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3894976
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Factor IX is the precursor of a serine protease that functions in the intrinsic blood clotting pathway. Deficiencies in this plasma glycoprotein result in haemophilia B (or Christmas disease) and occur in about 1 in 30,000 males. Patients are currently treated with fresh frozen plasma or prothrombin complex concentrates prepared from pooled plasma from normal individuals. There are several problems with this method of treatment, including the probable exposure of the patients to contaminants such as the viral agents responsible for hepatitis and AIDS (acquired immune deficiency syndrome). As a first step towards an alternative source of pure human factor IX, we report here on the use of recombinant DNA techniques to produce biologically active factor IX in cultured mammalian cells. Stable cell lines were produced by cotransfecting a baby hamster kidney (BHK) cell line with a plasmid containing a gene for factor IX and a plasmid containing a selectable marker. Protein secreted by these cell lines reduces the clotting time of plasma from factor IX-deficient patients. We present additional evidence that this protein is authentic human factor IX.
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3895003
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The liquid suspension modification of the standard Salmonella mutagenicity assay employing Ames tester strains of Salmonella typhimurium TA1535 and T100 was used to study the influence of potassium, sodium and calcium on the mutagenic activity of MNU and MNNG. The toxic and mutagenic activities of MNU and MNNG were better expressed when potassium-containing solution was used as a solvent. Short-term pretreatment of bacteria cells with potassium-containing solutions increased the mutagenic efficiency of both chemicals. Potassium-induced increased sensibility of S. typhimurium TA1535 to MNU was completely reversible after 20 min incubation of bacteria in a nutrient broth at 37 degrees C. The mutagenic activity of MNU was reduced after a short-term pretreatment of S. typhimurium TA1535 with a 0.9% solution of CaCl2, while NaCl did not change the mutagenic response of bacteria to MNU.
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3895002
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The mutagenic activity of the cytostatic drug Platidiam (cis-diamminedichloroplatinum II complex, cis-DDP) produced in Czechoslovakia was tested. In the used Ames test, as an indicator system, Salmonella typhimurium his- strains were employed. The tests for mutagenicity were performed in vitro using assays both without metabolic activation and therewith, as well as with metabolic activation under in vivo conditions. The analyses revealed a mutagenic effect of the cis-DDP complex in Platidiam in all of the followed tests. These effects were direct, no metabolic activation was observed. Furthermore, the mutagenic activity of the drug was influenced by the duration of interaction between Platidiam and the mammalian organism, which was apparently due to the pharmacokinetic properties of the active substance.
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3895005
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A simplified method of renal scintigraphy carried out with 131I-Hippuran and 99mTc-DTPA diethylenetriaminopentacetate is described in man. Results were expressed as tubular clearance (with Hippuran) and glomerular clearance (with DTPA) per kidney, and compared to PAH and inulin clearances measured in the same patients. There was a close positive correlation between clearances calculated by means of renal scintigraphy and those measured by standard procedure for studying renal function. This study showed that a simple calculation allowed to express scintigraphical findings in terms of clearance.
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3895006
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5 cases of sarcoidosis with normocalcemic granulomatous nephritis and renal impairment are described. 24 earlier reported cases with normocalcemic granulomatous nephritis of sarcoidosis were extracted from the literature and reviewed together with the present cases. GFR was normal (greater than 80 ml/min) in 2 of the patients, slightly to moderately decreased (80-20 ml/min) in 14 patients, and severely decreased (less than 20 ml/min) in 13 patients. The patients (19 males and 10 females) were 12-68 (median 45) years old. All patients with GFR less than 10 ml/min were more than 43 years old. 1 patient died in terminal uremia on admittance. All but 1 of the patients treated with corticosteroids improved (22 patients) or stabilized (5 patients) at least initially. 1 patient treated with a relatively low dose of a corticosteroid progressed to terminal uremia. 8 patients had a relapse when the corticosteroids were tapered or discontinued. 12 of the patients had residual renal impairment after initial successful treatment and in 4 cases the impairment worsened after a corticosteroid-sensitive relapse. It could be concluded from the study that an initial corticosteroid dosage of 1 mg prednisolone/kg BW or more should be used in granulomatous nephritis of sarcoidosis.
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3895007
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Plasma renin activity (PRA), plasma aldosterone (PA), blood uric acid (BUA), plasma concentrations of catecholamines (Pcat) and plasma volume (PV) were measured simultaneously in 24 patients with pregnancy-induced hypertension. This hypertensive group was divided into labile (LH) and permanent hypertension (PH) groups according to the response of their blood pressure to home bed rest. As compared to normal theoretical values, PV was decreased in both hypertensive groups (LH = -70%; PH = -14%). As compared to a control group of 16 normotensive pregnant women, PRA was higher in LH and lower in PH whereas PA was lower in both hypertensive groups. In both hypertensive groups, BUA was higher than in the control group. No difference in Pcat was found between the three groups. In the PH group negative correlations were found between BUA and PRA, as well as between BUA and PV, but no correlation between PRA and PV nor between Pcat and BUA were found.
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3895008
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In order to examine the insulin secretion in chronic renal failure, isolated pancreatic islets either from uremic rats or from control rats were mixed into a short column of Bio-Gel P-2 polyacrylamide beads and perifused. Uremic rats had higher concentrations of blood urea nitrogen, serum creatinine, and immunoreactive insulin and lower concentration of plasma 1,25-(OH)2D3 than control rats. Although the basal insulin release in the presence of 5.0 mM glucose showed no difference between uremic and control rats, the initial insulin release in the presence of 16.2 mM glucose was significantly lower (p less than 0.05) in uremic than in controls rats. The insulin content in islets was not different between both groups. These findings suggest that there might be impairment of the initial insulin secretion without changes of insulin content in pancreatic islets in uremia.
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3895010
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Rifampicin is considered as one of the most potent antituberculous agents and is often used in renal transplant recipients. However, acute cellular rejection episodes were observed when rifampicin was prescribed in 4 tolerant renal transplant recipients. Acute rejection occurred in 3 out of the 5 patients, despite doubled daily dose of steroids. First, rifampicin is an enzymatic inducer and accelerates steroid metabolism. Secondly, rifampicin per se is an immunosuppressive drug, as already proved in animals. Rifampicin interferes with the active mechanisms involved in specific transplantation tolerance. In conclusion, we recommend a very cautious use of rifampicin in kidney transplant recipients.
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3895011
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The present study including 136 cadaver kidney transplants in 119 recipients has shown that the long term function and survival of kidney grafts are closely related to the early immunological reactions of the recipients. Under conventional immunosuppression the most important period for the outcome of the grafts extends to the first 4 months. Not only the number but especially the severity of the early rejection episodes are of prognostic value. Two groups can be distinguished using a classification of severity of early rejection episodes: the first one is characterized by an excellent graft survival and late function (87% one year graft survival) and includes those kidneys with zero or only 1-2 slight early rejection crisis (type 1 and/or 2). In the second group with more than two slight crisis or more severe forms of rejections (type 3 or 4) the one year graft survival is significantly reduced (52%: p less than 0.01). In this group compensatory hypertrophy is usually absent. This is in opposition to the functional improvement of 14 ml/min of GFR after 12 months observed in the patients with good immunological tolerance.
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3895012
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Calcium stones is responsible for 80 per cent of the stones in the upper track. It is a frequent and particularly recurrent disease and for this reason it is important to prevent its recurrence by medical treatment, dissolution of calcium stones being impossible. In the first part of this review, we have presented the theoretical basis and the clinical studies concerning conservative therapy involving high fluid intake and dietary advice on calcium and oxalate intake. Then, for the various drugs proposed for recurrence prevention we have reviewed their mechanisms of action and the controlled clinical trials concerning these drugs. Finally, the practical therapeutical choices for the management of these patients are presented according to the results of the previous metabolic evaluation.
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3895013
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Mammalian neural transplantation has recently been recognized to be a valuable technique for studying normal development and regeneration in the central nervous system. In addition, the ability of grafted neurons to reinnervate damaged regions of the host brain and to ameliorate some neuroendocrine deficits, cognitive disorders and motoric dysfunctions in young adult rodents has suggested that transplantation therapy may be effective in treating human neurodegenerative diseases and neurotransmitter deficiencies related to aging. It is of particular interest that initial studies of neuron transplants in aged rodents indicate that cholinergic, dopaminergic and noradrenergic neurons all integrate to some extent with the aged brain, and that the product of this graft-host interaction is improved behavioral performance of aged subjects. The present paper critically reviews the present domain of neural transplantation, its application to studies on the properties of the aged mammalian brain and discusses the possible therapeutic use of transplants in ameliorating transmitter-specific abnormalities associated with Parkinson's disease and Alzheimer's disease.
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3895014
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Vasopressin peptides have been shown to facilitate learning and memory in both animals and humans; however, the effectiveness in humans is controversial. In a double blind parallel group study, 17 demented subjects (either Alzheimer's or alcoholic) were given either desglycinamide-9-arginine-8-vasopressin (DGAVP) 92 micrograms intranasally TID or an identical placebo for 1 week after having received 1 week of placebo. To our knowledge, this is the first report of DGAVP being used in subjects with dementia. The DGAVP group had a statistically significant improvement on the Buschke list learning of low imagery words. However, for various reasons discussed in the paper, we feel this finding needs to be replicated before any definite conclusions can be drawn. Since there were no other appreciable behavioral effects of this DGAVP regimen, our results should be considered negative. There was no evidence of any DGAVP-related adverse effects, except for possible weight gain.
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3895016
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Brown-Roberts-Wells stereotactic instruments were used for CT guided stereotactic surgery in 54 cases (65 operations). Stereotactic biopsy was done in 9 cases and successive regional chemotherapy was done in 3 cases. Stereotactic drainage was done in 2 cases of bacterial abscess, 3 cases of cystic neoplasm and 33 cases (43 operations) of intracerebral hematoma. CT guided stereotactic procedure was valuable for the correct cannulation to the center of the cavity. We tried to utilize CT image for the selection of targets for stereotactic functional neurosurgical procedures in 6 cases. In the cases of thalamotomy, the information derived from CT made the operation safer than that by contrast ventriculography alone. In all cases of electrode implantation for deep brain stimulation, accurate and precise electrode placement was achieved from CT images alone. This rapid and easy surgical technique was useful also for poor risk patients.
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3895017
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Six cases of meningiomas which accounted for 3.6% out of 167 intracranial tumors in children were studied with clinico-pathological method. Four meningiomas located in the convexity, two meningiomas developed within the lateral ventricle. CT scan with contrast material showed homogeneous enhanced tumors in four cases. Heterogeneous enhanced tumors were observed in two malignant meningiomas. There was evidence of recurrence in three cases. Two of in these cases were malignant meningiomas. Three patients received postoperative radiotherapy. One case of malignant meningiomas died seven years after the first operation. Five cases are still alive. Macroscopically three cases had cyst formation. Four convexity meningiomas were attached to the dura matter. Three malignant meningiomas were ill-defined and invaded the normal brain tissue. One case of malignant meningiomas invaded the skull. Six meningiomas were classified histologically into two fibrous, one transitional and three malignant meningiomas according to the World Health Organization (WHO) classification of brain tumors. All cases were examined for glial fibrillary acidic protein (GFAP) using the immunohistochemical method. Two cases of malignant meningiomas demonstrated the positive reaction to GFAP. Four cases were negative. These findings suggest that malignant meningiomas grow invasively into the surrounding normal brain tissue.
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3895018
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In two infants admitted to the neonatal intensive care unit with birth-weight of less than 1,000 g, serial cranial real-time sonograms were obtained to determine the subependymal germinal matrix hemorrhage and follow up the post-hemorrhagic hydrocephalus, compared with computerized tomographic scan. This paper reports the results of the placement of a subcutaneous ventricular reservoir in these extremely low-birth-weight infants to resolve progressive post-hemorrhagic hydrocephalus and protect their cortical mantle until their risks of ventriculo-peritoneal shunting procedure are acceptable. In these infants, the hydrocephalus and increased intracranial pressure were controlled and following shunting procedure after their medical and anesthetic problems resolved.
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3895021
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An increase in endogenous opiatergic tone has been suggested as a mechanism for suppression of gonadotropin release in hyperprolactinemia (hyperPRL). In an attempt to evaluate this possibility in hyperprolactinemic males, we have examined the effects of a specific opiate antagonist, naloxone, on plasma LH levels in adult male rats rendered hyperprolactinemic by transplanting two pituitary glands underneath the kidney capsule. Naloxone was administered intravenously (i.v.) at different dose levels (0.2,2, or 20 mg/kg body weight) and blood samples were collected at intervals ranging from 15 to 60 min after naloxone administration. In all experiments, plasma LH levels in the sham-operated controls were significantly increased after naloxone administration, while those in the pituitary-grafted group remained unaltered. Injecting naloxone daily for 3 or for 10 days failed to alter plasma LH levels in both sham-operated and pituitary-grafted animals. Administration of LHRH induced a 7-fold increase in plasma LH levels in both the pituitary-grafted animals and the sham-operated controls. These studies demonstrate that hyperPRL interferes with the naloxone-induced rise in circulating LH levels in the male rat.
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3895022
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The effect of exogenous progesterone (P) on the corpus luteum function (in terms of the secretion of P and 20-alpha-dihydroprogesterone (DHP), on the secretion of prolactin (Prl) and on the pituitary responsiveness to LHRH was studied in pseudopregnant (PSP) rats kept in alternating and constant lighting conditions (LD-PSP and LL-PSP rats, respectively). Rats were rendered pseudopregnant by appropriately timed stimulation of the cervix uteri (LL rats first received an ovulatory dose of hCG). LH responses were induced by constant rate infusion of LHRH (104 ng/h for 21 h). P was delivered by subcutaneously inserted Silastic implants; control rats received sham implants. In both LD-and LL-PSP rats the plasma P and DHP levels were high on day 8 of PSP. On day 12, however, the plasma P levels had fallen but the DHP levels had risen, demonstrating that between days 8 and 12 functional luteolysis had occurred and that neither the production of P and DHP, nor the timing of luteolysis are under the control of the lighting conditions. On day 12 of PSP the pituitary responsiveness to LHRH was much higher than on day 8. Moreover, on days 8/9 of PSP peaks of Prl were seen in all rats, but on days 11/12 such peaks were largely absent. In LD-PSP rats 'nocturnal' Prl peaks were seen on days 8/9 in all 9 experimental animals, but 'diurnal' peaks were seen in only 4 of these animals. Also, the diurnal peaks were on average much lower than the nocturnal peaks.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895023
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The two living representatives of the most ancient vertebrates, Agnathans, are lamprey and hagfish. Using immunological methods, we identified gonadotropin-releasing hormone (GnRH)-like molecules in the lamprey brain, but not hagfish. The lamprey GnRH was detected poorly by antisera directed at the C-terminus, suggesting that a C-terminal amino acid substitution may have occurred in the lamprey molecule compared with mammalian GnRH. In spite of this, lamprey and mammalian GnRH-like molecules have the same retention time on an isocratic HPLC system and parallel inhibition of mammalian 125I-GnRH in a radioimmunoassay. The lamprey GnRH-like molecule has a distinct HPLC elution pattern compared with dogfish shark, salmon, trout and probably birds. Thus lamprey GnRH represents another member of the growing family of GnRH molecules. Additionally, lamprey GnRH may be a stem molecule in the vertebrate evolution of GnRH.
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3895024
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The authors report a prospective, randomized 18-month study on the effect of prophylactic antibiotic treatment in 152 hydrocephalic patients in whom clean shunt operations or revisions were done. The treated group received methicillin (totally 200 mg/kg) divided into six i.v. doses during 24 hours starting at the induction of anesthesia. Patients allergic to penicillin received erythromycin instead. Seventy-nine patients received antibiotics, and 73 (the control group) received none. All patients were followed at least 6 months after operation or to their death. Eleven patients developed signs of infection, giving an overall infection rate of 7.2%; however, the infection occurred less than 1 month after the operation in only half of these. Six of the patients had septicemia, 4 had peritonitis, and 1 had meningitis. In the treated group, the infection rate was 8.9%; in the control group, the rate was 5.5%. There was no statistically significant difference. The prophylactic antibiotic regimen in this investigation did not reduce the infection rate connected with cerebrospinal fluid shunting procedures.
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3895026
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The three published randomized clinical trials of chymopapain injection vs. placebo injection for the treatment of herniated lumbar discs are reviewed. Despite some differences, the similarities in selection criteria, technique, and outcome assessment are great enough to justify pooling the results to obtain an overall assessment of chymopapain efficacy. These pooled results suggest that the odds of successful outcome (at least some improvement in symptoms after injection) are 2.6 times as great with chymopapain injection as those after placebo injection. This corresponds to a 50% greater probability of success with chymopapain than with placebo or a 23% increase in the number of patients successfully treated with chemonucleolysis over those successfully treated with placebo. The fact that data from 234 patients evaluated in randomized clinical trials could resolve a controversy over therapeutic efficacy that the uncontrolled evaluation of over 20,000 patients could not answer suggests that the current controversy over the relative efficacy of chymopapain and discectomy should be studied in the same way. The difficulties of such a study are discussed.
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3895025
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A case of a primary rhabdomyosarcoma that appeared to be arising from the filum terminale in a 48-year-old man is reported. The histological diagnosis of rhabdomyosarcoma was supported using immunocytochemical methods. Twenty-two cases of primary rhabdomyosarcoma of the central nervous system previously reported in the literature are reviewed briefly. The possible origin of these tumors from neuroectoderm is discussed.
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3895019
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The localization of neurons containing enkephalin-like immunoreactivity was studied within the human hippocampal formation. It was present in numerous dentate granule cells and a few larger neurons within the dentate molecular layer. In hippocampus proper, numerous pyramidal cells also demonstrated it, especially in field H1 of Rose (1926) and subiculum. No difference attributable to ageing or to dementia of the Alzheimer type was seen in this distribution. Post-mortem delay was the major factor affecting the intensity of its immunocytochemical localization to hippocampal cells and nonspecific background staining, due to binding of the secondary antiserum, increased directly with this. Some dendrites of dentate granule cells with immunoreactivity were found entering senile (neuritic) plaques in tissue from cases of Alzheimer's disease. These dendrites appeared morphologically normal.
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3895028
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Appropriate treatment for intracranial mass lesions depends upon accurate histological diagnosis. Although both advanced generation computed tomographic and magnetic resonance scanners can detect small lesions within the brain stem, only the combination of these advanced imaging tools with stereotactic instrumentation permits safe and accurate pathological diagnosis of such lesions. We present the results of 13 operations performed on 12 patients with mass lesions of the pons and mesencephalon. A definitive diagnosis was obtained in all patients. Aspiration of necrotic tumors (3 patients), neoplastic or benign cysts (2 patients), and chronic hematomas (2 patients) resulted in immediate neurological improvement in 7 of these 12 patients. No morbidity or mortality related to surgery occurred in this series. Both the preoperative clinical and radiographic diagnoses were erroneous in 6 patients so that accurate histological diagnosis indeed altered subsequent therapy. A transfrontal approach to the midbrain and a transcerebellar approach to the lateral pons are described. The importance of accurate diagnosis, the possibility of definitive therapy in selected patients, and the encouraging benefits and safety of stereotactic surgery indicate that empiric treatment of mass lesions of the midbrain and pons is no longer justified.
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3895020
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Neural tissue grafting presently stands as one of the more intriguing experimental strategies being applied to the problem of spinal cord regeneration. The following annotation presents an overview of recent investigations which have shown: that peripheral nerve grafts can stimulate axonal outgrowth in many descending and ascending fibre populations of the injured spinal cord and that central nervous system (CNS) implants, derived from segmental and supraspinal levels of the embryonic neuraxis, may likewise have the potential for promoting repair of damaged intraspinal neural circuitries in adult and neonatal recipients.
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3895031
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Macrophages and microglia in the developing and adult mouse brain have been identified by immunohistochemical localization of the macrophage-specific antigen F4/80 and monoclonal antibodies to the FcIgG1/2b (2.4G2) and type-three complement (Mac-1) receptors. In the adult mouse there are two classes of F4/80-positive cells; those associated with the choroid plexus, ventricles and leptomeninges and the microglia. The cells bearing Fc and complement receptors are indistinguishable, by their morphology and distribution, from those revealed by F4/80. During development macrophages invade the brain and can be followed through a series of transitional forms as they differentiate to become microglia. Macrophage invasion occurs when naturally dying cells are observed in large numbers and this is consistent with the idea that dying neurons and axons provide a stimulus for macrophage infiltration. Our results provide strong support for the hypothesis that the microglia are derived from monocytes and show that microglia possess receptors which would allow them to play a part in the immune defence of the nervous system.
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3895032
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After a single patient with progressive supranuclear palsy (PSP) improved when given amitriptyline, we compared the effects of amitriptyline, desipramine, and placebo on the symptoms and signs of four patients with PSP in a double-blind, double-crossover manner. There was good correlation between the use of tricyclic agents and symptomatic improvement, although all patients remained disabled. Amitriptyline produced better overall improvement, whereas desipramine preferentially improved apraxia of eyelid opening.
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3895033
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Previous studies with mesulergine (CU 32-085) demonstrated safety and efficacy in short-term observations of patients with Parkinson's disease. We compared mesulergine with bromocriptine in 20 patients with Parkinson's disease. Eighteen patients completed the randomized, double-blind, crossover study. Clinical assessments employed the UBC scale and "Mini-Mental State" examination; neurophysiologic measurements were undertaken on wrist rigidity and speed and accuracy of hand movement, and toxicity screening tests were compared. There were no significant differences between the effects of mesulergine (mean dosage, 27.4 mg/d) and bromocriptine (mean dosage, 40.8 mg/d).
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3895035
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The Philadelphia Neurological Society was founded 100 years ago by Charles K. Mills, together with Wharton Sinkler, J.T. Eskridge, and Francis X. Dercum. S. Weir Mitchell was the first president and served for 5 additional years. American neurology was born in Philadelphia at the Orthopedic Hospital and the Infirmary for Nervous Diseases. The growth in neurology in this country is reflected in the activities of the Philadelphia Neurological Society.
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3895034
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Nine patients with various focal dystonias participated in a 12-week, double-blind, crossover comparison of the dopamine agonist, lisuride, and placebo. Lisuride produced mild objective and subjective improvement in six subjects, but the improvement was not sustained with continued therapy. Because the patients generally identified the active drug by side effects, biasing the study toward finding an effect, and because the benefits were mild and transient, we conclude that lisuride is of limited use in the treatment of focal dystonias.
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3895036
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Among 30 patients with neurosyphilis diagnosed between 1970 and 1981, 43% had symptoms attributable to neurosyphilis, 43% had unrelated symptoms, and 14% were asymptomatic. Serum VDRL was positive in 86%, and the CSF VDRL was positive in 53%. Meningovascular and vascular syphilis were relatively more common than in the prepenicillin era; tabes dorsalis and general paresis were unchanged in relative frequency.
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3895037
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Six patients with severe postural cerebellar tremor were studied in a double-blind, placebo-controlled, crossover trial with isoniazid. Each phase of the study lasted 4 weeks, and in the isoniazid phase patients received an increasing dose up to 1200 mg/d. Patients were studied with self-rating scales, quantitative tremor recording, and blinded ratings of videotapes. All patients improved by at least one method, three improved by all methods, and four improved sufficiently to want to continue with the drug after the trial was finished. There is a definite, but limited, therapeutic role for isoniazid.
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3895038
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Digital subtraction angiography (DSA) has strongly influenced angiographic procedures. Because it is less invasive it has increased the total number of angiographies in all places where it was introduced. The paper gives an introduction to the procedure explaining the roles of "digital" and "subtraction" in DSA. It is written from a technical point of view. The examples are taken from and with the DVI system.
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3895040
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This short paper summarizes the basic concept and the technology of a new computed radiographic system which uses an energy-storage phosphorus panel called "Imaging Plate" as an image sensor. The "Imaging Plate" can be used to obtain radiographs in exactly the same way as the screen-film combination is used in conventional radiography. The system eliminates the drawbacks of conventional screen-film radiography by combining digital image processing and digitization of the x-ray energy pattern utilizing scanning laser stimulated luminescence.
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3895039
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DSA ranks among the modern imaging procedures which owe their development to the advances made in computer technology. Thanks to i.v. contrast injection, it has become possible to evaluate a lesion in the cervical vessels in at least 80% of cases and in 60% of cases when intracranial vessels are concerned. Intra-arterial contrast injection renders the diagnostic yield of DSA equal to that of conventional angiography with the benefit that the required contrast volumes are low and that the catheter need not always be placed selectively. Intravenous contrast injection is required with patients advanced in age, when critical cardiovascular conditions prevail, when the arterial access routes are completely occluded or in the case of postoperative checks of the cervical vessels. Although its field of application remains restricted, particularly in the case of intravenous contrast injection, the clinical application of DSA appears well established and its advantages are undisputed. Examples are given to demonstrate the clinical boundaries set to this new imaging procedure based on i.v. and intra-arterial contrast injection.
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3895043
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Anterior lesser curve seromyotomy with posterior truncal vagotomy (AS + PT) is a new operation for the treatment of chronic duodenal ulcer. Since April 1981 this technique was carried out in 84 patients for three different conditions: chronic duodenal ulcer (N = 48), perforated duodenal ulcer (N = 18) and as an additional procedure in Nissen fundoplication for reflux oesophagitis (N = 18). The surgical technique is described in detail. In the treatment of chronic duodenal ulcer, AS + PT has been compared to proximal gastric vagotomy (PGV) in a randomized clinical trial. 51 Patients (PGV: 26; AS + PT: 25) have been followed up for more than 1 1/2 years. Satisfactory clinical results (Visick grades I + II) were found in 88.5% of patients after PGV and in 92.7% after AS + PT. Basal acid output (BAO) was reduced by 70.2% after PGV and 85.7% after AS + PT, whereas the reduction in pentagastrin stimulated peak acid output (PAO) was 54.2% and 58.9% respectively. Neither in the chronic duodenal ulcer group nor in the two other groups of patients treated by AS + PT were serious postoperative gastric sequelae encountered. The results of this randomized trial suggest that AS + PT is at least as good as PGV in the surgical treatment of chronic duodenal ulcer. We anticipate that AS + PT, which is technically simpler and less time consuming than PGV, will replace PGV as the procedure of choice in the surgical treatment of chronic duodenal ulcer.
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3895041
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The recording of evoked potentials (EPs) has become one of the most useful functional diagnostic techniques in the neurosciences during recent years. In combination with the neurophysiological investigation of brain stem reflexes (BSRs) EPs provide good information concerning circumscribed and diffuse brain and brain stem lesions. In this article the role of EPs and BSRs will be pointed out with special regard to their use in neurosurgery concerning awake and comatose patients as well. Pathological findings caused by extracerebral factors or due to neurological (systemic) and otological diseases will be discussed from the aspect of differential diagnosis only. Evoked potentials described in this paper are short latency potentials which are related to more or less defined generators in the peripheral and central nervous system. EPs of long latency seem to play a role in cognitive, affective and integrative functions of the central nervous system and they will not be dealt with in this article. In recent years an increasing number of review articles and monographs dealing with several aspects of evoked potentials has appeared [16, 17, 18, 25, 69, 80, 84, 122, 123, 124, 127, 130].
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3895044
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Strokes and their sequelae are currently a major medical and social problem. Hence prevention is fundamental. The treatment of evident stroke whether general therapy, target treatment of the cerebral oedema, or specific treatment of the cerebral haemorrhage or thromboembolism is therefore equally important, though subject to controversy. In a case series of 1015 strokes, paramedical assistance and early physiokinesitherapy proved decisive. Specific treatment of the ischaemia using Buflomedil together with computerised EEG monitoring also looks promising.
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3895046
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Ectasia of a left adrenal vein in a 64-year-old man is described. The "cyst" thus formed contained 500 ml of blood. Its wall had three layers and was lined with endothelium. The structure of the adrenal was unimpaired. The morphology was indicative of malformation of the vein wall rather than neoplasia. The interest of the case lies in the fact that removal of this rare abnormality resulted in the cure of stable arterial hypertension. The literature reveals other cases of adrenal "cysts" of various kinds associated with continuous or paroxysmal hypertension or adrenal hyperfunction, followed by regression after asportation on all occasions. A morphogenetic classification of adrenal cysts is proposed with notes on each form.
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3895045
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A study is presented of erythrocyte filtration in 10 elderly patients suffering from vasculopathy and treated with 1000 mg X 2 cyticholine per diem for six days. Statistical analysis using the Student's "t" test showed a distinct improvement in the filtration index in all stages of treatment with maximum values (p less than 0.001) reached on the 2nd day, two hours after endovenous administration of 1 g cyticholine.
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3895047
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In view of the growing number of examinations proposed and employed for the diagnosis of diseases of the thyroid, a retrospective evaluation was made of their validity in a series of 2500 patients (1500 operated). Attention was paid to scintiscanning, oncotropic indicators, echography, needle biopsy, thyrolymphography and thyroid hormones as aids to determining the nature of thyroid lesions and the planning of their treatment. Scintiscanning and needle biopsy proved of primary importance in determination of the nature of a lesion. Echography supplied additional, though not necessarily indispensable information. Oncotropic indicators and thyrolymphography do not appear to be useful. They do not provide data enabling a diagnostic problem to be solved, but can only help to increase any doubts that may exist. Determination of thyroid hormones is clearly indicated when planning the management of hot lesions (single, multiple or disseminated nodes), in cold lesions where thyroiditis is suspected, and in all cases where the clinical evidence suggests hypothyroidism. In euthyroid subjects requiring surgery with no objective signs of hypofunction, preoperative determinations appear to be unnecessary, where as post-operative values are of assistance in assessing the functional efficiency of the residual thyroid tissue. The conclusion to be drawn, therefore, is that diagnostic examinations should be employed in a more selective and discriminating manner.
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3895049
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The centrifugal projection to the eye has been studied in rats with anterograde and retrograde tracing techniques. As a retrograde tracer Nuclear Yellow (NY) was used. Following NY injections into the vitreous body of the eye, labeled neurons were exclusively found bilaterally in nucleus oculomotorius. The course and termination site of the retinopetal fibers were studied with the anterograde tracer Phaseolus vulgaris-leucoagglutinin (PHA-L). Iontophoretic injections of PHA-L in nucleus oculomotorius resulted in labeling of retinopetal fibers which reach the eye via the optic tract and optic nerve. Preterminal arborizations were found in the inner nuclear layer of the retina. In addition, labeled fibers have been observed which seem to terminate within the optic tract and optic nerve. It is suggested that the projection from the nucleus oculomotorius to the retina constitutes a link in the multisynaptic efferent pathway from the visual cortex to the eye, by which the visual cortex can influence the functioning of the retina.
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3895050
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N-Methyl-D-aspartate (NMDA), quisqualate, kainate and potassium increased, in a dose-dependent manner, the efflux of radioactivity from rat cerebral cortex minislices preincubated with [3H]choline. Ketamine (1-5 microM) and magnesium (0.1-1 mM) reduced only the release evoked by NMDA. The non-parallel shift of the NMDA dose-response curve suggests that ketamine is not acting as a competitive antagonist of NMDA.
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3895053
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Globoid cell leukodystrophy (Krabbe disease) in man is a rare genetic disorder caused by deficiency of galactosylceramidase activity. Clinical and pathological manifestations are almost exclusively confined to the nervous system, particularly to the white matter and the peripheral nerve. The disease also occurs in four other mammalian species: dog, cat, sheep and mouse. Except for the feline disease, for which enzymatic information is lacking, these animal models are genetically equivalent to the human disease. The clinical and pathological features are fundamentally similar in all species, as might be expected from the same underlying genetic defect. Nevertheless, significant species differences are observed in the clinical course, severity of pathological alterations, and analytical biochemistry. These genetically "authentic" animal models provide an invaluable tool for studies of the rare human genetic disorder. Results of studies already done and the future potentials are discussed.
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3895065
|
A method to correct for background in lung DTPA transfer has been developed for use with a large field of view gamma camera. The method gives comparable values of T50 to those obtained by Jones et al. The correction factors vary from apex to base; therefore to allow intersegmental T50 comparisons each segment should be corrected for background using its own correction factor.
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3895069
|
Amniotic fluid volume was serially assessed by real-time ultrasound in 90 patients who presented with premature rupture of the membranes (PROM) and not in labor. The degree of oligohydramnios was correlated to the outcome of pregnancy, as reflected by pregnancy prolongation, intrapartum fetal heart rate patterns consistent with umbilical cord compression, cesarean section rate, fetal distress, infection, and perinatal mortality rate. These data suggest that in patients with PROM the degree of oligohydramnios is positively correlated with unfavorable pregnancy outcome.
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3895067
|
A review of the data from studies of oral contraceptives on coagulation and the fibrinolytic enzyme systems reveal an increase of a variety of coagulation factors. This is dose dependent and related to estrogens and appreciable above a dose of 0.5 micrograms of ethynylestradiol. Smaller amounts are less effective or not at all active. The mechanism of this increase is unknown. The pathophysiological significance is not yet clear. There is no available data that associate the increase of coagulation factors with disseminated intravascular coagulation. Conclusive evidence that low dose progesterone has any effect on the coagulation system is lacking.
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3895068
|
Renal disease in pregnancy may be progressive but only rarely. The problems encountered that create maternal and fetal morbidity and mortality relate to the development of superimposed preeclampsia and renal failure. Diagnosis is important to differentiate the cause of renal pathology so that appropriate treatment can be undertaken. The use of medications in renal disease in the presence of hypertension is controversial; however, adequate therapy should be given if indicated. Most cases of renal disease in pregnancy do not require termination; however, counseling concerning pregnancy is needed initially or subsequently.
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3895071
|
Among 460 twin pregnancies delivered at the University Central Hospital of Turku from 1970 to 1981, there were 41 (8.9%) with a weight difference of 25% or more between twins when calculated from the weight of the larger twin. The perinatal death rate in the first group (9.7%) was significantly higher (P less than .01) than the perinatal death rate (3.7%) in the group with the weight difference of less than 25%. The intrauterine mortality rate, in particular, was significantly increased (P less than .001) in the group with 25% or more difference being 6.5-fold when compared with the more difference being 6.5-fold when compared with the group with the lower weight difference. Among 271 twin pregnancies examined by ultrasound one to two weeks before delivery, there were 31 (11.4%) pairs of twins with a 3-mm or more difference in biparietal diameter, 11 (4.1%) with a 4-mm or more difference, and seven (2.6%) with a 5-mm or more difference. The sensitivity of measurements of biparietal diameter to detect the growth discordancy was 9 to 35%, the specificity 90 to 98%, and the positive predictivity 23 to 29%. This study indicates that a divergent growth pattern in twin pregnancy carries an elevated risk of intrauterine death, especially for the smaller twin. Measurement of biparietal diameter is not a method sensitive enough to detect these high-risk twin pregnancies.
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3895070
|
Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have noted fluid collections around the incision site. In this report of 100 postcesarean section patients, it is noted that echo-free areas anterior to the incision site, which correspond to the described fluid collections, were present in 29% of patients and were more frequently found in patients with excess blood loss at surgery. Patients whose echo-free areas were greater than or equal to 3.5 cm were significantly more likely to have postoperative morbidity. The significance of these findings and the role of ultrasound in the evaluation of the postcesarean section patient are discussed.
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3895072
|
In a majority of patients with candidal vulvovaginitis, drug therapy is convenient and effective. A small but significant group of patients remain symptomatic with recurrent, chronic candidiasis. A study of 805 patients was undertaken to delineate microbiologically candidal species. The study revealed that the recurrence rate for Candida tropicalis was twice the rate for Candida albicans, and that despite continuous medical care and multiple therapies, the recurrent C tropicalis patients remained symptomatic with persistence of the organism. The difficulty encountered with eradication of C tropicalis may have been due to the lack of susceptibility of the cell membrane to the commonly used antifungal agents.
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3895073
|
The relative viability of X-bearing and Y-bearing spermatozoa is influenced by factors in the vagina such as pH. The vaginal environment, in turn, is influenced by its flora. This study examined the relationship of the vaginal flora to the sex of conceptuses. It was found that women who carried Trichomonas vaginalis or Bacteroides sp or who had nonspecific vaginitis at first prenatal visit were significantly more likely to deliver females than women who carried none of these organisms (54 versus 37%, P less than .02).
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3895075
|
The diabetic state is usually considered to worsen as pregnancy progresses. However, the present study is a case report of an insulin-dependent pregnant diabetic needing no insulin during most of her pregnancy. A review of reported cases and possible contributing factors are discussed.
|
3895074
|
Forty-two women were administered ketoconazole, an orally absorbed antifungal agent. The symptoms of vulvar pruritus, burning, pain, and dysuria and the signs of vulvar erythema and fissures and vaginal erythema were associated with Candida albicans. Although ketoconazole relieved symptoms and signs seven days after therapy, a high recurrence rate occurred by 28 days after therapy.
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3895076
|
Nonimmune hydrops fetalis is becoming the predominant form of fetal hydrops due to the declining frequency of Rh isoimmunization. Reported is the preterm delivery of a hydropic twin with umbilical cord and cutaneous hemangiomata. The unusual umbilical angiomatous malformation was associated with marked edema of the cord. This produced an ultrasonographic abnormality detected antenatally as a multicystic mass in close approximation to the fetal abdomen. The hydropic twin responded to aggressive neonatal management. It appears that hemangiomata of the umbilical cord may be causally related to fetal hydrops and may represent another entry in the differential diagnosis of this disorder.
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3895077
|
The health consequences of obesity in adults encompass both metabolic and cardiovascular complications. Pregnancy in obese women also has a particular set of problems. For the obese pregnant woman, these include weight gain less than 5.4 kg, chronic hypertension and superimposed preeclampsia, gestational diabetes, multiple gestation, and the potential for a macrosomic child. The combination of obesity and maternal diabetes does not appear to have an additive effect on the excessive growth of infants of obese mothers. Furthermore, despite inadequate weight gain, hypertension, and multiple gestation, infants of obese mothers are usually born with a greater birth weight than those of nonobese women. In addition, the incidence of intrauterine growth retardation is lower after an obese pregnancy. Neonates born to obese mothers have increased risk for birth asphyxia and birth trauma. Recently infants born to obese women were noted to have transient neonatal fasting asymptomatic hypoglycemia. Hyperinsulinism is not present in the infants of obese mothers; thus, alternate fuel mobilization (free fatty acids, glycerol, ketones) may respond to the hypoglycemic stimulus. Suggestions and rationale for the management of the pregnant obese woman, fetus, and newly born infant are discussed in the text.
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3895079
|
A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions. Forty-one percent of patients had an hCG level above 6500 mIU/mL. The absence of an intrauterine gestational sac at an hCG concentration above this level had a sensitivity of 100%, a specificity of 96%, a positive predictive value of 86%, a negative predictive value of 100%, and was 98% efficient, based on a 19.4% prevalence of ectopic pregnancies among this group.
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3895078
|
The holoprosencephalies are a spectrum of cerebral and facial malformations resulting from incomplete division of the embryonic forebrain. Using ultrasound to search for structural defects in the fetal brain and to measure interorbital distances, the alobar variety can be diagnosed antenatally. A series of seven cases is presented. Criteria for diagnosis and guidelines for obstetric management are presented.
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3895080
|
The presence of an estrogen-regulated protein of Mr 24,000 (24K) was studied in 43 patients diagnosed as having endometrial adenocarcinoma. using an anti-24K monoclonal antibody, a modified immunoperoxidase system (avidinbiotin complex) was used to detect the presence of 24K in formalin-fixed, paraffin-embedded tissue samples. The positivity for 24K was correlated with low tumor histologic grade, few mitotic figures, few nucleoli, and a low degree of nuclear pleomorphism. These data suggest that 24K may be a potential marker of tumor differentiation.
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3895081
|
The detection of an asymptomatic liver hemangioma as an incidental finding in pregnancy is presented. At the present time a significant amount of data and experience in the diagnosis of hepatic hemangioma by ultrasound and bolus-enhanced sequential computed tomography exists. Although the natural history of liver hemangiomas is not understood completely, the course of asymptomatic, small, single lesions appears to be without any significant complication. Presently the routine use of angiography in liver hemangiomas is unnecessary. Guidelines for management of the asymptomatic liver hemangioma have been suggested.
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3895082
|
The differential diagnosis of a posterior fossa fluid collection in the fetus includes an enlarged cisterna magna, Dandy-Walker syndrome, or a posterior fossa cyst, each of which has differing implications for perinatal management. Causes of an enlarged cisterna magna include cerebellar hypoplasia, communicating hydrocephalus, and normal variation. Cerebellar hypoplasia is a frequent finding in the trisomies and therefore a careful search should be made for associated cardiac anomalies, growth retardation, and polyhydramnios.
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3895083
|
Group B streptococci commonly colonize parturient women, yet pregnancy-associated endocarditis due to this organism is rare. Most reports of group B streptococcal endocarditis are from the preantibiotic era and occurred in women with rheumatic mitral valve disease. Reported herein are two cases of fatal group B streptococcal endocarditis involving the aortic valve of women with no preexisting heart disease. One had undergone a second-trimester abortion and the other had a normal pregnancy and uncomplicated vaginal delivery.
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3895084
|
Gonococcal endocarditis is a rare and potentially fatal consequence of disseminated gonococcal infection. Presented is the first known case of culture-proved gonococcal and serratia endocarditis in pregnancy. The case was further complicated by fetal distress at 30 weeks' gestation as a result of maternal decompensation from worsening congestive heart failure secondary to rapid destruction of her aortic valve. Consequently, cardiopulmonary bypass with subsequent aortic valve replacement and implantation of a left ventriculoaortic shunt was initiated immediately after an emergency cesarean section.
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3895085
|
Neonatal genital prolapse is a rare condition. It usually occurs during the first few days of life and presents as a tumor mass protruding from the vulva. Most cases occur in association with meningomyelocele or other anomalies of the central nervous system. Two cases are presented to illustrate the usefulness of conservative management of this unusual problem. A historical review of the literature is presented to acquaint the reader with the variety of treatments that have been used in the past.
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3895086
|
This is the first report of an ovarian carcinoma developing in a patient immunosuppressed by Cyclosporin A. Thirteen months before the diagnosis of malignancy, the patient received a living related donor kidney transplant whose rejection was controlled by Cyclosporin A and prednisone. The tumor was rapidly fatal five weeks from diagnosis. The literature on malignant transformation in the immunosuppressed patient is reviewed with emphasis on a gynecologic perspective.
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3895094
|
A 29-year-old male patient with hairy-cell leukemia was referred for bone marrow transplantation. For tumor mass reduction a treatment with recombinant leucocyte A interferon was started. A complete remission could be achieved in the third month of treatment and no adverse side effects were observed. The patient refused bone marrow transplantation and a relapse was diagnosed 51 days after discontinuation of interferon therapy. Treatment of hairy-cell leukemia with recombinant leukocyte A interferon seems to be a promising approach.
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3895095
|
Five cases with advanced hairy cell leukemia refractory to treatment with splenectomy and chemotherapy as well as one patient presenting with a stage-A response to splenectomy were treated with rhu-IFN-alpha 2-arg. 5 X 10(6) were administered intramuscularly every day. Both patients, with advanced disease resistant to conventional therapy and treated for six or more months with rhu-IFN-alpha 2-arg, achieved complete clinical remissions. Three further cases treated for less than half a year and also with advanced disease achieved partial remission states with marked reduction of circulating hairy cells and with recovery of normal hemopoiesis. Minimal residual disease in the remaining patient during a three-month period of treatment did not respond. Side effects of rhu-IFN-alpha 2 low dose therapy were minimal in 5 cases and comprised a severe leukopenia reversible after dose reduction in one patient.
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3895096
|
Twenty-four patients with acute leukemia and blast crisis of chronic myelocytic leukemia in relapse or refractory to standard chemotherapy were eligible for treatment with mitoxantrone. Mitoxantrone was administered in a dose of 8-13 mg/m2 on five consecutive days. 5 of 20 evaluable patients were induced into complete remission, 1 patient achieved a partial remission. Side effects included moderate to severe bone marrow suppression, moderate mucositis and hair loss. No cardiotoxicity was observed. We believe that mitoxantrone is an active agent in the treatment of acute leukemia and suggest further studies in combination chemotherapy.
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3895097
|
The present study reports on the treatment of 44 patients with AML. 17 patients were male, 27 female. Mean age was 50.1 years. Treatment-regimen consisted of induction-therapy with daunorubicin 45 mg/m2 i.v. d 1-3, cytarabine 100 mg/m2 X 24 h continuous intravenous infusion (c.i.v.i.) d 1-7, 6 thioguanine 100 mg/m2 twice orally d 1-7. There were only two consolidation therapies with daunorubicin and cytarabine and no maintenance therapy. 30 patients (68%) achieved CR, 1 patient (2%) PR, 3 were non-responders (7%). There were 10 (23%) early deaths during or following induction therapy. Median disease-free survival was 6 months, median overall survival 7.5 months. We conclude, that the reported induction therapy is efficient though toxic. To improve long term results, consolidation and intensification therapy should be escalated.
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3895099
|
Twenty-five institutions are participating in the AML-6-trial designed to improve remission incidence and to delay the time of relapse. Therefore, an intensive cyclic therapy is employed early after achievement of remission using either the same drugs of the induction regimen or rotating combinations of alternative drugs, e.g. AMSA, 5-AZA and HD-araC. So far, 266 patients entered the trial. The overall C.R. rate is 71%. 58 patients are randomized to 'maintenance' arm I, 54 to arm II, 79/112 patients are still being studied. Toxicity was in 7% and 3% respectively a reason to interrupt the study during induction or 'maintenance'. Since the intensity of modern protocols for remission induction of AML presents a major problem in elderly patients due to toxicity, and since most studies indicate low remission rates with an increasing death rate in this age group, the AML-7-study was initiated to prospectively compare survival and quality of life of two different therapeutic strategies: immediate intensive remission induction versus supportive care, 'wait and see' policy, and palliative cytoreduction with hydroxyurea and ara C when necessary. During the first 8 months after activating this study, 27 patients entered, 13 were randomized to branch I, and 14 to branch II.
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3895098
|
102 patients with AML (leukemia after preleukemia, 2nd neoplasia included) were treated for remission induction by a modified TAD regimen in Munster; 55 patients (54%) achieved a complete remission (CR). For CR maintenance 40 patients were eligible for randomization according to the study protocol: cyclic chemotherapy (CT) alone vs. chemoimmunotherapy (CIT: plus allogeneic Neuraminidase-treated blasts in high dosage). 5 CR patients, induced identically in Essen, were randomized additionally. Evaluating all patients randomized there is only a marginally beneficial effect of CIT (21 patients) compared to CT (24 patients) concerning median survival (1020+ vs. 612 days) and relapse-free survival (494 vs. 380 days) until now. For patients receiving more than 2 cycles of maintenance therapy, however, CIT prolongs relapse-free survival significantly (930+ vs. 409 days; p = 0,02); that is also true for remission duration. This suggests that only repeated application of blasts may induce an immune response leading to a biologically relevant antileukemic effect.
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3895102
|
Encapsulated filtering blebs associated with elevated intraocular pressure or symptomatic dellen formation, unresponsive to conservative therapy, developed in 24 of 222 eyes following glaucoma filtering surgery over a five-year period, an incidence of 11%. Nine of 13 eyes were treated successfully with primary needling of the bleb. Ten of 11 eyes were successfully treated with primary bleb revision. Four eyes were successfully treated with a combination of needling and surgical revision and one eye required cyclocryotherapy. The overall success rate of needling or bleb revision was 96% after an average follow-up of 20 months. Thus, encapsulation of the filtering bleb, although requiring additional surgery in many cases, carries a favorable long-term prognosis.
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3895100
|
In a phase I/II study the tolerable doses and antileukemic efficacy of the combination AMSA and etoposide (VP 16-213) was assessed in 20 patients with refractory acute myeloid leukemia. The following 5 day treatment course was found tolerable and effective: AMSA 210 mg/m2/die on days 2, 3 and 4, and etoposide on days 1 and 5 as a 1 h infusion of 100 mg/m2 followed by a 23-h continuous infusion of 230 mg/m2. In 5 of 20 patients partial remissions were achieved; 4 of these patients were primarily resistant against two TAD induction cycles. Bone marrow aplasia without a residual blast population was achieved in 7 of the 8 patients with primary TAD resistance. AMSA/etoposide thus seems to express an antileukemic efficacy without cross-resistance against TAD.
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3895101
|
A group of 52 pediatric patients with lacrimal obstruction were considered to be high risk since they had been previously probed (27 patients) or were older (average age 23 months). At the time of probe and irrigation, a small, straight hemostat was placed into the nose to grasp the inferior turbinate and rotate it a full 90 degrees inward. All cases of congenital nasolacrimal duct obstruction (49) resolved following this maneuver. A small muscle hook with the tip directed upward was placed underneath the inferior turbinate to identify three patients with congenital nasolacrimal duct anomaly (absence or atresia of the nasolacrimal duct) who would not have benefitted from further probings and responded to dacryocystorhinostomy. Even though the results of our uncontrolled surgical trial cannot be compared to other treatment methods, the data suggest that even very difficult cases of congenital nasolacrimal duct obstruction will respond to a simple turbinate fracture with a hemostat without the necessity of complicated tubes or stents. A small muscle hook can be used to identify those rare cases of congenital nasolacrimal duct anomaly who may require specialized procedures such as dacryocystorhinostomy or inferior turbinectomy.
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3895104
|
Thirty-six cases of late onset endophthalmitis in patients with filtering blebs are presented. Onset of endophthalmitis ranged from 4 months to 60 years after bleb formation. Possible contributing factors could be identified only in a minority of patients. Aqueous, vitreous or both were cultured in all cases. Eighty-three percent of eyes were culture positive. Streptococci were the most frequent causative organisms, isolated from 57% of culture positive eyes. Twenty-three percent of eyes grew Hemophilus influenzae. Only two cases were caused by staphylococci. In general, the visual outcome was poor, probably primarily due to the virulence of the infecting organisms. Endophthalmitis remains a risk even many years after creation of a filtering bleb. The microbiologic spectrum in this clinical setting is considerably different from that of recent postoperative endophthalmitis. Based on the bacteriology and clinical course of the patients presented, recommendations for management are discussed.
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3895103
|
One case of "early" post-trabeculectomy endophthalmitis and five eyes with "late" endophthalmitis three to nine years after glaucoma filtration surgery are presented. Differentiation of early versus late endophthalmitis is based on the time of onset and pathogenesis. Retrospective analysis of 1100 consecutive trabeculectomies revealed an incidence of less than 0.1% for early and 0.2% for late endophthalmitis. Medical and surgical approaches are discussed. The presumed importance of identifying posterior extension into the vitreous and performing a therapeutic vitrectomy is emphasized.
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3895105
|
Eye hospitals, originally founded to care for the poor, have developed into academic centers and tertiary "hospitals of last resort." Inexorable economic pressures, especially price competition, are likely to close many of them, particularly those which are marginal in quality or management. Survival of the remainder may further depend on their ability to adapt to a rapidly changing environment and to fulfill, better than anyone else, the special mission of basic and clinical research and training. Society must be convinced that some of these complex, highly differentiated, relatively expensive eye hospitals are significant national resources, serve the public welfare, and are worth preserving.
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3895128
|
A new method is introduced which makes possible in vivo measurement of transverse lens diameter (T.L.D.) with ultrasound. The horizontal T.L.D. was measured for 7 nearly emmetropic subjects at accommodation stimulus levels of 0,2,4,6 and 8 dioptres. The unaccommodated T.L.D. was found to be proportional to the axial length. The mean unaccommodated T.L.D. was found to be larger than in vitro measurements reported in the literature.
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3895129
|
The effect of the extent of visual field upon driving performance has recently received a great deal of interest. With such a volume of traffic on the roads today, peripheral vision would seem to be essential for safe driving and yet past literature is inconclusive as to the relationship between the extent of visual field and driving performance. This paper reviews the research work and gives possible reasons for the lack of relationship reported in most of the studies. Until further research work does determine the minimum visual field required for safe driving, the role of the medical practitioner in advising patients when they are considered unsafe to drive is in question. The provision of a period of adaptation after complete loss of vision in a previously normal eye should also be considered, during which time the motorist is temporarily banned from driving.
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3895136
|
Imaging may play a major role in diagnosis when the clinical condition suggests a parasite, it may often be useful in confirming a diagnosis and assessing the results of treatment, and it may provide the first indication of parasitic infection when the symptomatology is vague. This article presents guidelines for reviewing diagnostic images for pediatricians looking for the diagnosis or the differential diagnosis of their patient's ill health when parasitic infection is suspected.
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3895137
|
Primary amebic meningoencephalitis is a disease caused by the free-living amebae of the genera Naegleria or Acanthamoeba. The clinical course may result in death a few days after presentation or it may be insidious, with progressive neurologic deterioration and death after a chronic course. This article describes the organisms involved, the clinical course, pathology, diagnosis, and treatment of the disease.
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3895138
|
Malaria continues to present staggering morbidity and mortality statistics. In this well-detailed article, the authors examine the increased incidence of malaria in many areas, describe the malarial parasites, discuss the clinical course, pathogenesis, diagnosis, and treatment, and address the issues of transfusion malaria, congenital malaria, immunity, chemoprophylaxis, and vaccine.
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3895140
|
The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment.
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3895141
|
This article discusses strongyloidiasis, hookworm infection, trichostrongyliasis, ascariasis, trichuriasis (whipworm infection), and enterobiasis (pinworm infection). For each infection, the author describes the organism, the epidemiology and geographic distribution, symptomatology and pathogenesis, and diagnosis and treatment.
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3895139
|
Toxoplasmosis infection occurs worldwide wherever cats are present. However, toxoplasmosis, the disease, is relatively rare. In this article, the author examines the cycle of transmission, addresses the problem of congenital transmission, discusses the symptomatology and pathogenesis, diagnosis and treatment, and prevention and control of the disease.
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3895142
|
Hyperglycemia in fetal sheep has been shown to increase the fetal metabolic rate. Fetal venous glucose infusion was performed in eight late gestation, chronically catheterized fetal lambs to assess any changes in substrate uptake by the ovine uterus and conceptus. Fetal glucose infusion (11.9 +/- 0.6 mg glucose X kg-1 X min-1) caused a stable increase in fetal plasma glucose concentration approximately 3-fold above baseline. The fetal glucose entry rate increased from 6.6 +/- 0.7 to 9.3 +/- 0.6 mg X kg-1 X min-1 by day 3 of infusion (p less than 0.01) despite a net umbilical glucose excretion during the period of fetal hyperglycemia. Due to a concomitant increase in fetal oxygen consumption, no change in fetal glucose/O2 quotient was observed. A significant relationship was noted (p less than 0.02) between the fetal glucose entry rate and the rate of fetal oxygen consumption. Fetal glucose infusion caused a decrease in uterine glucose uptake as well. No changes were observed in calculated net placental glucose uptake although the relative fetal contribution increased from net placental exit to fetus to a placental uptake amounting to 20.8 +/- 5.8% of the total placental glucose uptake (p less than 0.01). Although no changes in fetal lactate concentration occurred, both maternal and fetal lactate entry rates increased, the magnitude of increase being significantly related to fetal glucose concentration. Both maternal and fetal insulin concentrations rose during the period of fetal hyperglycemia and were related to the respective increases of maternal or fetal substrate uptakes but not to fetal oxygen consumption.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895143
|
Primary chondrocyte culture was carried out after enzymatic digestion of femoral and tibial epiphyseal cartilage of human fetuses, collected with informed parental consent within 12 h postmortem. Chondrocytes were cultured in HAM F-12 medium with penicillin and 15% serum. Three types of serum were used: human placental cord serum (HPS), fetal calf serum, and human male adult serum. Chondrocytes cultured with HPS grew as monolayers, formed abundant colony groups with a highly metachromatic pericellular matrix, and floating round cells were observed in the culture medium. By the 10th day of culture the great majority of proteoglycans present in the culture medium were found as aggregates. Chondrocytes cultured with fetal calf serum or human male adult serum grew as monolayers, were polygonal in shape, and the pericellular matrix was far less developed than in HPS cultures. By the confluent phase of growth, only approximately a third of the proteoglycans present in the culture medium were found as aggregates. Chondrocytes cultured with HPS proliferated significantly more rapidly than those cultured with fetal calf serum or human male adult serum. The results suggest that certain, as yet unidentified, factors are present in sufficient amount in HPS to allow chondrocytes in culture to retain phenotypic morphological and biochemical characteristics. HPS also facilitates growth of human fetal epiphyseal chondrocytes in culture. Primary human fetal epiphyseal chondrocyte culture could be a suitable experimental tool for the in vitro study of biochemical characteristics of cartilage and factors involved in fetal cartilage metabolism.
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3895150
|
With a randomized clinical trial, the possibility was assessed that a tracheal instillation of pulmonary surfactant prior to the first breath might prevent the development of some of the signs of neonatal respiratory distress syndrome. Of the 72 infants in the trial, all born at a gestational age of less than 30 weeks, 39 received 3 or 4 mL of surfactant, prepared from the lipids extracted from calf lung lavage. The treatment resulted in a significantly improved gas exchange during the first 72 hours of life. On the average, the arterial/alveolar PO2 ratio was 0.15 higher for the treated infants, and only about half as much extra oxygen had to be supplied. The respiratory support (peak inspiratory pressure X frequency) could be lowered significantly. Pulmonary interstitial emphysema occurred in 13 of the 33 control infants, but in only three of the 39 treated infants. Six of the control infants died in the neonatal period, but only one treated infant died. It is concluded that surfactant supplementation prior to the first breath is feasible and is of value as protection against the respiratory distress syndrome and the negative effects of hypoxia and ventilatory support.
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3895154
|
Several in vivo methods have been assessed for their capacity to predict sensitivity for anticancer agents in humans. Standard strategies have been developed for screening purposes. Adjustments of these strategies are frequently suggested in reports in which the correlation between assay results and clinical therapeutic efficacy is analysed. Low predictivity and high costs of these assays are important reasons for changing the screening strategy. In vivo methods which predict the clinical response in the individual patient, are under investigation. Only the results of the subrenal capsule assay (in normal mice) have been correlated with the clinical response in a larger study. The criticism of the method and the low predictivity for sensitivity in a prospective study provide no reason for optimism. Methods which study changes predicting the clinical response in patients are still in a developmental phase.
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3895158
|
The DNA sequence of a 1,076 base pair BglI-BamHI fragment containing the entire rnc gene for ribonuclease III (RNase III) was determined. An open reading frame of 681 base pairs was found in this region which encodes a protein of 227 amino acid residues (calculated molecular weight = 25,218). When this open reading frame was cloned into a high expression vector, pIN-III, a protein of apparent molecular weight of 26,000 was produced upon induction of the cloned gene. This product accounted for up to 5% of the total cellular protein, and comigrated with purified RNase III. RNase III enzyme activity was induced in parallel with the production of the 26,000 molecular weight protein. A putative promoter was found 170 base pairs upstream from the initiation codon. In the long leader region a very stable stem-bulge-stem structure was found which closely resembles typical RNase III cleavage sites. This structure may be cleaved by RNase III to auto-regulate the expression of the rnc gene.
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3895159
|
The screening of a cDNA library prepared from mRNA of Sendai virus induced Namalwa (human Burkitt's lymphoma) cells, using a human IFN-alpha 2 DNA probe under conditions of low stringency, identified two weakly hybridizing clones containing sequences related to, but discernably different from those of the IFN-alpha class. Sequence and hybridization analysis of these cDNAs as well as expression in E. coli provided evidence that they encode proteins which have the characteristics of IFN type I but which are sufficiently diverged in sequence from both IFN-alpha s and IFN-beta to suggest that they are representatives of a new and distinct class of interferons named interferon-omega. Hybridization of these sequences to genomic DNA reveals that this class contains at least four members.
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3895161
|
We characterize two dominant copy number mutants of a derivative of plasmid pMB1. One of the two mutations maps in the -35 region of the primer promoter and results in increased promoter activity. The analysis of the secondary structure in the proximity of the mutant sequence suggests a possible mechanism which could be the basis of the promoter-up phenotype. By comparing the properties of the mutant and the wild type plasmid in an in vitro system, we confirm that the primer and not its coding sequence is the target of RNA I inhibition. The second mutation affects the sequence of the primer so that it is less sensitive to inhibition by RNA I. We propose that this mutation stabilizes a secondary structure necessary for primer formation.
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3895160
|
Mutant AraC proteins were selected for their ability to induce but not to repress, or their ability to repress but not to induce the araBAD operon. One such unusual mutant is able to bind to the araI site with an affinity only two to three-fold weaker than the wild type AraC protein, but the mutant protein was shown, both in crude extracts and when purified, to contact only two of the three major groove regions of the DNA that are contacted by the wild type protein.
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3895171
|
Bitolterol, (3-4 diester colterol) is a new beta 2-adrenergic agonist. Since it in itself is biologically inactive, bitolterol is considered a pro-drug. When administered it is activated within the lung by esterase hydrolysis to the active compound colterol catecholamine N-t-butyl-arterenol). In preclinical and clinical studies to date, bitolterol has proved to be an effective bronchodilator for adult and pediatric patients with chronic stable asthma and for some with chronic obstructive pulmonary disease. Bitolterol has been compared with other beta 2 agents, including isoproterenol, metaproterenol and albuterol. There is no evidence for cardiotoxicity when bitolterol is used in combination with theophylline in human studies. It is effective for control of exercise-induced asthma.
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3895176
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Infection with Coxiella burnetti (Q fever) was diagnosed in 18 children younger than 3 years of age in The Netherlands during a 16-month period. The diagnosis was confirmed serologically by means of a complement-fixation test and immunofluorescence for IgM determination. A summary of the clinical, hematologic, serologic and epidemiologic features is given. Four children had relapsing episodes of fever during several months. The problem of childhood infection with C. burnetii, particularly in relation to the possibility of intrauterine infection or infection during birth and in the neonatal period, is discussed. In at least one child of this series, an infection by means of breast feeding was considered likely. Q fever is possibly underdiagnosed in children; it should be considered in children with fever of unknown origin.
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3895185
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E-Urocanic acid is a metabolite of histidine which accumulates in the skin and is excreted in sweat. It has been of interest to photobiologists and photodermatologists because of its intense absorption band at approximately 270 nm, a feature suggestive of a role as a natural photoprotecting agent for DNA. Early work concentrated on the E----Z isomerization resulting from UV excitation. Recent studies have revealed additional, potentially significant, photobiological properties, i.e. photochemical binding to DNA and an apparent involvement of the Z isomer in the phenomenon of photoimmunosuppression.
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3895186
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During 3 consecutive summers, patients from a total group of 40 persons with polymorphous light eruptions (PMLE) participated in a randomized, double-blind, cross-over study comparing the sun-protective effect of placebo capsules, a chloroquine derivative (200 mg daily of oxychloroquine), and a carotenoid preparation (betacarotene and canthaxanthine in a daily total dose of 100 mg). A total of 35 carotenoid, 38 chloroquine, and 27 placebo treatment periods were registered. Full freedom from sun sensitivity was obtained during 6 carotenoid and 8 chloroquine periods, but never with placebo treatment. In addition, a partial sun tolerance was induced in 17 carotenoid periods, 15 chloroquine periods, and in 14 placebo treatment periods.
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3895187
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Attempted suicide, a common clinical problem with complex origins, makes heavy demands on psychiatric services. Familiarity with established principles of assessment and management can facilitate decision-making, increase treatment engagement, and reduce the risk of subsequent attempts.
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3895188
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People who attempt suicide and those who complete suicide come from separate but somewhat overlapping populations. Because suicide affects a number of highly functioning individuals, it is important to review the knowledge on completed suicide. The majority of people who commit suicide are psychiatrically ill, especially with unipolar and bipolar depression and alcoholism. Other sociodemographic and symptomatic correlates, as well as familial clustering, are discussed.
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3895189
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This overview of suicidal behavior of children and adolescents covers aspects of epidemiology and risk factors. The risk factors can be classified as early developmental experiences, expression of affects, and current environmental situations. These risk factors include depression, aggression, parental suicidal behavior, family losses, and family violence and depression.
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3895175
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Fifty children with bacterial meningitis were prospectively evaluated in a randomized comparative trial of twice daily ceftriaxone with conventional ampicillin and chloramphenicol therapy. The groups were comparable in age, sex, days of illness before admission, severity of illness at admission, etiology and admission cerebrospinal fluid (CSF) parameters and bacterial colony counts. The pathogens were Haemophilus influenzae type b (34 beta-lactamase-negative, 8 beta-lactamase-positive); Streptococcus pneumoniae (4); Neisseria meningitidis (3); and Streptococcus agalactiae (1). Initial CSF colony counts ranged from 2.5 X 10(2) to 1 X 10(10) colony-forming units/ml. In 44 children a lumbar puncture was repeated 10.5 to 18 hours after starting treatment; 16 of 24 (67%) ceftriaxone patients and 12 of 20 (60%) conventional therapy patients had sterile cultures. The reduction in the CSF bacterial colony counts (6.3 log10 colony-forming units/ml) was similar in both groups. Ceftriaxone CSF levels ranged from 1.0 to 8.0 micrograms/ml, representing a mean CSF penetration of 11.3% (range, 3.0 to 24.5%) of the simultaneous serum concentration. The median ceftriaxone bactericidal titer in CSF was 1:1024 compared with 1:4 achieved with conventional therapy. There were no significant differences in clinical responses or in frequency of complications, except for diarrhea which occurred in 59% of the ceftriaxone group and in 22% of the other (P less than 0.01). Despite one H. influenzae type b relapse occurring in the ceftriaxone group, ceftriaxone appears to be safe and as effective as conventional therapy for bacterial meningitis in children older than 2 months of age.
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