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7787455
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[Protein profile in malnutrition states of the Ivory Coast child].
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Prospectively assessment of nutritional status, besides anthropometric parameters measurements, included determination of the following plasma proteins: albumin, transferrin, retinol-binding protein and thyroxine-binding prealbumin, usually regarded as useful indices of protein depletion states. Patients' inflammatory or infectious diseases were investigated by measuring the two most reliable acute-phase reactants (orosomucoid and c-reactive protein). This study was conducted on a group of 56 pediatric patients malnourished and 54 age- and sex-matched healthy subjects as controls. Data showed a higher prevalence of inflammatory process during the course of malnutrition as revealed progressive but severe alteration of the Prognostic Inflammatory and Nutritional Index (PINI) or CRP x a1-GPA/Alb x TBPA. On the other hand, kwashiorkor and marasmus seemed to be a precipitating cause of infectious or/and inflammatory process. We, therefore, conclude that the PINI scoring system should be for the pediatricians, a sensitive and precious tool allowing the correct follow-up of inflammatory pole in nutritional disorders in developing countries.
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7787457
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[Risk of contamination by Borrelia burgdorferi S. lato in a forest environment. Survey during 13 months of abundance of the tick Ixodes ricinus and its level of infestation by the Lyme borreliosis agent in Brittany].
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The authors, in a forest in Brittany previously studied for several years, caught by flagging, each month from April 1992 to May 1993, nymphs of I. ricinus tick, and looked by indirect immunofluorescence, for B. burgdorferi infestation. An amount of 1,506 ticks was thus studied. Infestation frequency was varying from 0 per cent in January and February to 14.4 per cent in August. Standarding of tick collecting method allowed to establish, for each month, a tick, "availability" index, and, according to the spirochete infestation frequency, to do estimation of the risk level, for human visiting the concerned forest, of being infected by B. burgdorferi. Obtained results show that this risk is the highest in August, and quite non-existent in January and February.
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7787456
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[AIDS. Hypothesis on the origin and emergence of HIV].
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Cross-species transfer of simian immunodeficiency viruses (SIV) may occur accidentally. This transfer, with the possible exception of the virus of the sooty mangabey monkey, leads to a biological dead-end. Thus, only serial passages of the virus from man to man, through blood inoculation, could explain its progressive evolution from SIV to HIV. Such an artificial cycle may have been initiated, in the 1910s, following the introduction of syringes and needles into the region of the African Great Lakes, a region where some communities were considering that the inoculation of blood from certain individuals or from monkeys was a very powerful magical remedy. The first HIV-1 infection may have emerged in the 1940s, in one of these isolated communities among which the virus remained at first confined before spreading to other populations.
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7787454
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[Prevalence of toxoplasmosis in a population of pregnant women in Antananarivo (Madagascar)].
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The prevalence of Toxoplasma antibodies by ELISA was studied in Antananarivo area, in the Republic of Madagascar, among a population of 599 pregnant women. The overall prevalence is 83.5%. From the age of 19 years old, 75% of the pregnant women have already antitoxoplasma antibodies. The ethnic factor, the foods habits or the presence of a domestic cat do not seem to have an influence on prevalence of toxoplasmosis among the studied population.
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7787453
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[Zoonotic cutaneous leishmaniasis to the north of Isfahan. Human infection in 1991].
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An epidemiological investigation was carried out in 1991 at four villages in Borkhar rural district, north of Isfahan, Iran, to obtain baseline data for studying the candidate vaccines of zoonotic cutaneous leishmaniasis (ZCL). A study of prevalence among 6,284 inhabitants showed a rate of 61.95% for scars and 2.9% for active lesions. The under 10 years old showed a rate of 42.9% for scars and 7.5% for active lesions. The above 10 years old showed a rate of 71.06% for scars and 0.7% for active lesions. The highest prevalence of the disease is in the seasons of autumn and winter. The incidence of the disease was 68.4 per thousand in 1991. Comparing the results of this study with those from the years 1963-1965 showed that the disease incidence has increased after 28 years and ZCL has remained as an important health problem in this area.
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7787452
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[Trypanosomiasis from Trypanosoma brucei gambiense in the center of north-west Uganda. Evaluation of 5 years of control (1987-1991)].
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In Uganda, a case-finding and treatment programme has been implemented by Médecine Sans Frontières (MSF) and the Ministry of Health in the North of West-Nile province. Data collected in the hospital of Moyo from January 1987 to June 1991 were analyzed. Forty eight hundred and twenty two cases of trypanosomiasis due to T. B. gambiense has been recorded. Cumulative incidence rate for this period was 5.6%. Passive and active case-finding strategies were used, both based on Card Agglutination Test (CATT) as screening tool, followed by parasitological examinations. The mobile teams identified 1906 of the 4,822 cases (39.5%). Case fatality rate was 2.6%. This study confirmed the association between social and political disruptions, large movements of population and extension of trypanosomiasis. Active case-finding seems to quickly reduce disease prevalence in hyper-endemic areas. An integrated programme is then necessary to control sleeping sickness transmission.
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7787451
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[Prevalence of urinary schistosomiasis in a school environment in N'Djamena (Chad)].
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A parasitologic investigation, realised between March and November 1993, among 532 pupils 6-15 years old living in N'Djamena's peripheric quarter and in 5 Chari Baguirmi's villages had showed urogenital schistosomiasis infection prevalence is 11.8%.
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7787450
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[Pathogenic approach of thrombopenia in dengue and its hemorrhagic complications].
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Dengue is a frequent viral infection in the intertropical countries. The frequency and the severe forms of this infection are a real problem of public health. The haemorrhagic forms of the disease are constantly associated with thrombocytopenia. Its pathophysiology is still unclear. Among the different hypothesis, immune mechanisms play the main role. The authors discussed here the responsibility of the binding of immune complexes and the role of cytokines.
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7787449
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[Epidemiology of schistosomiasis in a suburban school area of Bamako (Republic of Mali)].
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Epidemiology of schistosomiasis has been assessed in October, 1990 in three primary schools of a suburban district of Bamako: Magnambougou. It was a cross sectional study which was carried out on an hazardous sample of 549 pupils of 7 to 14 years old. The Kato-Katz and urine filtration methods were used to search schistosome eggs. The prevalence rate was 50% (256/512) in Schistosoma haematobium and 5.6% (26/464) in S. mansoni. Children from 11-14 years old were more infected by Schistosoma haematobium (59.4%), than those from 7-10 years old (35.2%) (p < 0.005). Among these children, 26.2% excreted more than 100 eggs per 10 ml of urine. The infection did not varied significantly no matter what the sex is (53.7 and 44.8% respectively in boys and girls) (p = 0.05). According to the residence, pupils living in Magnambougou were more infected (54.9%) than those of others district (31.1%) (p < 0.001). Likewise, S. haematobium infection was more important in A and C schools (64.9 and 73.2% respectively) than in B school (11.2%) (p < 0.001). Two major snails species which are the intermediate hosts of urine schistosomiasis in Mali (Bulinus truncatus and Bulinus globosus) were found in the shelters: however, B. truncatus was only infected in 13.1% (19/145). Contamination was local and "ruralization" activities (particularly gardening) seemed to be the most important displaying factor.
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7787448
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[Study of an HIV positive, tropical origin population in a refugee center in France].
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The study describes HIV positive refugee patients, who were seen over a 3 years period at COMEDE, a dispensary for foreign nationals. COMEDE offered a HIV test to every patient, and it followed up on the disease and its prevention. Out of 5,234 tests, 328 were positive (6.3%). Less than 5% of the patients refused the test. All the patients returned for the result; 88.4% were African and 11.3% Haitian. The mean age was 31.5 years. The male/female sex ratio was 1.28. In this study, 94.5% of the HIV patients were HIV1, 3% HIV2 and 2.5% carried both strains; 78% were asymptomatic, 7% had ARC and 12.5% had AIDS. The prevalence of tuberculosis was high (10.6%), especially for AIDS patients (65%); Treponematosis prevalence was 13% and toxoplasmosis was 62.8%; 40% had intestinal parasites. 36.4% of the women became pregnant during the study; 41% of the pregnancies were terminated, while 27% went full term. The proportion of missing patients after 6 months was high (57%) because of numerous factors which prevented them from returning. This study shows the importance of proposing a HIV test to this immigrant population, although follow-up is difficult, due to social and economic factors.
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7787447
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[Cerebral toxoplasmosis in a hospital environment in Lomé (Togo)].
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The authors report the clinical, serological and neuroradiological results of a study about 23 cases of cerebral toxoplasmosis in the Teaching Hospital of Lome. Response to antitoxoplasmic treatment was rapidly favourable with all patients. Cerebral toxoplasmosis was the inaugural manifestation of AIDS in 20 of the 23 patients.
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7787445
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[Variation of cholostase enzymes (5'-nucleotidase and alkaline phosphatase) during a specific treatment for malaria in the Gabonese child].
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Biological variations of 5'nucleotidase (5'NU) and alkaline phosphatase (AP) in 102 Gabonese children with malaria features (MF) and malaria infection (MI) receiving treatment are reported. [formula: see text] During the therapeutic assay, 5'NU rate decreases faster than AP'S; Fourteen days after the beginning of treatment, difference between AP MF and AP M1 is still significant. Enzymes decrease is an indication of the malaria drugs tolerance (MSP (*)).
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7787446
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[Malaria and febrile pathology of expatriates in Brazzaville in 1993].
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Between January 1 and December 31, 1993, malaria was found in 22.6% of unexplained fever cases among expatriates in Brazzaville, i.e. 0.5% of all consulting physicians at the Medico-Social Centre of the Coopération française. There are three possible explanations for the small proportion of paludism infection among expatriates: the low density of anopheles in the city centre, living conditions that restrict possible man-vector contacts and use of chemoprophylaxis. Considering the risks of self-treatment which are not insignificant, the authors on the importance of taking into account these facts when treating cases of fever among European residents in Brazzaville.
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7787444
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[Echographic morbidity due to Schistosoma haematobium in a peripheral district of Bamako in Mali, Missabougou].
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Frequency of urologic lesions was evaluated in 408 children from 6-15 years old in a suburban area of Bamako district in Mali, Missabougou; 65.2% from children were infected by Schistosoma haematobium, 13% by Schistosoma mansoni and 0.2% by Schistosoma intercalatum. Urologic lesions have been demonstrated in 223 cases among which 66 cases of urinary bladder lesions, 108 cases of hydronephrosis and 49 cases of mixed lesions. In order of the frequency we had the following uropathic lesions: wall thickening, wall irregularities, localised hypertrophies and hydronephrosis. We did not found any lesions in 185 children. Infection due to S. haematobium did not varied significantly in spite of age group, sex, schooling of children or the profession of the parents. Lesions were strongly correlated with age group (47.8 and 61.3% in 6-9 and 10-15 years old respectively) (p < 0.01) and with intensity of infection as measured by urinary egg counts (p = 0.0017).
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7787437
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Expression of growth factors and growth factor receptors in normal and tumorous human thyroid tissues.
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A number of growth factors have been implicated as stimuli of thyroid cell proliferation; overexpression of these growth factors and/or their receptors may play a role in the growth of thyroid tumors. To determine if immunohistochemical detection of growth factors and/or their receptors correlates with morphological alterations in proliferative lesions of thyroid, we examined the localization of epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha) and their common receptor, EGF-receptor (EGF-R), insulin-like growth factor-1 (IGF-1), IGF-1-receptor (IGF-R) and IGF binding proteins (IGFBP)-1, -2, -3, and -4, nerve growth factor (NGF), and its receptor NGF-receptor (NGF-R), transforming growth factor-beta (TGF-beta), and basic fibroblast growth factor (bFGF), in normal thyroid tissue and various thyroid tumors. We applied the streptavidin-biotin technique to formalin-fixed, paraffin-embedded tissues. We studied 8-16 different cases of each of the following: normal human thyroid, multinodular hyperplasia, follicular adenoma, papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. EGF, TGF-alpha, and their receptor EGF-R were widely expressed in normal thyroid and in all the thyroid lesions examined. IGF-1 and IGFBP-1 were diffusely present in all different thyroid tissues as well. There was no difference in staining intensity or distribution that correlated with the pathological process. IGFBP-4 seemed to have a variable expression. IGFBP-2 and -3 were detected only in medullary carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)
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7787438
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The action of methimazole and L-thyroxine in radioiodine therapy: a prospective study on the incidence of hypothyroidism.
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Thiourea drugs have been postulated to possess radioprotective property. We studied the effect of adjunctive antithyroid drugs (ATD) and L-thyroxine (L-T4) on the result of radioiodine (RAI) 131I therapy and determined the incidence of hypothyroidism and relapse of hyperthyroidism. One hundred and fifty-nine patients with Graves' disease were randomized prospectively to receive either RAI alone or adjunctive ATD in a form of block-replacement regimen of methimazole (MMI) plus L-T4 for 6 months. The patients were observed for a mean period of 4.6 (range 2-10) years. The incidence of permanent hypothyroidism was studied and the effect of ATD on iodine kinetics was analyzed. The cumulative incidence of hypothyroidism in the ATD group was significantly lower than the RAI group (p = 0.0009), and the difference is accounted by a reduction of early hypothyroidism within 12 months from 20.2 to 3.7% (p = 0.003). The incidence of late hypothyroidism was similar between the two groups. Treatment with ATD did not affect the one dose cure rate with RAI (61.2 vs 55.5%, p = NS), but the time to achieve euthyroidism was significantly earlier with adjunctive ATD (2 vs 8 weeks, p < 0.02). The incidence of relapse within the first year after one dose was also similar between the two groups (38.7 vs 44.5%, p = NS). Comparing the kinetics of the therapeutic dose with a tracer dose, patients receiving MMI were found to be underdosed by 22% (p = 0.003) and the biological half-life was significantly shortened. We conclude that ATD rendered euthyroidism earlier without compromising the one dose cure rate of RAI.(ABSTRACT TRUNCATED AT 250 WORDS)
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7787435
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A novel, nonradioactive in vivo bioassay of thyrotropin (TSH).
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A new and simple in vivo bioassay suitable for routine testing of pituitary and recombinant TSH preparations was developed. Male Albino Swiss CF-1 mice were given T3 in their drinking water to suppress endogenous TSH. T3, 3.0 micrograms/mL, given to mice for a period of 4 days decreased plasma total T4 (TT4) level to less than 10% of the nonsuppressed (control) level. Various doses of exogenous pituitary and recombinant TSH preparations were injected intraperitoneally and blood samples were obtained from the orbital sinus 6 h later. The TT4 level, measured by radioimmunoassay, served as the assay end-point. The assay required injection of approximately 3.0 micrograms of pituitary human TSH (phTSH), 1.0 microgram recombinant human TSH (rhTSH), 0.2 microgram bovine TSH (bTSH), and 0.1 microgram rat TSH (rTSH) to attain half-maximal response. The maximal level of TT4 after TSH stimulation was similar to that observed in normal, nonsuppressed mice. The procedure developed is relatively easy to perform, economical, and, unlike earlier TSH bioassays, does not require the use of radionuclides. This bioassay showed acceptable sensitivity and reliability in structure-function studies of pituitary TSH from different species as well as rhTSH.
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7787436
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Human liver triiodothyronine sulfotransferase: copurification with phenol sulfotransferases.
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To ascertain whether triiodothyronine (T3) sulfotransferase coeluted with the known phenol sulfotransferases (PSTs) during purification, human liver thermostable PST, thermolabile PST, and T3 sulfotransferase were assayed with p-nitrophenol, dopamine, and T3, respectively. Thermostable PST eluted from an ion-exchange column in two sequential peaks of activity (Peaks I and II), followed by a peak of thermolabile PST activity. There were three peaks of T3 sulfotransferase with thermostable PST: two within thermostable PST Peak I, and one peak of T3 sulfotransferase activity within thermostable PST Peak II. There was a minor peak of T3 sulfotransferase with thermolabile PST. Further purification of thermostable Peak I showed coelution of T3 sulfotransferase with thermostable PST during gel filtration and affinity chromatography. SDS-PAGE revealed a major protein band at 31 kDa. Dehydroepiandrosterone sulfotransferase comprised only 4% of the final activity. This report demonstrates coelution of T3 sulfotransferase with thermostable PST, shows a potential additional isozyme of T3 sulfotransferase, and points out the apparent minimal role of dehydroepiandrosterone sulfotransferase in T3 sulfation. The findings support the hypothesis that thermostable PST is the predominant human liver T3 sulfotransferase activity.
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7787434
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Expression of human thyrotropin receptor by recombinant adenovirus.
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We developed a new system for expressing a functional human thyrotropin receptor in eukaryotic cells using replication-deficient recombinant human type 5 adenovirus. COS-7 cells infected with recombinant adenovirus encoding human thyrotropin receptor cDNA showed specific thyrotropin binding (Kd = 1.8 x 10(-9) M) and cAMP responses after stimulation by human thyrotropin. Cells infected with control virus encoding firefly luciferase cDNA did not show thyrotropin binding nor cAMP responses following incubation with thyrotropin. This system will be useful for analyzing T cell immunity to thyrotropin receptor in patients with Graves' disease by expressing human thyrotropin receptor in patients' antigen-presenting cells.
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7787433
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An association between acromegaly and thyroid carcinoma.
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Acromegaly has been associated with goiter as well as with benign and malignant tumors. Three cases of thyroid carcinoma in patients with acromegaly had been reported in the literature. We previously reported two additional cases of thyroid carcinoma and now present a third from 100 patients with acromegaly, exceeding the expected prevalence. All three thyroid carcinomas were multifocal, suggesting a generalized promotion toward malignancy. These patients had elevated levels of growth hormone and somatomedin-C [insulin-like growth factor (IGF-1)] at the time of thyroid carcinoma diagnosis. We discuss the role of IGF-1 in both benign and malignant thyroid growth, including the presence of IGF-1 receptors on thyroid cells, stimulation of thyroid cell replication by IGF-1, and paracrine secretion of IGF-1 and its binding proteins by thyroid cells. We propose possible mechanisms for the development of thyroid carcinoma in patients with acromegaly and discuss implications for the physician treating patients with acromegaly.
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7787431
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Biphasic effects of thyrotropin on invasion and growth of papillary and follicular thyroid cancer in vitro.
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The rationale for TSH suppression in the treatment of follicular thyroid cancer (FTC) and papillary thyroid cancer (PTC) is to inhibit tumor growth, prevent recurrent disease, and eventually prolong survival. We analyzed the effects of TSH on invasion and growth of 3 FTC cell lines from 1 patient (FTC133, primary; FTC236, lymph node; FTC238, lung metastasis) and 2 PTC cell lines (PTC-UC1, PTC-UC3). Cell growth and invasion through an 8-micron pore polycarbonate membrane coated with Matrigel were measured using the MTT assay. The dose-response to TSH was biphasic, stimulating invasion and growth of FTC and PTC at low concentrations (0.1-10 mU/mL), and inhibiting them at high concentrations (100 mU/mL). Interestingly, the metastatic FTC cell lines had higher basal invasion, but were less responsive to TSH than the primary tumor. TSH (1 mU/mL) stimulated invasion of FTC133 by 21%, FTC236 by 8%, and FTC238 by 8% (p < 0.01). At 100 mU/mL, TSH inhibited invasion of FTC133 by 21%, compared to 11% in FTC236 and 12% in FTC238. Also, TSH dose-dependently influenced proliferation of follicular thyroid cancer cells. At low concentrations it stimulated growth of FTC133 (20%) and inhibited it at high concentrations (23%; p < 0.01). Again, the amplitude of TSH effects was significantly smaller in the cell lines from metastatic tumors. TSH affected invasion and growth of PTC-UC1 and PTC-UC3 also biphasically. These results show that TSH may act as a mitogenic and antimitogenic growth factor for invasion and proliferation of well-differentiated thyroid cancer cells in vitro.
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7787432
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Different growth control of the two human thyroid cell lines of adenomatous goiter and papillary carcinoma.
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To study the growth control of human thyroid cells in different stages of differentiation, we established two human thyroid cell lines of adenomatous goiter and papillary carcinoma. A 59-year-old female patient with adenomatous goiter was operated in September 1991, and a 27-year-old female patient with papillary carcinoma in May 1990. The thyroid cell lines were established by successive passage without cellular or genetic manipulations such as fusing other cell lines or oncogenic viral infection. These cell lines, human adenomatous goiter cells (hAG) and human papillary thyroid carcinoma cells (hPTC), exhibited a flattened polygonal shape and proliferated as a monolayer in cell culture. The doubling time of the hAG cells was 60 h in Ham's F12 medium supplemented with 10% fetal bovine serum, and that of the hPTC cells, 18 h in the same medium. Both cell lines expressed mRNA for TSH receptor and secreted cAMP into the medium during incubation with thyrotropin (TSH) at concentrations as low as 0.01 mU/mL. The effects of activators of protein kinase A (PKA), protein kinase C (PKC), tyrosine kinase (TK), and estradiol (E2) on proliferation of the hAG cells and the hPTC cells were assessed by measuring cellular DNA content in 24-well plates with diaminobenzoic acid. TSH stimulated proliferation of the hAG cells, but it inhibited proliferation of the hPTC cells. Since TSH activates two signaling pathways, the adenyl cyclase-PKA system and phospholipase C-PKC system, we tested effects of dibutylyl cAMP (dBC) and phorbol myristate 13-acetate (PMA), separately. dBC stimulated proliferation of the hAG cells, but it inhibited that of the hPTC cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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7787430
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Thyroid abnormalities among children in the contaminated area related to the Chernobyl accident.
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Gradual increases of various radiation-related diseases including thyroid cancer following the Chernobyl accident have been recently reported. We have carried out systematic thyroid surveys in school children aged 10-15 years in the highly contaminated area and compared the results with a similar survey in a nonaffected neighboring area as a control. Systematic examinations of the thyroid gland were performed in 888 schoolchildren (408 males and 480 females) in the districts of Chechelsk city with 5 to over 40 Ci/km2 of radiation level for 137Cs. In the control area (Bobruisk city), 521 children with the same age range (229 males and 292 females) were examined. Thyroid surveys were carried out as follows: palpation, ultrasonography, blood examinations of thyroid function, and measurements of daily urinary excretion of iodine. Certain thyroid abnormalities were observed in the high radioactive fallout area more frequently than in the control region. In particular, the prevalence of multiple micronodular lesions in diffuse goiter in the contaminated area was significantly higher than in the control area. However, endemic goiter due to iodine deficiency was present in both districts. The environment factor of iodine deficiency might have resulted in the early occurrence of ultrasonographic thyroid abnormalities attributed to radioactive contamination.
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7787428
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Effects of suppressive doses of levothyroxine treatment on sex-hormone-binding globulin and bone metabolism.
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The adverse effects of suppressive thyroxine treatment have previously been investigated and conflicting results have been published. This study aimed at evaluating the effects of subclinical hyperthyroidism on the liver and bones. We investigated the action of thyroxine on the liver by measuring sex-hormone-binding globulin (SHBG) levels and on bone turnover by evaluating osteocalcin (BGP) in both pre- and postmenopausal women. We compared the levels of both proteins to those of untreated subjects matched for age, menopausal status, and weight. Bone mineral density (BMD) was evaluated by biphotonic absorptiometry only in postmenopausal women with estrogen replacement therapy (ERT) and compared to two postmenopausal estrogen-treated controls. Forty-five women with multinodular goiter (38) or postsurgical thyroid carcinoma (7) were studied. They had received LT4 for 3 to 5 years (150 +/- 34 micrograms/day for nontoxic multinodular goiter, 184 +/- 46 micrograms/day for thyroid carcinoma). All patients had normal free T3 concentrations. No significant difference was found in SHBG values between patients and controls whatever the menopausal status and the BMI; a significant increase in BGP was noted in premenopausal women (9.6 +/- 2.2 vs 6.7 +/- 2.3 ng/ml; p < 0.0006). No significant BGP and BMD variations were observed in treated postmenopausal women. In summary, the study of carefully matched patients and controls revealed that thyroxine treatment has no effect on SHBG levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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7787429
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Role of neck ultrasonography in the follow-up of patients operated on for thyroid cancer.
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The aim of the study was to evaluate the role of neck ultrasonography in follow-up of patients with differentiated thyroid cancer. Sixty-three patients had total thyroidectomy and 131I ablation for differentiated thyroid cancer and had a negative whole body scan during follow-up. They were admitted for a high resolution neck ultrasound examination. Sixteen of 63 patients presented images suspicious for lymph node metastasis and/or for local recurrences (4 cases). Fine needle aspiration confirmed the suspicion of malignancy in 12 patients: only lymph node metastasis in 8 cases, local recurrence and lymph node metastasis in 3 cases, and in one case only local recurrence. Fine needle aspiration was suspicious for lymphadenitis in 4 cases. Thyroglobulin levels were very high in all patients with local recurrence and/or lymph node metastasis but undetectable in 2 cases presenting node metastasis and in 4 cases with lymphadenitis. All but one patient were admitted for surgery and the cytological diagnosis was confirmed. Early identification of a pathologic mass in the neck is a desirable goal; high resolution echography can play an important role in the follow-up of these patients and can detect local recurrences even when there is a negative whole body scan or undetectable thyroglobulin level.
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7787427
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Suppressive doses of thyroxine do not accelerate age-related bone loss in late postmenopausal women.
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To examine whether suppressive doses of thyroxine have any adverse effects on bone, we evaluated various bone metabolic markers (lectin-precipitated alkaline phosphatase, osteocalcin, carboxyl-terminal region of type I collagen propeptide, tartrate-resistant alkaline phosphatase, and urinary excretion of hydroxyproline and pyridinium crosslinks), incidence of vertebral deformity, total body and regional (lumbar spine and radius) bone mineral densities (BMDs), and rates of bone loss in 24 late postmenopausal (more than 5 years after menopause) women who were treated with levothyroxine (L-T4) after total thyroidectomy for differentiated carcinoma. Depending on the clinical records, including serum TSH levels measured by immunoradiometric assay, these patients were divided into two groups. One group of patients was given suppressive doses of L-T4 (TSH < 0.1 mU/L, n = 12) and the other group was given nonsuppressive doses of L-T4 (TSH > 0.1 mU/L, n = 12). There was no difference in bone metabolic markers and incidence of vertebral deformity between the groups. In patients with TSH suppression, Z-scores of BMDs calculated from age-matched healthy women (n = 179, aged 55 to 80) were nearly in the zero range of values (0.077 at total body, 0.228 at lumbar spine, and -0.117 at trabecular region of lumbar spine). The rate of bone loss in TSH-suppressed patients (-0.849 +/- 0.605%/year) was not significantly different from that of nonsuppressed patients (-0.669 +/- 0.659). These prospective and cross-sectional data suggest that long-term levothyroxine therapy using suppressive doses has no significant adverse effects on bone.
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7787425
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Three-dimensional structure of gurmarin, a sweet taste-suppressing polypeptide.
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The solution structure of gurmarin was studied by two-dimensional proton NMR spectroscopy at 600 MHz. Gurmarin, a 35-amino acid residue polypeptide recently discovered in an Indian-originated tree Gymnema sylvestre, selectively suppresses the neural responses of rat to sweet taste stimuli. Sequence-specific resonance assignments were obtained for all backbone protons and for most of the side-chain protons. The three-dimensional solution structure was determined by simulated-annealing calculations on the basis of 135 interproton distance constraints derived from NOEs, six distance constraints for three hydrogen bonds and 16 dihedral angle constraints derived from coupling constants. A total of 10 structures folded into a well-defined structure with a triple-stranded antiparallel beta-sheet. The average rmsd values between any two structures were 1.65 +/- 0.39 A for the backbone atoms (N, C alpha, C) and 2.95 +/- 0.27 A for all heavy atoms. The positions of the three disulfide bridges, which could not be determined chemically, were estimated to be Cys3-Cys18, Cys10-Cys23 and Cys17-Cys33 on the basis of the NMR distance constraints. This disulfide bridge pattern in gurmarin turned out to be analogous to that in omega-conotoxin and Momordica charantia trypsin inhibitor-II, and the topology of folding was the same as that in omega-conotoxin.
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7787424
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High-resolution solution structure of siamycin II: novel amphipathic character of a 21-residue peptide that inhibits HIV fusion.
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The 21-amino acid peptides siamycin II (BMY-29303) and siamycin I (BMY-29304), derived from Streptomyces strains AA3891 and AA6532, respectively, have been found to inhibit HIV-1 fusion and viral replication in cell culture. The primary sequence of siamycin II is CLGIGSCNDFAGCGYAIVCFW. Siamycin I differs by only one amino acid; it has a valine residue at position 4. In both peptides, disulfide bonds link Cys1 with Cys13 and Cys7 with Cys19, and the side chain of Asp9 forms an amide bond with the N-terminus. Siamycin II, when dissolved in a 50:50 mixture of DMSO and H2O, yields NOESY spectra with exceptional numbers of cross peaks for a peptide of this size. We have used 335 NOE distance constraints and 13 dihedral angle constraints to generate an ensemble of 30 siamycin II structures; these have average backbone atom and all heavy atom rmsd values to the mean coordinates of 0.24 and 0.52 A, respectively. The peptide displays an unusual wedge-shaped structure, with one face being predominantly hydrophobic and the other being predominantly hydrophilic. Chemical shift and NOE data show that the siamycin I structure is essentially identical to siamycin II. These peptides may act by preventing oligomerization of the HIV transmembrane glycoprotein gp41, or by interfering with interactions between gp41 and the envelope glycoprotein gp120, the cell membrane or membrane-bound proteins [Frèchet, D. et al. (1994) Biochemistry, 33, 42-50]. The amphipathic nature of siamycin II and siamycin I suggests that a polar (or apolar) site on the target protein may be masked by the apolar (or polar) face of the peptide upon peptide/protein complexation.
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7787423
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Complete 1H, 13C and 15N NMR assignments and secondary structure of the 269-residue serine protease PB92 from Bacillus alcalophilus.
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The 1H, 13C and 15N NMR resonances of serine protease PB92 have been assigned using 3D triple-resonance NMR techniques. With a molecular weight of 27 kDa (269 residues) this protein is one of the largest monomeric proteins assigned so far. The side-chain assignments were based mainly on 3D H(C)CH and 3D (H)CCH COSY and TOCSY experiments. The set of assignments encompasses all backbone carbonyl and CHn carbons, all amide (NH and NH2) nitrogens and 99.2% of the amide and CHn protons. The secondary structure and general topology appear to be identical to those found in the crystal structure of serine protease PB92 [Van der Laan et al. (1992) Protein Eng., 5, 405-411], as judged by chemical shift deviations from random coil values, NH exchange data and analysis of NOEs between backbone NH groups.
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7787422
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Theory and application of the maximum likelihood principle to NMR parameter estimation of multidimensional NMR data.
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A general theory has been developed for the application of the maximum likelihood (ML) principle to the estimation of NMR parameters (frequency and amplitudes) from multidimensional time-domain NMR data. A computer program (ChiFit) has been written that carries out ML parameter estimation in the D-1 indirectly detected dimensions of a D-dimensional NMR data set. The performance of this algorithm has been tested with experimental three-dimensional (HNCO) and four-dimensional (HN(CO)-CAHA) data from a small protein labeled with 13C and 15N. These data sets, with different levels of digital resolution, were processed using ChiFit for ML analysis and employing conventional Fourier transform methods with prior extrapolation of the time-domain dimensions by linear prediction. Comparison of the results indicates that the ML approach provides superior frequency resolution compared to conventional methods, particularly under conditions of limited digital resolution in the time-domain input data, as is characteristic of D-dimensional NMR data of biomolecules. Close correspondence is demonstrated between the results of analyzing multidimensional time-domain NMR data by Fourier transformation, Bayesian probability theory [Chylla, R.A. and Markley, J.L. (1993) J. Biomol. NMR, 3, 515-533], and the ML principle.
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7787421
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Internal motions of apo-neocarzinostatin as studied by 13C NMR methine relaxation at natural abundance.
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Dynamics of the backbone and some side chains of apo-neocarzinostatin, a 10.7 kDa carrier protein, have been studied from 13C relaxation rates R1, R2 and steady-state 13C-(1H) NOEs, measured at natural abundance. Relaxation data were obtained for 79 nonoverlapping C alpha resonances and for 11 threonine C beta single resonances. Except for three C alpha relaxation rates, all data were analysed from a simple two-parameter spectral density function using the model-free approach of Lipari and Szabo. The corresponding C-H fragments exhibit fast (tau e < 40 ps) restricted libration motions (S2 = 0.73 to 0.95). Global examination of the microdynamical parameters S2 and tau e along the amino acid sequence gives no immediate correlation with structural elements. However, different trends for the three loops involved in the binding site are revealed. The beta-ribbon comprising residues 37 to 47 is spatially restricted, with relatively large tau e values in its hairpin region. The other beta-ribbon (residues 72 to 87) and the large disordered loop ranging between residues 97-107 experience small-amplitude motions on a much faster (picosecond) time scale. The two N-terminal residues, Ala1 and Ala2, and the C-terminal residue Asn113, exhibit an additional slow motion on a subnanosecond time scale (400-500 ps). Similarly, the relaxation data for eight threonine side-chain C beta must be interpreted in terms of a three-parameter spectral density function. They exhibit slower motions, on the nanosecond time scale (500-3000 ps). Three threonine (Thr65, Thr68, Thr81) side chains do not display a slow component, but an exchange contribution to the observed transverse relaxation rate R2 could no be excluded at these sites. The microdynamical parameter (S2, tau e and R2ex) or (S(slow)2, S(fast)2 and tauslow) were obtained from a straightforward solution of the equations describing the relaxation data. They were calculated assuming an overall isotropic rotational correlation time tau c for the protein of 5.7 ns, determined using standard procedures from R2/R1 ratios. However, it is shown that the product (1-S2) x tau e is nearly independent of tau c for residues not exhibiting slow motions on the nanosecond time scale. In addition, this parameter very closely follows the heteronuclear NOEs, which therefore could be good indices for local fast motions on the picosecond time scale.
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7787419
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Isolation of the human peroxisome proliferator activated receptor gamma cDNA: expression in hematopoietic cells and chromosomal mapping.
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The nuclear receptor superfamily of transcription factors, which includes the retinoic acid receptors and v-erb A, play important roles in the molecular control of hematopoiesis. To identify nuclear receptors expressed in hematopoietic cells, we screened a human bone marrow cDNA library using a degenerate oligonucleotide and isolated a 1.85-kb full-length cDNA encoding a new human member of this superfamily, the peroxisome proliferator activated receptor gamma (hPPAR gamma). Two different hPPAR gamma transcripts were expressed in hematopoietic cells: a 1.85-kb transcript, which corresponds to the full-length mRNA (PPAR gamma 1), and a 0.65-kb transcript (PPAR gamma 2), which cannot encode all of the nuclear receptor functional domains. Normal neutrophils and peripheral blood lymphocytes, as well as circulating leukemic cells from patients with AML, ALL, and CML, express only PPAR gamma 2 on Northern blot analysis. In contrast, only the PPAR gamma 1 transcript was detected in a variety of human leukemia cell lines and in cultured normal primary bone marrow stromal cells. Both transcripts were detected in various fetal and adult nonhematopoietic tissues. We mapped the location of the hPPAR gamma gene to human chromosome 3p25 by somatic cell hybridization and linkage analysis. PPARs have been shown to be activated by peroxisome proliferating agents, long-chain fatty acids and arachidonic acid. Human PPAR gamma, although homologous to the PPAR gamma s of other species, has unique sequence and amino acid differences. Identification of hPPAR gamma will allow further understanding of its role in human cellular leukotriene, prostaglandin, and peroxide degradative or synthetic pathways, as well as its role in lipid metabolism and regulation of adipocyte differentiation.
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7787420
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Chemical shifts and three-dimensional protein structures.
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During the past three years it has become possible to compute ab initio the 13C, 15N and 19F NMR chemical shifts of many sites in native proteins. Chemical shifts are beginning to become a useful supplement to more established methods of solution structure determination, and may find utility in solid-state analysis as well. From 13C NMR, information on phi, psi and chi torsions can be obtained, permitting both assignment verification, and structure refinement and prediction. For 15N, both torsional and hydrogen-bonding effects are important, while for 19F, chemical shifts are primarily indicators of the local charge field. Chemical shift calculations are still slow, but shielding hypersurfaces - the shift as a function of the dihedral angles that define the molecular conformation - are becoming accessible. Over the next few years, theoretical and computer hardware improvements will enable more routine use of chemical shifts in structural studies, including the study of metal-ligand interactions, the analysis of drug and substrate binding and catalysis, the study of folding/unfolding pathways, as well as the characterization of conformational substates. Rather than simply being a necessary prerequisite for multidimensional NMR, chemical shifts and chemical shift non-equivalence due to folding are now beginning to be useful for structural characterization.
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7787418
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An upstream activator sequence regulates the murine Pgk-1 promoter and binds multiple nuclear proteins.
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The murine Pgk-1 gene is driven by a strong promoter that is regulated by a 304 bp upstream activator sequence (UAS). The activity of the UAS is high in undifferentiated embryonal carcinoma cells but declines when these cells are induced to differentiate with retinoic acid. The effect of the UAS on promoter activity is particularly striking when the activity of the Pgk-1 promoter is assayed following its integration into the genome, suggesting that it may function by regulating chromatin structure in the region of the core promoter. Three sites on the UAS bind nuclear proteins. Two of these sites bind factors present in both embryonal carcinoma cells and their differentiated derivatives whereas one site binds factors present only in differentiated cells. There appears to be both cooperation and antagonism in the binding of proteins to different sites in the UAS, suggesting that the activity of the Pgk-1 promoter is determined by the constellation of proteins assembled upstream of its transcription start site.
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7787416
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Overexpression of initiation factor eIF-4E does not relieve the translational repression of ribosomal protein mRNAs in quiescent cells.
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Translation of ribosomal protein (rp) mRNA is selectively repressed in mouse erythroleukemia (MEL) cells, which cease to proliferate upon differentiation, and in NIH 3T3 cells, for which growth is arrested by either serum starvation, contact inhibition, or treatment with the DNA polymerase inhibitor, aphidicolin. The efficiency of translation of rp mRNAs correlates with the expression of the gene encoding the cap binding protein, eIF-4E, as indicated by the fact that the abundance of the corresponding mRNA and protein also fluctuates in a growth-dependent manner. To examine the hypothesis that eIF-4E plays a role in regulation of the translation efficiency of rp mRNAs, we utilized an NIH 3T3-derived eIF-4E-overexpressing cell line. These cells overproduce eIF-4E to the extent that even under conditions of growth arrest, the abundance of the respective protein in its active (phosphorylated) form is higher than that found in exponentially growing NIH 3T3 cells. Nevertheless, this surplus amount of eIF-4E does not prevent the translational repression of rp mRNAs when the growth of these cells is arrested by blocking DNA synthesis with aphidicolin or hydroxyurea. In complementary experiments we used an in vitro translation system to compare the competitive potential of mRNAs, containing the translational cis-regulatory element (5' terminal oligopyrimidne tract) and mRNAs lacking such a motif, for the cap binding protein. Our results demonstrate that both types of mRNAs, regardless of their translational response to growth arrest, exhibit similar sensitivity to the cap analogue m7G(5')ppp(5')G. It appears, therefore, that the presence of the regulatory sequence at the 5' terminus of rp mRNAs does not lessen its competitive potential for the cap binding protein and that the growth-dependent decrease in the activity of eIF-4E does not play a key role in the repression of translation of rp mRNAs.
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7787417
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Overexpression, purification, and characterization of the ADP-ribosyltransferase (gpAlt) of bacteriophage T4: ADP-ribosylation of E. coli RNA polymerase modulates T4 "early" transcription.
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The bacteriophage T4 Alt gene product is a component of the phage head and enters the host cell in the process of infection together with the phage DNA. It immediately ADP-ribosylates host RNA polymerase, presumably at only one of the two alpha-subunits. Transcription from T4 "early" promoters, therefore, might be catalyzed, at least in part, by an altered RNA polymerase. The T4 alt gene was cloned into the expression vector pBluescript. E. coli cells, transformed with this recombinant vector, overexpressed the 76 kDa Alt gene product, which was purified to homogeneity. The purified enzyme not only ADP-ribosylates the alpha-subunit of RNA polymerase, but also subunits beta and beta', as well as the sigma 70-factor. The recombinant enzyme behaved like the native enzyme isolated from mature phage particles. The effect of the ribosylation reaction on the transcription activity of host RNA polymerase was investigated in vivo. It results in a modulation of T4 "early" promoter strengths, presumably, in a number of cases, leading to an overexpression of T4 "early" genes. The degree of overexpression, in some cases, should reach 50%, and seems to be well dosed for each promoter, controlling an individual transcription unit.
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7787414
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Lineage-specific alternative splicing of the human Fc gamma RIIA transmembrane exon requires sequences near the 3' splice site.
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The human Fc gamma RIIA gene produces multiple transcripts, including those with (Fc gamma RIIa1) and without (Fc gamma RIIa2) the single exon encoding the transmembrane domain (TM). Previously, a fluorescence-based RT-PCR assay showed lineage-specific differences in Fc gamma RIIA transcript ratios (Fc gamma RIIa2/Fc gamma RIIa1). The mechanism of this lineage-specific expression was investigated in this study. Differential transcript stability does not play a major role, because transcript ratios remained constant in cells with both low (K562) and high (Dami) ratios following actinomycin D treatment. Transient expression studies in K562 and Dami cells using a minigene construct containing a 5.0 kb genomic fragment including the TM exon and adjacent intron and exon sequences showed recapitulation of endogenous transcript ratios. The TM exon was efficiently spliced in by the constitutive splicing machinery in HeLa cells, an Fc gamma RIIA-negative cell line. Lineage-specific TM exon skipping was markedly diminished by two independent minigene mutations: a point mutation of the first nucleotide of the TM exon, and a five basepair intronic deletion near a putative branchpoint. These data demonstrate that cis-acting sequences in or near the TM exon 3' splice acceptor site contribute to lineage-specific differences in Fc gamma RIIA transcript ratios.
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7787415
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Transactivation by PPAR/RXR heterodimers in yeast is potentiated by exogenous fatty acid via a pathway requiring intact peroxisomes.
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Peroxisome proliferator-activated receptors (PPARs) are orphan members of the nuclear hormone receptor superfamily. PPARs bind to cognate response elements through heterodimerization with retinoid X receptors (RXRs). Together PPAR/RXR regulate the transcription of genes for which products are involved in lipid homeostasis, cell growth, and differentiation. PPARs are activated by fatty acids and by nongenotoxic rodent hepatocarcinogens called peroxisome proliferators through as of yet undefined signal transduction pathways. In an effort to elucidate the requirements for PPAR function and the pathways of its activation, we expressed mouse PPAR alpha and human RXR alpha in the yeast Saccharomyces cerevisiae. Mouse PPAR alpha and human RXR alpha had little activity individually in yeast; however, when cosynthesized, they were able to synergistically activate transcription via cognate response elements. Transactivation was independent of exogenously added activators of either receptor but was potentiated by the addition of petroselinic acid, a fatty acid shown to activate PPARs in mammalian cells. Similar experiments were carried out in a mutant yeast strain lacking peroxisomes entirely or in a mutant strain deficient for 3-ketoacyl-CoA thiolase, the final enzyme of the peroxisomal beta-oxidation cascade. The findings showed that constitutive transactivation by PPAR/RXR did not require the complete beta-oxidation pathway or intact peroxisomes but required intact peroxisomes for potentiation by exogenously added petroselinic acid. This study demonstrates that at least part of the mammalian peroxisome proliferator-signaling pathway can be faithfully reconstituted in yeast and that activation of PPAR by at least one particular fatty acid requires the integrity of peroxisomes.
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7787411
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Role of homeodomain protein binding region in the expression of Drosophila proliferating cell nuclear antigen gene: analysis with transgenic flies.
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The regulatory region of Drosophila proliferating cell nuclear antigen (PCNA) gene consists of a promoter region (-168 to +24 with respect to the transcription initiation site) and an upstream region containing three homeodomain protein binding sites (HDB) (-357 to -165). The PCNA gene regulatory regions with HDB (-607 to +137) or without HDB (-168 to +137) were fused with the lacZ and transgenic flies were established by P-element-mediated transformation. Male transgenic flies were crossed with wild-type females, and zygotic expression of the lacZ was monitored by quantitative beta-galactosidase assay, at various stages of development. Expression of the lacZ was high in embryos, first and second instar larvae, and adult females, and low at other stages of development. Only a marginal difference in expression was observed between flies carrying the homeodomain protein binding region and those not carrying it. Spatial pattern of the lacZ expression in the embryo visualized by immunostaining with the anti-lacZ antibody was similar to the distribution of the endogenous PCNA protein. Here, too, only a marginal difference was observed between transgenic flies carrying two different constructs of the PCNA lacZ. In genetic crossing experiments of transgenic flies with those carrying mutation in homeobox genes, no significant change in the lacZ expression pattern was observed. However, when male transgenic flies were crossed with female flies homozygous for a torso gain-of-function allele, repression of the lacZ expression was observed in the central region of the embryo. Because these local changes in the lacZ expression depend on the homeodomain protein binding region, unidentified homeodomain proteins are probably involved. Our results suggest that the promoter region is practically sufficient for expression of the PCNA gene and that the homeodomain protein binding region functions as a silencer when torso is activated ectopically.
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7787412
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Overexpression of the E2F-1 transcription factor gene mediates cell transformation.
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The E2F transcription factor can regulate expression of numerous cellular genes controlling proliferation, including proto-oncogenes and genes regulating cell cycle progression. Therefore, genes comprising the E2F gene family could potentially contribute to carcinogenesis. To test the potential of E2F to act as a transforming gene, a cDNA encoding E2F-1 was constitutively overexpressed in established rodent cells using a retroviral vector. Overexpressed E2F-1 was functional, as shown by stimulation of a transfected adenovirus E2 promoter driving a chloramphenicol acetyltransferase reporter gene in E2F-1 overexpressing cells. This stimulation was dependent on functional E2F binding sites in the promoter. Examination of phenotype showed that E2F-1 overexpression mediated cell transformation as measured by the ability of cells to form colonies in soft agar medium. In addition, overexpressed E2F-1 shortened the duration of the G1 cell cycle phase in proliferating cells, a property characteristic of other transforming genes. These data provide direct evidence that E2F-1 can act as a transforming gene and a critical regulator of cell cycle progression and suggest the possibility of E2F involvement in carcinogenesis.
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7787413
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Transcriptional activity of domain A of the rat glucagon G3 element conferred by an islet-specific nuclear protein that also binds to similar pancreatic islet cell-specific enhancer sequences (PISCES).
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A pancreatic islet cell-specific enhancer element in the rat glucagon gene, Glu-G3, contains two domains, one of which, domain A, has been shown to be necessary for Glu-G3 activity. In the present study, the functions of the isolated domain A of Glu-G3 were investigated by using transient reporter fusion gene expression and DNA binding assays. A single copy of domain A was transcriptionally inactive in glucagon-producing islet cell lines, whereas it did confer activity when combined with domain B, suggesting that Glu-G3 may be a bipartite element. Multiple copies of domain A did function independently as transcriptional enhancer in phenotypically distinct islet cell lines but not in several nonislet cell lines. Sequences (PISCES, pancreatic islet cell-specific enhancer sequences), similar to that of domain A of Glu-G3 and present in cell-specific control elements of the rat insulin I (Ins-E1) and rat somatostatin genes (SMS-UE), are shown to be required for transcriptional activity of these elements. In addition, a protein was detected in islet cell lines that bound to the PISCES motifs within Glu-G3, Ins-E1, and SMS-UE. These results support the view that cell-specific control elements of the glucagon, insulin, and somatostatin genes share a functional regulatory sequence, PISCES, and provide direct evidence for the existence of an islet-specific, PISCES-binding transcription factor or closely related proteins being involved in the coordinate expression of islet hormone genes.
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7787410
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Long-term evaluation of a continuous intra-arterial blood gas monitoring system in patients with severe respiratory failure.
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The purpose of this study was to evaluate the reliability and accuracy of a new continuous intra-arterial blood gas monitoring system (IABG; PB3300, Puritan Bennett) over a prolonged period of time (> 7 days). Prospective criterion standard study. Anesthesiological intensive care unit in a university hospital. 11 sensors were tested in 10 mechanically ventilated patients with severe respiratory failure. PO2, PCO2, and pH measured using IABG were compared to values obtained from 2 conventional blood gas analyzers. The quality of blood pressure tracings was assessed using a scoring system consisting of 5 grades. The median study period was 205h/sensor (range: 169-506h). 320 blood samples were obtained. The ranges of measured parameters were: PO2 = 46-433 mmHg, PCO2 = 25-79 mmHg, pH = 7.25-7.55. The mean (SD) differences for the whole study period were: -4.3 (11.9) mmHg for PO2, for the clinically important range (PO2 < 150 mmHg) -1.9 (5.4) mmHg, -2.8 (4.5) mmHg for PCO2, and -0.03 (0.04) for the pH value. The MD (SD) in relation to the sensor lifetime were for days 1-3: -1.1 (5.1) mmHg for PO2, -0.4 (3.9) mmHg for PCO2, and -0.01 (0.03) for the pH value; for days 4-6: -1.5 (6.0) mmHg for PO2, -3.3 (4.0) mmHg for PCO2, and -0.03 (0.03) for the pH value; for days 7-9: -2.5 (4.7) mmHg for PO2, -5.1 (4.6) mmHg for PCO2, and -0.04 (0.04) for the pH value; for days > 9: -4.9 (4.4) mmHg for PO2, -5.3 (4.1) mmHg for PCO2, and -0.05 (0.03) for the pH value. The IABG reliably measured blood gases and pH values with acceptable clinical performance based on the overall results. There was, however, a decline in the agreement of the sensors and conventional values with increasing sensor lifetime. The mean differences (bias) and the standard deviation of differences (precision) of PO2, PCO2 and the pH values were acceptable for clinical purposes up to day 6. The arterial blood pressure tracings and blood withdrawal were not adversely affected. No side effects due to the sensors occurred. In summary, a prolonged sensor use for a period of up to 6 days appears to be reasonable. This system offers on-line information on oxygenation, ventilation, and acid-base status and allows immediate detection of acute and potentially life-threatening events.
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7787409
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Is the transfusion requirement predictable in critically ill patients after admission to the intensive care unit?
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In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h. The values of initially measured systolic blood pressure, hematocrit level, and the values of 2 scores of severity of disease (Acute Physiology And Chronic Health Evaluation [APACHE-II], Mortality Prediction Model [MPM]) were calculated after the admission of patients to the ICU. The decision for transfusion was based on specific criteria. The median values of the scores, those of the variables, and the median number of transfused RBC units of the surviving group were compared to the values of the group of patients who died during hospital stay. The quantity of RBC transfusions was compared to the variables and score values by linear regression analysis. Additionally, the values of the patients who did not receive blood transfusion were compared to those of patients who required RBC. Furthermore, the patient group with neurosurgical diseases was compared to the group without neurosurgical diseases. 117 patients were prospectively and consecutively investigated in an 8-bed ICU of a university hospital. Nonsurvivors required significantly more units of RBC during the first 72 h (p < 0.05). Patients who did not require transfusion had a higher hematocrit and a lower APACHE-II value at admission (p < 0.001). In the MPM values no differences were found. Patients with neurosurgical diseases had a higher initial hematocrit value, and they required less units of RBC in comparison to patients without neurosurgical diseases. In the analysis of linear regression neither in the initially measured systolic blood pressure nor in the APACHE-II and MPM we found a strong linear correlation to the quantity of blood transfusion. A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.
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7787408
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Amino acid-enriched glucose-insulin-potassium infusion improves hemodynamic function after coronary bypass surgery. A double-blind study in patients with unstable angina and/or compromised left ventricular function.
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The goal of this study was to assess the effects of a combination of glucose-insulin-potassium (GIK) and the amino acids aspartate and glutamate upon perioperative hemodynamics in coronary surgery patients with unstable angina and/or compromised left ventricular function. Prospective, randomized, and double-blind clinical study. Operating theatre and intensive care unit (ICU) of a university hospital. 44 coronary artery bypass graft (CABG) patients with unstable angina and/or compromised left ventricular function. 22 patients (group A) were given 1l of an infusion with 250g glucose, 100 I.U. fast-acting human insulin, 72 mmol potassium, 32 mmol magnesium, 20 mmol phosphate, 65 mmol aspartate, and 65 mmol glutamate, while another 22 patients (group C) were given 1l of an infusion with 50 g glucose, 72 mmol potassium, 32 mmol magnesium, and 8 mmol phosphate. The infusion rate was 1.2 ml/kg/h from the anesthesia induction onward to the commencement of cardiopulmonary bypass, when it was reduced to 0.8 ml/kg/h. When 11 had been infused, but not later than 4 a.m., the infusion was continued by giving 10% glucose at the same rate to both groups. Additional insulin (median: 14.2 I.U., range: 0-41.5) or saline was given during bypass to the A and C patients, respectively. A blood cardioplegia technique containing aspartate and glutamate was used in both groups. At aortic cannulation, the cardiac index (CI) had increased from the pre-anesthetic level by 15.3% (mean) (SD: 31.7%) in group A and decreased by 7.7% (15.1%) in C patients, p = 0.0069. Also the changes in stroke index (SI; p = 0.022), left (LVSWI; p = 0.0037) and right ventricular stroke work index (RVSWI; p = 0.0097) were more favorable in group A. Despite longer aortic cross-clamp, p = 0.031, and perfusion times, p = 0.042, in A patients, the change in cardiac index was also better in this group after bypass: At decannulation, the difference between mean values was 31.8%, p = 0.0001, and at arrival in the ICU it was 16.1%, p = 0.028. The same was also seen 8 h postoperatively and on the 1st and 2nd postoperative mornings; p = 0.034, 0.040, and 0.037, respectively (Wilcoxon test). Favorable changes were seen for the A patients also regarding SI at decannulation (p = 0.0002) and after 8 h (p = 0.017); LVSWI at decannulation (p = 0.0002), at arrival in the ICU (p = 0.0023), and after 8 h (p = 0.0011); and RVSWI at decannulation (p = 0.0027), at the ICU (p = 0.021), after 8 h (p = 0.014), and on the 1st postoperative morning (p = 0.039). However, the response to a hemodynamic loading test (6% hydroxyethyl starch 5 ml/kg) was similar in the 2 groups, and there was no difference in the need for inotropic support. Amino acid-enriched GIK infusion improves hemodynamic function in CABG patients with unstable angina and/or compromised left ventricular function.
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7787405
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[Suitability of monoclonal test sera for determination of blood group markers in positive direct Coombs test].
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Monoclonal reagents of the IgM type allow to test some red blood cell antigens (K; Jka; Jkb) by the tube centrifugation method at room temperature, for the examination of which the indirect antiglobulin test was necessary in the past. This permits to test antigens also when the direct antiglobulin test is positive, provided the sera do not contain too much supplement. We tested a choice of monoclonal reagents of different manufacturers (for the ABO system, A subgroups, the Rhesus, MN, Kell, Kidd and Lewis system) for their ability to examine antibody-coated erythrocytes. To recognize false-positive reactions of the reagents, erythrocytes without the particular antigen were coated with an incomplete antibody, and then the reagent was tested with these self-made Coombs control cells. We found no false-positive reactions for all tested anti-A, anti-B, anti-AB, and anti-A1 reagents. Some anti-C, anti-c, anti-E, anti-e and anti-N reagents showed weak false-positive reactions, some anti-H, anti-D, anti-K, anti-Jka, anti-Jkb, anti-Lea, anti-Leb and anti-M reagents stronger false-positive reactions.
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7787404
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[Immunosuppressive effect of parenteral fat emulsions in defined immunostimulation].
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In the heterotopic rat heart allotransplant model we have previously shown that intravenous fat emulsions are to a various extent immunosuppressive or immunoneutral, dependent on their n-3/n-6 fatty acid ratio. Safflower oil (n-3: n-6 = 1:370), fish oil (7.6:1) and soybean oil (1:6.5) prolonged the transplant survival time to 13.3, 12.3 and 10.4 days compared to 6.7 days (oil control group; 1.2.1) and 7.8 days (saline control group) (p < 0.01), respectively. This study presents a correlation of graft survival to immunohistological, cell biological and biochemical parameters. 20% emulsions of safflower oil, fish oil, soybean oil and a 1:1 mixture of safflower and fish oil (oil control group) were continuously infused (9 g fat/kg body weight/day; n = 10 each group) after transplantation. Subpopulations of infiltrating and circulating immunocompetent cells and leukotriene B4 and B5 release of circulating mononuclear cells were analyzed (on the 4th postoperative day). In the 2 groups with the highest prolongation of graft survival the number of infiltrating cells was reduced by up to 40% and the peripheral blood mononuclear cell interleukin-6 release by up to 45%. Beyond that, circulating T cells were reduced in the fish oil group. Leukotriene B4 was released in all groups to the same extent, leukotriene B5 exclusively in the fish oil group. Intravenous fat emulsions show a varying immunomodulatory effect in dependence of the n-3/n-6 fatty acid ratio. Both n-6 and n-3 fatty acids, if applied as main fatty acid source, exert immunosuppressive effects by a diminished infiltration and mobilisation of immunocompetent cells. Soybean oil with a more balanced n-3/n-6 fatty acid ratio than safflower oil is significantly less immunosuppressive than safflower oil, and fat emulsions with a n-3/n-6 fatty acid ratio of 1:2 are immunologically neutral.
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7787403
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Protein synthesis in specific tissues during sepsis.
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The hypothesis that fractional protein synthesis rates (Ks) are tissue-specific and bidirectional during sepsis was tested in an animal model. Ks in liver, triceps muscle, and diaphragm were measured in septic (n = 27) and control rats (n = 26). Sepsis was induced by a reproducible model established in our laboratory (intraperitoneal injection of sterile NaOH 0.75 N at 0.075 ml/100 g of body weight). Ks were measured using the flooding-dose method in tissue obtained from the diaphragm, liver, and from the triceps muscle. In hepatic and diaphragmatic tissue, Ks were significantly higher in the septic animals (Ks: 112.2 +/- 8 and 5.4 +/- 1.9, respectively) than in control animals (Ks: 78.5 +/- 13 and 2.9 +/- 1.7, respectively). In the triceps, Ks were significantly lower in septic animals (Ks: 2.9 +/- 1.4) than in control animals (Ks: 5 +/- 1.8). The results suggest that in septic animals the rate of protein synthesis is enhanced in tissues of priority, such as the liver, and varies in response to differences in muscle activity.
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7787402
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[Study of treating experimental ulcerative colitis of spleen deficiency type with "guben yichang tablet" in guinea pigs].
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Guinea pigs were perfused with the extract of senna (20%). 3 days later glacial acetic acid (5%) was given intra-anally so as to replicate the animal model of Spleen Deficiency (SD) and ulcerative colitis which is the disease of Western medicine combined with the Syndrome in TCM. The model animals showed the symptoms of SD such as loose stool, anorexia, wasting, aversion of cold, laziness and loss of hair luster and the symptoms of ulcerative colitis such as abdominal distension and mucous bloody stool. The colonic lesion were observed by eyes that the mucosa were edematous, congestive with ulcerative foci. The pathological examinations showed edema and congestion in submucous layers; large amount of inflammatory cell infiltration; and the scaling and ulcer formation of epithelium mucosae. The above-mentioned symptoms and pathological changes were the same as SD and ulcerative colitis in clinical practice. The new medicine "Guben Yichang Tablet" against ulcerative colitis was given to guinea pigs for 7 days could abate their symptoms, increase their body weights and decrease the size of colonic ulcer and edema.
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7787401
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[Comprehensive study on mechanism of leukocytogenic effect of fuzheng shengbai capsule].
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In order to study the mechanism of the therapeutic effect of Chinese medicine in raising white blood cells, the effects of multiplication of splenocyte of leukopenic mice, the activity of interleukin-2 (IL-2), the lipoperoxidant (LPO) content, the concentration of blood serum testosterone of male mice by using Fuzheng Shengbai Capsules (FZSBC) were observed. The results showed that the multiplication of splenocyte, the activity of IL-2, and testosterone level of the experimental group were significantly higher than those of the control group (P < 0.05-0.01), LPO was decreased slightly, which had no statistic significance. Therefore, the increasing of WBC had no relation with the content of LPO but was positively correlated with T lymphocytes as well as the activity of IL-2. This study showed that the mechanism of leukocytogenic effect of FZSBC might be that it was related with promoting the proliferation of T lymphocytes, elevating the activity of IL-2 and raising the testosterone level, but was not relevant with anti-LPO.
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7787400
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[Effect of guzhen recipe on glucocorticoid receptor in senile rate thymocyte].
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The effects of Guzhen Recipe (GZ) which composed of Polygonum multiflorum, Cistanche deserticole, Rubus chiagii etc, on the number of thymocyte glucocorticoid receptor (GCR) sites, the GCR nuclear translocation rate, and the activity of serum thymic factors etc in senile rats were observed. The results showed: The number of thymocyte GCR sites, the contents of cytoplasmic protein, nuclear RNA and DNA, the thymus weight/body weight ratio and the serum thymic factors in senile rats were significantly decreased, while thymocyte GCR nuclear translocation rate increased obviously than that of young control rats. GZ, however, was capable of improving the above-mentioned changes of thymus in senile rats markedly, suggesting that GZ might weaken the inhibitory effect of glucocorticoid on the thymus by means of suppressing the translocation activity of GCR from cytoplasm to nucleus in senile rats, thus enhance thymus-dependent immune function in senile rats.
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7787398
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[Effect of shenmai injection on sIL-2R NK and LAK cells in patients with advanced carcinoma].
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Serum interleukin-2 receptor (sIL-2R) level activities of natural killer cell (NK) and lymphokine activated killer cell (LAK) cells were determined in 60 patients with advanced carcinoma (AC) before and after treatment with Shenmai injection (SMI), 40 healthy persons were taken as non-carcinoma control (NC). The results showed that: Serum sIL-2R level in AC were much higher than those in NC (P < 0.05) and activities of NK and LAK cells in AC were much lower than those in NC (P < 0.05) before treatment. There was no significant difference among gastric cancer, colonic carcinoma and lung cancer (P < 0.05). After treatment with SMI we also found that the level of sIL-2R in all patients were obviously lower (P < 0.05) while the activity of NK and LAK cells were significantly higher than that prior treatment (P < 0.05). Linear correlation was not found between sIL-2R and NK, LAK cells. These data suggested that the immune function was compromised in AC. The mechanism of the inhibitory effect of SMI on carcinoma might be related to the activity of biological response modifier.
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7787399
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[Tube pregnancy treated with trichosanthin and followed up by hysterosalpingography].
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Twenty cases of unruptured tube pregnancy were treated with Trichosanthin intramuscularly given. Only two cases were eventually operated, so the effective rate was 90%. The hysterosalpingography was taken in 14 of 18 cases who was willing to accept the procedure at 0.5-1.5 year after the conservative treatment. Both tubes were patent in 10 of 14 cases, the rate of patency was 71.4%.
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7787397
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[Study on objective parameters of syndrome differentiation of diabetic nephropathy].
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This is a study about objective parameters of Syndrome Differentiation of diabetic nephropathy (DN) using radio immunoassay (RIA) technique. The result showed that beta 2-microglobulin (beta 2-mG), alpha 1-microglobulin (alpha 1-mG) in blood rose significantly in both groups. The group of Spleen-Kidney Deficiency and Qi-Blood Deficiency as well as the group of Yang Deficiency caused edema and upward gush of turbid Yin, there was significant difference between two groups, also there was significant difference between the two groups in measuring on atrial natriuretic factor (ANP), pancreatic glucagon (PG) in blood and beta 2-mG. Immunoglobulin G (IgG), albumin (Alb), secretory immunoglobulin A(SIg A) in urine. So above-mentioned parameters offered us some objective data on Syndrome Differentiation of DN. It is vital in guiding the Syndrome Differentiation and treatment of DN.
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7787396
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[Study of relationship between TCM syndrome-types of malignant tumours and thyroid functional test].
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The relationship between the thyroid functional test in 107 malignant tumour patients' sera with Deficiency-Excessiveness Syndromes in TCM, was studied. The results revealed that there were significant differences between the FT3, FT4 in tumour and control groups (P < 0.01) as well as between the rT3, FT3/rT3 in each type of tumour and control groups (P < 0.05-0.01). There was also definite relationship between the FT3, rT3, FT3/rT3 and the degree of differentiation, rate of progression and malignancy of tumours as well. rT3 elevated and FT3 reduced in accordance with the lowering of body resistance and reinforcing of pathogenic factors. FT3, rT3, FT3/rT3 are essential factors that reflecting the wax and wane of body resistance in the cases with malignant tumours in modern medicine.
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7787392
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[Preliminary study on pathophysiology of liver-qi deficiency syndrome].
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The authors advocate a program for diagnosing Liver-Qi Deficiency Syndrome (LQDS) based on the TCM theory and clinical practice. Through investigation, LQDS was found to be widely existed as latent period or as external manifestation, which occupied 18.85% in Qi Deficiency Syndrome. The subjects were divided into four groups including normal group, Spleen-Qi Deficiency Syndrome (SQDS) group, LQDS with Liver diseases (LD) and LQDS with non-Liver diseases (NLD) group. In order to explore the essence, the simultaneous determinations were done on lactate dehydrogenase (LDH) and its isoenzyme, dopamine beta-hydroxylase (D beta H), trace element Zn and Cu, and other serological indexes such as GPT, TP, Alb, A/G, etc. The results were, the content of LDH and trace element Zn in both LQDS-NLD and SQDS were significantly lower than that of normal group. D beta H reflecting sympathetic nerve function in LQDS-NLD was significantly higher than that of both normal and SQDS group; comparing LQDS-LD and LQDS-NLD group, the content of GPT, LDH, LDH5 and trace element Cu in former was significantly higher than that of the latter, but the content of TP, Alb, A/G, D beta H and Zn in former was remarkably lower than that of the latter. In order to avoid confusion, in studying this syndrome, one should distinguish LD and NLD.
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7787395
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[Clinical observation on the treatment of ischemic heart disease with Astragalus membranaceus].
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92 patients suffering from ischemic heart disease was successfully treated with Astragalus membranaceus (AM). The effect of the treatment was compared with that of Nifedipine and Tab. Salviae miltiorrhizae. The clinical practice showed that the group treated with AM yielded better results. After having administered the drug, the patients were markedly relieved from angina pectoris (heart stroke). Meanwhile the improvement of clinical objective index such as electrocardiogram (EKG) and impedance cardiogram can also be observed. The effective rate of EKG improvement was 82.6%. The treatment of ischemic heart disease with AM was significantly more effective in comparing with control group (P < 0.05).
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7787394
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[Clinical observation on treatment of myelodysplastic syndromes with yisuikang].
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20 cases of myelodysplastic syndrome (MDS) patients were treated with Yisuikang (YSK) including MDS-RA 17 cases, MDS-RAEB 2 cases, MDS-RAEB-T 1 case. 14 patients were treated with YSK only, 6 cases were treated with both YSK and Western medicine. The result showed that 4 cases were remitted, 5 cases markedly improved, 6 cases improved and 5 cases ineffective, the total effective rate was 75.0%. It was found that YSK was effective in the treatment of MDS-RA or Qi-Blood Deficiency and Yu-Re Syndrome in TCM, while any other types were ineffective. They also found that types of TCM might be correlated with MDS.
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7787393
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[Study on effect of mediation principle in retarding progression of chronic renal failure].
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100 Patients with chronic renal failure(CRF) were treated mainly by the mediation principle (MP). Results showed that the progression of CRF with MP was slower than that without MP. There was very significant difference (P < 0.01) between the regression coefficient. In addition, the effect of MP on the factors in promoting the progression of CRF, e.g., hypertension, albuminuria, hyperlipemia and immune function etc. was discussed in detail.
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7787388
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Behaviour problems in Angelman syndrome.
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Angelman syndrome (AS) is a genetic disorder that is associated with a deletion on chromosome 15, and is characterized by abnormalities or impairments in neurological, motor and intellectual functioning. While behaviour problems have been reported in clients with AS, relatively little is known about their developmental course and outcome. In this study, data on the nature and prevalence of behaviour problems among clients with AS were gathered from two sources: (1) a review of published case reports; and (2) parent responses to a survey of behaviour problems in a small (n = 11) sample of children with AS. Data from both sources showed that behaviour problems were present in males and females of all ages, and included language deficits, excessive laughter, hyperactivity, short attention span, problems with eating and sleeping, aggression, noncompliance, mouthing of objects, tantrums, and repetitive and stereotyped behaviour. Identification and treatment of severe behaviour problems in clients with AS may improve their adaptive functioning.
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7787389
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[Effects of shi-ka-ron and Chinese herbs in mice treated with anti-tumor agent mitomycin C].
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The Shi-ka-Ron, and its constituent Chinese herbs Lithospermum erythrorhizon, Astragalus membranaceus and Ligusticum Wallichii were administered with antitumor agent, mitomycin C (MMC) to ICR mice, and their effects on murine macrophages and lymphocytes were studied. Peritoneal macrophages were significantly inhibited both in their number and chemotactic activity by MMC treatment. Splenic weight and blastogenic responsiveness to Concanavalin A of spleen lymphocytes also decreased significantly in MMC-treated mice. NK cell activity was also suppressed by MMC treatment. When these mice were orally treated with extracts of Shi-ka-ron or each Chinese herbs mentioned above, it showed protective effects to immunosuppressive mice on all 5 items studied. The number of macrophages, and the functions of macrophages and lymphocytes maintained the same or more than normal levels in MMC plus each group of these extracts treated mice. These results suggest that the Shi-Ka-Ron and Chinese herbs could resist immunosuppression induced by antitumor agent MMC, and its mechanisms might be correlated with stimulation of the RES (reticuloendothelial system), activation of T cell blastogenesis and NK cell cytotoxicity.
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7787385
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Urine fetish in a man with learning disabilities.
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Urine fetishes are uncommon. A 30-year-old man with learning disabilities and a fetish for observing women urinate is described, and the possible dynamic aspects of his paraphilia are discussed.
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7787387
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Alterations in replication timing of X-chromosome bands in Rett syndrome.
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A cytogenetic study has been carried out on 30 girls affected with Rett syndrome, 35 of their family members and 25 unrelated healthy control females. Karyotyping at the 850 band level revealed no detectable chromosome abnormalities in either the affected girls or their families. Observations on the sequence of the appearance of early replicating bands on both the active and the inactive X-chromosome demonstrated the same replication patterns in all of the groups investigated with the exception that band Xp21 appeared with greater frequency in the Rett syndrome cells. A degree of variation was detected both between and within the subjects when the timing of the latest bands to replicate was investigated for the active X, but the same consensus order was obtained for all groups. A comparable number of elongated X-chromosomes was found in the girls with Rett syndrome (8%) when compared to their mothers (12%) when synchronized cells were treated with a short pulse of BrdU. If a disturbance in X-inactivation does contribute to the aetiology of Rett syndrome, it is at a level which is not detected by observations on the relative timing of replication of chromosome bands.
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7787384
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Autism in immigrants: children born in Sweden to mothers born in Uganda.
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Three boys diagnosed as suffering from autistic disorder were born in Sweden to mothers born in Uganda. Two were related but the third boy was unrelated to the others. The prevalence for autistic disorder in Göteborg children born to mothers who were born in Uganda was 15% which is almost 200 times higher than in the general population of children. The possible reason for the high autism rate in this particular ethnic subgroup is discussed.
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7787382
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Electrophysiological correlates of psychopathology in individuals with mental retardation and epilepsy.
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One hundred adults with mental retardation and epilepsy were randomly selected from hospital and community settings for a detailed study of psychopathology (maladaptive behaviour, psychiatric illness and personality disorder). All of them had a recording of interictal EEG within the 12-month study period. Of all the EEG recordings, nine were completely normal, 48 showed excessive slow background wave, and a further 43 showed epileptiform discharges. Of the 43 with epileptiform discharges in the EEG, 12 showed bilateral, diffuse, generalized activities (including 3 Hz abnormality), 18 showed temporal lobe focus (five left-sided, four right-sided and nine bilateral), and the other 13 showed secondary generalization from a temporal lobe focus. A comparison of psychopathology between the groups with a generalized epileptiform activity in the EEG (n = 12) and focal changes (n = 18) did not reveal any significant differences.
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7787383
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Menopause in women with learning disabilities.
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A brief questionnaire concerning previous and current menstrual status was sent to 280 women over the age of 35 on the Wandsworth Register for People with Learning Disabilities: 196 questionnaires (70.4%) were returned. One hundred and seventy-one were used in the analyses; 45 were from women with Down's syndrome. The results suggested that, compared with data on normal women, menopause may occur earlier in women with learning disabilities and earlier still in women with Down's syndrome.
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7787381
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How do carers assess the severity of challenging behaviour? A total population study.
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The severity of management problems of 13 types of problem behaviour presented by a total population sample of people with learning disabilities, as reported by their primary carers on eight separate assessments over 5 years, was examined. Three types of residential setting were represented: hospitals, family homes and community houses. The results showed a remarkable consistency in carers' assessments of the severity of management problem posed to them. An association was found between the reported frequency of occurrence and the assessment of the severity of behaviours, with certain behaviours likely to be rated as severe regardless of the frequency with which they occurred. Differences between residential settings were found, with carers in family homes and community houses rating more behaviours as presenting severe management problems than carers in hospital. The results from this study and other studies which have examined the relative severity of different behaviour topographies are discussed.
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7787380
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Employment, retirement and elderly persons with an intellectual disability.
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A national Australian study of people with an intellectual disability of 55 years of age and over investigated their employment and retirement patterns, attitudes to work and retirement, and the degree to which they were involved in leisure or recreational programmes. Two cohorts were recruited: one included all known members of the target group who agreed to participate in the study in the states of Queensland and Western Australia; and the second was a proportional, random sample drawn from a national database on a state population basis. A large number of the participants had never been involved in full- or part-time employment, either in a competitive or supported environment, or in workshops. The majority of those who had worked expressed strong positive attitudes toward employment and concern about retirement, suggesting the need for pre-retirement programmes including transition and choice-making skills to prepare participants for the future.
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7787375
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[Medical aid according to the asylum application regulation--a report of experiences after the first year].
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In 1993 the Law Concerning Social and Medical Aid for People Asking for Political Asylum in the Federal Republic of Germany (Asylbewerberleistungsgesetz) was promulgated. In so far the main political aims of the new law are concerned it is to say that in the case of dental treatment they have failed at least in the first year. The author believes it to be more serious from a medical point of view that there is a tendency towards a medicine having two different "classes".
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7787374
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[Frequency analysis for achieving health goals--II: Analysis of mortality tables for cause of death, expected mortality].
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The article gives algorithms to calculate mean ages at death for specific causes, based on life table models. Parameters of interest are death due to a specific cause, dying after the "elimination" of the specific cause, or the transition into a "new" structure of mortality when a specific cause of death vanishes. The setbacks of widely used calculations are discussed in this context. These different approaches are demonstrated by means of data pertaining to accident and cardiovascular mortality of the male population of Berlin (West). The estimated impact on life expectancy varies according to both the mathematical model and the specific cause of death: differences are negligible in mortality due to accidents, whereas the results differ considerably in cardiovascular causes of death. The algorithm suggested allows to constrain the calculations to specific age groups. Topics such as "avoidable death" and "health objectives" have to be aware of these different methods.
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7787373
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[A new method for early detection of neurotoxic diseases (exemplified by pyrethroid poisoning)].
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This pilot-study should contribute to the question whether Pyrethroid intoxication can be distinguished from other diseases by characteristic clinical symptoms. The results show that the characteristics of the intoxication do not consist in singular symptoms but in combinations and correlations of symptoms, i.e. of central-neurological with peripheral- and autonomic-neurological as well as with characteristic immunological disturbances. Neurological symptoms consist in cerebro-organic disfunctions, locomotory disorders reminiscent of multiple sclerosis or M. Parkinson, and sensory, motoric and vegetative polyneuropathy, leading, for instance, to cardiovascular regulatory disorder like sympathicotonia or, orthostatic hypotonia. Non-neurological symptoms include immunosuppression with consecutive opportunistic infections, like candida albicans, most frequently of the alimentary tract, but also dermal and mucosal swellings, lichen-ruber-like efflorescences, loss of hair, conjunctivitis. Other symptoms are: hypoglycaemic crises inhibition of fertility, disturbances of blood clotting, and most frequently in children, suspected hematopoetic disorders.
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7787372
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[Evaluation of impact on health--a central responsibility of the public health service].
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Health impact assessment (HIA) is defined in this paper as the adequate coverage of health aspects within the context of environmental impact assessment. HIA is a typical task for the public health service. A project on HIA undertaken by the North Rhine-Westphalian Research Compound for Public Health found out that presently the opportunity to use HIA for preventive health purposes is still largely neglected. However, in a survey local health departments expressed great interest in receiving HIA-training. A workable concept and supporting tools are both necessary prerequisites for the practice of HIA becoming routine. This paper presents a ten step HIA-conceptl. Supporting tools are presently under development and testing.
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7787371
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[Complete nutrition and social assistance].
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Additional supplementary benefits for nutrition are provided by social legislation; they are based on recommendations which have to be reconsidered in general as regards contents and quantities. The practice of assessment by Public Health Offices has no standardized regulations. Surveys have indicated that the recommendations are based on low-price calculations. The fundamental basis of supplementary benefits cannot guarantee healthy nutrition and therefore ignores the aim of prevention which had originally been included in social legislation.
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7787369
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[Evaluation and utilization of complementary medical procedures--a survey of 793 physicians in general practice and the clinic].
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It is well known that complementary medicine is demanded by numerous patients and used by many doctors. In a representative postal survey of 793 female and male doctors working in practices and hospitals in the town and in the district of Kassel we could confirm the wide distribution of these procedures, especially as far as doctors in practice are concerned. It was the special interest of our study to analyse the motives for the use and the indications and to ask for a detailed and differential assessment of 18 complementary techniques.
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7787370
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[Measuring bone density--applications, critique, consequences].
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The supporters of bone density measurement or osteodensitometry claim that it is possible to reduce the frequency of fractures if a lack of systemic bone mineral content is detected in time. Important topical points of criticism are brought forward. Meaningful clinical use is only possible if reference data referring to population are accepted, and standardised quality assurance is safeguarded. Densitometrical methods do not guarantee sufficient prognostic data neither for diagnostic purposes nor for estimating the risk of fracture. In addition, they are not reliable enough for assessment of a treatment. The compensation of costs by statutory health insurance for bone density measurements as therapeutic aid should be restricted to regular controls of bone density after having diagnosed a pathological fracture, and to controls of certain secondary forms of osteoporosis.
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7787368
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[Effects of the Health Structure Regulation on prescribing behavior of established physicians].
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In 1992 the German Federal Minister of Health enacted a new law to secure the health insurance system by budgeting the expenses for prescriptions among else. The data derived from a sample of computer-assisted private practices show a significant decline of prescriptions both in natural units and in value since 1993, but the analysis of the patients' data also reveals a more or less deliberate pattern of procedure followed by the GPs with regard to certain groups of patients such as elderly or chronically ill patients.
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7787362
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Graft-to-vein fistulas associated with polytetrafluoroethylene dialysis grafts: diagnosis and clinical significance.
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To describe the diagnosis and morphology of abnormal fistulas between dialysis grafts and adjacent native veins in five patients and to discuss their clinical significance. Five patients with PTFE loop-type forearm dialysis grafts were found to have graft-to-vein fistulas in the presence of venous outflow stenosis or occlusion. Three patients underwent surgical revision and two patients underwent percutaneous angioplasty of the venous obstruction. Only one patient required ligation of the abnormal graft-to-vein fistula. The clinical history, dialysis records, surgical reports, and subsequent radiographs of the fistula were reviewed to determine the clinical significance of these fistulas. Two patients presented with partial graft thrombosis; the proximal portion of the graft remained patent due to persistent flow through the fistulous communication to an adjacent native vein. Two other patients had a graft-to-vein fistula arising from a pseudoaneurysm, which itself was originating from the graft. After either surgical or percutaneous treatment of the venous obstruction, all five grafts remained functional during the follow-up period. These iatrogenic, small-caliber fistulas are not uncommon but only manifest during periods of elevated graft pressure. Once the graft pressure is normalized, these fistulas have minimal hemodynamic effect and need not be specifically treated.
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7787360
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Radiologic placement of long-term central venous peripheral access system ports (PAS Port): results in 150 patients.
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The author reports experience with 150 peripheral access system ports (PAS Ports) placed in an interventional radiology suite. Complication rates from this series are compared with those of surgically placed tunneled catheters. The average cost of placement is compared with that of a surgically placed chest port. Findings were retrospectively reviewed in 150 patients in whom the PAS Port catheter was implanted. The age range was 26-84 years (mean, 46 years). The diagnoses in these patients included cancer (n = 68), acquired immunodeficiency syndrome (n = 52), osteomyelitis (n = 21), and abscess (n = 9). Implantation with use of fluoroscopic guidance and "Cath-finder" technology is described. One hundred fifty ports have been indwelling for a total of 24,151 patient days (range, 40-220 days; mean duration, 161 days). Sepsis occurred in 3.3%, local infection in 5% (early infection 1%, late infection 4%), temporary catheter occlusion in 3.3%, postinsertion phlebitis in 7.3%, and venous thrombosis in 2%. The cost of radiologic PAS Port insertion averaged $1,488 versus $3,720 for surgical chest port insertion. PAS Port central venous catheter placement by an interventional radiologist in this series is safe and cost effective and compares very favorably with surgery. Radiologists will likely see increasing requests by referring physicians for radiologically placed catheters and ports in this era of cost containment.
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7787356
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Prevention of significant hemobilia during placement of transhepatic biliary drainage catheters: technique modification and initial results.
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The authors evaluated a technique for the prevention of significant hemobilia during placement of transhepatic biliary drainage catheters (TBDCs). Twenty patients with strictures were randomized to two groups. In the control group, the biliary tree was accessed with an Accustick system and a TBDC was placed routinely. In the experimental group, following initial access, a rotating hemostatic valve was attached and the outer sheath was pulled back over the wire while contrast material was injected. If a major vascular structure was encountered, the tract was not used for TBDC placement. However, the outer sheath was re-advanced and used to opacify the ducts. This facilitated separate access. Once access was achieved without traversing a major vascular structure, a TBDC was placed, and the Accustick system was removed. If a portal vein or hepatic vein branch was traversed, no additional maneuvers were performed. However, if a branch of the hepatic artery had been traversed, the tract and biliary-arterial fistula were embolized with gelatin sponge pledgets. Both groups were evaluated for hemobilia for 6 weeks. In the control group, there were three cases of significant hemobilia; two were mild, one was severe. In the experimental group, the tract communicated with a major vascular structure in three patients. In these patients, a second access was used for TBDC placement. None of the patients in the experimental group experienced significant hemobilia. Visualization prevents the usage of tracts that communicate with large vascular structures. Initial results indicate that this reduces the frequency of significant hemobilia when TBDCs are placed.
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7787354
|
Thrombolytic therapy and balloon catheter thrombectomy in experimental femoral artery thrombosis: effect on arterial wall morphology.
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To determine vessel wall architectural changes after lytic therapy and balloon catheter thrombectomy in experimentally thrombosed arteries. Bilateral 5-cm femoral artery occlusions were created by ligation in 14 dogs. Two dogs served as controls, and 12 animals underwent balloon catheter thrombectomy on the left and lytic therapy with urokinase on the right either 24 hours (group 1, n = 6) or 7 days (group 2, n = 6) after creation of the occlusion. After treatment, the area of thrombosis was subjected to light and scanning electron microscopy. The IEL was intact in all lysed arteries. IEL fractures were present in 11 of 12 arteries treated with thrombectomy. For group 1 arteries, average luminal area after thrombectomy was 5.63 mm2 +/- 0.66 versus 1.94 mm2 +/- 0.7 after lytic therapy (P < .007). Mean control artery luminal area was 2.86 mm2 +/- 0.52. Similar differences were found in group 2 arteries. With lytic therapy, scanning electron microscopy grading revealed surfaces to be intact in group 1, but moderate injury was exhibited in group 2. All arteries treated with thrombectomy had severe injury. Lysis of acute thrombi (group 1) preserved arterial wall architecture, with an intact IEL and no endothelial injury. Lysis of chronic thrombi (group 2) was associated with mild to moderate injury. Catheter thrombectomy caused severe injury regardless of the time of intervention. These results may help explain the poor long-term patency observed after these interventions.
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7787353
|
Experimental investigation of hypercoagulant conditions associated with angiography.
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To evaluate changes in blood coagulability after high-velocity intravascular fluid injections under conditions relevant to angiography. In 101 rabbits, fluids were injected at 1,000 psi (6,890 kPa) via a multiple-side-hole catheter in the abdominal aorta, while blood was simultaneously aspirated via a second downstream catheter. The fluids injected included saline, contrast media, blood, tissue plasminogen activator, and heparin. The aspirate was evaluated for clotting time with an activated clotting time (ACT) device, for elevated levels of plasma hemoglobin to confirm capture of at least part of the injection bolus in the sample, and sometimes for hematocrit or fibrin degradation products (FDP). A single high-pressure injection of 2 mL of saline briefly accelerated the ACT of a blood-saline bolus (mean, 38% +/- 4). The mean volume of the hypercoagulable bolus was 15 mL. Systemic FDP levels became elevated within a few minutes after initial injection, suggesting activation of the fibrinolytic system by intravascular clot formation. Subsequent injections produced less hypercoagulability, probably reflecting the anticoagulant effects of FDP. Pressure-injected contrast agents had anticoagulant effects. The ACT was accelerated by up to 80% after injection of blood that had remained within the catheter for 3-10 minutes. Glove powder or gauze lint from wiping the guide wire markedly accelerated intracatheter clotting. Hypercoagulability after injection of clotting blood was partially prevented by injections with contrast agent and was completely inhibited by low-dose systemic heparinization. A hypercoagulable bolus may occur after angiographically relevant high-pressure fluid injections. The major contributing factors appear to be high jet velocities and injection of small amounts of clotting blood. Heparinization provides a simple and effective means of prevention.
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7787351
|
Peritoneal abscesses due to bowel perforation: effect of extent on outcome after percutaneous drainage.
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To determine the effect of extent of peritoneal contamination in enteric abscesses on final outcome and duration of percutaneous drainage. Results were retrospectively reviewed for 11 patients with varying degrees of peritoneal contamination secondary to subacute bowel perforation who were primarily treated with percutaneous drainage. Stepwise linear regression analysis of duration of drainage was performed with use of patient age and immune status, the site of bowel perforation, and the number of peritoneal compartments involved in the resultant contamination as independent variables. In 10 of 11 patients (91%) treatment of the resultant intraperitoneal collections with percutaneous drainage was successful irrespective of the extent of peritoneal contamination. There was no correlation between duration of drainage and extent of peritoneal contamination but good correlation with patient age and site of bowel perforation (r = 0.82, P = .02). In patients with enteric abscesses due to subacute bowel perforation, the duration of drainage and final outcome after percutaneous drainage are independent of the extent of peritoneal contamination.
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7787350
|
Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children.
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The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts. Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months. Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients. Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.
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7787348
|
Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up.
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To determine the efficacy and safety of percutaneous transluminal angioplasty (PTA) of the visceral arteries. We retrospectively evaluated the results of PTA performed in 20 visceral arteries in 19 patients (10 men, nine women; mean age, 63 years). Eleven patients had symptoms characteristic of mesenteric ischemia, four had atypical abdominal pain, and four were undergoing prophylactic dilation before undergoing another procedure involving the abdominal aorta. Clinical follow-up was possible in all patients. PTA was technically successful in 15 of 19 patients (79%); among these 15 patients, 12 (80%) did well clinically. Of the seven PTA procedures that were immediate failures, five failed secondary to an occult malignancy or to extrinsic arterial compression by the median arcuate ligament. Ten (83%) of the 12 patients in whom the procedures were immediate clinical successes are still clinically improved at 4-73 months follow-up (mean, 25 months). PTA was successful in only one of the four patients who had symptoms atypical of mesenteric ischemia, but it was successful in 11 of the 15 patients who had symptoms of mesenteric ischemia or who underwent prophylactic dilation. Major complications occurred in three (16%) of the 19 patients. PTA of visceral artery stenoses is effective in patients with symptoms of mesenteric ischemia. It is also effective as prophylaxis in patients undergoing additional procedures in the abdominal aorta.
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7787347
|
Impact of different patency criteria on long-term results of femoropopliteal angioplasty: analysis of 106 consecutive patients with claudication.
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To assess the impact of different patency criteria on long-term results after percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries. The results of femoropopliteal PTA in 106 consecutive patients with claudication (140 treated limbs) were analyzed. The treated artery segment was considered patent if (a) the ankle-brachial index (ABI) had increased by more than 0.10 initially and not deteriorated by more than 0.15 from the maximum early postprocedural level and (b) the ABI was consistently at least 0.15 above the preprocedural level. The third criteria was based on patients' subjective assessment of patency. Initial failures were either included or excluded and both primary (the outcome of the original PTA) and secondary patency (also repeated PTAs included) were determined. When the different criteria were applied, the patency rates at 3 years ranged from 42% to 82% in this patient population. These results stress the importance of uniform criteria when results of different kind of vascular interventions are reported.
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7787346
|
Lumbar spinal fusion using the Diapason system.
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Lumbar spinal fusion with the Diapason system was performed on 58 patients at Toho University Ohmori Hospital from November 1991 to November 1994. The first 44 consecutive patients were followed for more than 1 year, including 34 cases with degenerative diseases. Those 34 cases consisted of 22 men and 12 women, ages 19-78 years (average 47.4), with 49 vertebral levels; these patients were followed for an average of 26.3 months. The clinical improvement and rate of bony union after 1 year of surgery were examined and the intervertebral angulatory motion degree of fused vertebrae was measured using a radiographic functional photo image during 1 year. We also performed an experimental study to evaluate the rigidity of this system. There were no severe complications. Although there was no instrument breakage or screw migration, two cases of rod migration were observed in L5-S1 arthrodesis. A mean improvement rate of 84.3% in the Japanese Orthopaedics Association (JOA) score was revealed. Thirty-three of 34 (97.1%) patients demonstrated successful arthrodesis after their initial procedure. In 10 segments (20.4%) 3-5 degrees of angulatory mobility were still retained, and no angulatory motion was observed in 27 segments (55.1%) 3 months after the surgery; however, no angulatory motion was observed in 44 segments (89.8%) 1 year after the surgery. In our biomechanical study, we observed that the anterior intervertebral space became narrow and mobile with loading, but when the loading was removed, the space reverted to the initial site. This movement was thought to be due to a certain elasticity in the rod and screw, and not loosening at the connection level. This system was evaluated based on the results of both clinical and biomechanical study. Notwithstanding the fact that this method has been evaluated as semirigid fusion, it does provide satisfactory bony union in posterolateral fusion, with excellent clinical results.
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7787344
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Clinical application of the Diapason hook system: a preliminary case report.
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A preliminary case report of the clinical application of the Diapason hook system is discussed. The hooks were implanted in six patients for the fixation of the thoracic region (n = 3), the prevention of backout of pedicular screws (n = 3), and repair of the pars interarticularis (n = 1); the patients were followed for more than 6 months after the surgery. Results indicate that in all of the cases the initial purpose of the Diapason hook system was served. The advantages of the Diapason screw and hook system are its titanium alloy material and simplicity in implanting. Although there have been no instrument failures or any other complications, the cases need longer follow-up. In addition, the size of some hooks needs to be improved because they were too large to apply to the short segments.
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7787345
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Hydroxylapatite-coated Diapason screws: first clinical report.
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We report our preliminary experience with 27 patients who underwent surgery for posterior spinal arthrodesis using the hydroxylapatite-coated Diapason screws. Each of the patients was considered to have a condition that was mechanically risky from the surgical standpoint. The results were good for patients with lytic spondylolisthesis and were excellent for patients with osteoporosis, but were generally less successful for patients requiring "long lever arm" fixations and those with degenerative scoliosis.
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7787342
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The application of Diapason spinal fixator device: a comparison with the Steffee VSP plate.
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Twenty-five consecutive patients who had a variety of lumbar disorders and who underwent lumbar spinal fusion using the Diapason fixator were followed for a mean period of 20 months. The operations included 16 posterior lumbar interbody fusion (PLIF), 7 posterolateral fusion (PLF), and 2 combined PLIF and PLF (PLIF/PLF). As a control group, 38 patients undergoing PLIF using a Steffee VSP plate (VSP) were followed for a mean period of 24 months. There were no significant differences between the two groups regarding the operation time, blood loss, and improvement of preoperative symptoms. However, incidence of incomplete bony union and radiolucent zone around the screws were higher in the Diapason group than in the VSP group. Our study suggests that there was a possibility of insufficient rigidity of screw-rod fixation in the Diapason system.
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7787343
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MR imaging evaluation of the spine with titanium alloy pedicular screw fixation.
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We studied the cases of 60 patients who underwent magnetic resonance (MR) imaging evaluation after fixation with the titanium alloy pedicular screw system. Spine stabilization was required in the thoracic and lumbar region for various spinal disorders. The images were evaluated for the spinal and adjacent tissues. These pedicular screw systems were imaged safely and caused no particular clinical problems. The localized signal void artifacts were seen around the implants. This artifact did not interfere with the diagnosis for another disease. The spinal cord and dura mater appeared in midsagittal and in axial images except for regions lying close to the implants. After surgery MR imaging revealed the decompressed or the deformed spinal cord. However, the prognosis of spinal disorder could not be revealed by the intensity grade of MR imaging because of the distortion in the spinal cord.
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7787339
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Painful neuropathy: C-nociceptor activity may not be necessary to maintain central mechanisms accounting for dynamic mechanical allodynia.
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In neuropathic pain states, dynamic mechanical allodynia is mediated by large diameter A beta-fibers. We test whether ongoing peripheral C-nociceptor input is necessary to maintain central changes hypothetically responsible for A beta-mediated allodynia. A patient with long-standing diabetes mellitus demonstrated generalized signs of painless diabetic small fiber polyneuropathy. Following mechanical trauma, the patient additionally developed a typical neuropathic pain syndrome at the arm. Despite substantial impairment of cutaneous small fiber function, he complained of severe dynamic mechanical allodynia confined to a forearm skin area. Marstock test revealed a considerably increased cold perception threshold within the allodynic area and on the contralateral side. The patient could not perceive any warm sensation on either side. Histamine iontophoresis was not followed by any itch or pain sensations within the allodynic area or contralaterally. Nociceptive C-fiber axon reflex reactions were substantially impaired within the allodynic skin or contralaterally. Standard neurophysiological testing and quantitative vibrametry showed only mild impairment of large diameter sensory and motor fiber function at the arms. Cardiovascular reflex tests showed almost no heart rate variation indicating impairment of vagal small fiber function. (a) Cutaneous nociceptive C-fibers do not signal dynamic mechanical allodynia. This symptom may hypothetically be due to secondary changes in the central nervous system processing that might strengthen the synaptic ties between A beta-fibers and central nociceptive pathways, or due to peripheral multiplication of primary afferent low threshold mechanoreceptor input. (b) Ongoing nociceptive C-fiber input is not necessary to maintain either hypothetical mechanism. (c) Hypothetical secondary central hyperexcitability might work autonomously without any nociceptive C-fiber input for a long time or even indefinitely in some neuropathic patients.
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7787338
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Secondary gain concept: a review of the scientific evidence.
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The "secondary gain" concept originated in the psychoanalytic literature, where it was never vigorously examined. The purpose of this review is to determine if there are scientific studies that have explored the validity of this concept. A computer and manual literature review yielded 166 references in which primary, secondary, and tertiary gain were mentioned. Twenty-four (14.5%) of these reports were "secondary gain" studies. Fourteen "reinforcement" studies were also found. These 38 studies were grouped according to topics and reviewed in detail. Any medical treatment setting including pain treatment was utilized in the review procedure, i.e., no exclusion criteria. Any patient type, including those suffering from chronic pain, were utilized in the review procedure, i.e., no exclusion criteria. A significant but limited number of studies have investigated the "secondary gain" concept, and the results of some of these studies are in conflict. Results of some studies, however, are remarkably consistent in supporting the importance of "secondary gain" to behavior. Some studies have methodological flaws, usually relating to how the presence of secondary gain was established. Overall the results of the reviewed studies support the potential importance of the "secondary gain" concept to understanding illness behavior and underscore a need for future research in this area.
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7787337
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Pain in young adults. II: The use and perceived effectiveness of pain-coping strategies.
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The first goal of the study was to determine the internal reliability of the Coping Strategies Questionnaire (CSQ) in young adults. The second goal was to examine the relation of the CSQ to reported pain levels. The third goal was to investigate the relationship between the CSQ and concomitant pain problems. The fourth goal was to compare young adults and different chronic pain samples in terms of the frequency of coping strategy use and perceived effectiveness of coping strategies. The study included 252 undergraduate students who were given the CSQ, a demographic and pain level questionnaire, and a concomitant pain problem survey. The results indicated that the CSQ was internally reliable when used to assess pain coping strategy use among young adults. Catastrophizing was found to be associated with both pain level and concomitant pain problems, with subjects reporting higher levels of catastrophizing having higher levels of pain and a higher frequency of both migraine headaches and low back pain. Finally, differences were found when comparing the perceived effectiveness in controlling and decreasing pain, and in the use of specific coping strategies in the young adult and chronic pain samples. The young adult sample reported a greater perceived efficacy in controlling and decreasing pain, compared to a sample of low back pain patients and a sample of myofacial pain patients. The results indicate that the CSQ is a reliable measure for the study of pain-coping strategies used in this population, and one that relates to differences reported in the experience of pain.
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7787336
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Predicting subsequent employment status of SSA disability applicants with chronic pain.
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The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. Six clinical sites were ambulatory referral centers, both public and private. Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. No interventions were continued or initiated by the research team between assessment and follow-up. Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.
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7787334
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Abrupt-onset diabetes mellitus in the elderly.
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We present three elderly Japanese patients with abrupt onset of diabetes mellitus: a 61-year-old male with a complete defect of insulin secretion without insulin resistance, a 60-year-old male with an incomplete defect of insulin secretion associated with insulin resistance, and a 69-year-old female with a complete defect of insulin secretion and insulin resistance. The findings in these cases indicate the heterogeneity in insulin secretion and sensitivity of abrupt onset diabetes mellitus in the elderly. The changes in insulin secretion and sensitivity over time due to glucose toxicity may at least partially explain the heterogeneity.
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7787333
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Determination of a common clonal origin of gastric and pulmonary mucosa-associated lymphoid tissue lymphomas presenting five years apart.
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Mucosa-associated lymphoid tissue (MALT) lymphoma is often mis-diagnosed as a benign tumor. Dissemination to other sites occurs in MALT lymphoma. We report a 60-year-old man with gastric and pulmonary tumors of MALT lymphoma which occurred 5 years apart. Initially, the gastric tumor had been diagnosed as reactive lymphoreticular hyperplasia. To determine whether the two tumors arose from the same malignant clone, we amplified and sequenced the complementarity-determining region 3 of the immunoglobulin heavy chain gene using the polymerase chain reaction (PCR). The sequences were identical except for 11-nucleotide difference, suggesting identical clonality.
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7787332
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Von Hippel-Lindau disease with multiple spinal cord hemangioblastomas, syringomyelia and pheochromocytoma.
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A 31-year-old blind man presented with numbness and weakness in the left hand, and elevated blood pressure. Multiple hemangioblastomas in the spinal cord associated with syringomyelia were well demonstrated by gadolinium-enhanced magnetic resonance imaging (MRI). He also had pheochromocytoma in the right adrenal gland, which was disclosed by abdominal computed tomography, MRI and 131I-metaiodobenzylguanidine scintigraphy. MRI screening should be considered for patients with von Hippel-Lindau gene to detect the multiple lesions in this disease.
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7787331
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Pneumatosis cystoides intestinalis after chemotherapy for hematological malignancies: report of 4 cases.
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Pneumatosis cystoides intestinalis (PCI) is known to be a relatively rare condition which is characterized by gas cysts in the gastrointestinal mucosa. We treated four cases of PCI accompanied by hematological malignancies during chemotherapy treatment. All cases suffered from abdominal discomfort. Abdominal X-ray films revealed gas cysts in the intestine. PCI was observed during leukocytopenic states, and three cases had septicemia. Etoposide was administered to three cases, and prednisolone to all cases. It is considered that PCI sometimes occurs in patients with hematological malignancies during a period of leukocytopenia, and may be caused by intestinal mucosal damage due to myelosuppressive agents and immunosuppression from prednisolone.
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7787330
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Enlargement of multiple cavernous hemangioma of the liver in association with pregnancy.
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Four cavernous hemangiomas were found in a 34-year-old woman after the first delivery. All four hemangiomas became enlarged after the second delivery. Due to complaints of symptoms of compression, and to rule out malignancy, surgical intervention was employed. Histologically, the tumors were typical cavernous hemangiomas. Although a relationship between enlargement of hemangiomas and estrogen was suggested, estrogen receptors were not detected in the tumors.
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7787329
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Virus-associated hemophagocytic syndrome due to measles accompanied by acute respiratory failure.
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An 18-year-old male who was admitted to hospital due to fever, skin rashes, cough, and malaise showed laboratory examination findings of leukopenia, thrombocytopenia, mild liver dysfunction, and hypoxia. Bone marrow aspiration revealed 2% histiocytes with hemophagocytosis. Chest X-ray showed bilateral diffuse interstitial pneumonia. The titer of anti-measles virus antibody was < 1:4, and that at convalescence stage was 1:64. He was diagnosed as having hemophagocytic syndrome and acute respiratory failure due to measles, and was treated with methylprednisolone pulse therapy. He promptly recovered from thrombocytopenia and acute respiratory distress. Steroid pulse therapy may be effective in these conditions due to measles.
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7787328
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Aneurysmal dilatation of the pulmonary trunk with mild pulmonic stenosis.
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We present the unusual case of a 72-year-old woman whose chest X-ray showed an abnormal left hilar shadow. A pulmonary angiogram revealed an aneurysm in the pulmonary artery with a diameter of 55 mm that extended from the main pulmonary trunk to its bifurcation. Mild pulmonic stenosis with a systolic pressure gradient of 18 mmHg across the pulmonic valve was recognized. Mild dilatation of the ascending aorta was also present. The pressure gradient across the pulmonic valve was lower than is typical for an aneurysmal dilatation, suggesting that this patient represented a case of idiopathic pulmonary artery dilatation. We suspected the presence of a congenital structural alteration common to the pulmonary artery and the ascending aorta.
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