedure with arterial blood prior to the opening of the hepatocaval anastomosis. Levels of (s)thrombomodulin antigen and thrombin-antithrombin III complexes showed a significant increase with reperfusion of the graft liver and levels in the perfusate were higher (both: P = 0.0001) than the corresponding systemic levels. In parallel, antithrombin III decreased significantly with reperfusion and perfusate levels of antithrombin III and protein C activities were lower in the systemic circulation (both: P = 0.0001). In conclusion, high levels of (s)thrombomodulin antigen in the early reperfusion phase and in the perfusate strongly indicate endothelial damage to the graft liver vascular bed, paralleled and followed by signs of prothrombin activation. |
8042608 | Characteristics of bulimic women with and without alcohol abuse. | We compared the characteristics of hospitalized women with bulimia nervosa alone (N = 19) and with bulimia nervosa plus alcohol abuse (N = 13) using standard measures of depression, eating disorders, general psychiatric symptomatology, and temperament. Bulimic women with alcohol abuse had significantly higher lowest past weight, but did not differ from women with bulimia alone on age, age of onset of bulimia, current weight, and highest past weight. There were no differences in clinical symptoms of bulimia, depression, or general psychiatric symptomatology. On Cloninger's Tridimensional Personality Questionnaire (TPQ), bulimic women with alcohol abuse scored significantly higher on Total Novelty Seeking, on the Novelty Seeking Subscale Disorderliness, and on the Reward Dependence Subscale Attachment. Implications for understanding the relation between bulimia and substance abuse are discussed. |
8042607 | High rates of alcohol problems and history of physical and sexual abuse among women inpatients. | A total of 88 consecutive new women patients were surveyed on an adult psychiatric inpatient unit which did not have a specific program for the treatment of alcoholics. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the Michigan Alcoholism Screening Test (MAST) than those with no such history. Former drinkers and teetotalers were more likely to have been both physically and sexually abused than the others. Thirty-three patients (38%) reported a history of alcohol problems measured by scores of seven or more on the MAST, but only 20 had a diagnosis of alcohol abuse or alcohol dependence made by a psychiatrist. |
8042606 | A control profile of adult children of alcoholics: a preliminary investigation. | In order to more precisely investigate the nature of control and self-control issues for adult children of alcoholics (ACA), a group of ACAs was compared to a group of sex and age matched healthy normals and a sex matched group of college students on the Shapiro Control Inventory (SCI). The SCI provides a profile that is both general domain (positive sense of control, desire/efforts for control, agency of control, and mode of control) and domain specific (body, mind, interpersonal, self, career, environment). Analysis of variance and subsequent planned comparisons on the SCI showed significant differences between the ACA and the two comparison groups in general domain sense of control, in three of the four general domain mode quadrants, and in the domain specific areas of body, mind, interpersonal, and career. Individual areas where ACA subjects felt most out of control were weight, significant other, and family of origin; 89.5% felt concern with self-concept, stress, and relationship with significant other. Although a small subset of ACAs had a strikingly high "in control" profile, most did not. Finally, the sense of control profile of ACAs is compared with two clinical populations--borderline and depression--and is shown to fall midway between the clinical and normative groups. Guidelines and suggestions for further research are offered. |
8042605 | Are daughters of alcoholics more likely to marry alcoholics? | This study evaluates the relationship between having an alcoholic (i.e., alcohol-dependent) parent and the presence of a spouse with a similar diagnosis. Data relating to 708 men and 708 women, the parents of the questionnaire respondents, revealed that even after controlling for the increased rate of alcohol-dependent spouses among alcoholics, assortative mating appears to be associated with positive family histories of alcoholism. Within this sample, nonalcoholic daughters of alcoholics were more than twice as likely to marry an alcoholic as nonalcoholic daughters of nonalcoholics, irrespective of the alcoholic parent's gender. In contrast, in the same sample daughters of alcoholics did not demonstrate a higher rate for having a spouse with another of the more common psychiatric syndromes, a major depressive episode. In this sample, sons of alcoholics did not demonstrate an increased rate for marrying an alcoholic when compared to sons of nonalcoholics. |
8042604 | Predictors of drinking and driving in healthy young men: a prospective study. | This paper explores the ability of information about alcohol use and problem patterns in men's early 20s to predict drinking and driving by their early 30s. The sample consisted of 231 healthy young men who were students or nonacademic staff at a university. Subjects were evaluated initially with questionnaires and interviews, and subsequently followed-up using interviews with themselves and with a resource person. The reported rate of drinking and driving at follow-up was nearly 38%. Using logistic regression, the combination of variables that best predicted drinking and driving included prior alcohol-related auto accidents, a measure of typical drinking, and a measure of drinking-related problems. The overall prediction employing this combination was 72%, the specificity was 86%, and the sensitivity was 48%. |
8042603 | The consistency of estimates obtained through central-location sampling: analysis of the Partnership for a Drug-Free America Attitude Tracking Study. | To evaluate the reliability and validity of estimates of drug use obtained through multiple-site central-location sampling, data from the Partnership Attitude Tracking Study (PATS), collected annually beginning in 1987, are tracked longitudinally and compared with data collected through traditional household interviews. Comparisons with demographic estimates from Current Population Surveys indicate that central-location sampling can provide a broadly representative sample of the adult population. However, there is some coverage bias in central-location sampling, most notably in the underrepresentation of adults who do not have high school diplomas. Sample estimates obtained from central-location sampling are consistent over time. Basic demographic characteristics of the samples--education, income, marital status, and area of residence--vary by less than 5% across the four waves of the tracking study. Prevalence estimates of self-reported drug use demonstrate an even higher degree of consistency over time. Comparisons of PATS and National Household Survey of Drug Abuse data and the Monitoring the Future data indicate a higher level of drug use and a lower level of perceived risk of occasional use among PATS respondents. While the trends in use and perceived risk reported in all studies are similar, we suggest that perceived threats to confidentiality and anonymity often result in significant underreporting of drug use, particularly in household surveys. Sample estimate differences are attributed to sampling and measurement error. Some discrepancy in prevalence estimates is associated with the fact that the PATS sample is not a true probability sample; as a result, the sampling error of the overall study cannot be estimated precisely. It is also likely that the difference in estimates between the studies is a product of the decreased measurement error of PATS methodology. In central-location sampling, respondents are completely anonymous and may feel more comfortable in providing honest answers about illicit activities such as drug use. The potential applications of this methodology are discussed. |
8042602 | Treatment process and relapse to opioid use during methadone maintenance. | A general framework for studying drug abuse treatment process factors is presented, and components are then used to predict relapse to opioid use during treatment in methadone maintenance. Major domains of the treatment process research framework include client variables at entry, program characteristics, treatment events, and client outcomes. The analyses rely on the use of proportional hazards models to identify significant outcome predictors in a sample of 590 methadone maintenance clients from 21 clinics in the Research Triangle Institute/Treatment Outcome Prospective Study (RTI/TOPS) data system who remained in treatment at least 3 months. The analyses were performed on the total sample and separately on clients from three groups of clinics classified on the basis of the distribution of client relapse rates and tenure in treatment. Relapse rates were related to dosage level, client monitoring with urinalyses, and methadone take-home privileges in some clinics, and hence, these time-varying treatment events were important factors in treatment outcomes. Even at entry to treatment, some measures were found to be related to how the client later performed during treatment. Finally, it was also found that the particular area of professional speciality of the staff making client diagnosis at intake and preparing treatment plans was associated with client outcomes. |
8042601 | Children of substance abusers: the life experiences of children of opiate addicts in methadone maintenance. | We interviewed 70 substance abusers in methadone maintenance treatment regarding the life experiences of their 188 children. Sixty-four percent of the mothers reported using psychoactive drugs during their pregnancies. Eighty percent of parents reported an arrest during the time the child was growing up, 34% reported receiving treatment for an emotional disorder, and 14% were hospitalized. Four percent of the parents reported that their children had been placed in adoptive care, 9% in foster care, and 1% had a child in a group home. Forty-one percent of the parents reported that at least one of their children repeated a grade in school, 19% were involved in truancy, and 30% had been suspended from school. Twenty percent of parents reported their children's involvement with the law, and 17% reported drug or alcohol use. Problems with the law correlated highly with 1) being held back a grade, 2) truancy, 3) suspension from school, 4) expulsion from school, and 5) treatment for alcohol or drug abuse. |
8042600 | A comparison of male and female intravenous drug users' risk behaviors for HIV infection. | Despite the central role played by female intravenous drug users (IVDUs) in the worsening AIDS statistics of states in the northeastern United States, the relative paucity of research into the HIV risk behaviors--particularly risky needle practices--of female drug injections has left significant gaps in researchers' understanding of how and to what extent such women may differ in their risks from their better-studied male counterparts. This study, derived from a sample of 769 out-of-treatment IVDUs residing in an area (Paterson, New Jersey) characterized by high levels of AIDS and HIV infection among drug users, attempts to address this lacuna in the research literature by comparing the drug usage, AIDS knowledge, and needle and sexual behaviors of male and female IVDUs that place them at risk for HIV infection. In this sample, gender was found to be unrelated to HIV serostatus, injection frequency and injected drug of choice, and to most dimensions of knowledge about AIDS and the means of HIV transmission. Overall, it appears that the average Paterson female IVDU may be at greater risk for HIV infection as a result of involvement with a drug-using sex partner than because of especially risky needle practices, for females in this sample were significantly more likely than males to report injecting with a sex partner in the previous 6 months, and female IVDUs with one sex partner were more than twice as likely as males with one partner to report that this individual was an IVDU. Condom use was relatively rare, particularly among those with one partner. Moreover, female IVDUs were significantly more likely than males to be daily users of crack cocaine, and significantly more likely to report poorer health. However, current needle and sexual practices were found to be unrelated to HIV seropositivity among both males and females. In logistic regression analysis, only length of IV drug involvement was found to be independently associated with HIV seropositivity for both sexes. Implications of the data for future prevention efforts aimed at female IVDUs are discussed. |
8042597 | Laboratory evaluation of fibrinolysis in patients with a history of myocardial infarction. | The aims of this study were to determine whether elevated plasminogen activator inhibitor type 1 (PAI-1) activity after myocardial infarction reflects baseline PAI-1 or represents an acute-phase response secondary to the infarction, and to determine how tissue plasminogen activator (t-PA) activity and total t-PA antigen levels in healthy control subjects differ from those in patients after myocardial infarction. Compared with healthy control subjects, patients studied 1-3 months after infarction had elevated levels of PAI-1 activity and fibrinogen but normal levels of C-reactive protein and von Willebrand factor antigen, whereas patients with a noncardiac acute-phase response showed elevation of all four proteins. Elevated PAI-1 activity in the absence of elevations in other acute-phase proteins suggests an intrinsic increase in PAI-1 secretion in the post-myocardial infarction group. In addition, when compared with healthy control subjects, post-myocardial infarction patients had higher levels of total t-PA antigen (bound and free t-PA) but lower t-PA activity and a lower percentage of active t-PA. Overall, survivors of myocardial infarction have reduced t-PA activity and increased PAI-1 activity that is not due to a prolonged acute-phase response. |
8042596 | A method to examine the need for duplicate testing of common coagulation tests. | A statistical protocol for evaluating the need for duplicate coagulation testing was developed. It requires at least 32 sets of duplicate prothrombin times or partial thromboplastin times over the expected range of results. In addition to the statistical procedures, clinical evaluation of the duplicates is required. |
8042595 | Effect of analytic uncertainty of conventional and point-of-care assays of activated partial thromboplastin time on clinical decisions in heparin therapy. | The authors assessed the capability of assays of activated partial thromboplastin time (aPTT) for supporting clinical decision algorithms for heparin therapies of varying complexity. Blood samples were collected prospectively in three explicit management strategies from 100 sequential patients for whom heparin dosage was adjusted for therapeutic monitoring, femoral venous sheath removal after cardiac catheterization, or heparinization after thrombolytic therapy. In two- and three-way decision algorithms, conventional and point-of-care aPTT assays agreed with heparin assays in approximately two thirds of cases, and the two aPTT assays agreed in 80% or more of all cases. In six-way decision algorithms, the two aPTT assays agreed in only about half of all cases. The authors conclude that the reliability of point-of-care aPTT assays is similar to that of conventional assays. Both techniques can support two- and three-way decision algorithms but not some more complex patient classifications. |
8042594 | B-cell precursor bone marrow reconstitution after bone marrow transplantation. | Bone marrow transplantation is characterized by a prolonged period of humoral immunodeficiency in which many patients have abnormal circulating B-cell subsets, and oligoclonal and monoclonal gammapathies. In this study we examine B-cell precursor reconstitution in the post-transplantation marrow. Within 1 month after transplantation there is a marked increase in the percentage of immature B cells (to 80% of marrow lymphocytes), which can persist for more than 1 year. The increase in B-cell precursors is seen in both adults and children and appears to be independent of age. These cells have a normal precursor B-cell surface antigenic phenotype (CD19+, CD10+, CD20 negative to dim) and generally express very little CD34. No monoclonal or oligoclonal immunoglobulin gene rearrangements are detected in these cells, which enables them to be easily distinguishable from common precursor B-cell acute lymphocytic leukemia lymphoblasts. |
8042593 | Flow-cytochemical differential leukocyte analysis with quantitation of neutrophil left shift. An evaluation of the Cobas-Helios analyzer. | The Cobas-Helios (Roche Diagnostic Systems, Inc., Branchburg, NJ) is a new, fully automated hematology analyzer that performs a complete blood count and differential leukocyte count (DLC), classifying leukocytes by flow-cytochemical technology. The DLC component of the Cobas-Helios was evaluated according to the National Committee for Clinical Laboratory Standards H20-A protocol. Instrument performance was acceptable with respect to all parameters investigated, including imprecision, inaccuracy and clinical sensitivity for the identification of quantitative and qualitative leukocyte abnormalities. In a minority of samples with neutrophil left shift, neutrophils tended to overlap the monocyte domain, resulting in overestimation of monocytes and underestimation of neutrophils. This problem did not affect clinical sensitivity and was generally associated with a positive instrumental left-shift flag. Flags for the identification of specific qualitative abnormalities of the leukocyte population (atypical lymphoid cells, nucleated red cells, blast cells, immature granulocytes and neutrophil left shift) performed well. In addition to a conventional five-part DLC, the Cobas-Helios also identifies and quantitates atypical lymphoid cells and "large immature cells," the latter corresponding to bands and immature granulocytes. Counts of atypical lymphoid cells and large immature cells correlated well with the equivalent cell classes as enumerated by the reference method of the National Committee for Clinical Laboratory Standards. The Cobas-Helios offers the most reliable quantitative index of neutrophil left shift currently available in a commercial automated DLC analyzer. |
8042592 | Hydration of red cells in alpha and beta thalassemias differs. A useful approach to distinguish between these red cell phenotypes. | Differences in the pathobiologic features of alpha and beta thalassemic red cells include differing derangements in the ability of these cells to regulate their volume. To explore differences in cell hydration in these two red cell phenotypes, heterogeneity in hemoglobin concentration of individual red cells was quantitated. Red cells from 91 patients with alpha thalassemia (hemoglobin H disease) and 69 patients with beta thalassemia of the genotype beta-thal zero/Hb E were analyzed. Marked differences between these thalassemias were noted in the heterogeneity of hemoglobin concentration among individual cells. Decreased cell hemoglobin concentration and increased cell hydration were features of alpha-thalassemic blood samples, whereas both decreased and increased cell hemoglobin concentration as a result of cell hydration and dehydration, respectively, were features of beta-thalassemic blood samples. The documented differences in the hemoglobin concentration distributions should prove useful in distinguishing between the two thalassemic phenotypes. |
8042591 | CD8-positive B-cell chronic lymphocytic leukemia. A report of two cases. | Most B-cell chronic lymphocytic leukemias and a small normal subset of B lymphocytes express the T-cell-associated CD5 antigen; expression of other T-cell antigens has been reported only rarely. The authors report two cases of typical B-cell chronic lymphocytic leukemia, seen during 1 year, in which two-color flow cytometric analysis documented expression of the T-cell-associated CD8 antigen by the monoclonal B cells. Genotypic studies showing immunoglobulin but not T-cell-receptor gene rearrangements confirmed the B-cell origin of the neoplastic cells. The true frequency of the CD8-positive B-cell chronic lymphocytic leukemia, any clinical implications, and the possibility of a normal subset of CD5-positive CD8-positive B cells remain to be determined. |
8042590 | Hematogones in the bone marrow of adults. Immunophenotypic features, clinical settings, and differential diagnosis. | Hematogones (HGs) comprise a B-lineage lymphoid precursor cell population in the bone marrow (BM) that may simulate acute lymphoblastic leukemia or lymphoma. Increased numbers of HGs have been noted in children, but few reports describe their occurrence in adults. We identified 13 adult patients with significant numbers of BM lymphoid cells with the morphologic and immunophenotypic features of HGs. Common features in these patients included (1) presence of small numbers of lymphoid cells in the BM aspirate with morphologic features of HGs; (2) absence of cytologic atypia or abnormal localization of lymphoid cells in the BM biopsy; (3) absence of abnormal morphology or CD10 (common acute lymphoblastic leukemia antigen) expression in circulating lymphocytes; (4) normal BM karyotype; (5) persistence of cytopenia(s) without apparent cause, often for a prolonged period of time; and (6) no evidence of neoplastic marrow involvement, confirmed by clinical follow-up. Flow cytometry demonstrated surface expression of CD10, CD19, a lower percentage of CD20, minimal expression of CD22, and limited but polyclonal immunoglobulin light chain. Nine patients had received previous immunosuppressive therapy or BM transplantation or both, seven for hematolymphoid neoplasia. However, four patients with cytopenias of unknown etiology had no antecedent history of malignancy or marrow suppressive therapy. These findings demonstrate the clinical, morphologic, and immunophenotypic features of HGs in adults, and emphasize the difficulty in distinguishing these cells from residual marrow blasts after chemotherapy. |
8042589 | Plasma cell-rich thymoma. | A thymoma in the anterior mediastinum of a 49-year-old woman was histologically remarkable for the presence of a prominent plasma cell stromal component surrounding the neoplastic epithelial elements. Polyclonal immunoreactivity for kappa and lambda light chains was obtained by immunocytochemical staining of the plasma cells in the stroma. Although no evidence of myasthenia gravis or other type of autoimmune process could be demonstrated at the time of initial diagnosis, a polyclonal hypergammaglobulinemia of unknown cause subsequently developed in the patient. This case may represent an extreme example of aberrant immunologic modulation of the thymus to an autoimmune process with massive hyperplasia of the B-cell compartment of the gland. |
8042588 | A simplified multitissue block. | Multitissue blocks are rapidly gaining acceptance as useful control materials for the immunohistochemistry laboratory. Moreover, they may be conveniently and economically used to screen antibodies and optimize the assay conditions. Several schemes of preparation of multitissue blocks have been proposed. The author describes an improved method for preparing multitissue blocks; this method requires no special equipment or skills. |
8042587 | Association of gastric metaplasia and duodenitis with Helicobacter pylori infection in children. | Helicobacter pylori infection causes chronic-active gastritis and is associated with peptic ulceration. However, the link between gastric H pylori colonization and duodenal ulcers is not well understood. Therefore, a retrospective, case-controlled study was conducted to determine whether H pylori infection is associated with gastric metaplasia and mucosal inflammation in the duodenum. Biopsy specimens from the duodenal bulb were obtained from 31 of 47 children with H pylori-induced gastritis. Two control groups, matched for age and sex, consisted of 33 children with normal antral histologic evaluation and 33 with H pylori-negative gastritis. Coded duodenal sections were stained with periodic acid-Schiff, hematoxylin-eosin, and silver to examine for gastric metaplasia, mucosal inflammation, and Helicobacter-like organisms, respectively. Thirteen of 31 (42%) H pylori-infected children had gastric metaplasia, in contrast to 1 of 33 with normal histologic characteristics (P < .0001) and 2 of 33 with H pylori-negative gastritis (P < .001). H pylori was detected overlying ectopic gastric mucosa in only 2 of 13 cases. Duodenal ulcers were identified endoscopically in 10 of 13 children with gastric metaplasia and 9 of 18 H pylori-infected subjects without metaplasia (P = NS). Twenty-four of 31 (77%) children with H pylori gastritis had duodenitis compared with 4 of 33 (12%) with H pylori-negative gastritis (P < .001) and 2 of 33 (6%) with a normal antrum (P < .001). Duodenitis was present in 14 of 19 children with H pylori infection and duodenal ulcers and 10 of 12 infected patients without mucosal ulceration (P not significant). These findings demonstrate a higher frequency of both gastric metaplasia and mucosal inflammation in the proximal small intestine of H pylori-infected children. However, there was a lack of correlation between the presence of duodenal ulceration and both gastric metaplasia and duodenitis. |
8042586 | Toward objective quality assurance in cervical cytopathology. Correlation of cytopathologic diagnoses with detection of high-risk human papillomavirus types. | Using The Bethesda System, five pathologists independently diagnosed 200 smears that originally had been classified as "atypical," and the results were correlated with concurrent detection of human papillomavirus (HPV) DNA by Southern analysis and by polymerase chain reaction amplification. The smears were reclassified as benign reactive changes (negative), atypical squamous cells of undetermined significance, or squamous intraepithelial lesion (SIL). Exact five-way cytologic agreement was achieved in only 29% of smears, and no slide was diagnosed as atypical squamous cells of undetermined significance by all reviewers. The detection of high-risk types of HPV correlated strongly with the likelihood of a diagnosis of squamous intraepithelial lesion. High-risk HPV types were detected in approximately 60% of smears reclassified as squamous intraepithelial lesion compared with 30% of those reclassified as atypical squamous cells of undetermined significance and 10% of negative smears (P < .001). Every smear unanimously diagnosed by the panel as squamous intraepithelial lesion was associated with detectable HPV DNA, mainly of high-risk types. Low-risk HPV DNA types were found with similar frequency in all diagnostic categories assigned by the reviewers. Based on the consistent relation between high-risk HPV detection and diagnoses according to the Bethesda System, the authors conclude that HPV testing may have an important role in quality assurance in cervical cytopathology. |
8042585 | Hepatic neoexpression and increased plasma levels of Lewis Y, a carbohydrate antigen, in chronic inflammatory liver diseases. | The clinicopathologic relevance of the hepatic expression of Lewis Y (Le(y)), a carbohydrate antigen, and its plasma levels was studied in benign and malignant liver diseases. Tissue and plasma antigens, respectively, were determined with an avidin-biotin-peroxidase complex method and a radioimmunoassay using monoclonal antibody AH6. Normal liver cells and bile ductules did not express Le(y). In the inflammatory tissues, the liver cells and proliferated bile ductules expressed Le(y). The strongest expression by the liver cells was observed in chronic active hepatitis with severe activity and that by the ductules in liver cirrhosis. Only 1 of 16 hepatocellular carcinomas expressed Le(y). The plasma levels of Le(y) increased significantly but nonspecifically in chronic persistent hepatitis, chronic active hepatitis, liver cirrhosis, and hepatocellular carcinomas. It was concluded that (1) Le(y) is an inflammation-associated but not a cancer-associated antigen; (2) the more the tissue damage advances, the more the antigen is expressed; and (3) hepatic and plasma Le(y) are, however, nonspecific markers of necroinflammatory liver diseases. |
8042584 | Quantitative growth fraction evaluation with MIB1 and Ki67 antibodies in breast carcinomas. | Ki67 and MIB1 monoclonal antibodies are directed against different epitopes of the same proliferation-related antigen. Whereas Ki67 works only on frozen sections, MIB1 may be used also on fixed sections. The authors immunostained a series of 40 breast carcinomas with MIB1 and Ki67 antibodies on serial frozen sections and on fixed material. The Ki67 labeling index (LI) was 12.9 +/- 8.9 and 12 (mean +/- SD and median, respectively). MIB1 LI was 21.2 +/- 11.9 and 19.5 on frozen sections and 24 +/- 15.2 and 21.5 on fixed sections (mean +/- SD and median, respectively). Ki67 LI and MIB1 LI on frozen and fixed sections were strictly correlated (P < .001). The results are in keeping with the reported coincidental nuclear staining pattern of Ki67 and MIB1, but the mean and median values of MIB1 LI are almost twice the values of Ki67 LI. The cut-off values to define high and low proliferative activity with the two antibodies are therefore different. The differences in immunolabeling may be due to better survival of the MIB1 epitope in freezing and acetone fixation or to differing accessibilities of the MIB1 and Ki67 epitopes during the cell cycle due to molecular conformational modifications. The MIB1 monoclonal antibody is a reasonable substitute for the Ki67 monoclonal antibody. The advantages of MIB1 immunostaining on paraffin sections include the feasibility of retrospective studies and of obtaining clear morphologic specimens that are optimal for use with computer-assisted image analysis systems. Our image-processing system allows automatic nuclear counting, detects positive nuclei and measures their staining intensity. |
8042583 | Immunohistochemical detection of neuroblastomatous foci in composite adrenal pheochromocytoma-neuroblastoma. | To determine if immunohistochemistry might aid in the identification of neuroblastomatous foci in composite adrenal tumors, the authors analyzed two examples of composite adrenal pheochromocytoma-neuroblastoma, 18 pure pheochromocytomas, and six pure neuroblastomas using peanut agglutinin and a panel of antibodies directed against neuroendocrine and neural-associated antigens. Pure pheochromocytoma had the following immunopositivity: vimentin 14/18, chromogranin 18/18, synaptophysin 18/18, S100 protein 0/18 (tumor cells), neurofilament 14/18, J1 beta-tubulin (J1) 18/18, microtubule-associated protein-2 13/18, glial fibrillary acidic protein 13/18, and peanut agglutinin 17/18. Pure neuroblastoma reacted positively as follows: vimentin 0/6, chromogranin 5/6, synaptophysin 4/6, S100 protein 0/6 (tumor cells), neurofilament 5/6, J1 6/6, microtubule-associated protein-2 6/6, glial fibrillary acidic protein 1/6, and peanut agglutinin 6/6. Each component of both composite tumors reacted similarly to the pure neoplasms. Although the frequency of positive staining was similar for pheochromocytoma and neuroblastoma, the intensity and pattern differed for several antigens. Pheochromocytoma was diffusely positive for synaptophysin and chromogranin, whereas staining was focal and punctate in neuroblastoma. Microtubule-associated protein-2, J1, and neurofilament antibodies highlighted the fibrillar background of neuroblastoma, which pheochromocytoma lacked. Pheochromocytoma contained focal, ball-like immunoreactivity for glial fibrillary acidic protein and vimentin, which was absent in neuroblastoma. These immunohistochemical distinctions can assist the clinically important recognition of neuroblastomatous foci in composite adrenal pheochromocytoma-neuroblastoma. |
8042582 | Biologic significance of quantitative estrogen receptor immunohistochemical assay by image analysis in breast cancer. | The authors assayed 209 stage I and II mammary carcinomas for the estrogen receptor (ER) with an immunocytochemical assay (ICA) and quantitated the nuclear stain with the SAMBA 4000 Cell Image Analysis System (Imaging Products International, Inc., Chantilly, VA). The cases had been followed for 54-214 months (average, 64 months). The results were correlated with the patients' overall and disease-free survival times. Three of the parameters obtained from the quantitative analysis were evaluated: labeling index, mean optical density, and quick score. Statistical analysis was performed with the Kaplan-Meier product limit estimator for quantitated values and Cox regression for risk of mortality and disease progression. Mean optical density of the nuclei at a cut-off value of 10 produced the strongest association between quantitative ERICA and overall and disease-free survival times in discriminating high- and low-risk groups (P = .016 and P = .018, respectively). When the mean optical density results were categorized into ranges of values of potential biologic significance according to overall survival times, patients with mean optical density greater than 15 were found to be at lowest risk; patients with values between 5 and 15 had a statistically significant intermediate risk; and the group with values less than 5 had the worst outcome (P = .018). The probability of disease-free survival also was statistically significant (P = .038) among the three groups with cut-off points of less than 10, 10-35, and greater than 35. These results showed that quantified optical density has better discriminating power for risk prediction than that obtained by the biochemical assay for ER at a cut-off value of 10 or 20 fmol/mg. Estrogen receptor ICA has been adequately shown to be as or more accurate than ligand-binding assays. Our results corroborate those studies and support the utility of ICA assays for ER by showing that quantitation performed by image analysis is an objective and reproducible method yielding clinical prognostic information of higher reliability than that given by the dextran-coated charcoal ER assay. |
8042581 | Histologic grade of locally advanced infiltrating ductal carcinoma after treatment with induction chemotherapy. | Multiagent chemotherapy is often used to treat patients with locally advanced infiltrating breast carcinoma before mastectomy. One of the most important prognostic factors, histologic grade, may be altered by induction chemotherapy. Because locally advanced infiltrating breast carcinomas are frequently diagnosed by fine-needle aspiration, histologic grade can be determined in the mastectomy specimens only after chemotherapy. Histologic grade, with its three components, was examined in 30 mastectomy specimens after induction chemotherapy for infiltrating ductal carcinoma and compared with findings in available pretreatment incisional biopsy specimens. Histologic grade for the 24 axillary lymph node-positive carcinomas treated with induction chemotherapy was compared with the grade for 24 axillary lymph node-positive ductal cancers that had been treated by surgery only. Complete, partial, or no clinical response was seen in 4 (13%), 21 (70%), and 5 (17%) patients after chemotherapy. In six of seven tumors, there was complete agreement between biopsy and postchemotherapy mastectomy specimens in grade and in scores for the three components. Half of the 24 node-positive tumors from patients treated with chemotherapy and 21% of node-positive neoplasms from patients treated initially with surgery had a mitotic count score of 1. In these two node-positive groups, 71% of tumors from patients treated with surgery and 92% of cancers from patients treated with induction chemotherapy showed a nuclear pleomorphism score of 3. For these two groups, however, there were no statistically significant differences in histologic grade or in any of its three components. |
8042575 | Oral cephalosporins: newer agents and their place in therapy. | Cefprozil, cefpodoxime and loracarbef are three new oral cephalosporins available for the treatment of common community-acquired infections. They share with other cephalosporins a low incidence of side effects and offer the convenience of twice-daily dosing. These agents can be considered effective, although expensive, alternatives to traditional antibiotics in the treatment of skin, respiratory tract and urinary tract infections. Oral cefpodoxime offers an alternative to intramuscular antibiotics in the treatment of uncomplicated gonorrhea. |
8042574 | Heat emergencies. | Heat emergencies occur when the body is unable to adequately dissipate heat. Hyperthermic patients should be cooled immediately with a lukewarm-water spray and cool moving air. Patients with heat exhaustion respond well to administration of intravenous fluids. Patients with heatstroke have a complete loss of thermoregulation, a core temperature greater than 40.5 degrees C (105 degrees F) and impaired mental status. These critically ill patients must be cooled quickly to 39 degrees C (102 degrees F) to avoid devastating complications. Intensive care monitoring and support are indicated. To reduce the risk of heat injury in hot weather, frail and elderly persons must maintain hydration and may need to consider alternate living arrangements. Laborers, athletes and military personnel benefit from gradual acclimation to the heat, increased fluid intake, vapor-permeable clothing and frequent rest periods. |
8042573 | Indoor racquet sports injuries. | Family physicians can care for most patients injured while participating in indoor racquet sports. However, patients with injuries to the eye usually require ophthalmologic referral. The most common injuries that occur in persons participating in indoor racquet sports include contusions, sprains and strains, lacerations, eye injuries, bursitis and tendinitis. Musculoskeletal injuries that merit special consideration include lateral epicondylitis, DeQuervain's tenosynovitis, wrist intersection syndrome, patellar pain syndrome, meniscal injuries, Achilles tendinitis and plantar fasciitis. The family physician plays a critical role in providing patients with information about preventive measures. |
8042572 | Cervicography--an adjunct to Papanicolaou screening. | Cervicography is a technically simple screening test for cervical abnormalities and can be used in conjunction with the Papanicolaou test. Cervicography may be performed by both physicians and paraprofessionals; experience in colposcopic techniques is not required. A significantly greater percentage of premalignant disease is detected when cervicography is used in conjunction with the Pap smear than when the Pap smear is used alone. Cervicography may also be used as an effective intermediate triage test to evaluate women with atypical findings on Pap smear. |
8042569 | Thyroid disease in children. | Among thyroid diseases occurring in children are congenital hypothyroidism, acquired hypothyroidism, Graves' disease, subacute thyroiditis and thyroid nodules. Evaluation for suspected hypothyroidism or hyperthyroidism can be accomplished efficiently with a serum free thyroxine level and the new, highly sensitive thyroid-stimulating hormone assays. Rarely, measuring various thyroid antibody titers may be required to better define a particular thyroid disease. Solitary thyroid nodules in children occasionally represent malignancy. Evaluation of such lesions with radioisotope scanning and ultrasonography is helpful. In children, however, surgical excision is still required to definitively determine whether a nodule is malignant. |
8042568 | Erythema infectiosum and other parvovirus B19 infections. | The human parvovirus B19 has been identified as the causative agent in several diseases, including the benign childhood condition erythema infectiosum (fifth disease), a polyarthropathy that occurs in adults, aplastic crisis and hydrops fetalis. The virus has also been associated with numerous other hematologic, neurologic and rheumatic conditions. Except for the potential of neonatal death due to fetal hydrops, the prognosis of patients with parvovirus infection is generally good. The diagnosis of B19 infection may be established on clinical grounds but often requires confirmation with serum antibody testing. Treatment strategies may include supportive care, analgesic medications, transfusions with red blood cells or administration of intravenous immunoglobulin, depending on the clinical circumstances. |
8042567 | Photodamage, photoaging and photoprotection of the skin. | Overexposure to ultraviolet and visible radiation causes sunburn. Aspirin and other nonsteroidal anti-inflammatory drugs, cool baths and topical steroids offer only mild relief. Long-term sun exposure causes chronic inflammatory skin changes. Photodamage, rather than the normal aging process, may account for 90 percent of age-associated cosmetic skin problems. Physicians should stress to their patients that all ultraviolet exposure (including sun beds and tanning salons) causes skin damage. Regular sunscreen use during childhood and adolescence may result in an 80 percent reduction in the lifetime incidence of ultraviolet-induced skin damage, including nonmelanoma skin cancers. |
8042561 | Peri-operative changes of cellular and humoral components of immunity with brain tumour surgery. | Nosocomial infections, which are not uncommon in neurosurgical intensive care medicine, may possibly be favoured by an impairment of immunological competence of the patient. In a prospective observational trial, we investigated several parameters of cellular and humoral immunity in 32 patients before and after resection of an intracranial tumour. We quantified the effects of operative procedure, dexamethasone pretreatment, and tumour type. Dexamethasone alone causes an increase of neutrophilic granulocyte count and monocytes, whereas IgG and eosinophilic granulocytes decrease as well as lymphocytes. CD4+ T lymphocytes (T helper cells) and CD8+ T lymphocytes (T cytotoxic/suppressor cells) were more severely affected than B lymphocytes. Dexamethasone and operation in combination act synergistically on T lymphocytes and IgG, while no synergism is obvious in other clinical test parameters. The skin sensitivity reaction was depressed accordingly. With intracerebral tumours (gliomas WHO grades II to IV), levels of T helper cells and eosinophilic granulocytes were lower, and levels of IgM and neutrophilic granulocytes were higher than with benign extracerebral neoplasms. Postoperative nosocomial infections of the lower respiratory tract occurred almost exclusively in patients subject to severe depression of T helper cells. |
8042560 | Leptomeningeal dissemination of malignant gliomas. Incidence, diagnosis and outcome. | To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem. Eleven patients had neurological deficits due to dissemination, whereas the other 9 without these had CT or myelographic evidence of dissemination. The peak incidence of dissemination was seen in the first and second decades of life. The mean age of 22 patients with dissemination was 31 years, significantly lower than that (44.5 years) of patients without dissemination. Fifteen patients developed dissemination within one year after diagnosis (early dissemination), 60% of them were less than 30 years of age. All patients with late dissemination (more than one year after diagnosis) underwent a second craniotomy for tumour removal before dissemination, while none of the 15 patients with early dissemination did. Survival after diagnosis in patients with dissemination was shorter, although statistically not significant, than that of patients without dissemination. Survival after dissemination was limited in all patients (mean 19 weeks, range 2-39 weeks). Immunohistochemical study revealed that the disseminated tumour expressed less glial fibrillary acidic protein than the primary tumour. Our results suggest that dissemination does not seem to result from extended survival of the patients, but may occur at any time in malignant gliomas. Some malignant gliomas, especially in younger patients, have a capability to acquire biological characteristics suitable for dissemination in the earlier stage of the disease. |
8042559 | Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas. | A series of 12 patients with tectal plate gliomas, is presented treated by direct surgery. Mean age was 19 years. All patients presented with signs of raised intracranial pressure and supratentorial hydrocephalus on CT scan. Diplopia was the most common local sign. CT scan and MR imaging showed 4 intrinsic, 6 exophytic, and 2 ventrally infiltrating tectal tumours. The histological diagnosis was low-grade astrocytoma in 7, high-grade astrocytoma in 2, oligodendroglioma in one, oligo-astrocytoma in one, and ependymoma in one case. The suboccipital supra- and transtentorial approach was used in every cases. Tumour resection was generous at the level of the superior colliculi, but on the contrary, resection was limited at the level of inferior colliculi due to the auditory risk. Tumour removal was total (macroscopically) in 9 cases and partial in 3 cases. There were 4 surgical complications and one death related to surgery. Parinaud's syndrome was the most-common postoperative sequelae. Auditory hallucinations and the acoustic neglect syndrome were seen once. In three cases additional radiotherapy and chemotherapy were given once with severe sequelae. The treatment of tectal plate gliomas is controversial. The role of different therapeutic options remains open. We consider the tectal plate as a relatively safer territory for surgery than the ventral part of the midbrain. The brain stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) monitoring can help to determine the appropriate limit of surgery. |
8042558 | Facial nerve reconstruction in neurofibromatosis 2. | Between 1979 and 1989, 13 patients with neurofibromatosis 2 underwent reconstructions of the facial nerve after removal of bilateral acoustic or facial neurinomas. Seven patients received hypoglossal-facial nerve anastomosis, and five received sural nerve grafting in the cerebellopontine angle. End-to-end anastomosis and intracranial-intratemporal sural grafting were performed for one patient each, respectively. Re-innervation was seen in all cases. The results were good in 11 cases. Two patients presented with poor results due to development of neurinomas close to the site of the nerve reconstruction. The importance of reconstructive surgery in patients with neurofibromatosis is stressed. The problems regarding failure of re-innervation in some cases and difficulties in their management are discussed. |
8042557 | High sensitivity of the in vivo detection of somatostatin receptors by 111indium (DTPA-octreotide)-scintigraphy in meningioma patients. | The recent availability of isotope-labelled somatostatin analogues has allowed one to detect somatostatin receptors in normal tissue as well as in endocrine or non-endocrine cranial tumours. The purpose of the present study was to establish the value of somatostatin receptor scintigraphy using an 111Indium-labelled somatostatin analogue, octreotide, in the diagnostic work-up of meningioma patients. Twenty-two patients (16 women, 6 men, aged from 19-70 years) with newly diagnosed, residual or recurrent cranial meningiomas were examined. 111Indium-labelled DTPA-octreotide was injected i.v.. Planar and tomographic images were obtained with a gamma camera 4-6, and 24 hours after injection. In all of the meningiomas studied a high density of somatostatin receptors was detected by scintigraphy. No false negative test result was found. Due to this, a 100% predictive value of a negative test was calculated. However, when the tumours were taken in culture differing staining intensity could be seen in the light- and electron microscopic level even on individual cells of a single culture when silver intensified somatostatin-gold was used as ligand. We conclude, that in vivo somatostatin receptor scintigraphy may aid in the pre-operative differential diagnosis of skull base tumours. |
8042556 | Prognostic implications of meningiomas in the elderly (over 70 years old) in the era of magnetic resonance imaging. | During the 5 years from 1987 to 1991, 89 elderly patients, aged 70 years and over, were admitted to departments of neurosurgery in Yamaguchi prefecture with meningioma. The clinical features and prognostic implications of meningioma in the elderly were assessed retrospectively. Seventy-eight (88%) of the 89 patients underwent surgery, which was a higher rate than has been previously reported. The length of clinical history was also shorter than in previous studies, and was partly due to the recent introduction of magnetic resonance imaging (MRI). The incidence of poor prognosis (severe disability, vegetative or dead) in the elderly and a younger group aged less than 70 years was 13% and 7%, respectively, but the difference was not statistically significant. In the surgically treated elderly group, age did not influence the patient's outcome. The factors affecting the outcome were pre-operative neurological deficit (p < 0.05), histological malignancy (p < 0.05), and multiple operations (p < 0.05). Twenty-seven of the elderly meningioma patients were in good physical condition with minimal neurological involvement. They underwent total removal of the tumour at the first operation, and the histological diagnosis was benign. Twenty-five of these 27 patients fell into the best outcome category. Therefore, age alone was not a factor preventing proper surgical treatment of meningioma in the elderly. |
8042555 | Intracranial meningiomas: analysis of recurrence after surgical treatment. | Recurrence of intracranial meningiomas after surgery has long been recognized, but there is still no consensus about factors responsible for recurrence. To better understand such factors, we analysed data on 276 patients with meningiomas who were treated at our institution from 1976 to 1990 (mean follow-up = 5.1 years). Effects of sex, tumour histology, tumour site, and radiotherapy on recurrence were closely studied. Using World Health Organization criteria to define malignancy, 254 of the tumours were benign and 22 were atypical or malignant. For data analysis, distinction was made between "recurrence"(i.e., reappearance of tumour after total resection) and "regrowth" (i.e., tumour enlargement after subtotal removal). Recurrence was seen in 2 of 183 benign meningiomas and in 10 of 16 malignant meningiomas. Recurrence and regrowth rates for malignant meningiomas far exceeded those for benign meningiomas (p = 0.001). Neither sex nor tumour site was associated with subsequent recurrences in patients whose tumours had been completely resected. The influence of radiotherapy was studied in terms of its effects on benign versus malignant meningiomas, whether given after complete or incomplete resection, and whether given after primary resection or on reoperation. We found that radiotherapy did not decrease "recurrence" or "regrowth" regardless of when administered, either at first resection or on recurrence. This was true for benign as well as malignant meningiomas. However, due to the small number in our series, we cannot conclude that radiotherapy has no beneficial role in the treatment of meningiomas.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042554 | Exostosis of the posterior clinoid process. | We report an unusual case of exostosis arising from the lateral aspect of the posterior clinoid process. Its presence should be considered in approaching the parasellar regions. |
8042553 | Malpositioned endolymphatic subarachnoid shunt causing trigeminal neuralgia: case report. | A case is presented of a 64-year-old female with a fifteen year history of right facial pain. The last nine years the facial pain is described as an intense, stabbing pain in the maxillary division of the right trigeminal nerve. The patient had Meniere's Disease for which an endolymphatic subarachnoid shunt was placed fifteen years prior. The patient underwent intensive medical and several surgical therapies for pain. Some of the procedures were initially successful but none provided lasting relief. Because of severe recurrent right facial pain, the patient underwent a right open partial rhizotomy of the trigeminal nerve via a retrosigmoid approach. Intraoperative findings included the end of the endolymphatic subarachnoid shunt in association with the trigeminal nerve roots. The end of the shunt was removed at the time of surgery. Postoperatively the patient has been pain free for thirty months. It is proposed a malpositioned or migrated endolymphatic subarachnoid shunt may be a cause of trigeminal neuralgia. |
8042552 | A combined extradural-posterior petrous and suboccipital approach to the jugular foramen tumours. | An approach which improves on the conventional suboccipital craniectomy was used to explore a jugular foramen, a hypoglossal neurinoma, and a tentorial meningioma. A postero-medial mastoidectomy supplemented by the conventional suboccipital craniectomy made it possible to expose the entire sigmoid sinus. Subsequent medial retraction of the exposed sigmoid sinus and continuous dura mater and the extradural removal of petrous bone around the jugular foramen exposed the whole extracranial portion of the tumours. The tumours were totally removed by this approach in which the extradural route corresponded to the extracranial portion of the tumours and the suboccipital route to the intracranial portion. Facial nerve and hearing disturbances, which are frequent complications of the previous approaches, did not occur in our cases. Providing adequate exposure with simple surgical procedures and showing no adverse postoperative sequelae, this approach is most suitable for surgery upon jugular foramen tumours with extracranial extension. |
8042551 | Glycosphingolipid component profiles of human gliomas correlate with histological tumour types: analysis of inter-individual and tumour-regional distribution. | Three types of glycosphingolipid (GSL) component profiles have been established for human intracranial gliomas. GSL-type I shows only Glac- and lacto-series-sialoglycolipids. Type II consist of Glac- and Gtri-gangliosides, whereas only GSL-type III contains sulphatide and, as a major neutral glycolipid, galactocerebroside, besides gangliosides of the Glac-, Gtri-, and Gtet-families. Whole gliomas of malignancy grading I/II, III and IV, display GSL-Types III, II, and I, respectively. Thus, the GSL component distribution of the samples taken after surgery from three individual gliomas and two biopsies correlate closely with the general diagnosis of these tumours. Arthrobacter ureafaciens sialidase was used for the characterization of gangliosides. GSL-type analysis of multiple regional samples, taken from necropsy and biopsy, were determined by microanalysis of microscopic cryostat section, and shown to be in good agreement with their histology. The results validate the relevance of tumour ganglioside analysis for the characterization and diagnosis of gliomas. |
8042550 | The effect of Nicorandil on chronic cerebral vasospasm. | The present study is aimed at examining the therapeutic effect of Nicorandil on chronic vasospasm using beagle dogs subjected to a "two-haemorrhage" insult, as well as its dilatory effect on the PDA [phorbol-12,13 diacetate]-induced contraction of the canine basilar artery. 1. A total of 12 animals of either sex, weighing 7 to 12 kg, were assigned into saline control and Nicorandil-treated groups. Immediately after the second induction of subarachnoid haemorrhage (SAH), animals started to receive the agent via the venous route at the constant rate of 10 micrograms/kg/minute for six hours (day 3). On days 4, 5, and 6, the drug was given twice at the same rate for three hours. After the final angiograms, animals were sacrificed by exsanguination. 2. Using ring specimen of the canine basilar artery at a resting tension of 3 g, isometric tension was monitored to examine the effect of Nicorandil on PDA induced contraction. Nicorandil significantly ameliorated chronic vasospasm and inhibited PDA-induced contraction in a dose-dependent fashion. The present data indicate that Nicorandil provides a useful way of treating chronic vasospasm after SAH. |
8042549 | Immunogenicity and regenerative potential of acellular nerve allografts to repair peripheral nerve in rats and rabbits. | This study describes the ability of acellular nerve allografts (genetically different) to repair injured peripheral nerve in rats and rabbits. We recently reported the regeneration supporting potential and immunogenicity of acellular nerve allografts in rats. The present study extends our previous work and quantitates the extent of axonal regeneration through various nerve grafts in rats. In addition, the use of longer nerve grafts to repair rabbit peripheral nerve is described. Inbred strains of Fischer and Buffalo rats and New Zealand white and Dutch rabbits were used. Acellular grafts were prepared by repeated freezing and thawing of in situ degenerated nerves. Non-frozen predegenerated nerves were used as cellular grafts for comparison. Nerve isografts (genetically identical) were also performed. The graft length was 2.0 cm in rats and 4.0 cm in rabbits. In both rats and rabbits the cellular isografts showed the most rapid regeneration and target muscle innervation. The cellular allografts were invariably rejected and only showed limited regeneration. In contrast, acellular allografts, in spite of their mild immunogenicity, allowed significant regeneration through them. It is concluded that acellular nerve allografts are capable of supporting axonal regeneration because of their reduced immunogenicity, and thus can be used to bridge nerve gaps after nerve injury. |
8042548 | Facial nerve demyelination and vascular compression are both needed to induce facial hyperactivity: a study in rats. | It is generally assumed that hemifacial spasm (HFS) is caused by vascular compression of the facial nerve at the root exit zone (REZ), but the mechanism for the development of HFS is not known. Evidence has been previously presented that the signs of HFS are caused by hyperactivity of the facial motonucleus that is caused by the irritation to the facial nerve from the vascular contact. This assumption has been supported by the finding that daily electrical stimulation of the facial nerve in the rat facilitates the development of an abnormal muscle response that is a characteristic sign of HFS in man and is an indication of an abnormal cross-transmission that makes it possible to elicit a contraction of muscles innervated by one branch of the facial nerve by electrically stimulating another branch of the facial nerve. In the present study we show that close contact between a peripheral branch of the facial nerve and an artery also facilitates the development of an abnormal muscle response, but only if the facial nerve has previously been slightly injured (by a chromic suture) at the location of the arterial contact. We also show that blocking neural conduction in the facial nerve proximal to the artificial vascular compression abolishes the abnormal muscle contraction, which supports the assumption that the anatomical location of cross-transmission that is causing the abnormal muscle response is central to the vascular compression, most likely in the facial motonucleus. These findings may explain why the facial nerve is only susceptible to vascular compression near its REZ, where an injury to its myelin is more likely to occur than where the nerve is covered with schwann cell myelin. |
8042547 | Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence. | Sixty-one patients with trigeminal neuralgia who underwent microvascular decompression were analysed. Vascular compression of the trigeminal nerve root was found in all cases. The recurrence rate of pain in this series was 18% with an average follow-up of 80 months (range: 13 to 126 months). Ten patients developed recurrence of their trigeminal neuralgia during follow-up. Fifteen factors, including the clinical and operative findings in the pain-free patients versus the 10 patients with recurrence were analysed. Only the patients with venous compression singly or in combination with arteries were significantly related to recurrence. There was no relationship between recurrence and the duration of symptoms or the degree of compression. Based on vascular compression as the sole cause of TN, the results and interesting findings can not be explained. With reference to the hypothesis that vascular compression is only one of at least two causative factors for the development of trigeminal neuralgia, it is suggested that the intrinsic lesion in trigeminal neuralgia may be responsible for late recurrence. |
8042546 | Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography. | This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE. |
8042545 | Haemodynamic and metabolic changes following extra-intracranial bypass surgery. | In order to study the haemodynamic and metabolic changes following bypass surgery, the regional cerebral blood flow (rCBF), the oxygen extraction fraction (rOEF), the cerebral metabolic rate of oxygen (rCMRO2), and the cerebral blood volume (rCBV) were measured using a positron emission tomograph (PET) on 13 patients who had unilateral internal carotid artery and/or middle cerebral artery occlusion. The patients were divided into two subgroups according to pre-operative rOEF values from the arterial occlusion side: the misery perfusion group, which had high rOEF values (> or = 0.56), and the coupling perfusion group, which had normal rOEF values (0.38-0.48). A post-operative PET study was performed 1-2 months and/or 1-5 years following the surgery. Six of the misery perfusion cases showed a post-operative CBF increase, where an accompanying OEF decreased to its normal level, indicating an attenuated misery perfusion state. The CMRO2 values, however, remained low. The other 7 coupling perfusion cases had an ipsilateral CBF increase in the earlier PET study. We conclude that misery perfusion is attenuated following bypass surgery, although the procedure does not consistently improve oxygen metabolism. |
8042543 | The CT criteria for conservative treatment--but under close clinical observation--of posterior fossa epidural haematomas. | In order to assess whether the indications for conservative treatment of supratentorial epidural haematomas are applicable also to posterior fossa epidural haematomas (PFEDH), the author reviewed the records of 25 patients. With a PFEDH volume of no more than 10 ml, a thickness of no more than 15 mm, a midline shift of no more than 5 mm, and in the absence of a significant intracranial haematoma elsewhere on computed tomography (CT) scans, the patients undergoing conservative treatment achieved the same excellent outcome as those undergoing early surgery. These CT criteria for conservative treatment of PFEDHs are similar to those of supratentorial epidural haematomas except the volume factor, namely, 10 ml in the former against 30 ml in the latter. That means a PFEDH of 10 ml or larger in the small posterior fossa may produce the same degree of midline shift and compression, and be as dangerous as an epidural haematoma of 30 ml or larger in the more capacious supratentorial compartment. But also for epidural haematomas of the posterior fossa, which initially are smaller than 10 ml, the general rule remains valid that they should be under close clinical supervision. |
8042544 | Computer tomographic assessment of the pre- and postoperative ventricle width in patients with traumatic intracranial haematomas. | The cellular integrity of the brain tissue is not only disturbed by space occupying traumatic intracranial haematomas but also by traumatic brain tissue damage and the accompanying oedema. Due to the insufficiency of visual inspection, methods for an objective quantification of the ventride width are required. A number of techniques have been used for evaluation of the CSF-space after cerebral trauma. In the present study changes of the ventricle size have been evaluated by using planimetric measurements of CT scans. In 222 patients with traumatic intracranial haematomas significant changes in the ventricle width could be demonstrated when the data were analysed by Wilcoxon signed rank test for pair differences. Comparison of the initial cranial computed tomography (CT) with a CT 14 days later revealed a significant dilatation of the ventricle width in all age groups in the second measurement. When patients were divided into groups with or without signs and symptoms of brainstem alteration after trauma, patients with symptoms of brainstem alteration exhibited a significantly greater ventricle width as compared to patients without such symptoms and signs. |
8042542 | Penetrating craniocerebral shrapnel injuries during "Operation Desert Storm": early results of a conservative surgical treatment. | A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. On admission, all the patients received a computerised tomographic scan which revealed shrapnel fragments inside their brain. No attempt had been made to remove the metal fragments. A patient with an infected scalp wound was treated with a course of appropriate antibiotics and the wound dressed. Dexamethasone was not used. Anticonvulsants were used only in one patient who had been treated for a presumed cerebral abscess. The neurological status of the patients improved along with the reduction of oedema and the swelling of the brain as shown in the follow-up CT scans. No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only. |
8042540 | Venous malformation in the posterior fossa: guidelines for treatment. | Venous malformations in the posterior fossa are relatively rare. Although the introduction of CT and MRI has made them easier to detect, their treatment is still controversial. Based on our experience with six patients and a review of the literature, we have tried to establish guidelines for their treatment. Since they have a benign natural course and may provide venous drainage in the posterior fossa, venous malformation found incidentally, unruptured venous malformation with nonhaemorrhagic complications, and those accompanied by small intracerebellar haematoma of less than 2 cm in diameter due to their rupture, should be treated conservatively unless they are associated with a coexistent malformation. Venous malformation with intracerebellar haematoma larger than 3 cm or reexpansion of the haematoma due to rebleeding should be treated surgically by evacuation of the haematoma. Resection of venous malformations in the posterior fossa should be restricted to cases in which the malformation is small and does not serve as a functional venous drainage route. Radiation therapy, including the "gamma-knife", may be a treatment of choice in the future. |
8042541 | Monitoring of cerebrospinal dynamics using continuous analysis of intracranial pressure and cerebral perfusion pressure in head injury. | Cerebrospinal dynamics has been investigated by statistical analysis of results of computerised monitoring of 80 head injured patients admitted to the Intensive Care Unit at Pinderfields General Hospital. One minute average values of intracranial pressure (ICP), systemic arterial pressure (ABP), cerebral perfusion pressure (CPP), amplitude of the fundamental component of the intracranial pressure pulse wave and the short-term moving correlation coefficient between that amplitude and mean ICP (RAP) were recorded. It was found that reduction of CPP down to 40 mmHg was more often caused by decrease in ABP than increase in ICP. Further falls in CPP below 40 mmHg were caused by substantial increases in ICP above 25 mmHg. The relationship between the ICP pulse wave amplitude and CPP showed a significant gradual increase in amplitude with CPP decreasing from 75 to 30 mmHg. For CPP below 30 mmHg there is a sharp decrease in amplitude followed by a change in the coefficient RAP from positive to negative values. This was interpreted as a sign of critical disturbance in cerebral circulation. |
8042539 | Correlation between the layer of an intimal tear and the progression of aortic dissection. | Thoracic aortas isolated from dogs were evaluated to determine the correlation between the depth of an intimal tear and the progression of aortic dissection. Thoracic aortas obtained from 99 adult mongrel dogs were used. An intimal tear (aortic pocket) was created on the aortic wall and the aorta was connected in series to a closed circuit (150 mmHg/100 mmHg and 60 beats/min). The progression of the dissection was most notable in the aortic pocket prepared in the first one-third of the external media (87.5%). There was no correlation however between the width of the pocket and the progression of dissection. Examinations of samples from surgical patients have shown that dissection usually progresses at the same site. This has been attributed to the diseased media. Our results demonstrated that dissection occurred almost always at the same site without any medial changes suggesting that whether dissection develops or not likely depends upon whether the intimal tear reaches the first one-third of the external media or not. |
8042538 | Effects of nipradilol on venous hemodynamics: evaluation with a Doppler blood flow method. | Nipradilol is a newly synthesized beta-blocker which has a propranolol-like structure and contains a nitrate moiety. To examine the effect of nipradilol on venous blood flow, a single oral dose of nipradilol (6 mg) and propranolol (20 mg) was administered in the same 15 normal volunteers on separate days. Peak flow velocities, flow velocity integrals, and the diameter of the right brachiocephalic vein were measured before and 2 h after drug administration using Doppler echocardiography. These two beta-blockers significantly decreased systolic blood pressure to the same extent as they did heart rate. Nipradilol dilated the venous diameter by 8% and decreased peak flow velocity by 8% during systole and 9% during diastole. The flow velocity integral in one cardiac cycle also decreased significantly by 14%. Propranolol, however, failed to modify these parameters. These results suggest that nipradilol decreased venous return through its nitroglycerin-like direct vasodilating action. |
8042537 | Dual effects of cortical polarization on peripheral motor activity in the rabbit. | Anodal direct currents at intensities ranging from 0.3 to 30.0 microA were unilaterally applied for 30 min once a day to the premotor area of the rabbit cerebral cortex. The anodal polarization was repeated 10 times at intervals of 2-3 days, and the effect on the motor activity of the forelimbs during and after each polarization trial was compared with that before polarization. Peripheral motor activity was classified as either gentle flexion of forelimbs or struggle with violent movement of forelimbs. A current of 0.3 microA caused no change in motor behavior. Flexion of the forelimb contralateral to the polarized cortex was clearly increased when a polarizing current of 1.0 or 3.0 microA was applied, and peak flexion was observed between the third and seventh polarization trials. A current of 10 or 30 microA had no effect on forelimb flexion. Conversely, forelimb struggle on both sides was decreased when 10.0 or 30.0 microA, but not 1.0 or 3.0 microA, was applied. These results show that anodal polarization of the cerebral cortex exerts dual effects on peripheral motor activity, probably through changes in cortical excitability associated with the current intensity. |
8042536 | Partial purification and characterization of dendritic cell differentiation factor. | Previously, we reported that interleukin-2 (IL-2)-stimulated helper T cells produced an unknown soluble factor which induced dendritic cell-like differentiation in primary cultures of monocytic leukemia cells and we referred to this factor as dendritic cell differentiation factor (DCDF). In this study, we attempted to purify and characterize DCDF and investigated its biological effect on normal human monocytes. Gel filtration chromatography indicated that the molecular weight of DCDF is approximately 30-35 kDa. Chromatofocusing indicated that the isoelectric point of DCDF is approximately 5.0. DCDF, partially purified by subsequent gel filtration, chromatofocusing, and hydrophobic chromatography, significantly enhanced the HLA-DR expression of normal human monocytes and a human monocytic leukemia cell line, THP-1. This biological activity was not neutralized by any known antibodies to human cytokines. DCDF significantly amplified the T-cell stimulatory activity of monocytes in the allogeneic mixed leukocyte reaction (MLR). Moreover, DCDF significantly enhanced IL-1 beta and IL-6 production by monocytes in a dose-dependent manner. These results suggest that DCDF is a novel human cytokine which stimulates the accessory cell function of monocytes. |
8042535 | Effect of acute and chronic immobilization stress on plasma levels of nicorandil administered orally to rats. | Effects of acute (15h) and chronic (15h x 7 days) immobilization (IM) stress on plasma levels of nicorandil [N-(2-hydroxyethyl) nicotinamide nitrate (ester)] administered orally were examined in rats. The maximum plasma level was reached 30 min after administration. Acute IM stress significantly reduced plasma nicorandil levels both in the absorption and elimination phases (15 min and 2-6h after administration, respectively). Chronic IM stress further intensified the reduction of nicorandil levels in the absorption phase, but attenuated the influence of acute stress in the elimination phase. No significant difference was observed one day after removal of chronic IM stress. These results suggest that chronic IM stress markedly inhibits the absorption of nicorandil, but the distribution, metabolism and excretion were influenced more by acute IM stress. |
8042534 | Successful treatment of metastatic pulmonary tumors by bronchial arterial infusion chemotherapy in two patients with locally well controlled uterine cancer. | Pulmonary metastatic tumors in two patients with locally well controlled uterine cancer were treated with bronchial arterial infusion chemotherapy. The first patient underwent a radical hysterectomy and pelvic lymphadenectomy for stage IIb cervical cancer. Fifteen months after the operation, pulmonary metastasis was identified. Clinical evidence of tumor was negative after bronchial arterial infusion chemotherapy, systemic chemotherapy and radiotherapy. The patient continues to be healthy without recurrent signs six years after bronchial arterial infusion chemotherapy. The second patient underwent a radical hysterectomy and pelvic lymphadenectomy for stage II endometrial cancer. Fifteen months after the operation, pulmonary metastasis was identified. After bronchial arterial infusion chemotherapy and systemic chemotherapy, regression of the tumors was observed. This patient has also survived for two years since the lung metastases. These results indicate that bronchial arterial infusion chemotherapy is a potent treatment for pulmonary metastases of uterine cancer. |
8042533 | Collagen framework of the volar plate of human proximal interphalangeal joint. | The functional roles of the three-dimensional fibrillar ultrastructure of the proximal interphalangeal joint volar plates of human fingers were studied by light microscopy and scanning electron microscopy. The results revealed that the volar plate consists of three layers of fibers. The first layer forms an intracavity wall with two parts, the proximal "membranous portion", and the distal "meniscoid protrusion" that is separated from the middle phalangeal base by a "recess". The second layer contains the "check ligament", which lies parallel to the fibers of the tendon, anchors tightly into the middle phalangeal base, and protects the joint from hyperextension. The third layer connects to the fibers from the accessory ligament and ligamentous tendon sheath of the A3 pulley, perpendicularly crosses the fibers of the tendon, becomes the periosteum of the middle phalangeal base, and functions as a hanging support for the volar plate and as a gliding floor for the flexor tendon. |
8042531 | Issues of health care under weightlessness. | This review will address issues of effects of space flights on the body. Cardiovascular deconditioning often induce symptoms like orthostatic intolerance after flight, and during flight there will be space motion sickness during the first few days with headache, malaise, nausea and eventually vomiting. These symptoms disappear and do not interfere with the performance of the astronauts after several days. During long-term flights, effects will be muscle atrophy and calcium loss from the skeleton. Radiation effects will be a significant issue, increasing with the length of the space flight. Also during long-term flights, psychological problems will become of increasing importance. Astronaut health care will be discussed related to Space Shuttle missions and Space Station missions. Furthermore, countermeasures for long-term space flights (up to 6 months) will be outlined. The NASA health care programme is reviewed, and the frequency of illnesses and injuries encountered in the NASA programme is discussed. There will be a need for setting up an international health care programme in view of the upcoming international cooperation in the Space Station era. It is emphasized that the Space Station is an international platform. Therefore, the health care team will be composed of international personnel, mainly from NASA with participation of Europe, Canada, Russia, and Japan. Specialized medical doctors will form the team and support the crew members from the ground. Some issues, such as medical licensing and responsibility, remain to be solved. |
8042532 | Health care during prolonged weightlessness in humans. | The demands for accumulation of knowledge about the human adaptation to weightlessness of long duration and the implications for the health and well-being of the astronaut have become increasingly important also for the international space programmes which are under development. The health care during long duration space-flights starts already with the selection where professional, psychological and medical criteria are considered. Space flights in low earth orbit have not been extended beyond 1 year, so the predictable value for long term space flights is limited, because e.g. Mission to Mars will last from 1.5 to 3 years, depending on the position of the planets, the space vehicle etc. The long duration and the enormous distance covered will induce very special and until now unknown effects on the human psychology which might be seen as the one single major factor which might be prohibitive for such long duration flights. The Moon base will bring further knowledge useful for long duration space flights in the field of medical care in general, but also with regard to the development of countermeasures against the adverse effects of weightlessness on the human body. The Moon's gravitational field of 0.16 G makes it possible to study this as a threshold in the adaptation processes. |
8042530 | Psychological effects of bed rest in young healthy subjects. | In order to evaluate the effect of immobilization during bed rest on mental health, we performed psychosomatic investigations of 6 young males and 3 young females before, during and after 20 days bed rest. The psychological state was repeatedly assessed by measuring the following indices: 1) Zung's self-rating depression scale, 2) Cornell medical index, and 3) the General Health Questionnaire. Zung's self-rating depression scale is a measure of the state of depression, while Cornell medical index and the General Health Questionnaire are utilized for detection of neurosis. Although no influence of bedrest on Cornell medical index was seen, Zung's self-rating depression scale and the General Health Questionnaire displayed a tendency to development of depression and neuroses, respectively. This tendency had disappeared 2 months after the bed rest study. Both Zung's self-rating depression scale and the General Health Questionnaire may be appropriate indices to evaluate the effects of relatively short-term psychological stress due to bed rest. The urinary excretion of 17-hydroxycorticosteroid was used as an indicator of endocrine stress factors, but no significant variation due to bed rest was seen. We concluded that there is a need for further studies combining physiological research with psychosomatic investigations. |
8042529 | Orthostatic tolerance and autonomous nervous functions before and after 20-days bed rest. | To determine the critical factor that induces tachycardia during orthostasis after bed rest, we tested some autonomous nervous functions and the reaction to lower body negative pressure before and after 20 days horizontal bed rest. Subjects were 5 young healthy males and one female. Carotid vagal baroreflex sensitivity was evaluated by cardiac response to a gradual increase in carotid distending pressure of 150 mmHg within 10 s by neck suction after neck positive pressure. Combined effects of cardiopulmonary and aortic baroreflexes were assessed by the cardiovascular responses during Valsalva manoeuvre. Sympathetic reactivity was evaluated by a cold pressor test. The carotid vagal baroreflex tended to be diminished after bed rest in supine rest, but unchanged in seated position. Cardiac responses to Valsalva manoeuvre did not change after bed rest, although blood pressures decreased more during the manoeuvre after bed rest. Cold pressor response did not change after bed rest. Heart rate response during lower body negative pressure was increased after bed rest. In conclusion, combining our results from several autonomous nervous functions suggested that the exaggerated orthostatic tachycardia after bed rest could not be explained by the changes in sensitivity of carotid, aortic, and cardiopulmonary reflexes and sympathetic reactivity to cold stress. |
8042528 | Effect of 20 days bed rest upon peripheral capillary filtration rate, venous compliance and blood flow in arms and legs. | Capillary filtration rate, venous compliance and blood flow in arms and legs were measured during bed rest by strain gauge plethysmography using a liquid metal alloy in silastic tubes. Furthermore orthostatic tolerance to lower body suction was recorded. Six young healthy males and three young healthy females participated in the 20 days bed rest study. Neither arm nor leg blood flow was changed by bed rest. Arm blood flow varied between 2.18 +/- 0.30 and 3.03 +/- 0.35 vol%.min-1 and leg blood flow between 1.42 +/- 0.12 and 1.76 +/- 0.40 vol%.min-1. The capillary filtration rate tended to decrease in the arms from 0.27 +/- 0.07 vol%.min-1 at day 0 to 0.17 +/- 0.03 vol%.min-1 at day 3 and a tendency to an increase in filtration rate in the legs from 0.16 +/- 0.06 at day 0 to 0.56 +/- 0.21 vol%.min-1 at day 3 but both of these changes had recovered from day 10 on. There was a steady state in venous compliance of the forearm between 1.31 +/- 0.20 and 1.50 +/- 1.13 vol% during the first two weeks of the bed rest period but the values tended to increase to 1.75 +/- 0.16 and 1.89 +/- 0.22 vol% at days 16 and 19, respectively, while leg venous compliance showed a transient tendency to increase at day 3 (from 0.83 +/- 0.08 at day 0 to 1.30 +/- 0.32 vol% at day 3) to attain control values from day 5. Orthostatic intolerance measured during lower body suction decreased in the present subjects.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042527 | Cardiovascular effects of 20 days bed rest in healthy young subjects. | To evaluate the effects of inactivity on the cardiovascular system in normal subjects, left ventricular echocardiography and vascular ultrasound of the common carotid artery, abdominal aorta and femoral artery, and lower body negative pressure tests were performed in 14 healthy volunteers (mean age: 22 years) before and after 20 days of strict bed rest. Cardiac output was calculated from echocardiographic measurements and peripheral arterial flows by multiplying cross-sectional area of an artery by heart rate and time-velocity integral measured by pulsed Doppler ultrasound with angle correction. Systemic vascular resistance, lower body vascular resistance, leg vascular resistance and head vascular resistance were also calculated. After bed rest, heart rate increased (69 +/- 2 to 79 +/- 3 bpm), while left ventricular diastolic dimension (49 +/- 1 to 45 +/- 1 mm), systolic blood pressure (137 +/- 5 to 116 +/- 4 mmHg), cardiac output (6.2 +/- 0.3 to 5.4 +/- 0.3 1.min-1), abdominal aortic flow (4.1 +/- 0.4 to 3.1 +/- 0.3 1.min-1), femoral artery flow (0.66 +/- 0.07 to 0.33 +/- 0.04 1-min-1), and lower body negative pressure test tolerance time (750 +/- 71 to 582 +/- 48 s) decreased significantly (p < 0.05). However, common carotid artery flow (0.97 +/- 0.09 to 1.03 +/- 0.08 1.min-1) did not change. Although no significant changes in systemic vascular resistance, lower body vascular resistance or head vascular resistance were observed, leg vascular resistance increased significantly after 20 days of bed rest (6933 +/- 2905 to 13221 +/- 2606 dyn.s.cm-1) (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) |
8042526 | Carbohydrate and lipid metabolism after 20 days of bed rest. | To test the hypothesis that physical inactivity affects carbohydrate and lipid metabolism, we studied the influence of 20 days bed rest in 14 young subjects (9 men and 5 women). There were no changes in body weight or estimated per cent body fat after 20 days bed rest. Total cholesterol, triglyceride, high density lipoprotein cholesterol, and apolipoprotein B levels did not change statistically during bed rest. But apolipoprotein AI levels were significantly lower during and immediately after bed rest compared with control values (p < 0.05). On the 3rd day of bed rest a decrease was found in high density lipoprotein-2 cholesterol (p < 0.05) and an increase in high density lipoprotein-3 cholesterol (p < 0.01) compared with control level. To evaluate the carbohydrate metabolism, each subject underwent a 75 g oral glucose tolerance test. The glucose concentrations in response to glucose ingestion did not change during bed rest, but insulin concentrations increased. The insulin-response curve to glucose ingestion tended to shift to the right during bed rest. From the 3rd day of bed rest an increase (p < 0.05) of total insulin and a decrease (p < 0.05) in blood glucose/insulin ratio were found during the glucose tolerance test which suggested a decrease in insulin sensitivity. These results suggested that physical inactivity impaired carbohydrate- and lipid metabolism. |
8042525 | Effects of 10 and 20 days bed rest on leg muscle mass and strength in young subjects. | Sedentary voluntary students were exposed to 10 (n = 8) and 20 (n = 14) days bed rest to study effects of prolonged bed rest on isometric strength of knee extension and flexion, total leg strength, right hand grip and elbow flexion using different dynamometers. Further, muscle mass of right leg and arm was measured by dual energy X-ray absorptiometry, and cross sectional area of right thigh by X-ray computed tomography before and after bed rest and after 4 or 8 weeks of recovery. After 10 days bed rest, these variables tended to decrease except for the muscle mass of right arm which increased. After 20 days of bed rest, a similar trend was observed, but at a statistically significant level of p < 0.05. However, no correlation was observed between the decrease in knee extensor strength and cross sectional area of the thigh. Nor was a correlation observed between the sum total of isometric strength of the leg and the total muscle mass measured. The 24h urinary excretion of N2 and creatinine was not changed through the experiments. During recovery, the variables measured had reached the initial levels after 4 or 8 weeks. These changes were not affected by mild supine exercise training. The results suggest that isometric muscle strength was decreased in non-antigravity muscles as well as antigravity muscles by prolonged bed rest, but the rate of changes did not correlate to the corresponding changes in muscle mass. The decreases in maximum voluntary strength are probably not only due to the decrease in muscle mass but also due to reductions of neuromuscular function. |
8042524 | Decremental reset in basal metabolism during 20-days bed rest. | Changes in basal metabolism during 20 days bed rest were measured in 9 young healthy males and 5 females. Food intake was unrestricted and supplementary meals were allowed. All food intake was monitored. A special sleeping pattern was not enforced, although an ordinary day-night diurnal rhythm was kept in the rooms. Body temperatures were measured daily every 2 hours from 7:00 to 22:00. Basal oxygen uptake decreased significantly during the first 10 days of bed rest and levelled off during the following 10 days. Body weight and composition remained substantially unchanged in spite of a decreased energy consumption during the bed rest. In conclusion, basal VO2 was reset at a decreased level during the first 10 days of bedrest with no relationship to the dietary energy intake or to the body temperature, while no more change took place during the following 10 days. |
8042523 | Metabolic turnover of bone and peripheral monocyte release of cytokines during short-term bed rest. | Immobilization induces abnormal bone metabolism and rapid decalcification. Measurements of bone mineral content disclosed rapid decalcification, especially in lumbar vertebral and metacarpal bones in our short-term 20-day bed rest study. Many factors could contribute to the marked demineralization. The activities of osteoclasts and osteoblasts were studied by following serum levels of tartrate-resistant acid phosphatase and alkaline phosphatase, biomarkers for osteocyte activity. There were no alterations in these enzymes during bed rest. However, urinary excretion of pyridinium cross-links, resorption markers of bone matrix itself, increased by day 10 with subsequent decrease at day 20. So decalcification was induced without any relation to osteoclast activity. As cytokines strongly modulate the function of osteoclasts, peripheral monocyte release of interleukin 1 alpha and tumor necrosis factor alpha were assayed to determine the contribution to this rapid demineralization. Cytokines were released transiently by day 7 and later rapidly decreased. However, there was no correlation between cytokine release and bone matrix resorption. |
8042522 | Bone turnover and calcium metabolism during 20 days bed rest in young healthy males and females. | Bone is a dynamic tissue that functions not only as a mechanical support, but also as a major component of the metabolic and endocrine systems maintaining mineral homeostasis. It has been shown that immobilization induces decalcification of bone. To evaluate the effect of immobilization on bone mineral density and calcium metabolism, we investigated 9 young healthy males and females during 20 days bed rest. Three methods for measuring bone mineral density were performed to quantify whole body and regional bone changes: 1) dual energy X-ray absorptiometry, 2) quantitative computed tomography, and 3) multiple scanning X-ray photodensitometry, respectively. Bone mineral density showed a rapid decreasing tendency, especially in both lumbar and metacarpal bones (mean +/- SE: 4.6 +/- 0.6% and 3.6 +/- 0.4%, respectively). Urinary daily excretion of deoxypyridinoline, a sensitive marker of bone matrix resorption, tended to increase by day 10, and to decline by day 20 (mean +/- SE: 42.2 +/- 1.4, 27.6 +/- 2.2 nmol day-1, respectively). However, neither alkaline phosphatase nor tartrate-resistant acid phosphatase, both markers of osteoclast and mature osteoblast function, changed. These results showed that in the early stage of immobilization, bone matrix might be resorbed without any activation of osteoclasts, resulting in rapid decalcification of vertebral and cortical bones without any discernible changes in anatomical structure. |
8042521 | Effects of mild supine exercise during 20 days bed rest on maximal oxygen uptake rate in young humans. | Fourteen sedentary young volunteers performed a maximal exercise test on a bicycle ergometer before, after and eight or nine weeks after 20 days bed rest. They were divided into four groups. They all went through 20 days bed rest; 5 females and 6 males as controls while 3 males performed mild pedaling supine exercise for 30 minutes twice a day. Three other males from the control group started a retraining programme after bed rest performing mild pedaling exercise in the sitting position for an hour a day, 3-4 days a week for eight weeks. VO2max was reduced after bed rest in all groups. In the control group the 6 males decreased VO2max from 2.82 +/- 0.09 1.min-1 before bed rest to 2.42 +/- 0.14 1.min-1 after. The female controls decreased from 2.55 +/- 0.24 1.min-1 to 2.22 +/- 0.23 1.min-1. The exercise regime performed by the three males during bed rest did not prevent a fall in VO2max in that group from 2.76 +/- 0.06 to 2.57 +/- 0.09 1.min-1. The three males who performed bicycle exercise in the recovery period did not attain higher recovery values at 8-9 weeks than the other males. However the 5 female controls did not recover their > 13% loss in VO2max after 8-9 weeks of recovery. Calculation of peak oxygen pulse from VO2max divided by heart rate indicated that these changes in VO2max were caused exclusively by a reduction in stroke volume of the heart, a finding supported by resting echocardiography of left ventricular end-diastolic diameter and stroke volume.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042520 | Recent bed rest results and countermeasure development at NASA. | Bedrest studies of normal subjects provide opportunities to understand physiologic responses to supine posture and inactivity. Furthermore, head-down tilt has been a valuable procedure to investigate adaptation to microgravity and development of countermeasures to maintain the health and well-being of humans during space-flight. Recent bedrest experiments at NASA have ranged in duration from a few hours to 17 weeks. Acute studies of 6 degrees head-down tilt indicate that elevation of capillary blood pressure from 28 to 34 mm Hg and increased capillary perfusion in tissues of the head cause facial and intracranial edema. Intracranial pressure increases from 2 to 17 mm Hg going from upright posture to 6 degrees head-down tilt. Microvessels of the head have a low capacity to constrict and diminish local perfusion. Elevation of blood and tissue fluid pressures/flow in the head may also explain the higher headward bone density associated with long-term head-down tilt. These mechanistic studies of head-down tilt, along with a better understanding of the relative stresses involved with upright posture and lower body negative pressure, have facilitated development of suitable physiologic countermeasures to maintain astronaut health during microgravity. Presently no exercise hardware is available to provide a blood pressure gradient from head to feet in space. However, recent studies in our laboratory suggest that treadmill exercise using a graded lower-body compression suit and 100 mmHg lower body negative pressure provides equivalent or greater physiologic stress than similar upright exercise on Earth. Therefore, exercise within a lower body negative pressure chamber may provide a cost-effective and simple countermeasure to maintain the cardiovascular and neuro-musculoskeletal systems of astronauts during long-duration flight. |
8042518 | [Synthesis and biological activity of substituted benzyl/naphthylmethylisoquinolines and related quaternary ammonium derivatives]. | In an attempt to search for novel antihypertensive or antiarrhythmic agents, especially compounds mainly acting on calcium or potassium channels, with the isoquinoline alkaloids which possessed cardiovascular effects as lead compounds, and on the basis of previous works of our laboratory as well as integration of the structural feature of certain potassium channel blockers, 28 compounds (I1-6 and II1-22) were designed and synthesized among which 24 were not reported previously. 3,4-Dihydroisoquinolines were first synthesized by the Bischler-Napieralski cyclization with 3,4-disubstituted phenethylamine and aromatic acetic acid as starting materials. N-alkyl substituted tetrahydroisoquinolines were prepared by the alkylation of tetrahydroisoquinolines with corresponding substituted benzyl halides, or by the reduction of dihydroisoquinoline quaternary ammonium derivatives. Preliminary pharmacological studies in vivo showed that most of these compounds exhibited various degrees of hypotensive and bradycardial effects except I4 which exhibited hypertensive activity. The hypotensive effect of II1 was the most potent among these compounds in anaesthetized normotensive Sprague-Dawley rats. Analysis of the QSAR between hypotensive/bradycardial activities of certain compounds and their structural parameters of molecular mechanics (MM2) showed that the hypotension/bradycardia increased with the increase/decrease of the charge of the nitrogen atom in the isoquinoline nucleus. Thus, the charge of the nitrogen atom might be one of the important factors which could enhance the selectivity of the compounds acting on blood vessels or cardiac tissues. |
8042517 | [Leflunomide inhibits PAF induced DNA synthesis in rabbit synovial cells and PAF production from rat peritoneal macrophages]. | Leflunomide (LFM, HWA 486) is an isoxazol derivative with antiphogistic and novel immunomodulating properties. It has been shown to be very effective in preventing and curing arthritis. In this report we found that platelet-activating factor (PAF) at 0.1-10 micrograms.ml-1 significantly stimulated DNA synthesis in cultured rabbit synovial cells. While LFM and its metabolite A771726 elicited inhibitory effects on this action of PAF. These two agents were also shown to markedly inhibit A23187 induced PAF production from rat peritoneal macrophages. The inhibition was dose and time-dependent. The inhibitory effects of LFM and A771726 on DNA synthesis in synovial cells and PAF production from macrophages may play an important role in the antiinflammatory effects of LFM. |
8042516 | [Drug antagonism of TNF induced proliferation of bovine cerebromicrovascular smooth muscle cells]. | Effects of tumor necrosis factor (TNF) on the proliferation of bovine cerebromicrovascular smooth muscle cells (BCSMC) were investigated. At concentrations from 50 to 5000 U.ml-1, TNF was shown to induce proliferation of cultured BCSMC in a dose-dependent manner. After 24 h incubation of the cells, TNF significantly stimulated the proliferation of BCSMC and reached maximal effects after 48 h incubation, then the effects slightly decreased. At concentrations from 10(-6) to 10(-4) mol.L-1, both imperatorin (Imp) and iso-imperatorin (Isi) were found to antagonize the TNF induced proliferation of BCSMC. Their maximal inhibitory effects were 42.2 and 36.1% at 10(-4) mol.L-1 respectively. 6-(alpha,alpha-diphenylacetylpiperazinly) phenyl-5-methyl-4,5-dihydro-3 (2H)-pyridazinone (DMDP) and 6-(alpha-phenylacetylpiperazinyl) phenyl-5-methyl-4,5-dihydro-3(2H)-pyridazinone (PMDP) were also found to possess similar effect at lower concentration (10(-6) mol.L-1), but no significant effect was observed when the drug concentration was higher. |
8042515 | [Pharmacokinetics and disposition of vinpocetine in rats]. | A reverse-phase HPLC method for determination of vinpocetine in biological samples was developed. The method was simple, highly specific and accurate. After i.v. administration of vinpocetine in rats, the plasma concentration-time curves of vinpocetine was found to be fitted to a two-compartment open model. Dosing 5 and 10 mg.kg-1 vinpocetine in rats, the elimination of the drug from plasma accorded with linear kinetics and the elimination half-lives were shown to be 1.76 +/- 0.27 h. The volumes of distribution were 7.30 +/- 0.49 L.kg-1 (5 mg.kg-1) and 6.07 +/- 0.67 L.kg-1 (10 mg.kg-1) respectively. The drug levels were high in the lung, spleen, liver and kidney, moderate in brain, fat and testis and low in heart, muscle and blood. Our results demonstrate that vinpocetine was eliminated in a rapid rate and distributed widely in the body. The bioavailability of vinpocetine after ig administration was 54.54% in rats. A small amount of unchanged vinpocetine was detected in urine, feces and bile after i.v. and ig administration. |
8042514 | [Synthesis and interferon-inducing activity studies on the antiviral compounds of 2,5,6-trisubstituted-4(3H) pyrimidinone derivatives]. | In order to search for more ideal antiviral drugs, 21 substituted pyrimidinone derivatives were designed and synthesized, among which 11 were not reported before. The chemical structures were characterized by elemental and spectral analysis. The serum interferon-inducing activity was tested in mice. All 2-amino-5-bromo-6-substituted-4-(3H)pyrimidinone compounds were shown to have interferon inducing activity. The corresponding substituted pyrimidine thiones were less active. The new compounds of 6-sulfophenyl derivatives are soluble in water, but the interferon-inducing activity are not higher than the original compound of ABPP. |
8042513 | [Anti-ischemia reperfusion damage and anti-lipid peroxidation effects of paeonol in rat heart]. | Paeonol 60 mg.kg-1 ip, was given to rats for 15 days. On the 16th day myocardial ischemia reperfusion injury was produced in the rat heart by occlusion of the left coronary artery and the release of the occlusion. The results showed that paeonol significantly improved myocardial SOD activity (5.8 +/- 0.6.mg-1 compared with reperfusion control 3.4 +/- 0.9, P < 0.01), reduced the MDA content (11.4 +/- 1.7 nmol.mg-1 versus 17 +/- 1.3, P < 0.01) and cardiac CPK release (1523 +/- 478.5 U.L-1 versus 2355 +/- 626.5, P < 0.01). The myocardial ultrastructure was also protected keeping them from the oxygen free radical damage. It appears that paeonol is an efficient protective agent against ischemia reperfusion damage in the rat heart. |
8042512 | [Guanfu base A inhibit the post-infarction ventricular arrhythmias in dogs]. | Harris tow-stage left anterior coronary ligation was performed in anesthetized dogs. After twenty hours, severe ventricular arrhythmias were recorded under conscious state. Cumulative intravenous injections of guanfu base A, a new alkaloid isolated from the tuber of Aconitum coreanum in China, from 10 to 40 mg.kg-1 produced remarkable antiarrhythmic effect lasting over 30 min and a moderate reduction of heart rate. The P-R interval, QRS complex and Q-T interval of the sinus rhythm were not significantly altered. The antiarrhythmic potency of guanfu base A in this model was found to be about one third that of quinidine. |
8042511 | [Analysis of meperidine and its metabolites in urine of an addict by GC/FID and GC/MS]. | Analytical methods of GC/FID and GC/MS for identification and determination of meperidine, an analgesic drug, and its metabolites were established. The determination of meperidine spiked in urine was shown to have a good linear relationship in the range of 0.1-8.0 micrograms/ml urine (Y = 0.4995X + 0.1201, r = 0.9996). The detection limit was 20 ng/ml urine. With the developed methods, meperidine and its metabolites in urine collected from a meperidine addict were identified and determined. Meperidine, normeperidine, meperidinic acid in free and conjugate forms, normeperidine acid in free and conjugate forms, and acetyl-normeperidine were detected. Among these metabolites, acetyl-normeperidine was reported for the first time. |
8042510 | [Respiratory failure after nebulized terbutaline treatment in severely wheezy infants: report of three cases]. | Subjective clinical observations have suggested that nebulized bronchodilators are helpful in the treatment of some wheezy infants. Although the role of beta 2-agonists in the management of acute asthma in infants and very young children remains controversial, the use of beta 2-adrenergic agents in this age group has been widespread. beta 2-agonists nebulization continues to be the first-line treatment for acute attack of asthma, irrespective of age, in some institutes, but their uses are not without side effect especially in young wheezy infants. We report three cases of respiratory failure occurred after treatment with nebulized beta 2 bronchodilator in infants with chronic lung disease and acute wheezing. All the 3 cases were victims of prematurity. Case 1 was a case of Wilson-Mikity syndrome; case 2 was a case of bronchopulmonary dysplasia; and case 3 was a case of repeatedly wheezing infant. All 3 cases had severely wheezy dyspnea with retraction before nebulized beta 2 bronchodilator treatment. Respiratory failure was found 5 to 10 minutes after the treatment. We suggest that it must be very careful in the treatment of severely wheezy infants with beta 2-agonist nebulization, especially in cases with histories of prematurity and chronic lung disease. It is necessary to carefully monitor the vital signs of the infants during beta 2 agonist nebulization. |
8042509 | Scimitar syndrome complicated with right pneumonectomy syndrome: report of one case. | A 2-month-old infant, suffering from respiratory distress, was suspected to have scimitar syndrome from a chest roentgenogram and was diagnosed by cardiac catheterization. Ligation of the aberrant feeding arteries and right lung resection was performed at three and four months of age, respectively. However, the postoperative course was complicated with right pneumonectomy syndrome requiring continuous artificial ventilation. With supportive management, the patient improved gradually and was eventually weaned off the ventilator at three years of age. |
8042508 | Successful conversion of fetal atrial flutter with digoxin: report of one case. | A fetus suffering from tachycardia of more than 200 beats per minute was found to have an atrial flutter with two-to-one atrioventricular conductional block by the fetal ultrasonogram at 33 weeks of gestation. The tachycardia was successfully converted to sinus rhythm with maternal digitalization. The heart rate stayed in a normal sinus rhythm after the baby was born, however, an incomplete form of cor triatriatum was noted on the echocardiogram examination. |
8042507 | Transient leukemoid reaction in an extremely premature neonate. | A female newborn was delivered prematurely at gestational age of 26 weeks with birth weight of 1,000 grams. Her initial white blood cell count was 68,900/mm3, which increased to 207,000/mm3 on the fifth day of life with a remarkable shift-to-left pattern. The most immature myeloid series in the peripheral blood smear was promyelocyte; and the promyelocyte, myelocyte and meta-myelocyte accounted for 38% of the peripheral white blood cells. Neither hepatosplenomegaly nor skin rash was noted, but the platelet count dropped to 86,000/mm3 transiently on Day 8. Cytogenetic study for the bone marrow aspiration revealed normal results. The leukemoid reaction recovered within three weeks without specific treatment. Antenatal usage of steroid to promote lung maturation was considered to be one possible cause of the transient leukemoid reaction. |
8042506 | Cytomegalovirus-induced persistent mononucleosis in an infant. | Chronic mononucleosis has recently gained much attention in the literature. Almost all cases of this new syndrome have been ascribed to persistent Epstein-Barr virus infection. However, a case presented with infantile chronic mononucleosis syndrome caused by persistent cytomegalovirus infection. Transient clonal chromosomal change was noted during follow-up. |
8042505 | [Effect of furosemide on renal magnesium and calcium excretion of different ages (II)]. | Thirty normal students, including senior high, junior high and elementary school, were the subject for furosemide test. Ten cases, in each age group, were given oral furosemide 2 mg/kg for three consecutive days. The result showed there were increasing urinary magnesium and calcium excretion among the three different age groups after oral furosemide (P < 0.05). Successive increase of urinary magnesium and calcium excretion of senior high school students is more obvious than those of junior high and elementary school students. It is suggested that there is more effective action on renal magnesium and calcium excretion for senior high school students after oral furosemide than that for the junior high and elementary school students. It is obvious that increasing dosage of furosemide would induce more calcium excretion than magnesium excretion among students of the three age groups. Therefore, it encouraged to drink the proper amount of water to decrease the incidence of hypercalciuric stone when furosemide should be used. |
8042504 | [Effect of diuretics on renal sodium excretion of different ages (I)]. | Ninety normal students including 30 cases in senior high, 30 cases in junior high and 30 cases in elementary schools were the subjects for diuretic test. Thirty cases in each age group were divided into three subgroups. Students in each subgroup were given one of three oral diuretic drugs (acetazolamide 10 mg/kg, furosemide 2 mg/kg, hydrochlorothiazide 2 mg/kg) for three consecutive days. Although there was an increased urinary sodium excretion among the three different age groups during the period of oral hydrochlorothiazide, it showed no significant difference among the three age groups (P > 0.05). There was more increased urinary sodium excretion for students of senior high school during the period of oral furosemide and acetazolamide than for students of junior high school and of elementary school. The largest, successive natriuretic action was observed in students of senior high school during the period of oral furosemide. It is suggested that there is more effective natriuretic action for students of senior high school during the period of oral acetazolamide and furosemide than for students of junior high and of elementary school. |
8042503 | Bilious vomiting during the first week of life. | From Nov. 1988 to Nov. 1991, forty-five newborns, who were admitted due to bilious vomiting within the first 7 days of life followed prospectively. Twenty-three (51.1%) required surgical intervention, and the remaining twenty-two (48.9%) had nonsurgical conditions. Clinical findings of green vomitus, abdominal distension, lethargy, irritability and abdominal tenderness are more likely to indicate the need for surgery. But the onset of vomiting and time of first stool passage are not helpful in detecting the need for surgery situation. Initial routine plain abdominal roentgenogram is helpful in distinguishing infants with surgical or nonsurgical problems. Sixteen infants with normal plain abdominal roentgenograms had nonsurgical conditions. Specific findings on the plain abdominal roentgenogram were noted in 23 infants, and 19 (82.6%) of these needed surgical intervention. Contrast studies were indicated for those without signs of complete obstruction, perforation or peritonitis, but the plain abdominal roentgenogram was abnormal and clinical condition did not improved. |
8042502 | The effect of betamethasone on intraocular pressure in nephrotic children. | Intraocular pressure (IOP) was measured by Goldmann's or Schiotz's method in 46 nephrotic children, who were treated with betamethasone, and in 40 age-matched normal controls at the Taipei Municipal Chung-Hsin Hospital, from July 1, 1987 to June 30, 1990. We found the difference in mean IOP between patients treated at the end of a full-dose course of betamethasone and normal controls or patients before treatment, was statistically significant. This difference was also found between the measurement of IOP at the end of a full-dose course of betamethasone, and after stopping betamethasone therapy two to four weeks later. Although six of all patients had high IOP and suffered from headache or ocular pain, clinically, at the end of full-dose betamethasone therapy, the symptoms disappeared quickly after tapering or stopping of the drug. Therefore, we believe it is very safe to treat the nephrotic syndrome with betamethasone. On the other hand, these observations indicate that corticosteroid is a causative factor in increasing IOP. Susceptibility to full-dose betamethasone is firmly recognized, and patients need to be monitored on an individual basis. Nephrotic syndrome is a chronic disease which often requires long-term corticosteroid treatment. Children with the syndrome are at risk of developing steroid-induced increasing IOP. Careful ophthalmological examination of nephrotic children, as well as other pediatric patients who received corticosteroid therapy, is highly recommended. |
8042501 | Asphyxiated bladder syndrome in a pediatric intensive care unit. | Sixteen neonates and infants with asphyxiated bladder syndrome (ABS) were prospectively studied over a two-year period. Their transient urinary bladder distention had developed as a sequel of asphyxial events, and presented as delayed micturition in the absence of obstructive lesion. The incidence was 1.9 percent in this Pediatric Intensive Care Unit. Five cases occurred in the neonatal period. All patients were younger than three years of age (mean: 9.1 months), and the incidence of ABS was 2.8 percent within this age group. For intermittent decompression of the bladder, all responded successfully to the suprapubic bladder expression method (Crede's maneuver). Most (81.3%, 13/16) ABS cases coexisted with intestinal dysfunction as either paralytic ileus (62.5%, 10/16) or as gas-less abdomen (18.8%, 3/16). There was no evidence of association with either systemic or urinary bacterial infection. Normal spontaneous voiding and bowel function were regained in all cases except one, who died early. Mean (SD) duration of bladder dysfunction was 66.9 (40.3) hours. Sonography showed normal kidneys and collecting system in all patients both during and after ABS episodes. Half of the patients (8/16) died ultimately. No urinary tract abnormality was found in post-mortem examinations in five cases. |
8042500 | X-linked hypophosphatemia: molecular biology and treatment controversies. | X-linked hypophosphatemia, currently one of the most prevalent varieties of familiar rickets, is attributed to renal phosphate wasting secondary to a gene defect localized to X p22 chromosomal region. The proximal tubular phosphate reabsorption defect is associated with blunted 1,25-dihydroxyvitamin D synthesis to hypophosphatemia or parathyroid hormone administration. It is characterized clinically by hypophosphatemia, growth retardation, and rickets especially in male patients. As the affected patients mature, pseudofractures, skeletal deformities, osteomalacic bone pain, progressive ankylosis, and dental caries occur, which may be alleviated and even prevented with adequate medical therapy. Long term treatment combines phosphate supplementation with calcitriol, augmented occasionally by diuretics. Hypercalcemia, hyperparathyroidism, and nephrocalcinosis are potential complications which require careful monitoring and continued investigations. The use of recombinant human growth hormone to augment renal tubular reabsorption of phosphate and to promote linear growth remains to be examined in well controlled, clinical trials. |
8042499 | Soft tissue sarcoma. Epidemiology and prognosis in 508 patients. | We have evaluated epidemiology, prognosis and the association between metastases and local recurrence in a series of adult patients with soft tissue sarcoma (STS) of the extremity and trunk wall. 508 patients were diagnosed in the Southern Swedish Health Care Region from 1964 through 1989. The series was population-based, i.e., all patients within a defined area were included, irrespective of where treated, thereby avoiding selection bias in referral and follow-up. Epidemiology. The annual incidence was 18 per million. The median age was 64 years. One third of the tumors were subcutaneous, and these were smaller than the deep-seated tumors. Malignant fibrous histiocytoma and grade IV were the commonest. Differences were noted in clinicopathologic features among histotypes. The 5-year metastasis-free survival rate (MFSR) was 0.6. The crude local recurrence rate was 0.3. The majority of metastases and local recurrences occurred within 3 years. The referral pattern to the tumor center has become more favorable over time; in the last 5 years half of the subcutaneous and four fifths of the deep-seated tumors were referred before surgery. Prognostic factors. Tumor size, tumor necrosis, and vascular invasion were strong and independent prognostic factors for metastasis in a histologically mixed series. In MFH, storiform and pleomorphic subtype, tumor necrosis and tumor size were associated with a poor prognosis. Tumor necrosis and vascular invasion independently worsened the prognosis in leiomyosarcoma. In liposarcoma, tumor necrosis and in synovial sarcoma, tumor size were the only important prognostic factors. Tumor size, tumor necrosis, and vascular invasion were used in a prognostic system which identified two thirds of all patients with a 5-year MFSR of 0.8 and one third of the patients with a 5-year MFSR of 0.3. Metastasis and local recurrence. The causal association proposed for local recurrence and metastasis should be interpreted with caution. We suggest that highly malignant tumors combine local and distant aggressiveness, and that local recurrence is a marker of risk, and not necessarily a cause of, metastasis. Conclusions. 1. Population-based series are preferable when studying epidemiology in soft tissue sarcoma. 2. We propose that tumor size, tumor necrosis, and vascular invasion are strong and reliable factors that can be used to improve prognostic accuracy. 3. There is a growing body of evidence against a causal relationship between local recurrence and metastasis. |
8042498 | The effects of micromotion and particulate materials on tissue differentiation. Bone chamber studies in rabbits. | Motion at the interface between bone and implants for joint replacement may interfere with osseointegration and prosthesis stabilization. Particulate materials may cause foreign body and chronic inflammatory reactions resulting in bone resorption (osteolysis). The micromotion chamber (MC) and the bone harvest chamber (BHC) were implanted in the rabbit tibia, and the effects of micromotion and phagocytosable particulate materials on tissue formation within the chamber were assessed by studying bone ingrowth into a 1-mm pore. Using the MC, one short daily episode of motion (20 cycles/day, 0.5 mm amplitude) for three weeks decreased the amount of bone ingrowth. Using a different pore configuration, the same parameters of motion increased bone ingrowth. Increasing the amplitude of motion (from 0.5 to 0.75 mm), or the number of daily motion periods (from one to two per day) then decreased bone ingrowth. These studies suggest the existence of a window of externally applied strain: a small stimulus may facilitate and a large stimulus may discourage bone formation within the chamber. Cessation of a given set of motion parameters (producing primarily fibrous tissue) for an additional three weeks was accompanied by tissue differentiation into bone. Using the BHC, small, phagocytosable particles of bone cement, high density polyethylene and cobalt chrome alloy, at a concentration of 1.0 x 10(8) particles/mL, caused a foreign body reaction and inhibited the ingrowth of bone. Particles of titanium alloy had no effect on net bone formation. In studies using normal and immunodeficient rats, T lymphocytes were not a prerequisite for macrophages to phagocytose polyethylene particles. In the clinical situation, micromotion and particulate debris may be synergistic in producing prosthetic loosening. If an implant does not undergo osseointegration due to excessive micromotion, the fibrous tissue interface may provide a conduit for the subsequent migration of particles around the implant. |
8042497 | Theories of wear and loosening in hip prostheses. Wear-induced loosening vs loosening-induced wear--a review. | The observation of perioprosthetic granulomas containing wear debris around apparently well-fixed as well as around loose-fitting prosthetic components has led to the development of the hypothesis of wear-induced loosening. However, the hypothesis of wear-induced loosening can neither explain the rapid early prosthetic migration detected by roentgen stereophotogrammetry nor the epidemiology of clinical failure without supplementary ad hoc-assumptions. By contrast, apart from explaining the rapid early prosthetic migration detected by roentgen stereophotogrammetry, the theory of early loosening can explain the development of wear granulomas as well as to a great extent the epidemiology of clinical failure. |
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