Treatment of Bartholin's abscess. Marsupialization versus incision, curettage and suture under antibiotic cover. A randomized study with 6 months' follow-up. Conventional marsupialization was compared with incision plus curettage and primary suture of the abscess cavity under antibiotic (Clindamycin) cover in a prospective, randomized study of 32 patients with Bartholin's abscess. The median time to healing was 5 days less after suture than after marsupialization alone. The difference was statistically significant. 29 patients were followed up for 6 months. Recurrence of abscesses tended not to be more frequent after suture, making suture an attractive, safe and convenient alternative treatment for Bartholin's abscess.


Neonatal septicemia caused by pneumococci. Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed. The presenting clinical picture in early-onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS). The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances. The mortality is 50%, twice the figure given in recent GBS reports.


Testicular feminization syndrome and associated gonadal tumors in Denmark. We studied the incidence of testicular feminization syndrome in Denmark over a 7-year period and found it to be about 1:20,400. Twenty-one patients are described in greater detail. Four patients had gonadal tumors, none of these being malignant. Ten patients (47.6%) had inguinal hernias in early childhood. All patients but one were gonadectomized. Eleven patients (52.4%) disclosed signs of partial androgen function. Only 5 of them had their gonads removed immediately.


Gestational choriocarcinoma in a tubal ectopic pregnancy. A case is reported of a gestational choriocarcinoma arising in a tubal ectopic pregnancy of 7 weeks' gestation. Unilateral salpingectomy and single-agent actinomycin-D chemotherapy achieved a cure. A follow-up 4 years later revealed no evidence of recurrence, with two normal births within that period. The current trend to treat ectopic pregnancy by conservative surgery necessitates monitoring of beta-HCG titres in order to avoid missing a choriocarcinoma developing in an ectopic gestation, even though this is a very rare condition.


Metastasis from squamous carcinoma of the cervix stage 1B to a borderline cystadenoma of the ovary. A case of metastasis from squamous carcinoma stage 1B of the cervix to a borderline cystadenoma of the ovary is described. In addition, the patient had atypical endometrial hyperplasia. The patient underwent a radical hysterectomy with no adjuvant postoperative treatment and has resumed work, with no sign of recurrence one year postoperatively. The aspects of the metastasis to the ovary, multiple tumors in the genital tract and tumor-to-tumor metastasis are discussed. Reports on ovarian metastasis in low-stage squamous carcinoma of the cervix are few and it still seems justified to spare the ovaries at surgery in the young patient.


Two cases of neonatal pneumococcal septicemia. Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within a short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis.


Right atrial myxoma presenting as post partum ascites and fever of unknown origin. A case is reported of right atrial myxoma presenting clinically as ascites and fever of unknown origin. An extensive work-up, including laboratory investigations, X-ray imaging, laparoscopy and laparotomy, failed to explain the clinical picture which was manifested post partum. Echocardiography was diagnostic and led to the curative treatment of surgical resection.


Uterus didelphys with unilateral obstructed hemivagina and renal agenesis on the same side. A rare condition, complete or incomplete duplication of uterus and cervix with unilateral vaginal obstruction, is usually associated with ipsilateral renal agenesis. In such kinds of Müllerian and Wolffian duct anomalies as the one reported here with accumulation of menstrual blood in the obstructed vagina, the patient usually complains of a pelvic mass and associated severe and increasing dysmenorrhea. A case, diagnosed and treated at our Department, is presented.


A case of panic disorder induced by oral contraceptive. A 27-year-old woman experienced feelings of unreality and fear after taking an oral contraceptive in the form of birth control pills. She subsequently experienced a panic attack just after she had stopped taking the pills. This was characterized by palpitation, general fatigue, trembling of the whole body, and dyspnea. The panic disorder experienced by the patient could have been due to the drug's potentiating of the sympathoadrenal response to simple physiological stimuli, or possibly to a disorder in psychological functioning caused by an anxiotropic effect of rapid endocrinological change.


Endometrioid carcinoma of the ovary presenting as primary carcinoma of the breast. A case report and review of the literature. A case is presented of endometrioid carcinoma of the ovary, metastasizing to the breast in a 63-year old woman. Differentiation of metastatic cancer to the breast for primary breast carcinoma and discovering the primary tumor site are rather important for treatment and prognosis. Lumpectomy, followed by panhysterectomy, was performed and six courses of cisplatinum and cyclophosphamide were given. No signs of recurrence or metastasis are apparent 16 months after the discovery of the breast lesion.


Isolation of subclones with different tumorigenicity and metastatic ability from rat nephroblastoma cell line, ENUT. Seven subclones derived from a chemically induced rat nephroblastoma cell line, ENUT, were isolated and their cytological characteristics were examined in order to investigate the biological nature of the parent tumor. The subclones were divisible into two types based on morphological and biological features: polygonal cells with well developed junctional complexes and less developed cell surface microvilli, showing a doubling time of 13.0 to 14.0 h and tumorigenicity in nude mice of 42-100%, and spindle-shaped cells with poorly developed junctional complexes and well developed microvilli, showing a doubling time of 9.7 to 12.2 h and 100% tumorigenicity. Potential for both spontaneous and experimental metastasis to the lungs was apparently higher in the spindle-shaped clones than in the polygonal clones. In spite of their differing characteristics, the cytochemical phenotypes of the two clonal types were almost identical to those of immature renal tubules of the developing fetal kidney. The present findings suggest that these subclones possess characteristics of early nephrogenic epithelial cells, and we speculate that the biological differences observed among the subclones may be explained by differences in malignant progression. In addition, these clones appear to be a useful model for the study of tumorigenicity and metastasis.


DNA value and prognosis of renal tumors. Differences between childhood and adult tumors. In an attempt to reveal characteristic DNA ploidy patterns in primary renal tumors in children and adults, the nuclear DNA contents of 71 tumors were investigated. Nuclear DNA contents were measured by epifluorescence microscopy. The ploidy patterns of renal cell carcinomas (RCCs) and Wilm's tumors (WTs) were different. In RCCs there was no predominant DNA value, and aneuploidy indicated a poorer prognosis than diploidy. In contrast, a diploid pattern was predominant in WTs regardless of the prognosis. These results appear to reflect differences between adults and children in the mechanisms of tumorigenesis of renal tumors.


Benign fibrous histiocytoma of the renal capsule. The first case of benign fibrous histiocytoma of the renal capsule is reported in a male aged 44 years. The tumor had its point of origin in the renal capsule. Histologically, the tumor was composed of intersecting fascicles of fibroblastic cells forming a loose crisscross or "storiform" pattern. Electron microscopic studies of tumor cells revealed intermediate filaments and membrane-bound collagen fibers which continued to extracellular collagen bundles. This deep seated fibrous histiocytoma had a more prominent storiform pattern and fewer secondary elements such as xanthoma cells than cutaneous ones.


Defective bone formation by Hyp mouse bone cells transplanted into normal mice: evidence in favor of an intrinsic osteoblast defect. The hypophosphatemic (Hyp) mouse is an animal model for human hypophosphatemic vitamin D-resistant rickets. We have reported that bone cells isolated from Hyp mice born to homozygous mutant females produce abnormal bone when transplanted into normal mice. To test whether an environmentally acquired defect of the mutant cells contributed to the impaired bone formation observed in transplants, periostea and osteoblasts from normal and Hyp littermates were transplanted intramuscularly into normal animals. To test more specifically for an hypophosphatemia-induced cell alteration before transplantation, bone cells isolated from phosphate-depleted normal mice were transplanted into normal animals. The bone nodules formed in 2 week transplants were characterized by measuring their osteoid thickness and volume. Impaired bone formation was evidenced in Hyp transplants compared to normal littermate transplants by increased osteoid thickness and volume. In contrast to cells from mutant mice, cells isolated from normal mice with comparable hypophosphatemia produced normal bone. These results indicate that the inability of Hyp osteoblasts to produce normal bone when placed in a normal environment is not the consequence of prior exposure to an altered environmental but likely of an intrinsic cellular abnormality. These observations add further support to the concept that the osteoblast is an important target for the Hyp mutation.


Diet and risk of clinical diabetes in women. To determine the relations of diet with risk of clinical noninsulin-dependent diabetes, we analyzed data from a prospective cohort of 84360 US women. During 6 y of follow-up we identified 702 definite incident cases. Because body mass index (BMI) is a powerful risk factor for diabetes, we examined the relations of fat (including type), fiber, sucrose, and other components of diet to risk of diabetes, among women with BMIs (in kg/m2) less than 29 kg/m2. After controlling for body mass index, previous weight change, and alcohol intake, we observed no associations between intakes of energy, protein, sucrose, carbohydrate, or fiber and risk of diabetes. Compared with women in the lowest quintile of energy-adjusted intake, and relative risks (and tests for trend) for those in the highest quintile were 0.61 (P trend = 0.03) for vegetable fat, 0.62 (P trend = 0.008) for potassium, 0.70 (P trend = 0.005) for calcium, and 0.68 (P trend = 0.02) for magnesium. These inverse associations were attenuated among obese women (BMIs greater than or equal to 29).


Wheat-bran and oat-bran supplements' effects on blood lipids and lipoproteins. To compare the effects of oat-bran fiber on blood lipids, we studied 84 healthy middle-aged men and women who were placed on metabolic diets, for 2 wk, that were supplemented with either wheat bran (n = 42) or oat bran (n = 42). Fiber supplementation was 1.6 micrograms dietary fiber/J (6.8 g dietary fiber/1000 kcal) to a maximum of 16.4 g fiber/d. Significantly greater decrease with oat than with wheat were seen in total cholesterol (0.56 +/- 0.08 mmol/L and 0.29 +/- 0.08 mmol/L, P = 0.022) and low-density-lipoprotein cholesterol (0.39 +/- 0.07 mmol/L and 0.15 +/- 0.07 mmol/L, P = 0.024). No significant differences were seen in high-density lipoprotein, apolipoproteins A-1 and B, or triglyceride. We conclude that oat bran has an advantage over wheat bran in lowering serum lipids when tested in metabolic diets on large numbers of individuals with an initial mean serum cholesterol concentration above the desirable range, at 5.61 +/- 0.16 mmol/L.


Dinucleotide repeat polymorphisms at the SCN4A locus suggest allelic heterogeneity of hyperkalemic periodic paralysis and paramyotonia congenita. Two polymorphic dinucleotide repeats--one (dGdA)n and one (dGdT)n--have been identified at the SCN4A locus, encoding the alpha-subunit of the adult skeletal muscle sodium channel. When typed using PCR, the dinucleotide repeats display 4 and 10 alleles, respectively, with a predicted heterozygosity of .81 for the combined haplotype. We have applied these polymorphisms to the investigation of hyperkalemic periodic paralysis and paramyotonia congenita, distinct neuromuscular disorders both of which are thought to involve mutation at SCN4A. Our data confirm the genetic linkage of both disorders with SCN4A. Haplotype analysis also indicates the strong likelihood of allelic heterogeneity in both disorders.


The mitochondrial tRNA(Leu(UUR)) mutation in mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS): genetic, biochemical, and morphological correlations in skeletal muscle. Mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS) has recently been associated with an A----G transition at position 3243 within the mitochondrial tRNA(Leu(UUR)) gene. Besides altering the tRNA(Leu(UUR)) sequence, this point mutation lies within a DNA segment responsible for transcription termination of the rRNA genes. We have studied the distribution and expression of mutant mtDNAs in muscle biopsies from MELAS patients. Histochemical, immunohistochemical, and single-fiber PCR analysis showed that ragged-red fibers (RRF) are associated both with high levels of mutant mitochondrial genomes (greater than 85% mutant mtDNA) and with a partial cytochrome c oxidase deficiency. By quantitative in situ hybridization, the steady-state ratios of mRNAs:rRNAs were found to be similar to controls in six of eight patients studied. In two other patients the relative levels of heavy-strand mRNAs were slightly increased, but a patient with myoclonic epilepsy and RRF also exhibited a similar increase. These results directly correlate the A----G transition at mtDNA position 3243 with muscle mitochondrial proliferation, partial respiratory-chain impairment, decreased mitochondrially synthesized protein content, and no specific alterations in mitochondrial ratios of mRNAs:rRNAs.


Phenotypic, cytogenetic, and molecular studies of three patients with constitutional deletions of chromosome 5 in the region of the gene for familial adenomatous polyposis. We have studied three patients, one with extensive polyposis of the colon, who have constitutional interstitial deletions of the long arm of chromosome 5. High-resolution banding studies indicated that the deletion in the patient with polyposis spans the region 5q21-q22, which includes APC, a gene involved in familial adenomatous polyposis and sporadic colon cancer. Molecular analysis with probes for sequences flanking APC confirmed this conclusion. The deletions in the other two patients, who are too young to have developed polyposis, had breakpoints within this region, precluding the use of cytogenetic analysis alone in making definitive predictions about their risks. Molecular studies resolved the uncertainty; in situ and quantitative Southern hybridizations of four probes for polymorphic segments revealed that one of the patients has a deletion of MCC, a gene which is approximately 150 kb proximal to APC, and two flanking markers. He is at increased risk for polyposis, while the other patient is not. The physical descriptions of these patients, in conjunction with cases in the literature, begin to allow delineation of two distinct 5q-syndromes. These studies also provide precise physical mapping data for D5S71, D5S81, D5S84, and MCC on 5q.


Reduced mRNA and a nonsense mutation in the insulin-receptor gene produce heritable severe insulin resistance. Leprechaunism is an autosomal recessive syndrome of severe insulin resistance and is characterized by intrauterine growth restriction, acanthosis nigricans, hirsutism, and loss of glucose homeostasis. Here we report a new female patient of Hispanic and Afro-American descent whose fibroblasts and lymphoblasts had markedly impaired insulin binding (less than 10% of that in controls). Insulin binding to lymphoblasts established from both unrelated parents was partially impaired. Insulin-like growth factor-I (IGF-I) and epidermal growth factor (EGF) binding to the patient's fibroblasts were within the normal range. Insulin stimulation of receptor autophosphorylation and kinase activity was markedly reduced in the patient's fibroblasts. The patient's fibroblasts had both a reduced number of immunoreactive insulin receptor (6% of those in controls) and concomitantly reduced amounts of insulin-receptor mRNA, suggesting that both mutations inherited by the patient reduced insulin-receptor mRNA. Sequencing of the insulin-receptor gene and cDNA indicated that the patient was heterozygous for a paternally derived mutation at bp 1333, converting Arg372 to a STOP codon. This nonsense mutation was observed in the insulin-receptor gene, but not in cDNA, indicating reduced amounts of mRNA for the allele containing this mutation. The coding sequence of the maternally inherited insulin-receptor allele was normal. Both the marked reduction in insulin-receptor mRNA in the compound heterozygous fibroblasts of the proband and the partially reduced insulin binding in maternal cells suggest that the maternally derived mutation is located in an insulin-receptor gene sequence that controls cellular mRNA content.


[Malignant fibrous histiocytoma of the larynx]. Clinical description of a case of FMH in a 77 years-old man, heavy smoker and diabetic. At the beginning its appearance mimic a small polyp of the middle third of the right vocal cord. The patient refused any treatment at first, but one year later, when seen again in the office, a mass covering-up the right hemilarynx was detected and a total laryngectomy was advised and done. In spite of the correctness of the follow-up in the next six months, the unhappy commit suicide.


Localization of the calcium release channel gene in cattle and horse by in situ hybridization: evidence of a conserved synteny with glucose phosphate isomerase. In situ hybridization techniques were used to localize regionally the calcium release channel (CRC) gene on cattle and horse chromosomes, using a porcine CRC cDNA probe. In cattle, the hybridization signal peaked on the 18q23-q26 bands and in horse on the 10pter region. Previous studies have shown that the glucose phosphate isomerase (GPI) gene localizes at the same site in both species, indicating that the two loci are syntenic. As CRC and GPI are syntenic in human, pig and mouse, the present results in cattle and horse represent another example of synteny conservation in the evolution of mammalian chromosomes.


Transmandibular transpterygoid approach to the nasopharynx, parapharyngeal space, and skull base. The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasma had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.


Effect of the radioprotector WR2721 on irradiation-induced injury to ciliated cells of eustachian tube. Our previous studies revealed that injury to the ciliated cells of the eustachian tube may be the primary cause of irradiation-induced serous otitis media. The purpose of this study was to investigate the effects of the radioprotector WR2721 on irradiation-induced injury to ciliated cells of the eustachian tube (ET) in chinchillas. Twelve chinchillas were divided into two groups: the control group and the experimental group, which was pretreated with a single intraperitoneal dose of the radioprotector S-2-[3-aminopropylamino]ethylphosphorothioic acid (WR2721) 400 mg/kg. The two groups were exposed to 30 Gy of 13-MeV electrons in a single fraction to the area of the bullae and nasopharynx. Ciliary dysfunction was tested and ciliated cells of the ET were examined by scanning and transmission electron microscopy. Pretreatment with WR2721 was found to protect ciliated cells of the ET from irradiation injury.


Detection of human papillomavirus infection in diseased and nondiseased sites of the respiratory tract in recurrent respiratory papillomatosis patients by DNA hybridization. We examined 12 recurrent respiratory papillomatosis patients, who were undergoing treatment for recurrence of their disease, for the presence of human papillomavirus (HPV). Biopsies were obtained from their respiratory papillomas and nondiseased sites (NDS) of the respiratory tract: the nasopharynx, posterior tonsillar pillar, aryepiglottic fold, cervical trachea, intrathoracic trachea, and bronchi. The presence of HPV DNA was determined by using the ViraPap/ViraType DNA hybridization procedure. Two thirds of the patients were infected with HPV 6/11 in either the diseased papilloma or NDS: 50% of patients with papilloma specimens typed positive (6 of 12), and 40% of the patients typed HPV-positive in one or more biopsies from the NDS (4 of 10). No single NDS was more likely to be infected with HPV than any other. No oncogenic HPV types 16/18 or 31/33/35 were detected in the papillomas or NDS of these patients. Only patients with multiple, and not isolated, papilloma involvement were found to harbor HPV DNA in NDS; and 80% of those with infected NDS, compared to 20% of those without infected NDS, required a shorter (no more than 3 months) surgical treatment interval. Our results show that HPV infection frequently persists in adjacent, clinically normal sites, and suggest that the extent of NDS involvement may predict both the extent of disease and the likelihood of recurrence.


[Acute heart insufficiency in an 8-month-old infant presenting with hypocalcemia and Epstein-Barr virus infection: acute myocarditis? Or primary hypokinetic dilated cardiomyopathy?]. An eight-month-old was admitted for acute congestive heart failure with fever. The respective parts played by hypocalcemia (due to vitamin-D deficiency rickets) and acute Epstein-Barr virus infection are discussed. Hypocalcemia was sufficiently marked to induce heart failure per se but replenishment of calcium stores was followed by only partial improvement in cardiac manifestations. Initial management was difficult because of the risks associated with concomitant administration of calcium and digitalis. After eighteen months during which the patient's status remained stable, evaluation showed that clinical features were consistent with sequelae of acute viral myocarditis. The possibility of primary hypokinetic dilated cardiomyopathy was then considered. Esterified carnitine levels were found to be increased leading to further investigations which outruled mitochondrial cytopathy.


Leukocyte activation with increased expression of CR3 receptors during cardiopulmonary bypass. The effects of cardiopulmonary bypass (CPB) on the expression of leukocyte adhesive receptors, ie, complement receptor type 3 (CR3), were studied in 16 patients. The CR3 expression on leukocytes was determined by time-resolved fluoroimmunoassay on a standardized number of cells isolated from blood samples taken during various times during CPB. The results demonstrated that CR3 expression on leukocytes increased immediately after the start of CPB (p less than 0.05), concomitant with an early sharp increase of plasma concentrations of C3a (p less than 0.01). After release of the aortic cross-clamp, a second peak of leukocyte CR3 expression was induced (p less than 0.05), paralleled by a significant increase of leukotriene B4 (p less than 0.05) and elastase (p less than 0.05) levels in the late period of CPB. In vitro studies with leukocytes isolated from healthy donors (n = 5) showed a dose-dependent increase of CR3 expression stimulated by zymosan-activated plasma, indicating that the rapid CR3 expression on leukocytes is likely mediated by complement activation. However, the mechanisms for the second peak of leukocyte CR3 expression during CPB remain to be further elucidated. In conclusion, CR3 expression on leukocytes increased immediately after the start of CPB and was followed by a second peak of expression in the late phase of CPB. Pharmacological blockage of these adhesive receptors might reduce the leukocyte-mediated deleterious effects of CPB.


Expression of porcine pseudorabies virus genes by a bovine herpesvirus-1 (infectious bovine rhinotracheitis virus) vector. Recombinant DNA techniques were used to insert foreign genes into bovine herpesvirus-1 [infectious bovine rhinotracheitis virus (IBRV)] vectors which were attenuated by deletion and/or insertion mutations in the IBRV thymidine kinase (tk) gene. In one recombinant, the regulatory and coding sequences of the late pseudorabies virus (PRV) glycoprotein gIII gene, were inserted into the early IBRV tk gene. This recombinant efficiently expressed the PRV gIII gene indicating that immediate early IBRV proteins were competent to transactivate the late PRV gIII gene. IBRV vector viruses were also prepared in which the coding sequences of the early PRV tk gene, the late PRV gIII gene, and the E. coli beta-galactosidase gene were ligated to the late IBRV gIII promoter. Genotypes and phenotypes of the recombinant viruses were verified by restriction endonuclease and molecular hybridization experiments, thymidine plaque autoradiography, beta-gal plaque assays, and by immunoprecipitation experiments on extracts from 3H-mannose-labelled cells. The recombinant IBRV expressing beta-gal from the IBRV gIII promoter has been useful as an intermediate in the construction of IBRV vectors harboring foreign DNA sequences. The infectivity of the IBRV recombinant that expressed PRV gIII from the IBRV gIII promoter, was neutralized by polyclonal PRV antisera and by monoclonal antibodies to PRV gIII. The PRV gIII glycoprotein synthesized by the preceding recombinant has been used to coat microtiter test plate wells in a PRV gIII differential diagnostic test kit.


In vitro transcription and translation of genomic RNA from a porcine group C rotavirus. Eleven segments of ssRNA were synthesized from dsRNAs of a porcine group (Gp) C rotavirus (Cowden strain) using an in vitro transcription system. In vitro translation of unfractionated ssRNAs revealed at least nine viral proteins, ranging from 22 kDa to 93 kDa. The 37 kDa and 25 kDa proteins were glycosylated as demonstrated by the endoglycosidase H assay. In vitro translated products analyzed by SDS-polyacrylamide gel electrophoresis and partial protease peptide mapping were comparable to those synthesized in vivo (MA 104 cells).


[Partial obliteration of radical cavities with ceramic granules]. The canal wall surgery is the safest way to eradicate cholesteatoma. Extensive radical cavities often induced a permanently discharging ear. This article review first of all the common obliteration methods of radical cavities. Since july 1987 to may 1991 we made a partial obliteration of radical cavities with hydroxylapatite granulate in 72 cases. 66 patients were reexaminated. In more than 95% we see a permanent dry cavity, no cholesteatoma recurrence. The ceramic granulate technique is contradicted in fistula of the labyrinth, dissection of the sinus sigmoideus or of the dura. Compared with other relevant techniques (i.e. pedicaled subcutis muscle flaps, free tissue flaps or bone chips) we see no crumpling up of the obliterated areas and no retractions. We have leaved our obliteration technique with homologous cartilage chips because of the possibility of HIV-infection, and longer ear-secretion after cartilage chips.


Prevention by morphine of apomorphine- and oxytocin-induced penile erection and yawning: site of action in the brain. The effect of morphine administered systemically or into the paraventricular nucleus of the hypothalamus (PVN) on penile erection and yawning induced either by oxytocin or by the dopaminergic agonist apomorphine was studied in male rats. Systemic morphine (0.5 to 5 mg/kg intraperitoneally [IP]) prevented in a dose-dependent manner penile erection and yawning induced by the intracerebroventricular injection (ICV) of oxytocin (30 ng) or by the subcutaneous (SC) administration of apomorphine (80 micrograms/kg). Morphine (0.1 to 5 micrograms), but not U-69,593 (5 micrograms), injected into the PVN 10 minutes before oxytocin or apomorphine, was found to be able to prevent penile erection and yawning induced by the unilateral PVN microinjection of oxytocin (10 ng) or apomorphine (50 ng). The morphine-induced prevention of these behavioral responses was abolished by pretreatment with naloxone (3 mg/kg IP) 15 minutes before morphine. The present results suggest that morphine prevents apomorphine- and oxytocin-induced penile erection and yawning by inhibiting the activity of oxytocinergic neurons through mu-type receptors in this hypothalamic nucleus.


Hyperactivity, hyper-reactivity, and sensorimotor deficits induced by low doses of the N-methyl-D-aspartate non-competitive channel blocker MK801. Three doses of MK801 (0.05 mg/kg, 0.3 mg/kg and 1.0 mg/kg) were given systemically to adult male rats, which were then tested on a battery of previously learned, reactive and spontaneous behaviors. Hyperactivity, hyper-reactivity, reductions in rearing behavior and deficits in tongue extension were found at the 0.05 mg/kg dose. Similar, but more severe results were found at the 0.3 mg/kg dose, with the addition of difficulties in climbing, balancing on a beam, and abnormalities in orienting to tactile stimuli. A number of tasks could not be performed at the 1.0 mg/kg dose including tongue extension, orienting, balancing on a beam, and climbing. Additionally, abnormal postures, gaits, and swimming behaviors were observed at this dose. These results characterize the behavioral effects of MK801 as a syndrome of hyperactivity, hyper-reactivity, and sensorimotor deficits. Evidence of this syndrome was present at all three doses, including the 0.05 mg/kg dose, which previously has been claimed to induce deficits similar to hippocampal lesions. Learning literature employing MK801 is discussed in the context of the behavioral deficits found in this study.


Mechanisms of aldehyde-induced bronchial reactivity: role of airway epithelium. To investigate the relative irritant potencies of inhaled aldehydes, guinea pigs were exposed to formaldehyde or acrolein and specific total pulmonary resistance and bronchial reactivity to intravenous acetylcholine were assessed. The mechanisms associated with these responses were investigated by analyzing morphologic and biochemical changes in airway epithelial cells after in vivo and in vitro exposures. Immediately after exposure to formaldehyde or acrolein, specific resistance increased transiently and returned to control values within 30 to 60 minutes. Bronchial hyperreactivity, assessed by the acetylcholine dose necessary to double resistance, increased and became maximal two to six hours after exposure to at least 9 parts per million2 (ppm) formaldehyde or at least 1 ppm acrolein for two hours. The effect of exposure to 3 ppm formaldehyde for two hours was less than the effect of exposure to 1 ppm formaldehyde for eight hours; thus, extended exposures produced a disproportionate heightening of bronchial reactivity. Bronchial hyperreactivity often persisted for longer than 24 hours. Increases in three bronchoconstrictive eicosanoids, prostaglandin F2 alpha, thromboxane B2, and leukotriene C4, occurred immediately after exposure, whereas an influx of neutrophils into lavage fluid occurred 24 hours later. Histological examination of the tracheal epithelium and lamina propria also demonstrated a lack of inflammatory cell infiltration. Treatment with leukotriene synthesis inhibitors and receptor antagonists inhibited acrolein-induced hyperreactivity, supporting a causal role for these compounds in this response. Acrolein also stimulated eicosanoid release from bovine epithelial cells in culture. However, the profile of metabolites formed differed from that found in lavage fluid after in vivo exposure. Similarly, human airway epithelial cells did not produce cysteinyl leukotriene or thromboxane B2. However, cysteinyl leukotrienes were mitogenic for human airway epithelial cells in a concentration-dependent manner and exhibited a structure-activity relationship; leukotriene C4 was more potent than its sequential metabolites D4 and E4. The potency of leukotriene C4 was striking, stimulating colony-forming efficiency in concentrations as low as 0.01 pM. Together, these findings suggest that environmentally relevant concentrations of aldehydes can induce bronchial hyperreactivity in guinea pigs through a mechanism involving injury to cells present in the airways during exposure (rather than from subsequently recruited migratory cells) and that this response is dependent on leukotriene biosynthesis.


Salivary gland neoplasms in children.

Salivary gland neoplasms in children. Of 29 patients, aged 3 to 16 years, with nonvasoformative salivary gland tumors, 21 had malignant tumors. Mucoepidermoid carcinoma was the most common; adenocarcinoma, adenoid cystic carcinoma, and acinic cell carcinoma were equally represented. Pleomorphic adenoma was the exclusive benign lesion, occurring in eight patients. Mean follow-up for patients with malignant lesions was 13.6 years (minimum, 3.5 years). Absolute 2- and 5-year survival rates were 100% and 90%, respectively. Mean follow-up for benign lesions was 15.9 years; none recurred. Superficial or total parotidectomy is the treatment of choice for malignant parotid neoplasms. Benign parotid lesions are adequately controlled with parotidectomy based on extent of disease. Facial nerve sacrifice can often be avoided. We advocate postoperative radiotherapy for high-grade lesions or those with adverse prognostic factors, such as soft-tissue extension and perineural invasion.


Some immunohistochemical features of argyrophilic grain dementia with normal cortical choline acetyltransferase levels but extensive subcortical pathology and markedly reduced dopamine. Detailed immunohistochemical and biochemical studies are reported on two cases of progressive dementia showing no Alzheimer-type pathology but extensive argyrophilic grains as described previously by Braak and Braak. These cases had no specific clinical features, and the pathology of these brains showed subcortical gliosis (proliferation of astrocytes and microglia) without significant neuronal losses. Interesting novel immunohistochemical findings were the profuse appearance of complement-activated oligodendrocytes and oligodendroglial microtubular masses. Their appearance seems to indicate oligodendroglial reactions to widespread damage of myelinated axons. Cortical levels of choline acetyltransferase were normal, but striatal levels of dopamine and its metabolites were markedly reduced. This disease may be consistent with the criteria for progressive subcortical gliosis.


Rapid isolation of serum albumin using microporous PVC/silica cartridges. A protocol has been developed for rapid isolation of albumin from rabbit or bovine serum. It is based on the use of microporous plastic silica sheets that have been fabricated into rapid flow-through devices called ACTI-MOD cartridges. In the first step, the untreated silica plastic matrix binds a major portion of the non-albumin protein. A second step, using an ACTI-MOD anion-exchange quaternary amine, further purifies and concentrates the albumin. At this stage, the albumin appears to be at least ninety-nine per cent pure based on sodium dodecyl sulfate gel electrophoresis.


Localization of DNase I-hypersensitive regions during rat spermatogenesis: stage-dependent patterns and unique sensitivity of elongating spermatids. DNase I-hypersensitivity of rat spermatogenic cells was analyzed 1) to establish overall patterns of hypersensitivity in individual cell types, 2) to correlate these patterns with known changes in chromatin organization and function, and 3) to provide a foundation for further analyses examining DNase I-hypersensitivity and the localization of specific genes during spermatogenesis. Parameters for in situ nick translation, using radioactive and fluorescent probes to visualize DNase I-hypersensitive regions (DHR), were established for fixed and sectioned testicular preparations, permeabilized cells, and isolated germ cell nuclei. As anticipated, the pattern of DHR changed in a cell-type specific manner during the course of spermatogenesis, reflective of known stage-dependent alterations in the composition and structure of both the chromatin and the nuclear lamina/matrix as well as changes in gene expression. DHR in preleptotene spermatocytes were primarily peripheral, while in pachytene spermatocytes they were localized along the condensed chromosomes. The pattern of DHR changed from "checkerboard" in steps 7-8 round spermatid nuclei to "lamellar" in steps 10-11 elongating spermatids. In steps 12-13 elongating spermatids. DHR were localized throughout the nuclei or in a graded manner--increasing from anterior to posterior and mirroring the pattern of chromatin condensation. However, unlike the case in other stages, DNA of steps 12-13 elongating spermatids was exquisitely sensitive to nick translation even in the absence of exogenous DNase I. In contrast to the labeling of earlier stages, steps 16-19 spermatids and mature spermatozoa did not demonstrate DNase I-hypersensitivity under any conditions employed. A variety of agents that interact with topoisomerase II and DNA (teniposide, novobiocin, ethidium bromide, and adenosine triphosphate) were tested to determine the basis for the unique sensitivity to nick translation of steps 12-13 elongating spermatids. None of the agents tested, however, affected this unique labeling. The sensitivity of steps 12-13 elongating spermatids to nick translation in the absence of exogenous nuclease indicators the presence of endogenous nicks, which may relieve torsional stress and aid rearrangement as the chromatin is packaged into a form characteristic of the mature spermatozoon.


A comparison of regulatory features in primate lentiviruses. Historically, research into the regulation of gene expression in primate lentiviruses has focused on human immunodeficiency virus type 1 (HIV-1), the primary cause of acquired immunodeficiency syndrome (AIDS) in humans. The increasing emergence of HIV-2 as a human pathogen, and the importance of the various simian immunodeficiency viruses (SIV) as models for the treatment and prevention of HIV-1-induced disease, suggest that an understanding of gene regulation in these related viruses will become increasingly important. Here, the present state of knowledge in this latter field is reviewed. In general, while the data support the hypothesis that viral gene expression is regulated by very similar mechanisms in all primate lentiviruses, it also is clear that differences in detail do exist. These differences may influence the pathogenic potential of the different strains of primate lentiviruses and must be considered in evaluating SIV as an appropriate in vivo model for HIV-1.


Effects of isoproterenol and forskolin on carbachol- and fluoroaluminate-induced polyphosphoinositide hydrolysis, inositol trisphosphate production, and contraction in bovine iris sphincter smooth muscle: interaction between cAMP and IP3 second messenger systems. We have investigated the effects of isoproterenol (ISO) and forskolin on carbachol(CCh)- and fluoroaluminate (AlF4-)-induced phosphatidylinositol 4,5-bisphosphate (PIP2) hydrolysis, myo-inositol 1,4,5-trisphosphate (IP3) production, 1,2-diacylglycerol, measured as phosphatidic acid (PA) formation, and contraction in the bovine iris sphincter smooth muscle. The data from these studies can be summarized as follows. (1) CCh (20 microM) stimulated significantly PIP2 hydrolysis, IP3 production, PA formation, and contraction. (2) Addition of ISO (0.1-25 microM), which raises the tissue cAMP level, to muscle precontracted with CCh attenuated PIP2 hydrolysis, IP3 production, PA formation and contraction in a time- and dose-dependent manner. (3) AlF4- (10 microM) induced a slow but progressive hydrolysis of PIP2, accompanied by parallel production of IP3, formation of PA, and contraction of the smooth muscle. The effects of AlF4- were dose-dependent and inhibited by deferoxamine, an Al3+ ion chelator. (4) Both forskolin (1-25 microM), which directly stimulates adenylate cyclase, and ISO inhibited the responses induced by AlF4- (10 microM) in a dose-dependent manner. (5) NaF (1-5 mM) had no effect on the activity of phospholipase C (PLC), purified from bovine iris sphincter. Furthermore, phosphorylation of the enzyme by catalytic subunit of protein kinase A had no inhibitory effect on PLC activity against PIP2. In conclusion, neither the muscarinic receptor nor PLC are the target sites for cAMP inhibition; instead the putative G-protein, which couples the activated muscarinic receptor to PLC, may be phosphorylated by cAMP-dependent protein kinase. This could attenuate the stimulation of PLC by the G-protein, thus resulting in inhibition of PIP2 hydrolysis and consequently leading to muscle relaxation. These results demonstrate cross-talk between the cAMP and IP3-Ca2+ second messenger systems and suggest that this could constitute a regulatory mechanism for the process of contraction-relaxation in smooth muscle.


Cholera and pertussis toxins modify regulation of glucose transport activity in rat adipose cells: evidence for mediation of a cAMP-independent process by G-proteins. Adenylyl cyclase in rat adipose cells is stimulated by ligands for Rs receptors (e.g. isoproterenol) and inhibited by ligands for Ri receptors (e.g. adenosine). In contrast, Rs receptors mediate inhibition and Ri receptors mediate augmentation of insulin-stimulated glucose transport activity by a process independent of changes in cellular cAMP-dependent protein kinase activity [Kuroda M., Honnor R. C., Cushman S. W., Londos C. and Simpson I. A. (1987) J. biol. Chem. 262, 245-253]. The present study examines the possible role of G-proteins in the regulation of insulin-stimulated glucose transport activity by Rs and Ri receptors. First, conditions were established that permit intoxication of isolated rat adipocytes by cholera and pertussis toxins without compromising cell integrity. Effectiveness of toxin treatment was monitored by examining adenylyl cyclase activity in isolated plasma membranes. Secondly, neither toxin interfered with the ability of a maximal concentration insulin to initiate the glucose transport response. Thirdly, pertussis toxin eliminated the augmenting effects of adenosine on insulin-stimulated glucose transport activity, but enhanced the inhibitory effects of isoproterenol. Findings with ligands for other Ri receptors (nicotinic acid and prostaglandin E2) mirrored those with adenosine. Finally, cholera toxin elicited a modest depression of transport activity, and only in the absence of an Ri ligand (e.g. adenosine). Furthermore, in contrast to the enhanced stimulation of adenylyl cyclase by isoproterenol and GTP, cholera toxin eliminated the inhibitory effect of isoproterenol on transport activity. The augmentative effects of adenosine on transport activity were unchanged. Measurements of (-/+cAMP) cAMP-dependent protein kinase activity ratios reinforce the notion that modulation of glucose transport activity is independent of changes in cAMP. We conclude that regulation of glucose transport activity by Rs and Ri receptors is mediated by the G-proteins, Gs and Gi (or other toxin substrates), respectively. Inasmuch as such regulation occurs at the plasma membrane and appears to be cAMP-independent, it is suggested that glucose transporters may be direct targets for receptor: G-protein interactions.


1,25(OH)2D3 increases membrane associated protein kinase C in MDBK cells. To determine whether 1,25-dihydroxycholecalciferol [1,25(OH)2D3] affects protein kinase C (PKC) activity in kidney, as has been demonstrated in HL-60 cells we measured 1,25(OH)2D3 binding, PKC activity and PKC immunoreactivity in Madin Darby bovine kidney (MDBK) cells, a normal renal epithelial cell line derived from bovine kidney. Our data demonstrate that MDBK cells exhibit specific high affinity binding for 1,25(OH)2D3, indicating the presence of the vitamin D receptor (VDR). Treatment of MDBK cells with 1,25(OH)2D3 for 24 h increased membrane PKC activity and immunoreactivity. The effect of 1,25(OH)2D3 was dose-dependent, with a peak effect observed at 10(-7)M 1,25(OH)2D3. The 1,25(OH)2D3 induced increase in membrane PKC was paralleled by a comparable decrease in cytosolic PKC activity and amount. Although time course studies were consistent with a VDR mediated effect of 1,25(OH)2D3 on PKC protein synthesis, total PKC activity was not increased by 1,25(OH)2D3, suggesting an effect on PKC translocation or localization. These results suggest that 1,25(OH)2D3 modulates PKC mediated events in kidney, a classic target for this steroid hormone.


Pharmacokinetics of ganciclovir in renal transplant children. Three cytomegalovirus (CMV)-seronegative children received renal transplants from CMV-seropositive donors and developed clinical symptoms of CMV infection between days 20 and 34 post transplantation. Ganciclovir (DHPG) was administered in a 1-h infusion, and the doses and dose intervals were adapted to the degree of renal insufficiency, according to the manufacturer's recommendations for adults. Individual pharmacokinetic parameters of DHPG were determined and were markedly altered. Plasma clearances were 0.4, 1.1 and 2.2 ml/min per kg and were related to individual creatinine clearances (20, 45 and 60 ml/min per 1.73 m2); the corresponding elimination half-lives were 23.7, 9.9 and 3.9 h. In two patients, the doses had to be further reduced in order to maintain plasma levels within the recommended values for peak and trough plasma concentrations. Therefore, monitoring of DHPG appears essential in adjusting dosage for optimal efficacy and minimal toxicity.


Acral hyperpigmented macules and longitudinal melanonychia in AIDS patients. Two patients with AIDS are described who developed acral hyperpigmented macules of the fingers, palms and soles, buccal mucosa and genitalia, associated with longitudinal melanonychia. These pigmentary changes seemed to be independent of zidovudine and were associated in one with diffuse melanoderma and elevated levels of alpha-MSH. Histological and ultrastructural studies showed an increase of the dendrites and pigmentation of the melanocytes and few melanosomes in the keratinocytes.


Aggregation and cell cycle dependent retinoic acid receptor mRNA expression in P19 embryonal carcinoma cells. Differentiation of P19 EC cells along different pathways into derivatives resembling cells of the three embryonic germ layers is accompanied by characteristic differences in modulation of expression of each of the three retinoic acid receptor genes, RAR alpha, -beta and -gamma. Differentiation induced by addition of RA to P19 EC cells cultured in monolayer is accompanied by a rapid increase in expression of both RAR alpha and -beta. Induction of RAR beta occurs in a characteristic biphasic manner, suggesting that multiple factors and/or different mechanisms are involved in controlling its expression. RAR beta mRNA is induced to a far higher level during early aggregation in the presence of RA than during early differentiation in monolayer, suggesting that the direction of differentiation depends on the number and/or ratio of alpha and beta type of RA receptors. Aggregation of P19 EC cells in the presence of RA, but not DMSO, is accompanied by repression of RAR gamma, suggesting that the expression of RAR beta and RAR gamma during neuroectodermal differentiation is mutually exclusive. The effects of RA on RAR expression are significantly greater in G1 than in S-phase of the cell cycle. These results extend previous observations that commitment to differentiation is cell cycle dependent and indicates that critical target gene regulation in response to RA has to take place in G1 for differentiation to occur.


Expression of early developmental genes in Dictyostelium discoideum is initiated during exponential growth by an autocrine-dependent mechanism. Throughout growth, Dictyostelium cells continuously produce an autocrine factor, PSF, that accumulates in proportion to cell density. Production of PSF declines rapidly when cells are shifted to starvation conditions, and the properties of PSF are distinct from those of regulatory factors produced by starving cells. During late exponential growth, PSF induces expression of several early developmental genes, including those for proteins important in cAMP signaling and cell aggregation. Examples are the aggregation stage cAMP receptor (cAR1), the aggregation-specific form of cyclic nucleotide phosphodiesterase, and gp24 (contact sites B). Through PSF, growing cells detect environmental conditions (cell number high, food approaching depletion) that are appropriate for production of the gene products needed to initiate aggregation and development.


Biphasic lung diffusing capacity: detection of early asbestos induced changes in lung function. Asbestos related changes in the single breath carbon monoxide diffusing capacity (DLCO) were longitudinally analysed in 14 subjects exposed predominantly to chrysotile asbestos in an asbestos cement factory. These subjects were examined annually over the past nine years; their lung function was initially characterised with increased DLCO as the sole functional abnormality and they had normal chest radiographs. The radiological examination included a chest x ray film and, in the past two years, high resolution computed tomography (HRCT). A biphasic DLCO change was found: an initial increase followed by a relative decrease. The increase in DLCO was mainly caused by an increase in the membrane component (Dm). Indomethacin treatment applied after the sixth annual follow up significantly reduced DLCO and Dm. The decrease in DLCO correlated well with the parenchymal abnormalities found on HRCT, whereas the chest x ray film profusion score for small opacities (ILO classification) was unchanged. In conclusion, the data suggested that, as well as the absolute values of pulmonary function tests, the measurement of progression of functional parameters is essential in the assessment of pleural and parenchymal disease of the lung related to exposure to asbestos. High resolution computed tomography is suggested as the radiological method of choice in subjects with an isolated decrease in DLCO. Exposure to asbestos can be associated not only with a reduction in DLCO, but also with a temporary increase in DLCO caused by a subclinical inflammatory reaction.


Long term radiological effects of short term exposure to amosite asbestos among factory workers. Chest radiographs were read from a sub-cohort of 386 factory workers with short term exposure to amosite asbestos (median exposure six months) and long follow up (median 25 years). Prevalence of abnormality was determined independently by two readers from the first film available after 20 years from first employment. Serial films were obtainable for 238 men (median interval from first to last film: nine years). Progression was classified with a direct progression scoring scale. Individual dust exposure estimates were derived from dust counts from two similar plants. With as little as one month or less of employment, about 20% of the films showed parenchymal abnormality and about a third showed pleural abnormality. Those in the lowest cumulative exposure stratum (less than 5 fibre-years/ml) were similarly found to have high rates of abnormality. Dose-response relations were present in the data of both readers. Smokers had higher rates of parenchymal abnormality. On multivariate analysis, cumulative exposure was the exposure variable most closely related to parenchymal abnormality, and time from first employment was the variable most closely related to pleural abnormality. Progression (including first attacks) 20 or more years after ceasing employment occurred and was more common for pleural than for parenchymal abnormality. It is concluded that with exposure to high concentrations to amosite such as existed in this factory and with follow up for at least 20 years, (1) exposure for as little as a month was sufficient to produce radiological signs of parenchymal and pleural fibrosis, (2) no cumulative exposure threshold for parenchymal and pleural fibrosis was detectable, and (3) parenchymal and pleural progression were still detectable >/= 20 years after the end of exposure.


A resected case of hepatoblastoma originating in the caudate lobe. A very rare case of hepatoblastoma originating in the caudate lobe in an 18-month-old female infant is reported. Three years after surgical resection of the tumor, she is alive without signs of a recurrence.


Wilms' tumor with intracardiac extension. Intracardiac tumor extension from nephroblastoma is a rare event. We report on two cases with this peculiar condition who presented with a different set of signs and symptoms. Both were diagnosed in life but only one could be properly managed on time. Emphasis is made upon the most reliable methodology for early detection and the surgical approach as the only plausible way to solve this particular complication.


Vanadium redox cycling, lipid peroxidation and co-oxygenation of benzo(a)pyrene-7,8-dihydrodiol. Mechanism of lipid peroxidation triggered by vanadium in human term placental microsomes was reinvestigated in vitro. Production of lipid peroxyl radicals was estimated from co-oxygenation of benzo(a)pyrene and benzo(a)pyrene-7,8-dihydrodiol. Vanadyl(IV), but not vanadate(V) caused a dose-dependent co-oxygenation. Vanadate(V) required the presence of reduced nicotinamide adenine dinucleotide phosphate to trigger co-oxygenation of benzo(a)pyrene-7,8-dihydrodiol. To determine the role of pre-formed lipid hydroperoxides, the results obtained with partially peroxidized linoleic acid were compared with those of fresh linoleate. Superoxide dismutase inhibited the co-oxygenation of reaction when fresh linoleic acid was used. To further characterize the role of superoxide anion-radical in the vanadium redox cycling, the increase of optical density of vanadate(V) dissolved in Tris buffer was measured at 328 nm during the addition of KO2. The rate of this reaction producing peroxy-vanadyl complex was decreased by superoxide dismutase, especially, in the presence of catalase. It is suggested that vanadium catalyzes two separate processes, both leading to enhanced lipid peroxidation: (i) initiation, dependent on superoxide and triggered by peroxy-vanadyl; (ii) propagation, dependent on pre-formed lipid hydroperoxide not sensitive to superoxide dismutase. It is postulated that the vanadium-triggered initiation of lipid peroxidation may be crucial for toxicity in organs with limited endogenous lipid peroxidation.


Interaction of azoles with rifampin, phenytoin, and carbamazepine: in vitro and clinical observations. Twelve patients receiving therapy with an azole agent (ketoconazole, itraconazole, and/or fluconazole) for systemic mycoses experienced drug interactions with rifampin, phenytoin, and/or carbamazepine resulting in substantial decreases in azole concentrations in serum. All four patients receiving azoles and concurrent phenytoin and/or carbamazepine failed to respond to treatment or suffered a relapse of their fungal infection. Four of five patients with cryptococcosis who received itraconazole and rifampin responded despite decreases in their serum itraconazole concentrations; synergy between itraconazole and rifampin was documented by in vitro analysis of inhibition and of killing of Cryptococcus neoformans isolates from all patients receiving this combination. In contrast, two patients with coccidioidomycosis failed to respond to itraconazole/rifampin. Moreover, two patients with cryptococcosis suffered a relapse or persistence of seborrheic dermatitis while receiving itraconazole/rifampin. The latter combination showed synergy in vitro in the inhibition of the mycelial phase of Coccidioides immitis and, to a lesser extent, of the pathogenic spherule phase of this fungus; synergy in the killing of C. immitis was not noted, nor was synergy seen against Malassezia furfur, the purported etiologic agent of seborrheic dermatitis. These findings illustrate several drug interactions that may affect clinical outcome and that must be considered in the management of antifungal therapy.


Facial palsy and infection: the unfolding story. While it is now universally accepted that Ramsay Hunt syndrome is caused by varicella-zoster virus, Bell's palsy continues to be labeled "idiopathic." We review the literature associating Bell's palsy with various infectious agents as well as with Kawasaki disease, a condition in which an infectious etiology is suspected. Good evidence--mostly serological--exists for an etiologic role for the herpes group of viruses, mumps virus, and rubella virus. In addition, recent evidence has focused on Bell's palsy in human immunodeficiency virus infection and Lyme borreliosis. In view of the multiplicity of implicated agents, it is likely that the immunologic response associated with infection triggers a cranial or generalized polyneuropathy culminating in facial nerve compression, degeneration, and paralysis. The mounting interest in Bell's palsy, coupled with the increasing availability of more sensitive and specific tests, is likely to augment the available evidence for an infectious etiology and to clarify the role of other, previously unsuspected infectious agents.


Outpatient medical care of injection drug use related HIV. By the end of March 1990 470 HIV positive patients, 77% injection drug use (IDU) related, had attended the outpatient department of the Regional Infectious Disease Unit with a cumulative loss to follow-up of only 20%. Coincident with the prescribing of oral methadone and a specific all-day IDU-related HIV medical clinic the total number of appointments increased from 28/month in May 1986 to 300/month in May 1989 (P less than 0.001) and the number of defaulted appointments decreased from a maximum of 60% (17/28) to 16% (48/294, P less than 0.001) in these months. There was a significant initial increase in the number of defaulted appointments for the infectious disease (ID) clinics from 11% (77/726) to 16% (124/797, P less than 0.01) which returned to previous levels once a specific IDU-related HIV clinic was established. There was also a significant decline in the number of new patients referred which was greater for the urinary tract infection clinics (108 to 56 per 6 months, P less than 0.0001) than for the ID clinics (119 to 88 per 6 months, P less than 0.05).


Detection of an idiotope on a human monoclonal autoantibody by monoclonal anti-idiotypic antibody and its relationship to Epstein-Barr virus-induced autoimmunity. We have recently described a human IgM monoclonal antibody (mAb), reactive with both self antigens, i.e., cytoskeleton filaments and smooth muscle, and Epstein-Barr virus (EBV)-induced nuclear antigen (EBNA), produced by EBV-transformed B lymphocytes isolated from a patient with infectious mononucleosis (IM). In order to achieve higher antibody secretion in culture supernatant, the mAb-producer cells were fused with ouabain-resistant mouse myeloma cells and a stable human-mouse heterohybrid, coded HY 5488, producing up to 80 micrograms/ml IgM mAb, was isolated after 4 cloning procedures. Purified HY 5844 mAb was used to immunize mice for the production of a murine anti-idiotypic mAb, which was used to probe the expression of the idiotope of HY 5488 mAb (Id 5488) in sera of IM patients and normal controls by ELISA. It was found that Id 5488 is expressed both in IM patients and normal controls, and that Id 5488 expression is significantly higher in IM patients' sera; furthermore, in IM sera a statistically significant correlation between Id 5488 expression and anti-cytoskeleton and anti-smooth muscle autoantibodies was found. It is suggested that at least part of EBV-induced IgM autoantibodies appearing during IM are secreted by B lymphocytes programmed to the production of "natural antibodies" bearing Id 5488-like idiotopes.


Prevalence of anti-HCV among Chinese patients with acute and chronic liver disease. To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti-HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non-A, non-B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non-alcoholic fatty liver, 24 patients with toxic and drug-induced hepatitis, and 20 patients with other chronic liver diseases. Anti-HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug-induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti-HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion-associated), 16.4% in non-alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti-HCV prevalence was significantly higher in HBsAg-negative (15/34, 44.1%) than in HBsAg-positive cases (15/404, 3.7%; P less than 0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg-negative chronic liver disease in Taiwan.


Prevalence of hepatitis C infection in Hong Kong. A study of a cross-section of the Hong Kong Chinese population was done to investigate the seroprevalence of hepatitis C. Healthy subjects were random visitors of a health exhibition, while clinical subjects were recruited from an outpatient liver disease clinic, sexually transmitted disease clinics, dialysis centres and drug rehabilitation centres. A total of 910 subjects were tested. The assay kits were from Abbott and Ortho laboratories. Of the general population, 0.5% was found to be positive for antibody to hepatitis C (anti-HCV). Suspected chronic non-A non-B patients, parenteral drug abusers and haemophiliacs shared a common high (up to 70%) prevalence of anti-HCV. Sexual partners of index patients, homosexuals and female prostitutes as well as hepatitis B carriers had 0% prevalence. It was concluded that parenteral and blood product exposures were the two main risk factors for hepatitis C.


[The urethrocystogram and perineal sonography compared]. Perineal sonography and urethrocystography were performed on 45 patients in the same sitting to evaluate the sonographical method with regard to its applicability as a routine examination method. Corresponding results were obtained 14 times (= 30%). In 31 patients (= 70%) urethrocystographic and ultrasonic measurements diverged. The urethrocystogram must therefore remain an integral part in the work-up of urinary incontinence.


Anti-HCV antibody in Chinese cirrhotic patients with or without hepatocellular carcinoma: relation to multitransfusion. To investigate the positive rates of antibodies to hepatitis C virus (anti-HCV) in Chinese cirrhotic patients with or without hepatocellular carcinoma and to evaluate the influence of blood transfusion on the prevalence of anti-HCV in such patients, a longitudinal study in 30 cirrhotic patients (17 combined with hepatocellular carcinoma) was carried out. Five patients (16.7%) were anti-HCV positive before transfusion. The positive rate of anti-HCV in HBsAg-positive patients and HBsAg-negative patients was 9.5% (2/21) and 33.3% (3/9), respectively. The positive rates in cirrhotic patients with or without hepatocellular carcinoma were 23.5% (4/17) and 7.7% (1/13), respectively. The positive rate of anti-HCV increased significantly after multitransfusion, and the estimated infectivity of blood products was 6.1 patients per 1000 units of blood products. It was concluded that the aetiological role of hepatitis C virus on liver cirrhosis and hepatocellular carcinoma in the endemic area of hepatitis B virus is not so important as in Western countries, and transfusion might result in an overestimated pathogenic effect of hepatitis C virus in cirrhotic patients and patients with hepatocellular carcinoma.


A case of percutaneous industrial methanol toxicity. Methanol (CH3OH) is a chemical feedstock of increasing importance as well as a commonly used solvent. In the early 1980s methanol production was introduced at a new petrochemical complex in the Saudi port of Jubail. A case is presented of a consultant supervising tank cleaning prior to methanol loading. He wore positive pressure breathing apparatus but no protective clothing. After 2-3 hours working in the confined space of the tank, he worked on deck and continued to wear his methanol-soaked clothing which eventually dried out. Visual symptoms of acute methanol toxicity presented some 8 hours after exposure. The appropriate treatment (with ethanol provided by the ship bond) was carried out in hospital and the individual recovered completely. Most reported cases of methanol toxicity are social in origin, arising from ingestion. This particular case, though unusual, does present some interesting lessons.


Induction of allogeneic tumour- and lymphokine-activated lymphocytes against hepatocellular carcinoma. For clinical application of adoptive immunotherapy against hepatocellular carcinoma (HCC), it is not easy to prepare tumour specific effector cells such as cytotoxic T lymphocytes (CTL). To induce potent and broad-spectrum effectors, allogeneic cultured hepatoma cell lines (JHH-4 and HuH-6) were used as stimulators of peripheral blood lymphocytes (PBL) instead of autologous HCC cells. Allogeneic tumour- and lymphokine-activated killer cells (ATLAK) were generated by a mixed culture of lymphocytes and allogeneic cultured tumour cells with recombinant interleukin-2 (rIL-2). The tumour-killing activity of ATLAK induced by HuH-6 was confirmed against HuH-6 and other different HCC cell lines (JHH-2, HuH-7 and PLC). These activated lymphocytes were significantly more potent than lymphokine-activated killer cells (LAK) in [51Cr]-releasing assay. The JHH-4 stimulated ATLAK was reactive not only with JHH-4 but also with JHH-2. The lysis of allogeneic targets could be partially inhibited by anti-CD8 and anti-CD3 but not by anti-CD4. Anti-tumour cytotoxicity in these cultures might be mediated by CD3+CD56- and CD3+CD56+ effectors. These results imply that adoptive immunotherapy for HCC with ATLAK may be more feasible than that with LAK.


Cholestatic hepatocellular carcinoma diagnosed by deposits of Lipiodol and treated by combination of endoscopic retrograde biliary drainage and transcatheter arterial embolization. Cholestatic hepatocellular carcinoma, which grows into the bile duct and causes obstructive jaundice, is rare and difficult to diagnose. A case is presented in which cholestatic hepatocellular carcinoma was detected by deposit of Lipiodol. This is also the first case that was successfully treated by endoscopic retrograde biliary drainage and transcatheter arterial embolization.


Tumor necrosis factor stimulates Na+/H+ antiporter in human fibroblasts: dissociation between intracellular alkalinization and cytokine mRNA accumulation. Several hormones and cytokines stimulate the cellular Na+/H+ antiporter and this stimulation may be a signal transduction mechanism to mediate gene expression. We find that tumor necrosis factor rapidly stimulates both the Na+/H+ antiporter and the accumulation of mRNA coding for granulocyte-macrophage colony-stimulating factor and interleukin-6 in fibroblasts. Further experiments show that these phenomena occur independent of each other.


Hepatocellular carcinoma with an unusual papillary vesicular appearance. A resected hepatocellular carcinoma with grossly papillary, whitish cut surfaces and 'vesicles' in a noncirrhotic but hepatitis B surface antigen positive liver is described. This appearance has not previously been reported in the literature. Such an unusual appearance may lead to an erroneous diagnosis by both surgeons and pathologists. Histological features and possible mechanisms for the unusual gross appearance are discussed.


Reconstitution of defective respiratory burst activity with partially purified human neutrophil cytochrome B in two genetic forms of chronic granulomatous disease: possible role of Rap1A. Neutrophil plasma membranes from patients with the X-linked and autosomal recessive forms of chronic granulomatous disease (CGD) that lack cytochrome b are incapable of generating superoxide anion (O2-) in vivo and in vitro. The O2- generating activity of these defective membranes was reconstituted with the addition of partially purified human neutrophil cytochrome b in a detergent-based, cell-free activation system. Depending on the detergent system used, 50% to 100% of the activity of control membranes was recovered, and this activity was directly dependent on the cytochrome b concentration. However, when cytochrome b was purified to 99% homogeneity, the reconstitutive capacity of the cytochrome was lost, possibly because of subtle denaturation of the cytochrome or the removal of an additional required cofactor. Examination of the latter possibility with respect to a protein known to coassociate with the cytochrome, ie, Rap1A, indicated that this ras-like protein was present in the partially purified cytochrome preparation used to reconstitute activity in CGD membranes, but was missing in the highly purified preparation. However, the finding that Rap1A was present in normal amounts in the neutrophil membranes from all four major types of CGD (including those missing cytochrome b) suggested that the conditions required of the reconstitution assay did not favor the reassociation of the membrane-derived Rap1A with exogenously added cytochrome b or that another unidentified membrane component was lost during the final purification step. The normal expression of Rap1A in CGD cell membranes also indicates that this protein is not responsible for the absence of O2- production in the X-linked and autosomal recessive cytochrome b-negative forms of CGD. Finally, these results show that the expression of Rap1A in the plasma membrane is not dependent on the coordinate expression of cytochrome b, despite the close association shown for these two proteins in the normal cell membrane.


Liver-cell dysplasia and hepatocellular carcinoma. Liver-cell dysplasia is a well known histological entity with preneoplastic significance in experimental hepatic carcinogenesis. However, while the association of liver-cell dysplasia with hepatitis B virus can be considered as established, it is still controversial whether this lesion represents a premalignant condition in cirrhotic patients. Efforts have been made to render its morphological assessment more reliable, but no firm conclusions can be drawn from the available clinical studies, which are mainly retrospective or based on autopsy series. Preliminary results from a prospective study argue that liver-cell dysplasia is associated with an increased risk to hepatocellular carcinoma. The emergence of liver-cell dysplasia as a preneoplastic lesion in cirrhotic patients will have some impact in the future on their management, including selection for closer monitoring in early detection of hepatocellular carcinoma and for liver transplantation.


Cell kinetics in the study of hepatocellular carcinoma. Cell kinetics of normal, preneoplastic and neoplastic tissue in man have been thoroughly investigated during the last decade. Different variables that reflect tumour cell proliferation have been identified to correlate with the clinical outcome of the patients. Even so, we do not know whether some of these variables really assess tumour cell proliferation or tumour growth, are meaningful when compared with conventional predictive prognostic features, are reproducible between observers and laboratories or can be measured routinely in consecutive series of patients. For example, there are few studies of the cell kinetics of hepatocellular carcinoma (HCC) and the search for new prognostic indicators is of utmost importance for such a disease. Tumour volume doubling time appeared to be associated to survival for patients with small HCC submitted to different combination treatments. A preliminary analysis showed a relationship between 3H-Thymidine labelling index (3H-TdR LI) and survival for patients with HCC treated with hepatectomy alone or in combination with systemic chemotherapy. The results could indicate the usefulness of 3H-TdR LI following the natural history of the HCC, as reported for other tumour types. The cell proliferation rate defined by 3H-TdR LI is more accurate than by tumour volume and the requirement for only one small biopsy sample should also make it possible to determine the 3H-TdR LI in HCC.


Ultrasonography and guided biopsy in the diagnosis of hepatocellular carcinoma. Ultrasonographic screening and follow-up of patients with chronic liver disease lead to the detection of a large number of small asymptomatic hepatocellular carcinomas, so that the changing appearance of this neoplasm during its natural history has now been recognized. Ultrasonography provides information on shape, echogenicity, growth pattern and vascular involvement of the neoplasm. Three different shapes may be identified, depending upon the size and the invasiveness of the neoplasm: nodular, massive and diffuse. The echogenicity is variable and the tumour mass may appear hypo, hyper or isoechoic in comparison with the surrounding liver tissue. A mixed pattern and/or a hypoechoic ring may also be visualized. A tendency to change from a low echo pattern to a low periphery and finally to a massive pattern with increasing echogenicity has been shown in Japanese patients. The infiltrative growth pattern may be grossly distinguished from the expansive one on the basis of the aspect of the tumour boundary. Vascular invasion is easily recognizable as a mass within a major portal branch or even in the portal trunk. Duplex and color Doppler ultrasonography enable further insights on the vascular alterations related to this neoplasm. Abnormal signals, typical of HCC, are characterized by high-peak with broadening of spectrum. Low impedance continuous signals are less characteristic. Finally, ultra-sound guidance allows puncture of intrahepatic nodules as small as 1cm. The sensitivity of this procedure in the diagnosis of focal liver lesions is very high, varying between 91% and 95% with a specificity of 92%-100%.


Matrix-assisted laser desorption/ionization of high-mass molecules by Fourier-transform mass spectrometry. Following the first demonstrations of high-mass analysis using time-of-flight matrix-assisted laser desorption/ionization (MALDI) techniques by Hillenkamp, Tanaka and their co-workers, there have been significant efforts in a number of laboratories to adapt the new methodology to Fourier-transform mass spectrometry (FTMS). The motivation for this research is obvious. Namely, it would be desirable to couple the unparalleled high mass resolution of FTMS with the extended mass range provided by MALDI, particularly for analysis of polymers and biomolecules. Unfortunately, prior to the present work, attempts to mate FTMS and MALDI have met with limited success. The highest mass matrix-assisted laser-desorption-FTMS result previously obtained appears to be the unpublished low resolution spectrum of bovine insulin recently reported by Russell and co-workers. We, Campana and co-workers, and Hettich and Buchanan have had some success with MALDI-FTMS of biomolecules with masses lower than 3000 Da, including melittin, a variety of lower mass peptides, and oligonucleotides with masses lower than 1800 Da. Furthermore, with the single exception of Campana's report of obtaining mass resolution of 5000 for the molecular ion of melittin, such spectra have not displayed high resolution. Here, we report successful development of MALDI-FTMS, demonstrated with spectra obtained from a variety of high-mass polymer and biomolecule samples, using 355 nm radiation from an excimer-pumped dye laser for desorption/ionization and sinapinic acid as matrix. Some of these spectra are of much higher mass resolution than is possible with current time-of flight mass spectrometers.


Serum factor(s) induced by restraint stress in mice and rats suppresses lymphocyte proliferation. LACA mice were individually restrained in a specially made cylindrical cage for 10-20 h at room temperature (20 degrees C). Serum obtained from stressed mice was found to suppress normal mouse lymphocyte proliferation induced by concanavalin A, suggesting the presence of a suppressive factor(s) in the stressed serum. Adrenalectomy or injections of naltrexone (1, 10, or 20 mg/kg, ip), just prior to and in the middle of the stress period, did not affect the suppressive activity of serum from mice. However, the suppressive activity was totally abolished by general anesthesia with urethane (1.5 g/kg, ip). These results suggest that adrenal hormones and opiate receptors are not involved in the generation of the suppressive factor(s) and that the central nervous system plays a very important role in this process. SD rats were restrained in a supine position for 20 h at room temperature (20 degrees C) and serum from stressed rats was also found to be able to suppress normal mouse lymphocyte proliferation. A further analysis of "stressed serum" indicated that the suppressive factor(s) was heat stable (56 degrees C, 30 min) and acid stable (pH 3.8), but sensitive to 100 degrees C (3 min), an organic solvent (greater than 60% methanol), and proteinases (trypsin and chymotrypsin). From the measurement of gel filtration (HPLC), the molecular weights of the suppressive factor(s) were 155 and 370 kDa. Taken together, these results indicate that the suppressive factor(s) is a protein with a large molecular weight.


Phentolamine but not propranolol blocks the immunopotentiating effect of cold stress on antigen-specific IgM production in mice orally immunized with sheep red blood cells. The effect of cold stress on immunocompetence was investigated in mice intragastrically intubated with sheep red blood cells. Cold stress was found to consistently augment total IgG and IgM production by splenic lymphocytes. In addition, antigen-specific IgM production by cultured splenic lymphocytes obtained from cold stressed animals was enhanced compared to unstressed mice. However, serum levels of total and antigen-specific immunoglobulins were suppressed or unaltered following cold stress. The alpha-adrenoceptor antagonist, phentolamine, could block the effects mediated by cold stress while the beta-adrenoceptor antagonist, propranolol, potentiated the action of cold stress. Taken together, the data indicate cold stress-mediated enhancement in immunoglobulin production by orally immunized animals takes place through the activation of alpha-adrenergic pathways. The results also suggest alpha- and beta-adrenergic pathways independently regulate antibody production following oral administration of antigen. These observations illustrate the integrative nature of the immune and neuroendocrine systems.


Suppression of the development of adjuvant arthritis by a conditioned aversive stimulus. The present study evaluated the effect of a conditioned aversive stimulus (CS) on the development of adjuvant-induced arthritis in Lewis rats. Experiment 1 showed that presentation of a CS, on days 12, 14, and 16 following injection with adjuvant containing mycobacterium tuberculosis, resulted in a pronounced suppression of the development of arthritis as measured by a clinical disease severity rating scale and spleen weight. In contrast, presentation of the CS on days 0, 2, and 4 following injection did not have any effect on the development of arthritis. Experiment 2 showed that the suppression of adjuvant arthritis by exposure to the CS was blocked by administration of propranolol, a nonselective beta-adrenergic receptor antagonist. These results demonstrate that a CS can alter the development of adjuvant-induced arthritis, but the effect is dependent upon the timing of the antigen exposure and the presentation of the CS. Moreover, the present findings suggest that blocking beta-adrenergic receptors during presentations of the CS prevents the suppressive effect of the CS.


Effects of naloxone and nalmefene in rat spinal cord injury induced by the ventral compression technique. The neural injury prevention capabilities of narcotic antagonists have previously been reported. Of the available narcotic antagonists, naloxone has been the most widely studied. Other agents with higher potency, longer half-lives, and greater specificity, however, may be more desirable for the prevention of the "secondary injury" following a primary neural insult. The relative neural injury prevention efficacies of the various narcotic antagonists is not known. The establishment of the relative effectiveness of these drugs is warranted and is of potential clinical importance. Therefore, a study was undertaken to compare the effects of the two narcotic antagonists, naloxone and nalmefene, with respect to their neuro-protective efficacy following experimental spinal cord injury (SCI) in rats. Ninety adult Sprague-Dawley rats were divided into three groups--control; naloxone (2 mg/kg i.p., 45 min following injury); and nalmefene (0.1 mg/kg i.p., 45 min following injury)--following lesioning with the ventral SCI technique. Results were evaluated by the inclined-plane technique and neurologic examination at 1 day and 1 week following injury. Histomorphological evaluation of the injured segment of spinal cord was performed following euthanasia at 1 week following injury. A significant improvement (compared with the control group) was noted in both treatment groups. This was observed with respect to neurological examination and inclined-plane scores in both treatment groups at 24 h and 1 week following lesioning (with a significance level of at least p less than 0.001; analysis of variance). The nalmefene group demonstrated a greater level of function than the naloxone group at both 24 h and 1 week following injury (not significant; p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


Gordon Memorial Lecture. Chicken neoplasia--a model for cancer research. 1. The use of animal models has been immensely important for the advancement of our knowledge of the aetiology and pathogenesis of human diseases, including neoplasia. 2. Viruses, as oncogenic agents, were first described in the early 1900s when cell-free filtrates were used experimentally to transmit leukemias and sarcomas in chickens. In more recent years, studies with avian leukosis/sarcoma viruses have led the field in attempts to establish the genetic and molecular basis of viral oncogenesis. 3. Marek's disease of chickens was the first neoplasm proven to be caused by a herpesvirus and it remains the only neoplastic disease for which an effective vaccine has been developed and deployed. It serves as an elegant model as we seek an understanding of the pathogenesis of herpesvirus-induced lymphomas at both the cellular and molecular levels.


Kinetics of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions. The present study was undertaken in an attempt to relate the kinetics of hydroxyapatite dissolution to solution parameters, under experimental conditions relevant to the dental caries process. Thus, the dissolution of hydroxyapatite was studied in acetic, lactic, and dilute phosphoric acid solutions having initial pH values from 4 to 6. Rates of dissolution and the corresponding degree of saturation with respect to hydroxyapatite were determined at various times throughout the dissolution process. Rates of dissolution of all solutions were found to decrease with increasing degree of solution saturation and were greater in solutions with lower initial values of pH. However, rates of dissolution in partially saturated phosphoric acid solutions (without added organic acid) were at least one order of magnitude lower than those observed in the organic acid buffers with the same initial pH, over the same range of saturation values. The data obtained are consistent with a surface-controlled dissolution model in which the rate of dissolution is dependent upon the degree of saturation and the sum of the activities of the acidic species in solution, i.e., phosphoric and organic acids. These results suggest that in order to assess the cariogenic potential of a given medium (e.g., plaque fluid), one must determine both the degree of saturation with respect to the dissolving mineral and the activities of acidic species in solution.


Procedure for the study of acidic calcium phosphate precursor phases in enamel mineral formation. Considerable evidence suggests that an acidic calcium phosphate, such as octacalcium phosphate (OCP) or brushite, is involved as a precursor in enamel and other hard tissue formation. Additionally, there is in vitro evidence suggesting that fluoride accelerates and magnesium inhibits the hydrolysis of OCP to hydroxyapatite (OHAp). As the amount of OCP or brushite in enamel cannot be measured directly in the presence of an excess of hydroxyapatite, a procedure was developed that allows for their indirect in vivo quantification as pyrophosphate. This permits study of the effects of fluoride and magnesium ions on enamel mineral synthesis. Rat incisor calcium phosphate was labeled by intraperitoneal injection of NaH2(32)PO4. The rats were then subjected to various fluoride and magnesium treatments with subcutaneous implanted osmotic pumps. They were then killed at predetermined intervals; the nascent sections of the incisors were collected, cleaned, and pyrolyzed at 500 degrees C for 48 hours to convert acidic calcium phosphates to calcium pyrophosphate; the pyrophosphate was separated from orthophosphate by anion-exchange chromatography; and the resulting fractions were counted by liquid scintillation spectrometry. The activities of the pyro- and orthophosphate fractions were used to calculate the amount of acidic calcium phosphate present in the nascent mineral. The results demonstrated that the percentage of radioactive pyrophosphate in nascent incisors decreased with time, with increasing serum F- concentration, and with decreasing serum magnesium content. The technique described here should prove to be a powerful new tool for studying the effects of various agents on biological mineral formation.


An ultrastructural study of the effects of acidic phospholipid substitutions on calcium phosphate precipitation in anionic liposomes. A model membrane system was used to investigate the ability of specific membrane constituents to modulate the precipitation of calcium phosphate. Intraliposomal precipitation was induced in phosphate-encapsulated liposomes composed of 7:2:1 molar mixtures of phosphatidylcholine (PC), dicetyl phosphate (DCP), and cholesterol (Chol) by ionophore-supported (X-537A) Ca2+ uptake. Extraliposomal precipitation occurred when these reactions were initiated in metastable external solutions. In this case, the endogenously formed crystals penetrated through the enclosing lipid bilayers and seeded the external solution phase. Transmission electron microscopy (TEM) was used to monitor the effect of acidic phospholipids [phosphatidic acid (PA), phosphatidylserine (PS), phosphatidylinositol (PI), phosphatidylglycerol (PG)] on the precipitation reactions when these molecular species were incorporated into the liposome membranes. Compared with the precipitation reactions in 7PC:2DCP:1Chol liposomes containing no acidic phospholipids, calcium phosphate formation in the presence of monoester phosphate (PA) and amino- (PS) phospholipids was inhibited. Analyses of the lipid-mineral interactions in PA-containing (10 mol%) liposomes revealed close physical contact between the small crystals of apatite and the inner lipid bilayers; there was only minimal extraliposomal precipitation. A few small crystals adhered to the external surfaces of the liposomes. In PS-containing liposomes, lipid-mineral interactions were dependent upon the DCP content of the lipid membrane. Discrete clusters of crystals formed within the interior aqueous compartment when intraliposomal precipitation was initiated in 7PC:2DCP:1Chol liposomes doped with up to 10 mol% PS. There was no evidence for specific associations between these crystals and the enclosing lipid bilayers.(ABSTRACT TRUNCATED AT 250 WORDS)


Biochemical and histological sequences of membranous ossification in ectopic site. Porous hydroxyapatite ceramics alone (control) and ceramics combined with rat marrow cells were implanted subcutaneously in the back of syngeneic rats and harvested 1-8 weeks after implantation. The ceramics were examined biochemically and histologically. Alkaline phosphatase activity in the marrow cell/ceramic composites began to increase at 2 weeks and achieved a peak at 4 weeks, followed by a gradual decrease. Bone gla protein contents in the composites began to increase at 3 weeks and steadily increased as time passed. Histologically, osteoblastic cells were detected at 2 weeks and obvious de novo bone together with active osteoblasts began to appear at 3 weeks in the composites. The process was membranous ossification without cartilage formation and was observed in the pores of the composites. The pore areas occupied by bone increased as time passed. In contrast, ceramics alone did not show any bone formation and contained traces of these biochemical parameters. These results indicated that the biochemical sequences correlate with the histological sequences in the heterotopic membranous ossification.


[Computed tomography for evaluation of hepatocellular carcinoma after treatment with transarterial chemoembolization]. Totally 135 series of computed tomography (CT) and angiographic examination were performed in 53 patients with proved hepatoma treated by TAE. CT examination was performed four to six weeks after TAE, and a comparative angiographic examination was performed within three weeks after CT examination. The pictures of CT scanning were read to determine 1). the grading of lipiodol retention inside the tumor, 2). the presence/absence of filling defect in the tumor margins coated by lipiodol, 3). the presence/absence of residual tumor tissue within or surrounding the main tumor, and 4). the presence/absence of developed satellite nodules. In comparison with angiographic findings, CT demonstrated 96.3% specificity and 58.2% sensitivity in the grading of lipiodol filling, and 96.3% specificity and 65.7% sensitivity in the tumor margins of lipiodol coating. However, it was difficult for CT to detect small nodules, especially those less than 1 cm in diameter. We find no statistically significant association between newly developed satellite nodules and grading of lipiodol retention inside the tumor or tumor margins of lipiodol coating. Therefore, when CT pictures reveal filling defect over the margins of the tumor coated by lipiodol or less-than-50% lipiodol filling inside the tumor, repeated angiography and further treatment with TAE are suggested.


Regulation of C-myc protooncogene expression in osteoblastic cells by arachidonic acid metabolites: relationship to proliferation. Prostaglandin E2 and leukotriene B4 are metabolites of arachidonic acid with well-characterized effects on osteoblastic cells. Prostaglandin E2 has been shown to be a potent bone-resorbing agent and to stimulate as well as inhibit osteoblastic cell proliferation. Leukotriene B4 has also been demonstrated to stimulate or inhibit osteoblastic cell proliferation, depending on the cell type tested. In the present study, the potential relationship of the effects of prostaglandin E2 and leukotriene B4 on osteoblastic cell proliferation to c-myc protooncogene expression was investigated. Prostaglandin E2 has been shown previously to inhibit normal rat osteoblastic cell proliferation. The present studies show that prostaglandin E2 at 10(-6) M decreased c-myc expression in these cells. In the human osteoblastic osteosarcoma cell line, G292, prostaglandin E2 increased c-myc expression and inhibited proliferation. In contrast, epidermal growth factor increased DNA synthesis as well as c-myc expression. Prostaglandin E2 also inhibited proliferation of another human osteoblastic osteosarcoma cell line, Saos-2, but it did not produce any changes in c-myc expression. In these cells, epidermal growth factor did not affect either DNA synthesis or c-myc expression. Leukotriene B4 did not show any effects on c-myc expression in any of the osteoblastic cells tested.


[Diaphragm pacing for the ventilatory support of the quadriplegic patients with respiratory paralysis]. Electrical stimulation of the phrenic nerve to pace the diaphragm in patients with chronic ventilatory insufficiency has been an established therapeutic modality since William W.L. Glenn first described using radiofrequency signals in 1978 to stimulate the phrenic nerves. Before this event, patients who were ventilator-dependent and thus bedridden because of respiratory paralysis associated with quadriplegia usually anticipated little chance for physical or psychosocial rehabilitation. Two cases of C1-C2 subluxtion with cord injury and chronic ventilatory insufficiency were implanted at VGH-Taipei with diaphragm pacemaker in 1988. Postoperative phrenic nerve stimulation was given according to individual training schedule. One case with total phrenic paralysis received bilateral phrenic nerve stimulation and became weaned from the ventilator 6 months later. The other case with partially active ventilatory function received unilateral phrenic nerve stimulation to compensate the ventilation. However, its final outcome still showed the necessity of a bilateral mode to achieve adequate ventilation irrespective of strenuous training for 2 years.


[Experience of surgical treatment for colorectal endometriosis: report of 6 cases]. Endometriosis is a common disease with 8-15% occurrence in women during their reproductive period. Involvement of the bowel wall occurs rather frequently and probably presents in 12-34% of patient with pelvic endometriosis. However, it is classically asymptomatic and difficult to find out. From 1977 to 1987, we had six patients of colorectal endometriosis with mainly bowel symptoms. Five of them were located at rectum and sigmoid colon, one at the hepatic flexure of colon. All of the cases developed constipation or diarrhea, and four of them had severe abdominal pain. Four cases developed rectal bleeding. Previous operation for pelvic endometriosis was noted in two cases. The detailed examination included digital examination, endoscopy, barium enema and CT scan. Suspected malignancy was the indication for surgery in 4 cases and one in rectal stenosis. Low diagnostic rate was due to the fact that endometrial tissue rarely infiltrates the mucosa. Therefore, pathology of biopsied specimen often reveals non-conclusive finding to prevent differential diagnosis. However bowel resection offers conclusive diagnosis and chances of cure. In our study, only one suspected endometriosis case received bilateral oophorectomy. The stenotic segment of rectum restored to normal caliber after operation.


[Spontaneous rupture of the ureter with urinothorax: a case report]. Rupture of the ureter in the absence of demonstrable cause is deemed spontaneous rupture. While urinothorax is a rare complication, it occurs in the following predisposing factors: external trauma, ureteral instrumentation, previous ureteral surgery, destructive ureteral disease, external compression or obstruction from stones. The above factors may produce retroperitoneal urinoma to make urinothorax. It has a clinical picture of respiratory embarrassment. Urinothorax demonstrates a significant elevation of pleural fluid creatinine and declination of glucose concentration as compared with the serum level. In many cases a temporary or permanent urinary diversion may resolve the urinothorax, then an indirect diagnosis of the urinothorax may be made. We report a case of spontaneous rupture of the ureter with urinothorax.