Endotracheal lidocaine instillation in pediatric anesthesia. The purpose of this study is to evaluate the effectiveness of lidocaine administered via the endotracheal tube in suppressing cough reflex during anesthetic recovery in children. Fifty ASA class I-II children, aged from 1-5 years old undergoing elective abdominal or urogenital surgery were randomly assigned into two groups. 2% lidocaine 1.5 mg/kg (1ml = 20mg) was administered in group B while normal saline (N/S) 0.1 ml/kg was used in group A (control group). Either one of the agents was instilled into the endotracheal tube right before the end of operation. Airway responses and other associated phenomena were recorded during the recovery period. Recovery condition was categorized into a two-grade categories, namely "good", and "poor" to denote the quality of recovery. Recovery conditions differ significantly between the control group and the experimental group. In group A, 3 patients were classified as the "good" grade but 22 patients were categorized in the "poor" grade. Group B (lidocaine 1.5 mg/kg) has a much better recovery condition than the control group, there were 19 in the "good" grade and only 6 in the "poor" grade. The experimental group treated with 2% lidocaine presented a significantly better recovery than the control group. This effective suppression of the cough reflex might be due to the local anesthetic effect exerted by lidocaine. For the sake of safety all patients were closely followed up at the post anesthesia room until the return of consciousness and laryngeal reflexes. In conclusion, we found that 2% lidocaine 1.5 mg/kg given intratracheally via the endotracheal tube could attenuate cough response during recovery in pediatric anesthesia.


[Emergency translaryngeal ventilation].

[Emergency translaryngeal ventilation]. Every anesthesia providers is aware of the serious consequences of anoxia subsequent to acute airway obstruction, and is trained to manage such situations when they occur. Nonetheless, a patent airway is not always attainable. Percutaneous needle laryngostomy with translaryngeal ventilation has been widely advocated for emergency ventilation in desperate situations in which other efforts, including intubation have failed. A review of literature suggested that using a large bore (> 18 Ga) needle/catheter with a jet ventilator, or alternatively connecting it to an oxygen source of high pressure (40-50 psi; i.e. anesthesia machine, wall outlet etc.) via a low compliance tubing will effectively resuscitate an animal or patient. However, this method may expose the patients to the risk of barotrauma which has inhibited its widespread adoption. In order to assess this risk, we have conducted an in vitro study employing a simple lung simulator and an anesthesia machine. Variables of the experiment included the make of the anesthesia machine, size of the needle/catheter, degree and duration of depression of the flush valve, as well as the size of the pop-off valve opening. Based on the data obtained from our study as well as others by an extensive literature review, we have proposed some guidelines for this technique when a jet ventilator is not available.


[The efficacy of intravenous fentanyl patient-controlled analgesia for postoperative pain relief]. The safety and efficacy of patient-controlled analgesia used for postoperative pain relief were evaluated. Cumulative 24-hour requirements were analyzed for possible correlation with patient characteristics. All patients who used a patient-controlled analgesia device for postoperative pain relief were reviewed from June to October 1991. The device Baxter's basal/bolus infusor with patient control module, was used to deliver fentanyl in 379 patients. The fentanyl requirement, verbal analog pain score, first passage of flatus, side effects, sedative score, and degree of satisfaction were examined. The fentanyl requirement during the first 24 hours after operation was analyzed with regard to age, body weight, and sex. The daily fentanyl consumption in the first three postoperative days was 928 +/- 352 micrograms (n = 338), 553 +/- 259 micrograms (n = 220), and 490 +/- 222 micrograms (n = 71), respectively. The requirement for fentanyl during the first 24 hours after surgery was significantly higher than for the next two days (p-value < 0.001). Fentanyl consumption correlated well with body weight, and inversely with age. No difference was found between fentanyl consumption and sex (p-value = 0.4687). The mean time to the first passage of flatus in patients with abdominal surgery was 54.6 +/- 26.4 hours. The incidence of nausea, vomiting, and dizziness was similar, about 20% of patients. Itching was noted in 7% of patients. Oversedation (class 4) was found in three patients during the first operative day, the sedative score for other patients were around class 1-3. No patient exhibited signs of respiratory depression or withdrawal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)


Disease surveillance in China.

Disease surveillance in China. In the past 10 years in China, because social conditions have been stable and the public health infrastructure has been well developed, the disease surveillance network has substantially improved. A computerized reporting system for notifiable diseases has been established that links China's 30 provinces, autonomous regions, and municipalities. Mechanisms for providing timely feedback to units that report data and for systematically assessing the quality of those data are important attributes of this system. During this period, data from the surveillance system have become more representative, and, simultaneously, more effective use of data has been promoted. Data collected through the disease surveillance network serve as the basis for formulating health policies and devising strategies for preventing disease.


The role of public health surveillance: information for effective action in public health. Public health surveillance can provide the quantitative information needed for setting priorities and establishing rational health policy. Although there are many examples of the effective use of such information, the full potential for surveillance has not yet been realized. To a large degree, failure to achieve this potential has resulted from limited perspectives regarding the role and conduct of surveillance. Both practitioners (those who conduct surveillance) and users (those who apply surveillance data in a real-world setting) have fallen victim to such myopia. Public health surveillance must be advocated as an essential part of the global health agenda if we are to achieve international goals for improving health status. As we improve our appreciation of the variety of uses for public health surveillance data, we need to understand more fully the determinants of the decision-making process. Effective dissemination of information and effective communication are as important as data collection and analysis. No longer do we have--or should we have--the luxury of collecting information for its own sake. The information collected must have a demonstrated utility. Developing and training personnel to have expertise in public health surveillance will necessarily incur opportunity costs. Bridging gaps in data methodology and coverage will force us to weigh alternatives and to compromise. We hope that the International Symposium on Public Health Surveillance will accomplish several goals. First, we wish to foster international understanding of the definition, role, and importance of surveillance in reducing morbidity and mortality, in improving quality of life, and in setting effective health priorities. Second, we hope that this symposium will serve as a springboard for identifying issues and topics that can be addressed in greater depth at future international meetings. Finally, we see the symposium as an essential step in developing a firm commitment on the part of countries, donor agencies, and multilateral organizations to develop the essential capacity for public health surveillance throughout the world. Each country should have the capacity to measure and monitor changes in health status, risk factors, and health-service access and utilization among its people. All countries should have the means to detect emerging health problems and implement measures for their control, to evaluate the impact of health policies and programs, and to communicate health information in a meaningful fashion to policymakers and the public. If we are successful in these endeavors, the long-term effects on the public's health will be well worth the struggle required to achieve them.(ABSTRACT TRUNCATED AT 400 WORDS)


Key issues in public health surveillance for the 1990s. In this paper, we have proposed a wider scope for public health surveillance in order to incorporate demographic and health-system monitoring, along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes, not a sector of activity or a type of health service, but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we have stressed the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available, let alone any knowledge about how to treat persons for the major diseases. Later on, largely as the result of impressive advances in biomedical knowledge, public health surveillance tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the new currents tend to recapture some of the spirit and scope of the early definitions, prompted perhaps by grave historical parallels--we face newly emerging health problems for which we have no clear-cut solutions. If one element needs to be stressed to promote the objectives of health surveillance today, it is that we need the ability to anticipate health outcomes and not just respond to them. This, in turn, requires that we give more weight to the surveillance of risk factors and that we increase our understanding of the complex causal interrelationships that link exposure to risk factors--including behavioral, life-style, and environmental ones--with adverse health conditions and disability. Needless to say, the first and foremost aim of health care--and modern surveillance is one of the tools needed to achieve this aim--is to promote the well-being of individuals while improving their health.


AIDS and infection control: experiences, attitudes, knowledge and perception of occupational hazards among Nigerian dentists. A questionnaire survey of 79 Nigerian dentists aged 21-60 years was carried out to evaluate their experiences, attitudes, knowledge, and infection control practices in relation to HIV infection. Their perceptions of various occupational hazards were also probed. 84.4% of them held the view that HIV-infected/AIDS patients should be treated in special treatment clinics. The risk of becoming infected was the paramount fear expressed by 88.6% of the dentists. This fear can be explained by the inadequate facilities in various dental clinics reported by 79.7% of them. Despite their lack of clinical experience in the management of oral manifestations of AIDS, a large proportion of them were quite knowledgeable. However, HIV infection was perceived with the highest degree of concern as the greatest occupational hazard by 87.2% of the dentists. Interdisciplinary collaboration among health professionals should be intensified to enhance prompt referral and comprehensive treatment of AIDS patients.


Variations in occlusal and space characteristics in a series of 6-18-year olds, in Ilala District, Tanzania. This study was carried out in Ilala District, Tanzania as part of a major oral health survey. The aim of the study was to investigate the variation in different occlusal and space characteristics among children and adolescents in different age group. A total of 698 children and adolescents aged 6-18 years were examined clinically. The subjects were categorized into three age groups, 6-9 years with early mixed dentition, 10-14 years with late mixed dentition and 15-18 years with permanent dentition. The examiners were calibrated before the survey and the agreement was satisfactory. Anteroposterior relationships of the dental arches were measured according to Angle's classification. Other occlusal and space variables included overjet, overbite, openbite, crossbite, crowding, spacing, and separate determination of diastema mediale. Most of the subjects in different age groups, 93-96%, had Angle's Class I molar occlusion. Large overjet (> 5 mm) occurred in 3-5% of the subjects. Deep bite (> 5 mm) was observed in about 2% of the children in all age groups. Anterior open bite was the most prevalent occlusal anomaly in all age groups, noted in 9-13% of the subjects. Transversal occlusal anomalies were rare. More than 33% of the subjects had spacing while less than 10% had crowding of the dentition. These results indicate that using the present criteria, most 6- to 18-year olds in Ilala district have optimal sagittal occlusion and a lot of spacing. The most common occlusal anomaly was anterior openbite.


A preliminary study of the periodontal status and treatment needs of elderly Nigerian subjects. One hundred elderly subjects comprising of residents of old peoples homes and patients attending routine outpatients clinic at the Lagos University Teaching Hospital were examined in Lagos. The mean age of subjects was 68.7 years. Using the Community Periodontal Index of Treatment Needs (CPITN) it was found that 23% had tooth deposits (plaque/calculusonly) whilst 70% had shallow or deep pockets. 87% of these elderly subjects were caries-free and none had restored or filled teeth. However, more than half of the subjects had an average missing teeth number of 8.829% of the subjects needed extraction with an average of 3.3 teeth. Among the subjects that needed dental extraction, none had healthy periodontal condition whereas, 79% of them were caries free. It is concluded from this study that the periodontal status of the subjects was poor and the incidence of caries was low. Furthermore, the majority of the missing teeth could have been largely due to periodontal disease. Dental health education which is directed towards improved oral hygiene procedures is suggested for the elderly dental population. It is also suggested that elderly patients be given free or subsidised treatment. Furthermore, the National Health Policy should be directed towards domiciliary dental treatment for the compromised elderly patients.


A retrospective study of characteristics of impacted mandibular wisdom teeth in 110 patients treated in Nairobi, Kenya. Analysis of 110 records of patients who presented with impacted mandibular 3rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilateral impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.


Case report of dentigerous cyst of lower incisor. This paper reviews the pathogenesis, clinical features and the behaviour of dentigerous cyst. A case of mandibular dentigerous cyst involving the incisor tooth (an unusual site) is presented to illustrate this pattern of behaviour. A recurrent pyogenic granuloma in the region of the lower incisors prevented the eruption of the lower left incisor with subsequent cystic formation around the tooth. The histological and radiological presentation is consistent with that of a dentigerous cyst. The significance of the potential of the cyst lining is stressed. The cyst was enucleated with the associated tooth as the latter was not in a favourable position to erupt. There was no recurrence after one year of treatment.


Oral health promotion and health education programmes for Nigeria--policy guidelines. Nigeria like other developing countries is presently faced with the arduous problem of coping with scarce resources to control existing and increasing oral disease levels. The World Health Organization has emphasized the importance of oral health promotion for initiating successful, effective, preventive oral health programmes. At present however, Nigeria is without formal oral health promotion and health education policies or programmes. In the "National Policy and Strategy to Achieve Health for All Nigerians" (Federal Ministry of Health 1986), no specific mention was made of oral health promotion or oral health education. The present paper therefore proposes definitive policy guidelines that will help in the development of coherent oral health promotion programmes for the country. The approach proposed tackles causes common to a number of chronic diseases and incorporates oral health into general health strategies.


Dystrophin cytochemistry in mdx mouse muscles injected with labeled normal myoblasts. A new technique enables correlation of dystrophin expression with the location of donor versus host nuclei in the same sections of mdx mouse muscle injected with normal myoblasts. Myoblasts from C57BL/6J mice or from humans were labeled with 0.01% fluoro-gold (FG) in Dulbecco's Modified Eagles Medium (DMEM) for 16 h at 37 degrees C before myoblast transfer. About 3 x 10(4) myoblasts were injected into the quadriceps muscles of mdx mice immunosuppressed with cyclosporine A (CsA). At 11, 21, or 25 days after myoblast transfer, injected muscles were dissected out and sectioned. These mouse sections were processed for dystrophin and then labeled with a fluorescent nucleus counterstain, 5 micrograms% Hoechst 33342 in phosphate-buffered saline (PBS), for 10 min at room temperature. Fluoro-gold labeling corresponding with Hoechst 33342 staining indicated survival of normal nuclei in dystrophic muscle. Dystrophin was found in the sarcolemma of myofibers containing FG-labeled nuclei but not of myofibers containing only Hoechst 33342-labeled nuclei. Control muscle samples showed neither FG labeling nor dystrophin. This study demonstrates that the donor human and mouse myoblasts survived and developed in host mouse muscles for at least 25 days after myoblast transfer, and that the localization of their normal nuclei correlates with dystrophin expression in muscle fibers of immunosuppressed mdx host mice.


Osteogenesis in marrow-derived mesenchymal cell porous ceramic composites transplanted subcutaneously: effect of fibronectin and laminin on cell retention and rate of osteogenic expression. Cultured-expanded rat marrow-derived mesenchymal cells differentiate into osteoblasts when combined with a porous calcium phosphate delivery vehicle and subsequently implanted in vivo. In this study, the effects of ceramic pretreatment with the cell-binding proteins fibronectin and laminin on the osteogenic expression of marrow-derived mesenchymal cells were assessed by scanning electron microscopy, [3H]-thymidine-labeled cell quantitation, and histological evaluation of bone formation. Scanning electron microscopic observations showed that marrow-derived mesenchymal cells rapidly spread and attach to both fibronectin- or laminin-adsorbed ceramic surfaces but retain a rounded morphology on untreated ceramic surfaces. Quantitation of [3H]-thymidine labeled cells demonstrated that laminin and fibronectin preadsorbed ceramics retain approximately double the number of marrow-derived mesenchymal cells than do untreated ceramics harvested 1 wk postimplantation. Histological observations indicate that the amount of time required to first detect osteogenesis was shortened significantly by pretreatment of the ceramic with either fibronectin or laminin. Fibronectin- and laminin-coated ceramic composite samples were observed to contain bone within 2 wk postimplantation, while in untreated ceramic the earliest observation of bone was at 4 wk postimplantation. A comparison was made of the initial cell-loading, in vivo cell retention characteristics, and rate of osteogenesis initiation of marrow-derived mesenchymal cells on two types of ceramic with different pore structure and chemical composition, with and without preadsorption with fibronectin or laminin. "Biphasic" ceramics contain randomly distributed pores 200-400 microns in diameter, and "coral-based" ceramics have continuous pores of approximately 200 microns in diameter. Laminin or fibronectin preadsorption significantly increases the number of cells retained in all ceramic test groups by day 7 postimplantation. In addition, by day 7 postimplantation, the biphasic ceramics retain a significantly greater number of cells for all test groups than do coral-based ceramics. The biphasic ceramics consistently have more specimens positive for bone with the identical cell-loading conditions used throughout this study. These results indicate that the retention of cells within the ceramic is an important factor for optimization of marrow mesenchymal cell initiated bone formation. The retention of cells within ceramics is augmented by the adsorption of the cell-binding proteins laminin and fibronectin, but this effect varies depending on ceramic pore structure and/or chemical composition.


Human cortical neuronal cell line (HCN-1): further in vitro characterization and suitability for brain transplantation. The human neuronal cell-1 (HCN-1) line has recently been established. Under favorable conditions, these cells differentiate into mature neuronal phenotypes. Here we report on further characterization of these cells. Cultured HCN-1 cells express fibronectin immunoreactivity and grow well on fibronectin substrate but do not respond to human bFGF. In the undifferentiated state, some HCN-1 cells show MHC class I antigen expression. After differentiation, HCN-1 cells and their processes are MHC class I negative. On the other hand, interferon-gamma stimulation enhances MHC class I expression but does not induce MHC class II immunoreactivity. Our in vitro data indicate that HCN-1 cells express mixed characteristics, including both neuronal and mesenchymal markers, and are consistent with the suggestion that the HCN-1 cell line resembles an immature neuroepithelial cell precursor with a complex origin. One possible application of the use of the HCN-1 cells includes intracerebral transplantation. We also examined the survival of dissociated HCN-1 cells implanted into rat brain parenchyma. The host animals were not immunosuppressed. Despite expression of MHC class I antigens, small clusters of HCN-1 cells survived in the rat brain. These xenografts did not induce distinct immunological responses within the host brain tissue. Surviving HCN-1 cells demonstrated similar features to those observed in culture. Our preliminary results suggest that the HCN-1 cell line would be suitable for intracerebral transplantation in primates or humans. However, it may be that short-term host immunosuppression or addition of HCN-1 cell differentiation factors would be beneficial for enhanced cell survival.


Entrapment of cultured pancreas islets in three-dimensional collagen matrices. In vitro culture of islets of Langerhans decreases their immunogenicity, presumably by eliminating passenger leukocytes and other Ia+ presenting cells within the islets. Islets cultivated in petri dishes either at 37 degrees C or at 25 degrees C gradually disintegrate during culture in a time-dependent manner which is related to the free-floating condition of the islets. Also, a fraction of the islets disperse as single cells and beta-cell aggregates or adhere to the bottom of the culture dishes. Thus, the retrieval rate of transplantable islets is dampened due to their disintegration and spontaneous dispersion in conventional petri dish cultures. Entrapment of freshly harvested islets of Langerhans in a three-dimensional collagen matrix was studied as an alternative method for islet cultivation. The contraction of collagen fibrils during in vitro culture counteracts the dispersion of islets and helps in maintaining their integrity while in culture. It was observed that the entrapped islets maintain satisfactory morphology, viability, and capability of glucose-dependent insulin secretion for over 2 wk. The oxygen consumption rate and glucose metabolism of these islets was not deranged when entrapped in collagen. Also, the retrieval of islets is easier and more efficient than that observed in conventional culture systems. Our results indicate that culture of islets in three-dimensional collagen gels can potentially develop into an ideal system applicable to clinical transplantation of cultured islets or beta-cell aggregates.


Influence of different substrates in detoxification activity of adult rat hepatocytes in long-term culture: implications for transplantation. Substrates used to immobilize hepatocytes for transplantation govern attachment and long-term metabolic activity of these cells. The choice of these substrates is based on the familiarity with proteinaceous materials that are constituents of the extracellular matrix. The use of substrates that recognize carbohydrates on the cell surface may provide an alternative method to attach adult mammalian hepatocytes. In this study, immobilized lectins on tissue culture plasticware were used to support hepatocyte attachment. Long-term cultures with these substrates were compared with control cultures seeded on a mixture of collagen types I and III (Vitrogen). To evaluate the attachment efficiency and long-term maintenance of diazepam metabolic activity of hepatocytes seeded on different commercially available plasticware, four different types of polymers (supplied as 60-mm dishes) were tested. Diazepam, a benzodiazepine metabolized by the P450 intracytoplasmic pathway, is associated with a synaptic receptor (GABA-benzodiazepine receptor) which plays an important role in hepatic coma. Polymethylpentene, a derivative of polypropylene treated by plasma discharge, was the best polymer to maintain P450 phenotypic expression, although other polymers provided similar cell attachment efficiencies. The amounts of adsorbed concanavalin A, Arachis hypogaea (peanut), Lens culinaris, and Pisum sativum agglutinin correlate with the percentage values of hepatocyte attachment. Cell attachment to wheat germ agglutinin increased with increased lectin concentrations in spite of constant amounts of adsorbed lectin, whereas hepatocyte attachment to Bandieraea simplicifolia agglutinin was lower and did not change at different lectin concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of fetal rabbit brain xenografts to three different strains of athymic nude rats: electrophysiological and immunohistochemical studies of intraocular grafts. Interest in the use of neural tissue transplantation for the study of CNS development and maturation and the potential use of this technique for the treatment of certain degenerative CNS disorders has led to our use of transplantation of neural tissue across species lines. Prior to extensive transplantation studies using athymic rats as recipients, we wished to evaluate the currently available strains of athymic rat for their suitability as host animals for xenografts of neural tissue. Fetal cerebellar and cerebral cortex tissue from rabbit brain of gestational age 20-25 days was dissected and transplanted to the anterior chamber of the eye of Harlan Wisconsin, Fisher 344 Jnu, or NCI-Harlan athymic nude rat strains. The brain tissue grafts were allowed to mature for 3 mo during which time the size and vascularity of each graft was monitored through the cornea of anesthetized hosts. In each group all of the transplants survived and grew to varying extents in the anterior chamber of the eye. Following the growth study in vivo extracellular recording of single neuronal activity was performed. Spontaneous neural activity was found in most transplants in all three groups with no difference in the viability or discharge rates of neurons between the groups. Illumination of the ipsilateral eye increased the firing rate of neurons in all three groups, suggesting excitatory cholinergic innervation of the grafted neurons from the host parasympathetic iris ground plexus. Antibodies directed against neurofilament protein, glial fibrillary acidic protein, synapsin, and tyrosine hydroxylase were used to characterize the transplants immunocytochemically and revealed no differences between the grafts in the three groups of recipients. All transplants contained significant numbers of glial and neuronal elements with the distribution resembling that in adult brain tissue. Some of the transplants contained a sparse innervation of tyrosine hydroxylase-positive fibers from the sympathetic plexus of the host iris. Furthermore, synapsin-immunoreactivity suggested that synaptogenesis had taken place within the grafts. Histological examination of the grafts revealed that 67% of the grafts had been infiltrated, to varying extents, by lymphocytes which led to areas of cell lysis and necrosis. All host animals had populations of T-cell receptor positive cells, most of which also expressed the T-cell surface antigens CD4 and CD8. However, no transplants were overtly rejected over the 15 wk period of study.(ABSTRACT TRUNCATED AT 400 WORDS)


Reversal of experimental diabetes by injection of syngeneic islets into peripheral veins. This study was undertaken to evaluate the safety and effectiveness of intravenous (i.v.) injection of islets, via a peripheral vein, in the treatment of experimental diabetes in highly inbred Lewis rats. Rats were made diabetic by the i.v. injection of streptozocin, and donor islets were isolated from neonatal rats. Two wk after the induction of diabetes, rats with glucose concentrations > 19 mM were divided into two groups: one group of six rats was injected with 2000 neonatal islets into the external jugular vein; the second group of rats, acting as control, was injected in the same vein with medium alone. Within 2 wk of the islet transplant, 100% (6/6) of the rats were cured of the diabetes. None of the control rats experienced any improvement. As expected, pancreatic islets so administered embolized to the lungs. Glucose tolerance tests in the rats receiving the islet transplant were indistinguishable from normal rats. These results could be important to clinical transplantation if the procedure is as successful in larger animals using autotransplanted islets or allografts protected from immune rejection.


Feasibility, safety, and efficacy of myoblast transfer therapy on Duchenne muscular dystrophy boys. Five billion normal myoblasts were injected into each of 21 Duchenne muscular dystrophy (DMD) boys aged 6-14 yr to assess the feasibility, safety, and efficacy of the Phase II myoblast transfer therapy (MTT). The Phase II study was designed to strengthen muscles of both lower limbs. Forty-eight intramuscular injections transferred the myoblasts into 22 major muscles at 55.6 x 10(6)/mL in 10 min under general anesthesia. Eleven boys had received 8 million myoblasts each 1 yr ago in the Phase I MTT. In the Phase II study, eight of them had their myoblasts subcultured from reserves frozen 1 yr ago. The donor myoblasts for each of the remaining boys were cultured from satellite cells derived from a 1-g muscle biopsy of a normal male who might or might not be histocompatible with the recipient. The immunosuppressant cyclosporine (Cy) is being administered to recipients for 6 mo after MTT to facilitate donor cell survival. There was no evidence of an adverse reaction to MTT or Cy as determined by serial laboratory evaluations including electrolytes, creatinine, and urea. Early objective functional tests using the KinCom Robotic Dynamometer were conducted on 13 subjects aged 6 to 13 before MTT and at 3 mo after MTT. Of the 69 muscle groups (knee extensors, knee flexors, plantar flexors) tested for isometric force generation in these subjects, 43% showed mean increase of 41.3% +/- 5.9 SEM, 38% showed no change, and 19% showed continuous force reduction of 23.4% +/- 3.1 SEM. The remaining subjects await the 3-mo post-MTT evaluation. The results indicate that 1) MTT is safe; 2) MTT increases muscle strength in DMD: 81% of the muscles tested showed either increase in strength or did not show continuous loss of strength; 3) more than 5 billion myoblasts can be cultured from 1 g normal muscle biopsy, providing unprecedented numbers of cells for MTT; 4) myoblasts, frozen over 1 yr, retain the ability to proliferate from 10 million to 5 billion, and to form normal myofibers; 5) injections of 5 billion myoblasts have not provoked any immunological rejection symptoms in the Phase II subjects, 11 of whom received 8 million myoblasts in the Phase I MTT a year ago; 6) it is safe to perform multiple injections of myoblasts into lower limb muscles without formation of emboli; and 7) donor cell rejection by the recipient can be prevented with Cy when properly managed.


The effect of transplantation site and islet mass on long-term survival and metabolic and hormonal function of canine purified islet autografts. Determination of the long-term function of islet transplantation in relation to the implantation site and the numbers of islets is of scientific interest and, with human islet transplant trials in progress, is a pressing clinical question. In this study, highly purified canine islets were isolated by collagenase digestion and Ficoll purification, and autotransplanted into either the spleen (in 10 dogs) or the liver (in 12 dogs). Dogs transplanted with islets into the spleen or liver received 264,300 +/- 20,300 (mean +/- SEM) and 158,600 +/- 15,000 islet equivalents (150-microns-sized islets) respectively. Graft survival at 1 yr was 86% in intrasplenic islet autografts (ISTx) and 50% in intraportal islet autografts (IPTx). Intravenous glucose tolerance tests and mixed meal-oral glucose tests were performed 1-12 mo from islet transplantation. Compared to controls, ISTx and IPTx dogs showed a similar decrease of glucose tolerance after both intravenous glucose tolerance tests and mixed meal-oral glucose tests. On intravenous glucose tolerance tests, plasma insulin levels were lower in ISTx than in IPTx dogs and controls. On mixed meal-oral glucose tests, insulin values were higher in IPTx dogs than in controls. There was a positive correlation (r = .56, p < 0.05) between the number of transplanted islet equivalents and the K values. These results demonstrate that, in dogs with islet transplant: 1) long-term islet survival can be achieved in the spleen better than in the liver; 2) islet survival is related to the mass of transplanted islets in the spleen, but not in the liver, where other factors probably affect islet survival; 3) the ability of metabolizing glucose is reduced after both intrasplenic and intraportal islet autografts; 4) both reduced insulin secretion (predominant in ISTx dogs on intravenous glucose tolerance testing) and insulin resistance (predominant in IPTx dogs on mixed meal-oral glucose tests) are the probable causes of the decreased glucose tolerance.


Polymer-encapsulated PC12 cells: long-term survival and associated reduction in lesion-induced rotational behavior. Intrastriatal implantation of a dopaminergic cell line surrounded by a permeable, thermoplastic membrane was investigated as a method of long-term dopamine (DA) delivery within the central nervous system (CNS). An increase in DA release from PC12 cell-loaded capsules maintained in vitro was associated with an increase in mitotic activity of the encapsulated cell line. A significant reduction in apomorphine-induced rotational behavior was observed after PC12 cell-containing capsules were implanted into unilaterally 6-hydroxydopamine (6-OHDA) lesioned rats, which was sustained for 24 wk. Four wk after implantation, microdialysis studies revealed the presence of DA near PC12 cell-containing capsules, which was comparable to extracellular striatal levels of unlesioned controls. Extracellular striatal DA was undetectable by microdialysis in lesioned animals near empty polymer capsules. Histological analysis after 24 wk in vivo demonstrated that encapsulated PC12 cells survived, continued to express tyrosine hydroxylase, and that encapsulation prevented tumorigenesis. The data suggested that the release of a diffusible substance, most likely DA, from an implant is sufficient to exert a long-term functional influence upon 6-OHDA unilaterally lesioned rats and that capsules containing DA-secreting cells may be an effective method of long-term DA delivery in the CNS.


A critical reappraisal of gastrointestinal complications of allogeneic bone marrow transplantation. Gastrointestinal toxicity is a common early complication of allogeneic bone marrow transplants. Etiologies include mucosal damage from pretransplant conditioning, opportunistic infection, and graft-versus-host disease. Because the clinical, laboratory, radiographic, and histological findings of acute graft-versus-host disease are nonspecific, accurate diagnosis is difficult or impossible. We review the differential diagnosis of gastrointestinal complications of bone marrow transplants and implications for therapy.


Repeated transplantation of microencapsulated hepatocytes for sustained correction of hyperbilirubinemia in Gunn rats. In previous studies we demonstrated that transplantation of microencapsulated hepatocytes could correct congenital hyperbilirubinemia in Gunn rats for 4 to 6 wks. Reduction in hyperbilirubinemia followed a single transplantation of isolated encapsulated hepatocytes (IEH). After 4 to 6 wks of transplantation IEH gradually lose their functionality. To sustain long-term supplementation of liver function we have investigated the efficacy of monthly IEH transplantation for 6 mo. Hepatocytes, isolated from young Wistar rats, were microencapsulated with a collagen matrix within an alginate-poly L-lysine composite membrane. We transplanted IEH intraperitoneally into homozygous Gunn rats at monthly (4-wk) intervals for 6 mo. Control Gunn rats received intraperitoneal transplantations of empty microcapsules. Total serum bilirubin was measured in the IEH-transplanted and control Gunn rats at weekly intervals for the duration of the 6-month study. A significant (p < 0.01) and sustained decrease (by nearly 50%) in total serum bilirubin levels was observed following monthly IEH transplantations in Gunn rats for the duration of the study. No such decrease in total serum bilirubin levels was seen in the controls. The Gunn rats exhibited good tolerance for the multiple IEH transplantations. Thus, repeated IEH transplantation may be one strategy for providing long-term supplementation of liver function in congenital metabolic liver disease.


Long-term functional recovery of hepatocytes after cryopreservation in a three-dimensional culture configuration. Hepatocyte cryopreservation is essential to ensure a ready supply of cells for use in transplantation or as part of an extracorporeal liver assist device to provide on-demand liver support. To date, most of the work on hepatocyte cryopreservation has been performed on isolated hepatocytes, and has generally yielded cells which display low viability and greatly reduced short-term function. This report presents the development of a freezing procedure for hepatocytes cultured in a sandwich configuration. A specially designed freezing unit was used to provide controlled temperatures throughout the freeze-thaw cycle. Cooling rate, warming rate, and final freezing temperature were evaluated as to their effect on hepatocyte function as judged by albumin secretion. Under optimized conditions (cooling at 5 degrees C/min and warm at > or = 400 degrees C/min), freezing to -40 degrees C resulted in full recovery of albumin secretion within 2-3 days post-freezing, whereafter albumin secretion levels remained normal for the duration of the experiments (2 wks). Freezing to -80 degrees C lead to an approximate 70% recovery of long-term protein secretion when compared to control cultures. In addition, the overall hepatocyte morphology as judged by light microscopy, closely followed the functional results. The sandwich culture configuration, thus, enables hepatocytes to maintain a satisfactory level of long-term protein secretion after a freeze-thaw cycle under optimized conditions, and offers an attractive tool for further studies into the mechanisms of freezing injury and subsequent hepatocellular recovery. These results are a promising step in the development of satisfactory storage procedures for hepatocytes.


Factors affecting in vitro growth of harvested enterocytes. Selective enterocyte transplantation may be an alternative to whole organ transplantation for increasing absorptive capacity. Our aim was to determine the effect of initial cell number and viability, proportion of intact crypts, and basement membrane components (BMC) on the in vitro growth of rabbit enterocytes. Enterocytes were harvested using warm trypsinization from ileal segments in 40 rabbits. Initial cell viability was 92 +/- 4% (mean +/- SD), cell yield was 7.7 +/- 3.6 x 10(6) cells/cm, and there were 0.51 +/- 0.33 crypts/100 cells. Initial cell viability correlated with cell yield (r = -0.508, p < 0.001) and % crypts (r = 0.313, p < 0.05). Cell yield also correlated with % crypts (r = -0.645, p < 0.001). Enterocytes (5 x 10(6)) were incubated in growth media in plain or BMC coated growth culture vessels for 14 days. There was a correlation between both number of cells seeded (r = 0.824, p < 0.001) and cell viability (r = -0.696, p < 0.01) and % growth colonies containing epithelial cells at 14 days. Both total growth colonies (r = -0.565, p < 0.05) and colonies with epithelial cells (r = -0.589, p < 0.05) had a negative correlation with % crypts. Incubating cells in BMC coated vessels (n = 6) resulted in significantly more dispase liberated cells after 14 days than in plain vessels (n = 6) (6.6 +/- 1.1 vs. 3.8 +/- 1.0 x 10(6), p < 0.05) but viability was similar (97 +/- 2% vs. 96 +/- 2%).(ABSTRACT TRUNCATED AT 250 WORDS)


A 9L gliosarcoma transplantation model for studying adoptive immunotherapy into the brains of conscious rats. A rat model for brain tumor immunotherapy is described that closely mimics the type of treatment that could be administered to humans. It involves surgical implantation of a permanent cannula in the brain, through which tumor cells and various effector cells and/or cytokines can be injected. The advantage of this system over more conventional animal surgical procedures is that conscious animals can be treated multiple times while avoiding morbidity and mortality associated with reoperative procedures. Using this system to study adoptive immunotherapy for brain tumors, we provide evidence that the 9L gliosarcoma tumor from the Fischer rat strain can be reduced or destroyed in situ following adoptive immunotherapy with specifically activated cytotoxic T lymphocytes.


A primate model of Huntington's disease: functional neural transplantation and CT-guided stereotactic procedures. In this article, we show that 1) computed tomographic (CT)-guided stereotactic infusion of an excitotoxin into the striatum of a nonhuman primate provides a useful neuropathologic and behavioral model for Huntington's disease. 2) High-resolution positron emission tomography (PET) can be used to image the decreased glucose utilization and the preservation of dopaminergic terminals in the lesioned striatum by using 2-fluoro-deoxy-D-glucose (2FDG) and N-(C-11)-methyl-2-beta-carbomethoxy-3-beta-phenyl tropane (CPT) as tracers. 3) Transplantation of cross-species striatal fetal tissue into the lesioned caudate-putamen reduces many of the abnormal motor movements and behavioral changes seen in the Huntington's disease primate model. 4) Graft rejection results in the return of the abnormal signs of the pregrafted state. These results indicate that treatment of the neuronal deficit in Huntington's disease can involve intervention at the local neuronal circuit level. CT-guided stereotactic implantation of cells that might protect or replace this defective circuitry may eventually provide an effective treatment for Huntington's disease.


Assessment of artificial liver support technology. Despite more than 30 yr of research and development, an artificial liver has still not yet become clinical reality. Although previous attempts using a multiplicity of techniques including hemodialysis, hemoperfusion, plasma exchange, extracorporeal perfusion, and crosshemodialysis have shown minor improvement in patients with acute hepatic failure, limited clinical trials have failed to demonstrate any survival benefit. Encouraged by the progress on techniques that maintain long-term cultures of hepatocytes, more recent efforts have been directed at the use of hepatocytes as the basis of liver support. This review takes a critical look at past and present concepts in the development of artificial liver supports and both qualitatively and quantitatively evaluates the advantages and disadvantages of the available methodology.


Autotransplants in advanced non-Hodgkin lymphoma: are they effective? Recent data suggest that intensive therapy followed by a bone marrow autotransplant is effective in advanced intermediate and high-grade non-Hodgkin lymphoma (predominantly large-cell lymphoma). Twelve studies of autotransplants were analyzed to determine outcome. Results compared to data from 29 chemotherapy studies. Complete remission was reported in 53% of autotransplant recipients versus 17% of persons receiving chemotherapy. Two-year disease-free survival was 16 and 2%, respectively. It is uncertain whether these differences indicate superiority of autotransplants or reflect selection biases. Also unknown is whether similar results might not be obtained with similarly intensive treatment without an autotransplant.


Embedded adrenal cells graft reduced local and early nonspecific inflammatory phenomena which follow agarose beads implantation. Microencapsulation of adrenal cells is proposed for reducing the nonspecific inflammatory reaction observed around polymer implants. This hypothesis was tested by comparing both host cellular reaction and the surrounding graft cell populations which appeared either when agarose embedded cells or when empty agarose beads were implanted. Our results showed that the fibrotic material that surrounded the implanted empty agarose microbeads was not as severe and important when adrenal cells were present. Similarly, T lymphocyte population surrounding the graft was considerably reduced together with the percentage of CD4 and CD8 positive cell subpopulations. The activation macrophage marker IaD disappeared. Our results support the hypothesis that embedded adrenal cells may be a suitable solution for reducing early inflammatory events due to microcapsules implantation.


Endothelial cell senescence inhibits unidirectional endothelialization in vitro. We investigated the effects of cellular senescence on unidirectional endothelialization in vitro, simulating the anastomotic endothelialization of vascular prosthesis. The experiments were carried out with three different cumulative population-doubling levels (CPDLs) of bovine aortic endothelial cells (ECs), which have finite life span. Young ECs with 22 CPDL, middle aged with 46, and senescent with 70 at the time of inoculation were used. The effect of aging on unidirectional endothelialization, as well as cellular morphology and proliferative and migratory potentials of isolated cells, were qualitatively and quantitatively analyzed. The unidirectional endothelialization rate was determined by our newly designed method to prepare the square monolayer sheet with linear margins between cell-adhesion and noncell-adhesion regions. The results showed that endothelial cell senescence retarded not only proliferation and migration but also unidirectional endothelialization. Time-lapsed videomicroscopic study of unidirectional endothelialization process revealed that ECs at several rows back from the leading edge represented much slower rate of migration than did the ECs at the leading edge. These findings suggest that high cellular mobility observed for the ECs at the leading edge may result in localized excessive cell replication. Thus, atherosclerotic vessels containing senescent or injured ECs may have limited capability of anastomotic endothelialization.


Epidermal wound healing: the clinical implications of a simple mathematical model. The role of biochemical regulation in the healing of epidermal wounds remains the subject of much biological debate. We have previously developed a mathematical model which focuses on the role of mitogenic autoregulation in reepithelialization (23-25). Here, we discuss some predictions of our model and their clinical relevance. We investigate both the effects of adding mitotic regulators to healing wounds and the dependence of healing time on wound shape. The latter study suggests a possible mechanism for the control of changes in wound shape during healing. The predictions we make are amenable to experimental verification, and suggest new ideas for experimental research.


Quantitative analysis of unidirectional 2-D tissue formation of endothelial cells. We developed a reliable and quantitative method for measuring the dynamic process of unidirectional two-dimensional (2-D) tissue formation of endothelial cells (ECs) in vitro. The culturing of bovine ECs in an assembled culture chamber provided a square monolayered cell sheet with a linear margin when disassembled at the confluency. The cell sheet maintained in culture showed a unidirectional which was determined from the daily observation of tissue, allowed us to determine quantitatively the dynamic process of unidirectional endothelialization in vitro. The endothelialized distance and the endothelializing zone on a glass slide were found to be nearly 500 microns/day and 750 microns in width, respectively. Thus, the method developed here provided information of the 2-D tissue formation process. This model would be useful as an in vitro model which simulates the anastomotic endothelialization of an artificial vascular graft.


Cell transplantation for myocardial repair: an experimental approach. Myocardium lacks the ability to regenerate following injury. This is in contrast to skeletal muscle (SKM), in which capacity for tissue repair is attributed to the presence of satellite cells. It was hypothesized that SKM satellite cells multiplied in vitro could be used to repair injured heart muscle. Fourteen dogs underwent explantation of the anterior tibialis muscle. Satellite cells were multiplied in vitro and their nuclei were labeled with tritiated thymidine 24 h prior to implantation. The same dogs were then subjected successfully to a myocardial injury by the application of a cryoprobe. The cells were suspended in serum-free growth medium and autotransplanted within the damaged muscle. Medium without cells was injected into an adjacent site to serve as a control. Endpoints comprised histology using standard stains as well as Masson trichrome (specific for connective tissue), and radioautography. In five dogs, satellite cell isolation, culture, and implantation were technically satisfactory. In three implanted dogs, specimens were taken within 6-8 wk. There were persistence of the implantation channels in the experimental sites when compared to the controls. Macroscopically, muscle tissue completely surrounded by scar tissue could be seen. Masson trichrome staining showed homogeneous scar in the control site, but not in the test site where a patch of muscle fibres containing intercalated discs (characteristic of myocardial tissue) was observed. In two other dogs, specimens were taken at 14 wk postimplantation. Muscle tissue could not be found. These preliminary results could be consistent with the hypothesis that SKM satellite cells can form neo-myocardium within an appropriate environment. Our specimens failed to demonstrate the presence of myocyte nuclei.(ABSTRACT TRUNCATED AT 250 WORDS)


Hepatocyte immobilization on PHEMA microcarriers and its biologically modified forms. Polyhydroxyethylmethacrylate (PHEMA) based microcarriers with different bulk structures were prepared by a phase inversion polymerization technique. PHEMA surfaces were further modified chemically by glow-discharge treatment, and biologically by covalent attachment of fibrinogen and collagen. Hepatocytes were isolated from young male Wistar rats using an in situ portal vein collagenase perfusion technique. Freshly isolated hepatocytes were seeded at 6 x 10(5) cells/mL and microcarrier concentration was 10 g/L. Stationary microcarrier cultures were carried out in standard (nontissue culture) polystyrene petri dishes in a humidified 5% CO2 incubator at 37 +/- 0.5 degrees C. Cell attachment was followed by light microscopy by taking samples from the culture medium every 30 min. Urea and protein syntheses by microcarrier-attached hepatocytes were determined by standard techniques. Nonswellable (highly cross-linked) hydrophilic PHEMA microcarriers did not support cell attachment and viability. However, swellable (low cross-linked) PHEMA microcarriers (pretreated in FBS) allowed high attachment and cell spreading. PHEMA microcarriers treated in dimethylaminoethylmethacrylate (DMAEMA) glow-discharge plasma also improved the cell attachment characteristics of the PHEMA microcarriers. The highest attachment efficiencies (immobilization yields) were observed with the biologically modified PHEMA microcarriers, especially modified with fibronectin. Metabolic activity, as estimated by urea and protein syntheses, was also higher in these microcarriers.


Behavioral effects of neural transplantation. Considerable evidence suggests that transplantation of fetal neural tissue ameliorates the behavioral deficits observed in a variety of animal models of CNS disorders. However, it is also becoming increasingly clear that neural transplants do not necessarily produce behavioral recovery, and in some cases have either no beneficial effects, magnify existing behavioral abnormalities, or even produce a unique constellation of deficits. Regardless, studies demonstrating the successful use of neural transplants in reducing or eliminating behavioral deficits in these animal models has led directly to their clinical application in human neurodegenerative disorders such as Parkinson's disease. This review examines the beneficial and deleterious behavioral consequences of neural transplants in different animal models of human diseases, and discusses the possible mechanisms by which neural transplants might produce behavior recovery.


False diagnosis of epilepsy in children. Epilepsy is frequently diagnosed incorrectly through a failure to obtain an adequate history and placing inappropriate emphasis on the electroencephalogram (EEG). We describe four children with common, nonepileptic events who were diagnosed initially as having epilepsy.


Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I. Three hundred and forty three patients with attack disorder labelled as epilepsy were admitted for assessment to a Neuropsychiatry ward in a small English mental hospital over a 5 year period. After assessment it was decided that 63% (215) of these patients had epilepsy, but in 128 (37%) a diagnosis of non-epileptic seizures was made. Just over a third of these patients (46) had an additional history of present or past epileptic seizures as well, so that 24% of the total population had non-epileptic seizures only. The methods used to make this diagnosis are reviewed and an attempt made to classify the non-epileptic attacks from which the patients were suffering. A variety of management strategies were offered and at discharge from hospital the majority of patients had practically lost their non-epileptic seizures. At follow-up 2 years later, seizures had returned in most patients. In 8% of the patients it was clear that the diagnosis of non-epilepsy had been erroneous. The importance of classifying the kind of non-epileptic event the patient suffers from and of translating treatment in hospital to the community is emphasized.


Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part II. Previous childhood sexual abuse in the aetiology of these disorders. In a group of female in-patients clinically diagnosed as having non-epileptic attack disorder there was an increased incidence of a proven previous history of sexual abuse in childhood, when compared with a group of women with epilepsy and a group of women with other psychiatric disorders admitted to the same ward. This was particularly true of women with the 'swoon' and 'abreactive' type of non-epileptic attack disorder (see Part I). The incidence of a history of previous abuse was similar to the two control groups for other types of non-epileptic attack disorder. The swoon was seen as a cut-off phenomenon: the abreactive attack as a kind of acting out the memory of the abuse, part of a post-traumatic stress disorder. Both may respond to counselling for the abuse although it is too early to be certain, and there is a risk of further episodes of the non-epileptic attack disorder during periods of stress. Some patients with epilepsy, however, also had a history of previous sexual abuse: in some the stress of the abuse may have precipitated the epileptic seizures.


Seizure behaviour in a patient with post-traumatic stress disorder following rape. Notes on the aetiology of 'pseudoseizures'. A patient is described who began to have paroxysmal convulsive behaviour, followed by a post-ictal aggression, which was initially diagnosed and treated as epilepsy. The behaviour began after the patient was raped. She had many of the symptoms of post-traumatic stress disorder. It is suggested that the paroxysmal behaviour was an 'acting out' of intrusive and vivid memories of the rape, so called 'flashbacks'. Because the rape had occurred comparatively recently and the events that occurred during the rape were known, it was easy, in this particular patient, to understand the relationship between the previous trauma and the paroxysmal behaviour. The case throws some light on the relationship between similar paroxysmal behaviour in the victims of child sexual abuse and the trauma they had suffered and explains why they behave in the way that they do.


Memory failure in epilepsy: retrospective reports and prospective recordings. People with epilepsy frequently complain of memory difficulties and previous research provides some support for the existence of memory dysfunction. However, our clinical experience is that many who report serious memory difficulties perform quite adequately on psychometric tests. One explanation for this discrepancy is that these patients are exaggerating the difficulties they encounter in their daily lives. This study aimed to examine this hypothesis by comparing patients' retrospective reports of memory to prospective recordings of everyday memory failures. Results demonstrated that far from over-emphasizing their daily problems, people with epilepsy believed fewer memory failures occurred when rated retrospectively than was indicated by a prospective recording device. While there was good agreement between the methods of assessing memory failures for the frequency of their most troublesome difficulties, subjects tended to underestimate the incidence of the less pervasive everyday problems. The results are interpreted through the theory of memory introspection proposed by Herrmann.


The impact of chronic epilepsy on the family. The emotional impact of intractable epilepsy on family members is a neglected topic, with the majority of studies confined to childhood epilepsy. Our clinical experience suggests that family members, particularly parents, may at times be under considerable emotional strain, especially when seizures are frequent and accompanied by injury. The purpose of this study was to explore the psychological and physical well-being, satisfaction with social circumstances and perceived level of support in families with an adult member with intractable epilepsy. Forty-four families were administered rating scales of mood and answered questions relating to their social situation and physical health. Levels of stress and dissatisfaction with their social situation was high, particularly in primary carers (the mother in most instances). Respite periods away from their caring role were few and the perceived level of support was low. Poor emotional adjustment was associated with severity of tonic and atonic seizures and episodes of status. Additionally, perceived low levels of support were associated with depression.


Some issues in the assessment of epilepsy occurring in the context of learning disability in adults. Epilepsy is a common condition in people with learning difficulties. The assessment of seizure disorders in this group requires special consideration of psychological and social, as well as medical, aspects. We consider an integrated approach assessing epilepsy and learning difficulties in parallel. Such meticulous assessment can lead to improved quality of life with treatment changes, and will avoid unnecessary medical and social costs.


Non-epileptic seizures: management and predictive factors of outcome. We report a prospective series of 18 patients with a diagnosis of non-epileptic seizures (NES, pseudoseizures) identified in one unit. Sixteen patients agreed to complete a therapeutic programme. At the end of treatment eight were seizure free, three had only occasional NES and five were unchanged. At 1-year follow-up the situation remained similar regarding seizures, with responders demonstrating an improvement in social functioning and a marked reduction in demands on health service resources. Admission variables significantly associated with a poor outcome were an IQ of less than 80 and a past history of violent behaviour.


Epilepsy: patient views on their condition and treatment. To determine how patients with epilepsy feel about their condition, their current medication and their treatment, a mail survey was conducted among a random selection of 800 members of the British Epilepsy Association (BEA). Completed questionnaires were received from 437 members (55% response rate). This high response rate, achieved over a 4-week period, indicates great concern about their condition among the membership sampled. The majority of patients (80%) were adults; 20% were 18 years or younger. Some 72% of patients experienced one or less seizures per month and 52% were employed. Comments from an open-ended question about treatment indicated that respondents would like to see an increase in the provision of services and in the information conveyed (a more interactive communication between the patient and the physician); both issues should improve the emotional support provided by physicians. Positive feelings about medications were reported when seizures were controlled, although unhappiness was expressed with the length of time and varying doses that had to be taken before a 'correct' dosage level was established. Also expressed was a concern about the extent of management and of experimentation with medication left to the patient and care-giver. Opportunities exist for greater communication among physician, patient and care-givers to ease the feeling of frustration, discouragement and isolation seen with a condition which affects 2 to 3% of individuals during their lifetime.


Predictive factors for controlling seizures using a behavioural approach. A behavioural approach using EEG biofeedback for controlling complex-partial seizures has been successful at the Andrews/Reiter Epilepsy Research Program. Records for a random sample of 83 patients with uncontrolled seizures, one third of those receiving care between 1980 and 1985, document that 69 (83%) achieved control by completion of the programme. Additional data about initial age of seizure onset, number of years seizures had been uncontrolled and seizure frequency when treatment started were collected to determine whether these factors predicted seizure control. Only frequency was significantly related to whether seizures were controlled when treatment ended. Further study using discriminant analysis showed that earlier onset age and higher seizure frequency were associated with a significantly greater number of treatment sessions required. Thus, these two factors predicted difficulty in controlling seizures, as measured by number of sessions, although onset age did not predict whether control was eventually achieved. Since even the subgroup achieving the lowest rate of control (i.e., patients having daily seizures when treatment started) had 67% success, these results suggest that a behavioural approach can be useful for many people with currently uncontrolled complex-partial seizures regardless of their characteristics on factors examined in this study.


A review of interictal cerebral blood flow in the evaluation of patients for epilepsy surgery. The literature on cerebral blood flow (CBF) studies in patients with epilepsy is critically reviewed. Two methods are specifically addressed, radioactive xenon delivered through inhalation or vascularly, and single photon emission computed tomography (SPECT) using various tracers. Both regional and global blood flow were used in these studies to assess focal and generalized seizures. Electroencephalogram (EEG) foci were determined by various techniques, including interictal and ictal recordings from scalp or intracranial electrodes. All studies reported a positive concordance between EEG foci and CBF. However, there was a high incidence of false positive and false negative results. The methodology of almost all of the studies was inadequate to assess accurately the sensitivity and specificity of CBF to localize the seizure focus. Even when conservative estimates were made, the sensitivity and specificity of CBF was too low to be used as a diagnostic test for epilepsy, and inadequate to localize the EEG focus in the evaluation of patients for epilepsy surgery.


Employment among young people with epilepsy. The study reports the findings of a follow-up review of 38 trainees who had completed social skills training programmes run by BRAINWAVE The Irish Epilepsy Association and FAS, the state training and employment authority, during the period 1986 to 1990. The social skills programmes were aimed at young, unqualified school leavers. A total of 101 young people completed the programmes, 45 of whom had epilepsy. Of those with epilepsy, 38 were interviewed about their current employment position. On completion of the programmes 58% had found a job or gone on to further training. At the time of interview 39% were in work or training. Fifty-eight per cent were still experiencing seizures (a seizure in the last 12 months). Fifty per cent of those interviewed felt that they were being actively discriminated against because of their epilepsy. Fifty-eight per cent had made contact with the National Rehabilitation Board, the state placement service for people with a disability, but only 36% of these were in training or employment at the time of interview. Sixty-six per cent of those interviewed had found the programmes helpful in terms of increasing their self-confidence and social skills. The study points to the need for more specialized training and job placement programmes for young people with epilepsy.


Knowledge of epilepsy among relatives of the epilepsy sufferer. A 23-item questionnaire was constructed to assess awareness of basic facts about epilepsy. Close family members of the epilepsy sufferer achieved significantly higher scores on the questionnaire than individuals from families without experience of the condition. The questionnaire may be useful in the identification of family members of the epilepsy sufferer whose knowledge of the condition is low and who may require appropriate counselling.


Exacerbation of typical absence seizures by progesterone. Variation of seizure frequency during the menstrual cycle has been attributed in part to an antiepileptic action of progesterone reducing seizure frequency during the luteal phase, but studies have not distinguished patients with primary generalized, secondary generalized and absence epilepsies. We describe a patient whose absence seizure frequency increased when she was administered progesterone. This indicates that, in contrast to secondarily generalized seizures, progesterone may exacerbate absence seizures.


Fatal liver failure following generalized tonic-clonic seizures. We present three cases of fatal hepatic necrosis in patients with epilepsy taking anticonvulsants, in which the terminal illness presented as an unusually severe generalized tonic-clonic seizure with failure to regain consciousness. In two cases acute renal failure also occurred. It is not certain to what extent drug therapy, physiological and metabolic changes consequent on prolonged seizures, hitherto undiscovered infective agents, or a combination of any of these may play in such a process. We suggest, however, that the case against the drugs alone has yet to be proved.


Seizure circuit analysis with voltage sensitive dye. Voltage sensitive dye was used to produce a map of average membrane polarization for the purpose of analysing the circuitry involved in seizures. Dorsal hippocampus, ventral hippocampus, entorhinal cortex, substantia nigra and occipital cortex were selected to calculate the relative changes in polarization. Rats were induced with bicuculline to have convulsive seizures and mild limbic seizures with kainic acid. A 20 second sample of these seizures were recorded using the voltage sensitive dye. Control animals showed a relatively uniform polarization state in the five brain areas. The bicuculline seizure produced hyperpolarization in all five areas. The magnitude of the hyperpolarization varied among the regions to produce a distinctive pattern. The kainic acid seizure produced depolarization in the four limbic areas. The magnitude of the depolarization also varied, producing a different pattern compared with bicuculline or control. Future applications of this technique in animal models could help identify those areas in the brain which regulate seizure propagation, and the anatomical loci in which antiepileptic drugs interfere with this propagation. Ultimately, human applications would include linking voltage sensitive dyes with paramagnetic or positron emitting traces so that epileptic processes could be visualized using magnetic resonance imaging or positron emission computed tomography.


The occurrence, management and outcome of antiepileptic drug side effects in 767 patients. This study reports the nature of adverse drug reactions (ADR) occurring in 767 epilepsy clinic patients (adults and children), the drugs most commonly involved, how they were managed and the outcome of such management. One hundred and thirty four patients were found to have 155 separate ADRs. The majority appeared to be pharmacodynamic in nature, although 21 were clearly pharmacokinetic in origin and four due to drug interactions. The antiepileptic drugs (AED) perceived to be causative, in order of frequency were phenytoin, sodium valproate, carbamazepine, clonazepam, barbiturates, vigabatrin and clobazam. Management most often involved withdrawing the offending drug(s), usually replacing them with another AED. Of the 155 ADRs, 40.6% resolved totally, 27.7% showed a marked improvement, 16.1% improved, 14.8% did not change and one patient deteriorated. This study emphasizes the need to be vigilant for ADRs and demonstrates that their management is essentially clinical with some 85% of patients experiencing benefit.


Cerebral insult-like partial status epilepticus in the early-onset variant of benign childhood epilepsy with occipital paroxysms. Nine children with the early-onset variant of benign childhood epilepsy with occipital paroxysms had protracted, cerebral insult-like, ictal episodes of impairment of consciousness, vomiting, tonic deviation of the eyes and hemi-convulsions or generalized tonic-clonic seizures. Long term follow-up indicates that this is an entirely benign epileptic condition.


[Treatment of retinal detachment using pneumatic retinopexy]. A series of 46 eyes with idiopathic rhegmatogenous retinal detachment, treated by pneumatic retinopexy has been reviewed. Of 46 eyes 8 were aphakic and 3 pseudophakic. In 4 eyes proliferative vitreoretinopathy was preoperatively present. Anatomic success was achieved in 59% of cases after follow-up of 6-26 months. With additional operations (conventional and/or vitrectomy) anatomical success rate was increased to 98%.


[10 years' experience with the use of endoscopy in the intraoperative diagnosis of extrahepatic biliary tract diseases]. In the last ten years 375 patients were operated on biliary tract examined with intraoperative choledochoscopy. Sensitivity of choledochoscopy in our investigation was 72% and negative predictive value was 85% while specificity and positive predictive value for flexible choledochoscopy was 100%. There were no false positive results. After the instrumental exploration of the common bile duct, unsuspected stones were found in 9.19% of patients recorded with choledochoscopy and 3.44% of retained stones confirmed by postoperative cholangiography. Choledochoscopy was successful in determination of the level of obstruction by tumors in all patients (100%), but of limited value in determination of tumor extension through the bile duct wall in 66.66% of patients. Interventional procedures through the work channel of the instrument showed little success. Extraction of impacted stones was recorded in one patient (3.70%) while the biopsies were completely unsuccessful. We recommend choledochoscopy for each patient with open common bile duct, especially with proved multiple common bile duct stones.


[The role of Epstein-Barr viruses as etiologic agents in the mononucleosis syndrome]. Mononucleosis syndrome represents a number of symptoms with different etiology and pathogenicity with similar clinical features. The aim of the study was to investigate etiologic structure of mononucleosis syndrome, effects of etiologic factors and age on the severity of clinical features, clinical forms of the disease, complications and the outcome. The investigation was conducted in 46 patients treated at the Clinic who had been diagnosed as having mononucleosis syndrome. EBV-IM was confirmed in 43%, adenoviral IM in 13%, while in 44% of the patients etiology of the disease was not established. In both groups more severe forms were present in patients over 16 years of age, but more frequently in EBV-IM than in other patients with mononucleosis syndrome (40% vs 19.23%). Complications in the form of acute hepatitis were found only in patients with EBV-IM in 20% of the cases, mean age 17 years. We are of the opinion that EBV is a significant etiologic agent in mononucleosis syndrome, that the disease is more severe in older patients who also develop complications. The outcome for all the patients was favorable.


[Fatty material in the adrenal cortex 2 months after cessation of contamination]. The presence of lipid substances in the rat adrenal cortex was analysed two months after ending a one-month exposure to detergents. An increased quantity of neutral lipids was found throughout the adrenal cortex. An augmented triglyceride content was manifested to a higher degree in adrenocorticocytes. The largest quantity of phospholipids was observed in the adrenal cortex. The changes in the quantity and quality of lipid substances were described, which all testified to a stimulated activity of adrenal gland.


[Atypical symptomatic headache in the developmental period--case report]. The authors report a case of atypical symptomatic headache in developmental age. It is a complex headache in which three etiologic factors are permeated and superposed. The basic mechanism is connected with the presence of vascular congenital malformation (a. trigemini primitiva persistens), second mechanism is associated with immunologic events (leucopenia-dyshematopoiesis) in which central nervous system is secondarily involved with headaches partly superposed and personality features mildly neurotic, which would represent the third etiologic factor. Since it is the case of symptomatic headache as a notorius clinical entity but with peculiar, puzzling, atypical clinical features and course, the authors point to the complexity of this type of headache, diagnostic speculations and difficulties encountered in therapeutical approaches.


[Hypophyseal pseudomacroadenoma in primary hypothyroidism--2 case reports]. Primary hypothyroidism is often accompanied with hyperprolactinemia and if the untreated disease persists longer hypophyseal adenoma consisting of thyreotropic cells might develop. On the other hand, although rarely, simultaneous occurrence of primary hypothyroidism and hypophyseal prolactin adenoma might be encountered. If substitutional therapy, after the establishment of euthyroid status, does not eliminate clinical signs of hyperprolactinemia and normalize prolactin levels, a decision can be made in favor of hyperprolactinemia within primary hypothyroidism. In that case possible tumor changes in the hypophysis will show regressive tendency towards final disappearance. However if clinical signs and hyperprolactinemia persist after the establishment of euthyroid status, especially if accompanied with compressive signs this should be regarded as a coincidence of primary hypothyroidism and hypophyseal prolactin tumor. We report two female patients with primary hypothyroidism and hypophyseal pseudomacroadenoma.


[Inhibition of initial puerperal and postabortion lactation using oral prostaglandin E2 (Dinoprostone)]. Authors present their experience in oral administration of Prostaglandin E2 (Dinoproston, Upjohn) during postpartal and postabortal period (à 0.5 mg after legal pregnancy interruption) in suppression of lactation. Indications for postpartal lactation suppression were such as: stillbirth, postpartal neonatal death and maternal negative attitude towards breast feeding. The patients in whom the suppression of lactation was applied were of generative age (18-40 years) either primiparas or multiparas. All were delivered vaginally with no extra intrapartal or postpartal complications being the same in legal pregnancy interruptions which were performed by application of intravaginal, intracervical and intramuscular Prostaglandin preparations. The patients were administered 1 tbl od 0.5 mg Dinoproston preparation every 6-7 hours, 48 h after the delivery, i.e. 2 tbl in total (after meal). This method of lactation suppression was applied in 50 patients during 1990. Satisfactory results were achieved in all cases, while negative side effects and complications were not noted. Oral administration of PGE2 was found very efficient in postpartal and postabortal lactation suppression while compared with previously applied methods such as Estrogen-Testosterone preparation, i.e. small doses of Bromergon applied during 10-14 days. Oral administration of PG2 is more efficient and in a certain way more comfortable in relation to the previously applied methods.


[Dosimetric measurements and early complications in patients with differentiated thyroid carcinomas treated with radioactive iodine]. The aim of the study was to determine the exposure dose rate during the application of radioiodine therapy (ablative or tumoral dose) given in order to treat the differentiated thyroid carcinoma, during the medical visit and examinations of those patients, to establish the safety distance from patients both for population and for medical staff and to perceive early complications after the therapy. The dosimetric measurements were performed in 10 patients. The exposure dose rate during the application of the therapy ranged from 2000 to 10000 pC/kg.s, during the visit from 528 to 15 pC/kg.s and during the examinations of patients from 5500 to 200 pC/kg.s. The average safety distance from patients for population was about 8.5 m on the day O (the very day of the therapy) and 2.0 m on the day 4, while for the medical staff it amounted to 5.0 m on the day 0 and 0.5 m on the day 4. The early complications perceived were as follows: radiation thyroiditis in 5/10 patients, stomach problems in 1/10 patients and transitorial leucopeny, forty days after the therapy, in 2/10 patients.


[Multimodal evoked potentials and the blink reflex in patients with primary brainstem lesions]. In 17 patients with primary brainstem injury, out of 60 patients with severe head trauma, diagnostic and prognostic values of multimodal evoked potentials and blink reflex were evaluated in relation to clinical syndromes of the brainstem, the duration of coma and the outcome. Clinical classification of the brainstem syndromes according to Gerstenbrand and Rumpl was used for the evaluation of the clinical findings, the Innsbruck Coma Scale (ICS) for the evaluation of the coma level, and the Glasgow Outcome Scale (GOS) for the outcome. Analyses and measurements of the multimodal evoked potentials and blink reflex were used many times in the period of assessment (six months after the injury). The analysis of our results with multimodal evoked potentials and blink reflex revealed different correlation and sensitivity in relation to the clinical syndromes of the brainstem, the duration of coma and the outcome of the injury. The blink reflex and somatosensory evoked potentials had the best correlation and the greatest sensitivity, the auditory evoked potentials had somewhat, while the visual evoked potentials had none. Multimodal evoked potentials and blink reflex increase the specificity of the diagnosis of brainstem injury compared to clinical observation only, and improve prognostic reliability.


[Abdominal typhus today].

[Abdominal typhus today]. Abdominal typhus is all the rearer disease among acute infectious diseases in Vojvodina. In the last ten years (1981-1990) 16 patients with abdominal typhus were treated at the Department of Infectious Diseases in Novi Sad, mostly young individuals from 6 to 30 years of age (13 patients). Positive epidemiologic features were found in 13 patients. In 80% of the cases the source of infection was outside Vojvodina. They usually were admitted at the Department on the first and second week of the disease (11 patients), and 3 patients were admitted on the third week. None of the patients was suspected of having abdominal typhus at the time of admittance. Delayed hospitalization and unrecognized abdominal typhus were most likely due to the atypical onset and course of the disease. Atypical features in the clinical picture occurred in all the patients with a sudden onset of the disease. The abrupt temperature elevation in 50% of the patients was followed by shivering, fever and shaking. Hepatosplenomegaly was found in 12 patients, abdominal meteorism in 10, typical typhus tongue in none. Typhus state was not found in any of the patients. Normal leucocyte count was found in 7 patients, positive Widal's agglutination reaction in 13, coproculture in 8 and hemoculture in 15 patients. The atypical clinical picture was the result of early administration of broad-spectrum antibiotics before the established etiology of the febrile state.


[Antibody titer levels and the presence of herpes simplex virus antibodies in the serum in relation to gender]. We examined 600 serum samples from female patients for the presence of antibodies to herpes simplex virus (RVK). 293 serum samples belonged to males and 291 to females, while in 25 carcinoma of female genital organs (cervix, endometrium, ovarium) was verified. Antibodies to HSV were found in 117 samples of which 68 were taken from females, 29 from males. Out of 25 malignant cases 20 were positive to HSV antibodies. In the majority of samples only so called "anamnestic titre" 1:8 was proven while higher titres were more frequently found in females. Titre of 1:16 was detected in 27 females compared with 11 in males. Titre of 1:64 was detected only in 2 females. Of 25 female serum samples with malignant precesses in genital organs 20 were positive, titres being above 1:8 except in 4 cases.


[Postspinal headache as an anesthesiology problem]. Spinal anaesthesia, is nowadays one of the safest anaesthetic techniques with low complication rates. Postspinal headache is a complication of spinal anaesthesia. This paper presents several factors associated with the development of postspinal headache and discusses the reduction, prediction and treatment of postspinal headache.


[Diabetic retinopathy and other complications of diabetes mellitus]. The paper reviews the results of a ten-year follow up conducted in 140 diabetic patients at the Ophthalmology Clinic in Novi Sad. We analysed the number of the cases and ratios between diabetic retinopathy and other complications in eyes and other organs. Apart from retinopathy among eye diseases the most frequent was hypertonic fundus in 20%, cataract in 17% of the eyes and occlusive conditions in the retinal blood vessels in 2.6%. In the whole group only 8% of the examined eyes had no changes. Complications develop in 70% of diabetics with retinopathy and 48% of those without retinopathy. Nephropathy was found in 18% of diabetics with retinopathy and 13% of those without it. Macroangiopathy of the brain, heart and peripheral blood vessels was found in lower percentage but more frequently in diabetics with retinopathy.


[Smoking--II. Duration of smoking and factors affecting smoking as a social phenomenon]. According to the poll of 5,555 individuals (91% of the expected number) over 40 years of age, selected from electoral registers in all three districts of the community of Mali Idjos in 1987, the average duration of smoking among active smokers increases with age, divergently with regard to sex. The age of smokers at the time they started smoking increases with age groups, from 22.2 to 33.2 in males and from 28.1 to 49 in females. The onset of smoking in the oldest male group in this rural area occurred in the first years after the war (first land confiscation) while in the group from 70 to 74 years of age it occurred in the years of compulsory crop-purchase system. Agglomeration in the onset of smoking in two male age groups (60-64, 65-69) occurred at the time of the second land confiscation. The onset of smoking among females from all age groups, from 45 years on occurred in the first decade of the sexual revolution (1961-1971). The prevalence of smoking in the studied population was different in previous decades as well. It changes according to social factors: from political and economic changes among males to the changes in women's social status among females.


[Prognostic significance of morphologic and morphometric characteristics of communicating hydroceles in boys]. The paper reviews the results of a prospective study on external morphologic characteristics of communicating testicular hydrocele in boys, which might help the prognosis of future events in the peritoneal testicular covering. We examined 216 cases of communicating hydrocele and controlled their size and consistency every 3 months throughout the period of 15 months. It has been found that bigger hydroceles of about 3 x 3 cm which are always followed by the development of strained walls, remain in higher percentage unobliterated up to the 15th month of life, because of which an indication for surgical treatment is necessary (34.2%). More numerous were hydroceles exceeding 3 x 3 cm in children delivered before the 40th gestational week.


[Cytometric study of blast cells in acute leukemias and their prognostic value]. Cytometric assessment of the leukemic blasts was performed in the course of diagnosing acute leukemia. The results of the cytometric study were used as prognostic parameters. We measured the surface of the nucleus and of the cytoplasm, and calculated the nucleus-cytoplasm ratio. The investigation was carried out on peripheral blood and bone marrow smears in 50 patients with acute leukemia, classified according to the FAB classification. The results showed that the mean surface of the nucleus in all groups was significantly bigger in bone marrow cells than in the peripheral blood. In non-lymphoblastic leukemia no significant differences of the mean leukemic blast nucleus surface were found among the subgroups either in the bone marrow or in the peripheral blood. Concerning the mean surface of the blast cytoplasm in the peripheral blood it has been established that in the subgroup M-2 it is significantly the smallest in nonlymphoblastic leukemia subgroups, while in the bone marrow it is significantly bigger in M-2 and M-4 subgroups than in the peripheral blood. In lymphoblastic leukemia the mean surfaces of the cytoplasm in the peripheral blood were not significantly different from those in the bone marrow, while concerning the mean surface of the nucleus the difference was registered in favor of the bone marrow. The nucleus-cytoplasm ratio was rather high in the blasts of the peripheral blood and the bone marrow.(ABSTRACT TRUNCATED AT 250 WORDS)


[The effect of clonazepam on experimental epilepsy induced by electrostimulation]. The investigations were aimed at the study of effects of preparations which belong to the benzodiazepine group-Clonazepam (CZ), on total bioelectric activity (EEG) and epileptic discharge induced by electrostimulation of the hippocampus in the experimental animals (awake adult rabbits). Clonazepam was administered both intramuscularly (i.m.) and intravenously (i.v.) at a dose of 0.2-2.5 mg/kg of the body mass. The obtained results show that the administration of clonazepam prolongs the duration and the arrangement of the spindle in the bioelectric activity in rabbits and stops epileptic attacks of the grand mal type.


[Diagnostic significance of preoperative determination of CA-125 serum levels in the differentiation of malignant and benign pelvic masses]. Preoperative estimation of serum C-125 tumour marker was performed in 45 patients with adnexal malignancies, 50 patients with benign pelvic masses and in 30 healthy women who underwent plastic surgery for disturbed statics of genital organs. Elevated serum CA-125 values (above 65 U/ml) were observed in 38 (84.5%) patients with ovarian malignancies (chi = 355.93, SD +/- 251.86) and in 7 (14%) patients with palpable benign pelvic masses (chi = 48.09, SD +/- 77.08). Preoperatively evaluated serum CA-125 values were not evident in the control group (chi = 7.20, SD +/- 6.98). There were statistically significant differences (T = 8.13, p < 0.05) between preoperative mean serum CA-125 values in the patients with malignant and benign pelvic masses. Also, there was statistically significant difference between the control group, the group with malignancies (T = 7.48, p < 0.05) and the group with benign pelvic masses (T = 2.86, p < 0.05). Preoperative assessment of the serum CA-125 values proved to be significant but not absolutely reliable laboratory-diagnostic parameter in differentiation of malignant and benign pelvic masses in the female.


[Stereologic analysis of the human hypoglossal nucleus during the period ranging from the 22nd postovulatory week until birth]. The hypoglossal nucleus consists of the cells of the fourth stage of maturation according to Rakić. However, there are obvious differences and one of them is observable in the degree of staining intensivity of their Nissl bodies and nuclear inclusions. The stereological analysis revealed a constant decreasing of numerical density of the nerve cells nuclei in stages investigated. The decrease of the numerical density was highly significant (p < 0.001), probably due to the tissue growth and the total increase of nucleus i.e. its neuropi. The shrinkage of the tissue must be taken into consideration, too.


[Rhabdomyosarcomas in otorhinolaryngology]. The study reports two patients with very rare tumors, rhabdomyosarcomas. The first case was a six-year-old girl with tumor in the right nostril and epipharynx, the second was a 66-year-old male patient with protuberances in the hypopharynx. The diagnosis was based on the PH analysis. One case was treated with air therapy, the other was surgically treated. Both died soon after, the fact that points to an enormous malignant potential and unfavorable prognosis for the diseased.


[Intraosseous schwannoma].

[Intraosseous schwannoma]. Neurogenic tumors, primary bone tumors, are rather exceptional; about 50 cases have been reported so far. The study reports a case of intraosseous schwannoma, a primary bone tumor, in a 20-year-old male patient, localized in the distal end of the right tibia.


[Psychological characteristics of obese persons with special reference to periods of modified fasting]. It is well known fact that the results of modified fasting can be improved if the basic therapeutic method is combined with psychotherapeutic procedures. We have analyzed the data taken by a poll from 55 extremely obese women treated by modified fasting regimen. The results absolutely justify the above mentioned remark that radical reduction cures may cause critical moments most frequently recognized in hunger crisis when patients feel a need for conversion with medical staff. With no doubt, any help from a qualified person might be perfectly beneficial. Besides, obese persons are more inclined to depressive moods which may aggravate during these cures. In order to maintain the achieved result for a longer period of time if not for good, a continuous team work which include psychotherapeutic measures is of special significance. On the highest level it would be smart to establish an association of treated obese people, which would be a link between a patient and a professional.


[Treatment of post-traumatic hemarthroses of the knee and ankle in children using transcutaneous electric nerve stimulation]. TENS (transcutaneous electric nerve stimulation) was applied in 36 children with knee or ankle hemarthros. Pain was diminished after first or second treatment and completely disappeared at the end of the first or second day. Swelling usually disappeared in the interval between the third and seventh day. At the end of the treatment joint movement was significantly improved. In the control group who received only conventional conservative treatment (puncture, immobilization or inactivity, drugs) swelling and pain were still present after the seventh day and these patients needed additional physiotherapy for next seven days. We consider the TENS a method of choice in the treatment of posttraumatic hemarthros providing that treatment starts immediately after the injury and that it is continually applied during 3-5 days. The patients are advised to use crutches. It is a simple, painless method which is not combined with any additional treatment. Proteolytic ointments can increase and stimulate the therapeutic effects.


[Hemorheologic changes in patients with essential hypertension treated with prazosin]. Prazosin which is a selective alfa-1 blocking drug has a very good antihypertensive effect. Its hemorheological effects were studied in 20 patients with essential hypertension (I and II degree according to WHO classification). After 6 weeks of the therapy with prazosin, hematocrit and viscosity of the whole blood and plasma were significantly reduced, because of hemodilution, while aggregability of erythrocyte and "Tk" values were not significantly reduced. Platelet aggregation induced by collagen, ADP and adrenaline, showed a decrease after the treatment. Assuming the hemorheological effects not to be crucial in choosing an antihypertensive agent, we must not, however, neglect them, especially in patients with compromised hemorheological profile, and we should take advantage of the positive hemorheological effect of prazosin, particularly in a long antihypertensive treatment.


[Serum ionic calcium in the early neonatal period in premature and small-for-gestational-age infants]. We determined the value of serum ionic calcium in premature infants of different gestational age and infants small for gestational age, on the first and the 3rd day after the birth. The aim of the study was to determine the incidence of hypocalcemia and to confirm the hypothesis that the food for newborns should be calcium supplemented which would prevent poor postnatal bone mineralization. The subjects were divided into two groups: premature infants from 28 to 32 and from 32 to 36 gestational weeks. The third group consisted of intrauterine retarded newborns. The highest ionic calcium level was found in the intrauterine retarded newborns (1.30 on the first and 1.025 on the third day). High percentage (30%) of hypocalcemia was detected in premature infants from 28 to 32 gestational weeks. The high percentage of hypocalcemia in premature infants of smaller gestational age points to the need for calcium supplemented food which would prevent poor postnatal bone mineralization.


[Surgical treatment of perforating eye injuries due to intraocular foreign bodies]. Twenty-three consecutive cases of perforating ocular injuries with retained intraocular foreign body (IOFB) are examined in this retrospective study. The group most affected was that of males with mean age of 32 years, who sustained a job injury, presenting with a single corneal laceration. Of the 23 cases with injuries 22 (95%) were due to metallic foreign bodies. Of these, 12 (54%) involved foreign bodies of ferromagnetic origin. At surgery 14 (61%) of the 23 IOFB were removed with forceps and 9 (39%) with electromagnet. From these patients 87% obtained visual acuity equal or better than that on admission.