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8042102 | [The relationship between tuberculosis, vitamin D, potassium and AIDS. A message for South Africa?]. | The converging epidemics of tuberculosis and acquired immunodeficiency syndrome (AIDS) in the RSA and their expected catastrophic interaction afford an ideal opportunity for well-planned and essential research by clinicians, molecular biologists, epidemiologists and other health workers. The enigmatic relationship between tuberculosis, vitamin D and calcium is a field of study which should be considered urgently. An optimal vitamin D status not only assures sound calcium-phosphorus homeostasis, but is also essential for maximal immune competency. Hypovitaminosis D probably predisposes towards vulnerability to tuberculosis due to deficient monocyte-macrophage function. In contrast, hypervitaminosis D can correct this deficiency, but would do so at the cost of both B- and T-lymphocyte efficiency. One example of such a state is the endogenous over-production of activated vitamin D by gamma-interferon-activated monocytes, tissue macrophages and granulomatous tissue in tuberculosis. This would not only cause the coincidental hypercalcaemia, but may also complicate the effective co-ordination of monocyte-lymphocyte interaction and consequently compromise an appropriate immune response. It can reasonably be expected that the raised plasma interferon levels in the AIDS patient may trigger similar vitamin D-related pathophysiological processes. It is proposed that the ideal situation for enhanced vulnerability to tuberculosis in the AIDS patient will have been created if the known destructive effects of the human immunodeficiency virus on CD4-positive lymphocytes act synergistically with the vitamin D-mediated complications listed above. |
8042101 | Outcome of hospitalised anorexics and bulimics in Cape Town, 1979-1989. A retrospective study. | In a retrospective study of 73 girls and women treated in a psychiatric inpatient unit in Cape Town between 1979 and 1989, follow-up data were available for 49 (67%) of them. Internationally recommended measures were used to obtain further data, where possible, from 17 subjects (14 with anorexia, 3 with bulimia) who were 4 and more years post-hospitalisation, as well as 19 subjects (9 with anorexia, 10 bulimia) who had been out of hospital less than 4 years. Indirect information was available from 13 subjects. With regard to long-term outcome, 15 of the 17 subjects fell into the Morgan-Russell categories 'good' or 'intermediate'; in the short-term follow-up group, 14 of the 19 fell into these categories. Indirectly, we also discovered that 3 of the original subjects had died, 4 had remained ill, and 6 had recovered. These findings were similar to those from a previous study from this department and are useful feedback on the comprehensive treatment programme. They also throw light on what appears to be a culture-bound syndrome; at the time of study, the eating disorder affected mainly the middle-class white population, a pattern similar to that found elsewhere in the world. |
8042100 | Selective birth in twins with discordant chromosomal abnormality. | Selective termination in twin pregnancies with a chromosomal abnormality in one twin may be offered to prevent long-term suffering for the infant and/or the family. The procedure poses considerable risks to the remaining fetus and also to the mother, and these, together with the ethical aspects, should be discussed thoroughly with the couple. We report 2 successful cases of selective midtrimester termination by intracardiac potassium chloride injection, and recommend a management protocol for selective birth in twins with discordant chromosomal abnormalities. |
8042099 | Twin birth-weight discordancy in Transkei. | A study of twin birth-weight discordancy revealed a high incidence of 11.7% (1 in 9 deliveries) among 478 pairs of twins delivered. The second twin had a lower birth weight and a poorer perinatal outcome, as does the smaller twin irrespective of birth order. Major birth-weight discrepancies were found in dichorionic twins. In twins of unlike sex, males were heavier, irrespective of birth order, which suggests that fetal gender may be an important aetiological factor. It is suggested that growth retardation of one of a pair of twins, rather than twin transfusion syndrome, is a more important contributor to birth-weight discordancy. |
8042098 | Home nebulisers. Comparative study of lung deposition by different models. | Home nebulisers are extensively used in the ambulatory treatment of chronic chest conditions. This study compares the intrapulmonary deposition of aerosol generated by 6 different models of electrical home nebuliser in healthy male volunteers. Deposition was quantified by measurement of the radio-activity over the right lung during nebulisation of 3 ml normal saline containing 2 mCi of technetium-99m pertechnetate. The 3 cheaper nebulisers studied (Simba, New Constellation and Ariette) take considerably longer to nebulise the same volume compared with the 3 more expensive nebulisers (Eolo, Pharmoneb and Pari) (> 20 minutes compared with < 5 minutes). With one exception, in every comparison between two models, intrapulmonary deposition at 3 minutes was significantly greater for the more expensive nebuliser. Mean deposition with the cheapest model was only one-fifteenth of the mean for the most expensive model. Large variations between different individuals on the same model were observed (up to 6-fold). Factors accounting for the inter-individual variation in deposition are considered and the correct method of use of nebulisers is emphasised. Multiple regression of forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) and height versus deposition with very similar nebulisers in 12 volunteers shows that these parameters can account for 69% of the inter-individual variation observed (r = 0.83). The clinical application of the findings is considered. |
8042080 | Clinical use of a portable electronic device to measure haematocrit. | A small portable device called the blood electrometer (BEM) was developed to assist clinicians to distinguish patients with extreme blood loss from those with normal packed cell volumes. Blood was collected in 5 ml lithium heparin tubes from 80 normal controls and 24 patients in an intensive care unit. BEM and accurate microcentrifugal techniques were compared. Intraclass correlation coefficients between the techniques of r = 0.96 and r = 0.93 were found in the normal controls and patients respectively. Because the BEM operates on the principle of conductivity, changes in some of the biochemical variables which could influence conductivity were investigated in the patients. Mean plasma total protein and albumin concentrations were lower compared with normal reference ranges. Six of the 24 patients were acidotic and 4 alkalotic. Leucocyte counts obtained randomly from 13 patients were elevated. Changes in measurements which could influence conductivity did not affect the BEM reading. We conclude that the portable BEM could be of great value in circumstances where a fixed power source is not available and rapid haematocrit measurements in a large number of patients are required. |
8042078 | The Grande Roche ACE debate. | First, we had the discussion 'Are all ACE inhibitors equal?', and the debate was really in relation to heart failure. I came away with the impression that although there might be variations with renal function, hypotension and so on, most of you felt that it was ACE inhibition that was of primary importance, and that it was therefore permissible to extrapolate from one study to another. The recently published AIRE study of post-infarct patients used ramipril, with a change in mortality that gives credence to the idea that it's not just captopril, not just enalapril, but is likely to be a class effect of ACE inhibitors. I think that's the feeling I got from you. Do ACE inhibitors prolong life? I think Professor Weich made a very simple and a very good point, because it allowed us a general extrapolation. The simple point is: the sicker the patient, certainly with heart failure, the more the benefit of the ACE inhibitor. It's like the idea that in elderly hypertensives, or the diabetic hypertensive, the greater the risk factor the greater the benefit. The more we want to treat prophylactically, whether it's micro-albuminuria, or transient hypertension, or minimal left ventricular dysfunction, the longer we will have to treat, and the more patients we will have to treat to get objective evidence of any differences. Professor Oosthuizen suggested that we should also be thinking of renal impairment, potential renal impairment with cardiovascular disease in diabetes as another valid end-point.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042074 | [Basic aspects of public health surveillance for the 90s]. | In this paper we propose a wider scope for public health surveillance in order to incorporate demographic and health systems monitoring along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes--not a sector of activity or a type of health service--but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we stress the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available--let alone any knowledge about how to treat persons for the major diseases that affected them. Later on, and largely as the result of impressive advances in biomedical knowledge, surveillance activities tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the newer proposals tend to recapture part of the spirit and scope of earlier definitions, prompted perhaps by such thoughtful historic parallels as the newly emerging health problems for which we have no clear-cut solution. If one element has to be stressed to promote the objectives of health surveillance today, it is the need to anticipate health outcomes and not just respond to them. This, in turn, requires an increased attention to the surveillance of risk factors, and a greater understanding of the complex causal relationships that those factors--including behavioral, lifestyle, and environmental ones--with adverse health outcomes and disability. Needless to say that, the first and foremost aim of health care--and of modern surveillance--is to promote the well-being of individuals by improving their health. |
8042072 | [Does clinical depression increase the risk of death from non-violent causes?]. | Studies of the effect of depression on life expectancy have found controversial results. In the past, an excess mortality was attributed to conditions seen at psychiatric institutions. More recently, in addition to an excess mortality due to violent causes of death, some studies also found excess mortality due to non-violent and all-cause mortality. Hospital studies that evaluated this relationship are generally flawed and lack of control for potential confounders. Underlying physical illnesses could explain the excess mortality reported. On the other hand, community-based studies have studied small number of depressed subjects, and have used diverse measurements of depression which hamper comparability. This paper critically reviews recent published studies and discusses possible mechanisms for this association. |
8042073 | [Health and turism]. | Tourism and health are two closely linked concepts. Both are directly related and very important to national economy and social policies. In this paper we present some reflections regarding those salient aspects of health and tourism that require to be strengthened. A series of recommendations are offered to contribute to the improvement of sanitation in the tourism sector, with special emphasis on preventive measures, joint action between the sectors involved, and emphasizing the role of the emporiatry concerning the protection and promotion of the health of the tourist. Finally, it is recognized that the actions required are the responsibility of all of those individuals involved in tourism: the visitor and the residents on the one hand; and services providers and the authorities, on the other hand. |
8042071 | [Tobacco use in Mexico City]. | The results of a population based study carried out in a low income area of Mexico City are presented in this paper. The study was designed to investigate tobacco consumption as a cardiovascular risk factor in the population ages range of 35-64 years. A home interview was accomplished for 2,155 individuals. Monthly family income, employment status, years of schooling and tobacco consumption were investigated. The majority of the participants reported a monthly family income of 500 to one hundred new pesos and the average of school years was 5.8 +/- 3.2 years. In most cases (93.8%), participants reported to have a paid job and only 2.09 per cent were unemployed. A total of 74.2 of men and 24.5 per cent of women reported that they had smoked at least 50 cigarettes in their lifespan and 52.5 per cent of men and 17.9 of women were current smokers. Most smokers (62.9% men, 74.5% women) consume 10 or less cigarettes per day, but 33.2 per cent of men and 24.2 of women were heavy smokers, that is 10-29 cigarettes per day. Only eleven men and seven women smoked cigars or pipe. This results show a high rate of tobacco consumption in this population, therefore it is imperative to strengthen education programs aimed at promoting healthier habits and to stop tobacco consumption. |
8042070 | [An opinion survey on abortion in Mexico City]. | In view of the lack of information regarding abortion attitudes in Mexico, an abortion opinion survey was conducted in Mexico City among 387 women and 338 men. Respondents were asked if they agreed with a woman's abortion decision under seven different circumstances. Affirmative responses were analyzed by respondents' sociodemographic and reproductive health characteristics and a scale was created to measure respondents' overall attitudes toward abortion. Greatest support was expressed for a woman's right to an abortion, and to abortion in cases of fetal defect, threat to the mother's life, and rape. On the attitudinal scale, however, respondents generally disapproved abortion. Male respondents were more likely than female respondents to support a woman's abortion decision. Males in union, females not in union, respondents over thirty years of age, those with more than primary school education, those with fewer pregnancies, those with no history of child mortality, and those with a history of or experience with abortion, were also more likely to support an abortion decision. |
8042069 | [Treatment of tuberculosis in 100 children. A 5-year follow-up]. | This paper presents the results of a five year follow-up study of a cohort of children under fifteen years of age with tuberculosis. One group received standard treatment, and the other group received short course treatment. In the standard group there were four treatment failures, while in the other group, all the subjects had an excellent evolution and there were no failures. There was not a statistically significant difference regarding treatment failures, it is recommended, however, to carry out similar studies with greater sample sizes in order to determine the benefits of the short course treatment. |
8042068 | [Epidemiologic setting of the agricultural use of sewage: Valle del Mezquital, Mexico]. | Wastewater from Mexico City is used to irrigate over 85,000 hectares mainly of fodder and cereal crops in the Mezquital Valley. A cross-sectional study method is being used to test the impact of exposure to raw wastewater and wastewater from storage reservoirs on diarrheal disease and parasitic infections in farmworkers and their families. The study population in the rainy season survey included 1,900 households: 680 households where the farmworker is exposed to untreated wastewater (exposed group), 520 households exposed to reservoir water (semiexposed group), and 700 households where the farmworker practices rain-fed agriculture (control group). Preliminary analysis of the data from the rainy season study (dry season study in progress) has been carried out. Current information indicates that the risk of Ascaris lumbricoides infection is much higher in the exposed group than in the control group (95% CL = 2.9-10.8). According to the procedures employed Entamoeba histolytica infection was more frequent among subjects aged 5 to 14 years from households exposed to raw wastewater, than among subjects of the same ages belonging to the control group (95% CL = 1.07-1.72). When diarrheal disease rates were analyzed, children under 5 years from exposed households had a significantly higher prevalence than controls (95% CL = 1.03-1.64). The final results of this study are expected to aid decisions within the National Wastewater Reuse Programme in Mexico.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042067 | [Job satisfaction and its role in the evaluation of the quality of medical care]. | The Mexico City Health Services Department, introduced in 1991 a Quality Improvement Program aimed at producing a continuous improvement of health care delivery. A multidimensional study was carried out in order to evaluate the changes on quality assurance through work satisfaction. To this aim, the points of view of users, workers and the board of directors were taken into consideration. It was found that work satisfaction is related only with some aspects of performance at the workplace and mainly with the organizational environment. This study allowed us to compare different groups and work levels so as to determine intervention techniques related with their needs. |
8042066 | [Nosocomial urinary tract infections at a second-level hospital]. | In order to investigate the incidence, etiologic agents and number of episodes of nosocomial urinary tract infections, a prospective study was carried on at the General Hospital in Durango, Mexico. All the patients admitted to the hospital during the period of March to June, 1991, and whose hospital stay was longer than 48 hours, were included. The infection rate in 962 patients was 12.9 episodes per hundred. The service of Internal Medicine had the highest rate and Pediatrics the lowest. The infection rate was higher among older patients and there was no significant difference between genders. 73% of the patients had only one episode of infection and the presence of a permanent urinary-catheter was the main clinical condition associated with infection. Escherichia coli and Klebsiella sp. were the most frequently isolated microorganisms. Nosocomial urinary tract infections have a very high incidence in a general hospital, therefore there is a pressing need to implement effective control programs. |
8042063 | [Nosocomial infections of gynecologic-obstetrical origin at a perinatal care hospital]. | Nosocomial infections (NI) are still a major cause of morbidity among gynecology & obstetrics patients (GOP). At the Instituto Nacional de Perinatología (INPer), during 1989, there was an overall NI rate of 2.37 per 100 GOP discharged, while specific NI rates for the subgroups of puerperal and gynecologic surgery patients were 2.11 and 6.3 respectively. Endometritis and infected surgical wounds were the most frequent type of NI, having a multimicrobial etiology. There was a significant increase in hospital days of stay for those patients who developed NI. It is clearly necessary to improve the surveillance of NI as well as the collaboration among different wards dealing with GOP, in order to find more effective and efficient ways to prevent the development of NI. |
8042060 | Using STD occurrence to monitor AIDS prevention. | Monitoring the effects of AIDS prevention programmes is increasingly important but methodologically difficult. The use of surveillance derived measures of the occurrence of sexually transmitted diseases as indicators of high risk sexual behaviour, or of HIV incidence, has been widely recognized as a possible approach. This paper first examines the theoretical and empirical basis for this strategy, and highlights, using examples, some of the pitfalls in the interpretation of trends in sexually transmitted disease occurrence. Problems arising in the interpretation of the types of STD surveillance data currently available in countries in Western Europe are discussed. Ways in which STD surveillance systems might be developed so as to enhance their value in monitoring AIDS prevention are proposed. The paper goes on to identify areas of clinical and epidemiological research which might improve our ability to interpret such enhanced STD surveillance data. |
8042059 | Attitudes toward organ donation and transplantation. A model for understanding reactions to medical procedures after death. | The main purpose of this study was to reach a deeper understanding of factors influencing the attitudes toward organ donation and other procedures with the dead body. From a survey of 400 inhabitants of Uppsala, a city in the middle of Sweden, concerning attitudes toward transplantation issues, 38 individuals with different attitudes toward donation of their own organs were selected for follow-up interviews. From the interviews, more than 600 statements concerning motives and reactions to medical procedures with the dead body were listed. These statements were summarized in 20 motive categories, in which 17 the nature of the motives were negative to organ donation and three promoting such a procedure. The categories were then analyzed and interpreted within a frame of reference of psychodynamic defense theory. In several cases it was possible to relate them to common death anxiety defenses. Six different motive complexes were extracted. These are called (1) illusion of lingering life; (2) protection of the value of the individual; (3) distrust, anxiety and alienation; (4) respecting the limits set by Nature or God; (5) altruism; and (6) rationality. Individuals not willing to donate their own organs were judged as either (a) reacting out of strenthened death anxiety defenses, or (b) as having a special outlook on life, where the idea of what is 'natural' was emphasized. The adverse reactions of the positive attitude group were seen as initial reactions perceived as derivations of common death anxiety defenses and weakened when confronted with altruistic and fact-stressing arguments. In the 'undecided group' of 14 persons, 11 arrived at a definite opinion. Seven decided for organ donation when their mistaken beliefs were corrected or when they took time to work through their initial uneasiness, while 4 persons actually were clearly negative. Three still remained uncertain. The stability of these attitudes seems to be high, often being experienced as a part of one's philosophy of life. |
8042058 | One person's 'spoiling' is another's freedom to become: overcoming ethnocentric views about parental control. | Gaining cultural self-awareness by health and human services professionals in areas that are bastions of conservatism like childrearing is particularly difficult to achieve. It is argued that polarized ideas about parental control dominate the Anglo Dominant Culture's value orientations, reflected in both popular and scientific literature. Parental permissiveness is cast into an opposing category of 'noncontrol', imbuing it with negativism. Prejudice against Eskimo childrearing is examined in that context and a method is offered to 'loosen' the grip of Anglo beliefs about parenting. |
8042057 | Too far to walk: maternal mortality in context. | The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality--alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources. |
8042056 | Health cards, maternal reports and the measurement of immunization coverage: the example of Guatemala. | Immunization against major childhood diseases has been an essential component of health policies in developing countries. However, despite its importance and the efforts invested by many organizations in promoting immunization programs, consistent and accurate measurement of immunization coverage has not yet been achieved. In this paper, we explore the implications of alternative methods of measuring immunization coverage rates in Guatemala, using data from the 1987 Encuesta Nacional de Salud Materno Infantil, and we consider the dangers of making inferences about levels and trends in coverage from cross-sectional data. The results indicate that (1) service statistics may well lead to overestimates of coverage; (2) survey estimates derived from health cards can also produce severely biased estimates; and (3) in spite of problems associated with maternal recall, mothers' reports of their children's vaccination status probably result in substantially improved estimates of immunization coverage. |
8042055 | Midwives in Niger: an uncomfortable position between social behaviours and health care constraints. | Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries is mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments. |
8042054 | Alternative medicine in the United States. | Since the term 'alternative medicine' is defined residually as anything not regular medicine, it is not a useful category. It needs further specification in order to facilitate empirical investigation of the many varied types of health practices it denotes: namely, primitive medicine, folk medicine, herbal medicine, homeopathy, chiropractic, naturopathy, faith healing. New Age Healing, etc. The author's earlier classification of health professions into ancillary, limited, marginal, and quasi practitioners offers a fruitful set of categories for investigating relationships between these groups and organized medicine, and the movement of these groups from one status to another. Examples are the evolution of osteopathy from marginal to full acceptance as orthodox, and chiropractic's putative evolution from marginal to a limited medical profession. Within the quasi professional group, further subclassification distinguishes between folk and primitive healers, faith healers, and quacks; also between those who heal using natural forces and those who frankly invoke supernatural forces or entities. |
8042053 | Psychological distress in survivors of residential fires. | This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors overtime. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented. |
8042052 | The social impact of HIV infection on women in Kigali, Rwanda: a prospective study. | In Rwanda, a central African country, the prevalence of HIV infection now exceeds 30% in urban adults. This study identifies the social services and counseling needs of women who are already infected with the HIV virus, the outcome after disclosure of the woman's HIV test result to her partner and estimates the social support available to the women from their partners and relatives. Fifty-five HIV-positive women in Kigali were interviewed in 1988 and 47 of this group were interviewed again in 1991. The social services most needed by the women in 1988 were housing, employment and money. By 1991, the women prioritised food, housing and money as their current needs and food, childcare and money were their future needs in the event they became ill. The preferred sources of support in 1988 were individual counseling and women's support groups. By 1991, the preferred sources of support were individual counseling and their priest. In 1988, almost 75% of the women did not expect a supportive reaction from their partners after disclosure of the test result. In 1991, acceptance, understanding and sympathy were the most common reactions of the partners after disclosure. However, 8 (21%) had not told their partner their test result. After disclosure, 18 of the 37 partners were subsequently tested. Of those tested, 75% were HIV-positive and 25% were HIV-negative. Condom use was almost twice as high when the partner was informed of the test result, although in couples overall, a third were not using condoms despite knowing the test result.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042051 | Alzheimer's disease afflicted spouses who remain at home: can human dialectics explain the findings? | When one spouse has Alzheimer's disease (AD), marital interactions tend to decline. Findings from this study suggest that level of spousal interactions influence longitudinal outcomes for afflicted spouses. Thirty AD spouses and their spouse caregivers were assessed at baseline (time 1) and two years later (time 2). Continued in-home care at time 2 is predicted by high levels of positive spousal interactions, high caregiver commitment, good caregiver health, and shorter time as caregiver (all assessed at time 1). The same variables but in an inverse relationship predict which AD spouses are deceased at time 2. Nursing home placement is predicted by AD spouses' higher educational level, unhappy marital relationships, and low caregiver commitment. Afflicted spouses' cognitive and functional impairment levels, their physical health and depression do not predict outcomes. A theoretical explanation is developed drawing on Riegel's dialectical theory of human development and Bowlby's attachment theory. It is suggested that interactions between spouses are crucial for afflicted spouses' survival. |
8042050 | Dissent in science: styles of scientific practice and the controversy over the cause of AIDS. | In this paper, we use a scientific controversy, and the efforts to legitimize and undermine a theory, to examine the co-production of facts and the rules for verifying facts over time. We discuss these processes in terms of what we call 'styles of scientific practice.' In contrast to the focus of idealist philosophers on theory production and validation as forms of logic or ways of thinking, our styles of practice also include the activities of hands and eyes and the discourses between multiple actors in diverse situations. We discuss aspects of the different styles of practice deployed by opponents in a current controversy surrounding the etiology of AIDS to understand how the same data are interpreted in different ways to support diametrically opposed views. Our study describes and examines rules of confirmation used by supporters of the theory that HIV causes AIDS. For example, we introduce an 'epidemiological' style of practice used by AIDS researchers to synthesize information to understand this disease. Styles of practice stress the historically located collective efforts of scientists, technicians, administrators, institutions, and various 'publics' as they build and sustain ways of knowing. Yet, we also show that the 'history' is also a contested construction, not a given in dusty archives. We describe the different versions of history constructed by various participants in the debate to validate their current constructions and definitions of the disease AIDS. Finally, we discuss the politics behind disease definitions and the consequences of different definitions. |
8042048 | The technocratic body: American childbirth as cultural expression. | The dominant mythology of a culture is often displayed in the rituals with which it surrounds birth. In contemporary Western society, that mythology--the mythology of the technocracy--is enacted through obstetrical procedures, the rituals of hospital birth. This article explores the links between our culture's mythological technocratic model of birth and the body images, individual belief and value systems, and birth choices of forty middle-class women--32 professional women who accept the technocratic paradigm, and eight homebirthers who reject it. The conceptual separation of mother and child is fundamental to technocratic notions of parenthood, and constitutes a logical corollary of the Cartesian mind-body separation that has been fundamental to the development of both industrial society and post-industrial technocracy. The professionals' body images and lifestyles express these principles of separation, while the holistic ideology of the homebirthers stresses mind-body and parent-child integration. The conclusion considers the ideological hegemony of the technocratic paradigm as potential future-shaper. |
8042044 | Surgical adjuvant treatment of esophageal carcinoma: a Japanese Esophageal Oncology Group experience. | To improve the survival rate of patients with esophageal carcinoma, many types of treatment adjuvant to surgery have been examined. In Western countries, neoadjuvant chemotherapy or chemoradiation therapy has been preferentially studied. In Japan, preoperative radiotherapy was regarded to be the best treatment arm in the past, but the JEOG study clarified the role of postoperative radiotherapy. After this study, JEOG has concentrated on examining the best postoperative adjuvant treatment. In Japan radical operation, which includes not only complete removal of the main tumor but also an extended dissection of the lymph nodes in the mediastinum, abdomen and neck, has elevated the survival rate significantly during these 10 years. Thus, surgery itself is regarded as the major factor in the treatment of esophageal carcinoma. We considered it essential to compare the best adjuvant chemotherapy with surgery alone, to determine whether adjuvant treatment should be performed or not. |
8042040 | Pathologic prognostic factors in esophageal carcinoma. | Thus, many interesting and promising techniques are now available for the study of potential prognostic factors in esophageal carcinoma, and the results may supplement the information that is obtained by routine histopathologic analysis. It may become possible to define subgroups of patients with lower risk tumors, for whom more aggressive therapy is indicated, especially within the group of early-stage lesions. It is clear, however, that much more data is necessary to define the role each study should play in predicting tumor behavior. While the relevance of the newer techniques is still being established, it is important that all of the data from these studies be incorporated into ongoing research studies, since in this era of cost-conscious medicine it may soon become impossible outside of a research setting for pathologists to perform large batteries of special studies to define parameters of unproven prognostic value. |
8042037 | Esophageal cancer trends and risk factors. | Esophageal cancer displays unique epidemiologic features that distinguish it from all other malignancies. It shows marked geographic variation both internationally, with exceptionally high rates (some of the world's highest for any cancer) in limited areas of Asia, and nationally, with clustering of increased rates within the United States as well. However, the patterns are changing with rates of squamous cell carcinomas decreasing and adenocarcinomas increasing rapidly in several western countries. The causes of the clusters of squamous cell carcinomas in parts of Asia and Africa are not well known, but within the United States and other western countries, tobacco and alcohol consumption are the major determinants. Nutritional factors also may play a major role, with diets high in fresh fruits and vegetables consistently associated with reduced risks. The causes of the rapidly increasing rates of adenocarcinomas of the esophagus, and reasons or its occurrence primarily among white men, are enigmatic. Additional research on the etiology of this emerging cell type is warranted, and may provide information crucial to the development of readily implementable preventive strategies. |
8042023 | [Attrition, dentin apposition and protein synthesis in the pulp and desmodont of young and old rats]. | Occlusal attrition and responsive adaptations in the pulp-dentinal unit are still problematic. In this study, up to 2 years-old rats were used to measure the amount of occlusal attrition, of dentin apposition and of the incorporation of 3H-proline into the pulpal and periodontal ligament tissues. Two to four SIV-rats each, 45, 365 and 730 days of age, were once injected with 3H-proline 2 hours or 5 days prior to exitus. After cardiac perfusion, the molar blocks of both jaws were decalcified in EDTA and divided into bucco-oral and mesio-distal slices. The latter were embedded in Epon. Semithin sections served to measure the amount of attrition and of tertiary dentin apposition, as well as for autoradiographic labelling and determination of the rate of dentin apposition and proline incorporation in pulpal and periodontal ligament tissues. The results show that (1) the molar cusps lost up to 40% of their initial height during the two years of life, (2) occlusal dentin apposition in the intercuspal region led to an increase in dentinal thickness by 50 to 70%, while in the pulp horn region dentinal apposition occurred early in life and later did not keep phase with attrition, and (3) protein synthesis in pulp and periodontal ligament essentially did not change within the two years of life. These findings are related to that of other authors and discussed in connection with dentinal innervation. |
8042024 | Marginal fit of porcelain crowns with galvanized frames. | Twenty extracted premolars were prepared for artificial crowns with a beveled shoulder. Ten porcelain-fused-to-galvanized-gold (PFGG) and ten porcelain-fused-to-metal (PFM) crowns were made according to the manufacturer's instructions by independent experienced dental technicians. Six sites per crown were selected for analysis. Photographs of these regions were projected on a screen for a total magnification of x 120. After cementation, the crowns were sectioned in the mesio-distal direction. The polished sections were analyzed for marginal accuracy and thickness of the cement. Measurements were recorded using the procedures described above. Before cementation, PFGG crowns exhibited primarily overextended margins, while 80% of the PFM crowns revealed short margins. The PFM crowns depicted a significantly smaller marginal gap (36 microns) than the PFGG crowns (53.7 microns). After cementation, the difference in the marginal gap was not statistically significant. The assessment of the thickness of the cement resulted in a significantly thinner cemental layer for the PFM crowns (PFM 40.2 microns, PFGG 48.5 microns). Although the results of this study demonstrated a diminished marginal gap and cement line for PFM crowns, this difference is too minimal to be clinically significant. |
8042022 | [Composite polymers--an amalgam substitute for deciduous tooth cavities?]. | In this prospective clinical study, 29 class II restorations in deciduous teeth were placed in 17 patients using the recently developed compomer Dyract. The restorations were clinically and macrophotographically evaluated immediately after placement and after 6 months in situ. In addition, marginal adaptation and loss of substance were quantitated using replicas. Clinical and macrophotographical findings were excellent. Quantitative marginal analysis scored 92.5% "continuous margin" immediately after placement of the restorations and 95.4% after 6 months. Mean loss of substance at the margins of the restorations was 20.8 microns with a standard deviation of 64.6 microns. Providing that the positive results of this short term study are confirmed by long term data, Dyract may replace amalgam in deciduous teeth. |
8042021 | The effect of experience and training on the diagnosis of approximal coronal caries from bitewing radiographs. A Swiss-American comparison. | The purpose of the present study was to compare the development of skills in the radiographic diagnosis of approximal coronal caries. Swiss (Bern) and American (Alabama) dental students with and without clinical experience, Swiss general practitioners, and Swiss and American dental school faculty viewed bitewing radiographic films of 13 teeth. The observers examined the 26 approximal surfaces on the radiographic films and responded, on a five point certainty scale, whether approximal caries was present. Mean sensitivity ranged from a low of 0.59 for American faculty to a high of 0.80 for Swiss students with clinical experience, mean specificity ranged from 0.84 for Swiss pre-clinical students to 0.95 for American faculty. For a summary measure of accuracy, i.e., area under the receiver operating characteristic (ROC) curve, the scores for student observers tended to increase with experience. The scores for Swiss and American students with clinical experience and faculty did not differ significantly. Inter-examiner agreement (Kappa) could only be characterized as moderate at best. Formal didactic instruction and clinical experience produced dental students with skills in the diagnosis of approximal caries from bitewing radiographs similar to that of faculty dentists. |
8042019 | Genetics and epidemiology of adult-type hypolactasia. | The prevalence of adult-type hypolactasia varies from less than 5% to almost 100% between different populations of the world. The lowest prevalence has been found in northwestern Europe, around the North Sea, and the highest prevalence in the Far East. The reason for the variation is that selective (primary) hypolactasia is genetically determined by an autosomal recessive single gene. It is assumed that thousands of years ago all people had hypolactasia in the same way as most mammals do today. At that time in cultures where milk consumption was started after childhood, lactase persistence had a selective advantage. Those people with lactase persistence were healthier and had more children than people with hypolactasia, and the frequency of the lactase persistence gene started to increase. The present prevalence of hypolactasia can be explained fairly well by this culture historical hypothesis. This article reviews the evidence for the inheritance of adult-type hypolactasia and the occurrence of hypolactasia in different countries and populations of the world. |
8042018 | Management of lactose intolerance. | The management of lactose intolerance comprises two parts: (1) the basic principles of treatment in persons intolerant to a dietary dose of lactose, and (2) main manoeuvres to reduce the lactose content in food, and/or consumption of special products of milk or exogenous lactase enzyme. The tactics of management depend on the type of hypolactasia, the severity of intolerance, and on the age of the patient. Special attention is paid to the development of lactose intolerance in some patients via iatrogenic mechanisms such as certain drugs, gastric surgery and ionizing radiation. |
8042017 | Clinical picture of hypolactasia and lactose intolerance. | Selective adult-type hypolactasia, the main cause of primary malabsorption of lactose, shows considerable variation in terms of its symptoms, which mainly depend on the amount of milk consumption. The article discusses congenital lactase deficiency and familial lactose intolerance. Links between hypolactasia and non-specific abdominal complaints, coronary heart disease and cataract are presented. The decrease in lactase activity in the brush border of jejunal mucosa, associated with diseases of the mucosa or any other condition which damages the enterocytes, is discussed as a cause of secondary hypolactasia. It is shown that adult-type primary hypolactasia and selective lactose malabsorption represent a major problem in the everyday work of general practitioners, particularly in populations where hypolactasia is common. Therefore, the examination and treatment of non-selected patients with vague abdominal complaints is important in primary health care. As the need for calcium in humans is largely met by the intake of milk, the consumption of milk has to be in amounts that are tolerable for the individual. |
8042016 | Diagnosis of hypolactasia and lactose malabsorption. | The article briefly describes the various methods that are available for diagnosing hypolactasia. Special attention is drawn to the fact that different methods are useful at different levels of the health care organization. When the test result indicates lactose malabsorption, general malabsorption should be excluded by a glucose-galactose tolerance test, for example. If the glucose-galactose tolerance test produces a normal result, it can be assumed that the patient has primary adult-type selective lactose malabsorption. The possibility of secondary lactose malabsorption must be excluded according to the principles described by Villako & Maaroos (104). |
8042015 | Metabolism of lactose in the human body. | The article describes the metabolism of lactose in both normo- and hypolactasia in the human body. Attention is drawn to the differences in lactose tolerance among lactose malabsorbers. |
8042014 | Hypolactasia and lactase persistence. Historical review and the terminology. | Lactase (more precisely lactase-phlorizin hydrolase) is located in the brush border of the small intestinal enterocytes and is responsible for the hydrolysis of dietary lactose. The earliest studies on lactase activity in mammals were published around the turn of the century. In 1903, it was found that the dog had a very low lactase activity and therefore lactose remained unhydrolysed, causing diarrhoea. Human hypolactasia was demonstrated in 1963, and it was soon found that it is very common, commoner than lactase persistence in most parts of the world. In 1973, adult-type hypolactasia was shown to be inherited by an autosomal recessive single gene. This article reviews the early expansion of the knowledge on lactase and hypolactasia as well as the correct terminology. |
8042013 | Trolox protects hyperglycemia-induced cataractogenesis in cultured rat lens. | Hyperglycemia-induced cataractogenesis has been studied in rat lenses cultured in 50 mM glucose using an inverted microscope connected with a Universal C-mount and a CCD camera. Digital images were acquired and the opacity was determined by quantitating the transmitted light. Antioxidants, butylated hydroxy toluene (BHT) and 6-hydroxy-2,5,7,8-tetramethenyl-chroman-2-carboxylic acid (Trolox) provided good protection against 50 mM glucose-induced cataractogenesis in rat lenses for upto 8 days. Sorbitol levels in the 50 mM glucose+antioxidant groups were approximately 1.5 mM fold higher than in 50 mM glucose. The results, besides further demonstrating that oxidative damage is the major mechanism of sugar-induced cataractogenesis, show that Trolox or related amphipathic compounds could be of therapeutic use in the prevention of diabetic cataracts. |
8042012 | Application of the non-radioisotopic carbonyl metalloimmunoassay (CMIA) to diphenylhydantoin. | As part of our ongoing work to develop the new non-isotopic assay method carbonyl metalloimmunoassay (CMIA), whose efficacy has already been proven in the laboratory for phenobarbital and cortisol, we here present the steps involved in establishing CMIA of 5,5 diphenylhydantoin (DPH), one of the most commonly used antiepileptic medications. First, anti-DPH antibodies were obtained by injection of the immunogen DPH-3-valerate-BSA into rabbits. The titer value and specificity of these antibodies were examined by RIA using [14C]-DPH as tracer, and an antibody batch selected for its high titer value and good specificity for metabolites of DPH and other antiepileptic drugs. Next the organometallic complex Cr(CO)3-DPH, chosen as the CMIA tracer, was synthesized and shown to conserve a high recognition value for anti-DPH antibodies (CR = 200%). Isopropyl ether was selected as the best organic solvent for use in separating the free and bound fractions of the tracer. Employing the Cr(CO)3-DPH complex as tracer and FT-IR spectroscopy as the detection method, we were able to obtain a titration curve by CMIA using an amount of tracer identical to that used in RIA. The titer value obtained in CMIA is approximately twice that obtained by RIA. These results demonstrate the feasibility of DPH assay by the CMIA method. |
8042011 | Vasomotor responses in rats "intoxicated" with doxorubicin. | In rats intoxicated with doxorubicin, vasomotor responses were evaluated 12 hr after the last dosage. In rats pretreated with doxorubicin, hypertensive responses to L-norepinephrine and L-epinephrine, and hypertension by occlusion of both common carotid arteries were significantly (p < 0.05) reduced when compared with controls. Doxorubicin pretreatment also significantly reduced the arterial hypotension due to L-isoprenaline. In rats intoxicated with doxorubicin, pretreatment with L-sulpiride (12.5 to 50 mg/Kg/day for 30 days in drinking water ad libitum) did not modify the effects of doxorubicin on vasomotor reactivity. In contrast, pretreatment with amitriptyline (12.5 to 50 mg/Kg/day in drinking water ad libitum for 30 days) potentiated the inhibitory effects of doxorubicin on vasomotor responses. In conclusion, our research shows that doxorubicin intoxication induces a significant reduction of alpha- and beta-adrenergic reactivity and of baroreceptor activity. |
8042010 | Serum collagenase activity reflects the amount of liver collagenase in chronic carbon tetrachloride-treated rats. | To examine whether serum collagenase activity reflects the amount of collagenase activity in the fibrotic liver of rats, we simultaneously measured serum and hepatic collagenase activities in rats with carbon tetrachloride-induced liver injury. Serum collagenase was measured after reactivation by denaturing and dissociating the inhibitors with potassium thiocyanate and aminophenylmercuric acetate, while hepatic collagenase was measured after the removal of plasma protein and activation with aminophenylmercuric acetate. Serum and hepatic collagenase activities increased in the carbon tetrachloride-treated rats with the progression of liver fibrosis, and both activities of collagenase were closely correlated each other. These results suggest that serum collagenase activity measured in these assay conditions could be used as a noninvasive marker for hepatic collagenolysis in carbon tetrachloride-treated rats. |
8042009 | Enzymatic reduction of xenobiotic alpha,beta-unsaturated ketones: formation of allyl alcohol metabolites from shogaol and dehydroparadol. | A novel reductive metabolism of shogaol [1-(4'-hydroxy-3'-methoxyphenyl)-deca-4-ene-3-one], a major pungent and pharmacologically active principle of ginger, was investigated in rat liver in vitro. The ethyl acetate extractable metabolites formed by incubation of this alpha,beta-unsaturated ketone with rat liver 12,000 x g supernatant fortified with NADPH-generating system were analyzed by high performance chromatography and gas chromatography/mass spectrometry. In addition to the saturated ketone and reduced alcohol metabolites, an allyl alcohol, 1-(4'-hydroxy-3'-methoxyphenyl)-deca-4-ene-3-ol, was identified as a new metabolite of shogaol. Likewise, dehydroparadol [1-(4'-hydroxy-3'-methoxyphenyl)-deca-1-ene-3-one], a non-pungent analog of shogaol, was also reduced to the corresponding allyl alcohol by the postmitochondrial fraction of rat kidney in the presence of NADPH-generating system. |
8042008 | Selected tissue distribution of liposomal methylprednisolone in rats. | The distribution of methylprednisolone (MPL) in various rat tissues following 2 mg/kg IV bolus doses of liposomal drug (L-MPL) and drug in solution was investigated. Animals were sacrificed at selected times post-dosing until 120 h. Liver, spleen, thymus, heart, lungs, muscle, kidney and brain were excised and the concentrations of MPL were measured using HPLC after homogenizing organs in buffer. The incorporation of MPL in liposomes did not alter the uptake of drug by heart, lung and muscle. Drug concentrations in brain were undetectable. In the kidney the MPL concentrations after 1 h were higher for liposomal drug and not detectable at later time points. Tissue to plasma partition coefficients were close to unity in lung, heart, and muscle at 1-2 h after the dose of drug in solution and increased by 7.5 times for spleen and 6 times for thymus after the dose of L-MPL. There were no significant differences between the weights of organs expressed in percent of body weight. These results demonstrate that, while the sequestration of L-MPL by lymphatic tissues occurred, the uptake of drug by the other tissues did not increase. This may be beneficial for preferential targeting of the immune system. |
8042007 | Immunization with synthetic peptide segments of a sperm protein impair fertility in rats. | The nucleotide sequence of the cDNA encoding a sperm protein (rSMP-B) was determined in a previous study. Two peptide segments corresponding to the extracellular domain of the deduced sperm polypeptide were synthesized as multiple antigen peptide (MAP) and designated as rSMP-229 and rSMP-230. Polyclonal antibodies were raised against the two MAPs. Sera obtained from rabbits immunized with rSMP-230 interacted with human and rabbit sperm membrane proteins with estimated molecular sizes of 72 and 20.1 kD, respectively. Adult female and male rats were immunized with the MAPs and their fertilities determined. Immunization of female rats with rSMP-229 and rSMP-230 induced infertility in 25% and 83% of the treated animals, respectively. All male rats immunized with rSMP-229 remained fertile; whereas animals immunized with rSMP-230 did not mate with normal cycling female rats. Three impotent male rats were found to regain their mating potency 45 days after the last booster injection. These findings demonstrated that immunization with rSMP-230 induced a reversible impotency in male rats. Serum testosterone and LH levels were reduced in rSMP-230-immunized male rats and were elevated in rSMP-229-immunized animals. Histopathological examination of sections of testes from male rats immunized with rSMP-230 showed impairment of spermatogenesis and sloughing of germ cells into the lumen of the seminiferous tubules. The testes of male rats immunized with rSMP-229 showed normal morphology and active spermatogenesis with scattered foci of nodular hyperplasia of Leydig cells in the interstitial areas. In conclusion, immunization with synthetic peptide segments corresponding to different domains of a deduced sperm protein induced infertility in a significant number of female rats and transient impotency in male rats. |
8042006 | Tissue lipid peroxidation may be triggered by increased formation of bilirubin in vivo. | Following the administration of phenylhydrazine, cadmium chloride and ethanol to rats there was a marked increase in the concentration of liver lipid peroxides and a sharp decline in GSH levels. The oxidative stress generated by the action of these toxic compounds led to the induction of liver heme oxygenase, which exhibited a 3-fold increase in activity over the control value. Patients with various forms of liver disorders showed increased levels of plasma lipid peroxides as well as hyperbilirubinemia. In view of the known ability of bilirubin to cause lipid peroxidation in illuminated erythrocyte membranes, the results of the present paper suggest that in severely impaired liver, as in some liver diseases, lipid peroxides may be also produced by a mechanism involving heme oxygenase. |
8042005 | Polyploid accumulation associated with hyper-phosphorylation of histone H1 in hepatocytes of LEC mutant rat. | In this study, we analyzed effects of copper toxicity on the process of mitosis by examining polyploid accumulation and histone H1 hyper-phosphorylation, which result from defects in mitotic completion, in regenerated LEC rat liver. The proportion of polyploids with 8c nuclear DNA content in LEC rats was significantly higher than that in normal rats (P < 0.05). The degree of histone H1 phosphorylation was about 2.5-fold higher in LEC rat than normal rat. These results suggest that the accumulated copper in LEC mutant rat causes the block of mitotic completion in cell cycle. |
8042003 | Influence of stevioside on hepatic glycogen levels in fasted rats. | The influence of stevioside, the sweet glycoside of Stevia rebaudiana leaves, on the glycogen levels of fasted rats was investigated. In one set of experiments, single doses of stevioside (200 mumol) or steviol (200 mumol) were given orally to 24-hours fasted rats, either alone or simultaneously with fructose. Under these conditions both stevioside and steviol increased the initial glycogen deposition in the liver. In another set of experiments, stevioside was given to the rats in the drinking water at the beginning of the fasting periods (5:00 p.m.) of 24 and 48 hours. Two different concentrations were given, 1.0 and 2.0 mM. Increased hepatic glycogen levels were found at 48 hours with stevioside (1.0 mM) and at 24 hours with stevioside (2.0 mM). Steviol had no effect on hepatic glycogen levels when given in the drinking water. It can be concluded that stevioside exerts a stimulatory action on hepatic glycogen synthesis under gluconeogenic conditions. |
8042004 | Effects of flumazenil (Ro15-1788) on blood glucose and serum lipids in normoglycemic and normolipidemic rats. | The intraperitoneal administration of flumazenil, an imidazoldiazepine with selective antagonistic properties on the central benzodiazepine receptors, induced in normoglycemic-normolipidemic rats a significant increase in blood glucose levels and significant decreases in the serum lipids. |
8042002 | Effects of diabetes on the antinociceptive effect of (+/-)pentazocine in mice. | The antinociceptive effect of (+/-)pentazocine was examined in streptozotocin-induced diabetic mice. Although intracerebroventricular (i.c.v.) administration of (+/-)pentazocine (10 nmol) produced a significant antinociceptive effect in both non-diabetic and diabetic mice, the antinociceptive effect of (+/-)pentazocine was greater in diabetic mice than in non-diabetic mice. The antinociceptive effects of (+/-)pentazocine in both diabetic and non-diabetic mice were significantly antagonized by s.c. administration of nor-binaltorphimine, a selective kappa-opioid receptor antagonist. On the other hand, the antinociceptive effects of (+/-)pentazocine were potentiated when non-diabetic mice were pretreated with beta-funaltrexamine, a selective mu-opioid receptor antagonist. Furthermore, there was no significant difference in the antinociceptive effect of (+/-)pentazocine between diabetic mice and beta-funaltrexamine-treated non-diabetic mice. These results suggest that the hypo-responsiveness of mu-opioid receptors may account for the enhanced kappa-opioid receptor-mediated antinociceptive effect of (+/-)pentazocine in diabetic mice. |
8041999 | [Pneumopathy induced by pirindopril. A case report]. | Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease. |
8041998 | [Diffuse interstitial pneumonia revealing Erdheim-Chester's disease]. | Erdheim-Chester's disease is a rare form of visceral xanthogranulomatosis. We report a case of a patient aged 50 presenting with a diffuse interstitial pneumonia which revealed Erdheim-Chester's disease with localisation in the bones, peri-aortic region and also with neurological involvement. The diffuse interstitial pneumonia which progressed chronically was characterised by a diffuse thickening of the septa with subpleural cysts and bilateral apical bullae with thickening of the pleura. Respiratory function tests showed a restrictive ventilatory defect with resting hypoxaemia which was aggravating by exercise. Broncho-alveolar lavage showed a lymphocytosis (26%) also with polymorpho neutrophils (11%). The pathological diagnosis was confirmed by transbronchial lung biopsy showing an excess of foamy histiocytes in the interstitium which are characteristic of the disease. The progress of this interstitial pneumonia is stabilised without immunosuppressive drugs. |
8041997 | [Pulmonary malacoplakia and Rhodococcus equi pneumonia in a patient infected with the human immunodeficiency virus. A case report with review of the literature]. | We report a case of pulmonary malakoplakia in a patient suffering from AIDS secondary to a Rhodococcus equi pneumonia. The association between these two pathologies only occurring in the immunodepressed does not seen fortuitous. Deficiency in cellular immunity and macrophage cellular activity as well as failure of intracellular bactericidal and phagolysosomal function are very probably the links. The treatment of this opportunistic germ rests on prolonged poly-antibiotic therapy or indeed surgical excision. |
8041996 | [Proximal bronchial cancer with hypoxemia due to right to left intrapulmonary shunt. Correction of hypoxemia after pneumonectomy]. | The authors report a case of a patient who was in hospital for a bronchial cancer completely occluding the left superior and inferior lobar bronchi. Respiratory function tests showed: an FEV1 of 1.7 litres, FEV1 (vital capacity ratio of 60%), a TLC of 76% of the predicted value and a PaO2 of 52 mm of mercury with an elevated alveolar arterial oxygen gradient. The ventilation perfusion lung scan showed that the left lung was not ventilated but was perfused. A left pneumonectomy was judged to have removed the cancer and enabled a correction of the hypoxaemia. The authors recall the functional repercussions of absent ventilation of one lung by a proximal bronchial obstruction and the therapeutic implications in the realm of neoplastic pathophysiology. |
8041995 | [Tuberculous lymphadenopathy revealed by polyneuropathy. Causal relation or simple coincidence?]. | We report a case of cervical and mediastinal lymphadenopathy revealed by a sensory-motor polyneuropathy of the lower limbs. A search for a cause was unsuccessful; the improvement following antituberculous treatment posed a question as to whether the polyneuropathy was tuberculous in origin or simply a coincidence. |
8041994 | [Iatrogenic diffuse interstitial pneumonia linked to 5-aminosalicylate]. | Iatrogenic pneumonias to sulphasalazine are most usually seen during the course of a haemorrhagic proctocolitis (RCH). We report a case in which a young woman was treated with 5-aminosalicylate (Pentasa) and prednisolone during an exacerbation of RCH. After 3 months of treatment the steroid therapy was stopped and the Pentasa was continued at the same dose (3 g per day). She presented with increasing dyspnoea on effort. Clinical examination was normal but a CT scan of the chest showed interstitial micro nodules; there was also a restrictive ventilatory disorder, hypoxaemia on effort and an alveolar eosinophilia (1.8%) The clinical progress, respiratory and blood gases all improved rapidly after stopping the Pentasa with the disappearance of the interstitial nodule over 5 months, suggesting that the role of the Pentasa was causal in the genesis of the pneumonia. |
8041993 | [Recurrent hemothorax due to pleural endometriosis]. | We report a case of a 31 year old woman with recurrent hemothorax at the beginning of mens. Pleural biopsy confirmed the diagnosis of pleural endometriosis. Medical treatment with a Gn-RH analogue failed to cure and we realised surgical pleurodesis. |
8041992 | [Late recurrences of spontaneously resolved mediastinal-pulmonary sarcoidosis]. | Five cases of recurrent thoracic sarcoidosis which happened 5.5 years on the average after spontaneous resolution of the disease are reported. Initially, these patients were characterized by the frequency of the presence of a Löfgren's syndrome and the absence of extrathoracic sarcoid localizations. Recurrence of sarcoidosis was potentially severe essentially because of extrathoracic localization which needed oral corticosteroid treatment in 2 patients. Because recurrence of sarcoidosis is rarely observed, the diagnosis should be, in the absence of erythema nodosum, confirmed histologically in order to exclude a lymphoma or one of the various etiologies of diffuse interstitial lung disease. A sustained and regular surveillance of sarcoid patients after spontaneous resolution, particularly those with a Löfgren's syndrome, is suggested. |
8041991 | [Measuring and speaking about respiration. Role and ethical function of a psychopathological interview in a medical service]. | On the occasion of a respiratory function exploration, it was given to the patient the possibility of evoking, in respect of freely association, the psychical sense assumed by his symptom in his history. The unity of time, place and methodology, clinical psychopathology, defined our "experimental device". When the patient of this study, with SAS, said to the physician "I forget myself" with regard to ther apneas, the symptom, spoken, referred to a construction, "complementary" (Bohr, 1927) to another one described and objectivated by medicine. Each interpretation of the somatic phenomenon is related to the occurrence of speaking in the context of discursive associations and transference coordinates. The symptom is related to psychical reality, conflicts and desire of the patient. By the relations established between the advent of the spoken symptom and other events, the patient considers it as a response to a personal question. Then, he can reach a fragment of his verify, hear himself and hear the effects of his speaking. Without this possibility of reappropriating subjectively and intersubjectively the suffering in its irreducible singularity, he would remain alienated from his suffering, as to a trauma. Our approach gives evidence of the methodological as well as praxeological revision of the psychopathology contribution to the medicine. |
8041990 | [Treatment with clarithromycin of 173 HIV+ patients with disseminated Mycobacterium avium intracellulare infection]. | No treatment was established for disseminated M. avium intracellulare (MAC) infection, a common disease of end stage of AIDS. An open study was conducted to assess in 173 AIDS patients, the activity of clarithromycin. Initial bacteriologic eradication from blood was observed in 136/147 evaluable patients (93%). Acquired resistance to clarithromycin associated with relapse appeared to develop after 2 to 7 months of drug treatment in 31/136 patients with initial success. Early bacteriological relapse was associated with clinical deterioration. Side effects of drug treatment were elevated liver enzymes (26%) and impaired hearing (4%). Side effects conducted to stop treatment in 14 cases (8%) to modified treatment in 8 cases (5%). Our study gave new argues for activity of clarithromycin in disseminated MAC infection. |
8041989 | [Prognostic factors in the survival of patients with neuromuscular diseases after an episode of acute respiratory insufficiency]. | We have studied the survival of 49 patients suffering from neuromuscular disease, who were hospitalised in the Respiratory Intensive Care Unit between 1981 and 1990 (29 males and 20 females with a mean age of 49.3 +/- 17 years with a range of 15 to 79). The neuromuscular diseases consisted of 8 with multiple sclerosis, 9 with amyotrophic lateral sclerosis, 8 with Steinert's disease, 11 myopathies, and 10 suffering from miscellaneous neurological diseases. Initially 27 of the 49 patients had been intubated and ventilated. During the hospital stay long-term ventilation was undertaken in 27 patients (21 by tracheotomy and 6 by nasal mask). The principal prognostic factor was the aetiology. Three groups of varying degrees of severity could be individualized: progressive neuromuscular disease (amyotrophic lateral sclerosis and multiple sclerosis), primary muscle disorders (myopathies and Steinert's disease), and neuromuscular disease with little or no evolution (survival at two years was 15%, 45% and 71% respectively for three groups. p = 0.001 by log-rank testing). The other factors which influence survival are age (p < 0.01), the presence of false route (p < 0.01), and the reason for hospitalisation (acute as opposed to chronic progressive deterioration, p < 0.05). In a multivariate analysis the most significant factors associated with the diagnosis were age, the reason for hospitalisation, and the existence of false routes. The initial treatment (intubation) and the prescription of long-term ventilation did not bring with it any significant further information as to prognosis, compared to the model which included these four factors. |
8041988 | [Small cell bronchial cancer. Comparison of results of weekly polychemotherapy using multiple drugs with standard chemotherapy. European Lung Cancer Working Party]. | The administration of multiple cytostatic drugs on a weekly basis has been proposed as a new intensive chemotherapy modality for small-cell lung cancer. The European Lung Cancer Working Party has conducted a randomized trial comparing to a standard regimen (cyclophosphamide + adriamycin + etoposide given at the cycle beginning) a weekly chemotherapy with 7 active drugs (cyclophosphamide + adriamycin + etoposide on day 1; cisplatin + vindesine on day 8; methotrexate + vincristine on day 15). A total of 215 eligible patients have been registered. There has been no significant difference between the 2 arms for response and for survival. The total relative dose-intensity has been lower in the weekly chemotherapy arm. This approach has failed to improve current results. |
8041987 | [Anti-influenza vaccine. Bibliographic review]. | A large number of papers are regularly published about anti-flu vaccine with discordant results regarding their efficacy. Through a recent review the efficacy of the vaccine has been evaluated both in terms of the immune response, the protection against clinical disease, but also as regards the impact from an epidemiological and economic point of view. In the majority of papers in which the immune response was studied before and after vaccination a 60 to 100% case of protection was obtained serologically by measuring the protective antibodies. These levels varied as a function of the type of the vaccination (inactive or living) and also of the immune state of the subject. In subjects of more than 60 years of age the immune response was 1.5 to 2 times less that in the young adult. The protection against clinical disease in children and adults is of the order of 40 to 70%, according to whether the infection is confirmed or not. On the other hand the vaccine is less effective in the elderly subjects, but gives a protection of the order of 75% protection against complications or of mortality linked to influenza. Finally there are a certain number of epidemiological and economic arguments which would justify the vaccine use on a large scale. |
8041986 | [Right to left shunts in the adult]. | Right to left shunts in the adult in their usual location are either intraarticular or intrapulmonary, and are often congenital. The acquired intrapulmonary shunt of the cirrhotic is now well defined by the hepatopulmonary syndrome. The major complication of right to left shunts are paradoxical pulmonary emboli which are often more severe than haemoptysis or chronic hypoxia. The diagnosis of intracardiac shunts as well as intrapulmonary shunts is now easier, thanks to transoesophageal ultrasound associated with contrast. Pulmonary angiography enables the treatment of arteriovenous fistula to be carried out by embolisation, and also avoids any surgery. |
8041983 | [Comparative study between continuous and bolus subarachnoid administration of 2% lidocaine]. | To compare anesthesia with lidocaine 2% by bolus or by continuous perfusion through a subarachnoid catheter. Thirty-one patients undergoing surgery on a lower limb were studied prospectively. Patients were divided into two groups: 14 received subarachnoid anesthesia in continuous perfusion (group CP) while 17 were given subarachnoid anesthesia in bolus form (group B). An 18G Tuohy needle was used with a 20 G catheter. An initial bolus of 20 mg (1 ml) was administered in group CP and followed by continuous perfusion at a rate of 16 mg/h (0.8 ml/h). In group B an initial 20 mg bolus was followed by additional ones of 10 mg (0.5 ml). The optimum sensory level was T 10. The two groups were homogeneous with respect to age, weight, height and medical history. Fewer boluses were needed with continuous perfusion. Seven patients (50%) in group CP required additional boluses. The ratio of total drug dose administered in mg to time of surgery was significantly higher in group CP. The sensory and motor blockade levels obtained were similar in the two groups. One case of hypotension and one of bradycardia were recorded. Two cases of minor headache were recorded in group B. Sedation was used in 7 patients (50%) in group CP and in 13 (76%) in group B. Subarachnoid administration of lidocaine 2% in continuous perfusion affords the same sensory and motor blockade as administration in bolus form and does not reduce the overall amount of lidocaine used. |
8041982 | [Comparative study between anesthesia by continuous perfusion with propofol or thiopental-isoflurane in laryngeal surgery]. | To compare two anesthetic protocols for maintenance of anesthesia during laryngectomy (propofol vs thiopental-isoflurane), assessing its effects on intraoperative hemodynamic stability and recovery time after withdrawal of anesthesia. Thirty-one patients undergoing laryngectomy. Anesthetic technique was the same except for the maintenance anesthetic used (isoflurane in group I [n = 16]; propofol in group P [n = 15]). We recorded heart rate and systolic/diastolic arterial pressure before surgery, 10 minutes after induction, at 10, 60 and 120 min after start of surgery and at the end of the procedure. Postanesthesia recovery time was measured by the Steward test (recovery of consciousness, control of voluntary movement and of breathing) applied at 3, 5, 10, 30 and 60 min after withdrawal of anesthesia. There were no demographic differences between the two groups and heart rate and systolic/diastolic pressures were comparable. Postanesthetic recovery time was shorter in group P than in group I, with a statistically significant difference 5 min after withdrawal of drug (p < 0.05) owing to the item recovery of consciousness in the Steward test (p < 0.05 at times 5 and 10 min for this item). There were no significant differences in control of breathing or movement. Propofol for anesthetic maintenance is effective and safe. There are no differences in hemodynamic changes produced by propofol and isoflurane. Time until recovery of consciousness is longer with isoflurane, although we believe that this is not clinically relevant in this type of procedure. |
8041980 | [Oral premedication with clonidine in patients undergoing coronary revascularization surgery]. | To analyze the effect of premedication with clonidine on level of sedation, anesthetic requirements and hemodynamic repercussions in patients undergoing coronary revascularization. Thirty patients were divided into two groups and randomly assigned for premedication with clonidine 0.005 mg/kg p.o. (C) or lorazepam 0.03 mg/kg p.o. (L), along with morphine 0.15 mg/kg i.m. and scopolamine 0.005 mg/kg i.m. in a prospective double-blind study. The level of sedation before surgery and anesthetic requirements in the two groups were compared, as were systolic and diastolic arterial pressure, heart rate and hemodynamics during and after surgery. Fentanyl was used for anesthetic induction in boluses of 0.15 mg every 10 seconds; maintenance boluses of 0.5 mg were used up to a maximum dose of 0.07 mg/kg. If hemodynamic variables analyzed (systolic and diastolic arterial pressure and heart rate) were not kept within 30% of baseline values with this regimen, isoflurane was added. No differences between the two groups were found for level of sedation. The total dose of fentanyl was lower in group C (0.052 +/- 0.002 mg/kg vs 0.058 +/- 0.002 mg/kg) (p < 0.05). The number of patients requiring isoflurane was similar (4/11 and 6/9) in both groups. The hemodynamic profile prior to extracorporeal circulation (ECC) revealed arterial pressures and heart rates to be lower in the group treated with clonidine (p < 0.05); after ECC systemic resistance in group C was lower (630 +/- 103 vs 795 +/- 106 din.s.cm-5) (p < 0.05) and this was not compensated for by a significant rise in cardiac index (2.62 +/- 0.09 vs 2.40 +/- 0.08 l/min/m2) at similar occlusion pressures. Use of clonidine in the type of patient studied does not improve the level of sedation over that achieved with lorazepam. Fentanyl requirements decreased with clonidine. With respect to hemodynamic profile, systemic vascular resistance fell in the clonidine group after removal of ECC, and thus this drug offers no advantages for routine premedication. |
8041981 | [Continuous epidural perfusion with meperidine on demand for the treatment of postoperative pain]. | To determine whether epidural administration of meperidine through a system affording patient-controlled analgesia (PCA) is appropriate for postoperative pain. A prospective double-blind study of 30 patients undergoing high abdominal surgery randomly into two groups. After surgery with the same type of general anesthesia for both groups, group A received epidural meperidine through a PCA pump (initial boluses of 50 mg + infusion of 10 mg/h with additional doses of 25 mg upon patient demand and closure time of 90 min). Control group B received 0.9% saline serum through an epidural PCA system with identical perfusion characteristics. All patients had access to additional analgesia with subcutaneous meperidine (1 mg/kg weight). There was a wide interindividual variation in meperidine consumption in group A, with a mean total dose of 301.4 +/- 73 mg in 24 hours and no patient requiring additional subcutaneous meperidine. Subcutaneous meperidine required in group B reached 273 +/- 65.8 mg in 24 hours, with no significant differences between groups A and B for total dose given. No side effects inherent to the technique were found. Sufficient control of pain was achieved for all patients receiving epidural meperidine. Epidurally administered PCA with meperidine affords better pain relief with greater patient satisfaction than the same amount of drug given subcutaneously in successive doses upon patient request. |
8041979 | [Premedication with clonidine in the neurosurgical patient: sedation, anesthetic requirements and hemodynamic perfusion]. | To analyze the effect of premedication with clonidine on postoperative sedation, anesthetic requirements and hemodynamic repercussions in patients undergoing craniotomy due to supratentorial intracranial pathology. Twenty ASA I/II patients in a double-blind prospective study were assigned randomly to receive lorazepam (0.03 mg/kg/po, n = 10) or clonidine (0.005 mg/kg/po, n = 10) the night before and 90 minutes before surgery. Arterial pressure and heart rate were monitored continuously during and immediately after surgery (first 24 hours). Anesthetic induction was achieved with thiopental (maximum 6 mg/kg) and maintained with O2/N2O and an infusion of alfentanyl (1 microgram/kg/min). Hemodynamic response to surgical stimulus was treated with additional boluses of alfentanyl up to a maximum dose of 0.1 mg/kg and with an increase in infusion dosage to 2 micrograms/kg/min. When these were ineffective, isoflurane was given. All patients were extubated in the operating room. No differences in level of sedation were found between the two groups. The infusion dose and total amount of alfentanyl given were smaller for patients treated with clonidine (0.8 +/- 0.04 vs 0.6 +/- 0.01 microgram/kg/min and 22.4 +/- 5.3 vs 17.5 +/- 4.9 mg, respectively) (p < 0.05). No differences were found in isoflurane requirements (5/5 vs 2/8). Mean arterial pressure and heart rate were lower with clonidine from 3 minutes after intubation until the patient's arrival in the recovery room (p < 0.05), with marked bradycardia (49 +/- 5 vs 73 +/- 7 bpm) (p < 0.05) upon intubation. Premedication of neurosurgical patients with clonidine offers no advantages over lorazepam with respect to sedation. Nevertheless, clonidine may offer advantages with respect to the amount of alfentanyl required and attenuation of perioperative adrenergic response. |
8041972 | [Intraoperative hydatid anaphylactic shock]. | Certain parts of Spain continue to have a high incidence of hydatid disease. Anaphylaxis mediated by IgE, due to the high concentration of antigens in the blood stream, is a serious but fortunately infrequent complication of surgery. We present two cases of anaphylactoid reaction in patients undergoing surgery for excision of hydatid cysts and one case of a patient scheduled for cholecystectomy with unsuspected hydatid disease. This represents three cases presenting vascular collapse accompanied by metabolic acidosis, from among a total of 53 surgical patients handled by our department between January 1992 and May 1993. Early, essentially clinical, diagnosis and immediate start of treatment with adrenaline, suspension of inhaled anesthetics, administration of 100% oxygen, and restoration of intravascular volume with colloids or crystalloids were decisive in assuring the favorable outcome for these patients. Hydatid disease must be considered as a differential diagnosis in cases of shock during surgery in areas where it is endemic. Although infrequent, the possibility of anaphylaxis must be kept in mind whenever there is sudden hemodynamic deterioration during surgery for removal of a hydatid cyst. Early diagnosis and appropriate treatment are essential for a favorable outcome. |
8041971 | [Severe accidental hypothermia: rewarming by total cardiopulmonary bypass]. | We present a case of a 20-year-old male with a history of habitual drug use who suffered extreme hypothermia (26 degrees C) after several hours' accidental exposure to low ambient temperature. The patient presented in deep coma with recurring ventricular fibrillation that yielded to electrical defibrillation once a central temperature of 27.4 degrees C was reached through internal rewarming with intravenous liquids and gastric lavage with warm water. Because this method was slow, we decided to continue rewarming with extracorporeal circulation through cannulation of the femoral vein and artery. The patient recovered consciousness after three hours, with no neurological secuelae. Emergency room staff have available the means for recognizing hypothermia and a protocol for its management. Extracorporeal circulation is an effective method for internal rewarming and must be used when the patient requires cardiopulmonary resuscitation or presents signs of severe hemodynamic instability. |
8041970 | [Importance of the daily and political newspapers in Madrid on the introduction, popularization and awareness of anesthesia]. | The introduction of surgical anesthesia in Spain and its spread throughout the country between 1847 and 1848 was facilitated by several medical journals and new daily and political newspapers in existence at the time, particularly in Madrid. This study was undertaken to determine the possible impact of articles reporting the discovery of anesthesia that were published in the contemporary daily press. Research involved a review of the daily press in Madrid, where most newspapers were published. We found 141 references to events surrounding the introduction of anesthesia in Spain in 24 Madrid newspapers. Analysis of the articles revealed how the daily press contributed to the rapid dissemination of information about the discovery. The press provided an important means of spreading news about and popularizing anesthesia and was also an instrument for exchanging scientific opinion for Spanish surgeons of the day. |
8041969 | Cardiac tamponade secondary to hemorrhagic pericarditis during continuous hemofiltration for renal failure. The role of the anticoagulant. | Cardiac tamponade secondary to hemorrhagic pericarditis during continuous hemofiltration (CHF) for renal failure is reported. Cardiac tamponade developed while heparin was being used as an anticoagulant and did not recur when nafamostat mesilate was substituted. The role of the anticoagulant in the etiology of hemorrhagic pericarditis in dialysis patients is discussed. |
8041968 | Acute renal failure in a patient with HELLP syndrome--an unusual complication of eclampsia. | Acute renal failure occurring in a 24-year-old primigravida with eclampsia and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is described. She also had transient disseminated intravascular coagulation. Hemodialysis, fresh blood transfusions, and antihypertensive therapy were administered, and resulted in complete recovery. Kidney biopsy revealed acute tubular necrosis. |
8041967 | Simplified approach to calculation of V, G, and nPCR for monitoring hemodialysis patients. | Urea kinetic modeling (KM) permits the calculation of urea volume (VKM), urea generation rate (GKM), and normalized protein catabolic rate (nPCRKM) but requires complex, iterative calculations. Simpler methods for estimation of these parameters (V(est), G(est), nPCR(est)) were compared with those obtained from kinetic modeling. Kinetic modeling was performed on 17 patients using the 3 BUN method, producing 19 data sets. All were within 25% ideal body weight and all had less than 20% difference between VKM and V(est). V(est) was estimated as 0.195 (height) + 0.296 (weight) - 14.01. G(est) was estimated, using interdialytic changes as: [formula: see text] where U is urinary urea excretion rate. nPCR(est) was estimated as: (G(est) x 9.35) + (0.294 x V(est)) x (0.58/V(est)). There was no significant difference (Student's t test) between mean +/- SD V(est) (41.24 +/- 3.86 L) and VKM (40.71 +/- 5.24 L), G(est) (7.23 +/- 1.92 mg/min) and GKM (7.04 +/- 2.10 mg/min), and nPCR(est) (1.12 +/- 0.24 g/kg/day) and nPCRKM (1.10 +/- 0.23 g/kg/day). Correlation between V(est) and VKM was poor (r2 = 0.56, slope = 0.41). Correlations between G(est) and GKM and nPCR(est) and nPCRKM were good (r2 = 0.95, slope = 0.87; and r2 = 0.99, slope = 1.02, respectively). Assessment of nutritional status using G(est) and nPCR(est) can be carried out with high degree of accuracy even if V(est) and VKM are not identical. |
8041966 | Acute renal failure in a medical setting: changing patterns and prognostic factors. | The clinical characteristics of 118 patients (60 male) with acute renal failure (ARF) admitted between 1980 and 1991, were retrospectively analyzed and compared with our earlier series of the 1960s. The mean age was 53 years (16-82 years). There was a marked decline in the hypotension-related cases (43% vs. 17%, p < 0.01) and a concomitant increase in the nephrotoxic cases (5% vs. 17%, p < 0.005) in recent years. The number of ARF cases significantly decreased after 1986 (31%) compared to the pre-1986 era (69%, p < 0.001). A complete (35%) or partial recovery (55%) was the rule in the majority of the patients. The overall mortality was 27%, virtually unchanged in comparison to the 1960s (30%). However, a tendency toward lower mortality was seen after 1986 (17%) in comparison to before (32%, p < 0.05). Sepsis and cardiovascular complications were the leading causes of death. Fewer deaths were observed among younger patients (< 30 years, 12.5%) compared to middle-aged patients (30-59 years, 34%, p < 0.05) and to these older than 60s (53.5%, p < 0.002). Also, deaths were rare in patients with only renal involvement (6%), increasing to 30% when 2 vital organ systems were affected (p < 0.005) and to 67% in cases with multiple organ failure (p < 0.001). Early institution of dialysis and the nonoliguric forms of the syndrome seem to be associated with better prognosis. In conclusion, the incidence of ARF has declined in recent years, with a concomitant tendency towards lower mortality. Death rate is mainly determined by the age and the number of organ involvement. Early dialysis seems to contribute to the lower mortality seen in recent cases. |
8041965 | High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy. | We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase. |
8041964 | Ischemic renal failure in chronic hypoxic rats. | The after effects of renal ischemia were studied in hypoxia-adapted rats. It was felt that chronic hypoxia animals which had already adapted to a low oxygen level might be more tolerant of renal ischemic insult; however, chronic hypoxia is always accompanied by polycythemia, which may cause severe RBC trapping and consequently might enhance renal damage after renal ischemia. Chronic hypoxic rats were prepared by exposure in an altitude chamber 15 h per day for 4 weeks. The plasma sodium, potassium, urea, and creatinine levels were determined to compare the changes in these parameters between the baseline and 3 h after a 45-min occlusion of both renal arteries in 12 sea-level (SLB) controls and in 12 chronic hypoxic (CHB) and 11 chronic hypoxic plus RBC pheresis (to reduce hematocrit: CH + P) rats. From the parameters measured, the CHB rats were found to be more tolerant of renal ischemia. However, this was not the case in the rats with pheresis. It is concluded that after chronic hypoxia, some humoral factors in the plasma may play an important role in reducing the renal damage after ischemic insult. |
8041963 | Amplification-independent overexpression of thymosin beta-10 mRNA in human renal cell carcinoma. | The structurally related small (< 5 kD) polypeptides, namely thymosins beta-4 and beta-10, were originally defined in the rat immune system. Previously it was shown that both the beta-4 and beta-10 genes are constitutively expressed at higher levels in neoplastic human kidney. Also, it was shown that human embryonic kidney contained more of these proteins than the adult tissue. The present study used a human thymosin beta-10 cDNA to examine the possibility that overexpression of the beta-10 mRNA in renal cell carcinoma was due to gene amplification. Southern blot analysis of genomic DNA extracted from normal and neoplastic tissue indicated no amplification of the thymosin beta-10 gene in RCC. No amplification or rearrangements were found in the human RAR-alpha gene in normal versus RCC tissue. Decreased expression of both the thymosin beta-4 and beta-10 proteins in the normal adult human kidney was found to be derived from a corresponding decrease in levels of the cognate mRNAs. These findings suggest that the thymosin beta-10 gene is deregulated in renal cell carcinoma. |
8041962 | Role of angiotensin II in renal vasoconstriction with acute hypoxemia and hypercapnic acidosis in conscious dogs. | To evaluate the role of renin-angiotensin in the renal vasoconstriction with combined acute hypoxemia and hypercapnic acidosis preceded by acute hypoxemia, we studied eight conscious mongrel uninephrectomized dogs with chronic renal catheters and controlled sodium intake (80 mEq/24 h x 4 days). The animals were studied during combined acute hypoxemia and hypercapnic acidosis (PaO2 34 +/- 1 mm Hg, PaCo2 57 +/- 1 mm Hg, pH 7.20 +/- 0.01) preceded by 80 min of acute hypoxemia (PaO2 34 +/- 1 mm Hg) during: (a) intrarenal infusion of vehicle (n = 8); or (b) intrarenal administration of the angiotensin II antagonist [Sar1,Ala8]-AII, 70 ng kg-1 min-1 (n = 8). The combination of acute hypoxemia and hypercapnic acidosis resulted in diminished effective renal plasma flow and increased renal vascular resistance during intrarenal vehicle infusion. Intrarenal [Sar1,Ala8]-AII did not abolish the renal vasoconstriction in the initial 20 min of this combined blood gas derangement but resulted in a more prompt return of the renal vascular variables toward control levels with continuation of the blood gas derangement for an additional 20 min, suggesting a role for angiotensin in renal vasoconstriction. These observations suggest that while renin-angiotensin may not mediate the initial renal vasoconstriction in the first 20 min of combined acute hypoxemia and hypercapnic acidosis, in uninephrectomized conscious dogs, it attenuates the spontaneous recovery of renal hemodynamic variables to baseline as the blood gas derangement continues. |
8041961 | The effects of oral chloroquine administration on kidney function. | The effects of 3 consecutive days of oral chloroquine (1 mg/100 g body weight) on kidney function and blood pressure were studied in male Sprague-Dawley rats that were challenged with hypotonic saline infusion 24 h after the last chloroquine administration. The rats were anesthetized with Inactin [5 ethyl-5-(1'-methylpropyl)-2-thiobarbiturate, Byk Gulden] and continuously infused with 0.077 M NaCl for 8 h; urine flow and electrolyte excretion rates were monitored during the last 5 h. Blood pressure and glomerular filtration rates were also measured. Kidney function was compromised in chloroquine-treated rats, which retained significantly more of the infused Na+ and Cl- by comparison to control-vehicle-treated rats. Throughout the experimental period, chloroquine-treated rats exhibited low blood pressure (80 mm Hg vs. 127 mm Hg) which was associated with low glomerular filtration rate. The plasma aldosterone concentrations were significantly (p < 0.01) elevated in rats pretreated with chloroquine at the end of the 8-h infusion of hypotonic saline, but corticosterone levels were significantly (p < 0.01) lower in the treated rats. It is concluded that chloroquine administration impairs kidney function, resulting in inappropriate Na+ and Cl- retention. This effect is likely to be mediated via chloroquine-induced increases in plasma aldosterone concentration and lowering of GFR. |
8041960 | Amino acid supplementation to hyperalimentation in uremic rats: effects of amount and composition of amino acids on nutrition and uremia. | We evaluated amount and composition of amino acids in supplementation of hyperalimentation from the standpoint of whether it may improve nutrition and/or reduce the indexes of uremia such as BUN. Rats with established uremia, by 5/6 nephrectomy, were treated with various isocaloric solutions containing different amount of essential amino acids and histidine (EAA) or standard amino acids (SAA) which were formulated to provide Cal/N ratios of 300, 600, and 900. The BUN was lower and the nutritional index was better in rats infused with EAA compared with those administrated SAA, while severe distortion of plasma amino acid concentration, hyperammonemia, and fatty liver were observed at the Cal/N 300 condition. Rats infused with SAA gained positive nitrogen balance at the condition of Cal/N 300; however, plasma amino acid distortion was still observed. These results indicate that administration of EAA alone for treatment of renal failure needs high-calorie and low-nitrogen conditions such as Cal/N 600 for avoiding complications. Administration of standard amino acid solution is safe and nutritionally effective in the Cal/N 300 condition, but there are a few problems concerning nitrogen availability and plasma amino acid pattern. |
8041958 | Heat shock proteins and the kidney. | The heat shock (HS) response is remarkably conserved during evolution and is evoked under many conditions of stress. There are a number of ways in which this ubiquitous response may be important for the understanding of renal pathophysiology. Ischemia, toxin exposure, and oxidative stress induce this response. Several models of hypertension are associated with increased susceptibility to environmental stress and increased accumulation of heat shock protein mRNA. HSP70 polymorphism has been demonstrated when comparing normotensive and hypertensive rats. Heat shock proteins may play a role in renal diseases through their important involvement in immunological processes. Several observations point to a role of the heat shock response in systemic lupus erythematosus (SLE). Autoantibodies against HSP70 and ubiquitin are found in many patients with this disease. Autoantibodies against ubiquitin and ubiquitinated histone H2A are localized to the kidney glomerular basement membrane of SLE patients with active disease. A better understanding of the HS response may thus provide important insight into renal pathophysiology and may suggest paradigms for therapeutic interventions. |
8041959 | Functional, histologic, and ultrastructural study of the protective effects of verapamil in experimental ischemic acute renal failure in the rabbit. | The present study was performed in vivo in rabbits to evaluate the functional and morphologic effects of verapamil in a model of ischemic acute renal failure (ARF). Particularly impressive was the ultrastructural integrity of renal tubules in the animals exposed to both ischemia and verapamil. Three groups were studied: Group A: no ischemia; Group B: renal ischemia alone; and Group C: renal ischemia with verapamil. Creatinine clearance was higher in Group C (0.77 mL/min/kg) compared to Group B (0.13 mL/min/kg) at 24 h of reperfusion (p < .005) as well as at 48 and 72 h (0.73 mL/min/kg) vs. 0.35 mL/min/kg; p < .05 and 0.90 mL/min/kg vs. 0.46 mL/min/kg; p < 0.05, respectively). Light microscopic evaluation of Group C rabbits revealed significantly better preservation of proximal tubule (PT) brush border (p < .0005) and less desquamation of PT (p < .05) compared to Group B. Ultrastructural examination of in vivo perfused kidneys also demonstrated decreased loss of microvilli of PT (p < .0005) as well as less cellular edema (p < .005), fewer cells with apical PT membrane rupture (p < .01), better preservation of mitochondria (p < .005), less flattening of the PT basolateral labyrinth (p < .05), and fewer hypertrophic actin bands at the basal surface of PT epithelial cells (p < .05). These results suggest that verapamil markedly attenuates PT morphologic injury in a rabbit model of reversible ischemic ARF. The functional protection observed in these studies may be related, in part, to the improved structural integrity of the renal tubules. Renal transplantation and anticipated renal ischemia (i.e., surgical interventions) are two important situations where treatment with verapamil or other calcium channel blockers may prove to be clinically beneficial. |
8041942 | [Testicular seminoma in stages I and II non-bulky. 16 years' experience]. | From June 1977 through June 1993, ninety-five patients with testicular seminoma were treated in our center. This paper reports on 67 assessable patients--52 with stage I and 15 with non-bulky stage II disease. Median follow-up is 8 years (range: 4-16 years). Postorchiectomy radiotherapy consisted in 30 Gy (1.5 Gy/day) precautionary treatment to ipsilateral hemipelvis and paraaortic nodes (stage I) or 40-45 Gy to the same area plus 25.5-30 Gy prophylactic irradiation to mediastinum and supraclavicular fossae (stage II). Ten-year actuarial survival is 100%-96.8% +/- 2.2 considering deaths from other diseases. Ten-year disease-free survival is 95.3% +/- 2.6. The 3 relapsed patients were rescued with chemotherapy or radiotherapy (1 and 2 cases, respectively). Acute side-effects were nausea (30% of cases) and vomiting (18%) which disappeared after oral antiemetics. Late toxicity-asymptomatic osteolysis of the ipsilateral pubic region--was observed in 1 patient only (1.5%) who received cobalt therapy to inguinal canal and hemiscrotum (40.5 Gy in 27 fractions). The current diagnostic and therapeutic approaches to testicular seminoma are discussed. In stage I the conventional treatment is low-dose (20-25 Gy) subdiaphragmatic radiotherapy and a policy of surveillance is justified only for clinical trials. In non-bulky stage II disease lumboaortic and hemipelvic irradiation (36-40 Gy) is the treatment of choice whereas precautionary irradiation should not be given to the mediastinum. If abdominal CT scans show nodal metastases, chest CT is necessary for staging instead of chest X-ray films. When abdominal CT findings are negative or questionable, bi-pedal lymphography must be performed. Residual testis US should be the routine examination for the early diagnosis of metachronous contralateral seminoma. The semen should be tested for further storage and sexual functions should be accurately analyzed to distinguish between organic and psychologic causes. Although limited, our experience demonstrates the good prognosis of this condition and the optimal tolerance in testicular seminoma patients even with a radiotherapy regimen which is now considered suboptimal, though it was the standard about 10 years ago. |
8041941 | [Radiotherapy results in the treatment of malignant tumors of the nasal fossa and vestibule]. | The authors report their personal experience in the treatment of malignant tumors of the nasal cavity and vestibule with irradiation alone or combined with surgery. From January 1976 to December 1989 we treated 40 patients with 22 squamous cell carcinomas, 12 adenocarcinomas or other glandular types, and 6 other histologic types of lesions: 23 patients received irradiation alone and 17 patients were treated with surgery and postoperative irradiation. The protocol included surgery as the treatment of choice: irradiation alone was administered to inoperable tumors or to the patients refusing surgery; postoperative irradiation was given when macroscopic or microscopic residual disease was observed after surgery or to particular histologic types. In the whole series of patients, 3- and 5-year local control rates were 70% and 50%, respectively; better results were obtained in the patients receiving the combined treatment (64% at 5 years) than in the patients receiving irradiation alone (43% at 5 years). Disease stages (I and II versus III and IV) were the only statistically significant prognostic factor; worse results in irradiated patients might be due to the higher rate of advanced lesions in this group. Salvage therapy (irradiation in 8 cases, surgery in 2 and chemotherapy in 1) was successfully performed in 5 of 11 treated patients. The 3- and 5-year overall survival rates were 88% and 70%, respectively. Severe complication rate was lower than 10% (3 cases only). |
8041940 | [Digital storage phosphor radiography. Doses and image quality]. | Digital radiography (DR) based on storage phosphor technology is progressively replacing conventional screen-film system radiographic techniques (CR). However, many questions about image quality and dose reduction are still open. Thus, since DR spatial resolution is always lower than that of high quality screen-film images and image noise is conversely higher, for general radiography examinations especially, the signal-to-noise ratio is always lower with DR than with CR at the same dose level. However, the wide dynamic range, the linear response of storage phosphor detectors and the automatic read-out control of the digital system, enable lower DR X-ray imaging efficiency to be overcome, producing a nearly perfect readout of the image data every time an exposure is made. Moreover, post-processing can make the detection of abnormalities easier. This is why in many ROC clinical accuracy studies DR performed equally or better than CR. Good quality DR images, similar to conventional ones at the same dose levels, are therefore achievable in chest, abdomen, bone and soft-tissues examinations. Dose evaluation protocols are strongly needed in DR since overexposures due to technical mistakes may be overlooked; moreover, doses can be adjusted to the peculiar diagnostic need. The S values shown on any hard-copy image can be used to this purpose, even though it must be pointed out that they do not express the actual mean dose to the detector. |
8041939 | [The percutaneous treatment of purulent intrathoracic fluid collections in HIV+ patients]. | Eighteen HIV+ patients with purulent fluid intrathoracic collections (16 pleural empyemas and 2 lung abscesses) and persistent sepsis were treated with percutaneous drainage; all patients had received antibiotics for 5-7 days at least. Empyemas and lung abscesses were cured (according to clinical and radiographic criteria) in all patients (100%). One major complication was successfully treated--i.e., a pneumothorax with a iatrogenic lesion of the internal mammary artery, requiring selective embolization. In our experience, CT is the method of choice to guide lesion puncture. Van Sonnenberg Sump catheters (12-16 F) have been inserted in the last six months with the Trocar technique. The maneuvers were successful in all cases, with good compliance and management of patients in a 9-25 days' period (mean: 14 days). In our experience, the percutaneous drainage of intrathoracic fluid collections in HIV+ patients should be considered the method of choice. |
8041938 | [A PACS system in clinical reality: the Trieste project]. | The authors report on their experience gained during 5 years' use of a PACS Comm View (AT & T and Philips) in daily clinical practice. The system proved to be very effective in the preparation phase (retrieval of previous investigations), with major advantages over the conventional retrieval modality. The rate of unretrieved images is < 2% and their retrieval times are 10-210 seconds according to different archiving systems. The retrieval of previous images at the two workstations of our department took actually place 20 times a day--that is, much more than in past years. The reporting function was not implemented at the workstation due to its inherent limitations. Communicating the diagnoses (images and reports) to the hospital wards with PACS and RIS was highly appreciated by the referring physicians and a questionnaire distributed among them demonstrated that rapid data access: 1) avoids exam repetitions or unnecessary investigations (81.3% of answers); 2) avoids the request of previous medical records (80% of answers); 3) markedly shortens (two or more days) hospitalization time (100% of answers); 4) has a major impact on treatment choices (100% of answers) and 5) improves the efficiency of referring physicians (93.8% of answers). All the images acquired by the 5 connected modalities were entered in a juke-box with optical disks. Therefore, archive size is likely to reduce in the future. Slightly fewer films (about 14,000 USD/year) are now used. |
8041937 | [Echography and magnetic resonance of the penis. I. Its anatomy]. | The use of such new diagnostic imaging methods as ultrasonography (US) and Magnetic Resonance Imaging (MRI) has given radiology an increasingly important role in the study of penis abnormalities. The normal anatomy of the penis was investigated with US with real-time units, high-frequency linear probes, and with an 0.5-T MR unit. The two methods are definitely better than conventional radiologic techniques because they allow the direct and detailed demonstration of all anatomical structures. Both the normal and the abnormal anatomy are better depicted when the exam is performed after pharmacologically induced erection. The normal US and MR features of the different anatomical structures must be known to diagnose penis conditions. US exhibited better spatial resolution than MRI and demonstrated very small structures which may be missed at MRI because of gap interslices. On the other hand, MRI exhibited better contrast resolution, especially on T2-weighted sequences. Thus, the two imaging methods must be considered as complementary, even though US is suggested as the method of choice because of its cost-effectiveness and widespread availability. |
8041936 | [Cholangiocarcinoma of the main biliary tract. Judging its resectability by imaging procedures]. | Eighteen patients with main biliary tract cholangiocarcinomas and no spread to the gallbladder and to the papilla of Vater underwent a combined US, ERCP/PTC and CT study. Angiography was performed on a selected group of 12 patients. We divided the infiltrating, polypoid or stenosing lesions in three groups: upper portion tumors, involving the confluence and the common hepatic duct (8 patients); middle portion tumors, originating from the common bile duct between the confluence of the cystic duct and the upper duodenal profile (6 patients); and finally lower third tumors, originating from the common bile duct between the upper rim of the duodenum and the papilla of Vater (4 patients). According to ERCP and/or PTC, US, CT and angiographic findings, only 9 of 18 cholangiocarcinomas were judged as resectable. The authors stress the need to optimize the use of imaging methods: US can locate the biliary obstruction; ERCP and/or PTC can show the tumor and its spread out of the duct, and finally angiography can exclude or confirm the vascular involvement of the hepatic hilum. |
8041935 | [Splenic abscesses. Their percutaneous treatment and the role of the interventional radiologist]. | Percutaneous abscess drainage is not as common in the spleen as in other anatomical sites, probably because of an uncontrollable fear of bleeding. Five cases of intrasplenic abscess drainage are presented. A double-way 12/14-F vanSonnenberg catheter was percutaneously inserted under CT guidance in four patients and under US guidance in one patient. Orthogonal scout CT views were useful to check the correct positioning of the drainage. In three patients the maneuver was successful, with no recurrence at follow-up at 12, 16 and 24 months, respectively. In one patient with a splenic abscess due to iatrogenic ischemic necrosis, the drainage allowed delayed surgery after relief of symptoms. Another patient died of sepsis five days after multiple well-functioning drainages. No early or late complications occurred. Bleeding was never observed in our series and there are no recent literature reports on this complication. Whenever it occurs, bleeding can be treated with selective embolization. In our experience, the percutaneous drainage of splenic abscesses, performed by the radiologist, should be considered the treatment of choice in these cases. |
8041934 | [The evolution of the liver metastases from colorectal carcinoma treated with hepatic intra-arterial chemotherapy. The echographic and CT aspects]. | The response of liver metastases to chemotherapy relies mainly on quantitative US and CT investigations, the two techniques being indifferently used. The morphologic changes of metastatic lesions during treatment have received little attention and their significance is still questionable. Based on the review of 53 US and 41 CT examinations of 15 patients treated with hepatic arterial chemotherapy for colorectal liver metastasis, our study was aimed at assessing: 1) the relationship between US and CT measurements of metastasis response to chemotherapy and 2) changes in the US and CT patterns of liver metastases during treatment and the existence of specific patterns of favorable response to chemotherapy or of disease progression. We concluded that: 1) as to quantitative response to chemotherapy, US and CT, performed on 13 patients within 1 month, were in agreement in all but 1 case, 2) US and CT patterns of treated liver metastases were different in case of favorable response and of disease progression; lesion outline, homogeneity and calcifications are useful diagnostic criteria to this purpose, 3) liver perfusion abnormalities may occur at various times during and after chemotherapy; these ischemic lesions must be differentiated from new metastases. |
8041933 | [The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)]. | The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse. |
8041932 | [Videoproctography in the study of rectal intussusception. The authors' own experience]. | Videoproctography has proved to be a useful diagnostic technique to investigate anorectal disorders; it can provide morphological and functional information which no other diagnostic method yields. From a series of 898 videoproctographs, the findings of 117 patients with rectal intussusception were retrospectively reviewed. The most common symptoms were an incomplete emptying feeling (93% of cases), obstructed defecation (78%), and a feeling of upright rectal weighting (71%). Of the three known types of rectal intussusception, the most common type was distal intussusception (44%), followed by the rectoanal type (38%) and finally by the proximal type (19%). The three types of intussusception were frequently (42%) associated with other disorders of rectal ampulla and especially with rectocele (15%), mucosal prolapse (8%), and descending perineum syndrome (12%); they had different clinical correlations and proctographic patterns and could be recognized in different defecation phases. In our personal experience, proctography with videorecording was a useful diagnostic tool in the dynamic assessment of this morphofunctional disorder which represents one of its major indications. |
8041931 | [Imaging diagnosis in pseudomembranous colitis]. | Pseudomembranous colitis (PC) is a dangerous inflammatory disease which arises as a complication of systemic antibiotic therapy. The colon is the preferred localization of PC, which is caused by the alteration in the bacterial population of the bowel which favors the growth and activation of several germ types--e.g., the Clostridium difficile, whose toxins can damage the colonic mucosa deeply. Later, the condition may affect extramucosal structures thus causing an actual parietal alteration. Clinically, PC patients present with diarrhea, abdominal pain, onset or worsening of fever, impairement of the main body functions. The colonic mucosa appears macroscopically edematous and is covered with yellowish plaques, called "pseudomembranes", which adhere strictly to the mucosa. Pseudomembranes are made by fibrin, mucus, leucocytes and epithelial remnants. The diagnosis is made on the basis of laboratory tests--i.e. the demonstration of Clostridium difficile or its toxins in the feces. Endoscopy is the examination of choice when PC is suspected because it can demonstrate the typical mucosal alterations directly. In this paper the main etiologic, pathologic and clinical features of PC are presented and the role of diagnostic imaging examinations is discussed, not only in demonstrating the typical lesions but also in the spatial evaluation of the condition and in its follow-up. |
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