[Endoscopic interventions in cicatricial strictures of esophageal anastomoses]. Endoscopic balloon hydrodilation was conducted in 39 patients with cicatricial stenoses of esophageal anastomoses, in 12 patients it was combined with electrodissection of the esophageal anastomosis, in 3 with bougienage, and in 10 with temporary endoprosthetics. The anastomosis was dilated adequately (to 2.0-2.5 cm) in 38 patients. In one case endoscopic treatment was ineffective; another surgical intervention was performed. In another case endoprosthetics was complicated by decubitus of the cervical esophagus (favorable outcome). In late-term period of 2 months to 4 years restenosis occurred in 6 of 38 patients; the course of dilation was repeated in 4 patients, 2 patients underwent a reconstructive operation. The authors believe that in development of cicatricial stenosis of the esophageal anastomosis modern methods of therapeutic endoscopy should be resorted to in the first place, and only if they prove ineffective should the question of repeated surgical intervention be discussed. Balloon hydrodilation is the principal method of operative endoscopy in cicatricial stenoses of esophageal anastomoses, which in some cases should be combined with other endoscopic interventions (electroincision and temporary endoprosthetics).


[An experimental assessment of methods for applying intestinal sutures in intestinal obstruction]. The results of various methods used in applying intestinal sutures in obturation were studied. Three series of experiments were conducted on 30 dogs--resection of the intestine after obstruction with the formation of anastomoses by means of double-row suture (Albert--Shmiden--Lambert) in the first series (10 dogs), by a single-row suture after V. M. Mateshchuk [correction of Mateshuku] in the second series, and bu a single-row stretching suture suggested by the author in the third series. The postoperative complications and the parameters of physical airtightness of the intestinal anastomosis were studied in dynamics in the experimental animals. The results of the study: incompetence of the anastomosis sutures in the first series 6, in the second 4, and in the third series one. Adhesions occurred in all animals of the first and second series and in 2 of the third series. Six dogs of the first series died, 4 of the second, and one of the third. Study of the dynamics of the results showed a direct connection of the complications with the parameters of the physical airtightness of the anastomosis, and the last-named with the method of the intestinal suture. Relatively better results were noted in formation of the anastomosis by means of our suggested stretshing continuous suture passed through the serous, muscular, and submucous coats of the intestine.


The use of non-steroidal anti-inflammatory drugs for the relief of pain in laboratory rodents and rabbits. The data concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) and evidence for their efficacy in laboratory rats and mice are reviewed. This information is then extrapolated to clinical situations and dose rates that take account of ulcerogenic side effects are recommended. NSAIDs have the potential to be a very useful group of analgesics and should always be considered when attempting to provide pain relief in laboratory animals.


The scope for improving the design of laboratory animal experiments. The factors which need to be taken into account in designing a 'good' experiment are reviewed. Such an experiment should be unbiased, have high precision, a wide range of applicability, it should be simple, and there should be a means of quantifying uncertainty (Cox 1958). The relative precision due to the use of randomized block designs was found to range from 96% to 543% in 5 experiments involving 30 variables. However, a survey of 78 papers published in two toxicology journals showed that such designs were hardly used. Similarly, designs in which more than one factor was varied simultaneously ('factorial designs') were only used in 9% of studies, though interactions between variables such as dose and strain of animal may be common, so that single factor experiments could be misleading. The consequences of increased within-group variability due to infection and genetic segregation were quantified using data published by Gärtner (1990). Both substantially reduced precision, but toxicologists continue to use non-isogenic laboratory animals, leading to experiments with a lower level of precision than is necessary. It is concluded that there is scope for improving the design of animal experiments, which could lead to a reduction in animal use. People using animals should be required to take formal training courses which include sessions on experimental design in order to minimize animal use and to increase experimental efficiency.


Subcutaneous administration of HMG-CoA reductase inhibitors in hyperlipidaemic and normal rats. Recent reports demonstrate a hypocholesterolaemic effect of daily subcutaneous injections of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in different rat models of hyperlipidaemia. However, this effect is not seen after oral administration of HMG-CoA reductase inhibitors in rats. We found that oral administration of the HMG-CoA reductase inhibitor Simvastatin also had no effect on plasma cholesterol in severely hyperlipidaemic Nagase analbuminaemic rats (NAR). Simvastatin (an apolar compound dissolved in propylene glycol) was infused continuously for 28 days into the subcutis of control Sprague-Dawley rats (SDR) and NAR using an implanted osmotic pump. All doses which were effective in reducing cholesterol in the NAR (reductions up to approximately 60%), reduced apolipoprotein AI but not apolipoprotein B and caused a severe inflammatory reaction in the dermis. Similar toxicity was observed in the SDR. Subcutaneous administration of the vehicle (propylene glycol) did not cause this reaction and did not affect plasma lipids. Administration of Lovastatin in osmotic pumps resulted in a similar inflammatory reaction. Incorporation of Simvastatin into liposomes did not diminish the toxic effect. On the other hand, infusion of Pravastatin (a polar HMG-CoA reductase inhibitor dissolved in isotonic saline) caused no changes in the dermis and had no effect on plasma lipids in NAR or SDR. Liver microsomes prepared from the Pravastatin-treated rats demonstrated a 3- to 4-fold increase in HMG-CoA reductase activity as compared to untreated rats, confirming uptake of the drug. We conclude that continuous subcutaneous administration of the HMG-CoA reductase inhibitors Simvastatin, Lovastatin and Pravastatin for 28 days may not reduce plasma cholesterol in rats by a mechanism which is related to inhibition of HMG-CoA reductase activity in the liver. The decrease of plasma cholesterol effected by subcutaneous infusion of Simvastatin or Lovastatin in NAR coincides with, and may be related to inflammatory changes caused by administering these compounds into the dermis.


Struvite urolithiasis in a B6C3F1 mouse. In a 2 year carcinogenicity bioassay using B6C3F1 mice, one male mouse developed clinical signs near termination of the study, comprising skin sores around the prepuce, penile prolapse and urine scalding. The predominant finding at necropsy was a markedly distended urinary bladder filled with numerous crystallized particles. Microscopically, there was subacute cystitis with marked hyperplasia of the transitional epithelium. X-ray diffraction analysis of the crystals showed a diffraction pattern characteristic of struvite (ammonium magnesium phosphate). The implications of the spontaneous occurrence of bladder stones in rodents on long-term toxicology studies are discussed.


Spiral bacterium associated with gastric, ileal and caecal mucosa of mice. A spiral shaped bacterium was seen in smears and histological sections (stained by carbolfuchsin) of gastric, ileal and caecal mucosa as well as in stool smears from mice. A significant correlation between the presence of the spiral bacterium and the occurrence of gastritis was observed but the ileal and caecal mucosa seemed unaffected. The bacterium was Gram negative and grew on BHM and Skirrow's medium, under microaerophilic conditions, at 37 degrees C. Its major biochemical characteristics included positive catalase and oxidase reactions and a rapidly positive urease test. There were 2 or 3 spiral turns per cell and a tuft of up to 12 sheathed flagella on each pointed end. Entwined, braided periplasmic fibrils covered the surface of the cell. This spiral bacterium seemed to be part of the normal intestinal flora but was associated with gastritis.


Glycosuria and maternal licking in rats. Maternal anogenital licking (MAGL) has been studied to understand the mechanism of maternal behaviour. The present study showed that rats had glycosuria at the concentration of 18-20 mg/dl and glucose was the preference of postpartum rats. MAGL increased on suckling rats separated for 24 h. However, wiping anogenital region attenuated the increase of MAGL. Therefore, glucose preference of postpartum rats may be involved in MAGL.


Spinal dysplasia with stump tail and hind limb paralysis in a laboratory bred cat. A case is presented of a specified pathogen free bred cat which was apparently tail-less at birth and at three weeks of age revealed hind limb paralysis. The animal was euthanized at 4 weeks and X-radiography revealed an abnormal spinal curvature, greatly reduced caudal vertebrae and abnormal pelvic development. A small tail was dissected at post-mortem, but other abnormalities were not seen.


Fundamental frequency, jitter, and shimmer in preschoolers who stutter. This investigation examined acoustic correlates of phonatory control in the speech of 10 preschool-aged boys who were stutterers (mean age = 45 months) recorded relatively close to the time of stuttering onset and in the speech of 10 boys who were nonstutterers (mean age = 46 months). For each subject, acoustic measurements of fundamental frequency, jitter, and shimmer were extracted from the 100 msec midportion of 30 vowels selected from fluent utterances in spontaneous speech. Significant differences between the two groups for shimmer measures are among the few positive findings in recent publications concerning the fluent speech of children who stutter.


The correspondence of vocal tract resonance with volumes obtained from magnetic resonance images. The increasing availability of magnetic resonance imaging (MRI) as a research, and even clinical, tool in speech production makes possible a wide range of quantitative methods in vocal tract measurement. In these initial stages of application, it is essential that the limits of the method be identified. The present investigation was designed to apply the techniques of digital image analysis and volumetric measurement to MRIs obtained for the vocal tract during production of continuant speech sounds, and to apply these measures to a well-established and thoroughly tested model of acoustic transmission (Stevens & House, 1955). The results demonstrated that, although there were several sources of relatively large error and measurement bias, the vocal tract volumes obtained from MRIs were significantly predictive of vocal tract resonance frequencies. These results are discussed with respect to limits and potential for future application of MRI to speech production research.


Error monitoring in people who stutter: evidence against auditory feedback defect theories. Several theories purport that people who stutter suffer a speech-auditory feedback defect. The disordered feedback creates the illusion that some kind of error has intruded into the speech flow. Stuttering then results from actions aimed to correct the suspected, but nonexistent, error. These auditory feedback defect theories thus predict deviant error detection performance in people who stutter during speech production. To test this prediction, subjects who stuttered and those who did not had to detect self-produced (phonemic) speech errors while speaking with normal auditory feedback and with the auditory feedback masked by white noise. The two groups did not differ significantly in error detection accuracy and speed, nor in false alarm scores. This opposes auditory feedback defect theories and suggests that the self-monitoring processes of people who stutter function normally. In a condition in which errors had to be detected in other-produced speech, i.e., while listening to a tape recording, subjects who stuttered did detect fewer errors. Whether this might signal some general phonological problem is discussed.


Specific-language-impaired children's quick incidental learning of words: the effect of a pause. It was hypothesized that the initial word comprehension of specific-language-impaired children would be enhanced by the insertion of a short pause just before a sentence-final novel word. Three groups of children served as subjects: twenty 5-year-old, specific-language-impaired (SLI) children, and two comparison groups of normally developing children, 20 matched for mean length of utterance (MLU) and 32 matched for chronological age (CA). The children were randomly assigned to two conditions for viewing video programs. The programs were animated stories that featured five novel object words and five novel attribute words, presented in a voice-over narration. The experimental version introduced a pause before the targeted words; the control version was identical except for normal prosody instead of a pause. Counter to the predictions, there was no effect for condition. Insertion of a pause did not improve the SLI children's initial comprehension of novel words. There were group main effects, with the CA matches better than either of the other two groups and no differences between the SLI children and the MLU-matched children.


The conditions and course of clinically induced phonological change. This two-part study continued the evaluation of minimal pair treatment in phonological change (Gierut, 1989, 1990, 1991a; Gierut & Neumann, 1992). Three linguistic variables relevant to change were experimentally manipulated within an alternating treatments design to determine specifically the interplay of a maximal number of feature distinctions, feature class, and relationship of treated phonemes to a child's grammar in inducing sound change. The conditions of treatment that were shown to facilitate optimal phonological change in previous research were again experimentally replicated. Specifically, minimal pairs comparing two phonemes previously unknown to a child that also differed by maximal and major class features were found to be the preferred context motivating change. Important individual differences emerged and underscored the role of a child's pretreatment grammar in phonological change. These differences contributed to descriptions of possible courses of change followed by children with phonological disorders and bear upon the predictability of change and the effectiveness of treatments that may condition change.


Linguistic trade-offs in school-age children with and without language disorders. Factors influencing the occurrence of trade-off effects among linguistic components were examined. Several linguistic measures were used to represent syntactic and phonological production in order to determine whether interrelationship patterns would vary across measures. Linguistic interactions present in imitated speech were compared to those from spontaneous speech. Group effects were explored by comparing data from children with language-learning disabilities, children with reading disabilities, and normally developing children. Results indicated trade-offs between some linguistic measures and positive relationships among others. More trade-offs were present in imitated speech than in spontaneous utterances. In general, interrelationship patterns were similar across groups. Interpretation of these results in reference to current models of sentence production is offered.


Grammatical morphology and speech perception in children with specific language impairment. Many English-speaking children with specific language impairment have been found to be especially weak in their use of grammatical morphology. In a separate literature, many children meeting the same subject description have shown significant limitations on tasks involving the perception of rapid acoustic changes. In this study, we attempted to determine whether there were parallels between the grammatical morphological limitations of children with specific language impairment and their performance profiles across several perceptual contrasts. Because most English grammatical morphemes have shorter durations relative to adjacent morphemes in the speech stream, we hypothesized that children with specific language impairment would be especially weak in discriminating speech stimuli whose contrastive portions had shorter durations than the noncontrastive portions. Results from a group of eight children with specific language impairment with documented morphological difficulties confirmed these predictions. Several possible accounts of the observed morphology-perception parallels are offered.


A study of developmental speech and language disorders in twins. Fifty-seven same-sex twin sets (32 monozygotic and 25 dizygotic) were examined for concordance of speech and language disorders. Results showed monozygotic twins to have higher concordance than dizygotic twins. In addition, monozygotic twins were more similar in the types of disorders they presented than dizygotic twins. Positive family histories for speech, language, and learning disorders were reported in the nuclear families of the twins.


Variables influencing perceptions of the communicative competence of an adult augmentative and alternative communication system user. The effects of aided message length, partner reauditorization, and observer background on perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Two groups of subjects participated: naive adults with minimal exposure to nonspeaking persons, and speech-language pathologists currently working with AAC users. Four scripted videotaped conversational conditions involving an AAC user and a normally speaking partner were employed to manipulate aided message length and partner reauditorization. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC user. Results indicated a significant interaction effect involving subject group and aided message length. The speech-language pathologists were affected by aided message length. Furthermore, significant differences between subject groups were found in specific conditions. Future research directions are discussed.


Long-term measures of electrode impedance and auditory thresholds for the Ineraid cochlear implant. Measures of electrode impedance and of detection thresholds for electrical stimuli were extracted from the records of patients implanted with the Ineraid cochlear prosthesis. An analysis of impedance measures, obtained at 1, 12, 24, and 36 months after surgery, demonstrated (a) a significant decrease in impedance over the first year for electrodes that carried current and (b) significant increases in impedance at 24 and 36 months for electrodes that did not carry current. An analysis of detection thresholds, obtained at the same times as the impedance measures, demonstrated that averaged thresholds for the current-carrying electrodes varied no more than 0.5 dB over the 3-year period. These results support the conclusion that stimulation with the Ineraid device does not produce deleterious changes in the electrodes or in the target neural tissue.


Relationships between speech recognition threshold, average hearing level, and speech importance noise detection threshold. The aim of this study was to determine (a) if the speech importance noise detection threshold (SINDT) could be used as an accurate estimator of speech recognition threshold (SRT), and (b) whether the SINDT correlates well with various measures of the pure-tone threshold average (PTA). Pure-tone threshold, SRT, and SINDT tests were administered to 94 adults with various degrees of hearing loss. The results demonstrated that SRT can be accurately predicted from SINDT and that these two are highly correlated (r = 0.97). Since a SINDT measurement takes less time than SRT determination, the SINDT test may be recommended as an alternative for SRT in some applications.


The role of localization in visual reinforcement audiometry. The response task employed in visual reinforcement audiometry (VRA) has been characterized both as a localization response and, alternatively, as a pure operant conditioning behavior independent of localization. This study examined the role of localization in VRA conditioning and threshold procedures by varying the localization information provided to normal infants. Results indicate (a) that the VRA response is not contingent on localization but (b) that performance may be significantly influenced by localization. The findings suggest that any variable that alters proper localization cues, including equipment arrangement or impaired auditory function, may degrade response performance.


Distortion-product emissions and auditory sensitivity in human ears with normal hearing and cochlear hearing loss. Distortion product emissions (DPEs) at 2f1-f2 frequencies were measured in 53 human ears; 21 of them exhibited cochlear hearing loss. DPEs were obtained as a function of stimulus level (DPE growth curves) at seven frequency regions between 707 Hz and 5656 Hz. Several distinctly different shapes or patterns of DPE growth curves were observed. These included single-segment monotonic growth curves with and without saturation at moderate and high stimulus levels, diphasic growth curves with nulls at moderate stimulus levels, and non-monotonic growth curves with negative slopes at high stimulus levels. Low-level, irregularly shaped segments were more frequent in normal-hearing ears, suggestive of normal low-level active nonlinearities from the outer-hair-cell subsystem. High-level, steeply sloped segments were frequent in hearing-impaired ears, suggestive of residual nonlinearities from a cochlear partition without functional outer hair cells. The stimulus level at which the DPE could just be distinguished from the noise floor, the DPE detection threshold, demonstrated moderate positive correlations (r's from 0.50 to 0.81) with auditory thresholds when all ears, both normal and impaired, were considered together. Those correlations were not strong enough to quantitatively predict auditory thresholds with any great accuracy. However, DPE thresholds were able to predict abnormal auditory sensitivity with some precision. DPE thresholds correctly predicted abnormal auditory sensitivity 79% of the time in the present study, and up to 96% of the time in previous studies. These results suggest that DPE thresholds may prove useful for hearing screening in cases where cooperation from the subject is limited or where corroboration of cochlear hearing loss is required. Different patterns of DPE growth curves suggest underlying micro-mechanical differences between ears, but the differential diagnostic value of those patterns remains to be determined.


Speechreading enhancement by voice fundamental frequency: the effects of Fo contour distortions. Recognition of words in sentences of known topic was measured in normally hearing adults via speechreading alone and speechreading supplemented with auditory presentation of signals intended to convey variations of voice fundamental frequency (Fo) over time. Three signals were used: (a) the low-pass filtered output of an electroglottograph (unprocessed Fo), (b) a constant amplitude sine wave whose instantaneous frequency was intended to equal that of Fo (processed Fo), and (c) the same sine wave restricted to a small number of discrete frequency steps (quantized Fo). As the number of steps in the quantized Fo contours increased from 1 to 12, the speechreading enhancement effect increased. The quantized Fo contour with 12 steps was as effective as the processed Fo contour (without quantization), but this processed contour was significantly less effective than the unprocessed electroglottograph signal. The results show that the auditory Fo speechreading enhancement effect is sensitive to the errors introduced by the Fo extraction and regeneration process used in this study. It is also sensitive to the quantization of Fo contours into less than 12 steps. Whether more than 12 steps are required for the full enhancement effect remains to be determined.


Masking of tinnitus induced by sound.

Masking of tinnitus induced by sound. Two experiments were performed in which 8 listeners used external sound to mask the tinnitus induced by a 95-dB SPL tone presented for 1 min. Wider bandwidth noises were more effective maskers than noises of critical bandwidth, which, in turn, were more effective than tonal maskers. Contralateral maskers were often effective, but less so than ipsilateral maskers. Tuning curves showed some degree of frequency specificity that was not related to the frequency of the tinnitus-inducing tone. There were consistent and pronounced differences between individual listeners. Overall, our results indicate both similarities and differences between the masking of induced tinnitus and the masking of pathological tinnitus.


Discovery and expository methods in teaching visual consonant and word identification. An experiment was conducted to examine the processes involved in lipreading as well as to investigate an optimal approach to teaching lipreading skill. We compared discovery and expository methods of learning to lip-read. Twenty-six college students with normal hearing were trained over 3 days to lip-read consonant-vowel (CV) syllables. The training material consisted of a prerecorded videotape of four different talkers. The task was a forced-choice procedure with feedback. Subjects learned with training, but there was no difference between the two learning methods. As a retention measure, subjects returned 4 weeks later and repeated the training. There were significant savings of the original learning. Three weeks after the retention phase, subjects were tested with a 10-item forced-choice monosyllabic word task. Those subjects who had extensive training on CV syllables did no better on identifying the monosyllabic words than did a control group of 9 subjects with no training. Nevertheless, performance for all three groups (discovery, expository, and no training) improved during training in the word identification task.


The role of spectral and temporal cues in vowel identification by listeners with impaired hearing. This study examined the use of duration and formant frequency in the labeling of synthetic CVC stimuli forming a beet-bit continuum. Durational and F2 frequency cues to vowel identity varied systematically across stimuli. Subjects with normal hearing tended to rely primarily on F2 frequency in vowel labeling, whereas subjects with impaired hearing relied less on F2 information. This group difference was observed even for stimuli with large F2 differences, which were easily discriminated by all subjects. The effect of vowel duration on labeling was similar for both groups, with long-duration stimuli receiving more "beet" responses than short-duration stimuli across the F2 range. Psychoacoustic measures of frequency resolution and temporal resolution were poor predictors of a subject's use of formant information and duration information in labeling.


The identification of affective-prosodic stimuli by left- and right-hemisphere-damaged subjects: all errors are not created equal. Impairments in listening tasks that require subjects to match affective-prosodic speech utterances with appropriate facial expressions have been reported after both left- and right-hemisphere damage. In the present study, both left- and right-hemisphere-damaged patients were found to perform poorly compared to a nondamaged control group on a typical affective-prosodic listening task using four emotional types (happy, sad, angry, surprised). To determine if the two brain-damaged groups were exhibiting a similar pattern of performance with respect to their use of acoustic cues, the 16 stimulus utterances were analyzed acoustically, and the results were incorporated into an analysis of the errors made by the patients. A discriminant function analysis using acoustic cues alone indicated that fundamental frequency (FO) variability, mean FO, and syllable durations most successfully distinguished the four emotional sentence types. A similar analysis that incorporated the misclassifications made by the patients revealed that the left-hemisphere-damaged and right-hemisphere-damaged groups were utilizing these acoustic cues differently. The results of this and other studies suggest that rather than being lateralized to a single cerebral hemisphere in a fashion analogous to language, prosodic processes are made up of multiple skills and functions distributed across cerebral systems.


Effects of vocal task and respiratory phase on prephonatory chest wall movements. A vocal reaction time paradigm was used to explore prephonatory respiratory kinematics. Movements of the rib cage and abdomen were recorded prior to production of utterances differing in length and intensity, and vocal responses were elicited in different phases and volumes of the quiet breathing cycle. A velocity threshold was used to distinguish prephonatory adjustments from the cyclical movements of the chest wall that are characteristic of quiet breathing. The results suggest that a variety of prephonatory kinematic events can occur prior to initiation of vocalization in response to a stimulus. Further, prephonatory movements appear to be adaptive in that they are influenced by the length of the utterance to be spoken and the respiratory volume at the time of voice initiation.


Choosing a treatment procedure for early stuttering: issues and future directions. The new responsibility of speech-language pathologists to provide direct, early intervention for stuttering creates a further responsibility for them to choose justifiable treatment procedures for that intervention. This paper has two purposes. The first is to encourage clinicians to evaluate the conceptual and practical aspects of the treatments they use for early stuttering. The second purpose of the paper is to overview available early intervention procedures and consider the advantages, disadvantages, and prominent issues associated with each. The procedures considered are environment manipulation, prolonged speech, and response-contingent stimulation. It is concluded that clinicians have no cause to be satisfied with any currently available early intervention procedure. Further, it is concluded that (a) although anticipatory struggle theories have made a useful contribution to scholarship, their line of theoretical reasoning is questionable for clinical practice; (b) although theoretically sound for the purpose, variants of prolonged speech pose prohibitive conceptual and practical shortcomings if they are used to treat very young stuttering children; (c) despite its disadvantages, response contingent stimulation is the most conceptually and practically justifiable method for early intervention with stuttering.


Reliability of speech naturalness ratings of stuttered speech during treatment. This study evaluated the reliability with which relatively sophisticated and unsophisticated judges used a 9-point scale to rate the speech naturalness of speech samples from 10 clients in a treatment program for stuttering that employed prolonged speech. Judges rated repeated speech samples from different speakers during various phases of the program. Different groups of sophisticated and unsophisticated judges made ratings at either 15 sec, 30 sec, or 60 sec intervals while listening to the samples. Of the reliability indices, intraclass correlations were significantly higher for sophisticated judges although the consistency and agreement of unsophisticated judges were generally equivalent to that of sophisticated judges. Both agreement scores and intraclass correlations were higher when ratings were made at 60 sec rather than 30 sec intervals. The predominant variable that influenced judgement reliability appeared to be differences among the subjects. The methodology partially replicated Martin, Haroldson, and Triden's (1984) initial investigation on the use of this scale. However, the levels of intra- or interjudge reliability in this study were lower than the levels achieved by Martin et al.'s judges. There were important differences between the Martin et al. study and this one that may account for the findings, and these are discussed.


[Efficiency of prevaccination screening of anti-HBc in the anti-hepatitis B vaccination programs]. The convenience of carrying out pre-vaccination screening of VHB markers depends on the relative costs of screening and vaccination and also on the prevalence of susceptible subjects in each group of the population. The aim of the present work was to analyse the efficiency of pre-vaccination screening of antiHBc in Catalonia in 1991. The per-unit cost of screening was calculated at 1366 ptas. The formula applied was: cost per-unit of screening + (1-X) x the cost per-unit of vaccination of anti-HBc (-) = cost of vaccinating the group. "X" being the threshold of prevalence of markers below which screening cases to be efficient. This prevalence is compared with those expected in the groups of the population to be vaccinated. By applying the above-mention ned formula and taking into account costs in time and travel of the people to be vaccinated, a prevalence threshold of 23% is obtained. This prevalence is much higher than that found in adolescents and students of medicine and nursing, similar to that found in health professionals and lower than that of other risk groups. Systematic screening of anti-HBc is only recommended in groups of the population where a prevalence higher than 20-25% can be expected. Below this threshold vaccination without previous study of markers is more efficient. This enormously simplifies the strategies of universal vaccination of children, adolescents or both.


[Prognostic effect of beta 2-microglobulin in multiple myeloma]. The aim of the present study was to compare the prognostic influence of beta 2-microglobulin (B2M) corrected according to renal function versus the uncorrected form and relate these values with other characteristics of the disease in a series of patients with multiple myeloma (MM). The serum levels of B2M were determined by the radioimmunoassay method (RIA) in 107 patients with newly diagnosed MM and the prognostic influence of B2M was statistically evaluated with univariant and multivariant analysis. The mean value of B2M obtained in patients with MM was 7.8 +/- 8.0 micrograms/ml, with a median of 5 micrograms/ml. Ninety percent of the patients studied presented serum values of B2M higher than the normal limit. The value of B2M corresponding to the median of the series (5 micrograms/ml) separated two groups of patients with different survival (48 vs 19 months) (p = 0.0001). Similarly, the most discriminative value of corrected B2M in agreement with creatinine (2.5 micrograms/ml) permitted the differentiation of two groups of patients although the differences in survival were less significant (36 vs 26 months, p = 0.03) demonstrating its lesser influence as a prognostic factor with respect to the uncorrected B2M. In contrast, a significant association was observed between high values of B2M and Bence Jones myeloma, clinical stage III, anemia, renal failure and intense involvement of the general state. Multivariant analysis demonstrated that B2M plays a greater prognostic role when used as a discrete rather than a continuous variable and that together with the degree of involvement of the general state, serum albumin and the proportion of plasma cells in the bone marrow, they make up the best set of variables for the prediction of prognosis in patients with MM. Beta 2-microglobulin is one of the most important independent prognostic factors in multiple myeloma with its prognostic value being greatest when used uncorrected according to the values of creatinine.


[Bronchiolitis obliterans associated with organizing pneumonia. Clinico-pathological study of 6 cases]. Over the last three years six patients diagnosed of bronchiolitis obliterans with organizing pneumonia were studied. Diagnosis was established by open lung biopsy in 4 and by transbronchial lung biopsy in 2. The initiation of the symptoms was subacute although one patient evolved to respiratory failure requiring mechanical ventilation. The mean age of presentation was 68 years with male predominance over females of 5:1. The most frequent symptoms were fever and general malaise in 6 patients, cough and dyspnea in 4, respectively and weight loss in 2 patients. Functional respiratory tests showed restrictive ventilation disturbances in 4 out of 5 patients, mixed in 1 and a reduction in diffusion capacity in the 5 patients in whom it was determined. The radiologic pattern of multifocal alveolar infiltration was present in 6 cases. Interstitial involvement was also associated in 3 patients with pleural effusion in 2. Histologic findings of intraluminal polypoid masses affecting the bronchiols and alveolar conducts (bronchiolitis obliterants) with extension to the alveoli forming conjunctive Masson polyps (organizing pneumonia) was found in the 4 patients who underwent open lung biopsy and in 1 diagnosed by transbronchial biopsy although there were quantitative differences in the degree of alveolar involvement. Response to treatment with steroids was favorable in 5 out of 6 patients while the remaining patients spontaneously improved following thoracotomy.


Inhibition of human T-lymphocyte activation by macrolide antibiotic, roxithromycin. Effects of macrolide antibiotic, roxithromycin (RXM) on human lymphocytes in culture were studied. The drug showed a dose-dependent inhibition of 3H-thymidine and 35S-methionine uptake responding to T cell mitogens and purified protein derivative of tuberculin (PPD). Activation by PPD, as assessed by 3H-thymidine uptake, was more sensitive to inhibition than the response to T cell mitogens. The drug produced a loss of blasts when added soon after transformation commenced. Immunosuppressive effects of RXM were further characterized by using four different types of metabolized RXM, RU 28111, RU 39001, RU 44981 and RU 45179. The most potent inhibitor of lymphocyte transformation was RU 45179, followed by RU 44981, RU 39001 and RU 28111 have little activity.


Intracerebroventricular injection of antibodies directed against Gs alpha enhances the supraspinal antinociception induced by morphine, beta-endorphin and clonidine in mice. The intracerebroventricular (i.c.v.) injection of antisera directed against different sequences of Gs alpha to mice enhanced the antinociceptive potency of the opioids morphine, beta h-endorphin-(1-31) and of the alpha 2-agonist clonidine when studied 24 h later in the tail-flick test. The activity of DAGO, DADLE, DPDPE and [D-Ala2]-Deltorphin II remained unchanged after that treatment. Cholera toxin (0.5 microgram/mouse, i.c.v.), agent that impairs the receptor regulation of Gs transducer proteins promoted comparable changes in the supraspinal analgesia induced by these substances. Six days after a single i.c.v. injection (0.5 microgram/mouse) of pertussis toxin the antinociceptive activity of all the opioids and clonidine appeared diminished. It is concluded that opioids and clonidine promote analgesia after binding to receptors functionally coupled to Gi/G(o) proteins, moreover, the activity of morphine, beta-endorphin and clonidine in this test seems to be counteracted by a process involving activation of Gs alpha transducer proteins.


Complete dissociation of DOCA-salt hypertension and red cell ion transport alterations. Our previous study revealed major ion transport alterations that resulted in a pronounced elevation of red cell Na+ content in DOCA-salt treated homozygous vasopressin-deficient (DI) Brattleboro rats in which only a moderate increase of systolic blood pressure occurred. In contrast, no changes of red cell Na+ content were observed in heterozygous vasopressin-secreting (non-DI) Brattleboro rats with a severe DOCA-salt hypertension. Using a chronic supplementation of DI rats with an antidiuretic agonist dDAVP (1-desamino-8-D-arginine vasopressin) we did not demonstrate any significant changes of red cell ion transport in dDAVP-treated DI rats with a fully developed DOCA-salt hypertension. The absence of ion transport alterations seems to be mainly due to dDAVP-induced correction of altered K+ metabolism seen in DOCA-salt treated DI animals. It can be concluded that DOCA-salt hypertension can develop even without red cell ion transport alterations which are usually caused by cell K+ depletion.


The pharmacological differences and similarities between stress- and ethanol-induced gastric mucosal damage. Stress- and ethanol-induced gastric mucosal damage are the two commonly used ulcer models in animals. They share some of the similarities but also have differences in the etiology of gastric ulceration. This article reviews the influences of various protective drugs on these two types of gastric damage in rats. Verapamil (a calcium antagonist) or N-ethylmaleimide (a sulfhydryl depletor) prevents cold restraint-, but potentiates ethanol-provoked gastric lesion formation. N-Acetylcysteine (a mucolytic agent) and acetaminophen (an antipyretic analgesic) have the opposite actions. Prostaglandins provide a much better antiulcer effect on ethanol-induced lesions. Cimetidine (a histamine H2-receptor antagonist) prevents only stress-induced mucosal damage. These differences in drug actions indicate that stress and ethanol may have dissimilar ulcerogenic mechanisms in rats. On the other hand, carbenoxolone (a mucus inducer), histamine H1-receptor antagonists, leukotriene inhibitors (FPL 55712 and nordihydroguaiaretic acid) and mast cell stabilizers (like zinc compounds, sodium cromoglycate, FPL 52694 and ketotifen), all protect against gastric mucosal damage by stress or ethanol in rats. However, the role of gastric sulfhydryls in both types of gastric lesions is still controversial. These findings imply that the two types of lesion formation share some of the ulcerogenic mechanisms. This communication attempts to analyze the various findings and to relate them to the etiology of stress and ethanol-induced gastric lesions. It also summarizes the uses, and the antiulcer mechanisms, of the drugs that have been studied utilizing these two animal ulcer models, and suggests their possible implications in man.


Non-right sidedness: an association with lower IL-2 production. Using a laterality questionnaire, 138 normal healthy individuals were classified as right-sided and 25 as non-right sided. Interleukin-2 (IL-2) was generated from whole blood obtained from these subjects using mitogen (PHA) stimulation. IL-2 was quantitated in picograms/ml using an enzyme immunoassay (ELISA). Additionally, sera from these subjects were tested for 7 autoantibodies by standard serological methods. As compared to right sided subjects, non-right sided individuals had significantly lower IL-2 production. Non-right sided individuals with autoantibodies had significantly lower IL-2 production than right sided subjects with or without autoantibodies, but did not differ significantly from their non-right sided counterparts without autoantibodies. These data support the increasing evidence for the differential and lateralized regulation of immune functions by the right and left cerebral regions.


Kinetic analyses demonstrate that the equilibrium assumption does not apply to [125I]endothelin-1 binding data. The kinetics of [125I]Endothelin-1 ([125I]ET-1) binding were studied using membranes from rat heart, rat lung, rat brain, and porcine vascular smooth muscle at 37 degrees C in 0.05M Tris-HCl buffer (pH = 7.4). The dissociation half-life (t1/2, diss.) for bound [125I]ET-1 was in excess of 30 hours for each tissue studied. Equilibrium-time requirements for proper Scatchard analysis of [125I]ET-1 were also far in excess of 30 hours for each tissue. These data suggest that determination of dissociation constants, Kd, and receptor concentrations, Bmax, by conventional Scatchard analysis is not feasible with [125I]ET-1. Kinetic analyses may provide a more accurate means for determining [125I-ET-1] binding characteristics including Kd and Bmax.


A transient rise in plasma beta-endorphin after a traditional 47 degrees C hot-spring bath in Kusatsu-spa, Japan. To clarify the mechanism of the intoxicating feeling attained after a traditional 47 degrees C hot-spring bath called 'jikan-yu' in Kusatsu-spa, Japan, we examined the change in plasma levels of beta-endorphin and methionine enkephalin in 7 healthy subjects. The mean sublingual temperature rose from 36.8 degrees C to 38.6 degrees C and the plasma beta-endorphin level from 16.2 pg/ml to 49.5 pg/ml 2 minutes after completing a 3-minute bath in 47 degrees C hot-spring water. However, the plasma methionine enkephalin level was not changed. This feeling of intoxication may be explained by the transient rise in plasma beta-endorphin level.


Age and food restriction alter the porphyrin concentration and mRNA levels for 5-aminolevulinate synthase in rat Harderian gland. The effects of age and food restriction on the porphyrin concentration in Harderian glands were studied in male Fisher 344 rats. Harderian gland porphyrin concentrations increased with age; this was statistically significant in 20 month old animals compared with 3 month old animals. Food restriction (by 40%) prevented the age-associated rise in porphyrins; thus, in 20 month old food restricted rats had porphyrin concentrations similar to those found in young animals. In a second experiment, we correlated the age-associated rise in Harderian gland porphyrin concentrations with an increase in mRNA levels for 5-aminolevulinate synthase (ALV-S). Both the porphyrin concentration and ALV-S mRNA rose at 12 and 18 months of age, but decreased by 24 months of age. It is concluded that, a) porphyrin biosynthesis in the Harderian glands increases up to 20 months of age but decreases in rats that are 24 months old, and b) food restriction prevents the porphyrin rise associated with age in the Harderian gland of male Fisher 344 rats.


In situ hybridization: optimization of the techniques for collecting and fixing the specimens. An overview is presented concerning the different protocols for collecting and fixing the specimens for in situ hybridization analysis. Particular attention is devoted to the problem of avoiding the tissue RNA degradation due to the ubiquitous and rather resistant RNases. The choice of the final protocol largely depends on a compromise between the need to maintain morphological details, the care to avoid loss of the target nucleic acids and the capability of the probe to diffuse within the specimen.


Autoradiographic detection of radiolabelled probes by in situ hybridization. In the context of in situ hybridization techniques, autoradiography is used to localize radiolabelled probes within intact tissue sections or cell preparations. The present report describes in detail a standardized autoradiographic procedure. Topics include the choice of the emulsion, its preparation and layering onto the slides, the development procedure and the analysis of the results. Special attention is devoted to the practical aspects, so that the technique will be generally applicable, according to the reader's needs.


Non-radioactive nucleic acid probes: labelling and detection procedures. A comprehensive overview is given concerning the in situ hybridization techniques using non-radioactively labelled probes. Details are given on the preparation of the probes with different reporter molecules and on the corresponding revealing assays. The development of non-isotopic labelling methods for nucleic acid probes has facilitated the diffusion of the in situ hybridization techniques to the research as well as to the clinical pathology laboratory. Non-radioactive probes have several advantages over the radiolabelled ones, including cost, shelf-life, safety and, last but not least, resolution of the signal.


Use of sulphonated probes for detecting human immunodeficiency virus-1 transcripts by in situ hybridization. A detailed procedure is described that allows detection of the presence of human immunodeficiency virus-1 (HIV-1) transcripts within both acetone-fixed tissues and peripheral blood mononuclear cells. This assay uses cDNA probes labelled by a non-isotopic procedure that results in the modification of cytosine residues through covalent linkage to a sulphone group. In situ hybridized probe is then detected by an alkaline phosphatase-conjugated antibody specifically directed against the sulphone hapten. This procedure is specific, rapid and safe and can be applied in the research as well as in the clinical pathology settings.


From two dimensional (2D) to three dimensional (3D) analysis by confocal microscopy. The confocal microscope is becoming increasingly important as an apparatus to analyze the 3-D topography of the cell. Main reasons are the high resolution optical sectioning capacity, the non-invasiveness which leaves the object intact, and the imaging capabilities. This chapter introduces a description of the confocal principle, the basic concepts of confocal fluorescence microscopy and some criteria for cell preservation. Optimization of in situ immunofluorescence, hybridization and detection procedures in combination with new digital microscope techniques can fully express their capacities only if the preparation of biological specimens is accurate for 3-D analysis. Some applications of confocal microscopy to the study of intranucleolar antigens, enzyme translocations and fluorescence in situ hybridization, are described in association with 3-D software image processing, as a useful framework for the study of the 3-D visualization of proteins and chromatin domains.


Localization of cloned human DNA sequences and analysis of chromosomal alterations by in situ hybridization. The in situ hybridization technique was used for the localization on human chromosomes of single-copy and repeated sequences and, in addition, for the characterization of altered human chromosomes. Two anonymous clones, single or low-copy, obtained from a human X chromosome library were localized on the distal part of the long arm and in the paracentromeric region of X chromosome, respectively. A genomic fragment of the single-copy thyroglobulin (TG) gene was used to confirm the localization on the distal part of the long arm of chromosome 8. The localization and distribution on human chromosomes of the glyceraldehyde-3-phosphate dehydrogenase (GAPD) multigene family obtained by in situ hybridization and by somatic cell hybrids were compared. A phosphoglycerate kinase (PGK) c-DNA clone, which detects genic and pseudogenic sequences on the X chromosome, was used for the characterization of three small ring markers present in unrelated female patients.


From immunohistochemistry to in situ hybridization. The revolutionary evolution in science and technology has made it possible to face adequately three main challenges in modern medicine: old diseases changing, new diseases appearing, diseases remaining unknown. In this paper we review the road travelled by the pathologist in search of a method which is based upon the application to routine work of instruments and techniques which once were available for research only. Application to tissue studies of immunological and molecular biology techniques allows a dynamic interpretation of biological phenomena with special regard to gene regulation and expression. The method implies stepwise investigations, including immunohistochemistry, EM and in situ hybridization, in order to progress from the suggestive features detectable in routinely stained preparations to more characteristic, specific and, finally, pathognomonic features. HE-stained preparations and appropriate immunohistochemical stains enable recognition of phenotypic changes which may reflect genotypic alterations. Thus there is a logical and methodological link between the simple HE and the most powerful techniques so far introduced in pathology: immunohistochemistry and in situ hybridization.


Genetic variants of alpha-1-antitrypsin (AAT). This paper reviews the genetic variants of alpha-1-antitrypsin (AAT) which have been sequenced with special emphasis on the s.c. deficiency variants. These result in AAT low plasma levels via three main mechanisms: 1) intracellular storage; 2) intracellular degradation; 3) lack of synthesis. Intracellular storage occurs with the classical Z variant and with a few variants called M-like, because of their isoelectric focusing (IF) pattern. The storage phenomenon causes liver damage and can be demonstrated at both light and electron microscopic level with the help of immunohistochemistry. We report a new deficiency variant of AAT (M-Cagliari) characterized by very low plasma levels, massive storage of AAT and liver cirrhosis. By using immunohistochemical techniques and DNA analysis we could demonstrate that M-Cagliari has antigenic and genetic properties other than the Z AAT.


Breakdown of mucosal defences in congestive gastropathy in cirrhotics. The gastric mucus-bicarbonate barrier, the first line of mucosal defence, has been evaluated in patients with congestive gastropathy and cirrhosis of the liver. Fourteen cirrhotic patients of both sexes (Child's class A or B), with or without oesophageal varices, but with endoscopic signs of congestive gastropathy, and a matched group of healthy controls were studied. The amount of luminal mucoproteins, a Mucoprotective Index as a qualitative assessment of mucus secretion and the output of gastric bicarbonate were determined in basal conditions. In patients with congestive gastropathy a significant (p < 0.01) reduction in all the above parameters was observed, suggesting a substantial impairment of the gastric mucus-bicarbonate barrier. Whether this is an independent phenomenon or a consequence of altered local microcirculation remains to be determined.


Role of the spleen in endotoxin-induced hepatic injury in chronic alcohol-fed rats. The present experiments were designed to study the role of the spleen in endotoxin-induced hepatic injury in chronic alcohol-fed rats. Administration of 2 mg/kg body weight of endotoxin caused severe hepatic injury in chronic alcohol-fed rats as compared with controls. This injury was significantly less in those whose spleens had been resected 1 week prior to endotoxin administration. There were no differences in plasma endotoxin levels 16 h after intravenous injection of endotoxin between sham-operated control rats, and chronic alcohol-fed rats with and without splenectomy. The plasma tumor necrosis factor (TNF) level 1 h after intravenous injection of endotoxin was significantly higher in chronic alcohol-fed rats than in controls. However, TNF levels were significantly lower in those with splenectomy. Neutrophil infiltration was seen in the liver sinusoid of sham-operated chronic alcohol-fed rats as early as 1 h after injection of endotoxin, and was observed even 15 h later. These results suggest that endotoxin-induced liver injury is closely related to factors derived from the spleen and induced by plasma endotoxin, especially when Kupffer cell function is reduced by chronic alcohol feeding. In addition, TNF and neutrophils may play an important role in this type of liver injury.


Liver function after bilateral nephrectomy. Consequences of bilateral nephrectomy (NX) for liver functions and for hepatic excretion of various endogenous substances were characterized in rats 24 h after NX. Plasma concentrations of urea, creatinine, fibrinogen, and glutathione increased significantly after NX, whereas the concentrations of total protein, albumin, and lipids decreased. The hepatic excretion of urea, creatinine, phospholipids, cholesterol, and aldosterone significantly increased in uremia, and excretions of protein and glutathione diminished. Active biliary transport can be diminished after NX by the effects of uremic toxins on the liver cells or by the competition phenomena between endogenous substances, which are normally excreted in urine, at the hepatocellular level. Reduced glutathione content and increased lipid peroxidation in hepatocytes have been found. Changes in lipid and protein metabolism after NX can be proved.


Decreased hepatic uptake of cholesterol and retinol in the dimethylnitrosamine rat model of cirrhosis. The fenestrated endothelium of the liver sinusoids forms a sieve between the circulation and hepatocytes. Fenestrae selectively permit the entrance of relatively small chylomicron remnants into the space of Disse to contact hepatocyte receptors, but obstruct the passage of the larger parent chylomicrons. Much of dietary cholesterol and most of retinol are transported as esters in the core of chylomicrons. In the dimethyl nitrosamine rat model of cirrhosis, we have described a rapid reduction in size and number of fenestrae well before the onset of cirrhosis. Concurrent with this decreased porosity is a decreased trapping of radio-labelled dietary cholesterol and retinol by these livers. We postulate that the less porous "liver sieve" hinders the hepatic uptake of chylomicron remnants, with consequent disturbance of cholesterol and retinol metabolism.


Immunoquantification of cytochrome P-450 3A on rat paraffin-embedded liver tissue. The cytochrome P-450 3A family is involved in the metabolism of several drugs, including nifedipine, cyclosporine, quinidine and erythromycin. The purpose of this study was to develop a reliable method to obtain a relative quantification of cytochrome P-450 3A apoproteins in rat liver specimens by immunocytochemistry and to correlate such quantification to erythromycin N-demethylase activity, a biochemical pathway sustained by that enzymatic system. Thirty-six male Wistar rats were treated with an injection of either saline or dexamethasone phosphate (10, 30 or 50 mg/kg), a potent inducer of cytochrome P-450 3A. Specimens taken from the same lobe were processed for immunocytochemistry and determination of erythromycin N-demethylase activity. Paraffin sections were treated with a polyclonal antiserum directed against cytochrome P-450 3A. The density of cytochrome P-450 3A immunostaining measured by an automatic image analyzer increased with the dose of dexamethasone pretreatment, and with the erythromycin N-demethylase activity, both parameters being closely correlated. Our data indicate that in rats, when cytochrome P-450 3A is concerned, there is a close correlation between the results of immunoquantitation and biochemical activity. This suggests that such a method of investigation might be used on small paraffin-embedded liver specimens obtained by needle biopsy.


Immunoperoxidase localization of ursodeoxycholic acid in rat biliary epithelial cells. Evidence for a cholehepatic circulation. To explain the hypercholeretic effect of ursodeoxycholic acid, a cholehepatic shunt circulation has been postulated. This pathway includes secretion by the hepatocyte into bile and absorption by the biliary epithelial cells. To test this possibility, we have attempted to localize ursodeoxycholic acid in hepatocytes and portal bile duct cells by an indirect immunoperoxidase technique using specific polyclonal antibodies against ursodeoxycholic acid and cholic acid conjugates. Rat livers were fixed with paraformaldehyde, incubated with antibodies directed against bile acids and examined by electron microscopy. After infusion of ursodeoxycholic acid and incubation with antibodies against this bile acid, an electron-dense staining was observed on the apical (luminal) membrane of the portal bile ductal cells. In contrast, no staining was observed when no ursodeoxycholic acid was infused, or after infusion with taurocholate and incubation with antibodies against cholic acid conjugates. These observations are consistent with absorption of ursodeoxycholic acid by the portal bile ducts and a cholehepatic circulation of this bile acid.


The role of integration host factor in gene expression in Escherichia coli. Integration host factor is a sequence-specific, histone-like, multifunctional DNA-binding and -bending protein of Escherichia coli. The characterization and functional analysis of this protein has been done mainly in bacteriophage lambda and other mobile genetic elements. Less is known concerning the role of integration host factor (IHF) in E. coli, although it has been implicated in a number of processes in this organism including DNA replication, site-specific recombination, and gene expression. This review presents recent work which suggests that IHF alters the activity of an unusually large number of operons in E. coli. We discuss the possible physiological relevance of the involvement of IHF in gene expression and the hypothesis that IHF is a member of a class of functionally redundant proteins that participate in chromosome structure and multiple processes involving DNA.


Septal membrane fusion--a pivotal event in bacterial spore formation? Formation of the asymmetrically located septum divides sporulating bacilli into two distinct cells: the mother cell and the prespore. The rigidifying wall material in the septum is subsequently removed by autolysis. Examination of published electron micrographs indicates that the two septal membranes then fuse to form a single membrane. Membrane fusion would be expected to have profound consequences for subsequent development. For example, it is suggested that fusion activates processing of pro-sigma E to sigma E in the cytoplasm by exposing it to a membrane-bound processing enzyme. Asymmetry of the fused membrane could restrict processing to one face of the membrane and hence explain why sigma E is associated with transcription in the mother cell but not in the prespore. Asymmetry of the fused membrane might also provide a mechanism for restricting the activity of another factor, sigma F, to the prespore. Attachment of the flexible fused septal membrane to the condensing prespore nucleoid could help drive the engulfment of the prespore by the mother cell.


Expression of a functional neisserial fbp gene in Escherichia coli. The ability to acquire iron from a human host is a major determinant in the pathogenesis of Neisseria gonorrhoeae and Neisseria meningitidis. Pathogenic Neisseria spp. do not synthesize siderophores and instead express a receptor-mediated, high-affinity iron acquisition system in the iron-restricted environment of its host. A ferric-iron-binding protein (Fbp) of Neisseria spp. is also iron-regulated and may play a central role in this novel iron-uptake system. To define the physical properties of Fbp further, we used polymerase chain reaction to synthesize DNA fragments containing the fbp structural gene with and without the sequence encoding the Fbp leader peptide. These fragments were ligated into pUC13 to create in-frame fusions with the alpha peptide of lacZ. The expression of Fbp was under the control of the lacZ promoter. Both fusion clones produced Fbp in large amounts, facilitating the purification of quantities of Fbp sufficient for elucidating the biochemical, immunologic, and functional properties of this protein.


Control of gene expression in the temperate coliphage 186. IX. B is the sole phage function needed to activate transcription of the phage late genes. Using plasmid clones we have determined that the late control function B is the only phage function that is needed to activate a late promoter of coliphage 186, and we predict that it functions as an auxiliary factor to RNA polymerase in the activation of late transcription. We have also shown that a high concentration of B will activate late transcription from a prophage, and we conclude that replicating DNA is not a template requirement for B to function. The original demonstration of a need for the replication gene A in late transcription can be explained by the fact that replication leads to an increase in B gene dosage, with the consequent increase in B concentration leading to the efficient activation of the late promoters.


Control of gene expression in the temperate coliphage 186. X. The cI repressor directly represses transcription of the late control gene B. We have found that the repressor of 186 lytic transcription, CI, represses transcription of the late control gene B, with no involvement of the B protein itself. In clone studies we showed that CI repressed transcription from the B promoter and that temperature inactivation of CIts led to B derepression. We conclude that CI repressor directly represses transcription of the B gene and, with prophage induction, it is probable that the inactivation of the CI repressor not only derepresses early lytic transcription, but also derepresses B gene transcription, leading to the activation of transcription from the late promoters.


Expression of bacterial cytotoxin genes in mammalian target cells. We have studied the expression of the gene fragments encoding the enzymatically active portion of three bacterial cytotoxins: exotoxin A (ETA) of Pseudomonas aeruginosa, and pertussis toxin (PT) and adenylate cyclase toxin (CYA) of Bordetella pertussis, in sensitive mammalian target cells. Expression of active ETA and CYA was lethal to the producing cells and stable transfectants of Cos-1 cells containing the corresponding genes could not be obtained. The expression of the PTS1 subunit was tolerated by the producing mammalian cells. Since PT is cytotoxic because of ADP-ribosylation of G-proteins, we assume that the endogenously expressed PTS1 may not find the cellular target G proteins or PTS1 alone may not be sufficient for ADP-ribosylation of these proteins in vivo.


Identification and sequence of a Na(+)-linked gene from the marine bacterium Alteromonas haloplanktis which functionally complements the dagA gene of Escherichia coli. A 4.0 kb fragment from a plasmid genomic DNA library of the marine bacterium Alteromonas haloplanktis ATCC 19855 was found in the presence of Na+ to complement the dagA gene of Escherichia coli. We have completely sequenced this fragment and the position of the Na(+)-linked D-alanine glycine permease gene (dagA) on the fragment has been determined by complementation. The predicted carrier protein consists of 542 amino acid residues (M(r) 58,955). Its hydropathy profile suggests it is composed of eight transmembrane segments with a long hydrophilic region between segments six and seven. Significant similarity has been found between this Na(+)-linked permease and the Na+/proline permeases of E. coli and Salmonella typhimurium and the human and rabbit intestinal Na+/glucose cotransporters.


Conservation of the photosynthesis gene cluster in Rhodospirillum centenum. Intraspecies and intergenus complementation analysis were utilized to demonstrate that photosynthesis genes are clustered in distantly related purple photosynthetic bacteria. Specifically, we show that the linkage order for genes involved in bacteriochlorophyll and carotenoid biosynthesis in Rhodospirillum centenum are arranged essentially as in Rhodobacter capsulatus and Rhodobacter sphaeroides. In addition, the location and relative distance observed between the puf and puh operons which encode for light harvesting and reaction-centre structural genes are also conserved between these species. Conservation of the photosynthesis gene cluster implies either that there are structural or regulatory constraints that limit rearrangement of the photosynthesis gene cluster or that there may have been lateral transfer of the photosynthesis gene cluster among different species of phototrophic bacteria.


Loss of the pigmentation phenotype in Yersinia pestis is due to the spontaneous deletion of 102 kb of chromosomal DNA which is flanked by a repetitive element. The pigmentation (Pgm+) phenotype of Yersinia pestis encompasses a variety of different physiological traits, all of which are missing in Pgm- mutants. We have previously shown that loss of the Pgm+ phenotype is accompanied by the spontaneous deletion of at least 45 kb of chromosomal DNA, referred to as the pgm locus. Using chromosomal walking, we have now mapped the full extent of the pgm locus in Y. pestis strain KIM6+. Our results indicate that the locus spans 102 kb of DNA which is absent in the spontaneous Pgm- mutant, KIM6. Yersinia pseudotuberculosis PB1/0 contains sequences homologous to the entire pgm locus while only part of this region hybridized to Yersinia enterocolitica WA-LOX DNA. Restriction enzyme mapping and hybridization studies revealed the presence of a repetitive element at both ends of the pgm locus and in multiple copies elsewhere in the Y. pestis genome. This element may be responsible for generating the deletion.


flhF, a Bacillus subtilis flagellar gene that encodes a putative GTP-binding protein. We describe the sequence and characterization of the Bacillus subtilis flhF gene. flhF encodes a basic polypeptide of 41 kDa that contains a putative GTP-binding motif. The sequence of FlhF reveals a structural relationship to two Escherichia coli proteins, Ffh and FtsY, as well as to other members of the SRP54 family, in a domain presumed to bind GTP. flhF is located in a large operon consisting of chemotaxis and flagellar genes. Cells deficient in flhF are nonmotile. Through the use of anti-flagellar antibodies we have established that flhF is a flagellar (fla) gene. Thus, flhF is a unique flagellar gene in that it encodes a GTP-binding protein with similarities to members of the SRP54 family of proteins. These data suggest that flagellar biosynthesis in B. subtilis requires GTP.


Identification and characterization of FliY, a novel component of the Bacillus subtilis flagellar switch complex. The Bacillus subtilis gene encoding FliY has been cloned and sequenced. The gene encodes a 379-amino-acid protein with a predicted molecular mass of 41,054 daltons. FliY is partly homologous to the Escherichia coli and Salmonella typhimurium switch proteins FliM and FliN. The N-terminus of FliY has 33% identity with the first 122 amino acids of FliM, whereas the C-terminus of FliY has 52% identity with the last 30 amino acids of FliN. The middle 60% of FliY is not significantly homologous to either of the proteins. A fliY::cat null mutant has no flagella. Motility can be restored to the mutant by expression of fliY from a plasmid, although chemotaxis is still defective since the strain exhibits smooth swimming behaviour. fliY::cat is in the cheD complementation group. One of the cheD point mutants does not switch although the population grown from a single cell has both smooth swimming and tumbling bacteria, implying that the switch is locked. Expression of fliY in wild-type B. subtilis makes the cells more smooth-swimming but does not appear to affect chemotaxis. Expression of fliY in wild-type S. typhimurium severely inhibits chemotaxis and also makes the cells smooth swimming. Expression in a non-motile S. typhimurium fliN mutant restores motility but not chemotaxis, although expression in a non-motile E. coli fliM mutant does not restore motility. The homology, multiple phenotypes, and interspecies complementation suggest that FliY forms part of the B. subtilis switch complex.(ABSTRACT TRUNCATED AT 250 WORDS)


gltF, a member of the gltBDF operon of Escherichia coli, is involved in nitrogen-regulated gene expression. We report here the construction and analysis of insertional mutations in each of the three genes of the gltBDF operon and the nucleotide sequence of the region downstream from gltD. Two open reading frames were identified, the first of which corresponds to gltF. The gltB and gltD genes code for the large and small subunits, respectively, of the enzyme glutamate synthase (GOGAT). gltF codes for a protein, with a molecular mass of 26,350 Da, which is required for Ntr induction. Histidase synthesis was determined as a measure of Ntr function. First, insertions in gltB, gltD or gltF all prevent Ntr induction. Second, complementation analysis indicates that high-level expression of both the gltD and gltF genes is required for the induction of the Ntr enzymes under nitrogen-limiting conditions, indicating that the phenotype of the gltB insertion probably results from polarity on gltD and gltF. Third, glutamate-dependent repression of the glt operon appears to be mediated by the product of the gltF gene. Thus, the gltBDF operon of Escherichia coli is involved in induction of the so-called Ntr enzymes in response to nitrogen deprivation, as well as in glutamate biosynthesis.


Interstate differences in incidence and mortality from melanoma. A re-examination of the latitudinal gradient. To investigate the patterns of cutaneous malignant melanoma (CMM) mortality in Australia. A descriptive analysis of melanoma incidence and mortality in Australia supplemented by a case series analysis of melanoma survival. Melanoma mortality rates were based on tabulations supplied by the Australian Bureau of Statistics for the years 1969-1989. Melanoma incidence rates were based on State cancer registry records for the years 1977-1990. The case series survival analysis was based on detailed individual records from the population-based cancer registries in Tasmania and South Australia. The level of and rise in melanoma mortality rates during 1969-1989 in Australia; the five-year survival rates for Tasmanian and South Australian cases; and male:female incidence ratios related to latitude. We found annual increases in melanoma mortality rates of 2.5% in men (P < 0.0001) and 1.1% in women (P < 0.0001) for all Australia. The five-year survival rates (with 95% confidence intervals [CI]) were: 67% (59%-75%) for Tasmanian men; 79% (76%-83%) for South Australian men; 80% (74%-86%) for Tasmanian women and 88% (86%-91%) for South Australian women. A change in the male:female incidence ratio with latitude was also found--women have significantly higher incidence rates at higher latitudes, but similar rates to men at lower latitudes. The age standardised mortality from CMM for the period 1969 to 1989 shows little variation by State for women, despite a considerable range in latitude. CMM mortality in men is increasing at a faster rate than that in women. Between 1982 and 1987 the male:female incidence ratio in high latitudes in the Southern Hemisphere showed an excess of cases in women, a finding which we believe has not been reported before.


The treatment of gynaecological malignancy in a general public hospital. To assess the adequacy of treatment of gynaecological cancer in a public hospital and to determine the influence of referral patterns on patient outcome. A retrospective analysis of clinical histories. A tertiary-level general public hospital. 89 patients admitted between 1 January 1979 and 31 December 1987 for primary treatment of a gynaecological malignancy. The primary study parameter was patient survival. During data analysis, the study parameters were altered to include the adequacy of initial surgery and survival time in relation to the involvement of the Gynaecology Unit. Initial presenting symptoms had a major influence on the referral patterns of patients with a gynaecological malignancy. All patients who presented with abnormal vaginal bleeding were managed by the Gynaecology Unit. Patients with ovarian cancer who presented with non-specific abdominal symptoms and ascites were often managed by other units. There was a statistically significant difference in the adequacy of initial surgery depending on whether the patient was managed by the Gynaecology or the Surgical Unit (P < 0.05). The median survival time of patients managed by the Gynaecology Unit was 20 months; this was considerably longer than the figure of 14 months for other units (P < 0.05). Patients with ovarian cancer who are managed by a specialised gynaecology unit are more likely to have adequate initial surgery and a longer median survival time. Female patients presenting with non-specific abdominal symptoms, ascites and other signs of intra-abdominal malignancy should be reviewed by a gynaecology unit before initial surgery.


General practitioners' attitudes to computer-generated surgical discharge letters. Members of the Department of General Surgery, Fremantle Hospital. To assess general practitioners' attitudes to a computed-generated general surgical discharge letter. To identify the six most important items of information in an ideal discharge letter. One hundred and thirty general practitioners who had received at least six computer-generated surgical discharge letters in one year were circulated with a questionnaire. Most general practitioners approved of the computer-generated discharge letter which included all six of the most important items of information they requested. Eighty-four per cent wished to see a similar computer-generated discharge system extended into other areas of hospital practice.


Hepatotoxicity from paracetamol self-poisoning in western Sydney: a continuing challenge. To determine the annual incidence of admissions for paracetamol overdosage in the years 1985 to 1990, morbidity and mortality rates, predictors of poor prognosis and the most appropriate use of N-acetylcysteine (NAC). A retrospective review of case records of all patients with a discharge diagnosis of paracetamol overdosage. A 900-bed tertiary referral teaching hospital in western Sydney with a busy accident and emergency department. 306 patient records were reviewed and details of the overdose and admission were recorded. NAC infusion in patients with possible paracetamol hepatotoxicity. Blood paracetamol levels; elevated alanine aminotransferase levels; prolonged prothrombin time; severe liver injury; and NAC side effects. Annual admission rate was constant at circa 55 per annum. Female to male ratio was 2:1. Predictors of liver injury included paracetamol dose over 10 g, presentation more than 10 hours after the overdose and chronic ingestion of more than 80 g alcohol per day. There were no deaths. Fifty-five patients (18%) had toxic paracetamol levels, 51% received treatment with NAC, including 40% of those with non-toxic levels, and 11% of those treated with NAC experienced side effects. Paracetamol overdosage continues to be a significant cause of hospital admissions in western Sydney. Severe hepatic damage occurs infrequently and the prognosis for liver injury, when it occurs, is good. Treatment with NAC should be reserved for patients with definite indications for the drug.


Motility-like dyspepsia. Current concepts in pathogenesis, investigation and management. Motility-like dyspepsia, a clinical subgroup of functional dyspepsia, refers to the cluster of symptoms which suggests an underlying motility disturbance of the upper gut. Characteristic symptoms, in addition to upper abdominal pain or discomfort, are nausea, vomiting, early satiety, anorexia, postprandial abdominal bloating and excessive repetitive postprandial belching. Patients with concomitant symptoms of irritable bowel syndrome are currently excluded from this clinical entity. Delayed gastric emptying of solids and/or liquids, postprandial antral hypomotility and antroduodenal incoordination, gastric myoelectrical arrhythmias and dysfunction of visceral afferents are the major alterations in upper gut sensorimotor activity which have been described. An empirical trial of medical therapy is warranted if there are no "alarm" symptoms at presentation. If symptoms are not relieved after 2-4 weeks, then investigations of the upper gastrointestinal tract, preferably by endoscopy, to exclude the presence of organic disease, is advisable. Management approaches are then reassurance, dietary manipulations and attention to psychosocial aspects. Prokinetic agents appear to be useful as short-term medical therapy in some patients, but optimum long-term treatment strategies, including the use of medications which may improve a diminished tolerance to gut distension, are not established.


Hearing loss in the elderly. A survey in general practice. To determine the prevalence of undiagnosed hearing impairment in people aged 60 years or over in a general practice setting. A self-administered questionnaire followed by physical examination and audiometry. A group general practice in the Melbourne suburb of Moorabbin. Two hundred and one people aged 60 years or over who were not known to be hearing impaired. Results of air-conduction audiometry. Seventy-five of the 201 people had undiagnosed hearing loss (37%). The assessments of hearing ability by the patients and their relations were good predictors of the outcome of the audiogram (P < 0.001). Occupational history, medical history and physical examination were poor predictors (P > 0.05). The use of audiometry for screening for hearing impairment in older general practice patients is likely to have a high yield. A large proportion of people with abnormal audiograms will, however, refuse a hearing aid.


Transplantation of the cornea.

Transplantation of the cornea. Corneal transplantation is the most widely practised form of allografting in clinical practice. The operation is used to correct developmental abnormalities of corneal shape such as keratoconus, to overcome opacities of the cornea, to relieve pain and to mend perforations. Corneal transplantation is generally successful but contrary to popular belief, corneal grafts can be rejected. This is a particular problem for patients treated for the sequelae of inflammatory disease. The relative importance of measures such as systemic immunosuppression and tissue typing is less in corneal transplantation than in other forms of clinical allografting. Overcoming rejection, achieving the best optical configuration in a graft, and increasing the number of donor corneas available for transplantation represent the main avenues for achieving improvements in corneal transplantation.


Bone marrow transplantation.

Bone marrow transplantation. Over the last 20 years allogeneic bone marrow transplantation from an HLA-identical sibling donor has become the treatment of choice for a number of human haematological malignancies, severe aplastic anaemia, some congenital diseases of the immune and haemopoietic systems, and some inborn errors of metabolism. Recently, the successful introduction of HLA-matched unrelated donor transplants, convenient T cell depletion technology, combination immunosuppressive therapy to minimise graft-versus-host disease, blood products that are seronegative for cytomegalovirus, effective antiviral agents, and cloned haemopoietic and immune system growth factors have markedly increased the scope of bone marrow transplantation. Additionally, autologous transplantation appears to have promise especially in lymphoma and breast cancer.


Identification of infection of an Australian resident with the human immunodeficiency virus type 2 (HIV-2). To present the first confirmed case of human immunodeficiency virus infection type 2 (HIV-2) in an Australian resident. HIV-2 infection in a west African man resident in Sydney was diagnosed in 1992 at Westmead Hospital, Sydney, by serological testing. He was asymptomatic and the blood CD4 T-lymphocyte concentration was not significantly reduced. Infection was probably acquired before migration to Australia. The patient was initially tested for HIV-1 antibody as part of an application for permanent residency. He was in no obvious risk group or transmission category. His serum was repeatedly positive by Genetic Systems enzyme immunoassay (EIA) and borderline by Abbott EIA, was reactive to the HIV-2 peptide on a synthetic envelope peptide assay, and was strongly reactive to all HIV-2 specific viral protein bands on an HIV-2 western blot test. HIV-2 was isolated by co-cultivation of the patient's peripheral blood mononuclear cells and identified by hybridisation using HIV-2 specific oligonucleotide probes, with further confirmation by polymerase chain reaction. The patient was counselled regarding the clinical course and prognosis of HIV-2 infection, the possible indications for zidovudine therapy, modes of transmission of the virus and safer sex precautions. This is the first documented case of HIV-2 infection diagnosed in Australia and raises the possibility of other undetected cases. The cost effectiveness of general testing for HIV-2 needs to be assessed and formal epidemiological sentinel programs should be established to monitor specific Australian populations.


Epidural injection of depot corticosteroids. Australian Pain Society Limited. This position statement is for general information and discussion only and is not intended as medical advice. Its purpose is to review the current literature on a controversial subject so as to assist medical practitioners who have an interest in pain management. The epidural injection of depot corticosteroids is one of a number of treatment techniques for chronic pain, and it is the view of the directors of the Australian Pain Society Limited that patients with chronic pain require assessment and treatment within multidisciplinary pain management programs. This statement does not encourage or discourage medical practitioners from using epidural steroid injections as a treatment modality. While this review of the pertinent literature may be of assistance to practitioners, no responsibility can be accepted by the Australian Pain Society Limited, or its directors, for any inaccuracy contained in studies referred to therein. All liability is expressly disclaimed for any loss or damage which may arise from any person acting on any statement or information contained herein.


What is nursing ethics?

What is nursing ethics? This article tries to bring some clarity into the current confusion about the nature of nursing ethics. It distinguishes between the empirical, prescriptive and analytic dimensions of ethics. It then describes six contemporary understandings of the parameters and aims of ethics via six different approaches: moral education, management, professional conduct, bioethics, clinical ethics and political ethics.


Swedish nursing instructors' views of nursing. The views of Swedish nursing instructors of the concept of nursing are examined. The approach is an inductive one based on grounded theory, which is derived from phenomenology and sociological field research methods. The data were collected by selective sampling and by interviewing 14 teachers in two nursing schools (one small and one large) in Sweden. The analysis shows that the core of nursing can be described as helping the patients either to manage their daily living or to die with dignity, and it consists of three stages which continually interact. Three types of nursing emerged inside this process of help. The relationships between (1) the nurse and different kinds of the art of nursing, (2) the nurse and various kinds of assumptions concerning the patient, and (3) the nurse and different kinds of co-operation with other health care personnel groups define the different types of process of help. The theory of nursing practice generated here is one that can be employed to test nurse orientation in many contexts.


The role of the nurse teacher.

The role of the nurse teacher. This paper reports on selected findings of a small exploratory study of the role of the nurse teacher. A questionnaire was circulated to teaching staff in one college of nursing. Quantitative data collected included a range of biographical detail, an outline of career patterns, professional qualifications and specific preparation undertaken for the teaching role. Qualitative data gathered in the study was transcribed and categorised into themes. The areas that are reported here include the identification of the factors that influenced decisions to work in nurse education, educator's views on preparation for the teaching role and areas of satisfaction and dissatisfaction in their work. Issues related to classroom teaching role, clinical teaching role, management and research are discussed.


The perceptions of nurse teachers regarding the preparation for their role in Project 2000 programmes. This paper discusses the findings related to the perceptions of nurse teachers regarding the preparation for their role in Project 2000 programmes. Data were collected by utilising three rounds of a Delphi survey with a panel of experts made up of Grade 2 nurse teachers. The panel of 201 respondents was obtained from 25 of the 28 colleges of nursing and midwifery that had implemented Project 2000 between September 1989 and April 1991. The profile of the respondents revealed that 68% work in general nurse courses, 18% in mental health, 8% in mental handicap and 6% in child care. Over half of the respondents hold a degree related to health care and over a quarter are studying for one. The findings suggest that the nurse teachers working in Project 2000 programmes consider their teacher preparation course an important means of preparation for the activities within their role. Degree and diploma courses are also considered important along with additional professional qualifying courses and subject related courses. What did not appear evident was any preparation for the many specific activities they carry out apart from teaching. Experience came out strongly as an important means of preparation for all the activities. Staff development programmes were said by 52% of respondents to be organised within their colleges and perceived by many as an important means of preparation.


Planning, designing and developing an assessment tool for a 12-week accident emergency module as part of a pre-registration course: practical account. The process of designing and developing an assessment tool for pre-registration students was governed by the need to assess students clinical competence during their 12-week exposure to the Accident and Emergency Department. It took the form of continuous assessment using a competency coding system ensuring criterion reference based assessment.


An evaluation of a training course in the short-term management of violence. Few comprehensive studies have been carried out regarding the nature and extent of violence towards staff in the caring professions. Scarcer still are studies which have thoroughly evaluated the impact of training in the management of violent and aggressive behaviour. Against this background, the following paper describes an evaluation of a 10-day in-service education course in the short-term management of violence. Set within an AB design, a combination of questionnaires and video rated role plays were used to investigate the impact of the training on the knowledge, effect and behaviour of course participants in two groups (N = 25). Results in most areas indicate that positive and significant changes have been brought about. Directions for future research in this area are identified and discussed.


Devising a checklist to evaluate the non-verbal aspects of teaching skills and delivery. This article proposes that teachers should constantly reflect upon and evaluate their performance if they are to improve teaching skills and delivery. Interaction Analysis and a true qualitative (anthropological) approach to evaluation are critically reviewed and are considered unsuitable for a teacher wanting to self-assess performances regularly. The use of a checklist in combination with video recording of the session to be evaluated is suggested as an alternative. An example of a checklist designed to focus on non verbal skills is given together with an overview of 'ideal' teacher behaviours.


Population-based mortality assessment--Baidoa and Afgoi, Somalia, 1992. Since 1990, Somalia has been the site of an intense civil war that has disrupted health-care services and food delivery to a substantial part of the country. A regional drought, in combination with the ongoing civil disturbances, has further resulted in widespread famine. Multiple international government- and nongovernment-aid agencies are involved in the relief effort for Somalia. However, security problems in most areas of Somalia have prevented recent, systematic population-based assessments of the health and nutritional status of local Somali populations for use in directing relief efforts. To characterize the mortality of various Somali populations and to provide data on major population centers outside of the capital (Mogadishu), CDC, in collaboration with the United Nations Children's Fund (UNICEF) and the U.S. Agency for International Development, conducted a survey (1) of urban populations in a central region of Somalia (Figure 1). This report describes two pilot assessments performed during November 20-25 and December 5-6, 1992, in the towns of Baidoa and Afgoi.


Knowledge of the purpose of community water fluoridation--United States, 1990. Expansion of water-fluoridation programs in the United States has been based on the clear documentation of the caries-preventive benefits of fluoride (1), as well as resources made available since the 1970s through the Fluoridation and Preventive Services Block grants administered by CDC. An estimated 135 million persons in the United States--approximately 61% of the population served by public water supplies--have access to drinking water with clinically important levels of fluoride (0.7 ppm or higher) for the prevention of dental caries (2). Efforts to expand the implementation of community water fluoridation require dissemination and understanding of information about health benefits and purported health risks. This report summarizes results from the 1990 National Health Interview Survey (NHIS) regarding public knowledge of the purpose and value of fluoridation of community drinking water.(ABSTRACT TRUNCATED AT 250 WORDS)


Tuberculosis transmission in a state correctional institution--California, 1990-1991. During September and October 1991, active tuberculosis (TB) was diagnosed in two inmates and one employee of a California state correctional institution (1991 average annual inmate population, 5421; employees, 1500). This report presents findings from an investigation by the California Department of Health Services (CDHS), the California Department of Corrections (CDOC), and CDC to determine whether ongoing transmission of Mycobacterium tuberculosis was occurring in the institution.


[Protein turnover and amino acids metabolism in septic rats]. This study was carried out to elucidate the protein and amino acids metabolism in septic rats, using constant infusion of 1-13C-leucine (4mg/hr), 5-13C-glutamine (2mg/hr), 1,2-13C-leucine (4mg/hr), or U-14C-leucine (2.0uCui/hr). Whole body protein kinetics showed that protein breakdown rate was increased in sepsis, but no change was found on protein synthesis rate (PSR). Intestinal mucosal fractional synthesis rate (FSR) was increased with sepsis. However, sepsis caused significant decrease of muscle FSR. Both leucine and glutamine oxidation rates were significantly increased in sepsis. Fraction of leucine degradation via glutamine was significantly increased in sepsis. We concluded that 1) both leucine and glutamine were utilized as important energy fuels in sepsis, 2) whole body PSR was influenced by the change of PSR in each organ, 3) the pathway from leucine to glutamine was significant in the degradation of leucine.


[Induction of immunogenic variant of a murine fibrosarcoma]. Immunogenic variant was induced from the methylcholanthrene induced fibrosarcoma (MCA-F) by in vitro treatment with the mutagen 1-methyl-3-nitro-1-nitrosoguanidine (MNNG). D-10 tumor cell which was cloned from MNNG treated MCA-F tumor cell was rejected by normal syngeneic C3H-HeJ mice but not by 650 rad irradiated immunosuppressed mice. Host which had rejected D-10 tumor growth, rejected parental MCA-F tumor cells. But active immunotherapy using D-10 tumor cell against MCA-F tumor cells. But active immunotherapy using D-10 tumor cell against MCA-F tumor bearing mice was not successful. Cytotoxic T cell (CTL) established from D-10 immunized spleen cells showed D-10 specific cytotoxic activity and not lysed parent MCA-F cells. CTL clone C-E-6 showed specific cytotoxic and proliferative activity against D-10 cell. In vivo tumor neutralizing assay also showed its specificity against D-10 tumor cell. Active immunotherapy and adoptive immunotherapy using immunogenic variant, D-10 was not successful. D-10 tumor cell possesses very strong neoantigen induced by MNNG treatment and parental MCA-F antigen.


[Ultrasonographic finding of hemoperitoneum and indication for laparotomy in blunt abdominal trauma]. The usefulness of the ultrasonography (US) for the indication for laparotomy was evaluated. I analyzed 200 blunt trauma patients who took US exams at my emergency center immediately after admission. Ninety-five percent of patients with hemodynamic instability, whose hemoperitoneum was revealed by US, underwent laparotomy. No negative laparotomy was performed in those patients. Only 5.4% of US hemoperitoneum-negative patients with stable hemodynamics required laparotomy because of peritoneal irritation or the evidence of traumatic diaphragmatic hernia. US hemoperitoneum-positive patients with stable hemodynamics were treated selectively, and 46% of such patients eventually underwent laparotomy, depending on findings of serial US, CT, DPL and Intravenous urogram. In two third of them laparotomy was indicated because of serial US showing the appearance or increase in hemoperitoneum. The maximum width of echo free space in Morison's pouch became more than 10 mm in the all exams when the laparotomy was indicated. I believe that US finding of hemoperitoneum should be an integral part of evaluating laparotomy indications in blunt abdominal trauma.