Experimental animal-modelling of Indiana type continent urinary reservoir. To gain experience in animal experiments prior to introduction in human practice is fundamental in our opinion. Apart from achieving practice in operative technique, analysing and possible avoiding unnecessary complications might be the ethical positive consequences of this practice. On the other hand, functional tests prior to human use will be possible, and as it has been demonstrated in our present study, modifications of technique might be the result of animal experiments.


Enduring negative psychological characteristics of male and female step-children toward the step-parent. Many divorced people remarry, and if either one or both of the remarried partners has a child or children from a former marriage, then the youth need adjust to not only the new marital structure, but to the new step-parent as well. The present research was conducted to determine: (1) enduring negative psychological characteristics of male and female step-children toward the step-parent, and (2) a comparison of the similarities and/or differences of each. Results suggested ten of the most frequently stated variables of both subject groups, similarities or significant differences between them by subject status, and their relevancy to the step-child-step-parent relationship.


[Outcome of 89 psychiatric emergencies managed by 3 mental health centers in an emergency service]. This paper deals with the assessment after 2 years of the outcome of 89 psychiatric emergencies taking in charge in Saint-Luc hospital's (Brussels) emergency room, by 3 community mental health services. After the triangulation of the demand, in the emergency room, 91% of the patients go to the community mental health service. In 92.5% of cases, the crisis intervention is carried out by the same therapists they met in the emergency room with the collaboration of other members of the outpatient team. Crisis interventions are brief (less than 3 months) in 50% of cases, less than 1 years in 11.5% of cases and lead in 35% of cases to long-term in charge (more than 2 years: psychiatric and social follow-up).


Posterolateral lumbar spine fusions: private v. NHS. Comparative, preliminary study. In the present study comparative evaluation has been carried out between the groups of patients (31 in each group, private and National Health Service) treated by posterolateral lumbar spine fusion for mechanical lower back pain. The same surgical team was involved in the treatment. The patients were evaluated independently at an average follow-up of more than three years in each group. The acceptable clinical results (good and fair) showed a remarkable difference between the two groups, with the private group enjoying the better outcome. The difference of final outcome was analyzed by looking at the waiting time for surgery, the social classification of the patients and the provision of state benefit for disability.


Controlled comparison of RO 11-1163 (moclobemide) and placebo in the treatment of depression. Moclobemide was compared to placebo in two parallel groups of depressed patients, in a multicenter randomized, double-blind study of six weeks treatment duration. Forty seven patients participated in the study: 23 received moclobemide (flexible dose 300-600 mg/day) and 24 placebo. They were evaluated weekly for efficacy and tolerability. Moclobemide was more efficacious than placebo as judged by analysis on the total score on the Hamilton depression scale (p < 0.05) and by the overall assessment of efficacy (p < 0.01). Moclobemide was also more effective than placebo in the subgroup with neurotic depression (p < 0.05). In addition, the number of patients prematurely terminating treatment for inefficacy, was higher in the placebo than in the moclobemide group (12 versus 2, p < 0.01). The number and the severity of side-effects tended to be slightly greater in the moclobemide than in the placebo group, but this did not reach a level of significance. Cardiovascular tolerability was good in both treatment groups. No hypertensive crisis was reported. Hematology, clinical chemistry and urine analysis were not affected by the treatment in any clinically significant fashion.


An open multicentre study to evaluate the efficacy and tolerance of fluoxetine 20 mg in depressed ambulatory patients. In this study, 544 out-patients suffering from depressive disorders were enrolled in 6 weeks open study with fluoxetine 20 mg. A statistically significant decrease of the Hamilton Rating Scale for Depression (HRS-D) score is observed during treatment. All individual item HRS-D scores and in particular suicidal ideation, sleep disturbances and anxiety showed the same improvement. Side-effects were carefully recorded and presented a lower incidence rate than in other studies. New issues in methodology management concerning ambulatory studies are discussed.


[Effects of hydroxyzine on attention and memory in elderly subjects]. A single intake of hydroxyzine 25 mg was compared to placebo, and lorazepam 1 mg as a verum, in a double-blind, triple-crossover trial. Each of the 12 elderly volunteers was tested on three different days, once under each condition. At 2.5 hours after drug intake they were assessed or reassessed for attention, immediate and delayed (30') memory, cognitive ability and feelings of anxiety and fatigue. Some subjects mentioned a minimal sedation under hydroxyzine 25 mg and under lorazepam 1 mg, but only hydroxyzine preserved memory and attention, while lorazepam caused clear deficiencies in memory recall.


[Cognitive-behavioral approach to alcoholism: preliminary report of the realization of a therapeutic group]. The heterogeneity of alcoholic patients has lead alcohologists to find specific treatments for them. The cognitive-behavioural approach enables recognition of the cognitive and communicational distortions disclosed by these patients. This approach attempts to correct these distortions by training social skills. In accordance with this orientation, we have organised a therapeutic group for alcoholic patients. We have estimated how much patients appreciate this approach and how they expect it to change their drinking behaviour. Thirty-five alcohol-dependent patients have agreed to take part in three groups during their stay in hospital for detoxification. Each session deals with one of the following themes: "reproach & refusal", "request & emotions" and "relapse". The rating is assessed through a self-administered questionnaire. The appreciation of the method is very good for all measured parameters, and 76% of the patients consider it can help them.


[Which abstinence in alcohol problems?]. Examining the place of abstinence in alcoholism, the authors review the different tendencies in recent literature (total abstinence, controlled drinking, responsible drinking). According to the type and severeness of these problems, different approaches are presented in the frame- work of family therapy. Through the development of a clinical case, the authors illustrate the interest of prescribing compulsory abstinence within the context of voluntary hospitalization, family and individual psychotherapy.


[The elderly subject and social violence: the body as a factor in communication]. The social inferiority of an elderly person stems from his physical inferiority--actual or alleged but always possible. And yet this "inferior" body is paradoxically hypertrophic: at first it masks the person, then takes up its space until it negates it. Hence, an elderly person is not only a body but a lonely body. In his relations with other people, his body becomes a receiver, a receptacle and a source of communication. Social violence underlies relations with elderly people: such violence may be deceptive, widespread and continuous or, on the other hand, manifest, episodic and conspicuous. In the first case it may be a way of assigning subalternate roles to them in relation to the efficiency expected of them or a way of mythologizing their condition as one of pseudo-happiness. In the second case is generally relates to assaults, thefts, bag-snatching, etc. In any case, however, communication with them entails violence: their body perceives this and reacts to it. This is why their body's language is violent: their body cries out, it is stunned and it is acted upon (even--and unavoidably--in relations with a therapist).


[Therapy for couples in their sixties].

[Therapy for couples in their sixties]. There is small interests in marital therapy for 60 years and more, for which a, at least, partially specific approach seems us necessary. After reviewing the weak literature regarding this topic the authors present six marital therapy in this age group. They propose in their conclusions a five points model of care: brief taking in charge or "coevolution", psychiatric approach, "problem solving", specific crisis of this ages, speaking about sexual life.


[No hypofrontality in schizophrenia demonstrated by positron emission tomography]. We studied cerebral glucose metabolism, using Positron Emission Tomography (PET) and (F-18) fluorodeoxyglucose, in 15 young schizophrenic patients compare to 15 age-matched healthy volunteers. The PET investigation was made in a quiet room with a dimly light. Each subject remained in a supine resting state with eyes closed. Results failed to demonstrate any differences in glucose utilization between schizophrenic patients and control subjects, as far as absolute or relative, left and right values are concerned. Besides, variability of metabolic values was significantly higher in schizophrenics than in controls.


Rheumatic heart disease in Africa.

Rheumatic heart disease in Africa. Rheumatic heart disease continues to be relatively common in many parts of Africa, predominantly affecting young people. Special attention should be given to its prevention by the inexpensive methods that have proved effective elsewhere, and to this end assistance should be provided by the international community.


[The practice of electroconvulsive therapy: current contribution. II.--administration and evaluation of treatment]. In this second of a two-part review about electroconvulsive therapy (ECT) practice, the author highlights recent advances in ECT course management with a special emphasis on pre-ECT evaluation, treatment procedures, evaluation of outcome and post-ECT course. Pre-ECT assessment should include an evaluation of medical risk factors and concomitant use of psychotropic or medical agents have to be reconsidered. Practical and technical aspects of stimulus administration and their relationships with post-ECT cognitive disabilities are then presented. Monitoring of treatment response and cognitive changes during ECT course is also discussed as well as post-ECT pharmacotherapy maintenance or continuation ECT.


[Current psychoanalytic observations on dreams]. What is a dream from a psychoanalytical point of view? Freud first contemplates the fulfillment of the wish (1900), then the compulsion to repeat (1920) and finally the benefit of pleasure (1925). Following J. Lacan, a function of coding can be brought out: the dream substitutes the picture translated enjoyment of the sign from traumatic reality. Thus, the dream dreamt is not a message but a means of enjoyment of the unconscious.


[Psychiatric commitment and current legislation of 26 June 1990 relative to mentally ill persons]. A study on the psychiatric confinements in the Walloon region in the year 1984 allows to define the patient's psychopathology and the context of the requests. The new law of the 26 June 1990 relating to the protection of the mentally ill person will probably be used mostly in such situations. Its conditions of implementation, positive aspects and the difficulties it could create are detailed.


[HIV infection in women. Psychological and somatic obstacle]. We consider the word "impediment" in the meaning of what compels someone, makes someone feel uncomfortable. What are the consequences/implications of seropositivity for the woman in her sexual life, in her motherhood and how does she then cope with it? The following clinical observations account for the suffering induced by seropositivity and the diversity of the processes spontaneously set by HIV-infected women in their sexual life. To answer that suffering, the commonly used psychotherapeutical approach is a palliative one.


[AIDS, burnout and fear of knowing. Dialectic observations for the benefit of clinical psychology and liaison psychiatry]. A review of the literature regarding burn-out provide a sample of specific variables that describes the phenomenon. This could potentially leads to the emergence of a set of actions intending to facilitate the task of health workers (at least if personnel managers pay it attention). However, it does not preclude the risk of burn-out, neither does it explain its nature. This syndrome seems to be more prevalent in certain medical departments and it occurs to us--through careful listening to health workers and AIDS patients--that, to learn about something that affects health workers, we have to ask patients, supposing they were in the first line. We then realized that knowledge makes distress.


[AIDS: challenge to liaison psychiatry. Various expectations by clinicians concerning liaison psychiatry]. Interdisciplinary group work could be conceived as shared common abilities in order to provide a global management of diseases. In this regard, psychologists should assumed several tasks: to advise on patient's psychological resources to keep them less anxious or more cooperative, to humanize hospital and death, to prevent burn-out. This does not mean a management of the illness, but a careful listening to help patients to find a meaning to what they are living. The aim should not to harmonize different skills but to define each other place (physician, social worker, nurse, psychologist...) concerning queries that involve us and that wonder us about life, health, sexuality, love, the way we take risks.


[The adolescent in general psychiatry].

[The adolescent in general psychiatry]. Ever since the works of anti-psychiatry and the bringing out of the danger of trying to master the adolescent, we have been made aware of a certain iatrogenic pathology. What is less known are the identification risks which exist between the young patient and the mentally-ill person. This identification can be imaginary, but it always runs the risk of becoming symbolic and opening up the way to chronification. So it would seem to us to be important to promote a special setting for adolescents.


[Prevalence of human immunodeficiency virus infection in a psychiatric population in Central Africa]. In an African population of 292 women, hospitalised for psychiatric reasons, the seropositivity for HIV was clearly found higher than in the general corresponding population; this was particularly significant for first hospitalisations; furthermore, the seropositivity became twice as high in the group hospitalised several times. The HIV, known for neurotropism, seems responsible for a psychic fragility factor, favorising psychiatric breakdowns as well as their recurrences. No specific psychiatric diagnosis appears to be related to the seropositive patients. This study suggest that psychiatric breakdowns are already favoured in the period preceeding immunodeficiency symptoms (AIDS or ARC).


[Integrated care of HIV-seropositive patients: liaison psychiatry revisited]. Psychiatric, psychologic and psychotherapeutic care of HIV patients is integrated inside a specific medical institution. The psychological representations that AIDS mobilizes pervade the intense medical relationship between internists, nurses and the HIV patients. This relationship becomes the central node for the differentiation of psychologists and psychiatrists function inside the team. We propose here three different functions: the bio-psycho-social integrated care of the patients; the "binding" of psychical representatives inside the HIV patient who is in a death process; the binding of the representatives disseminated inside the medical team by the patient.


Is REM latency a dying concept?

Is REM latency a dying concept? Twenty years have passed since the discovery that a shorter REM latency was one of the most significant biological correlates of depression. Its diagnostic and clinical discriminant power have been challenged both in terms of sensitivity and specificity. The present paper is a review of the relevant literature of these years until the present time and has focused on (a) technical problems concerning the REM latency, (b) its diagnostic value, (c) the state or trait meaning, (d) the use of the cholinergic and aminergic challenge, (e) the effects of treatments. A summary of (f) the effects of age and (g) REM sleep propensity as a cycle phenomenon have been added. The conclusions tend toward considering REM sleep disorders as an expression of a multiple circadian cycle abnormality, globally seen as a trait, itself highly correlated with psychiatric pathology and especially with affective disorders.


Cholinergic and noradrenergic neurotransmission: impact on REM sleep regulation in healthy subjects and depressed patients. The reciprocal interaction model of NonREM- and REM sleep regulation suggests that the cycling alternating pattern of Non-REM- and REM sleep is under the control of noradrenergic/serotonergic and cholinergic neuronal networks. This model was tested in healthy humans by administration of cholinergic agonists/antagonists and noradrenergic antagonists prior to or during sleep. Cholinomimetics like physostigmine, RS 86 and galanthamine provoked an earlier onset of REM sleep, whereas subchronic treatment with scopolamine, a cholinergic antagonist, only led to a heightening of REM density. Simultaneous administration of noradrenergic antagonists with a cholinergic agonist did not provoke a more pronounced REM sleep advance. Comparative studies with the cholinergic agonist RS 86 in depressed patients, schizophrenic patients and patients with other psychiatric disorders revealed the most pronounced REM sleep response in the depressed group. The REM sleep response to cholinergic stimulation in depression did however not predict the treatment response to a differential-therapeutic strategy.


Naps and depression.

Naps and depression. In healthy subjects, napping has often been seen as an "abnormal" form of sleep, while sleep has been considered as a necessary feature of life. Social and cultural biases influence the occurrence of napping behavior. However, several observations indicate the presence in man of a two per day modulation of sleep propensity. On the other hand, alterations of nocturnal sleep have been widely described in affective disorders, but little is known about the presence of daytime sleep in depressed patients and the possible effect of daytime sleep episodes on nocturnal sleep. Some attempts to characterize daytime sleep in depression are reviewed. A recent study based on continuous polygraphic recordings indicate that napping occurrence appears to be similar in depressed patients than in control subjects. However, naps structure and organization were different in depressed patients in comparison to controls. Napping seems thus to be more prevalent in depressed patients than previously assumed. Possible effects of naps on mood, alertness in depressed patients remains to be explored.


[Contribution of neo-electroencephalography in adult functional and psychiatric disorders]. Two comparative studies of the basic activity at rest, with closed eyes taken in conventional EEG and analysed in Neo-EEG are carried out in adults showing functional or psychiatric disorders. The first open study involves 18 subjects suffering from a affection called "neurodystony" and 24 depressed subjects. The second study made in double-blind compares the results of the conventional EEG with the Neo-EEG in 19 depressed patients, 28 alcoholic patients and 26 psychotic patients. The Neo-EEG discloses abnormalities in about 60% of the cases when the conventional EEG is normal. The conventional EEG as well as the Neo-EEG diagnose a greater number of low voltage in alcoholic subjects and clear abnormalities in psychotic subjects. Low voltage is never detected in psychotic patients. In depressives, the Neo-EEG shows about 65% of abnormalities of which an asymmetry of the basic frequency in the center of the two hemispheres when they are analysed separately. That asymmetry develops in parallel with the clinical state. The asymmetry is also found in psychotic patients. In nervous or neurodystonic subjects, the Neo-EEG only discloses 25% of abnormalities. The Neo-EEG appears as an easy method, able to detect dysfunctions which cannot be disclosed with the conventional EEG and useful to follow their developments. Moreover, the result of this technique brings to the fore abnormalities not detected with the conventional EEG: this eventually leads to prescribe other therapies than those initially considered.


[Resectoscopic endometrial ablation in the treatment of recurrent, dysfunctional menometrorrhagia: our experience]. Advances in hysteroscopic surgery provide additional options to hysterectomy for the treatment of dysfunctional uterine bleeding resistant to medical therapy and multiple curettages. Two techniques are now available: (a) Resectoscopic endometrial ablation. (b) Electrocoagulation or laser photovaporisation of endometrium. 52 patients underwent resectoscopic endometrial ablation at the Gynaecology Department of Parma University from January 1991 to April 1993. All patients suffered from dysfunctional uterine bleeding without atypical histologic findings on endometrial biopsies and had a normal shaped uterine cavity. 41 patients were subsequently contacted for follow-up. Follow-up period ranged from a minimum of 3 months to a maximum of 24 months. 78.1% of the patients reported a satisfactory outcome (amenorrhea or decreased menstrual flow). No operative complication occurred. Post operative complications included one case of hematometra. resectoscopic endometrial ablation is an advantageous technique but our follow-up period is relatively short and long term sequelae have yet to be determined.


[Pregnancy and breast-feeding: developmental stages of mother-child bonding]. Several authors, confronting the mother-child relationship during pregnancy and breast-feeding, talk about an uterine and extra-uterine symbiosis. In this way, one bypasses the fact that the so called unions end with the processes of separation constituted by the birthing/birth (by the termination, that is to say, of the first maternal nurturing (that of placenta) as well as by the termination of the second maternal nurturing (that of the individual breast-feedings). The careful observation of these unions demonstrates that they coexist and they imply equilibrium through the processes of separation that not only allow a partial autonomy of the developments of mother and child, but also make room for the detachments represented by the birthing/birth and by the end of the individual breast feedings. The author is trying to illustrate some physiological and pathological equilibrium between these tendencies towards reciprocal dependence and reciprocal mother-child autonomy.


[Efficacy of mini-TENS in the treatment of primary dysmenorrhea]. Recent knowledge on the pathogenetic mechanisms which are thought to be responsible for primary dysmenorrhea in most young females allow us to abandon old therapeutical approaches for several medical solutions with high effectiveness rates. But a number of patients remain for whom these treatments are not suitable or not effective. Mainly for these patients, today we can offer a valid alternative, a new kind of electroanalgesy, TENS, now easier to use owing to the miniaturization of the machine. In fact, in two groups of patients resistant or insensitive to modern medical therapies, we obtained good analgesia during the menstrual period, without important side effects and with high compliance by the patients.


A study on the isolation of aflatoxin-producing strains from agricultural products in Korea. In order to isolate aflatoxin-producing strains from agricultural products in the Youngnam district of Korea, rice, barley, unhulled barley, corn, soybean, Meju (soybean paste), peanut, and soil samples were collected from markets or homes. From the 347 samples, 280 strains of Aspergillus spp. were isolated. As a result of screening by thin layer chromatography (TLC), 29 strains showed fluorescent spot and four strains had the same Rf values as those of standard aflatoxins. The percentage of contamination of aflatoxin-producing strains was 1.4%. The four strains were classified as the Aspergillus flavus group by the examination of characteristics and morphology.


Prevalence of cardiovascular diseases in rural area of Hmawbi and urban Yangon city. With improvements in life expectancy and as more and more people have access to modern medicine, non-communicable diseases are emerging as a health problem in both urban and rural communities in Myanmar. Of all non-communicable diseases, cardiovascular diseases (CVD) are known to be the major health problem. Since many studies that have been conducted in both developed and developing countries have shown a difference between rural and urban communities with regard to cardiovascular diseases, our study had the objective of finding out the prevalence of ischemic heart disease, hypertensive heart disease and rheumatic heart disease in a rural and urban community. The risk of obesity and smoking in the occurrence of CVD was also studied. A cross-sectional survey was conducted in three urban townships of Yangon City (Sanchaung, Latha and Pabedan) and one rural township of Hmawbi. The results showed that CVD were a health problem in both the urban and rural communities. Coronary heart disease was seen to be more prevalent in the urban townships than in the rural Hmawbi Township, but hypertension (HT) and rheumatic heart diseases (RHD) were more prevalent in the rural township of Hmawbi. Obesity which has been blamed as the major risk factor for CHD and HT in the developed countries was not found to be a risk factor in the study townships, but smoking was.


Diet and blood nutrient correlations with ischemic heart, hypertensive heart, and stroke mortality in China. Though major differences exist in subcategory mortality levels, cardiovascular disease remains a leading cause of death among both Asian Chinese and Westerners. This paper examines the possible relationship between cardiovascular mortality and biochemical, diet and lifestyle factors based on two surveys in China. Statistically significant associations indicate five variables negatively correlated: molybdenum, oleic acid, liquor consumption (males), legumes, and age at first pregnancy with ischemic heart disease; molybdenum, oleic acid (females) and age at first pregnancy with hypertensive heart disease; and legumes and age at first pregnancy with stroke. Five variables were positively correlated: triglycerides and herpes antibodies with ischemic heart disease; salt and phosphorus (females) with hypertensive heart disease; and only albumin (males) with stroke. Some findings confirm those observed in the West (salt, triglycerides, herpes, legumes, oleic acid, and liquor), but molybdenum and age at first pregnancy have not been emphasized previously. Still others significant in the West have not been observed here, such as cholesterol and smoking.


Prevalence of goiter in a rural community in Sri Lanka. The prevalence of goiter in a rural community was determined in a defined geographical area, namely, the Hindagala Community Health Project (HCHP). In this area which is divided into six Public Health Midwife (PHM) areas, the mean altitude varies from 450 to 775 meters. The house-to-house goiter survey conducted by the trained field health staff covered 70% of the population. The total goiter prevalence was 7% while the prevalence of visible goiter was 2.8%. The goiter prevalence was higher in the females than in the males at all age groups. Among males, the prevalence was highest in the school-going age group 6-18 years, while among females the highest prevalence was in the early childbearing period of 19-34 years. Further, an increasing trend in the prevalence was observed with increase in mean altitude of the PHM area. Correlation between community prevalence and age-sex specific prevalence gave the best relationship with the 6-18 year age group and a regression equation to predict the community prevalence from the prevalence in the school-going age group is presented.


Nutrition promotion: the role of monitoring physical growth. Growth monitoring has been included as one of the basic strategies for child survival. In this paper, the rationale for this is reiterated both for individual as well as population nutritional surveillance. Methods for and approaches to growth monitoring are described. In addition, potential problems in implementing growth monitoring projects and interpreting the results are discussed. Despite its lack of sensitivity and specificity as a diagnostic tool, its advantages in terms of low cost, simplicity, reliability and social acceptability justify its use in nutritional surveillance, particularly in populations at risk of malnutrition.


Mortality experience in a rapidly developing economy in Taiwan: infant mortality, gender gap, and occupational risks. Mortality data of Taiwan for 1981 through 1986 were analyzed using three different statistics in order to assess the role of environmental and lifestyle factors in causing mortality variations. Infant mortality rates from different geographic regions generally correlated well with overall mortality from all ages, suggesting that there are many common risk factors affecting the entire age range of the population. The mortality rates of tobacco- and alcohol-related causes of death and cancers were much higher in males than females. A number of cancer sites, including the lung, the liver, the stomach, and the nasopharynx, showed more than twofold excesses in males. In contrast, females had a tenfold excess of genital cancer and a 33% higher rate of diabetes. With rapid industrialization, occupational hazards played an increasing role in the development of cancer and other causes of death. During the study period, fishermen showed increased risk for cancers of the stomach, the esophagus, and the liver, while construction workers had an increased risk for cancer of the esophagus. Peasants and soldiers had an elevated suicide mortality. Among apprentices, fatal injuries were high. Findings from this study are useful in setting priorities for health and safety programs and directing efforts such as health education programs and other preventive strategies against disease.


Cancer in the elderly: a prospective study among Hawaiian Japanese men. In the United States, little has been done to compare the cancer risk of elderly subjects, aged 65 and older, with that of younger subjects. Although the elderly constitute only 12% of the population, they are diagnosed with more than 50% of the cancers. The study consisted of 7,783 Japanese-American men, born from 1900-1919 and examined from 1965-1968. During 154,000 person-years of follow-up, 1,478 incident cases of cancer were identified. The incidence rate of cancer was high among the elderly (142.7 per 10,000 person-years) compared with younger subjects (48.2 per 10,000 person-years), yielding a significant (p < 0.05) rate ratio of 3.0. Of the site-specific cancers, prostate cancer showed the highest rate ratio of 7.0, followed by oral, stomach, lung, and colon cancer. In addition, the five-year age-specific rates for stomach and colon cancer rose directly with age. A similar pattern was also observed for lung and prostate cancer in men before age 80, but the rates declined thereafter. The findings from this study suggest that the reduction in risk for cancers of the prostate, oral cavity, stomach, lung, and colon must be viewed as a major goal for improving the public health in the elderly population.


Child health and nutritional status in Ulaanbaatar, Mongolia: a preliminary assessment. Over 85% of Mongolia's foreign trade and development aid, which formerly came from the USSR, have abruptly ceased causing shortfalls in almost all sectors. The UNICEF Mongolia Country Program and the East Asia and Pacific Regional Office (UNICEF/EAPRO) realized that Mongolian children are likely to suffer the most as reduced income and food availability aggravate problems associated with malnutrition. Hence, from 16 June-7 July 1992, a team from the Institute of Nutrition at Mahidol University, Thailand, collaborated with local UNICEF personnel and government health officials in designing and initiating the 1992 Mongolian Child Nutrition Survey. This paper presents the preliminary survey data of 342 randomly selected children aged 0-48 months in Ulaanbaatar. Results indicate that the four major health and nutrition problems are protein energy malnutrition (PEM), iodine deficiency disorders, vitamin D deficiency, and an unusually high rate of acute respiratory infections. Also requiring more in-depth study are low birth weight, iron deficiency anemia and vitamin A deficiency.


The effect of atrial dilatation on reperfusion arrhythmias: development of supraventricular tachycardias on reperfusion with atrial stretching. The study was aimed at investigating the effect of atrial dilatation on the genesis of supraventricular tachyarrhythmias following myocardial reperfusion. Experiments were carried out in 26 mongrel dogs under pentobarbital narcosis with artificial ventilation. Electrophysiological study was performed for studying the arrhythmic condition of the heart. Investigations were carried out: (i) in normal condition, (ii) during atrial stretching (balloon dilatation of the left atrium), (iii) in reperfusion following myocardial ischemia, (iv) in reperfusion combined with atrial stretching. On reperfusion the irritability of the atrium increased moderately (on atrial extrastimuli in 3 dogs non-sustained atrial tachycardia, in 7 dogs repeated atrial responses could be induced). Reperfusion with atrial stretching, however, very markedly enhanced the atrial vulnerability, and in 19 dogs atrial tachycardia appeared spontaneously. Comparison of the effect of atrial stretching to that of atrial stretching + reperfusion showed that the reperfusion significantly augmented the arrhythmia-inducing effect of atrial stretching. Aortocoronary bypass operations were followed by development of supraventricular tachycardia in 41 out of 428 operated cases. Atrial dilatation was detected in 37 cases, mostly before the appearance of atrial tachycardia. The data seem to prove that atrial dilatation has an important part in the pathogenesis of supraventricular tachyarrhythmias following reperfusion of myocardial ischemia.


Circadian pattern of serum androgens in women with Cushing's syndrome. Circadian profiles of the serum levels of cortisol and five androgens were studied in 20 females including 8 controls, 7 patients with ACTH-dependent Cushing's syndrome and 5 with hypercortisolism due to adrenal adenoma. A significant 24-h periodicity was found for each steroid in all groups. Besides hypercortisolaemia, a significant increase of 11-hydroxyandrostenedione was shown in both forms of Cushing's syndrome. The most conspicuous finding was a decreased dehydroepiandrosterone and its sulphate in adrenal adenoma. The peaks for the studied steroids were shifted from the morning hours towards the noon in ACTH-dependent Cushing's syndrome and towards the evening (for cortisol) and night hours (for androgens) in adrenal adenoma.


Treatment of polyglandular autoimmune syndrome with cyclosporin-A. The case history of a 30-year-old female patient is reported. Following an unknown viral infection that had occurred four years earlier, insulin-dependent diabetes mellitus vitiligo, Addison's disease, amenorrhoea, hyperthyreosis and, finally, severe pancytopenia with dominant thrombocytopenia developed. On the basis of clinical aspects and laboratory findings, an infrequent polyglandular autoimmune syndrome (type II) was verified. Substituent therapy and steroid stoss therapy also was introduced, without any sign of improvement. For the lack of therapeutic effect and owing to serious thrombocytopenic bleeding, treatment with Cyclosporin-A was indicated, which produced total remission of the illness. Nowadays the patient being on follow-up, has no sign of disease activity.


Combined cyclosporin-A and methylprednisolone treatment of Graves' ophthalmopathy. Twelve patients with Graves' ophthalmopathy (grade 1-6, ATA classification) were treated with Cyclosporin-A, systemically in combination with methylprednisolone. We observed slight or moderate favourable effect in 9 cases. Our data suggest that the benefit was due to the methylprednisolone, the effectivity of which was enhanced by the cyclosporin even in the glucocorticoid-resistant cases.


Can occupational guidelines for work-rest schedules be based on endurance time data? Within the European Community, work is in progress to establish occupational guidelines for physical workload, including work-rest schedules. A model has been proposed which relies upon endurance time as a valid estimate of the short- and long-term physiological responses to continuous and intermittent exercise. On the basis of recent results from several Scandinavian research groups, the present paper questions the use of this model as a contribution to occupational guidelines. It is believed that the proposed model has a limited validity as a predictor of endurance time, as an indicator of short-term physiological responses, and as an estimator of risk for musculoskeletal disorders.


Lipid abnormalities in uraemic patients on chronic haemodialysis. Patients kept on haemodialysis because of chronic renal insufficiency were investigated for lipid profiles. The cholesterol level did not differ as compared to the age-matched control, while the triglyceride level was elevated. The correlation was found between the lipid parameters, period spent in dialysis programme and level of serum creatinine and urea. In renal failures of different origin the lipid levels are in relationship with the underlying disorders.


[Treatment of Fournier's gangrene. A review based on 3 new cases]. We describe three new cases of Fournier's gangrene-a necrotizing fasciitis of urogenital or anorectal origin. Though in the initial report the disease was believed to be idiopathic, the source of infection or immuncompromising factors can be identified in nearly all cases today. We present a combination of aggressive surgical therapy and adjunctive use of Imipenem which was successful in the treatment of all our cases. By using fully resorbable nutrition colostomy could be avoided successfully.


Porphyrin studies in chronic renal failure and renal transplantation. Haemoglobin (Hb), free erythrocyte porphyrins (FEPs), protoporphyrin and haem contents as well as delta-aminolevulinic acid (ALA)-dehydrase activity were estimated in blood samples from patients with chronic renal failure (CRF), from those with renal transplantation, and from healthy control subjects. In CRF patients a highly elevated FEPs level and a significantly increased protoporphyrin concentration were found. A well-defined decrease was observed in the mean value of ALA-dehydrase activity, Hb and haem contents when compared to the control values. However, in patients with renal transplantation significant decreases were observed in Hb and haem concentrations while the ALA-dehydrase activity and the FEPs and protoporphyrin concentrations were approximately at the control levels.


The significance of birth weight discordance in twins. The author found, among 329 twin pairs, 50 (15.2%) cases of weight discordancy reaching or exceeding 22%. Among the 50 twin pairs, there were 65 boys and 35 girls, a sex ratio of 185.7. This degree of weight discordancy appears to be unrelated to maternal age, parity and gestational length. Growth retardation of one or both fetuses was significantly more frequent (80%) among weight-discordant than among concordant one (11.1%). There were more perinatal deaths between discordant than concordant twins. Among the twins who were born with evidence of growth discordancy, there was slightly increased incidence of abnormal presentation, delivery by cesarean section, and low Apgar score as compared to the concordants.


Anesthesia for the healthy child.

Anesthesia for the healthy child. This article focuses on anesthesia for the healthy older infant and child, with nearly normal anatomy, physiology, and development, who is scheduled for an elective, relatively limited surgical procedure. Topics addressed in this section include: (1) monitoring technology used to enhance and maintain the anesthesiologist's clinical assessment; (2) pharmacological preparation designed to sedate, reduce anxiety, and/or make a child cooperative during the induction of anesthesia; (3) aspects of the induction of general anesthesia; (4) drugs commonly used for anesthetic premedication, induction, and/or maintenance; (5) aspects of emergence from anesthesia; and (6) equipment.


Anticardiolipin antibodies: association with anti-DNA antibodies, disease activity, renal involvement and a history of thrombosis in systemic lupus erythematosus. A one-year study was conducted to evaluate the clinical significance of anticardiolipin antibody (ACA) whether it was a reliable predictor for thromboembolic events and related diseases in systemic lupus erythematosus (SLE) patients. The correlation between ACA and anti-ds-DNA antibodies and disease activity was also studied. Of particular importance was the question if any association could be found between ACA positivity and renal disorders in SLE patients. One hundred and eighty-seven serum samples from 88 SLE patients were assayed for ACA. Clinical records of these patients were reviewed for a history of thromboembolic events, related diseases and renal disorders, 80.7% of the 88 SLE patients were positive for ACA. The incidence of thrombosis and related diseases within this group was 35.1%. Since the correlation was not significant, it does not seem to be advisable to use elevated ACA values as predictive for thromboembolic events and related diseases. On the other hand, an apparent association between ACA levels, anti-DNA antibody levels and disease activity was found.


Perioperative fluid and transfusion management. Optimal perioperative fluid management in pediatric patients entails a knowledge of the effects of preoperative fasting, perioperative third space losses, and hemorrhage on the patient's fluid compartments. We explain which of the various available intravenous fluids should be used to correct various fluid and electrolyte losses that may occur. The authors also review techniques for limiting homologous transfusion requirements and discuss certain complications associated with blood transfusion.


Effect of choriocarcinoma supernatant on natural killer and lymphokine-activated killer cell activity. The effect of JEG-3 choriocarcinoma supernatant on human natural killer cell and lymphokine-activated killer cell activity was investigated. Choriocarcinoma supernatants from JEG-3 cell lines were obtained at the time of their optimal growth. K562 erythroblastoid cells were used as target cells for natural killer and lymphokine-activated killer cell mediated lysis in a 51Cr release assay. The choriocarcinoma supernatants had a significant dose-dependent suppressive effect on natural killer and lymphokine-activated killer cell activity. This suppression was more expressed at high effector: target cell ratios. Therefore, choriocarcinoma supernatants appear to have potent inhibitory effects on many aspects of cellular immunity, although, additional studies should be performed to further characterize and identify immunoregulatory molecule(s) in choriocarcinoma supernatants.


Anesthesia for the newborn and ex-preterm infant. This article addresses the pertinent aspects of neonatal physiology and pharmacology, general considerations in the anesthetic care of surgical neonates, management details of selected neonatal surgical lesions, and anesthetic considerations for the ex-preterm infant.


Is the incidence of acute mountain sickness (AMS) at medium altitude in the Austrian Alps influenced by the height of home residence of the alpinist? In previous studies the incidence of acute mountain sickness (AMS) at medium altitude was examined in the Austrian Alps, where many tourists come from low parts of Europe. This study assesses the influence of the height of home residence on the incidence of AMS at medium altitude. The severity of high-altitude adaptation disorder was quantified by using a scoring system after an interview and a clinical examination in 84 lowlanders, mainly those from Hungary. Forty-two alpinists with a home residence of 800 to 1000 m served as control. The incidence of AMS was 1.4% at 2000 m and 7.4% in 3000 m. The most frequent symptoms were slight headache and peripheral or periorbital oedema. The AMS-score of the Hungarian alpinists did not differ significantly from that of the alpinists with a home residence of height 800 to 1000 m. in contrast to the situation at high altitude, at medium height tourists from lowlands are not at higher risk of AMS than other alpinists.


Preoperative evaluation and preparation of the pediatric patient. A successful anesthetic is built on the foundation of the preoperative evaluation and preparation, six features of which will be discussed: (1) content and timing of the anesthesiologist's preoperative evaluation; (2) value of preoperative laboratory testing; (3) psychological effects of hospitalization and surgery; (4) approaches to psychological preparation; (5) pharmacological premedication (except for drugs designed to sedate or reduce anxiety, reviewed in the article by Bennie and McNiece); and (6) preoperative feeding schedules.


Pain management in children.

Pain management in children. Recent research into the mechanisms of pain and pain management and the development of new pharmacological agents have greatly increased the possibilities for preventing and treating postoperative pain in the pediatric patient. This article briefly reviews the physiology of pain and the measurement and assessment of pain, and then discusses in some detail the various modalities useful in treating pain in the pediatric patient during the perioperative period.


Postanesthesia recovery.

Postanesthesia recovery. The care provided in the postanesthesia recovery unit has become much more sophisticated in recent years. We address what type of care should be provided and what equipment is required to provide such care in the present day pediatric postanesthesia care unit. In this regard a wide variety of potential postanesthetic complications are described and their management is discussed. In addition, an update of pediatric cardiopulmonary resuscitation is presented including a discussion of surgery in the do-not-resuscitate patient.


Noncardiac surgery in the patient with congenital heart disease. The patient with congenital heart disease who presents for noncardiac surgery requires careful evaluation and planning to avoid adverse perioperative events. This chapter presents a physiological approach to the management of anesthesia for the most common congenital heart lesions. The various congenital heart defects are categorized into lesions resulting in: (1) left-to-right shunting; (2) right-to-left shunting; (3) complete mixing of pulmonary and systemic circulation; (4) complete separation of the pulmonary and systemic circulations; (5) increased myocardial work; and (6) mechanical obstruction of the airway.


Anesthesia for selected procedures.

Anesthesia for selected procedures. This article reviews selected procedures for which a particularly close working relationship between the surgeon and the anesthesiologist is essential for patient safety. Anesthetic considerations for upper and lower gastrointestinal endoscopies, bronchoscopy for aspirated foreign bodies, resection of mediastinal masses, thoracotomies for procedures requiring one-lung anesthesia, and surgery for burn patients are reviewed.


Anesthesia outside the operating room.

Anesthesia outside the operating room. Many new diagnostic and surgical procedures rely on immobile equipment such as computed tomography or magnetic resonance scanners, biplanar fluoroscopes, or radiotherapy units. To facilitate these procedures in infants and children, anesthesiologists must provide services in a variety of unique environments. This article reviews the anesthetic equipment and techniques that have been adapted to provide anesthesia for children outside the operating room.


Malignant hyperthermia.

Malignant hyperthermia. Malignant hyperthermia is a rare disease triggered by succinylcholine and the volatile anesthetic agents in genetically predisposed individuals. Recent studies have implicated an abnormality in the calcium release channel of the sarcoplasmic reticulum in skeletal muscle as the likely etiology. Genetic studies have narrowed the search for the chromosomal abnormality to human chromosome 19. Although the mortality from this disorder has dramatically decreased in the past decade due to the discovery of dantrolene, elective diagnosis of the disorder is only now appearing on the horizon.


Pediatric liver cysts and abscesses.

Pediatric liver cysts and abscesses. Cystic liver lesions in children pose diagnostic and therapeutic dilemmas. When discovered during evaluation of abdominal distension, the likely cause is benign hepatic cyst. Surgical intervention aimed at resection is highly curative. Echinococcal disease, usually distinguishable from nonparasitic cystic disease, is rare in children in the United States. Therapy is aimed at sterilization and complete excision of hydatid tissue. Cystic liver lesions in septic children represent liver abscesses, pyogenic or amebic, which are frequently fatal if not diagnosed early and treated appropriately. Ultrasonography and computed tomography have simplified the diagnosis and treatment of these diseases, but a high index of suspicion is required because the signs and symptoms of liver abscess in children are nonspecific.


Biliary atresia.

Biliary atresia. Although biliary atresia is characterized by luminal obstruction of the extrahepatic bile ducts, the etiology and the pathophysiology of the liver are still controversial. The prognosis of biliary atresia has been improved after the introduction of Kasai's hepatic portoenterostomy, but there are still many problems to be solved in the treatment of this disease. Successful results of hepatic portoenterostomy depend on early diagnosis and operation, adequate operative technique, prevention of postoperative cholangitis, and precise postoperative management. However, we are on the verge of a new era in the therapy of biliary atresia combining portoenterostomy with liver transplantation.


Surgical jaundice in infants: other than biliary atresia. After biliary atresia, the lesions responsible for surgical jaundice in the infant are perforation of the common bile duct, choledochal cyst, bile plug syndrome, and miscellaneous congenital lesions in descending order of frequency. Perforation of the common bile duct commonly presents with an insidious onset of bilious ascites and is best treated by simple peritoneal drainage. Choledochal cyst usually presents later in childhood but presents in infancy if obstruction of the biliary tree is complete or near complete. Excision is the treatment of choice. Any condition leading to alteration in bile composition may cause bile plug syndrome. Spontaneous resolution is the rule: occasionally, intraoperative irrigation is necessary. Most miscellaneous lesions lend themselves to operative correction.


Choledochal cyst.

Choledochal cyst. The most commonly encountered variant of choledochal cyst (type I) is characterized by fusiform dilatation of the bile duct. Patients usually come to medical attention within the first decade of life. The diagnosis is readily established by ultrasound or computed tomography. Choledochal cyst has been diagnosed in the fetus by maternal ultrasound. Treatment is by surgical excision.


Portal hypertension.

Portal hypertension. Increased portal pressure is the product of both increased resistance to splanchnic flow through the liver and increased blood flow in the portal circuit. Although portal hypertension in children is less common than in adults, the important clinical end results are the same, ie, esophageal variceal hemorrhage, ascites, and hypersplenism. The etiology of portal hypertension in children is very different from adults in whom cirrhosis (most commonly secondary to alcohol) is the predominant cause. In children, extrahepatic obstruction due to portal vein thrombosis is the most common cause. However, as children survive longer with biliary atresia, cystic fibrosis, and other liver diseases, the incidence of intrahepatic obstruction causing portal hypertension is increasing. The treatment has also undergone a dramatic evolution over the last decade with the near extinction of portosystemic shunt procedures and their replacement with endoscopic treatment of esophageal varices and liver transplantation.


Malignant liver tumors of children.

Malignant liver tumors of children. Malignant liver tumors in children are uncommon but have a high mortality. Survival rates have improved with advances in chemotherapy, imaging, tumor biology, and supportive care. However, complete surgical resection is the cornerstone of successful management. Important determinants of outcome are stage, histology, and resectability. A multidisciplinary team approach to the care of pediatric patients with liver tumors using the latest guidelines from clinical trials provides the best opportunity for care.


Liver injuries in children: treatments tried, lessons learned. Liver injuries continue to present the pediatric trauma surgeon with a formidable challenge. Most injuries are minor and are managed nonoperatively, but major injuries can be life-threatening and require immediate operation. Diagnosis is made clinically and confirmed by means by hepatic enzymes and computed tomography. The mortality associated with serious liver injuries in children is about 10%, usually from associated injuries, but exceeds 50% if major lacerations or juxtahepatic venous injuries are present.


Liver transplantation in children.

Liver transplantation in children. Children with end-stage liver disease now have a greater chance of survival through treatment with hepatic transplantation. This article reviews the pediatric liver transplantation process, including selection and evaluation of candidates, operative procedures, postoperative complications, and long-term survival.


Cholecystitis and cholelithiasis in children. Cholecystitis and cholelithiasis are being recognized with increasing frequency in infancy and childhood. Hematologic disorders continue to account for a large proportion of cases; however, many children are noted with cholelithiasis in association with total parenteral nutrition, ileal disorders, and prolonged fasting. Spontaneous stone resolution has been noted in many cases in infancy and a period of observation is indicated in the absence of obstructive symptoms. Cholecystectomy remains the procedure of choice for symptomatic cholelithiasis and cholecystitis and a laparoscopic procedure is possible in most cases after infancy.


Arterial access in infants and children. Intraarterial access is used to provide continuous monitoring of systemic arterial blood pressure and to provide access to sample arterial blood. The use of chronic indwelling arterial catheters became commonplace in the 1970s and was rapidly adapted to the care of infants and children. The placement of intraarterial catheters can be technically challenging for even the most experienced surgeon, especially in small infants. Arterial catheters can directly injure vessels, resulting in thrombosis or occlusion. Distal embolization or ischemia can also occur. Catheter flushing may cause retrograde flow with the potential for embolization at remote sites. Local insertion site complications, such as hematoma, hemorrhage, and infection, can occur. Arterial catheters can also be a source of systemic sepsis. Although the risks and complication rates are low, the potential for devastating injury exists and deserves the greatest respect whenever placement of an arterial catheter is contemplated.


Peripheral and central venous access.

Peripheral and central venous access. Peripheral venous access is indicated for the administration of fluids, drugs, or if nutrients when other routes are unavailable. Central venous access is indicated if peripheral access is unsuccessful or if hypertonic, irritant, or vasoconstrictor solutions are used. Because of anatomical variations, different peripheral cannulation sites are more appropriate in different age groups. The preferred sites for long-term central venous access in infants and children are the external jugular, facial, internal jugular, saphenous veins at the groin, and subclavian veins. The practical aspects of peripheral and central venous access and the complications are discussed.


Permanent central venous access devices. The development of permanent central venous access devices in the last 20 years has been accompanied by decreased complication rates, improved patient comfort, and increased cost-effectiveness. Subclavian venous access, first applied to infants and small children in the early 1970s, has given way to the Silastic permanent right atrial catheter by both cutdown and percutaneous techniques. The disadvantages of an occlusive aseptic dressing, frequent catheter irrigation, and disturbance of body image led to development of the totally implantable venous access system, which has been successfully used for long-term infusion of chemotherapeutic agents, antibiotics, blood products, and total parenteral nutrition. The recent introduction of permanent peripheral central venous catheters has further decreased the expense and complication rate of long-term venous access in infants and children. These developments and the accumulated expertise in finding alternative venous access sites (common facial, deep inferior epigastric, lumbar, and azygos veins) have helped minimize mechanical and septic complications and have increased the safety of even the most difficult venous access procedures.


Intraosseous infusion in infants and children. Intraosseous infusion was used extensively for the parenteral administration of blood, fluids, and pharmacological agents in the 1940s. The technique was "discovered" and popularized again during the 1980s. Substances injected intraosseously are found rapidly in the central circulation. Drugs should be given in the equivalent dose used for intravenous administration. The preferred site for intraosseous infusion is the proximal tibia. Insertion is performed 1 to 3 cm below the tibial tuberosity on the flat anteromedial surface of the tibia. After about 5 years of age, the distal tibia or femur are the preferred sites. Needles made specifically for resuscitative intraosseous infusion are available. Increased awareness of the role of intraosseous infusion, familiarity with the technique of insertion, and careful use of landmarks to guide insertion should minimize complications.


Fluids and electrolytes in infants and children. The fluid and electrolyte management of the surgical neonate must take into account the acute transition to extrauterine life superimposed on the gradual changes associated with fetal and neonatal maturation and growth. With this transition, there are acute changes in body water distribution, and a striking increase in evaporative losses from the skin and respiratory tract. These changes, as well as those in renal function and sodium balance in the preterm and full-term infant are discussed.


Intravenous nutrition for the pediatric patient. Nutritional management of infants and children differs from that of adults because of the extra requirements for growth and the limitations of physiological immaturity. Although parenteral nutrition (PN) is an accepted practice and a potentially life-saving therapy for pediatric patients who cannot be fed through their gastrointestinal tract, it is associated with the risk of serious metabolic, mechanical, and infectious complications. Candidates for PN should be selected according to well-defined indications, with initial nutritional assessment and with careful attention given to fluid, electrolyte, vitamin, trace element, and caloric requirements. Total calories should be administered so that the nonprotein-calorie to gram-nitrogen ratio is in the range of 150 to 250:1. Although short-term supplemental nutritional support can be administered through a peripheral vein, long-term total PN is best delivered by central venous access. PN should be initiated and monitored in accordance with well-established protocols. The lowest complication rate and highest cost-effectiveness are achieved by an interdisciplinary team that includes one or more nurses, dietitians, pharmacists, and physicians. The development of safe, reliable, and miniaturized intravenous pumps with built-in monitors has made home parenteral nutrition possible and desirable in selected patients.


Blood products.

Blood products. Modern transfusion therapy offers the seriously ill patient an array of blood products, designed to improve oxygen delivery, maintain intravascular volume, suppress infection, and induce hemostasis. Depending on the patient's clinical circumstance, the choice of product may need to incorporate consideration of the state of intravascular volume, history of prior transfusion reactions, the possible existence of serum antibodies directed against the relevant blood component, and the risk of transmission of infectious disease, as well as the relative cost of the blood product chosen. Fortunately, the contemporary blood bank has acquired considerable expertise in preparing safe products and in providing sound guidance for the clinician in their proper use.


Isotope studies in children: an update.

Isotope studies in children: an update. Hepatobiliary scintigraphy is an accurate, simple, and relatively noninvasive method for the diagnosis of biliary atresia, a condition in which early diagnosis is of paramount importance. Radionuclide gastrointestinal transit studies are useful in devising the surgical approach in children with suspected gastroesophageal reflux. Renal scintigraphy in the newborn period is used to decide the need for surgical intervention in a hydronephrotic kidney. Relatively new radiopharmaceuticals such as metaiodobenzyleguanidine, thallium, and deoxyglucose are useful in detecting tumors and in predicting the viability.


Computed tomography imaging of abdominal trauma in children. The authors discuss the role of computed tomography (CT) in the evaluation of children following blunt abdominal trauma. Appropriate techniques for scanning children are described, as well as clinical indications that place children at high risk and low risk for abdominal injury. Examples of both solid organ and bowel injuries are shown, with special emphasis on the correlation of CT appearance and clinical outcomes. The authors conclude that CT is an effective tool for the diagnosis of abdominal injury in the pediatric patient, and that the clinical impact of CT appears to be changing with the increasing use of nonoperative therapy for solid organ injury.


Selected topics in hepatobiliary imaging. With the advent of ultrasound, computed tomography, and magnetic resonance imaging, hepatobiliary imaging is changing. The advantages and disadvantages of each new imaging modality will be reviewed. The radiographic approach of a child who presents with a mass or jaundice will be discussed. The role of duplex Doppler ultrasound in the preoperative and postoperative management of liver transplantation patients will be presented.


Imaging of abdominal masses in children. Abdominal imaging has undergone extensive change over the past several years. In many cases, the developments have been so rapid as to preclude an orderly comparison of competing procedures with prospective comparison studies. Consequently, no rigid imaging protocol will be universally accepted and many issues are unresolved. This article reviews the various imaging procedures used in imaging pediatric abdominal masses with emphasis on technique, indications, risks, and costs. The relative merits of imaging modalities in various clinical situations are outlined and specific recommendations are given.


New concepts in imaging of the gastrointestinal tract in children. This article highlights some of the significant recent advances in imaging of the pediatric gastrointestinal tract that have occurred over the last decade. The current roles of the newer imaging modalities, including ultrasound, computed tomography, and magnetic resonance imaging, are discussed and illustrated. Particular emphasis is given to antenatal evaluation, suspected gastric outlet obstruction, inflammation, and other causes of the acute abdomen. Enhancements in fluoroscopic techniques are outlined, including the use of the newer contrast agents as well as air reduction of intussusception. Continued good communication between the pediatric radiologist and pediatric surgeon is vital to improve the care to children with disorders of the gastrointestinal tract.


Contrast studies of the gastrointestinal tract in the neonate. The approach to imaging the gastrointestinal tract in neonates, including both the method of examination and the choice of contrast media, is specialized and requires close cooperation between the pediatric surgeon and the pediatric radiologist experienced in the evaluation and care of these children. Although the physical examination and the plain radiographic findings are occasionally sufficient to make a specific diagnosis, contrast studies are also frequently required. The use of the plain radiographs in planning the approach to further imaging and the selection of the appropriate contrast media for a variety of common situations are discussed.


Interventional procedures in pediatrics. Pediatric intervention has grown substantially over the last 20 years. Interventionalists now work closely with surgeons and other physician groups to diagnose and treat a wide variety of pediatric disease processes. Using image guidance and intravenous sedation in most instances, the interventionalist performs vascular and nonvascular procedures such as embolotherapy, abscess drainage, dilation of strictures, biopsy, and percutaneous nutritional procedures, to name a few. It is my hope that the current and future techniques will lead to improved, more effective, and safer methods for treating sick children of all ages.


A biologic approach to tumor imaging.

A biologic approach to tumor imaging. The planning of imaging protocols for follow-up evaluation of children with cancer should be based on knowledge of biologic behavior of the tumor rather than on intuitive protocols. This article gives examples of how such biologic information can be integrated into imaging protocols.


Bilingualism: theoretical perspectives of language diversity. Bilingualism and second language acquisition are discussed with reference to different theoretical perspectives. An integrated definition of bilingualism is provided and concepts underlying second language acquisition are presented. Theoretical perspectives according to Dodson (1985), Skinner (1985) and Krashen (1982) are explored. It is concluded that due to the diverse nature of bilingualism, a single universal theory of second language acquisition does not seem feasible. The need for an increased awareness of the complexity of bilingualism and second language acquisition, particularly within the multicultural and multilingual South African context, is highlighted.


Language abilities of 18-month-old Zulu speakers. The receptive, expressive and pragmatic language abilities of 18-month-old Zulu speakers were assessed in order to obtain preliminary norms. Twenty-five participants of the Birth to Ten cohort study were investigated using parent reports, mother-child and tester-child interactions. Data was transcribed and analysed using nonparametric statistics. Results demonstrated that receptively subjects understood two-part instructions. Expressively, the mean lexicon was 4.12 words and mean length of utterance 0.65. Pragmatically, subjects were functioning on a nonverbal level and exhibited culture-specific items. The results provided information which could enable speech, language and hearing therapists to engage in primary and secondary prevention. An appropriate test battery for these children is discussed.


Future trends in language intervention: addressing cultural bias in service delivery. In this paper the cultural biases in a widely-used language intervention approach--the Hanen Early Language Parent Program--that trains parents to be conversational partners with their language-delayed children, are explored. In many respects this program represents the best of current clinical practice. It is empirically and theoretically grounded in recent research on parent-child interaction; studies have documented its efficacy; and it is a family-centred approach. And yet, in clinical practice, it does not work with all families. Not surprisingly, these families are often from nonmainstream backgrounds. Potential reasons for the lack of effectiveness with some families become apparent as research on patterns of language socialization in a wide variety of cultures is reviewed. This review reveals that all of the basic premises of this program rest on culturally relative beliefs and values. Specifically considered are cultural variation in (1) aspects of social organization related to interaction, (2) the value of talk, (3) how status is handled in interaction, (4) beliefs about intentionality, and (5) beliefs about teaching language to children. Suggestions for incorporating this information into clinical services with nonmainstream families are offered.


Augmentative and alternative communication in South Africa: accessibility and implementation. This paper deals with the development of a community-based service for the implementation of augmentative and alternative communication (AAC) strategies for people with severely limited verbal expression. The concept of community-based intervention is explained and the process of training as done in the Centre for Augmentative and Alternative Communication (CAAC) is described. Data of pre- and post-training evaluations is discussed as well as follow-up data obtained in the various training contexts. Finally, critical issues related to the follow-up data are discussed.


[Guidance to parent of black babies with a cleft lip and palate]. There are indications that the parents of babies with a cleft lip and palate often require more information regarding their baby's birth defect than what is given to them. In South Africa shortcomings exist in the literature covering the specific requirements of parents of black cleft lip and palate babies. In this study the unique requirements of parents of black cleft lip and palate babies was determined and, based on these results, an information pamphlet was prepared for this population group. Based on the results obtained with the help of fifteen participants it was established, firstly, that the needs of black South-African parents of children with a cleft lip and palate are similar to the needs of parents of babies with the same birth defect world-wide. Secondly, it was established that the information pamphlet which was compiled as part of the study made a positive contribution to parent guidance conducted with the participants. Important therapeutic implications were also reflected by the results.


The provision of speech, language and hearing services in a rural district of South Africa. In this paper the delivery of a speech, language and hearing therapy (SLHT) service in a rural area is discussed. In the light of the need to relate the delivery of this service to principles of primary health care (PHC) and community based rehabilitation (CBR), a brief theoretical background is given. Obstacles to service delivery are then presented, followed by a description of some attempts to implement principles of PHC and CBR. The author concludes that many challenges need to be faced in providing SLHT services that will benefit the majority of the population of South Africa.


The nature and management of communication disorders in a rural area: the role of the community speech and hearing therapy workers. Six hospitals where Community Speech and Hearing Therapy Workers (CWs) are working in Gazankula were visited. Firstly, data were collected from records, reports and case files over an 18 month period to determine the nature and prevalence of the communication disorders seen by the CWs. Secondly, the CWs were interviewed about their work situation, organisation of their time and intervention strategies used with communicatively disordered people in order to evaluate the efficacy of their work. Methodological issues requiring consideration when undertaking this type of research are discussed. The results are discussed in terms of the implications for course modifications as well as policy decisions within the profession of Speech and Hearing Therapy.


Community work project in Gazankulu: a community-based training experience. Speech Pathology and Audiology students at the University of the Witwatersrand participated in a field trip to learn about rural community work. In collaboration with rehabilitation workers at Tintswalo Hospital, Gazankulu, projects in pre-school language stimulation, aphasia assessment and intervention, and hearing screening were undertaken. Projects adhered to community work principles. These were successful in terms of both providing a service to the community and teaching students principles and practice of community work.


The Renfrew Word Finding Scale: application to the South African context. The Renfrew Word Finding Scale (Renfrew, 1988) was administered to 30 Indian (Group A) and 30 White (Group B) Durban English speaking children aged between eight and nine years to determine its suitability for assessment of expressive vocabulary. Mean scores for both groups were statistically compared to the British norms in terms of mean raw scores and mean mental age. Mean scores for groups A and B were compared to each other. Item analyses were carried out to obtain further information regarding possible lexical characteristics for each group and common problems with certain items. Both groups performed significantly poorer than expected according to the British norms. Group A was significantly lower than Group B, thus indicating the test's unsuitability for use with these population groups in its present form.


Ectrodactyly-mandibulo-facial dysostosis: case report and delineation of an entity. We describe a 24-year-old woman with tetramelic ectrodactyly, mandibulo-facial dysostosis and cleft uvula. This rare association has previously been reported in two families, but with ectrodactyly affecting only the feet. We propose the new term ectrodactyly-mandibulo-facial dysostosis for this entity.


Microcephaly, focal segmental glomerulonephritis and marfanoid habitus in two sibs. Two female sibs aged 15 and 18 years with microcephaly, mental retardation and marfanoid habitus who developed focal segmental glomerulonephritis leading to renal failure are described. This combination of features appears to represent a unique syndrome distinct from previous reports of microcephaly in association with the nephrotic syndrome. The mode of inheritance is likely to be autosomal recessive.


Thanatophoric dysplasia of the straight-bone type (type 2). We describe two cases of type 2 thanatophoric dysplasia. Cloverleaf skull and relatively straight, shortened long bones distinguish this condition from the more common type 1 thanatophoric dysplasia.


Hypoplastic thumbs and hydranencephaly: a new syndrome? We report a fetus with hypoplastic thumbs and hydranencephaly. The features did not fit well into any syndrome described in the London dysmorphology database, and we suspect this may represent a previously undescribed syndrome, although a diagnosis of XK-aprosencephaly syndrome remains possible.


Alopecia, mental retardation, epilepsy and microcephaly in two cousins. We report two cousins, born to consanguineous parents, with an alopecia-mental retardation syndrome and the additional features of microcephaly and epilepsy. Similar reported cases are reviewed and genetic heterogeneity is suggested.


Skin mastocytosis, hearing loss and mental retardation. A girl with skin mastocytosis, hearing loss, microcephaly, mild dysmorphic features and severe mental retardation is described. The symptoms of the child resemble those reported in 1990 by Wolach et al. in another patient sufficiently to suspect the same entity in both. Inheritance may be autosomal recessive.


Association of autosomal dominant cleft lip and palate and translocation 6p23;9q22.3. Orofacial clefting (OFC) is genetically complex in that no single gene defect is responsible for all forms. We have identified a family who exhibit autosomal dominant orofacial clefting together with some features of ectodermal dysplasia. In this family there is concordance between these features and an apparently balanced translocation t(6;9)(p23;q22.3) which raises the possibility that a locus for one form of orofacial clefting may be located at one of the translocation breakpoints. Fluorescent in situ hybridization has shown that a candidate gene for OFC, which maps to distal 6p, is located on the derived chromosome 9 in affected individuals from this family. Further characterization of the translocation breakpoints and of their relationship with the candidate gene will determine whether a gene important for normal facial and/or ectodermal development is disrupted in this family.


Scalp lipomas and cerebral malformations--report of a case and review of the literature. A child is reported with a scalp lipoma and underlying bony skull defect and porencephaly. The clinical picture is compatible with a diagnosis of encephalocraniocutaneous lipomatosis, although there is no alopecia overlying the lipoma and no scleral lesions. In addition, this child has unilateral ptosis and syndactyly. This report extends our appreciation of the phenotype of this neurocutaneous disorder.


Uptake of thyroxine by cultured human adipocyte precursors isolated from lean and obese subjects. The mechanism of thyroxine uptake by human adipocyte precursors has been studied in primary culture. Also the rates of transport of this hormone into the isolated cells of adipose tissue were compared for lean and obese subjects. It was demonstrated that thyroxine transport into the human adipocyte precursor cells is an active, energy-dependent process characterized by very low rate (Km = 10 pmol/l, Vmax = 8 fmol FT4/10(6) cells/min.). By comparing the rates of thyroxine transport into the precursor cells of adipocytes isolated from adipose tissue of lean and obese subjects it was possible to demonstrate a clear tendency to the lowered rate of transport of thyroxine to the cells in obesity. The results of this study suggest that the lowered rate of thyroxine transport to preadipocytes and adipocytes observed in obesity may significantly influence the metabolic state of these cells.


[Activity of Ca(+2)Mg(+2) --ATPase in erythrocyte membranes of women with diabetes mellitus type I]. The activity of Ca(++)-Mg++ ATP-ase present in erythrocyte membranes was determined in basal conditions and following stimulation with calmodulin in 8 women with insulin-dependent diabetes and in 9 healthy women. The isolation of erythrocyte membranes and the determination of activity of Ca(++)-Mg(++)-ATP-ase were carried out according to the method of Gietzen et al. A decrease in the activity of Ca(++)-Mg(++)-ATP-ase in basal conditions was found in fractions with the highest erythrocyte content obtained from diabetic patients. After stimulation with calmodulin the activity of Ca(++)-Mg(++)-ATP-ase in all the fractions was lower in diabetic patients than in the controls. Low activities of the enzyme were accompanied by high values of HbA1c. The results suggest that glycosylation of the ATP-ase or/and calmodulin may be the main cause of the observed fall in the enzyme activity in diabetes. Also the disturbances concerning the cumulation of intracellular calcium may be related to the changes caused by glycosylation of Ca(++)-Mg(++)-ATP-ase or/and calmodulin.


[Investigation of the insulin gene by the amplification method in vitro]. Forty one patients with familial non-insulin-dependent diabetes (type 2) were included into the study. The fragment of insulin gene including the sequences coding for beta chain and part of C-peptide as well as 5'untranslated region was amplified in vitro by using the polymerase chain reaction. The digestion of the fragments by using the restriction enzyme Pst I followed by electrophoretic separation allowed to recognize the alpha and beta alleles of insulin gene. The investigations have shown that the beta allele occurs more frequently in diabetic patients than in healthy control subjects (P < 0.05).


[Thyroid function in patients during long-term treatment with amiodarone]. Thyroid function was evaluated in 31 patients with disturbances of heart rhythm both before and after 13 months of treatment with amiodarone. An increase in blood serum T4 concentration and transient increase (only during the first three months of treatment) in TSH concentration have been observed in almost all the patients studied. Clinically evident form of hyperthyroidism was found only in one female patient. In two patients the changes in hormone concentrations suggesting hyperthyroidism were not accompanied by clinical manifestations, and in four patients there was no clinical hypothyroidism despite hormone levels suggesting such a state. In addition to the determinations of T3, T4 and TSH also the results of TRH-TSH test played an important role in diagnosing both hypo- and hyperthyroidism.


[Effect of calcitonin on secretion of TSH stimulated by giving thyroliberin (TRH) in euthyroid subjects]. The effect of calcitonin on TRH-induced secretion of thyrotropin was studied in 15 subjects with normal thyroid function. It was found that calcitonin has no significant effect on thyrotropin secretion both in basal conditions and following stimulation with TRH.


[Effect of thermal dehydration on blood levels of hormones regulating volume and electrolyte content of sweat in patients with kidney transplantation]. The thermal dehydration test was performed in 12 patients with renal transplant and in 20 healthy subjects. The study was aimed at the evaluation of the effect of volume regulating hormones on electrolyte composition of thermal sweat in patients with renal transplant. Blood plasma renin activity (PRA) as well as plasma concentrations of aldosterone (ALD), vasopressin (AVP) and atrial natriuretic peptide (ANP) were determined before and after thermal dehydration in all the subjects studied. In all the subjects sweat was also collected after 15 and 45 minutes of exposition to heat and the concentrations of sodium, potassium and chloride were determined in all sweat samples. Significantly elevated PRA and ANP concentrations and significantly lowered plasma AVP concentrations but normal ALD levels were found before thermal dehydration test in all the patients with renal transplant. After the exposition to heat lasting 1 hour the direction of changes was similar, their magnitude was, however, different in renal transplant patients than in healthy subjects. In addition, lower concentrations of sodium and chloride in thermal sweat and lower total concentration of sweat solids were found in renal transplant patients than in healthy controls. No significant correlation was found between the plasma concentrations of the hormones determined and the electrolyte concentrations of thermal sweat both in the renal transplant patients and in healthy subjects. The results suggest that the volume regulating hormones have no effect on the electrolyte composition of thermal sweat induced by short exposition to heat both in renal transplant patients and in healthy subjects.


Plasma endothelin 1/2 levels in healthy blood donors as measured by RIA--a clinical application. Normal endothelin 1/2 levels and their correlation with age were evaluated. For clinical application of the endothelin 1/2 RIA test, optimum storage conditions were investigated. Plasma endothelin 1/2 (ET) levels were measured in 36 healthy blood donors, mostly males, of mean age 36 +/- 8 years, subdivided into three age groups: 17-30, 31-40 and above 40 years old. The mean normal ET levels in the three age groups, and corresponding standard deviations, were: 0.58 +/- 0.19, 0.62 +/- 0.31, and 0.80 +/- 0.28 fmol/ml, respectively. The mean ET level for the whole normal population was 0.66 +/- 0.28 fmol/ml. Only differences between mean ET levels for the first and last groups were statistically significant (p < 0.05). Differences between mean ET levels in smokers (53% of total population) and non-smokers, women and men, irrespective of age, were found not to be statistically significant. At this stage of our work, we conclude that other factors than age alone play a role in enhancing ET levels above the age of 41 years. In our study of optimum storage conditions for endothelin 1/2, we found that after one week of storage at -24 degrees C the mean level of ET measured in frozen plasma dropped to 85% of the initial activity, while after the same period the respective decrease in ET activity in frozen extracts was 49%. Over the next two weeks, ET levels in plasma and extracts dropped to 57% and 32% of "zero time" activities, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Chronic metoclopramide treatment stimulates T lymphocyte proliferation in the spleen but not in the thymus. The effect of chronic metoclopramide administration (for 10 days at a daily dose of 5 mg/kg body weight subcutaneously) on cell proliferation in spleen and in thymus was investigated. Cell proliferation was evaluated by the stathmokinetic method with the use of vincristine. It was found that metoclopramide administration results in a statistically significant increase in the value of the mean mitotic activity rate index (MMAR) of splenocytes in the areas around arteries. At the same time no statistically significant changes were demonstrated in the MMAR index values obtained for splenocytes present in the germinal centers of the spleen. No significant changes in the MMAR index could also be found for thymocytes.


[Isolation of prolactin from lyophilized porcine pituitary glands]. The optimal conditions for lyophilization of porcine pituitary glands and isolation of pure prolactin from lyophilized preparation have been investigated. The isolation method consisted in the extraction of crude pituitary preparation with acidified acetone followed by precipitation of crude prolactin preparation (acid acetone powder) by increasing the concentration of acetone in the extract to 92%. Further purification of prolactin was achieved by fractional precipitation at varying pH values and gel filtration on Sephadex G-75 column in a pH 7.5 phosphate buffer. This final procedure resulted in obtaining the monomeric form of prolactin. The identity of the isolated hormone was confirmed by spectrophotometric and radioimmunological methods as well as by polyacrylamide gel electrophoresis.


[Lipid metabolism in children and adolescents with insulin dependent diabetes. II. Evaluation of changes in lipoprotein A-I in children and adolescents with insulin dependent diabetes]. The levels of lipoprotein A-I (LP A-I) containing apolipoprotein A-I (apo A-I) and devoid of apolipoprotein A-II (apo A-II) have been determined in a group of 86 children and adolescents with insulin-dependent diabetes of age between 1.3 and 22 years. The duration of diabetes in the studied group ranged between 0.25 and 15 years. The patients studied were further divided into subgroups taking into account the duration of diabetes as well as the occurrence of complications of diabetes, obesity and predisposition to early development of atherosclerosis in family history. The analysis of the results took into account the relations between the levels of LP A-I and other parameters of lipid metabolism like cholesterol, triglycerides, HDL-cholesterol, apo A-I and apo A-II concentrations as well as the effectiveness of metabolic control of diabetes. LP A-I concentration was the lowest in group of children with diabetes lasting up to one year. This parameter was correlated positively with the levels of HDL-cholesterol and apo A-I, and negatively with HbA1c. It was not related to the coexisting complications, obesity or predisposition to atherosclerosis in family history. The above results indicate that the state of metabolic control of diabetes significantly influences the level of LP A-I. Considering the importance of LP A-I in preventing atherosclerosis it should be stressed that a decrease in its level during the period of prolonged hypoglycemia constitutes still another risk factor for development of atherosclerosis in diabetic children and adolescents.


[Lipid metabolism in patients with insulin dependent diabetes. III. Effect of metabolic control of diabetes on the concentration of some blood serum lipid constituents in patients with insulin dependent diabetes]. The levels of the following blood serum lipid constituents: total cholesterol, triglycerides, phospholipids, HDL-cholesterol, lipoprotein fractions, as well as apolipoproteins AI, AII and B, have been determined in patients with insulin-dependent diabetes lasting from 3 months to 15 years in relation to the degree of metabolic control characterized by the levels of fructosamine and glycosylated hemoglobin HbA1c. The group of patients having the level of HbA1c exceeding 10% was characterized by significantly higher levels of cholesterol, triglycerides and Apo-B, and lower content of alpha-lipoprotein as compared to the group with HbA1c level beneath 10%. When fructosamine concentration was considered as an index of metabolic control of diabetes, it was found that the levels of cholesterol, phospholipids and apolipoproteins apo-A and apo-AI are highest in the group with the poor metabolic control and differ significantly from the respective values found in patients with mediocre and good metabolic control. Considering biological role of the individual lipids and lipoproteins, it should be stressed that the proper control of glycaemia is important for preventing the development of atherosclerosis in patients with insulin-dependent diabetes.


[Lipid metabolism in patients with insulin dependent diabetes. IV. Effect of sex, age, excess body weight, duration of diabetes, insulin dosage and family history on lipid metabolism in patients with insulin dependent diabetes]. The levels of the following blood serum lipid constituents: total cholesterol, triglycerides, phospholipids, HDL-cholesterol, apolipoproteins AI, AII and B, and lipoprotein fractions have been determined in patients with insulin-dependent diabetes in relation to sex, age, duration of diabetes, coexistence of obesity, insulin dosage and history of genetic predispositions. The age of the patients was between 1.3 and 22 years and the duration of the disease ranged between 3 months and 15 years. The analysis of the results revealed that sex, age, daily insulin dose and the known genetic predispositions have no influence on the values of the parameters of lipid metabolism. However, an increase in the levels of cholesterol, HDL-cholesterol, triglycerides and apolipoproteins AI and B was observed along with the progressing duration of the disease. An increase in the levels of cholesterol, apolipoprotein B and beta-lipoprotein, and a decrease in the level of alpha-lipoprotein have been found in diabetic children with coexisting obesity. The above analysis indicates that besides metabolic control of diabetes its duration and accompanying obesity may negatively influence the course of the disease contributing to the precocious development of atherosclerosis.


Prolactin and LH release in response to vasoactive intestinal peptide (VIP) administration in spontaneously hypertensive and normotensive rats. Vasoactive intestinal peptide (VIP) was injected intravenously at a dose of 10 micrograms in spontaneously hypertensive and normotensive Wistar-Kyoto rats. In order to evaluate the hemodynamic and hormonal effects of this peptide, the mean arterial pressure, heart rate as well as a serum rLH and rPRL levels, the contents of LH-RH in hypothalamus and the content of LH in pituitary tissue were determined. The same procedure was applied in rats receiving placebo. Serum rPRL concentration was measured additionally after combined administration of VIP+dopamine. VIP injection produced a decrease in mean arterial pressure and an increase in heart rate in both spontaneously hypertensive and normotensive rats. Serum rPRL concentration was significantly increased at 10 minutes after injection. The combined therapy (VIP+dopamine) partially inhibited this response. Serum rLH concentration, the content of LH-RH in hypothalamic tissue as well as the content of pituitary LH after VIP injection in spontaneously hypertensive and normotensive rats did not differ from the values obtained for the control group. 1. VIP injection produced the dramatic hypotensive effects in hypertensive rats; 2. A marked increase in PRL concentration in response to VIP was partially inhibited by dopamine in hypertensive and normotensive rats; 3. VIP injection did not change LH-RH and LH release in both hypertensive and normotensive rats.


Growth rate in children with vitamin-D-dependent rickets in relation to 1-alpha-hydroxyvitamin D3 dosage. Growth rate of five children with vitamin D-dependent rickets was analyzed during the long-term treatment with an active analog of vitamin D3. Considerable increase in growth rate together with the improvement of biochemical values and radiological pattern took place during the initial phase of administration of 1-hydroxyvitamin D3. During the maintenance treatment of long duration with 1-hydroxyvitamin D3 both the acceleration of growth and catch-up growth persisted. However, in 4 among 5 children studied an inhibition of growth was observed during different periods of time. Only in one boy was this connected with the conclusion of the process of physiological growth. In three remaining children a slow-down in growth rate appeared during the pre-pubertal period or was the effect of lowering the dose of 1-hydroxyvitamin D3 as an countermeasure to hypercalciuria. In such cases inhibition of growth was caused by the administration of too small a dose of 1-hydroxyvitamin D3 in relation to the requirement. In all cases the appearance of biochemical features of rickets aggravation, such as low blood serum phosphate concentration and elevated alkaline phosphatase activity, preceded the observable inhibition of growth. The results obtained allow us to conclude that the inhibition of growth observed during the long-term treatment of rickets with 1-hydroxyvitamin D3 may be regarded as the first signal of inadequate dosage of 1-hydroxy vitamin D3.


[Effect of prolonged hemodialysis therapy on secretion of testosterone induced by luliberin in men with chronic renal insufficiency]. The effects of prolonged hemodialysis therapy on testosterone secretion have been studied in 41 men with chronic renal insufficiency. Fifteen healthy men served as control group. LH-RH stimulation test was performed in all the studied subjects. It was found that blood serum testosterone concentration is lowered in all the patients with renal insufficiency irrespective of the time of duration of hemodialysis therapy as compared to the control group. In patients dialyzed longer than 50 month testosterone level was higher than in those subjected to shorter period of hemodialysis therapy. Reactivity of testosterone secretion in LH-RH stimulation test was greater in patients dialyzed over 50 months than either in those dialyzed during the shorter period or in the controls.


[Numeric description of circadian rhythm of TSH in patients with cold tumors of the thyroid gland before and after surgery]. Circadian rhythm of TSH was analyzed in patients with cold tumors of the thyroid before and after surgical removal of the tumors and in control subjects. By using special computer program BIOR based on harmonic and regression analysis, designed for verifying and comparing various biorhythms, significant differences were found between TSH biorhythms in patients with cold thyroid tumors before and after the operation.


[Studies of the hypothalamo-hypophyseal corticoliberin system. VII. Effect of ether stress and dexamethasone on the hypothalamo-hypophyseal-adrenal axis]. The effect of ether stress and dexamethasone on hypothalamo-hypophyseal-adrenal axis was investigated in sexually mature male Wistar rats. Separate group of rats was subjected to ether stress during 2 minutes. The remaining animals were treated with dexamethasone during 7 days. CRF-immunoreactive and vasopressin-immunoreactive neurons were detected within paraventricular nuclei and median eminence by using specific antibodies. Body weight of the rats as well as the weights of pituitary and adrenal glands were also measured. The levels of ACTH and corticosterone were determined in blood serum. It was found that the ether stress caused a considerable decrease in the amount of CRF-immunopositive substances in the outer layer of median eminence and a decrease in the amount of vasopressin-immunoreactive neurocytes in the parvocellular fragment of paraventricular nuclei. Dexamethasone administration caused an increase in the amount of CRF-immunopositive perikaryons within paraventricular nuclei and also an increase in vasopressin-immunopositive nerve fibers in median eminence.


[A case associating primary parathyroid hyperfunction with hyperthyroidism]. A case of rare association of hyperparathyroidism with fully developed hyperthyroidism appearing in a woman 23 years old with advanced generalized cystic fibrosis has been presented.