[The effect of levels of alkali salts in Alginate-LF-250 on physico-mechanical properties of materials used in making impressions based on irreversible colloids]. The aim of this paper is the examination of physical-mechanical properties of alginate composition regarding the change of alkali salt alginate composition in the limits of the presence from 8 to 20%, and after the standard ISO 1563, 1978 (E). The combinations make homogenized mixtures of micronized powders of the basic component, retarders, accelerators, system stabilizators, the means for colloides and constituents lowering, which are prepared in the relation of 16 gr/40ml. The change of alkali salt alginate concentration from 8 to 20% does not effect the working time and the time of alginate mash binding, while percentage of permanent deformation of the binding material is larger than the allowed standard after ISO 1563, 1978 (E) in case when alginate alkali salts in the composition are present in the smaller quantity than 12%.


[Histologic picture of dental pulp in dogs treated with ZnOOK paste]. The activity of zinc-oxide paste on histologic changes of the pulp was examined while the indirect capping of the exposed dog tooth pulp was performed. The results showed that the histologic changes observed in dog tooth pulp were accompanied with hyperaemia and blood vessel dilatation then with the pulp oedema, slight disorder of odontoblast palisade and the presence of the traces of occurrence of tertiary dentin.


[Newly discovered rotavirus serotypes in 4 years of collecting samples from children with diarrheal syndromes]. In the four year period from 1985 to 1988 from 527 treated patients with diarrhoea syndrome age 0-7 years hospitalized on Clinic for infectious disease in Sarajevo, 170 patients (32.2%) had rota virus isolated as the cause isolated. Subgrouping and serotyping of rota virus are undertaken in 115 cases. Subgrouping was done well in 94.7% and serotyping in 58.2% cases. Serotype 1 of subgroup II isolated in 58.2% of to cases during four years of work, and other serotypes were isolated sporadically. For the first time in Europe, during these four years serotype 9 rota virus isolated in 17 cases. For the first time in ex Yugoslavia and Republic of Bosnia and Hercegovina, and second time in Europe serotype 8 of rota virus has been isolated in sample of feces.


[Hemorheologic changes in diabetes mellitus]. 78 diabetics and a healthy control group of 100 were evaluated according to their haemorrheological parameters (whole blood viscosity, plasma viscosity, aggregability and rigidity of erythrocytes). Diabetics were divided according to type of diabetes, quality of metabolic control and expression of microangiopathy. Hyperviscosity was noted in both groups of diabetics as compared to the control group. Changes in patients with IDDM were more pronounced in erythrocyte rigidity, while in patients with NIDDM they were more expressed in cell aggregability. These changes were present even before the clinical onset of the late complications of diabetes, although they were more expressed in patients with complications. Changes in patients with good metabolic control, were less expressed in comparison to those with poor metabolic control. The conclusion is that metabolic derangements in diabetes have an important influence on haemorrheological properties. Thus, reducing blood viscosity in these patients, may be a promising approach to improving microcirculation and delaying the progression of microangiopathy.


[The effect of PUVA therapy on circulating T lymphocytes]. In this article effects of photochemotherapy on T lymphocytes of peripheral blood and capable lymphocytes to blastic transformation by patients with psoriasis generatisata were presented. No statistical changes were found in relation to healthy persons.


[A mini circular external fixator--Kosevo type]. In this experiment we showed factors of interest for compression's grade after experimental examination. We used mini circular external fixator type Kosevo and showed it's employment. The conclusion that the compression's grade was 30 kp/cm2 and depend of bone's thickness. At the end you can see clinical and medical economic effects of using thus fixator.


[The Mirizzi syndrome in biliary surgery]. In the paper are 2 cases of the so called Mirizzi's syndrome presented, as a special clinical entity in the surgery of the biliary tract. Pablo Mirizzi (Cordoba, Argentina, 1948) performed the basic scientific observations, so the syndrome was named after him. There are 4 basic components: 1. Anatomic variations of the gall entrance, namely ductus cystic with the main gall canal, while ductus cystic has a prolonged parallel course with choleductus, 2. Impacted concrement in the gall throat or even ductus cystic, 3. A part of entire choleductus compression with extra luminar pathologic substrate, and 4. The consequences of the gall recurrent cholangitis, namely cholangitis cirrhosis. A long lasting compression of the choleductus wall due to the jammed concrement, sooner or later, may bring to the wall necrosis and penetration of the concrement into the choleductus lumen (make a bilio-biliary fistula) with all the perils. The mentioned circumstances, in the course of the operation being a number of serious post-operative complications (being obvious from the presented cases). Now days, a great importance is given to the Mirizzi's syndrom in the prevention of the post-operative complications relating to the outstanding clinical entity.


[Evaluation of a 10-year study of family health care]. Family is fundamental component in society and place where health or disease are creating. Family health care in our country has not found its place yet, although there is reason for its development. Some experimental areas in our country, which were making progress in family health care, should important advantages of family health care are greater satisfaction of population and 6 medical staff, better efficiency, effectiveness, economisation and better quality of health care. Modification of schooling system and improving the quality of specialisation medical staff, modification of method of micro-organization of health care schools and were organisations charges in information system by using computers and help of society which will sanction recommended charges by law, are necessary for existence of family health care. That's way implementation of purposes of strategy "Health for all by the year 2000" of WHO is very important in our country, specially those purposes considering concept of family health care which we were experimentally developing for 10 years in Sarajevo.


[Identification of oxymetholone metabolites in the urine using gas chromatography-mass spectrometry]. Metabolite of 17-methyl-17-hydroxy-2-(hydroxymethylen)-androstan-3-one (oxymetholane) in urine after a single oral administration was monitored by gas chromatography+mass spectrometry. During the investigation prepared TMS-ethers and TMS-enol-ethers of conjugated steroid fraction two new metabolites of oxymetholone have been identified: tetrahydrooxymetholone and tetrahydro-6-hydroxy-oxymetholone.


[Morphometric characteristics of thyroid cells in irradiation-stressed rats treated with pinealectomy and melatonin]. The authors were investigating the qualitative and quantitative characteristics of the cells of the thyroid gland of pinealectomized and melatonin treated rats whose body irradiated with 8 Gy gamma rays. It was established that melatonin decreased height of the thyreocytes in peripherical and central part of gland, and nuclear volume of thyreocytes only in the central part of gland. The results suggest the role of melatonin in determination of the behaviour of thyreocytes upon Pinealeotomy and Radiation.


Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Early reports associated Candida parapsilosis with endocarditis in intravenous narcotic addicts. More recently, this species has emerged as an important nosocomial pathogen, with clinical manifestations including fungemia, endocarditis, endophthalmitis, septic arthritis, and peritonitis, all of which usually occur in association with invasive procedures or prosthetic devices. Outbreaks of C. parapsilosis infections have been caused by contamination of hyperalimentation solutions, intravascular pressure monitoring devices, and ophthalmic irrigating solution. Experimental studies have generally shown that C. parapsilosis is less virulent than Candida albicans or Candida tropicalis. However, characteristics of C. parapsilosis that may relate to its increasing occurrence in nosocomial settings include frequent colonization of the skin, particularly the subungual space, and an ability to proliferate in glucose-containing solutions, with a resultant increase in adherence to synthetic materials. Recently developed molecular techniques may facilitate the continued exploration of the epidemiology and pathogenesis of C. parapsilosis infections.


Health effects of Halon 1301 exposure.

Health effects of Halon 1301 exposure. An accidental discharge of a Halon 1301 system is reported. Thirty-one workers were assessed, 22 who were present at the time of the discharge, and 9 who worked the next shift. The incident was complicated by a small Freon-22 leak several hours later. Throat, eye, and nasal irritation and lightheadedness were reported by the majority of workers. Workers present during the halon discharge reported significantly more lightheadedness, headache, voice change, cough, and a fast heartbeat than did those who worked the later shift. These differences were significant even after correcting for confounding factors such as age, sex, and sense of anxiety at the time of the incident. The possible causes for the irritant symptoms include breakdown products of Halon 1301 and Freon-22 or contaminants from the halon discharge system. Although these irritant effects may not be an effect of Halon 1301 alone, they may occur in these discharge situations, and workers should be advised of this possibility. The possible cardiac and central nervous system effects also should be considered. The importance of a clear-cut protocol to deal with such incidents as well as worker education are discussed.


Cross-cultural patterns in eating disorders: a review. Eating disorders were previously thought to be isolated to achievement-oriented, upper and middle class individuals in Western countries. It now appears that these disorders may be increasing in other sectors of society and in a number of diverse cultural settings. We review the studies that comprise the relevant cross-cultural research literature on eating disorders. We also discuss the changing cultural factors that may be contributing to the apparent increase in these disorders around the world and directions for future research on such factors.


[Muscle antigens recognized with autoantibodies in patients with Graves' ophthalmopathy]. The aim of this work was to characterise the eye muscle antigens reacting with autoantibodies from Graves ophthalmopathy patients to elucidate the function of these antibodies. As estimated by ELISA test antibodies of IgG class reacting with porcine microsomal membranes are present in about 25% of patients while of IgM class in about 15% of patients with Graves ophthalmopathy. Their presence do not correlate with ophthalmopathy index, neither they have relation to treatment. Anti eye muscle antibodies were present at some stages of the disease in three patients who develop ophthalmopathy, from the group of 26 patients treated during one year for hyperthyroidism. However, sporadically these antibodies were found also in about 20% of patients with Hashimoto disease, Lupus erythematosus or Scleroderma. Some of them cross react with antigens of skeletal muscle and liver. Eye muscle antigens reacting with patients antibodies are localised in plasma membranes and in membranes of smooth reticulum. Affinity purification of solubilised porcine eye muscle membrane proteins on a column with immunoglobulins from pooled serum of patients resulted in 23 fold purification of the antigen. The sensitivity of ELISA was not significantly increased by the use of affinity purified antigen, however some of previously negative ophthalmopathy sera gave positive reaction. Porcine eye muscle membrane proteins were separated by SDS PAGE and transferred to nitrocellulose. The reactions of electroblotted proteins with sera from patients with Graves ophthalmopathy and also sera from healthy controls shown very complex pattern. There was not a single antigen or antigens reacting only with antibodies present in sera of ophthalmopathy patients and not in controls. Patients sera reacted more often than control sera with an antigen of about 40 kDa. The reaction of sera from some patients with proteins about 100, 70 and 65 kDa were stronger than between these proteins and control sera. No changes in the pattern of reaction between antibodies and eye muscle antigens were noticed in serum of the same Graves' patient with or without ophthalmopathy during one year follow up and treatment, regardless of clinical course of the disease. When human eye muscle membrane fractions from tissue obtained during strabismus repair or at autopsy was used for immunoblotting, smaller number of proteins reacted with autoantibodies. Again there was no single antigen or antigens reacting with antibodies from sera of all Graves ophthalmopathy patients. Sera of some patients reacted with antigens about 50 kDa, not recognized by controls. The results of present study show, that the anti eye muscle antibodies are present in some of Graves ophthalmopathy patients.(ABSTRACT TRUNCATED AT 400 WORDS)


[The effect of monotherapy on concentration of selected blood serum hormones and upon cognitive function of children with epilepsy]. The studies included 64 children with newly diagnosed epilepsy, aged from 6 to 15 years of life. In 25 children with partial and secondary generalized seizures monotherapy with carbamazepine was introduced; in 19 children with primary generalized seizures--with phenobarbital, and in patients with both types of seizures--with primidone. Monotherapy was controlled by means of blood serum drug concentration level monitoring; the therapy was successful in all the children. The group did not include patients with mental retardation, and epilepsy was idiopathic. Prior to the institution of treatment, a single determination of blood serum triiodothyronine, thyroxine, TSH, prolactin, cortisol, LH and testosterone was made. Psychological test were carried out employing Wechsler's scale, Bender-Santucci test, rhythmic structures developed by Mira Stambak and test of manual dexterity (card display). In order to evaluate short-term effects of the employed drugs upon the blood serum concentration values of the studied hormones, a repeated determination was made one month after the initiation of therapy. The third determination was made one year after the onset of treatment in order to assess the long-term effects. The effect of drugs upon their cognitive functions was assessed in a follow-up psychological testing performed after one year of therapy. The studies combined with statistical analysis led to a conclusion that after one month of monotherapy there occurred a significant drop in thyroxine concentration levels, still augmented after one year. Patients treated with carbamazepine showed a significant decrease of T3 levels after one month and one year, whereas treatment with phenobarbital and primidone did not result in significant changes of T3 concentration. Yet, T3 and T4 concentration values did not exceed normal limits. No type of monotherapy resulted in significant long-term changes of TSH concentration levels. No clinical signs of hypothyroidism nor goiter were observed in the studied children. After one month of monotherapy with carbamazepine and phenobarbital there was observed a significant increase of prolactin and cortisol levels, which was absent after one year. The values observed did lie within normal limits. No significant changes were observed with respect to the effect of the studied drugs upon blood serum LH and testosterone levels. After a one-year monotherapy with primidone the children revealed a significant improvement of results measured on performance scale and by means of a full Wechsler scale. Carbamazepine and phenobarbital did not affect the intelligence quotient of the studied children.(ABSTRACT TRUNCATED AT 400 WORDS)


[Superiority of magnetic resonance imaging (MRI) over computerized tomography (CT) in diagnosis of hypopituitarism]. Hypopituitarism can be a result of various lesions of hypothalamus, pituitary stalk, or of the pituitary gland itself. The aim of the study was to assess the value of CT and MRI examinations in determination of the cause of hypopituitarism. Seventeen patients with hypopituitarism (9 women and 8 men) aged 22 to 61 years have been examined. In three cases growth deficiency was observed, 4 women had galactorrhoea, 4 patients had diabetes insipidus, 16 patients had supra-adrenal insufficiency, 14 had signs of hypogonadism and 10 hypothyroidism. In each case plasma concentrations of LH, FSH, PRL, TSH, alpha-subunit, ACTH before and after appropriate stimulation with TRH, metoclopramid, LH-RH, GRF or metyrapon were determined with RIA. Every patient was examined both with CT and MRI (0.5 T Toshiba MRT 50a). All 17 patients had abnormal MR images of hypothalamo-pituitary area, while only 10 of them had abnormalities in their CT scans. In remaining 7 patients the MRI revealed: three cases of congenital malformation of hypophyseal stalk, two cases of empty sella, one posttraumatic lesion of the stalk and one case of granulomatous infiltration of the stalk. We found MRI superior to CT in establishing the case of hypopituitarism.


[A case of pituitary stalk tumor diagnosed with magnetic resonance (MRI)]. Authors present a case of 28-year old female with anterior hypopituitarism and diabetes insipidus, with properly functioning anterior pituitary cells as showed by means of measuring pituitary hormones in response to neurohormones i.v. injections. Magnetic resonance imaging revealed neoplastic tissue in the pituitary stalk destroying supraopticohypophysial and paraventriculohypophysial tracts, as well as portal blood system, thus preventing release of vasopressin and these hypothalamic neurohormones from accessing anterior pituitary.


Increased plasma VIP concentration in patients with prolactinoma. Vasoactive intestinal polypeptide (VIP) is now considered to be a prolactin-releasing factor (PRF). The aim of this study was to determine the VIP concentration in peripheral blood in patients with prolactin-secreting adenoma compared to healthy subjects. We also examined the effect of bromocriptine administration on the plasma VIP concentration in patients with prolactinoma. Nine patients with prolactinoma (6 women and 3 men, aged 27-50) and 7 healthy control subjects (4 women and 3 men, aged 26-40) were examined. Blood samples for prolactin and VIP were collected at 06:00, 12:00, 18:00, 24:00. In prolactinoma blood was taken before and after bromocriptine administration. Serum prolactin concentration was determined by the radioimmunoassay. VIP concentration was measured by a specific radioimmunoassay Kit-INCSTAR Corp. (Minnesota, USA). Statistical significance was calculated using the analysis of variance. A single 5 mg oral dose of bromocriptine decreased the mean prolactin concentration during the first 24 hours of treatment. Plasma VIP concentration was higher in prolactinoma patients compared to healthy subjects. There was no change in plasma VIP level after bromocriptine administration. in patients with prolactin secreting adenoma the plasma VIP concentration is increased.


New long-acting bromocriptine (Parlodel MR and Parlodel LAR) in the treatment of pituitary tumours with hyperprolactinemia. In order to assess the efficacy and tolerability of new long acting bromocriptine: Parlodel MR (oral form) and Parlodel LAR (injectable form suitable for repeatable administration) 40 patients (29 women and 11 men) with pituitary tumours with hyperprolactinemia (PRL 70 micrograms/l) were investigated in a double blind study. Patients were divided into 2 groups of 20. In the first group Parlodel R or Parlodel MR in equivalent doses was given, the other group was administered Parlodel R or Parlodel LAR. During the next 6 months 20 patients were treated with Parlodel MR and the other 20 with Parlodel LAR. In all patients pituitary and peripheral hormones, CT scan and visual fields were examined before and after 28 days of bromocriptine treatment. During the next six months 20 patients were treated with Parlodel MR while the other 20 with Parlodel LAR. Serum PRL fell in all patients and values in the normal range were obtained in 36 patients. In 30 out of 35 patients with signs of pituitary tumour in CT scan, a significant tumour shrinkage was observed. Most patients achieved considerable clinical improvement: disappearance of galactorrhoea, resumed menses in women, increased potency in men. There were no difference in efficacy in Parlodel R, Parlodel MR and Parlodel LAR, but in the case of Parlodel LAR the least number of side effects was found. Treatment with long acting bromocriptine-Parlodel MR and LAR of patients with pituitary tumours with hyperprolactinemia is an efficacious, safe and better tolerated method than Parlodel R treatment.


Mixed pituitary tumours--effects of bromocriptine treatment: Parlodel MR and Parlodel LAR. Majority of pituitary tumours secrete one of the named hormones: PRL, GH, ACTH, proopiomelanocortine, alpha and beta subunit of TSH, LH, and FSH. Some of those tumours secrete two or more hormones. The aim of this study was to determine the effect of bromocriptine (Parlodel MR and LAR) upon secretion of hormones and tumour size in 10 patients with mixed pituitary tumours. In all patients pituitary and peripheral hormones, CT scan and visual fields were examined before and after treatment with bromocriptine: Parlodel MR and LAR. Bromocriptine treatment decreased PRL secretion in all 10 patients; GH--in all 6 in whom it was increased; TSH--in 2, FSH--in 2 and alpha-subunit in all 6 in whom they were increased. In 5 patients treatment resulted in shrinkage of the tumour mass by 20 to 35%. In all examined subjects clinical improvement was achieved. Our results demonstrate that bromocriptine (Parlodel MR and LAR) is very effective and well tolerated in the treatment of patients with mixed pituitary tumours particularly those with hyperprolactinemia.


The effect of oral ethanol ingestion on the diurnal neurotensin secretion in man. Neurotensin is a tridecapeptide, present in the central nervous system and the gastrointestinal tract in man and animals. The affect of orally administered ethanol (1 g/kg body weight) on the neurotensin secretion over 24 hr period was studied in eight young healthy men. No significant circadian rhythm of neurotensin secretion was detected in the eight subjects studied. Ethanol produced a progressive rise in the plasma level of neurotensin reaching a maximum at 12:00 (13.8 +/- 8.6 pmol/l). At 12:00 and 14:00, the neurotensin concentrations were significantly higher than on the placebo day (p < 0.05). The secretion rate of neurotensin was determined approximately using the area under the curve method. Ethanol produced a transient rise in neurotensin secretion over the first 12 hrs period (08:00-20:00 h) after its administration (p < 0.02). The observation that ethanol increases transiently the neurotensin secretion in man supports the hypothesis that neurotensin may be involved in the biological effect of ethanol. The source of its secretion remains to be elucidated.


[Results of 3-stage treatment: (I) corticotherapy, (II) linear acceleration and (III) orbital decompression in 206 patients with malignant Graves ophthalmopathy]. There is no, so far, a rational method of therapy based upon the etiology of autoimmune Graves' ophthalmopathy. As a malignant Graves' ophthalmopathy we defined the most severe eye changes leading to the sight loss or permanent disability of vision which are classified as exceeded class 3c according to the eye changes classification of the American Thyroid Association [27]. The aim of the study was to develop the most efficacious method of therapy for malignant Graves' ophthalmopathy. The material consisted of 206 patients treated according to the 3-stage method: 1-st--corticotherapy, 2-nd--radiotherapy, including linear accelerator, 3-rd--orbital decompression. Moreover, in four patients plasmapheresis was applied and in additional five cyclosporine was administered. In all 206 patients the estimation of the results of the treatment was based on the Donaldson ophthalmopathy index [4]. It has been proved that corticotherapy combined with linear accelerator radiotherapy has been the most efficacious method of treatment. It has also the least number of side effects. Orbital decompression as the 3-rd stage of treatment was employed in those cases in which the previous two stages of medical therapy were unsuccessful.


[Relationship between clinical classification of hyperthyroidism for three grades of severity and level of triiodothyronine (T3) and thyroxine (T4) concentrations in serum]. The aim of the study was to assess the relationship between the clinical classification of hyperthyroidism based on the 3-degree score system and T3 and T4 serum concentration. 161 patients with Graves disease or toxic goiter were studied. By comparing the number of scores separating the 3 subgroups in relation to the severity of disease with T3 and T4 serum concentration of tyreotoxic patients we found a very high statistically significant correlation. We also found the marked (by +50%) statistically significant increase in the serum T3 concentration related to the degree of hyperthyroidism severity.


[Treatment of hypothyroidism with L-thyroxin]. To compare an efficacy of the galenic form of desiccated thyroid gland--Thyreoideum "Polfa" with the synthetic L-thyroxine (Eltroxin Glaxo) in the treatment of hypothyroidism 15 patients were investigated. In all 15 cases before and after treatment ECG and the serum concentrations of cholesterol, thyroxine (T4), triiodothyronine (T3) as well as thyrotropin (TSH) in response to TRH were performed. After the treatment with Thyreoideum "Polfa" in doses 0.2 to 0.6 mg/daily there were neither clinical improvement, normalization of ECG, the serum concentrations of cholesterol, T3, T4 nor TSH. However, after the L-thyroxine treatment (Eltroxin Glaxo) in doses 100 to 200 micrograms/daily the clinical signs of hypothyroidism disappeared in all 15 patients. In ECG the statistically significant increase in voltage of the R and T waves after L-thyroxine treatment were observed. Also a significant decrease in the serum concentration of cholesterol and an increase in T4 and T3 were found. The serum concentration of TSH in response to TRH after the L-thyroxine treatment significantly decreased. L-thyroxine appeared to be a very efficacious in the treatment either primary or secondary hypothyroidism.


[Anaplastic thyroid carcinoma developed after treatment of "hot" thyroid nodule with radioiodine]. A case of 55 years old woman with "hot" right lobe toxic thyroid nodule, presenting with paroxysmal atrial fibrillation, and therefore treated with 131I 666MBq (18 mCi) is described. After six years she became pyrexic and suffered of severe cough proxyisms. The fine needle biopsy of the above nodule showed the presence of anaplastic thyroid carcinoma. Strumectomy followed by local radiotherapy resulted in complete disappearence of all symptoms. The microscopic of the removed thyroid tissue confirmed the above diagnosis. After 22 months' observation the patient remained in good general condition. The possible reasons for the development of the thyroid carcinoma in this case are discussed.


A correlative study between cortisol and ACTH in Cushing's disease following bilateral adrenalectomy and in Nelson's syndrome. Correlation analysis was used to investigate the interrelation between plasma ACTH and serum cortisol concentrations determined at 8:00, 12:00, 16:00 and 22:00 h in 48 patients bilaterally adrenalectomized for Cushing's disease, including 23 patients with a pituitary adenoma (Nelson's syndrome). In the patients without evidence of a pituitary adenoma a significant inverse correlation was found at 8:00, 16:00, 22:00 h and additionally when all the pairs of estimations were analyzed. In a full-blown Nelson's syndrome an inverse correlation was not proved (p = 0.05). During remission in Nelson's syndrome an inverse correlation between cortisol and ACTH concentrations was stated at 8:00 h and after the evaluation of all the pairs of estimations. The results of our studies have shown that exogenous cortisol exerts a partial inhibitory action on ACTH secretion in patients bilaterally adrenalectomized for Cushing's disease. In active Nelson's syndrome this influence is questionable, it comes however into prominence during remission.


Incidentally found adrenal tumours: results of investigation of the pituitary-adrenal axis. In the last 7 years 64 patients (48 women, 16 men, aged 25-75 yrs) with incidentally found asymptomatic adrenal tumours have been observed in the Department of Endocrinology. In 11 patients a routine clinical investigations revealed metastatic tumours at the adrenal glands. In the remaining 53 patients the diameter of the adrenal tumours was < or = 3 cm. Only two of them were treated surgically; the rest has been observed regularly and ultrasonographic examinations have been repeated every 3 to 6 months. Twenty three patients with adrenal tumours < 3 cm of diameter were treated by surgery. The macroscopical examination revealed adrenal cortical adenoma in 11 cases, adrenocortical carcinoma in seven, and pheochromocytoma in 5 patients. The investigation of the pituitary-adrenal system (urinary excretion of 17-OHCS before and during dexamethasone administration, 17-KS, "free" corticosteroids, plasma ACTH, cortisol and S-DHA levels) did not reveal any abnormality except that in 10 patients the plasma ACTH concentration was low, especially in the morning. These values were significantly lower as compared with the remaining patients and with control group. One of the possible interpretations is a pituitary suppression by only periodically increased concentrations of the corticosteroids.


[Primary hyperaldosteronism suppressed after glucocorticoid administration]. Authors present a case of glucocorticoid suppressible hyperaldosteronism in 18 year old female. Unmeasurable low plasma renin activity and marked increase in aldosterone concentration was established. After administration of dexamethasone, normalization of aldosterone concentration and blood pressure has been observed.


Lower 24-hour growth hormone levels in type I diabetics responding to thyrotropin-releasing hormone (TRH). The aim of the study was the evaluation of growth hormone secretion under physiologic conditions in two groups of type I diabetics: responding and nonresponding to TRH stimulation. Both groups matched for age and metabolic control of diabetes were studied during 24-hours and after GHRH stimulation. The whole diabetic group (n = 18) showed circadian rhythm of GH secretion with mesor value of 4.03 micrograms/l. TRH-responders had lower mesor GH value than TRH-nonresponders: 3.53 vs. 5.32, p < 0.05. GH response to GHRH was almost identical in both groups. C-peptide level was lower in TRH-responders: 0.16 vs. 0.56 microgram/l, p < 0.05. No correlation was found between growth hormone response and HbA1 and C-peptide levels. It is concluded that type I diabetics responding to TRH stimulation are characterized by lower mean 24-hour GH levels and lower C-peptide values.


Thyrotropin-releasing hormone (TRH) does not suppress growth hormone response to L-dopa in insulin-dependent diabetes mellitus. Thyrotropin-releasing hormone (TRH) blunts growth hormone (GH) response to various stimuli in normal subjects. We were interested if similar inhibitory effect of TRH could be demonstrated in diabetes mellitus where GH is abnormally regulated. In this study we compared the effect of TRH on GH response to L-dopa in normal and diabetic subjects. TRH 0.2 mg iv blunted GH response to L-dopa 0.5 g p.o. in normal subjects with peak GH values 13.1 and 7.3 micrograms/l, p < 0.05. In the diabetics no inhibitory effect of TRH was demonstrated and GH was even paradoxically increased after TRH: 14.9 and 21.9 micrograms/l, p = NS. Lack of inhibitory effect of TRH was more pronounced in patients with proliferative retinopathy. It is concluded that TRH has no inhibitory effect on L-dopa-induced GH response in diabetic subjects. This finding provides further evidence for disturbed GH regulation in diabetes mellitus.


Measurement of bone mineral density (BMD) with quantitative computed tomography (QCT) in postmenopausal osteoporosis: effect of estrogen. To determine the efficacy of the estrogen replacement therapy (ERT) on the bone mineral density (BMD) measured with quantitative computed tomography (QCT) in postmenopausal osteoporosis 16 women aged 46-72 were examined. They were divided into two groups: 8 women treated with conjugated estrogens (Group I) and 8 who did not received ERT (Group II). In all 16 patients the serum hormonal concentrations (LH, FSH and estradiol) were measured with radioimmunological methods. The bone densitometry was performed in all of them using the single-energy computed tomography (QCT) with the computer Picker 1200. Bone mineral density was measured in three lumbar vertebra (L1-L3) and expressed in milligrams K2HPO4 per ml. The bone mineral density (BMD) was statistically significantly higher in the estrogen treated group (Group I) in every vertebra compared with that of controls (Group II). The serum FSH concentration was statistically significantly lower in the ERT group (Group I) and a statistically significant correlation between FSH level and average BMD (Lmean) was present. 1. the ERT is very efficacious in preventing bone loss in postmenopausal women; 2. measurement of BMD in lumbar vertebra L1 or L3 may be a sufficiently reliable and accurate, cost-effective and time-saving method of screening for osteoporosis; 3. the serum FSH determination seems to be useful in monitoring of the estrogen therapy for postmenopausal osteoporosis.


[Time-resolved fluorescence of europium ions and its application for determination of biologically active substances]. At present radioimmunoassay is still one of the most widely used analytical procedure. It is, however, continuously challenged by a number of non-isotopic techniques. This article reviews the measurement of europium chelates with high sensitivity using time-resolved fluorescence and its use as labels in immunoassays of protein and peptide hormones, haptens, virus antigens and for detection of inborn metabolic errors. It can be concluded that the time-resolved fluorescence detection of lanthanides and their chelates has been applied in a wide variety of both routine and research application. This technique is anticipated to gain wide use for measurement of numerous anylates of different origin. In immunoassays time-resolved fluorometry is one of the most promising alternatives available in the non-isotopic field.


[Incidence of goiter in children of the Tarnobrzeg district and environmental factors]. A group of 1897 school children from Tarnobrzeg district were examined out of this number 1241 (65.4%) children displayed goiter. Goiter incidence was also established depending upon age and sex. The analysis also included goiter incidence in relation to its size according to the WHO classification. In certain patients, newborns and their mothers, determinations of iodine excretion were made; the values were found to be within the normal. This range suggests that other etiological factors than iodine deficiency might possibly contribute to goiter development in the studied children.


[Changes in laboratory parameters of thyroid function in children with simple goiter from the Mazovia region]. Endocrinological Out-Patients Clinic at Children's Hospital in Dziekanów Leśny takes care of the children from Mazovia region. Hormonal findings in children with simple goiter were analyzed in several groups of patients. In all those patients preferential T3-secretion and decreased T4 production was found. These findings allow to conclude, that in Mazovia region there is iodine deficiency, which is probably the main cause of goiter development.


[Prevalence of goiter in children of the Poznan province]. The aim of our study was the evaluation of goiter prevalence in the children in Poznań and surrounding towns and villages. In 3065 children 4-16 years old the thyroid size and serum concentration of T3, T4 and TSH were determined. Our results indicate that the goiter prevalence in the group of investigated children was 20%. We also observed that the changes in the concentration of thyroid hormones and TSH were not associated with the clinical symptoms of thyroid gland dysfunction.


[Goiter prevalence in children and adolescents in Lower Silesia in the years 1985-1990]. Investigations of the goiter prevalence in children, aged from 0 to 18 years of age living in Lower Silesia were performed. The children were our clinic outpatients in the years 1985-1990. A separate analysis of children from each of the four districts was made because of a different geographical structure. The highest number of goiter was observed in the Wrocław district. In the year 1983-1989 an increase number of newly diagnosed goiter was cases observed in all analyzed districts, than from 1989 to 1990 a decrease, tendency in goiter prevalence was noticed except in Wrocław district where the number of cases was stable. In the adolescent period the number of cases with newly diagnosed goiter increased with higher frequency among the girls.


[Frequency of goiter in children and adolescents in the Szczecin region]. The study was carried out in 2153 children and adolescents (1066 girls and 1087 boys) aged 5-20 years. The examined group was chosen randomly, according to a simple drawing scheme. The aim of the study was to evaluate frequency, size and character of goiter in developmental age population in Szczecin's region. The goiter was found in 14% of examined population (18.4% in girls and 9.8% in boys). Frequency of goiter approximated to 37% in girls and 16% in boys during puberty spurt (between 10 and 16 year of age). Small degree of thyroid enlargement was predominant in examined population. Large goiter was present more frequent in girls than in boys. We did not find clinical symptoms of thyroid gland dysfunction in examined group. Frequency of nodular goiter was 7% of children's and adolescent's population with higher incidence in boys (9%) than in girls (6%).


[Goiter in school children from the Rzeszow district]. 14481 children at the age of 6 to 15 including 7242 boys and 7239 girls underwent the examination. Children from rural areas were the majority-12240. Goiter was classified according to WHO scale from 1974. Goiter was find in 4354 children (1790 boys and 2384 girls), which constituted 30.1% of examined group. Small size goiter was predominant. O-B goiter was found in 2588 children, I. in 1299, II. in 386 III. in 81. Mielec region deserves special attention because goiter was diagnosed there in 49.3% of all examined children. Iodine deficiency seems to be the primary reason for goiter endemy.


The relationship between autoimmune thyroid disease and iodine intake: a review. There is evidence to suggest that elevated levels of iodide in the diet are associated with autoimmune thyroid disease (ATD) in susceptible individuals, and that autoimmune thyroiditis (Hashimoto's disease) is less common in susceptible individuals who live in regions with dietary iodine deficiency. There are epidemiologic studies in endemic goiter areas that report an increase in ATD, particularly thyroiditis, after the therapeutic administration of iodized salt, bread and oil. Lymphocytic infiltration of the thyroid is rarely found in patients from severe endemic goiter regions, yet there is a reversal of this observation after dietary iodine supplementation. Thyroid antibodies, both thyroglobulin (TgAb) and peroxidase (TpAb) or microsomal, were not detected in serum from patients with endemic goiter, but became positive in 43% of subjects three and six months after therapy with iodized oil, and there developed transient hyperthyroidism. Similarly, the addition of iodine to the diet or the administration of iodine-containing medications increases the frequency of ATD and the severity of existing autoimmune thyroiditis. Furthermore, autoimmune thyroiditis has been induced by the administration of excess iodide to strains of chickens and rats that are genetically predetermined to develop the disease. We are beginning to understand the pathogenesis of ATD. In hyperthyroidism the evidence clearly supports the hypothesis that TSH receptor antibodies (TRAb) stimulate the TSH receptor to induce excessive and sustained secretion of thyroid hormones. Cellmediated immune mechanisms, such as antibody dependent cellmediated cytotoxicity (ADCC), initiate the lymphocytic infiltration and thyrocytotoxicity in autoimmune thyroiditis. The mechanisms that initiate the development of the abnormal immune response and the relationship of ATD with excess iodide are poorly understood. There is evidence that an increase in the iodination of thyroglobulin (Tg) enhances its immunogenicity. The results of clinical and experimental studies support the requirement of a genetic predisposition to the development of ATD that may be precipitated by exposure to certain environmental factors. Another mechanism supported by experimental data is the direct toxic effect of excess iodide on iodide-deficient thyroid glands. High concentrations of iodide after oxidation to iodine causes epithelial necrosis and inflammation associated with lipofuscin accumulation suggestive of toxicity mediated by lipid peroxidation from excessive amounts of free radicals. The epithelial damage would initiate inflammatory and immune responses. Although these mechanisms would relate to the onset of autoimmune thyroiditis on exposure to excessive amounts of iodide, the relationship of iodide intake and autoimmune hyperthyroidism is less clear.(ABSTRACT TRUNCATED AT 400 WORDS)


[Goiter in school children from the Swietokrzyski region]. 5982 of children living in Kielce district, aged 6.5-14.5 years were randomly selected for the study. The size of the thyroid gland was examined clinically. In some children the estimation of serum T3, T4 and TSH was performed, as well as iodine urine excretion. The iodine content in drinking water was also measure. The results of the study show that the Kielce district belongs to the mild degree of iodine deficiency. The verification of the iodine prophylaxis in this region is necessary.


Problems of iodine and thiocyanate in domestic animals in goitrogenic areas of southern Poland. High incidence of goitre in human together with low level of iodine in water and cow milk have been observed in Southern Poland (Table I). Therefore, iodine deficiency was considered as the only cause of goiter development. The correlation coefficient between iodine concentration in water and cow milk was r = 0.76 (Fig. 1) and indicate the possibility of iodine determination in milk instead of water. The iodine determination in milk reflects the level of iodine in water as well as in food, a negative correlation has been obtained between goitre incidence in human and iodine concentration in water (r = 0.43) (Fig. 2.). A low correlation coefficient suggest that iodine is not a solely factor responsible for goitre development. Studies on cows have indicated that thiocyanate may have effect on goitre development as well. There has been found higher concentration of thiocyanate (SCN) in blood plasma and in enlarged thyroids (Table II). Thiocyanate belongs to goitrogenic compounds and its main source are the plants of Brassica species widely cultivated in southern Poland. It has been found that cows fed with Brassica plants have high level of SCN both in blood and milk with no alteration of plasma iodine level. The transfer of iodine from plasma to milk is only slightly affected (Table III). The level of SCN in the thyroid depends on its plasma concentration; the calculated correlation coefficient is r = 0.88 (Fig. 3). Enhanced thyrotropin (TSH) secretion (during goitrogenesis) may be accompanied by increased accumulation of SCN in the thyroid (like iodide) and reduced oxidation to SO4 (unlike iodide) (Fig. 4). Therefore we postulated that TSH may be partly responsible for increased SCN level in goitrous thyroids. The question arise whether increased ingestion of SCN does really potentiate iodine deficiency and goitrogenic process in animals breeding in southern Poland. For explanation some additionally experiments were performed on laboratory animals. It have been observed that enhanced level of plasma SCN following feeding with Brassica plants increased proportionally the goitrogenic action as well as the accumulation of 131J by the thyroid and its conversion into organic form (Fig. 5). The latter data was confirmed by positive correlation between thyroxine and plasma SCN levels in sheep (r = 0.49), (Fig. 6) Thiocyanate like other monovalent anions suppress goitrogenic effect of propylthiouracil. However, anti-goitrogenic properties of SCN depends on normal iodine ingestion (Fig. 7).(ABSTRACT TRUNCATED AT 400 WORDS)


[Catalytic method of iodide ion determination in urine]. Kinetical catalytic method of iodide determination in urine was described. After wet ashing process in chloric/perchloric acid mixture kinetics of the trace iodide catalyzed reaction, cerium IV arsenic III was investigated. On the basis of nonlinear calibration curve determination of urine iodide in the range 0.1-5 microM/l was possible. High sensitivity range of iodide concentration and simplicity of performance predestinate described method for epidemiological studies in iodide deficiency regions.


[Dietary iodine intake in children and clinical and biochemical features of iodine deficiency in chosen districts of south-east Poland]. The study on the effects of Czarnobyl accident on thyroid gland function in children (MZ XVII program) revealed a high incidence of goiter in the population of children in district Kraków and Nowy Sacz. Other study on Tarnobrzeg population showed that the frequency of goiter in school children was 67%. The goiter prevalence, urine iodine excretion and iodine food consumption in the same populations were compared. The detailed investigation of iodine intake in children by feeding questionnaire shows a low consumption of iodine. The urine iodine excretion in the population of Kraków-district was low, but higher than in Nowy Sacz-district and nearly normal in Tarnobrzeg. High frequency of goiter in children and of IDD in newborns screened for CH, as well as low urine iodine excretion, together with low iodine intake with food are the markers of iodine deficiency in Kraków and Nowy Sacz districts. The improvement of feeding as well as iodine salt supplementation is necessary. The situation in Tarnobrzeg district looks differently and needs additional study.


Genetics of dermatophytes.

Genetics of dermatophytes. By the end of 60s a team of scientists has started at Medical Faculty of Olomouc the research of micromycetes pathogenic for both the humans and animals. In this study, the appropriate results are summarized as concerned with the genetics of dermatophytes. Among these results, those significant in deeper assessing the biology of dermatophytes and etiopathogenesis of dermatophytoses have been selected. In our opinion, they may be of interest for the successors in the direction mentioned. Here are also formulated certain open problems and the applicative outputs are traced, for example, those concerning with vaccines. The approaches used, even unusual in the medical mycology from a traditional scope, are believed to prove the convenience of genetic methods when researching mycopathogens. We regret to miss at the edition of this publication the late founder of the team, RNDr. Nora Hejtmánková, CSc. which had the greatest contribution to the Chapters on the karyology and variability of dermatophytes as well as to the hybridization analysis of Trichophyton mentagrophytes complex.


Interferon induction in porcine leukocytes with transmissible gastroenteritis virus. Leukocytes were harvested from the peripheral blood, mesenteric lymph node and small intestinal lamina propria from groups of three piglets before, and 1, 2 and 3 weeks after infection with virulent transmissible gastroenteritis virus (TGEV) at 2 weeks of age. The donor piglets developed clinical signs of transmissible gastroenteritis which persisted for up to 3 days, and they developed peak serum titres of TGEV-neutralizing antibodies 2 weeks post-infection. The leukocytes were cultured in the presence of pokeweed mitogen (PWM), various dilutions of purified TGEV, or control media for 3 or 5 days, and the culture supernatants were tested for antiviral activity in MDBK cells challenged with vesicular stomatitis virus. The antiviral activity was characterized as porcine interferon (IFN)-alpha or porcine IFN-tau on the basis of its stability at pH 2.0 and neutralization by anti-human IFN-alpha antibodies. Viability of the leukocytes in culture, determined by trypan blue exclusion, was highest for the peripheral blood leukocytes and lowest for the mesenteric lymph node leukocytes. There were no consistent differences in antiviral activity between cultures incubated for 3 or 5 days. Porcine IFN-alpha was found in the supernatants of the leukocyte cultures stimulated with TGEV antigen, harvested before or after infection of the donor piglets with TGEV. Porcine IFN-tau was demonstrated in the supernatants of the leukocyte cultures stimulated with PWM, more frequently when the leukocytes were harvested post-infection. This was the first demonstration of IFN induction in vitro in leukocytes from porcine gut-associated lymphoid tissue.


Observations on the conditions of work of Polish seafarers and their health. Conditions of work of seafarers depend on the influence of physical, chemical biological and psycho-social factors. In 1971-1973, the health of 3000 sefarers was examined; their main health problems were: neuroses (10.13%), arterial hypertension (4.63%), ulcer of stomach and duodenum (2.80%), renal calculi (2.80%), and the alcoholic addiction (1.73%). Those seamen worked on cargo ships which technically differed from ships which sail the seas in the nineties; they were slower, to load them and unload took much time, and they stayed in ports for long periods of time. Recent technical developments in shipbuilding, and the trend to build larger ships with more powerful engines and greater cruising speed, the mechanization and automation of ships operation, and computerization, caused the change in their crews structure and number. It also changes the psycho-social work environment. Using the same method, health examinations of 3,300 seafarers were conducted in 1983-1985. There was an increase in the prevalence of neuroses, arterial hypertension, ulcer of stomach and duodenum, and calculus of kidney. In 1990-1992, a group of 4,688 seafarers was examined. Their health problems were different, in comparison with the populations previously examined. For example, neuroses were recorded in 1.16% men, and ulcer of stomach and duodenum in 0.13% of men examined. The above differences in the health status of seafarers examined cannot be attributed only to the changes in their work conditions.(ABSTRACT TRUNCATED AT 250 WORDS)


Prevalence of HIV-antibodies in maritime workers and in other selected population groups in Poland. The objective of the present work was to determine prevalence of HIV-antibodies in the following population groups: 1. Seamen, fishermen and dockers from region of Gdańsk and Szczecin 2. Travellers abroad. 3. Special risk groups (intravenous drug users, prostitutes, homosexuals, haemophiliacs) mostly from Gdańsk region. 4. Hospital patients, prisoners, other people. Abbott recombinant HIV 1/HIV 2 EIA was used for the detection of antibodies to HIV type 1 and/or type 2. In the period from 1987 to 1992, 70,297 examinations were made. HIV-antibodies were detected in 165 people (0.23%). Out of 35,084 subjects in the first group (926 women and 34,158 men). 20 men were found seropositive (0.06%). The majority of them--16 men were seamen, 3 were fishermen and one was a harbour worker. In the second group made of 27,403 people including 3,640 females, HIV-antibodies were revealed in 9 men (0.04%) and one woman. In the third group, there were 965 people including 482 women; among them there were 104 men and 19 women infected (12.8%). Out of the 349 prostitutes examined 2 were infected (0.05%). Among 79 homosexuals, 4 were found infected. In the sample of 14 haemophiliacs none demonstrated HIV-antibodies. In 6,845 subjects of the fourth group (5938 males and 907 females), 12 males were seropositive (0.18%). In that number 5 were prisoners, other 5 were hospital patients and 2 were known to have homosexual relationship with infected men. The majority of subjects with HIV-antibodies were men--145 (88%) of the total number of subjects infected, aged 20-40.


Is there need for change of health examinations for sea pilots? Sea pilots must be capable of carrying out their work in all situations. Thus, they must not have any disease or defect, that could impair their job performance. By periodic medical examinations attempts are made to ensure their working capacity. In most countries these examinations are carried out by a general practitioner and they include only few if any objective laboratory tests. The aim of the present investigation was to study the effectiveness of the periodic medical examinations to find out in the population of pilots examined persons with health risks, especially risks for cardiovascular diseases. All the pilots examined were over 45 years old (n = 135, response rate 88%). Self-evaluation of health was carried out by a questionnaire. Blood analyses were made and chest X-ray as well as exercise-ECC were taken. The most common subjective symptoms concerned musculoskeletal and gastrointestinal systems; sleep disturbances were also quite common. The three most frequent diseases diagnosed earlier by a doctor were musculoskeletal and gastrointestinal diseases, and arterial hypertension. About 24% of pilots had a lower physical working capacity than predicted. The body mass index indicated at least 11% overweight in half of the cases. At exercise-ECG four pilots appeared to have an ischaemic heart disease and additionally eleven pilots had abnormal ECG. Over 80% of pilots had a serum cholesterol value higher than 5 mmol/l, and serum triglyceride values exceeded the normal value of 2.0 mmol/l in every fourth case. Serum glutamyl transaminase was pathological in over 20% of the cases, and serum glucose level in 8%. The findings by routine physical examinations were very few consisting of stiffness in musculoskeletal system, two cases of elevated blood pressure, two heart murmurs, varicose veins etc. In two cases an inguinal hernia was suspected. The current periodic health examinations does not seem to effectively prevent a person with possible health defect from working as a sea pilot. More objective tests must be included in these examinations and more attention should be paid to prevention of overweight, effective treatment of musculoskeletal symptoms, improving physical working capacity and helping pilots to manage their psychic stress.


Work-related lost time accidents in deep-sea fishermen. To evaluate the problem of work-related accidents and injuries in fishermen, a survey was conducted among crews of deep-sea fishing trawlers-factory ships of 3 large fishing companies, covering the period of 10 years (1977-1986). In the surveyed population of 10,475 men and a control group of 4,073 workers employed on shore, there were altogether 1,688 work-related accidents recorded, including 33 fatal accidents. Their incidence was 16.54 per 1000 per year (0.32 fatal cases per 1000 men per year). In the control group (n = 4,073 workers), the incidence was 27.98 per 1000 men (0.03 fatal accidents per 1000). There were more accidents recorded in the control group, than in fishermen. But the incidence of fatal cases was about 10 times higher among fishermen than among workers employed on shore. Among 33 fatal cases in fishermen, there were 12 cases of drowning, 6--injuries, 2--intoxications, 1--burn, and 12 cases sudden death at sea considered as "work-related accidents".


Work-related accidents and injuries in Baltic fishermen. Data on the incidence of work-related accidents and injuries in Baltic fishermen employed on medium-size and small fishing vessels were collected during 9 years, and were compared with this incidence in the control group of shore workers, and in a group of deep-sea fishermen surveyed previously. The non-fatal and fatal injuries in Baltic fishermen occurred much more frequently, than in deep-sea fishermen employed on large ocean-going trawlers-factory ships. This may be related to the difference in the conditions of work on various types of fishing vessels.


Some mortality data for Grimsby "lumpers" and fishermen. All death certificates supplied to Grimsby District Health Authority for the years 1967-1980 were examined. Certificates showing the occupation on fisherman (or similar term) or lumper were extracted. Brief analysis of the data on the age and cause of death stated on those certificates is presented. There was no indication that the mortality pattern differed significantly between the two groups or from that of the community from which the lumpers and fishermen came.


Traumatism with fatal outcome in maritime workers. 102 work-related injuries with fatal outcome among crews of ships of Northern Water Basin in Russia were analysed. The alcohol use and abuse was a major risk factor in accidents and fatal injuries in seafarers and fishermen. Medical and social aspects of the problem, and prevention measures were discussed.


Assessment of phonocardiographical investigations among seafarers. A total of 763 seafarers were selected at random for the examinations. Their number represented 9.82% of the total employed. About 86.63% of them were examined. Another group examined were 202 college undergraduates--all the undergraduates of the second year of studies. The average age of seafarers was 41.14 +/- 8.84 years, and of undergraduates 22.54 +/- 1.29 years. A normal heart first sound was recorded in 95.41% of seafarers, normal second sound in 95.94%, and in 95.05% and 95.05% of the undergraduates, respectively. Normal third and fourth sounds were recorded jointly in 4.45% of seafarers and 0.99% of the undergraduates, whereas abnormal ones in 1.05% of seafarers and 0.99% of the undergraduates. Aortic ejection sound and systolic zone clicks were detected only in seafarers: in 0.79% and 1.31% of the subjects, respectively. Systolic zone murmurs were recorded in 4.19% of the seafarers, including those with heart defects (1.44%), therein mitral valve insufficiency (0.79%), mitral valve prolapse syndrome (0.39%) and aortal valve stenosis (0.26%). In all other cases the recorded heart murmurs in undergraduates and seafarers were considered functional (not pathological).


Health care for nautical tourist.

Health care for nautical tourist. Nautical tourism is one of the developing branches of tourism in Europe. It differs from other forms of tourism. Conditions under which nautical tourists live are similar to those of seamen employed on vessels in costal shipping. The health care for nautical tourists should be organized according to the principles of health care for crews of merchant ships engaged in constal shipping.


Efficacy of hyperbaric oxygenation in atopic dermatitis. Ten patients (5 with atopic dermatitis and 5 with asthma-prurigo) aged 8-38 years, were treated with hyperbarie oxygenation, at the Institute of Maritime and Tropical Medicine. Daily one exposure was applied at 0.1 MPa pure oxygen, during 15 days. Parallelly to the clinical evaluation also G, M, E immunoglobulins and the level of C3 and C4 complement were determined. All patients given this treatment improved clinically. In 9 of them, the level of IgE immunoglobulin decreased. The complement levels also decreased.


Ruminal biohydrogenation of fatty acids from high-oleate sunflower seeds. The objective of these experiments was to examine methods of modifying the fatty acid composition of bovine tissues. In the first experiment, four steers were fitted with duodenal fistulas and were assigned to four diets in a Latin square design. The steers were fed a control diet or the same diet containing 10% high-oleate partially crushed sunflower seeds, serum-coated sunflower seeds, and heat-treated, serum-coated sunflower seeds for 5 d. Samples of digesta and feces were collected on d 5. The inclusion of sunflower seeds (plain or serum-coated) in the diet increased (P less than .05) the digesta concentration of stearate. The percentage of stearate in the digesta and feces was increased (P less than .05) from 51 to 67% and from 64 to 74%, respectively, when steers were fed the untreated sunflower seed. The fecal concentration of oleate was increased (P less than .05) by dietary sunflower seeds in steers that were fed the serum-coated, unheated sunflower seeds. In a second experiment, heifers (four per group) were fed a corn-based control diet or diets containing 10% of high-oleate sunflower oil encapsulated with calcium alginate, either plain, coated with blood meal, or with blood meal integrated into the pellet. After 50 d on treatment, samples of perianal adipose tissue were obtained by biopsy. The fatty acid composition of the adipose tissue was not modified by the inclusion of the encapsulated oleate in the diet. In summary, limited ruminal bypass of sunflower seed oleate was accomplished with sunflower seed but not with encapsulated oleate.


Adequacy of long-term hemodialysis.

Adequacy of long-term hemodialysis. The gross mortality rates for end-stage renal disease patients treated with hemodialysis in the United States are twice those reported in Japan and Europe. This observation has prompted an inquiry into the methods used to administer dialysis therapy in these three areas of the world. It is apparent that shorter treatment time with multiple reuse of dialyzers was more frequently employed in the United States, and adequacy was more often judged by urea kinetic modeling, with the assumption that urea was a suitable surrogate for uremic toxicity. The possibility that inadequate therapy may result from too short dialysis time along with dialyzer reuse is suggested.


Recent developments in peritoneal dialysis. Significant developments over the past 10 years have established continuous ambulatory peritoneal dialysis as a successful kidney-replacement treatment. Peritonitis rates have fallen, and investigators are attempting to establish objective criteria for adequacy of dialysis. Malnutrition is a serious concern, but short-term experience with intraperitoneal amino acids promises success in the management of this complication. A significant improvement in the well-being of patients with end-stage renal disease was produced by recombinant human erythropoietin, and use of recombinant human growth hormone promises catch-up growth for children receiving long-term peritoneal dialysis treatment. As increasing numbers of patients are maintained on continuous ambulatory peritoneal dialysis over longer periods, we will begin to encounter beta 2-microglobulin-related amyloidosis possibly at the same rate in these patients as in those receiving long-term hemodialysis treatment.


Treatment of renal anemia with recombinant human erythropoietin. It has been 6 years since the first reports of the use of recombinant human erythropoietin for the treatment of renal anemia appeared in the medical literature. During this period, erythropoietin has become established as a safe and highly effective therapy, and it is currently being evaluated for other nonrenal types of anemia. The initial clinical trials were in hemodialysis patients, followed by patients receiving continuous ambulatory peritoneal dialysis, and its use in predialysis and renal transplant patients is increasing. Various treatment schedules have been tried and compared; there are now reports of dosage frequencies varying from once daily to once weekly. Information has accumulated on the secondary effects of correction of renal anemia, particularly in relation to quality of life, exercise capacity, and cardiac function. Large multicenter trials have documented the safety profile of erythropoietin, whereas smaller studies have sought to elucidate the pathophysiology of its side effects, eg, hypertension and thrombotic events. This article reviews the latest developments in the use of erythropoietin in renal failure, concentrating particularly on those that have been published within the past year. Although there have been exciting advances in our understanding of the physiology and molecular biology of erythropoietin, these are amply described elsewhere and are beyond the scope of the present review.


Factors affecting kidney transplantation success. Forty percent of kidney transplants function for more than 10 years, allowing their recipients a lifestyle that is dialysis-free. Causes of success or failure of transplants are grouped into patient-related immunogenetic, pre- and perioperative, and postoperative factors. Some factors turn out to be interdependent, eg, the effect of pretransplantation transfusion and ethnic mismatch or donor age and ischemia; thus, no single analysis can be considered definitive. However, in documenting recent evidence gleaned predominantly from multifactorial analysis, we hope to assess relative risks associated with clinically important factors more accurately.


Immunologic mechanisms of transplant rejection. This article reviews recent progress in understanding the mechanisms of organ transplant rejection and focuses on studies that suggest new approaches to diagnosis and treatment. The alloimmune response is initiated by recognition of donor major histocompatibility complex antigens by the immune system of the host. During rejection, the upregulation of major histocompatibility complex antigens on donor tissue enhances this recognition phase. Rejection can be prevented by interfering with the interaction of recipient T cells with alloantigens using interventions such as antibodies against major histocompatibility complex proteins or accessory adhesion molecules, peptide-binding antagonists, and genetic alteration of major histocompatibility complex protein expression. Patterns of cytokines produced in the graft following transplantation may be used to distinguish rejection from other causes of transplant dysfunction. In addition, specific antagonists of individual cytokines show promise as antirejection treatments.


Viral infection in the renal transplant recipient. The viral infections with greatest impact on the renal transplant recipient are those due to cytomegalovirus, Epstein-Barr virus, and the two hepatitis viruses, hepatitis B and C. All of these are modulated by the administered immunosuppressive therapy, and all have both direct and indirect effects on the transplant patient. The direct effects are the infectious disease clinical syndromes that are produced (fever and malaise, pneumonia, hepatitis, and so forth). The indirect effects are several--all of these viruses contribute to the patient's net state of immunosuppression, predisposing him or her to the development of opportunistic superinfection with a variety of pathogens. In addition, both Epstein-Barr virus and hepatitis B virus have been clearly linked to the development of certain malignancies (lymphoproliferative disease and hepatocellular carcinoma, respectively). Finally, cytomegalovirus has been linked to allograft injury. Although antiviral strategies effective for cytomegalovirus and Epstein-Barr virus infection are being developed, similar programs are not yet available for the hepatitis viruses.


Clinical measurement of renal clearance. The importance of renal clearance in uronephrology has motivated the continuous reassessment of well-established methods and the relentless search for better techniques. Concerning radionuclide methods, data in the current literature confirm the validity of the simplified one-compartment model or the empirical single-sample method for renal clearance measurement, and new algorithms have been described to broaden the application of the techniques to the pediatric population. Based on the same principles, accurate measurement of renal clearance can also be obtained using contrast agents. Using the technique for determination of the glomerular filtration rate during radiographic contrast examination is recommendable. However, potential adverse effects of the contrast substances should be compared with those of other methods before using this technique for measuring renal clearance without scheduled contrast roentgenographic examination. Controversy remains concerning the validity of predicting glomerular filtration rate from plasma creatinine. Although the predicted clearance is correlated with reference clearance, analysis of individual results reveals that important differences of up to 50 mL/min frequently occur.


Radiographic techniques in renal parenchymal disease. In his or her practice, the nephrologist usually has a substantial number of patients on dialysis for chronic renal failure. The longer a patient remains on either peritoneal dialysis or hemodialysis, the more at risk he or she is of developing acquired cystic disease of the kidney and renal cell carcinoma. Due to recent developments such as lower osmolar intravenous contrast media, sonography, and magnetic resonance imaging, the radiologist has the ability to assess the kidney in chronic renal failure with a growing number of less-invasive modalities. The lower osmolar agents appear to be less toxic to the kidney. Thus, they can be used when the benefit of the information obtained from a necessary procedure, eg, computed tomography or coronary arteriography, surpasses the risk. Duplex Doppler sonography can assess the pressure of flow in the arcuate vessels of the kidney with measurements of the resistive index. The resistive index is a proven tool for assessing rejection of the renal allograft--another newer application is in the diagnosis of obstruction. An elevated resistive index found in a kidney with a dilated collecting system confirms the diagnosis of obstruction. Studies are being made on its application in other renal disease processes as well.


Uronephrologic nuclear medicine.

Uronephrologic nuclear medicine. Nuclear medicine offers a rapid noninvasive means of evaluating suspected urinary tract disorders. Over the years, radionuclide scintigraphy has gained an important role in the evaluation of the renal transplant, possible obstruction, infection, and renovascular hypertension. During the past year, the importance of nuclear medicine within these areas has been confirmed. The diagnostic value of both diuresis and angiotensin-converting enzyme inhibitor renography is now generally accepted, whereas there is still disagreement about the optimal protocol. Renal scintigraphy is useful in patients with renal infection. Nuclear medical examinations have assumed a dominant role in the control and monitoring of renal transplants owing to their ability to quantify perfusion and function, but they do not obviate graft biopsy.


Diagnosis of renal transplant rejection in the cyclosporine era. The introduction in 1983 of cyclosporine as a prophylactic immunosuppressive agent has contributed to improved renal allograft survival at many transplant centers. However, in view of its profound nephrotoxic potential, the use of this drug in renal transplant patients has caused diagnostic confusion. An accurate assessment of whether the allograft dysfunction is from drug overdose or from acute rejection is important before one can manage the problem appropriately. The two practical measures that would help in distinguishing acute rejection from cyclosporine-induced toxicity are 1) a trial of cyclosporine dose-reduction and subsequent assessment of renal function, and 2) histologic assessment of the renal allograft biopsy specimen. In recent years, several new diagnostic techniques to assess the immunologic activity within the graft environment have been developed that could further enhance our discriminating ability. However, these sophisticated techniques are not readily available to most clinicians who are currently managing patients with graft dysfunction. This article focuses on the different methods of distinguishing rejection from cyclosporine-induced toxicity. The data were abstracted from relevant papers published in the scientific literature during the past 12 months.


The insulin resistance syndrome.

The insulin resistance syndrome. Insulin resistance is a frequently occurring abnormality. Although there can be insensitivity to any of insulin's actions, insulin resistance par excellence is a decreased insulin-mediated whole-body glucose disposal rate. A distinction is made between primary and secondary insulin resistance. Primary insulin resistance is of unknown origin, is only partially experimentally reproducible, and is essentially irreversible (spontaneously or by treatment). In addition, it is both pathway-specific (ie, glucose storage) and organ-specific (mostly skeletal muscle), and is compatible with a postreceptor defect in insulin action. Primary insulin resistance is found in a proportion (approximately 25%) of otherwise healthy people, in non-insulin-dependent diabetes mellitus, essential hypertension, and some forms of dyslipidemia. The idea of an insulin resistance syndrome derives from the striking pattern of overlap among these clinical conditions. Their tendency to cluster in the same individuals is evident from both cross-sectional and longitudinal observations. It is proposed that the insulin resistance syndrome is a large constellation of interrelated changes in metabolic, anthropometric, and hemodynamic variables centered around insulin resistance or hyperinsulinemia. There is a significant genetic component, a predisposing influence for non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and possibly, a distinct atherogenic potential.


Assessment of autonomic nervous function in human hypertension. In spite of the popular belief that "nervous tension," "stress," and hypertension are causally related, it has been difficult to prove a role of autonomic dysfunction in the genesis of essential hypertension. There are three major reasons for this: 1) autonomic function cannot be assessed with one simple test, 2) the short-term "phasic" and long-term "tonic" autonomic control of blood pressure are not necessarily interrelated, and 3) hypertension is a dynamic process in the course of which there are changes in autonomic control. Some of the controversies in the field stem from the lack of appreciation of these limitations.


Blood pressure measurement and monitoring. Recent developments in blood pressure measurement have emphasized recordings taken outside the physician's office. Such readings can recognize the spuriously high levels recorded in "white coat" hypertension. Nocturnal and early morning readings can detect silent complications and impending cardiovascular accidents.


Bioceramics in orthopaedic surgery: state of the art and preliminary results. Ceramic materials utilized in orthopaedic surgery can be divided into bioinert, causing minimum tissue reaction, and bioactive types, capable of stimulating bone tissue growth, establishing a bond capable of supporting physiological loads. Alumina is a bioinert ceramic which shows excellent mechanical resistance and an extremely low level of wear when given appropriate structural characteristics. It is therefore used to make prosthetic hip components (head and acetabulum), to coat metal prosthetic shafts and to make prostheses for small joints. Among the bioactive ceramics, bioglass, bioglaze and hydroxylapatite are included in the study. At present, bioglass and bioglaze appear interesting, but not sufficiently so as to find a precise niche in orthopaedic surgery. Currently the bioactive ceramic with the most possibilities for use in orthopaedic surgery is hydroxylapatite. The close interfacial bond which is established with bone tissue allows it to be used as a filler for defective bones in various skeletal diseases and as a coating for metal prosthetic substrates.


Surgical treatment of Legg-Calve-Perthes disease. Thirty-two patients (out of 52 undergoing surgery) with Legg-Calvé-Perthes disease (LCP) were examined retrospectively to assess the efficacy of surgical treatment on epiphyseal morphology at the primary healing. The analysis of the clinical results of the 33 hips considered indicated that it is necessary to operate above all on 3rd grade hips. For these the most frequent operation indicated is osteotomy of the pelvis. Femoral osteotomy must be limited to cases with only a slightly deformed femoral epiphysis in patients below the age of 7-8 years.


Cooper's technique in the treatment of neuromuscular pes cavovarus. The authors present the technique described by Cooper to correct neuromuscular pes cavovarus and the results of 13 cases of pes cavovarus treated at the Orthopaedic Clinic of "La Sapienza" University in Rome. Cooper's technique seems to be a valid way of correcting pes cavovarus, particularly in growing patients or those with anterior deformities.


Arthrolysis in the treatment of ankylosis and severe post traumatic stiffness of the elbow. Between 1977 and 1989 the authors performed arthrolysis on 18 patients with ankylosis or severe post traumatic elbow stiffness. After an analysis of the cases, the operative technique is described and original parameters are proposed to evaluate the consequent results. The validity of arthrolysis as a possible alternative to arthroplasty or arthroprosthesis is confirmed by the 67% positive results.


Allograft revision surgery of failed hip replacements: X-ray pattern and clinical results. The authors describe their experience with allograft in 23 cases of revised hip replacements, paying particular attention to the clinical results and the X-ray appearance. They conclude by emphasizing the particularity of the surgical technique and the various factors involved in the use of bone grafts in such elective surgery as hip replacement.


Percutaneous pinning of displaced supracondylar fractures of the humerus in children. Case report. The authors report their experience with closed reduction and percutaneous pinning of twenty-two supracondylar fractures of the humerus in children. In cases with neurovascular complications there was a marked regression within six hours following reduction. The results after 15 months to 13 years were satisfactory (excellent + good) in 90% of the cases, avoiding the risks and possible cicatricial complications of incisions and the discomfort of orthopaedic treatment in traction and subsequent thoracic-brachial plaster cast.


Thrombophlebitic complications in arthroscopic surgery of the knee. Arthroscopic surgery is generally considered to be free of any significant complications. In particular, there is a much lower incidence of vascular complications as compared with open surgery of the knee. A careful examination of the literature, made by the authors, and an in-depth analysis of a significant sample (790 patients over 2 years) out of a total of more than 2200 knee arthroscopies performed over 7 years, has shown that thrombophlebitis is in fact an important complication especially in patients over the age of forty. The need for an accurate preliminary study to identify the patients at risk and for regular and specific out-patient check-ups to prevent the onset of severe vascular and thrombophlebitic complications is stressed.


Measurement of extensor hallucis longus power in patients with hallux valgus. Is the Dandy sign reliable in cases of hallux valgus? The authors took manual and dynamometric measurements of the power of the extensor hallucis longus (EHL) muscle in 100 patients with juvenile hallux valgus and 141 normal patients. Three degrees of valgus deformation were recognized: mild (15-25 degrees), moderate (26-35 degrees), and severe (> 35 degrees). Neither the manual nor the dynamometric measurements showed any difference in EHL power between the normal patients and those with mild valgus deformity. In the patients with moderate valgus deformity, the manual measurement usually showed the EHL force to be the same as that of the normal patients, while the dynamometric measurement gave a lower value. The patients with severe valgus deformation were shown to have a slight to moderate loss of power on manual measurement and a greater loss of power on dynamometric evaluation. Both methods of measurement are equally reliable. When the valgus deformation is mild to moderate, any loss of EHL power must be attributed to another cause; when the valgus deformation is severe, however, it by itself provokes a significant loss of EHL power. The Dandy maneuver is unreliable only in cases of severe hallux valgus.


Functional evaluation of patients fitted with total knee prostheses. Degenerative or inflammatory diseases of the knee joint account for a large proportion of diseases affecting the elderly. Treatment aims to eliminate pain, correct the deformity and maintain complete joint mobility. In cases of total joint degeneration, fitting of a joint prosthesis is the technique currently favoured since elimination of pain and correction of the deformity, accompanied by recovery of joint mobility (the fundamental requirements for normal everyday life) can only be obtained if the knee joint is completely replaced. With the discovery of new materials and increasingly sophisticated knowledge about articular mechanics, the knee prosthesis, although more recent than the hip prosthesis, has become ever more widespread to the point that it now represents an irreplaceable aid in the treatment of this common disease. The clinical results obtained are already stable and particularly encouraging and prosthesis design is sophisticated and accurate. There is, however, still the suspicion that current prostheses can be considered "rudimentary" in comparison with the physiological and biomechanical behaviour of the human joint. We therefore wanted to begin an evaluation using a gait analysis system to assess patients fitted with knee prostheses. The first impressions gained in this study are the subject of this article.


Genu recurvatum following distal epiphysiodesis of the femur: X-ray evaluation and therapeutical approach. Acquired genu recurvatum may have bone, capsulo-ligamentous or combined origins. It may affect the tibia or femur and various etiologies are possible. However, its pathogenesis is often linked to partial anterior epiphysiodesis following traumatic damage to the femoral or tibial growth plate. In this study we examine femoral recurvatum, a form which occurs only rarely. The clinical and radiographic characteristics are described in depth and the surgical indications for correction of this deformity are defined. Radiographic examination was used to complete the goniometry of the recurvatum deformity by calculating the dia-intercondylar angle, measureable on lateral radiographs of the knee. The normal value is 33 degrees (+/- 3 degrees) while in the patients with femoral recurvatum it was noticeably higher. In cases of isolated femoral recurvatum we carried out a supra-condylar osteotomy with removal of a bone wedge aimed at normalizing the dia-intercondylar angle. In the cases treated at our Centre, the objective, subjective, functional and radiographic results were good, with a mean follow-up of 6 years. as well as completing the goniometry of the recurvatum, the dia-intercondylar angle makes it possible to draw up a correct pre-operative plan, enabling precise surgical correction to be carried out.


Staging of malignant tumours of the foot. Tumours of the foot in general, and malignant tumours in particular, are extremely rare. In the absence of a large series it is necessary to resort to surgery based on "principles" and not on experience or on data drawn from retrospective clinical studies. Enneking's "Surgical Staging System" (S.S.S) is a method of staging musculo-skeletal tumours which has been universally adopted-for several years and which is based, as already known, on the concept of anatomo-surgical "compartments". In the particular case of the foot, the S.S.S. suggests the surgical criteria specific to each anatomical region. The authors illustrate the principles with some examples taken from their experience, evaluating the surgical, oncological and functional aspects.


Morphological or functional criteria in evaluation of the newborn hip? Classifying the infant hip as normal or dysplastic before the stage of radiological significance, in other words during the first three months of life, has always been trusted to functional maneuvers causing clinical signs. From the results it is possible to deduce if the hip morphology is normal or somehow altered. In other words, because insufficient radiographic significance makes it impossible to directly assess the "morphological" criterion, diagnosis of the state of the hip is carried out using an indirect "functional" criterion. In contrast to radiographic imaging, ultrasound screening is already significant in the first weeks of life; it is therefore now possible to obtain real images of the infant hip earlier than it was possible using radiography. This eliminates the need for symptomatic evidence of dislocation. As a result, the "functional" indirect criterion used up till now for early diagnosis of infant hip can today be replaced by a direct "morphological" criterion. This innovation is not without epidemiological consequences, and this must be taken into account in order to rationalise between the opposing risks of over or under estimating the incidence of congenital hip dysplasia.


Sciatic nerve palsy associated with total hip arthroplasty. Six cases of clinically evident sciatic or peroneal nerve palsy occurred in a consecutive series of 380 total hip arthroplasties (THA). An additional eight cases of peroneal nerve palsy due to pressure from Thomas splint or tight bandages were seen. Factors apparently causing nerve palsy were significant lateralization and lengthening in four cases and dislocation of the hip in one case. The cases with neuroapraxia of the peroneal nerve were seen from the third to the fifth day of Thomas splint immobilization. EMG studies were conducted in all six group 1 patients; at the end of one year the results were good in two cases, fair in three cases, and poor in one case. The results suggest that limb lengthening should be limited to 4 cm to minimize this complication. It was also seen that patients with peroneal nerve palsy due to local compression do well, though some are bothered by mild residual dysesthesia over the dorsum of the foot. In contrast, patients with sciatic nerve palsy do not have such a good outlook.


Synovial osteochondromatosis of the sole of the foot. A case report. Synovial osteochondromatosis of the foot is a rare disorder. We present the first report of synovial osteochondromatosis of the intermetatarsal/tarsometatarsal joints. When a mass develops in the sole of the foot and heterotopic ossifications are revealed radiographically, synovial osteochondromatosis should be considered in the differential diagnosis.


Reduction and osteosynthesis of subcapital fractures of the femoral neck: possible repercussions on post-fracture hemarthrosis of the hip. Intracapsular hip pressure was measured in undisplace or less displaced subcapital fractures of the femoral neck before and after open reduction and internal fixation with three-flanged nails. After reduction and osteosynthesis, intracapsular pressure increased in three out of five cases. The result is discussed in relation to the possible role of intracapsular pressure sustained by hemarthrosis in the pathogenesis of post-traumatic vascularity of the femoral head.


Bilateral aseptic necrosis of the humeral head following combined therapy for Hodgkin's lymphoma. A young woman treated with combined therapy (chemo- and radiotherapy) for Hodgkin's disease later developed avascular necrosis of the humeral heads. The unusual location of the aseptic necrosis, and particularly the fact that it occurred bilaterally, made the case exceptional. The hypothesis is that the radiotherapy was a contributory factor.


Kienbock's disease in an eleven-year-old girl. A case report. Kienbock's disease occurs most frequently between 20 and 30 years of age (Gillespie, 1961). The youngest patient with Kienbock's disease in literature written in English is a 10-year-old boy (Nakamura et al., 1990). We report the case of an 11-year-old girl with Kienbock's disease whom we treated with radial shortening. Five months after surgery, radiographs showed signs of rapid disappearance of avascular necrosis of the lunate, and the patient had excellent clinical results. Two years postoperatively no recurrence of avascular necrosis of the lunate has occurred.


A case of non-ossifying fibroma.

A case of non-ossifying fibroma. The authors describe a case of non-ossifying fibroma which, because of its particular clinical and radiographic features, had previously been diagnosed as osteoid osteoma. Taking this as the starting point, the relationship and the differential diagnosis between these two well-known disorders is discussed.


A solitary metastasis of the patella.

A solitary metastasis of the patella. A case is reported of a solitary metastasis of the patella from a "poorly differentiated adenocarcinoma", the first sign of the primitive tumour for a long time unidentified. The authors point out that this occurrence, although rare, should be considered in the differential diagnosis of knee pain.


Osteolysis of the distal clavicle in a woman. Case report and review of the literature. An unusual case of osteolysis of the distal clavicle in a woman is presented. Although almost 100 cases of osteolysis of the distal clavicle have been reported in the literature, none have occurred in females (Neer and Rockwood, 1984). After acute acromioclavicular dislocation, surgical reduction was carried out by transferring the coracoid process to the clavicle. Three years later the osteolysis of the outer clavicle appeared to be related to pain and functional impairment of the joint. The pain is quite tolerable and surgical excision of the distal clavicle has not yet been necessary.


[Radiologic diagnosis of morphologic and functional changes in the bronchopulmonary system in workers employed in production and processing of ethylene oxide]. A total of 3475 subjects, engaged in such production for 2-20 years, were annually and before starting work examined by clinical and x-ray methods; 2427 of these were regularly exposed to ethylene oxide (the main group). X-Ray examinations included roentgenomorphologic (total fluorogram of the thoracic cavity organs and long-distance roentgenograms, tomograms, bronchograms, if necessary) and roentgenofunctional (roentgenopneumopolygraphy) methods of examination of the bronchopulmonary system. Chronic bronchitis was detected in 407 workers of the main group and in 79 controls; in 76.2% of the main group patients and in 90% of controls it was chronic nonobstructive functionally unstable bronchitis, in the rest it was chronic obstructive bronchitis.


[Computerized planning of radiotherapy]. The hypophysis was studied by MR tomography in 148 patients with the most prevalent diseases of the hypothalamohypophyseal system and in 13 ones with primary hypothyrosis. The findings evidence a great variety of changes in the MRT picture in the examinees. The method permits a reliable diagnosis of hypophyseal macroadenoma and of an 'empty' sella turcica. Qualitative and quantitative criteria for MRT diagnosis of these conditions are suggested. The diagnostic value of MRT for the detection of macroadenomas is still to be researched. The method was effectively used for a dynamic follow-up of the hypophyseal status in the course of pathogenetic therapy; the formation of an 'empty' sella turcica is possible against the background of dopamine agonist therapy and substitution therapy of primary hypothyrosis.


[MRI and computerized tomography in the evaluation of lumbar spine after herniated disk surgery]. The authors analyze the results of comprehensive radio-diagnosis in 44 patients previously operated on for lumbar hernias. All the findings of magnetic resonance tomography and computer-aided tomography were divided into 3 groups: (1) natural consequences of a surgical intervention without clinical manifestations; (2) complications after a surgical intervention; (3) recurrent hernias or hernias on an adjacent level. The most intricate problem was the differential diagnosis between a recurrent hernia and a postoperative epidural cicatrix. Criteria to distinguish between these two conditions are suggested. The authors emphasize that the optimal variant for examination of the patients operated on is a combination of magnetic resonance tomography and computer-aided tomography.


[Developmental defects of the facial the skull in some forms of craniosynostosis]. Changes in the facial skull of 74 patients with untimely synostosis of craniocerebral sutures and pathologic shape of the cerebral skull are characterized. All the patients presented with shortened base of the skull, gross deformations of the facial skull. Certain regularities in the formation of these defects were distinguished.


[Radiologic densitometry in the evaluation of disorders of bone mineral density in patients with diabetes mellitus]. Presents a quantitative assessment of the total content of minerals in bones of 50 diabetics and 50 controls, carried out by a modified photodensitometric procedure. The data evidence a significant reduction of the mineral content in the bones of diabetes mellitus patients, this permitting an earlier detection of osteoporosis in the course of diabetes.


[Tolerance to standard and non-ionic contrast media in patients with ischemic heart disease and stable angina pectoris during coronary angiography]. Angiography of the coronary arteries with iohexol was carried out in 45 coronary patients with stable angina pectoris and that with diatrizoate in another group of 45 similar patients. Iohexol was tolerated better that diatrizoate. Physiological and hemodynamic side effects of iohexol were less marked than those of diatrizoate.


[Role of radiologic diagnosis in the evaluation of morphologic and functional changes in muscular veins of the leg in the pathogenesis of varicose disease]. A total of 100 patients with varicosis of lower limb veins were investigated with the help of distal ascending phlebography in horizontal, vertical and tilted positions. Considerable differences in x-ray images of musculi gastrocnemius and soleus (MGS) were noted. Four main types of MGS (conic, spindle-form, U-form, and balloon-like) were singled out. Correlation between muscular vein sizes and stages of varicosis was revealed. An important role of the pathology of muscular veins in dysfunction of the leg pump as one of the factors of pathogenesis of lower limb varicosis was confirmed.


[Nuclear magnetic tomography in the diagnosis of spinal cord cysts]. Magnetic resonance tomography (MRT) was used in examinations of 172 patients with spinal cord abnormalities. Thirty-eight cysts were detected: 25 in syringomyelia, 5 in intramedullary tumors, 4 posttraumatic and 4 postoperational ones. Based on the MRT patterns, two types of syringomyelia were distinguished, the occlusive and idiopathic ones. The size and site of cyst, as shown by the MRT, did not conform to its neurologic symptoms. A characteristic feature of tumorous cysts was a highly intensive signal originating from their contents. Traumatic cysts were detected against the background of diffuse atrophy of the cord. Computer-aided tomography did not give full-value information in such cases and therefore could not be recommended in cases with suspected intramedullary cysts.


[Diagnostic perspectives of mobile radiographic computerized tomography]. The authors assess mobile methods of x-ray computer-aided tomography (CAT) and suggest an organization and methodological scheme of its application. Their program of the first and up to now the only one in this country mobile CAT device is based on the new principles of mobile CAT application. It is realized in special hospitals of large regions, where the patients with the optimal indications for CAT are assembled. Over 15,000 examinations were carried out with the use of the suggested CAT program over 4 years, that resulted in detection of 1295 brain tumors, 804 cases with neoplastic involvement of the abdominal cavity and the retroperitoneal space. The authors claim that wide application of mobile CAT devices according to the program they suggest will help decide the problem of unavailability of such examinations, for it will rule out the principal cause of this unavailability--economic problems arising because of high price of this equipment. One mobile device may replace 3 permanent CAT devices, if used according to the program suggested by the authors.


Novel roles for neurotrophins are suggested by BDNF and NT-3 mRNA expression in developing neurons. The results of our in situ hybridization experiments demonstrate that sensory neurons, sympathetic neurons, and motoneurons express brain-derived neurotrophic factor and/or neurotrophin-3 mRNAs during development in mouse. In accordance with previous data, we also find neurotrophins in the targets of sensory neurons (skin) and motoneurons (muscle) and the neurotrophin receptors p75, trkA, and trkB in sensory and sympathetic ganglia. These results suggest that neurotrophins have roles other than being target-derived factors that support neuron survival during developmental cell death (neurotrophic hypothesis), but may be transported in an orthograde fashion in neurons and released from axon terminals. We discuss several novel roles for neurotrophins, including autocrine/paracrine regulation of neuron survival, regulation of Schwann cell activity, and neuron to target signaling.