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3895190
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This article considers some of the psychophysiologic mechanisms that underlie the driven, apparently self-destructive behavior of addicted persons. The authors review the available literature on the association between suicidal behavior and substance abuse. These issues are discussed in the context of the epidemiology and phenomenology of self-destructive behavior.
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3895191
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Current perspectives on Münchausen's syndrome and other factitious illnesses are presented in this article. Self-destructive behavior manifested by the artificial production of illness remains a puzzling but fascinating clinical entity. A distinction between the clinical features of those cases that are more treatable suggests an optimistic rationale for approaching these difficult patients.
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3895177
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Seventy-five children who acquired positive throat cultures for Group A streptococci among 250 cultured weekly were studied during the school years 1972-1973 and 1973-1974 in order to investigate streptococcal M protein antibodies. Eleven (14.7%) of the children had strain-specific serum M protein antibodies at the time a positive throat culture was first detected or 6 weeks previously. Eight of 64 (12.5%) children acquired strain specific serum M protein antibodies within 6 weeks and another 6 of 46 (13%) did so within 1 year of infection. The presence of strain-specific serum M protein antibodies did not appear to be protective. One-third of the 75 children who acquired positive throat cultures had a significant rise in anti-streptolysin O or anti-hyaluronidase antibody titers. Among those who acquired Group A streptococci, 25 children had positive cultures on 7 or more culture dates.
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3895192
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This article reviews the literature and presents data from the Psychiatric Consultation Service of the Medical University of South Carolina on self-destructive behavior in hospitalized medical and surgical patients. Fatal suicide attempts are rare and usually occur in patients with severe, painful chronic illnesses, psychosis, or dementia. Less overt forms of self-destructive behavior include refusal of medical treatment and uncooperative behavior.
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3895193
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It appears certain that the causes of self-destructive dermatoses are many and complex. The disorder spans diagnostic categories and varies from unconscious picking at the skin to severe self-destructive actions. Although not limited to any one diagnosis, skin disorders appear to be more prevalent in depression. This association may involve activation of the hypothalamic-pituitary-adrenal axis commonly found in depression. Two specific types of commonly occurring dermatoses-neurotic excoriations and dermatitis artefacta-are reviewed in this article. The major distinction of these disorders centers on whether the patient can admit to self-mutilation. Because of the difficulties in dermatitis artefacta with insight and body-image, it has been compared with anorexia nervosa. Often, dermatitis artefacta coexists with anorexia nervosa. In both disorders, neurotic excoriations and dermatitis artefacta, the personality style tends to be introverted with emotional immaturity. These patients have difficulty when they are under stress; the problem is compounded because of poor communication skills. Pharmacotherapy is of limited usefulness, and psychotherapy is often times hindered by strong resistance to exploring long-standing emotional issues. Once an alliance is established with the therapist, however, these issues may be examined. Prognosis is variable but does seem to directly correlate with the duration of the illness. Young individuals may experience alleviation of symptoms after one session of psychotherapy, whereas older patients may never have resolution. Dermatologic abuse involving psychosis has many presentations; one of the most common involves infestation. Organic causes must always be excluded as part of the differential diagnosis. In schizophrenia, this presentation has one of the highest incidences of suicide.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895194
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Pathologic gambling is a prevalent disorder with important public health consequences. This article describes the syndrome, reviews several theories as to etiology, and offers suggestions for future research.
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3895195
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This article reviews the types of sexual anomaly that are especially likely to result in the physical harm or even death of the affected individual. Detailed descriptions based on the literature and the author's clinical material are given. Despite widespread awareness of masochistic behavior, our knowledge of its causation and the most effective method of treatment are still incomplete.
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3895196
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A chronic, and at times, progressive neurologic syndrome associated with boxing has been recognized for some time by boxing fans and people involved with the sport. Since Martland's first description of the syndrome in 1929, there has been only one randomly selected study of ex-boxers, that of Roberts, which showed a 17 per cent prevalence of this syndrome among boxers who fought between 1929 and 1955. This syndrome can be progressive but often is not. Furthermore, the extent of occupational exposure is probably a significant risk factor. Because of this, it would be expected that the prevalance of the syndrome in the modern boxer, as well as the amateur, would be significantly less than during the first half of the century, and, indeed, several studies appear to support this. Recent studies provide evidence that brain damage does exist in modern boxers and suggests that "subclinical" brain damage is likely to be more prevalent than obvious clinical dysfunction. There is clearly a discrepancy between subclinical evidence of neurologic involvement (for example, an abnormal CT scan) and signs of clinical neurologic dysfunction (for example, clinical exam and neuropsychological testing). The latter tend to show less frequent and consistent evidence of brain damage in boxers than does the CT scan. Although it is tempting to assume that an abnormal CT scan presages the development of neurologic dysfunction, it is not clear that this is the case. The prevalence of the syndrome, risk for progression to functional deficit, warning signs, and the natural history cannot be defined at this time. The only way to better define these parameters would be a controlled prospective study, which has yet to be undertaken.
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3895197
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This article addresses some of the therapeutic strategies that the author has employed over the past number of years in treating a large number of patients usually referred to in the literature as having borderline or narcissistic personality disorders. The author refers to these patients as characterologically difficult. The focus of the treatment strategies is on the more fragile of these patients.
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3895198
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This article critically reviews the evidence as to whether or not those who choose medicine for a career have an increased risk of suicide. Evidence is examined in relation to medical students, physicians, physicians' wives, women physicians, psychiatric residents, and psychiatrists.
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3895199
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One of the most perplexing and dangerous aspects of borderline personality disorder is the wide array of suicidal and parasuicidal behaviors. Close phenomenologic evaluation of these behaviors reveals that they can be differentiated into various subcategories. Approaching these behaviors with a biologic perspective may prove helpful in elucidating the underlying etiologies and therapeutic approaches.
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3895203
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Macrophages--alone or interacting with other host defense elements--can modify the tumor growth, which usually means a process ending with tumor-cell killing, but in some instances may promote tumor progression. The knowledge on the actual capacity of host extra- and/or intratumoral macrophages to be activated by different kinds of biological modifiers or other effector cells, is necessary in order to design effective immun-manipulation in cancer patients. Progression of malignant tumors can be considered as the outcome of innumerable interactions between tumor cells and host cells with a clear indication on the failure of host defense. Host defense against tumors represents a complex series of interrelated specific and non-specific reactions of different cell types including macrophages. There is little doubt that macrophages--at least in vitro--can effectively destroy tumor cells by cytolytic mechanism, although in few instances their supportive effect on tumor growth is also documented. All of these events require the activation of macrophages.
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3895204
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Even in the hands of a skilled clinician, the clinical diagnosis of deep venous thrombosis is often inaccurate. With the proper use of noninvasive tests as a screening procedure to determine which patients should have phlebography, diagnostic accuracy can be markedly improved.
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3895205
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Despite advances in the management of liver trauma during the past 40 years, haemorrhage has remained the commonest cause of death. This article outlines the diversity of opinion between the desire to determine the extent of damage and resect devitalised tissue with its attendant risk of exacerbating haemorrhage, and the alternative of a more conservative approach.
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3895206
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This study was designed to assess whether transcendental meditation (TM) could influence various endocrine responses in 10 experienced male meditators. Nine matched subjects, uninformed of the TM procedure, acted as controls. Meditators successfully practised their technique for 40 min in the morning while controls relaxed for this period. No significant differences emerged between these 2 groups with respect to carbohydrate metabolism (plasma glucose, insulin and pancreatic glucagon concentrations), pituitary hormones (growth hormone and prolactin) or the 'stress' hormones, cortisol and total catecholamines-although meditators tended to have higher mean catecholamine levels. Plasma free fatty acids were significantly elevated in meditators 40 min after completing the period of TM. No clear evidence was thus obtained that any of the stress, or stress-related, hormones were suppressed during or after meditation in the particular setting examined.
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3895208
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A patient with an intrarenal arteriovenous malformation is described. Ultrasound suggested this to be a renal cyst but auscultation revealed a loud bruit and, on the basis of this, arteriography rather than cyst puncture was carried out.
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3895210
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One hundred and thirteen patients were entered into a randomized, prospective double-blind, placebo controlled trial to assess the use of co-trimoxazole in reducing wound infections after dog bites. Although there was a reduction in the wound infection rate from 13.8% in the placebo group to 5.5% in the treatment group this did not reach statistical significance (P = 0.135). If hand wounds are considered separately, no infections occurred in the treatment group and a benefit seems likely.
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3895211
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Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity.
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3895212
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An experiment was conducted to examine the effect of pathogenic Escherichia coli inoculated into the yolk sac of day-old turkeys. Escherichia coli was isolated from the yolk sac of stunted poults and inoculated directly into the yolk sac of day-old birds. Poults were administered either .1 ml of uninoculated sterile Todd-Hewitt broth or .1 ml of a 10(-3) or 10(-2) dilution of a 24-hr E. coli culture containing 3.4 X 10(8) viable bacteria/ml. In addition, poults were fed either 28 or 22% protein diets from 0 to 21 days of age to form a 3 X 2 factorial arrangement. Body weight gain and feed consumption were measured weekly, and dry matter and protein retention and nitrogen-corrected metabolizable energy were measured from 7 to 10 and 17 to 20 days postinoculation. Intestinal mucosal dipeptidase and maltase activities were determined at 21 days of age. Average mortality by 7 days of age was increased from 1 to 36% from the E. coli inoculation of the yolk sac. Escherichia coli significantly depressed body weight gain and feed consumption 27 and 30, 13 and 16, and 6 and 8%, respectively, during the first, second, and third weeks of the experiment but failed to affect feed efficiency. Feeding a 28% protein diet alleviated the depression in feed consumption and body weight gain to some extent compared with a substantial depression at 22% protein. Nitrogen content and gross energy of the excreta were increased by both dilutions of E. coli for the 7 to 10-day period; this was indicative of a malabsorption of nutrients.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895221
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Inhibition of DNA replication by the antitumor drug cis-diamminedichloroplatinum (II) (cis-DDP) has been proposed to be responsible for its cytotoxicity. Treatment of primed phage M13 mp8 viral DNA templates with the drug followed by second-strand synthesis using large fragment DNA polymerase I reveals that cis-DDP forms an adduct with DNA that inhibits DNA synthesis in vitro. This inhibition occurs at all (dG)n (n greater than or equal to 2) sequences in the template strand, confirming that these regions are the major cis-DDP binding sites on DNA. trans-Diamminedichloroplatinum (II), which is inactive as a drug, also forms adducts that inhibit DNA synthesis. Although considerably lower specificity is observed with the trans isomer, there appears to be a preference for d(GpNpG) sequences, where N is any intervening nucleotide. The monofunctional adduct formed between chlorodiethylenetriamineplatinum(II) chloride and DNA does not inhibit DNA synthesis in this system.
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3895217
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Prenatal real-time ultrasonographic diagnosis of microphthalmia is presented. Diagnosis was made at 18 weeks' gestation in a fetus of a patient with a previous infant affected with the syndrome of cryptophthalmia with absence of septum nasi and ambiguous genitalia (Fraser syndrome). Recognition of microphthalmia as a part of Fraser syndrome and the easy visualization of fetal facial bones and orbits in the second trimester made the diagnosis possible.
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3895222
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Transcriptional activity of plasmids carrying wild-type and mutant trp operons was visualized in cell lysates of Salmonella typhimurium. Plasmid and transcription-unit sizes varied with the size of the cloned operon. Following 3-(3-indolyl)acrylic acid derepression, all operons of a particular type exhibited the same high level of transcriptional activity. An estimated 11-14 transcripts must be initiated each minute to maintain the 190-base-pair spacing of RNA polymerases observed on the promoter-proximal half of the wild-type trp operon. A decline in RNA polymerase density was observed on promoter-distal portions of cloned trp operons, which may be attributable to premature transcription termination accompanying translation inhibition due to indolylacrylic acid's interference with normal tryptophanyl-tRNA synthetase activity.
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3895220
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Antigen expression by villous and extravillous human trophoblast populations at discrete anatomical sites has been reviewed. The various different antigenic phenotypes have been highlighted using a panel of monoclonal antibodies reactive with characteristic trophoblast membrane antigens, a trophoblast-leucocyte common antigen, class I MHC antigens, epithelial cell cytokeratin and epithelial membrane markers. This approach has allowed three separate fetal trophoblast populations to be identified within term amniochorionic membranes, and also has facilitated further definition of trophoblast populations in maternal uterine tissues. Furthermore, antigenic alterations have been noted in the maternal uterine gland epithelium in pregnancy leading to the expression of a trophoblastic phenotype, thereby suggesting a mechanism of extrinsic regulation of gene expression in these tissues. The possible involvement in the immunoregulatory control of maternal responses in pregnancy of MHC-linked gene products expressed by trophoblast has been discussed.
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3895224
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Saccharomyces cerevisiae contains two RAS genes, RAS1 and RAS2. An insertion mutation in RAS2 (ras2::LEU2) does not affect growth on glucose based media but it does prevent growth on media with pyruvate or other noncarbohydrate carbon sources. This defect is pH sensitive and is most severe at pH 7 and above. The ras2::LEU2 mutation also causes markedly higher levels of glycogen in the derepressed phase of growth after glucose exhaustion. Selection for restoration of growth on pyruvate yields unlinked suppressor mutations. Some of the suppressors also reduce glycogen as well as trehalose (the other reserve carbohydrate in yeast) to levels much lower than those of wild-type strains. These suppressor mutations do not suppress the lethality of ras1 ras2 double mutants. The results indirectly accord with yeast RAS2 governing a G protein activity of adenylate cyclase.
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3895218
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Five cases of intestinal atresia were diagnosed using real-time ultrasonography following clinical evidence of polyhydramnios. No correlation was noted between ultrasound findings and the severity of the lesions. Two of the five babies died at 35 and 77 days respectively. Prematurity and presence of other abnormalities were factors in the deaths.
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3895223
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We have cloned and sequenced the cDNA made to the region of RNA encoding the structural proteins of three complementation group C mutants of Sindbis virus, ts2, ts5, and ts13, and of their revertants. These mutants possess defects in the posttranslational processing of their structural proteins at the nonpermissive temperature. Comparison of the deduced amino acid sequences of the mutants with those of the revertants and with the parental HR strain of virus showed all three mutants to have single amino acid substitutions in the highly conserved COOH-terminal half of the capsid protein that give rise to temperature sensitivity. ts2 and ts5 were found to have the same lesion and thus represent independent isolations of the same mutant, whereas ts13 possessed a different change. Reversion to temperature insensitivity in all three mutants occurred by reversion of the mutated nucleotide to the parental nucleotide, restoring the original amino acid. It has been previously postulated that the capsid protein possesses an autoproteolytic activity that cleaves the capsid protein from the nascent polyprotein during translation. Comparison of the amino acid sequence of the capsid protein with that of serine proteases leads us to hypothesize that histidine-141, aspartate-147, and serine-215 of the Sindbis capsid protein form the catalytic triad of a serine protease. This hypothesis is supported by the finding that all three temperature-sensitive lesions mapped occur near these residues: ts2 and ts5 change proline-218 to serine and in ts13 lysine-138 has been replaced by isoleucine.
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3895226
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The aspartate receptor, an integral membrane protein in the bacterial chemosensory system, has been solubilized in functional form by a combination of detergent, phospholipid, and glycerol. The conformation of the solubilized receptor is the same as that of the protein in vivo, as indicated by aspartate binding, rates of methyl esterification, and quantitative correlation of stimulus with this covalent modification. Studying the functional solubilized receptor in a homogeneous solution avoids many difficulties associated with an in vivo or a vesicle-reconstituted receptor. The technique of adding lipids, detergent, and glycerol to solubilize the protein in active form appears to be generally applicable.
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3895219
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Six cases of cystic hygromas detected during second trimester ultrasound examination are reported: 4 fetuses (67 per cent) had a 45, X karyotype, 1 fetus had trisomy 18, 1 fetus had a normal karyotype (46,XX) and at autopsy multiple anomalies were observed. In the latter case the family history suggested an autosomal recessive pattern of inheritance. In order to reach a definite diagnosis and give proper genetic counselling when a fetus is found to have cystic hygroma, a fetal karyotype as well as a family and reproductive history should be obtained.
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3895225
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We studied the molecular composition of the complement C5b-9 complex required for optimal killing of Escherichia coli strain J5. J5 cells were incubated in 3.3%, 6.6%, or 10.0% C8-deficient serum previously absorbed to remove specific antibody and lysozyme. This resulted in the stable deposition after washing of 310, 560, and 890 C5b67 molecules per colony-forming unit, respectively, as determined by binding of 125I-labeled C7. Organisms were then incubated with excess C8 and various amounts of 131I-labeled C9. Plots of the logarithm (base 10) of E. coli J5 cells killed (log kill) vs. C9 input were sigmoidal, confirming the multihit nature of the lethal process. When C9 was supplied in excess, 3300, 5700, and 9600 molecules of C9 were bound per organism for cells bearing 310, 560, and 890 C5b-8 complexes, respectively, leading to C9-to-C7 ratios of 11.0:1, 10.8:1, and 11.4:1 and to log kill values of 1.3, 2.1, and 3.9. However, at low inputs of C9 that lead to C9-to-C7 ratios of less than 3.3:1, no killing occurred, and this was independent of the number of C5b-9 complexes bound. Formation of multimeric C9 at C9-to-C7 ratios permissive for killing was confirmed by electron microscopy and by binding of 125I-labeled antibody with specificity for multimeric but not monomeric C9. These experiments are the first to demonstrate a biological function for C9 polymerization and suggest that multimeric C9 is necessary for optimal killing of E. coli J5 cells by C5b-9.
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3895227
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Most mitochondrial proteins are encoded in the nucleus and translated in the cytoplasm as larger precursors containing NH2-terminal "leader" peptides, which are strikingly basic in overall amino acid composition. Recent experiments indicate that these leader peptides are both necessary and sufficient to direct post-translational recognition and import of precursors by mitochondria. In this report, we demonstrate a critical role for one or more of the basic arginine residues in the leader peptide of the subunit precursor for the human mitochondrial matrix enzyme, ornithine transcarbamoylase (ornithine carbamoyltransferase, carbamoylphosphate: L-ornithine carbamoyltransferase, EC 2.1.3.3). The distal three of four basic residues, all arginines, in the leader peptide of ornithine transcarbamoylase were replaced at once with charge-neutral glycine residues. The altered ornithine transcarbamoylase precursor failed to be taken up by intact mitochondria in vitro. Moreover, it also failed to be proteolytically cleaved upon incubation with a mitochondrial matrix fraction containing the Zn2+-dependent protease, which normally cleaves the leader peptide.
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3895228
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RNA polymerase initiating at Escherichia coli ribosomal RNA promoter-leader regions can efficiently read through factor rho-dependent termination signals. Dissection of the promoter-leader region reveals that the ability to read through termination signals is conferred independently by both promoter and leader regions. Events in the leader also affect the transcription rate of structural genes downstream of the leader. When cells are grown in rich medium, the rrnC leader reduces transcription by a factor of approximately 4 when downstream of the rrnC promoters and by a factor of 2 when downstream of the lac promoter.
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3895229
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Second-order spectral analysis is used to detect rigorously and to characterize the principal periodicities in the positions of conserved sequences common to tRNAs and rRNAs. It is shown that the shared periodicity having the largest spectral amplitude is 9, followed by 8 and 10, thus forming a closed triad of significant multiplets centered at 9 bases. This conclusion is proposed to reflect a closed triadic set of fundamental tandem repeat lengths in a class of ancestral macromolecules possessing a restricted sequence symmetry. The terms "remanent" and "archeomodular" are used to describe a relic modular format, traces of which are shown here to persist despite the changes that have occurred in the primary structures of ribonucleic acids during the course of their evolution.
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3895230
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By analogy with receptor-mediated endocytosis, clathrin-coated membrane segments at locations other than at the plasma membrane have been implicated in intracellular membrane transport/sorting. The crucial role of the Golgi apparatus in these processes prompted us to study the distribution at this level of clathrin-immunoreactive sites in various polypeptide hormone-secreting cells. With a polyclonal antibody recognizing the polymerized form of clathrin (structural coats or cages), we found that the Golgi area had the highest degree of specific labeling of various cytoplasmic regions, including the subplasmalemmal web. Moreover, the Golgi labeling was not homogeneously distributed, most of the immunoreactive sites being associated with membrane segments at the trans pole. The labeled membranes comprised regions of trans cisternae with and without condensing secretory material, newly formed (maturing) secretory granules freshly released from trans cisternae, and typical coated vesicles. The cis Golgi cisternae, as well as the cytoplasmic region containing transfer (shuttle) vesicles and transitional cisternae of the rough endoplasmic reticulum, were only weakly labeled. Clathrin concentration, degree of assembly of triskelions into coats, duration of clathrin association with membranes, or presence of a coat protein different from clathrin could account for the low immunoreactivity observed at the cis pole as compared to the trans pole.
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3895231
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The major nontubulin proteins in purified brain microtubules are high molecular weight species traditionally classified into two groups known as microtubule-associated proteins 1 and 2 (MAP 1 and MAP 2). In an earlier study, we found that MAP 1 consisted of a complex of polypeptides and we characterized the highest molecular weight species--MAP 1A--with the use of a monoclonal antibody. In the current report, we describe four monoclonal antibodies raised against electrophoretically purified MAP 1B. All of the antibodies reacted exclusively with this protein. Together with peptide mapping, these results indicated that MAP 1B was structurally distinct from the other MAPs. Another distinctive property of MAP 1B was that most of it remained soluble during microtubule polymerization, resulting in an extreme underestimate of its abundance in the brain. Immunofluorescence microscopy of rat brain sections and cultured rat brain cells indicated that compared to MAP 1A and MAP 2, MAP 1B was particularly prominent in axonal as well as dendritic processes. Together, these data indicate that MAP 1B is a major, previously undescribed component of the neuronal cytoskeleton.
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3895232
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Lymphocyte-mediated lysis of cells of the Raji, Daudi, Jijoye, and Bjab lines was elevated when fresh human serum was added to the assay. A higher proportion of effector-target conjugates was observed in the presence of human serum. In similar experiments lysis of 1301, Rael, and P3HR-1 cells was unaltered. All cell lines activated the alternative pathway of complement but they varied in the expression of receptors for complement component 3 (C3) and in the ability to fix the C3 cleavage products on their membrane. The enhancement of lysis in the presence of human serum occurred only with those cells that bound C3. This characteristic was correlated to the expression of C3 receptors. Analysis of the nature of the deposited C3 was performed with Raji cells. Raji cells exposed to human serum bound C3b as indicated by the immunoadherence test. The C3b was further processed to C3bi, because the immunoadherence declined with time and conjugate formation increased with Daudi cells, which carry the C3 receptors CR2 and CR3. This suggests that in the lytic assay lymphocytes with C3bi receptors are recruited in the presence of human serum. We assume that the bridge of C3 molecules between targets and effectors increases the avidity of their interaction.
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3895253
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Sexual behavior and sexual preference measurements were obtained from ovariectomized female rats treated with estrogen, estrogen and progesterone, or estrogen followed by third ventricular infusion of luteinizing hormone releasing hormone (LHRH) or saline. The lordosis-to-mount ratio and the occurrence of receptive and proceptive behaviors were scored to assess total sexual receptivity. Sexual preference was determined by placing the test female in the center of a four-winged choice box apparatus in which each of the outer wings contained one of the following incentive animals: a sexually active male (SM), a castrate male (CM), a female in proestrus (PF), and an ovariectomized female (OF). Time spent in close proximity to the incentive animals was measured as an index of sexual preference. Estrogen and progesterone treatment resulted in high sexual receptivity and a marked preference for SM. Estrogen alone or in combination with saline also produced a significant preference for SM. Animals treated with estrogen and LHRH exhibited high levels of sexual receptivity compared to estrogen saline treated controls, but no enhancement of preference for SM was detected. The results indicate that fractionation of sexual receptivity and sexual motivation occurs following estrogen-LHRH treatment.
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3895254
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In a placebo-controlled double blind study, single oral doses of lofepramine (140 mg and 210 mg) and amitriptyline (100 mg and 150 mg) were given to 5 healthy volunteers. Heart rate, blood pressure, systolic time intervals, and electrical impedance cardiogram were recorded in supine and upright position for 8 hours after drug administration. In addition, plasma drug concentrations were measured simultaneously. Amitriptyline caused a more pronounced increase in heart rate, especially under orthostatic stress, than did lofepramine. Both drugs reduced total peripheral resistance; amitriptyline's effect was greater. A rise in blood pressure (supine position) and shortening of the electromechanical systole under lofepramine indicated an improvement of cardiac performance. In contrast amitriptyline, particularly, in the upright position, lowered blood pressure and lengthened electromechanical systole. Since both drugs have a comparable antidepressant activity, lofepramine is suggested to induce fewer untoward cardiovascular reactions than amitriptyline.
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3895255
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Oxaprotiline (C 49/802 BA), a further development and structural analogue of maprotiline, is characterized by a very potent and extremely specific inhibitory effect on the re-uptake of norepinephrine. In an open early phase II study oxaprotiline was investigated in 10 inpatients with endogenous depression with regard to its antidepressive efficacy and occurrence of adverse effects. Oxaprotiline was given in a dosage up to 225 mg over a period of 28 days. 9 out of 10 patients completed the study, and, of these, 5 were found to be either very much improved or much improved. Standardized rating scales (HAMD, Bf-S, EWL-K) indicated significant improvement after 4 weeks of treatment. Except dry mouth, generally mild, there were no remarkable side effects; there was no influence of oxaprotiline on heart, cardiovascular and routine laboratory parameters. The results of this study indicate that oxaprotiline is an effective antidepressant without significant adverse effects.
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3895256
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The spatial resolution of a NaI(T1), 25 mm thick bar detector designed for use in positron emission tomography has been studied. The position along the 500 mm long detector is determined from the centroid of the light distribution in the crystal as measured by a linear array of photomultiplier tubes. A Monte Carlo computer simulation was performed to investigate the factors limiting the spatial resolution. The program allowed us to study the effect of various phototube configurations and crystal surfaces. Since the resolution is affected by the width of the light distribution, we studied the effect of sharpening the distribution by modifying the front crystal surface with grooves cut perpendicular to the long axis of the crystal and by using non-linear preamplifiers. The simulation predicts a spatial resolution (FWHM) of 3 mm with this crystal. Experimental measurements of spatial resolution were performed concurrently with the simulations. In particular, a modified grooved crystal was measured to have 4.0 mm spatial resolution, an improvement over the original crystal without grooves. With delay line pulse shortening, which increases the count rate capability of the detector, the grooved crystal was measured to have 5.5 mm spatial resolution.
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3895261
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Long hair worn by both sexes in a majority of the rural population of Punjab (India) increases the hazard of descalping injuries. Forty-six cases seen over a period of 10 years are reported. Agricultural machinery accounted for 83 percent of these injuries. Males were most commonly involved (63 percent), and 48 percent of the patients were minors. Nearly all cases reported had at least half the scalp avulsed, 56.5 percent being total scalp avulsions, with bare bone exposed in 48 percent of the total. The method of chiseling the outer portion of the exposed bone down to bleeding points and immediately applying a split-thickness skin graft is presented as the procedure of choice for wound closure. This reduced the average hospitalization period by 49 percent as compared with older methods. Follow-up of 67 percent of patients has revealed a surprising instability of the grafted skin, with an ultimate danger of malignant degeneration.
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3895262
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This study is a retrospective analysis of a consecutive series of 85 patients with primary melanomas of the trunk (51 patients) and extremities (34 patients) treated by wide excision and flap repair. Both the standard rhombic flap (39 cases) and the double-Z rhomboid flap (46 cases) were used. Postoperative follow-up was 11 to 49 months, with a mean of 20 months. Major postoperative flap necrosis was encountered in one case (1.1 percent). There were no local recurrences and only one instance of intransit metastasis. As compared with skin grafts, flap repairs were found to be free of the classic contour defect. In this series, flap repair also permitted earlier mobilization and resulted in shorter hospital stays.
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3895263
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Cyclosporine, the first of a new generation of selective immunosuppressive agents, has already proved to be of exceptional value in human organ transplantation; however, its role in human reconstructive surgery remains to be established. The possibility that short-term treatment could be sufficient for indefinite survival of bone, muscle, nerve, and vein allografts is attractive and might provoke changes in prevailing attitudes regarding the use of allogenous tissues in reconstructive procedures. Cyclosporine may start a new line of immunosuppressive agents with more potent therapeutic effect and less potential toxicity. This new generation of drugs, together with the experience in tissue transfer amassed by plastic surgeons during the last decade, may eventually result in unprecedented possibilities in surgical reconstruction.
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3895265
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On the occasion of the 40th anniversary of the liberation of Germany from the fascist dictatorship, a survey is presented on the hitherto existing investigations into the various forms of the abuse of psychiatry for the purposes of the fascist system. The paper deals with forced sterilization, the murders of children and of adult mental patients and with the attempted legalization of so-called "active euthanasie". The causes of this development are discussed and the ethical consequences for the present.
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3895276
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In the mid-nineteenth century opium and its derivatives, such as laudanum and morphine, were the most common poisons in suicides in England and Wales. With legislative restrictions on these 'dangerous drugs' such a use declined. This study attempts to show this trend and indicates the large variety of these opium-related suicides.
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3895283
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Insular lizards, birds, and mammals in high-density populations often exhibit reduced situation-specific aggression toward conspecifics. This aggressive behavior can be expressed in the form of (1) reduced territory sizes, (2) increased territory overlap with neighbors, (3) acceptance of subordinates on the territory, (4) reduced aggressiveness to certain classes of conspecifics, or (5) abandonment of territorial defense. These behavioral traits can be explained by two nonexclusive hypotheses. The resource hypothesis suggests that territorial behavior is primarily adjusted to resource densities, and that resources are more abundant on islands than on the mainland (e.g., because of a lack of competing species). The defense hypothesis suggests that, in addition to any effects of resources, the costs of defense against both territorial intruders and contenders for vacant territories are higher on islands. Recent theoretical and empirical studies indicate that these behavioral changes can occur as a result of elevated defense costs, independent of resource densities. Reduced predation, more benign climates, and an absence of habitat sinks on islands would all tend to increase the density of potential intruders and contenders, and hence the costs of defense for owners of insular territories. The two hypotheses differ in their predictions about the rates of biomass production (growth or reproduction) for holders of insular territories. Reproductive and growth data from insular-mainland pairs indicate the importance of elevated defense costs, and also suggest that many insular vertebrates reallocate their breeding resources so as to produce young that are more competitive. The suite of ecological and behavioral traits exhibited by insular territorial vertebrates can best be explained by three factors operating in concert: higher available resource densities, higher defense costs, and (sometimes) a reallocation of resources to produce young that are more competitive.
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3895289
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The rate of positive 125I-fibrinogen accumulations after typical ascending phlebography was significantly less (9/40 = 23%) with iopamidol compared with ioxithalamate (16/40 = 40%). The iodine content of the contrast media used in this intraindividual study (40 patients) was 250 mg/ml. With the 125I-fibrinogen uptake accepted as a method of reference, the clinically observed postphlebographic symptoms of thrombophlebitis were false positive in 1/6 and false negative in 3/4 of the cases. These incidences were registered for both contrast media. With the lowered iodine content (250 mg/ml), too, pain reactions were seen in approx. 50% during the injection of the ionic agent, but in none of the cases using the non-ionic agent. Not one of the commercial contrast media can be regarded as "ideal" at this time. Nevertheless, it can be concluded, that non-ionic contrast media with iodine content of 250 mg/ml are highly effective in preventing acute and delayed reactions. Moreover, this concentration seems to be adequate for optimal imaging in phlebography.
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3895277
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In vivo exposure therapy for phobias is uniquely suited for controlled studies of endocrine and physiologic responses during psychologic stress. In this study, exposure therapy induced significant increases in subjective anxiety, pulse, blood pressure, plasma norepinephrine, epinephrine, insulin, cortisol, and growth hormone, but did not change plasma glucagon or pancreatic polypeptide. Although the subjective and behavioral manifestations of anxiety were consistent and intense, the magnitude, consistency, timing, and concordance of endocrine and cardiovascular responses showed considerable variation.
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3895290
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Sonographic evaluation of the width of the spinal canal is inferior compared to CT or myelography, concerning accuracy and especially quantity of information received. The advantage of sonography is the lacking of X-ray exposure, the non-invasive procedure and the low cost of apparatus and operational time. For these reasons sonography is favoured as a screening method in detecting spinal canal stenosis in a group whose handicap was largely occupational or sport-related.
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3895284
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Edema developed in the respiratory and endothelial cells cytoplasm after whole-body gamma-irradiation. In the cytoplasm of granular cells, the osmiophilic substance level decreased and giant laminar bodies periodically formed reducing the respiratory and endothelial cells edema. Collagen fibres actively grew in the interstice and capillary lumens.
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3895291
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The authors reviewed 23 cases of focal nodular hyperplasia and 13 cases of hepatic adenoma, all of which were confirmed pathologically. All solitary masses that exhibited normal or increased uptake of technetium 99m-sulfur colloid were shown to be hyperplasia; while previous criteria such as a central blood supply on angiograms or a central scar on computed tomography (CT) or ultrasound (US) scans were helpful, they were relatively infrequent. A mass that was slightly hypodense and homogeneous on a CT or US scan and highly vascular with an intense capillary stain on an angiogram was almost always hyperplasia. Acute hemorrhage within a focal hepatic tumor was common in adenoma but did not occur in hyperplasia.
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3895292
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Computed tomography (CT) was compared with fundoscopy and ultrasound (US) in 62 patients with primary choroidal melanoma. All lesions were detected with CT and fundoscopy and all but one with US. Of five cases of extrascleral extension, four were identified with CT and fundoscopy and two with US. CT best depicted the extent of retrobulbar tumor. Tumor thickness was best evaluated with CT, with good correlation between CT and US. Tumor enhancement was noted in all 51 patients who had both noncontrast and contrast CT. Because of its higher density, tumor could be distinguished from retinal detachment on CT scans in most cases.
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3895293
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Phantoms were used to compare imaging of various masses in the glandular region for two types of breasts. In one type, normal glandular tissue contains no fat clumps; in the other type, randomly distributed spherical fat clumps exist. The size distribution and number of fat clumps per unit volume in the phantoms represented those found in actual normal glandular tissue. For a 5-cm path length between the scanning window of the phantom and the centers of the masses, the presence of the fat clumps caused distortions and deviations of the beam, resulting in image distortion. This degradation was reduced when successive slabs of the material containing the fat clumps were removed. Image degradation appeared to be less severe when a 2.25 (rather than a 3.5) MHz transducer was used. The results show that the thickness of tissue containing fat clumps between the scanning transducer and a mass plays a role in the detectability of masses and diagnostic usefulness of the image of a breast. This suggests that imaging of the breast in the compressed configuration should be performed regardless of whether the freely suspended breast is imaged. Also, transducers of lower nominal frequency may have an important role in breast imaging.
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3895295
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A solid, acrylic phantom was developed to assess the iodine perceptibility of three digital subtraction angiography (DSA) systems, including one using a recursive filter technique. Three phantoms, designed to mimic flow of iodinated boluses through blood vessels, were used. Each contained four triangular boluses of different widths and of a specific iodine concentration. Motion, required to test recursively filtered DSA systems, was simulated by placing the phantoms on a motorized cart. The phantoms were also used to test flow curve generation in applicable systems. Intersystem differences in perceptibility were attributed to differences in system noise, system resolution, and dynamic range. Flow curves produced with the phantoms were similar to those obtained in patient studies.
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3895294
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Sonographic and laboratory findings are presented for a case of left-scrotum testicular cysts in a 30-year-old man. Previously reported cases of this rare congenital malformation have occurred in infants and young boys. The patient showed previous evidence of the cyst at age 13. Sonographic images correlated well with previously published gross and microscopic descriptions.
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3895285
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The contents of gamma-aminobutyric acid (GABA) and glutamate (GL) as well as GABA-aspartate- and alanine aminotransferase activities were measured in rat cerebellum, cerebral cortex and truncus cerebri 1, 3, 6, 24 and 48 hr following total-body gamma-irradiation (60Co) with a dose of 30 Gy. All the indices under study changed in a similar way in the cortex and truncus cerebri while in the cerebellum, GABA level increased and GABA-alpha-ketoglutarate aminotransfearse activity decreased 60 min after irradiation. The levels of GABA and GL in the cortex and truncus cerebri decreased immediately and increased 24 hr after irradiation. Activity of aminotransferases changed in a phase manner: changes in aspartate- and alanine aminotransferase activity were more pronounced than those of GABA-alpha-ketoglutarate aminotransferase activity and correlated with the glutamate level changes.
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3895286
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The administration to rats of amino acids (valine, leucine, and isoleucine) for 10 days after whole-body X-irradiation with a dose of 7 Gy increased the survival rate and average life of animals and normalized some carbohydrate and nitrogen metabolism indexes. The insulin-like effect of these amino acids on glucose absorption by phrenic muscles of the exposed rats was detected.
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3895287
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A study was made of the effect of different radiation doses on the brain enzymes degrading enkephalins. Enkephalin aminopeptidase activity decreased during the first 60 min following irradiation with a dose of 774 X 10(-4) C/kg and increased after a dose of 3096 X X 10(-4) C/kg; enkephalinase A exhibited opposite changes. 48 hr after irradiation, enkephalin aminopeptidase activity exceeded the normal level, and no significant changes occurred in encephaliase A activity irrespective of the radiation dose.
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3895305
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Eighty nulliparous college female undergraduates were cast randomly into a series of eight treatment conditions representing all possible combinations of the three major components of the Lamaze method of childbirth preparation (relaxation training, informative lectures, and breathing exercises). Assessments of the efficacy of these pain coping strategies were subsequently made in the context of a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus, patterned so as to resemble labor contractions. Dependent variables included self-reported pain, systolic and diastolic blood pressure, frontalis EMG, and heart rate. Results of the study indicated that relaxation training comprises the most therapeutically active component of the Lamaze treatment regimen, with significant effects (treatments X trials) on self-reported pain, frontalis EMG, and heart rate. The implications of these findings are discussed from the perspective of designing new, and hopefully more efficacious, methods of preparing women for labor and delivery.
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3895306
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Man's long-standing efforts to alter living things through genetic manipulation have become reality. Recent advances in recombinant DNA technology have the potential to alter the drug-development process profoundly. The pharmaceutical industry has had to adjust its research efforts and develop new state-of-the-art laboratories. In addition to the standard biological and in vivo assays, many new tests are required, e.g., amino acid sequencing, high-pressure liquid chromatography, and radioimmunoassays. Academic researchers have played a vital role in developing the new biotechnology, supplying most of the basic scientific knowledge and the initial supply of the scientific work force. The recent shifting of support for scientific training from the government to the pharmaceutical industry has resulted in unprecedented academe-industry relationships. Universities now stand to profit significantly from patent rights resulting from biotechnology research efforts. While the advances in biotechnology have had considerable impact on the pharmaceutical industry and academia, they have thus far had only a minor impact on the regulatory process. To date, the preferred regulatory path appears to be modification of existing procedures through the issuance of guidelines, which can be updated as knowledge increases.
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3895316
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A renal transplantation was performed on 6 dialysis patients using high concentration aluminum water. The post-graft course in 3 patients led to the appearance of worsening or neurological symptoms, with associated deterioration on the EEG. In 3 other patients there was progressive improvement in clinical signs, though with long-term persistance of electrical abnormalities in 1 case. These 6 cases are compared with 10 dialysis patients without aluminum intoxication who underwent renal transplantation in the same conditions. These results are then analyzed with reference to those already published in the literature. Three factors (length of exposure, water aluminum concentration and seizure disorder) seem significant to the prognosis of renal transplantation in patients with aluminum intoxication.
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3895310
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Achilles tendon was evaluated by B scan ultrasound in 54 cases (20 normal and 34 symptomatic subjects). The ultrasonographic features of tendon's diseases were correlated with the anatomical patterns. On the basis on their experience, the authors concluded that ultrasonography is a simple and highly accurate method for the diagnosis of Achilles tendon diseases and that it should be the initial imaging procedure.
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3895309
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The recent great diffusion of sports has significantly increased the traumatic pathology of Achilles tendon. Owing to the importance of a correct diagnosis and prognosis and of an adequate therapy (especially for professionals), a clinical and radiological study has been performed. Echotomography has been associated with xeroradiography in 185 athletes with painful symptoms; among these 79 were normal while 106 showed various types of tendinopathies. The main results can be summarized; peritendinitis: non uniform thickening; hyperechogenicity of Kager's triangle; insertional tendinopathies: thickening; calcifications; tendinosis: thickening; degeneration nodules; tendinous ruptures: rough contours of the rupture; degeneration nodules. The good echotomographic results allowed a correct diagnosis in about 85% of the 39 surgically treated patients.
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3895329
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The response of plasma renin activity (PRA) to stepwise reductions in renal arterial pressure (RAP) induced by suprarenal aortic constriction (SAC) or hydralazine (0.1-30 mg/kg i.v.), and the effect of indomethacin (5 mg/kg i.v.) or propranolol (1.5 mg/kg) s.c.) on the PRA response were examined in anesthetized rats whose right kidneys had been removed 6-7 days earlier. The stepwise reduction of RAP by SAC or hydralazine produced a steep increase in PRA when RAP was below approximately 100 mm Hg. Above this level, PRA was unaffected by changes in RAP. The SAC-induced increase in PRA was nearly abolished by indomethacin. On the other hand, propranolol failed to affect the SAC-induced increase in PRA. The hydralazine-induced renin release was remarkably suppressed by either indomethacin Or propranolol. These results suggest that SAC-induced renin release is mainly dependent on the prostaglandin system, whereas hydralazine-induced renin release is dependent on the prostaglandin and the adrenergic nervous system. We estimated the threshold pressure for increasing renin release is approximately 100 mm Hg.
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3895328
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Renal functional adaptation to additional nephrons was studied in rats in which a third kidney was transplanted isogeneically. Total renal function did not increase when an extra kidney was added. Quantitation of the contribution of each kidney, by means of a 99mTc-DTPA scan, showed that the glomerular filtration rate of the native kidneys had decreased to counterbalance the added function. The glomerular filtration rate of the transplanted kidneys as well as its number of glomeruli were 20% less than that of the intact native kidneys. The present findings once again illustrate the kidney's remarkable capacity for functional adaptation to a change in the total number of nephrons.
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3895330
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The effect of a continuous intra-aortal infusion of prostaglandin E2 (PGE2) (0.03 microgram . min-1 . kg-1) on the course of postischemic renal failure (180 min cessation of blood flow by inflation of a pneumatic cuff) has been investigated in 11 conscious sodium-replete dogs. The glomerular filtration rate (51Cr-EDTA: endogenous creatinine clearance) was less decreased in the PGE2 group (group B, n = 6) than in the control group (group A, n = 5; 13 ml . min-1 vs. 22 ml . min-1; p less than 0.05). Renal blood flow (electromagnetic flow probe) was markedly lower in the control group (82 ml . min-1) than in the PGE2 group (130 ml . min-1; p less than 0.05), even exceeding baseline levels in the latter group. Accordingly, the excessive rise in renal vascular resistance in the control group (+277%) was abolished in the PGE2 group (-20%) (p less than 0.05). Nitrogen retention was also markedly improved. Plasma renin activity, which was markedly raised initially (25.8 ng angiotensin I . ml-1 . h-1) was not significantly further increased during the subsequent 7 days. Urinary excretion of PGE2 was diminished in the control group and elevated following PGE2 infusion. It is suggested that the beneficial effects of PGE2 are mediated by preservation of renal perfusion. Additional effects of prostanoids on the ultrafiltration coefficient (KF) and cytoprotection by reduction of intracellular calcium accumulation must also be taken into consideration.
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3895331
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To examine the PGE2 and renin release during autoregulatory dilation of preglomerular vessels, experiments were performed in three groups of anesthetized dogs. By reducing the arterial perfusion pressure from 113 +/- 3 to 78 +/- 3 mm Hg, renin release rose to 20 +/- 50% and PGE2 release to 74 +/- 12% of the maximal values attained at two perfusion pressures below the range of autoregulation. During ureteral occlusion, PGE2 and renin release rose to maximal values already at control blood pressure and remained unaltered as the arterial perfusion pressure was reduced from 124 +/- 7 to 68 +/- 2 mm Hg. Renal blood flow fell in proportion to the perfusion pressure indicating abolished autoregulation. At a perfusion pressure below the range of autoregulation, saline infusion restored sodium excretion and reduced renin release but did not alter PGE2 release. We conclude that PGE2 release is raised by autoregulatory dilation of preglomerular arteries. Prostaglandins enhance renin release when afferent arterioles are dilated. Renin release mediated by a macula densa mechanism is not PGE2 dependent.
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3895335
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125I-labeled E. coli was injected into the biliary tree of normal rats and rats with 3 weeks' obstruction of the common bile duct to investigate the liver clearance capacity for bacteria. Bile was collected during 15 min, immediately, 1 h, 4 h, or 24 h after the injection. Tissue specimens from the liver, lungs, spleen and kidneys, and blood and urine specimens were collected simultaneously. In normal rats, 40% of the bacteria was recovered in the bile immediately after the injection, whereas 30% was already trapped in the liver. Incubation of the bacteria in the bile duct for 1h, 4h, and 24h resulted in liver retentions of 43%, 15%, and 4%, respectively. The recovery in the bile was 13% after 1-h incubation, and further prolongation of the incubation did not result in a significant decrease. In contrast to these findings, 70% of the injected bacteria was retained in the biliary tree in rats with chronic biliary obstruction (P less than 0.05) as compared to normal rats) and only 1% was trapped in the liver (P less than 0.005) 15 min after injection. One-hour incubation of bacteria in the bile duct decreased the retention in the bile to 30%, but the retention in the liver increased only slightly in these animals. Four and 24 h after injection less than 30% of the bacteria was retained in the hepato-biliary system. Most of these animals showed almost no radioactivity exceeding the background count in the blood, urine, spleen, lungs, and kidneys 15 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895336
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A linkage between prorenin, renin, and intrinsic coagulation systems has been suggested recently. We studied the behavior of renin, prorenin, and kallikrein in a patient affected by congenital factor XII deficiency. Captopril test, upright posture, and furosemide administration provoked in our patients changes of renin and prorenin similar to those found in normal and hypertensive subjects. Unchanged kallikrein levels confirmed that no interaction between prorenin activation and factor XII-kallikrein system appears to be present.
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3895337
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This study was carried out to clarify the mechanism of the immune regulatory effect of factors which were liberated from the ischemic damaged liver. By occlusion of the hepatic vessels (hepatic artery and portal vein) for 40 min daily during 5 days to induce the ischemic damage of the liver, reduced thymus weight (50 +/- 5 mg; control, 274 +/- 23 mg) and cell count (0.7 +/- 0.3 X 10(7); control, 3.5 +/- 0.3 X 10(8] and complete differentiation of thymocytes were observed, i.e., helper cells reacting to monoclonal antibody W3/25 were 34 +/- 8% and suppressor/cytotoxic cells to OX-8, 49 +/- 5% (in control W3/25:89 +/- 1%, OX-8:89 +/- 1%). These quantitative and qualitative changes of thymocytes were correspondent to those of animals treated with 40 mg CsA/kg per day for 5 days; however, medication with 10 mg prednisolone/day 5 times could not induce any alteration of thymocyte subpopulation (W3/25:89 +/- 1%, OX-8:87 +/- 1%) although the weight and cell count decreased to 92 +/- 8 mg and 4.1 +/- 0.6 X 10(7), respectively. Furthermore, 5 days after liver allotransplantation (BDE to LEW), the weight and cell count of the thymus were extremely reduced (58 +/- 6 mg, 2.7 +/- 0.2 X 10(7], and thymocyte differentiation was observed (W3/25:56.6%, OX-8:61 +/- 11%). On the other hand, in heart transplantation the atrophy of the thymus was not so strong (105 +/- 28 mg, 1.3 +/- 0.6 X 10(8], and there was no change in the subpopulation (W3/25:89 +/- 2%, OX-8:88 +/- 1%).(ABSTRACT TRUNCATED AT 250 WORDS)
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3895338
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Histological changes in bronchus-associated lymphoid tissue (BALT) following single intratracheal administration of five different antigens were studied in the rat. After administration of T-dependent antigens (i.e., horseradish peroxidase, bovine serum albumin, and Bacillus Calmette Guérin) only minor changes in BALT in the rat occurred. Intratracheal administration of a T-independent antigen (lipopolysaccharide) and a partly T-independent antigen (paratyphoid vaccine) resulted after 1 week in an increase in cytoplasmic IgM-containing (cIgM) blast cells and plasma cells; these appeared to enter via the high endothelial venules (HEV). After 6 weeks, germinal centers were seen.
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3895348
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A recurrent conclusion of studies on margination and emigration of leucocytes into acute inflammatory lesions has been that these two processes are the result of different stimuli. The recent description of tachyphylaxis of skin lesions to neutrophil chemotaxins is compared with the purported regulation of acute inflammation by deactivation of neutrophils, inactivation of chemotaxins and inhibition of cell migration. It is concluded that tachyphylaxis might regulate the intensity of the peak neutrophil influx whereas chemotaxin inactivators and migration inhibition factors might regulate the subsequent low grade neutrophil influx into lesions. It is suggested that the chemotaxin receptors which manifest tachyphylaxis may be located on endothelial cells of post-capillary venules. The literature indicates that an alteration in endothelium provides a sufficient stimulus for margination to occur. It is emphasised that attention should be directed towards determining the minimal changes in endothelium necessary to permit or induce margination to proceed. Emigration of marginated neutrophils might then occur in response to chemotaxin diffusing to the vessel wall or by locomotion along a gradient of substratum-bound chemotaxin. The selectivity of the leucocyte infiltration of tissues that occurs in some types of inflammation could be exerted by the stimulus for margination or the stimulus for emigration. It is noted that selective margination of lymphocytes occurs in post-capillary venules of lymphoid tissues. The role of a lymphocyte chemotaxin as the stimulus for emigration in this location is unknown. To encompass the known phenomena, a general theory of leucocyte margination and emigration would predict that leucocytes selectively marginate onto acceptor molecules expressed by endothelium and extravasate in response to a chemotactic stimulus. Endothelium-bound chemotaxins may function as acceptor molecules. A bipartisan model of leucocyte migration to extravascular locations is proposed which contends that leucocyte can be recruited non-specifically as inflammatory cells or they can be recruited specifically as effector cells of immune reactions. It is suggested that tachyphylaxis is a characteristic of inflammatory cell recruitment but not of immunologically driven cell recruitment. The binding of chemotaxins to endothelial cells in vivo, the selectivity of margination, the status of margination in desensitised tissues and the role of chemotaxins in lymphocyte recirculation through lymph nodes are identified as critical questions to resolve the mechanisms of leucocyte margination and emigration.
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3895341
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A comprehensive review of methods for allocation of treatments to patients in clinical trials is presented. Attention is restricted to controlled, prospective trials, as opposed to comparisons involving historical or other 'external' controls. We describe the features of each method and classify them according to whether their primary focus is randomization, efficiency, or balance with respect to prognostic factors. Methods which prevent bias, ensure an efficient treatment comparison and are simple to implement will contribute to the ability of clinical trials to provide precise and valid treatment comparisons. We assess critically the extent to which the methods achieve these goals, review the relationships of the allocation methods with subsequent analyses of the trial results, discuss current usage and provide guidelines for choice of method.
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3895362
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The follow-up of women treated for breast cancer rather varies according to school of thought. This follow-up is often too irregular, insufficient or unnecessarily exhaustive and costly. It depends on numerous factors such as the doctor-patient relationship, stage of disease, frequency and usual site of metastases, time lapsed since first treatment, and validity and reliability of tests. In early stages, attention must be paid to discovery of recurrence and metastasis, either in the opposite breast or in other organs. In advanced stages, the examination involves an evaluation of the degree of extension and ongoing disease activity with search for evidence of stability.
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3895361
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Salpingitis is exceptional in pre-pubertal girls. The authors compare a case of histologically and bacteriologically well documented salpingitis in a 3 year old girl to another case in a pre-pubertal 14 year old girl and review the literature on the subject. Six other cases have been reported. The clinical presentation is very variable and, in the absence of ultrasonography or laparoscopy, laparotomy is required for both the diagnosis and the treatment.
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3895363
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Chorionic villus biopsies made during the first trimester of pregnancy offer the advantage of earlier antenatal diagnoses than usual methods. This technic was introduced about 15 years ago but recently improved thanks to innovations in equipment and the contribution of echography. 75 biopsies were made using aspiration technic by echographic-guided catheter. These biopsies were carried out before elective abortion, 18 in an ambulatory setting one to three weeks before the abortion in order to test the social acceptability and tolerance of this method, as well as the inherent risks involved. The biopsy technic is described as well as preliminary results of chromosomic analyses of biopsied chorionic tissues. Drawing from a perspicacious review of the literature, the respective advantages of various biopsy technics and their uses (i.e. sex determination and chromosome analyses by culture and especially direct methods, study of fetal DNA, and enzyme assay) are examined. Finally, the risks of biopsy technic in the immediate and near future are discussed, and the indications today for this new technic are described.
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3895360
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It is generally accepted that glucocorticoids are ulcerogenic. The different pharmacological, biological and clinical arguments on which this opinion is founded are reviewed. It is concluded that, particularly in pneumology, none of them is sufficiently sound to justify the prophylactic measures generally systematically used. In fact it appears that glucocorticoids are not primary offenders by rather potentiate ulcerogenesis. Prophylactic measures are therefore indicated only in ulcerogenic conditions such as association with non steroidal anti-inflammatory agents or in some pathological situations such as rheumatoid arthritis and severe cirrhosis. These conditions are generally not encountered in pneumology and therefore the ulcerogenic risk in this case can be considered as non existent.
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3895356
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In many diseases in which cellular abnormalities of neutrophil locomotion are found, patients have oral complications. Localized juvenile periodontitis (LJP) is used as an example of a severe periodontal disease that is related to compromised neutrophil function. Studies of chemotaxis and binding of LJP neutrophils in response to chemotactic factors N-formylmethionylleucylphenylalanine (FMLP), a structural analogue of a bacterial product, and complement fragment C5a were carried out to identify the molecular basis of the compromised neutrophil function. The rate of chemotaxis in LJP neutrophils was significantly lower than that of control neutrophils, and LJP neutrophils demonstrated fewer binding sites for these chemotactic factors than did normal neutrophils. The respective numbers of binding sites for FMLP on LJP neutrophils and normal neutrophils were 9,200 and 20,000 and for C5a were 133,000 and 218,000. However, for both chemotactic substances, the dissociation constants for LJP and normal neutrophils were similar. The expression of FMLP receptors was altered in LJP neutrophils, but no modulation abnormality was noted for the C5a receptor.
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3895352
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Diethylcarbamazine (DEC) is an effective microfilaricidal drug against Wuchereria bancrofti, Brugia malayi, and Brugia timori--the three lymphatic-dwelling filariae infecting humans. However, effectiveness in killing the adult stage of these parasites has been more difficult to establish. The present review of available evidence from the literature suggests that: (1) in addition to being a microfilaricidal agent, DEC in conventional dosages effectively kills adult worms of these three parasites in many patients; (2) relatively high total dosages of DEC (including dosages considerably in excess of those currently recommended) generally give better long-term therapeutic results than lower dosages; (3) spaced doses of DEC (weekly or monthly) are more effective than the same total dosage given in consecutive daily doses; (4) chronic administration of low-dose DEC, as in medicated salt, can effectively control filariasis caused by W. bancrofti or B. malayi; and (5) rational determination of the DEC regimen ideal for the killing of adult filarial parasites awaits the development of assays capable of sensitively detecting the presence of living adult parasites.
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3895364
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A review of current literature concerning developments of new parameters in fetal biometry is presented. To be sure, these parameters are very useful for detection of fetal malformations but outside of femoral length they do not contribute more valuable information than the already accepted parameters for determination of gestational age or detection of disorders of fetal growth.
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3895366
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Adult Onchocerca volvulus were transplanted into chimpanzees with or without complete or partial digestion of associated nodule tissue. Survival of adults worms was limited, but low level microfilarial densities remained detectable in skin over partially digested nodule transplants for 12 months. Human nodule tissue transplanted with adult worms showed enhanced survival as compared to subcutaneous tissue transplanted without worms. It is postulated that this reflects the action of an immunosuppressive factor utilized by the parasite to permit its own survival.
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3895367
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The digestive tract and its development from undifferentiated primordia of first, second and third stage larvae of Wuchereria bancrofti are described at the ultrastructural level. In the young first stage larva the future oesophageal cells form a long column surrounding the cuticularized pharyngeal thread. In the midbody region, a small number of cells associated with the inner body represent the intestinal precursor. The large R-cells around the anal vesicle are fully differentiated.--The late first stage larva shows numerous, small oesophageal cells aligned around the pharyngeal thread. The few intestinal cells have greatly enlarged and start to form small lumina between their central membranes. The anal vesicle has increased and is divided in an inner and an outer portion.--In the second stage larva the oesephageal cells gradually differentiate into an inner muscular core around the triradiate cuticularized lumen, and an outer glandular sleeve. The intestinal cells start to form small microvilli at their luminal sides. Large amounts of particulate matter fill the lumina of oesophagus and intestine at this larval stage. The R-cells are still located between the posterior end of the intestine and the inner portion of the anal vesicle. Small, undifferentiated cells around the outer portion of the anal vesicle start to form the rectal tube.--The third stage larva has a fully differentiated digestive tract. The glandular portion of the oesophagus contains an abundance of secretory granules and vacuoles, the intestinal cells show lipid inclusions and long, tightly packed microvilli. The narrow rectal tube opens to the exterior.
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3895351
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The use of antimicrobial agents during pregnancy poses unique concerns because of both potential toxicity and special pharmacokinetic considerations that have important therapeutic implications for both mother and fetus. Various physiologic adaptations occur with advancing gestation, including marked increases in maternal intravascular volume, glomerular filtration, and hepatic and metabolic activities; thinning and maturation of the fetomaternal membrane; and increases in transplacental diffusion capacity. The net result is that maternal antimicrobial concentrations tend to be 10%-50% lower in late pregnancy and the immediate postpartum period than in the nonpregnant state. Placental transfer of antimicrobial agents and their excretion in amniotic fluid or breast milk are similarly affected by hemodynamic changes, membrane transport characteristics, and maturation or metabolic activity of the specific organs involved. Review of the literature suggests that, although the need for caution in the use of antimicrobial agents during pregnancy has been well emphasized, firm data on the pharmacokinetics, efficacy, and optimal use of these drugs in this situation are extremely sparse and urgently needed. However, recommendations regarding the use of specific antibacterial, antifungal, antiviral, and antiparasitic agents against selected infections during pregnancy can be made.
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3895365
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We report the results of a double-blind placebo controlled study of bornaprine, an anticholinergic drug, in the treatment of Parkinson's disease. We studied 17 patients presenting persistent tremor in spite of a stable long-term L-Dopa therapy. The bornaprine, in doses of 8 mg/die, compared with placebo significantly improves tremor. Only mild side effects occurred. We think the bornaprine may be of value in the treatment of parkinsonian tremor.
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3895358
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The misconceptions of two physicians, Austin Flint and Max von Pettenkofer, in interpreting epidemiologic data on the water transmission of enteric disease are reviewed. Austin Flint failed to recognize the transmission of typhoid fever from well water in an epidemic he investigated in North Boston, New York, in 1843. He later discovered and freely admitted his error. Max von Pettenkofer, who had studied cholera in the 1854 outbreak and in many subsequent outbreaks, failed to confirm John Snow's observations in England on the water transmission of cholera. Pettenkofer eventually swallowed live cholera bacilli and did not develop cholera. He remained convinced to the end of his life that cholera is not directly transmitted by drinking water.
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3895357
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Pertussis and diphtheria, bacterial infections responsible for significant childhood morbidity and mortality in the developing world, are potentially controllable by mass immunization. The incidence of pertussis has been dramatically reduced in many areas of the world over the past 25 years by the use of pertussis vaccine. The massive increase in incidence of clinical pertussis in Great Britain and other European nations occurring after publicity about vaccine reactogenicity precipitated a marked decrease in vaccine acceptance has documented the efficacy of the vaccine and the necessity of continued immunization. The issue of potential toxicity is, nevertheless, being addressed with the development of a cell-free, component pertussis vaccine. The use of diphtheria toxoid, directed at protecting recipients against the systemic effects of diphtheria toxin, has resulted in excellent control of the disease in the United States and elsewhere. Certainly the use of these two vaccines on a mass scale is the preferred approach to worldwide control, if not eradication, of these infectious diseases.
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3895369
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A double-antibody radioimmunoassay for human neuron-specific enolase (NSE) was developed, using rabbit antiserum against the gamma subunit of enolase purified from human brain. Intra-assay variance was 3.8-5.1% and inter-assay variance 4.3-7.3%, and recovery of NSE added to normal serum was 100.2% on average. Normal serum NSE levels for 451 adults ranged from 3.6 to 10.8 ng/ml (mean 6.6 ng/ml). Antibodies raised against the gamma gamma enolase isozyme did not cross-react with the alpha alpha and beta beta isozymes at concentrations of 1,000 ng/ml, but showed a cross-reactivity of 41.5% (theoretically 50%) with the alpha gamma isozyme. It was also shown that hemolysis of 160 mg/dl hemoglobin can add 5.73 ng/ml of NSE to the true level. The coefficient of correlation between the radioimmunoassay and the sandwich enzyme immunoassay [1] was 0.99 (n = 21), and values determined by the RIA were about twice those obtained by the EIA. Serum NSE was abnormally high in 42 of 52 patients (80.8%) with small cell lung carcinoma, and in all 38 children with neuroblastoma.
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3895372
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A case of a perinatal acquired focal brain lesion is reported, and the process of resorption and healing demonstrated by ultrasound. Within four weeks a cortical area of increased echogenicity was resorbed. After two months, the resulting porencephalic cyst had been transformed into glial tissue of very high echogenicity. The neurologic development of two children with such glial focus was good. These cases demonstrate that porencephalic cysts are not always the final state after resorption of a focal brain lesion. They are no reliable prognostic indicator of poor neurological outcome. Traumatic and complicated delivery, asphyxia and coagulopathy are conditions which have been found several times in connection with a focal brain lesion. In contrast to periventricular injury, prematurity does not seem to be a factor of higher risk.
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3895354
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The historical development of the concept of neutrophil killing of bacteria by oxygen-independent mechanisms is traced. The role of oxygen-independent microbicidal mechanisms in relationship to neutrophil management of microbes is critically evaluated. In the ultrastructural sense, oxygen-independent killing of bacteria requires the deposition of a bactericidal component (granule proteins) or the establishment of a hostile, non-physiologic environment in the phagolysosome. Accordingly, this review is concerned with the identification and cellular location of cationic proteins that participate in nonoxidative killing of gram-negative bacteria by human polymorphonucleur neutrophil granulocytes. Studies reviewed support the hypothesis that oxygen-independent mechanisms function in vivo and are important in host defense against infection. The chemistry of antimicrobial proteins, the biologically active site of each protein, and the mechanism by which the proteins trigger bacterial death all need to be determined at the molecular level.
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3895373
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Survey of the sequence in which modern imaging procedures should be employed in diseases of the central nervous system, the thoracic and abdominal organs, and the extremities, and the rating of these methods also as regards the costs involved.
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3895355
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The neutrophil is a key element in host resistance to bacterial infection. Bacterial products capable of subverting the antimicrobial properties of neutrophils can have a potentially deleterious effect on the host. Current knowledge of the effects of endotoxins derived from the outer cell envelope of gram-negative bacteria on neutrophil function is summarized. Available evidence indicates that endotoxins bind to neutrophils, both in vitro and in vivo. The lipid A region of the endotoxin macromolecule appears to be important in promoting the association of endotoxin with the neutrophil cell membrane. Endotoxin-neutrophil interactions can result in altered neutrophil adhesive and locomotory properties. Moreover, endotoxins have been demonstrated to induce selective degranulation of specific (secondary) granule constituents and to alter the oxidative and microbicidal properties of the neutrophil. Further studies are needed to define on a molecular level the nature of the endotoxin receptor, the precise structural components of endotoxin responsible for altering neutrophil behavior, and the transductional event(s) leading to neutrophil activation as a result of endotoxin exposure.
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3895376
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Two patients with dermatitis herpetiformis and one with linear IgA disease were examined. Two of the patients had oral lesions and all three showed IgA deposits detected by direct immunofluorescence in apparently normal buccal mucosa. To localize the target structures for IgA deposition, biopsy specimens were taken from normal appearing buccal mucosa for immunoelectron microscopy. The patients with dermatitis herpetiformis had distinct IgA deposits in the upper connective tissue. These were often associated with elastic fibers and occasionally also with capillary walls. In contrast, the patient with linear IgA disease had IgA deposition at the subbasal lamina. Though the clinical expressions may be similar the present immunoelectron microscopic findings in oral mucosa clearly differentiate dermatitis herpetiformis from liner IgA disease.
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3895377
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The marginal adaptation of Silux after application of different dentin adhesives was investigated in dentin cavities prepared in extracted human teeth. The cavity diameter ranged from 1.8 to 6.4 mm and the cavosurface angle was 90 degrees, 110 degrees, 135 degrees or 160 degrees. The investigation included the following adhesives: Clearfil, Creation 1150, GLUMA, NPG-GMA + PMDM, Palfique, Panavia, Scotchbond and Superbond. Silux Enamel Bond was used as control. The most effective adhesive was GLUMA followed by Superbond and then NPG-GMA + PMDM; Palfique, Panavia and Scotchbond were all less effective than NPG-GMA + PMDM, and both Clearfil and Creation 1150 were inferior to the control, Silux Enamel Bond. None of the adhesives were able to prevent the formation of marginal gaps when measured 10 min after polymerization. After water absorption for 1 day, only GLUMA and Superbond produced gapfree fillings. Increasing the cavosurface angle resulted in a significant improvement of the effect of all adhesives, the main reason for this being the reduced ratio volume of filling to area of cavity wall.
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3895379
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A prospective study was carried out in 51 patients admitted for abdominal complaints of at least 1 year's duration. Despite previous hospitalization for the same complaints, no certain diagnosis had been established. After systematic diagnostic procedures in the Medical Dept., Rikshospitalet, 33 patients were given a psychosomatic and 18 patients an organic primary diagnosis. The organic diseases were three cases of Crohn's disease, two of cancer, two of duodenal ulcers, one of gastric ulcer, two of gastroduodenitis, five of postresection syndrome, one of lactose intolerance, one of hyperthyroidism, and one of degeneration of the columna. The patients' condition was registered after 1 year of individual treatment. There was a significant decrease in the number of symptoms, in the psychosomatic score of anxiety, depression, and stress, and in days on sick leave and consultation with physicians in connection with the second compared with the first hospitalization for the whole group, for the psychosomatic group, and for the patients with upper gastrointestinal disease. Increased vitality based on muscular testing was also indicated in the same groups of patients. The study suggests that patients with uncharacteristic abdominal disorders may need a thorough examination at least once in the course of their illness; on the one hand, this may help patients with psychosomatic disease to cope better with their problems, and, on the other hand, primary organic lesions may be difficult to diagnose on the grounds of simple screening procedures.
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3895380
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Abdominal and mental symptoms were assessed in 103 outpatients with chronic peptic ulcer disease. Patients with present symptoms and a history of duodenal or prepyloric ulcer were included if they had no other disorder requiring treatment. A normal female population was used for comparison of mental symptoms. Besides the cardinal ulcer or acid-related symptoms, there was a high rate of indigestion and bowel dysfunction symptoms, usually associated with the irritable bowel syndrome. Mental symptoms were reported by almost all patients. Symptoms of anxiety, depression, and neurasthenia were seen significantly more often among the female patients than in the normal women. We conclude that a wide range of both abdominal and mental symptoms should be taken into account in the therapeutic management of peptic ulcer disease, in evaluation of clinical trials, and in studies of the natural history.
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3895381
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The liquid antacid Novaluzid (10 ml seven times daily) was compared with ranitidine (150 mg twice daily) and with placebo in 57 patients with symptoms and endoscopic signs of oesophagitis and gastro-oesophageal reflux. A randomized three-period change-over design with the double-dummy technique was used. Each treatment period lasted 6 weeks. Only 37 patients (64.9%) completed the entire trial. In retrospect, five patients receiving placebo were withdrawn because of insufficient effect, six patients because of side effects while taking Novaluzid and two while taking ranitidine. The remaining seven dropouts/withdrawals were for reasons without evident relationship to the treatment given. Statistical analyses based both on the 37 completers and on the 43 patients who had at least two treatment periods showed that ranitidine and Novaluzid were superior to placebo with regard to pain score (p less than 0.005) but not with regard to regurgitation, dysphagia, histology, and appearance on endoscopy (p greater than 0.05). It was impossible to distinguish statistically between ranitidine and Novaluzid. In conclusion, ranitidine and high-dose antacids are of equal effectiveness in the short-term treatment of reflux oesophagitis, and both are superior to placebo with regard to symptomatic relief.
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3895383
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A critical evaluation of the endoscopic diagnosis of gastric ulcer was carried out. In a randomized design it was elucidated whether endoscopists are biased by knowledge of the radiological diagnosis when interpreting their endoscopic findings. In addition, the interobserver variation of the endoscopic diagnosis was determined. A total of 156 patients had a barium-meal examination and were subsequently endoscoped by the same two physicians in one session. Before the endoscopy, the patients were randomized in two groups. In 74 patients the physicians knew the radiologic result at the endoscopy; in 82 they did not. One endoscopist was significantly influenced by his knowledge of the radiological diagnosis. The interobserver variation, expressed as the kappa coefficient, was 0.54 and 0.60, respectively, in the two groups. The disagreement especially concerned small ulcers.
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3895384
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A double-blind, placebo-controlled trial was performed, using 400-mg cimetidine tablets or placebo twice daily for 4 weeks in 100 patients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) grade 2 or 3. Symptomatic assessment was made weekly and endoscopic assessment on completion of the treatment period. Symptomatically, a significant effect of cimetidine versus placebo on epigastric pain/discomfort was recorded after 2 weeks' treatment (p less than 0.05). Endoscopically, there was a significant improvement, according to our grading scale of EPC, in the cimetidine-treated group, as compared to the placebo-treated group (p less than 0.05). On the basis of our findings, patients with NUD and EPC who have epigastric pain/discomfort as a prominent symptom seem to profit from treatment with cimetidine.
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3895385
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About five per cent of the adult population each year will see their doctor with complaints that are finally characterised as irritable bowel syndrome (IBS). The complaints are constipation (perhaps alternating with diarrhoea), abdominal pain (dull or colicky), abdominal distension, abdominal rumbling and flatulence. The diagnosis of IBS implies that a relevant examination has precluded any organic disease. The etiology is unknown and the syndrome probably does not represent a disease entity. It is therefore difficult, if not impossible, to produce a definite rationale of treatment. However, several aspects of the pathogenesis of the individual symptoms of IBS are well known: 1) chronic constipation is most likely due to fibre-depleted diet, psychological factors, local organic disorders (e.g., anal fissures, hemorrhoids, diverticulosis) and disturbance of the body fluid balance (e.g., high consumption of diuretic compounds such as coffee and tea); 2) pain is related to spasms and motility disturbances causing increased intraluminal pressure; 3) meteorism is not due to an increased amount of intestinal gas, but "air traps" and segmental accumulation of gas seem to occur. Furthermore, psychopathological factors and perhaps also food intolerance may play an etiological role. At present the rationale of treatment in IBS is: 1) management of constipation, 2) ease of spasms, 3) reduction of surface tension of intestinal contents, 4) ease of mental stress.
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3895386
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To compare the effects of conventional medical treatment with treatment that combines medical treatment and psychotherapy, 101 out-patients with irritable bowel syndrome (IBS) and 103 with peptic ulcer disease (PUD) were randomly allocated to two treatment groups. All patients with PUD received medical treatment with antacids and anticholinergics or antacids and H2-receptor antagonists, while the patients with IBS received bulk-forming agents and, when appropriate, anticholinergic drugs, antacids and minor tranquillisers. In addition, the patients in one group with IBS and one group with PUD received dynamically oriented individual psychotherapy in ten hour-long sessions spread over three months. There was a greater improvement in the psychotherapy groups for patients with IBS after three months and for both IBS and PUD patients after 15 months. The difference had become more pronounced after 15 months, with the patients given psychotherapy showing further improvement, and the patients who had received medical treatment only showing some deterioration. In the short-term, the results were more in favour of the psychotherapy group in patients with IBS than PUD, but in the long run, the combination of medical treatment with psychotherapy improved the outcome for both IBS and PUD.
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3895387
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Non-ulcer dyspepsia (NUD) is a poorly defined condition that is not very suitable for conventional randomised double-blind studies. A multi cross-over model (MCO-model) has been designed allowing identification of individual drug responders with a defined degree of certainty. The model involves regular interchanges between periods with active drug and placebo, and the evaluation is based on the number of times the active drug is associated with fewer symptoms than the preceding or following placebo period (X-score). A drug responder may be defined by a certain minimum value for the X-score. The risk of being wrong may then be easily calculated from the probability distribution of the X-score. The effect of cimetidine in patients with NUD has been studied using a variant of the MCO-model including 6 treatment periods of 2 or 4 days' duration. So far, the conclusion that the MCO-model is able to identify individual cimetidine responders among patients with NUD appears to be justified. The preliminary findings furthermore suggest that cimetidine responders among patients with NUD are characterised rather by symptoms suggestive of reflux esophagitis than by hypersecretion of acid.
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