[Kawasaki disease in Pernambuco, Brazil. Considerations on a case seen in a general hospital]. The first case of Kawasaki disease in Pernambuco, Brazil, is described. An 18-month-old by presenting with fever, adenomegaly and mucocutaneous rash, had right and left coronary arteries dilation and aneurysm detected on echocardiography. Treated with a high dosage of aspirin, the patient is asymptomatic after a 7-month follow-up, with regression of coronary lesions.


[Mapping with Technetium-99 methoxy-isobutyl isonitrile at the bedside after coronary thrombolysis]. To evaluate the feasibility of bedside Technetium99-methoxy-isobutyl-isonitrile (99mTc-MIBI) cardiac imaging to assess perfusion after thrombolytic therapy (TT) for myocardial infarction (MI). We studied 9 patients (mean age 59 +/- 9 years) submitted to TT with 100 mg of rt-PA in 90 minutes within the 6 hours of the onset of MI with subsequent angiography. 99mTc-MIBI was injected intravenously in a doses of 740 MBq immediately before TT start. Imaging was performed in three moments: study 1--as soon as the TT finished, study 2--3-18 hours after TT; study 3--7-10 days after TT. A perfusion score was established in each study and then compared to determine the perfusion patterns after TT. We compared through linear regression, the perfusion score with left ventricle ejection fraction, and with CKMB enzymatic peak. All patients had a patent infarct related artery. The perfusion score of study 1 varied from 12 to 22, mean 15.8 +/- 3.7, and correlated with ejection fraction (r = 0.9, p < 0.01) and peak CKMB (r = 0.78, p = 0.03). Four (44%) patients presented perfusion score improvement in study 2 (varied from 12 to 23, mean 16.8 +/- 4.3) and 8 (88%) in study 3 (varied from 12 to 28, mean 19.0 +/- 4.3). Bedside 99mTc-MIBI cardiac imaging is useful to quantify myocardial area under risk before TT, and to identify the late (7 to 10 days) benefit of TT.


[Isradipine: a Brazilian multicenter study for the evaluation of the efficacy and safety in the treatment of mild and moderate arterial hypertension]. To evaluate the efficacy and tolerability of isradipine, a new dihydropyridine calcium antagonist, in the treatment of mild-to-moderate hypertension. One hundred and eighty outpatients with different races, who had supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg, with a mean age of 52.03 +/- 11.47 years, 70 men, 110 women; underwent the study. After a two-week wash-out period patients received isradipine 2.5 mg b.i.d. for 90 days. Follow-up visits were performed at the 30th, 60th and 90th days of treatment. At the end of treatment (90 days), a statistically significant decrease (p < 0.05) in SBP and DBP in supine position was observed. A mean SBP was reduced from 159.28 +/- 16.99 to 142.51 +/- 15.12, and mean DBP declined from 101.49 +/- 6.82 to 86.63 +/- 7.40. Heart rate, weight, electrocardiograms and laboratory tests did not shows significant changes during treatment when compared to baseline evaluation. The most frequent related side effects (headache and dizziness with nausea) were transient, and at the end of the study 96.7% of the patients did not have any complaint. However, two patients were withdrawn from the trial because of important headache. Isradipine 2.5 mg by oral route, b.i.d. has shown to be effective and well tolerated in the treatment of mild-to-moderate hypertension in patients of both sexes and several ages and races.


[Unstable angina: comparison of the effects of diltiazem and propranolol]. To evaluate the effects of diltiazem and propranolol in patients with unstable angina. Fifty-six patients with unstable angina, mean age of 55.4 +/- 8.5, 41 men and 15 women, were evaluated in a randomized, double-blind study of two groups of patients treated with diltiazem or propranolol at total daily doses of 180 mg and 120 mg respectively during the first 48 hours. After that the total daily doses was adjusted to 240 mg and 160 mg, respectively, until the 7th day. The first 48 hours, four times daily, clinical evaluation, CKMB data, ECG were obtained and two times daily until 7th day. A coronary arteriography was done on study entry. A significative reduction of angina crisis number, duration, intensity and the number of sublingual nitrates doses were observed equally in both groups. The SAP, DAP, HR and RR did not show statistical differences between groups. Individual groups analysis showed significative reductions of SAP, DAP and HR in propranolol group. The CKMB data, ECG alterations and coronary arteriography characteristics were similar. Both drugs were effective for the unstable angina treatment.


Human T lymphotropic virus type I-associated myelopathy. A report of 10 patients born in the United States. Human T lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) (tropical spastic paraparesis/HAM) has rarely been reported in the United States. We present 10 well-documented cases with positive Western immunoblot test results and polymerase chain reactions for HTLV-I. The clinical and laboratory features of these American-born patients resemble those previously reported series of tropical spastic paraparesis and HAM from the Caribbean and Japan, but important differences were observed. In our study there were equal numbers of whites and blacks and of men and women. Age at onset was younger than that reported from the Caribbean and Japan. Rate of progression to paraparesis varied but was more rapid than previously reported. Half were transfusion recipients but six had multiple sexual partners, with one regularly interacting with prostitutes and reporting a history of drug abuse. Although more rapid progression was seen in the transfusion recipients, this did not explain the earlier age of onset in this group of patients. The HTLV-I, and the associated myelopathy, are endemic in Florida, suggesting that immigration from, and proximity, to the Caribbean basin are contributing risk factors.


Reduction of the substantia nigra width and motor decline in aging and Parkinson's disease. We studied the functional significance of the involutional and degenerative changes in the substantia nigra as seen on magnetic resonance imaging. The width of the pars compacta correlated with motor performance in both healthy elderly subjects and idiopathic Parkinson's disease groups. Patients exhibited significant reduction of the width of the pars compacta and the level of this reduction correlated strongly with the clinical status evaluated by the Unified Parkinson's Disease Rating Scale. These results suggest that pars compacta shrinkage may account for a substantial part of the structural substratum of motor decline in the elderly. Moreover, an analysis of the relationship of the midbrain damage with specific symptoms in Parkinson's disease could contribute to a better understanding of the pathogenesis of this degenerative process.


Effect of long-term therapy on the pharmacodynamics of levodopa. Relation to on-off phenomenon. To determine how the response to levodopa is altered by long-term therapy, we examined the dose response to 2-hour infusions of levodopa in three groups of parkinsonian patients: those who were previously untreated, those who exhibited stable responses, and those who exhibited fluctuating responses to levodopa therapy, using tapping speed as an index of bradykinesia. The baseline tapping speed was greater in the patients with stable responses than in the untreated patients, probably representing a "long-duration response" to levodopa therapy. A "short-duration response," indicated by an increase in tapping speed lasting hours, was observed in most patients in all groups. The onset of the short-duration effect was more rapid and the incremental increase in tapping speed was twice as large in the patients with fluctuating responses compared with the untreated patients and patients with stable responses. The duration of the short-duration effect was greatest in the untreated group but did not differ between the groups with stable and fluctuating responses. Dyskinesia was not observed in any of the de novo patients but was observed in three of 12 patients with stable responses and eight of nine patients with fluctuating responses to levodopa therapy. Dyskinesia appeared before or with the antiparkinsonian effects in patients with stable responses, giving no indication of a higher threshold for dyskinesia in these patients compared with those with fluctuating responses. The plasma half-life clearance, volume of distribution, and maximum plasma concentrations of levodopa did not differ among groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Apomorphine test for dopaminergic responsiveness in patients with previously untreated Parkinson's disease. We prospectively examined the predictive value of the apomorphine test for the therapeutic efficacy of sustained oral levodopa treatment in 62 patients with de novo Parkinson syndrome (no additional neurological deficit) who had not previously been treated with dopaminergic medication. Patients received 2 to 5 mg of apomorphine hydrochloride subcutaneously and a subsequent trial of oral levodopa of at least 3 months' duration. In three patients, response to apomorphine could not be evaluated owing to side effects experienced during the test. In the remaining 59 patients, the best predictor of response to oral levodopa was the apomorphine-induced relative decrease in the scores on the motor examination part of the Unified Parkinson Disease Rating Scale (UPDRS). At a cutoff value of 20% improvement in UPDRS scores, the test predicted the response to levodopa correctly in 50 patients (85%). The sensitivity of the test was 90%, specificity 88%. The positive predictive value was 95%. However, seven of 19 apomorphine test-negative patients experienced a good (n = 4) or partial (n = 3) improvement with levodopa therapy. Thus, the negative predictive value was only 63%. We conclude that response to apomorphine has a high predictive value for response to sustained oral levodopa treatment in most previously untreated patients, but a negative test should not preclude an adequate trial of oral levodopa.


Treatment trial of oxiracetam in Alzheimer's disease. Twenty-four carefully assessed patients with probable Alzheimer's disease were enrolled in a double-blind, placebo-controlled treatment study of oxiracetam, a nootropic agent reported to improve memory performance in patients with dementia. A broad battery of neuropsychological tests failed to reveal any improvement in the treated group or in any treated patient when individual test scores were analyzed. These findings indicate that oxiracetam is ineffective in reducing cognitive impairment due to Alzheimer's disease.


Double-blind parallel design pilot study of acetyl levocarnitine in patients with Alzheimer's disease. Acetyl levocarnitine hydrochloride has been reported to retard dementia in patients with Alzheimer's disease. In a double-blind, parallel design, placebo-controlled pilot study of 30 mild to moderately demented patients with probable Alzheimer's disease, tests of memory, attention, language, visuospatial, and constructional abilities were administered, and the level of acetyl levocarnitine was measured in the cerebrospinal fluid. Patients were then randomly assigned to receive acetyl levocarnitine hydrochloride (2.5 g/d for 3 months followed by 3 g/d for 3 months) or placebo. After 6 months, the acetyl levocarnitine group demonstrated significantly less deterioration in timed cancellation tasks and Digit Span (forward) and a trend toward less deterioration in a timed verbal fluency task. No differences were found in any other neuropsychological test results. A subgroup with the lowest baseline scores, receiving acetyl levocarnitine, had significantly less deterioration on the verbal memory test and a significant increase in cerebrospinal fluid acetyl levocarnitine levels compared with those receiving placebo. These results suggest that acetyl levocarnitine may retard the deterioration in some cognitive areas in patients with Alzheimer's disease and stress the need for a larger study of this drug.


Topography of cross-sectional and longitudinal glucose metabolic deficits in Alzheimer's disease. Pathophysiologic implications. Positron emission tomographic studies of cerebral glucose metabolism have shown high diagnostic specificity in distinguishing among the degenerative dementias and differentiating between Alzheimer's disease (AD) and normal aging. The current investigation was undertaken to characterize the regional glucose metabolic deficits in AD, using cross-sectional and longitudinal study designs. All subjects met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD (n = 45) or were normal (n = 20), and the AD subjects were subdivided into incipient and mild AD and moderate plus moderately severe subgroups based on the Global Deterioration Scale. The subjects underwent a non-contrast computed tomographic scan and a positron emission tomographic (PETT VI) scan. The AD subjects (n = 14) and normal control subjects (n = 15) received evaluations 2 to 3 years after baseline study. The brain regions that show glucose metabolic deficits cross-sectionally (temporal and parietal association areas, with lesser degrees of deficit in subcortical gray matter structures), over the stages of AD, also show further deficits longitudinally within the same AD subjects. The reduction in glucose metabolism is greater than would be expected from the degree of brain atrophy. The glucose metabolic deficits are discussed in the context of neuropathologic findings and neurotransmitter deficits in AD.


Agraphia in dementia of the Alzheimer type. This study describes graphic errors made in writing a simple sentence in 368 healthy older adults and individuals in different stages of dementia of the Alzheimer type. Errors of agraphia were present in both healthy and demented people and, in general, increased with the severity of dementia. The errors of agraphia were not correlated with measures of aphasia or psychometric measures of language and motor performance. Writing skill may represent procedural memory, and agraphia errors indicate alterations in long-term memory in dementia of the Alzheimer type.


Serial changes of cerebral glucose metabolism and caudate size in persons at risk for Huntington's disease. To determine the rate of change of glucose metabolism and caudate size in persons at risk for Huntington's disease. Eighteen persons at risk for Huntington's disease had two positron emission tomographic glucose metabolic studies and two magnetic resonance imaging scans separated by 42 (+/- 9) months. Ambulatory research subjects at a teaching hospital with magnetic resonance imaging and positron emission tomographic technology. Seven of the individuals were Huntington' disease gene negative by testing at the polymorphic DNA loci D4S10, D4S43, and D4S125; the remainder were gene positive by genetic testing or onset of chorea after study entry. None. Onset of chorea and imaging results. The gene-positive group demonstrated a significant 3.1% loss of glucose metabolic rate per year in the caudate nucleus (95% confidence interval [CI], -4.64, -1.48) compared with the gene-negative group. There was a 3.6% per year increase in the magnetic resonance imaging bicaudate ratio (95% CI, 1.81, 5.37), a linear measure of caudate atrophy. The rate of change in caudate size did not correlate with the rate of change in caudate metabolism, suggesting that metabolic loss and atrophy may develop independently. The results suggest that a reduction in caudate glucose metabolism and atrophy develop rapidly in Huntington's disease. The findings establish a strategy for using serial positron emission tomographic imaging to monitor experimental pharmacologic interventions in presymptomatic individuals who have developed caudate hypometabolism.


Neurologic and neuropsychological manifestations of human immunodeficiency virus infection in intravenous drug users without acquired immunodeficiency syndrome. Relationship to head injury. We examined 99 human immunodeficiency virus (HIV)-negative and 122 HIV-positive intravenous drug users (IVDUs) without acquired immunodeficiency syndrome (AIDS) to determine whether HIV-positive IVDUs had more neurologic and neuropsychological impairment than their HIV-negative counterparts. Controlling for age, education, drug use, history of head injury, and interactions between head injury and HIV status and drug use, HIV-positive subjects had more extrapyramidal signs and frontal release signs. These findings persisted when asymptomatic HIV-positive subjects without systemic signs of infection and HIV-negative subjects were compared. Neurologic findings were more severe in those with more systemic illness. Among those reporting a history of head injury with loss of consciousness, neuropsychological performance was significantly worse in the HIV-positive subjects, and this increased with severity of illness. This was not true in the group without head injury, suggesting an interaction between history of head injury and the seropositive state. No relationship was noted between head injury and either drug use or HIV state. Therefore, subtle neurologic and neuropsychological abnormalities may precede clinical evidence of AIDS in IVDUs and may be more evident in those with head injury.


Alcohol exacerbates behavioral and neurochemical effects of rat spinal cord trauma. Acute alcohol intoxication may exacerbate the consequences of central nervous system trauma, although the mechanism is uncertain. Effects of acute ethanol administration on behavioral and neurochemical changes were examined in rats after traumatic spinal cord injury. Survival rates were reduced and posttraumatic neurologic function worsened in ethanol-treated as compared with saline-treated controls. Ethanol-treated rats had significantly lower tissue levels of excitatory amino acids and higher levels of free fatty acids, thromboxane, and lactic acid than did controls. Tissue magnesium concentration was significantly reduced by trauma and recovered more slowly in ethanol-treated rats. Enhanced phospholipid hydrolysis with free fatty acid and thromboxane accumulation, increased release of excitatory amino acids, and decreased tissue magnesium levels may each serve to worsen secondary tissue damage and diminish neurologic recovery after spinal cord injury associated with acute alcohol intoxication.


Distinct syndromes of hemineglect.

Distinct syndromes of hemineglect. Hemineglect was assessed in 34 patients with right-hemisphere stroke using a letter-cancellation task and a line bisection task. No significant correlation (r = .39) was found between scores on the two tests. Ten patients who showed neglect on the cancellation task but performed normally on line bisection had frontal or deep lesions. Eleven patients with posterior lesions deviated rightward on line bisection; several of these had minimal or no cancellation deficit. A nonmotor task involving judgment of a bisected line was also performed abnormally by six patients with line bisection shift, suggesting that such shift does not result from a motor response asymmetry. We propose that separable components of the neglect syndrome may be associated with damage to discrete areas of the nondominant hemisphere.


Flexor plantar responses in children with upper motor neuron lesions. The usual plantar response in upper motor neuron lesions is extensor. As flexor responses were seen in a number of children with these lesions, a formal study was undertaken to assess the plantar reflex in affected children. Fifty-seven children with spastic cerebral palsy were examined. Ten had hemiplegias, so a total of 104 limbs were tested. Eighty-four (80.8%) of these had flexor and 12 (11%) had extensor responses. Half (3.9%) of the remaining eight responses were mute and half were variable. While exceptions to the extensor rule are known, this marked predominance of flexor responses is unusual. This may be the result of damage inflicted on the immature nervous system before full connections and myelination have been completed. Further studies, involving children who have sustained brain damage at different ages, will be needed to elucidate the various mechanisms involved.


Acute intracranial lesions and respiratory sinus arrhythmia. We studied the effects of acute intracranial lesions on the respiratory sinus arrhythmia (RSA) with the use of computerized measurements of the ratio of expiratory to inspiratory R-R intervals. The RSA was reduced below the 95th percentile for age in 20 of 27 patients, an average of 2 days after an acute event. Only four patients, without neurological deficits, had a normal RSA. Two patients, with signs of secondary brain-stem compression from a mass, had an increased RSA, without the bradycardia that is usually associated with Cushing's response. Twenty-three patients had their respiratory rate controlled by positive pressure ventilation during testing, and our preliminary findings suggested that this was not responsible for reducing the RSA. Acute intracranial lesions caused a diminished RSA, perhaps by reducing supratentorial influences on vagal cardioinhibitory activity. In contrast, once signs of secondary brain-stem compression occur, the RSA is greatly increased while the heart rate remains unchanged, offering a possible method of noninvasive monitoring for this complication.


Maintenance of amelogenin gene expression by transformed epithelial cells of mouse enamel organ. Electroporation was used to introduce foreign genes into cells derived from the mouse enamel organ epithelia (EOE). Optimal conditions for this electroporation were established. The introduction of a plasmid construct bearing the coding region for the large T-antigen from polyoma virus into EOE cells permitted the establishment of a derivative cell line that has the following characteristics: (1) the cells could be passaged many times; (2) they expressed a keratin-containing cytoskeleton; and (3) approx. 60% of the cells expressed amelogenin, a tissue-specific gene product unique to ameloblasts. Potential uses for such a cell line include analysis of: (1) the upstream regulatory regions required for temporally and spatially restricted expression of amelogenin; (2) the post-translational modification of amelogenin in synchronized cells and (3) the organization and biomineralization of enamel extracellular matrix in monolayer culture.


Perception of forces exerted by jaw and thumb. By comparing the results of force matching between the jaw and the thumbs, whether subjects have any knowledge about the magnitude of exerted forces irrespective of the motor system was studied. Subjects were asked to match isometric forces of their own choice exerted by flexion of one of the thumbs with the jaw, and the other way around. The results were compared with control experiments in which subjects matched forces exerted by flexion of one of the thumbs with the other thumb and vice versa. None of the subjects was able to match correctly in all experimental conditions. All subjects displayed inconsistent matching behaviour, showing a mixture of correct matching and mismatching. This holds both for absolute matches (in N), and for matches relative to the maximal forces. The results show that knowledge about the magnitude of exerted forces is different for the jaw and the thumbs. Sensations about isometric forces exerted by the jaw or the thumbs are different within each subject and from subject to subject.


Effects of epidermal growth factor and transforming growth factor-beta on insulin-induced differentiation in rat dental pulp cells. An established pulp cell line (RPC-C2A) was used to study the regulatory effect of insulin on dentinogenesis. Insulin increased alkaline phosphatase activity and the incorporation of [2,3-3H]-proline into collagenase-digestible protein, whereas [3H]-thymidine incorporation by the cells was inhibited by insulin. The enhancing effect of insulin on alkaline phosphatase activity was inhibited by epidermal growth factor (EGF) or transforming growth factor-beta (TGF-beta). The stimulatory effect of insulin on collagen synthesis was also inhibited when insulin was combined with EGF, but was accelerated by the addition of TGF-beta. Inhibitory effects of insulin on the [3H]-thymidine incorporation were potentiated by EGF, though EGF alone strongly increased the effect; whereas the addition of TGF-beta had no significant effect on the insulin action. These findings suggest that insulin may be concerned with the differentiation of pulp cells in dentinogenesis and that EGF or TGF-beta regulate the insulin effects.


Comparison of the effects of galactose and glucose on the pH responses of human dental plaque, salivary sediment and pure cultures of oral bacteria. Comparisons made in dental plaque in vivo demonstrated that galactose produces a significantly smaller decrease in pH than does glucose. In vitro studies with plaque, salivary sediment and pure cultures of oral bacteria done in the absence of intraoral factors such as flowing saliva confirmed this lesser acidogenicity of galactose. Pure culture showed that most of the bacteria tested produce a moderate to large decrease with glucose but only a few do so with galactose; most produced a moderate to little or no pH response with this sugar. This suggested that the smaller decreases in pH seen in plaque in vivo with galactose were largely due to bacterial differences, basically that resident micro-organisms individually have less galactolytic than glucolytic capability. Variance in capability was attributed to differences in membrane transport processes and metabolic pathways normally available to bacteria for galactose and glucose catabolism. In the in vitro experiments, because plaque and sediment can produce base as readily as they can produce acid, the nitrogenous substrates identified earlier as major stimulants of base formation, urea and arginine, were concurrently examined for their attenuating effects on the galactose and glucose pH responses. These showed, consistent with its lesser acidogenicity, that galactose could be countered more readily in its ability to reduce the pH by either of these two base-forming substrates than could glucose. The effects were different with urea and with arginine, urea attenuation occurred sooner and arginine attenuation later in both plaque and sediment. The corresponding acid-base pH profiles for pure cultures were different.(ABSTRACT TRUNCATED AT 250 WORDS)


Isolation of granule proteins from cells of the dental follicle and stellate reticulum of rat mandibular molars. The presence of a dental follicle is required for eruption of teeth of limited eruption but it is uncertain if any molecules indigenous to the follicle regulate this eruption. However, electron-dense granules of unknown composition and function are present in the fibroblasts of the dental follicle of rat molars, as well as the adjacent stellate reticulum, before and during tooth eruption. Here the granules have been isolated; two proteins, of 167 and 200 kDa, have been determined by biochemical and immunological methods to be major components of the granules.


Granule proteins of the dental follicle and stellate reticulum inhibit tooth eruption and eyelid opening in postnatal rats. Electron-dense granules within cells of the dental follicle and stellate reticulum of rat mandibular molars can be isolated; their major components are 167 and 200 kDa proteins. Injecting these granule proteins into postnatal rats results in a delay of incisor eruption and eyelid separation. These inhibitory effects were most pronounced with the 167 kDa protein (a delay of 3 days in incisor eruption and of 2 days in eyelid opening) and were opposite to the stimulatory effects of epidermal growth factor. Thus, these granules may play an inhibitory part in tooth eruption.


Task-related behavior of motor units in different regions of the human masseter muscle. Muscle activity patterns appear to vary regionally in the human masseter. However, studies of motor-unit (MU) behaviour in the masseter have been hampered by the absence of a reliable technique for locating needle-electrode recording sites. Here, voluntary MU behaviour patterns were examined in verified regions of the muscle. Activity was recorded from 50 stereotactically mapped masseter MUs. Initially, the task specificity of each MU was determined. Then for each task, the lowest sustainable firing frequency (LSFF) was reached by slow increases and decreases in voluntary firing rate, followed by sustained firing at the lowest possible rate. Pulse-discrimination and digital sampling of consecutive interspike intervals were used to measure the LSFF for each task to which the MU contributed. All MUs fired continuously during the performance of 2-6 separate tooth-contact and postural tasks. There were significant differences between LSFFs for the tasks performed by 47 units. Masseter MU task profiles appear to vary regionally, and are dependent on jaw position, the bite point along the tooth row, and the direction of effort. Descending neural drive to masseter MUs thus seems to be highly task dependent, even when the unit firing rate is controlled voluntarily at its LSFF.


Masticatory muscle fatigue: endurance times and spectral changes in the electromyogram during the production of sustained bite forces. The purpose of this experiment was to determine if the characteristics of fatigue observed in the limb muscle system are also evident in the muscles of mastication, specifically, the masseter and temporalis. Surface electrodes were placed bilaterally over the masseter and temporalis muscles of 10 adults. Each subject was instructed to maintain maximal and six levels of submaximal incisal bite forces for as long as possible. The power density spectrum of the electromyographic signals for each muscle was calculated at the onset and failure of the task. The decrease in endurance time with an increase in bite force followed a pattern similar to that in limb muscles, and each muscle was characterized by a consistent reduction in the mean power frequency of the power density spectrum and a variable change in r.m.s. power. The variability of changes in r.m.s. power (which is inconsistent with changes found in the limb muscles) was explained in terms of either changes in motor-unit firing rate or the muscle's relative contribution to the generation of bite force. The analyses also demonstrated a curvilinear relationship between bite force and r.m.s. power, but no relationship between bite force and the mean power frequency of the power density spectrum.


Contamination of human gingival crevicular fluid by plaque and saliva. Dental plaque and saliva are both possible contaminants of gingival crevicular fluid (GCF). Plaque samples from 12 sites in four subjects who had allowed plaque to accumulate for 24-48 h were quantified using the Plaque Index and then transferred to filter paper strips for fluid volume determination using the Periotron 6000. The mean volume of fluid for plaque scores of 0 was 0.02 (+/- 0.01) microliter, whereas for plaque scores of 3 the mean volume was 0.15 (+/- 0.07) microliters. In a clinical study, GCF samples, from 19/184 subjects (10.4%) were assessed as contaminated or suspected to be contaminated with saliva, but only 28/1740 strips (1.6%) were placed in these categories of contamination. An assay to confirm salivary contamination was established, using an immunochemical, double-antibody method with sheep anti-human salivary alpha-amylase followed by peroxidase-conjugated rabbit anti-sheep immunoglobulin. The detection threshold of the assay was 7.5 ng of alpha-amylase, which represents approx. 15-25 nl of saliva. The assay was evaluated on 90 GCF samples categorized as 'known' (n = 16), 'suspected' (n = 16), or 'not' contaminated (n = 58) with saliva; 81.25, 50-61.5 and 5.2-8.6%, respectively, were positive for salivary alpha-amylase. In some GCF samples salivary contamination was in excess of 50%. It was concluded that GCF samples seen to be contaminated with saliva should be discarded, whereas samples considered free from contamination may be used with confidence. Samples suspected of contamination may require an alpha-amylase assay before further analysis.


Relationship between size of distal accessory tubercles and hypocones in permanent maxillary molar crowns of southern Africans. The relationships between total occlusal crown area and the basal cusp areas of the accessory distal tubercle (C5) and the hypocone were analysed in molars of complete upper tooth rows of a southern African sample. While non-parametric tests between hypocone and C5 sizes did not yield statistically significant results, analyses of metrical data revealed a trend towards compensatory interaction between both cusps. Contrary to previous reports the size of C5 was found to be independent of total crown area. As enamel is thickest on cusp tips there may be a functional reason for the frequency of occurrence of the distal accessory tubercle. The pattern of distribution of the hypocone and C5 within a tooth row may be related to the occlusal wear pattern in Homo, which exhibits a marked lingual slope of wear in anterior molars and a horizontal or even buccal slope in posterior teeth.


The effects of magnesium and fluoride on the hydrolysis of octacalcium phosphate. The adsorption of Mg ions on octacalcium phosphate (OCP) and its effect on OCP hydrolysis, with and without F, were studied. The Mg adsorption isotherm was fitted by the Langmuir model with an affinity constant of 0.74 ml/mumol and maximum number of sites, 31.19 mumol/g. The hydrolysis rates were measured in a pH stat by titration of base and were strongly temperature dependent. The products were examined by X-ray diffraction and chemical analysis. OCP hydrolysis takes place in two stages: the fast initial process, which is attributed to the surface topotactical conversion, followed by the main, slower process, which involves the nucleation and crystal growth. Mg ions, as 1 mmol/l MgCl2, prevented the initial surface reaction and decreased the nucleation rate dramatically and the growth rate slightly; F increased the rates of surface reaction and both the nucleation and crystal growth processes. The Ca/P ratio (1.53) and the line broadening in the X-ray diffraction patterns of the apatitic products were not significantly affected by the F. Mg also did not affect the Ca/P ratio and the line broadening at (002) diffraction, but decreased the line broadening at (310) diffraction.


Enhancement by cyclosporin A of metastasis from hamster cheek pouch carcinoma. Daily intravenous administration of 50 mg/kg cyclosporin A (CsA), after excision of cheek pouch tumors induced with 9,10-dimethyl-1,2-benzanthracene (DMBA), enhanced the incidence of cervical lymph node metastasis to 93%, a significant increase over the rates observed for animals receiving a dosage of 25 mg/kg (43%), and for control animals receiving no CsA (40%). No significant effect was evident on the growth rates of the metastasized tumour cells in the lymph node.


The increased risk of ulcerative keratitis among disposable soft contact lens users. Previous controlled studies on contact lens-associated ulcerative keratitis were performed before the widespread use of disposable contact lenses. Therefore, a controlled study was undertaken to determine the relative risk of ulcerative keratitis among users of disposable soft contact lenses compared with the risk among users of other lens types. Forty-six consecutive cases of contact lens-associated ulcerative keratitis were identified between January 1990 and June 1992 at a corneal specialty practice in western Michigan. Five controls, matched to each case patient according to the dispensing data and prescribing practitioner, were obtained for 42 cases (91%). Users of daily-wear rigid gas-permeable lenses had the lowest risk of developing ulcerative keratitis. Relative to users of daily-wear soft contact lenses, users of extended-wear soft contact lens had an age-adjusted and sex-adjusted relative risk of 1.87 (95% confidence interval, 0.61 to 5.71). Disposable soft contact lens users had the highest risk of developing ulcerative keratitis, with an adjusted relative risk of 14.16 (95% confidence interval, 5.47 to 37.63) compared with daily-wear soft contact lens users and 7.66 (95% confidence interval, 2.27 to 25.83) compared with conventional extended-wear soft contact lens users.


Risks of keratitis and patterns of use with disposable contact lenses. Disposable soft contact lenses have been marketed as a safer alternative to conventional soft lenses. We undertook a case-control study of patients attending the casualty unit of an eye hospital to quantify the relative risk of keratitis in disposable lens wear and to establish associated patterns of use. All eligible contact lens users were identified and asked to complete a questionnaire (n=242). Keratitis, microbial or sterile, was the most common complication in disposable lens users, occurring in 16 of 41 subjects. The relative risks for all lens types were estimated by comparison with rigid lenses (the referent). Both extended- and daily-wear disposable lenses were associated with higher risks of keratitis than other lens types including conventional extended-wear lenses. Poor hygiene, disinfectant system failure, and lens type may all account for these statistically significant trends.


Electro-oculography in autosomal dominant vitreoretinochoroidopathy. Thirteen members of a family presumed to be harboring the gene for autosomal dominant vitreoretinochoroidopathy were examined. In four affected members, electro-oculography demonstrated marked reduction of the Arden ratio (range, 1.1 to 1.5; normal, > or = 1.8), despite electroretinographic evidence of mildly affected rod function and normal cone function. These findings suggested that a diffuse disturbance of the photoreceptor-pigment epithelium complex may have been present prior to wide-spread loss of photoreceptor function in the affected members of this family. As in previously described families, the pattern of inheritance appeared consistent with autosomal dominance.


Foveal cone electroretinograms in patients with central visual loss of unexplained etiology. Foveal cone electroretinograms (ERGs) were recorded in five patients (aged 24 to 66 years) referred because of central visual loss of unexplained etiology. These patients had no family history of visual loss and no diagnostic fundus abnormalities seen on ophthalmoscopy or fluorescein angiography. Foveal cone ERGs were elicited with a 4 degrees white stimulus flickering at 42 Hz centered within a steady 10 degrees white surround presented through the dilated pupil to the fovea by a hand-held, dual-beam stimulator-ophthalmoscope. All five patients showed reduced foveal cone ERG amplitudes. Their abnormal responses were similar to those previously reported in cases of clinically apparent macular degeneration and contrasted with previously reported normal responses in patients with optic atrophy or strabismic amblyopia. The progressive loss of central vision as determined by history and these subnormal foveal cone ERG amplitudes suggest that these patients have a form of macular degeneration.


Standardized full-field electroretinography. Normal values and their variation with age. Full-field electroretinograms were obtained in 269 normal subjects with the International Standardization Protocol endorsed by the International Society for Clinical Electrophysiology of Vision and the National Retinitis Pigmentosa Foundation Inc. Log rod and cone amplitudes decreased exponentially with age in adults; amplitudes declined to one half those in the young adult level (ages 15 to 24 years) by ages 69 and 70 years for rod and cone responses, respectively. B-wave implicit times increased with age for all responses. Lower limits of normal peak-to-peak amplitude and upper limits of normal b-wave implicit time (P < .05) were determined for each decade from birth to age 79 years. Naka-Rushton functions relating rod peak-to-peak amplitude to retinal illuminance were determined in 50 normal subjects. A significant decline in the log maximum asymptotic amplitude with age accounted for most of the amplitude decline in the standard protocol rod response. The average value of log k, the semisaturation constant, was only 0.1 log unit higher at age 70 years than at age 20 years, consistent with previous studies showing little decrease in photopigment optical density with age.


Leber's hereditary optic neuropathy. Clinical manifestations of the 3460 mutation. Leber's hereditary optic neuropathy is associated with three different point mutations of mitochondrial DNA that appear to be pathogenetic for the disease. These mutations affect nucleotide positions 3460, 11,778, and 15,257. We reviewed the clinical characteristics of 12 visually symptomatic patients from nine families with the 3460 mutation and compared them with previously published characteristics of symptomatic patients with the 11,778 mutation. The patients with the 3460 mutation were similar to the patients with the 11,778 mutation in most clinical parameters. However, the patients with the 3460 mutation had a higher incidence of visual recovery (20% vs 4%, P = .001), a higher percentage of pedigrees with more than one affected family member (78% vs 43%, P = .011), and a greater frequency of tobacco and alcohol abuse. The difference in visual prognosis between these two mutations and the need for modification of possible risk factors provide added significance to genetic testing for Leber's hereditary optic neuropathy.


Ocular findings associated with rhodopsin gene codon 267 and codon 190 mutations in dominant retinitis pigmentosa. Two members of a family with autosomal dominant retinitis pigmentosa were found to have a cytosine-to-thymine mutation in the second nucleotide of codon 267 in the rhodopsin gene that resulted in a proline-to-leucine change. Two members of another family with autosomal dominant retinitis pigmentosa showed a guanine-to-thymine mutation in the first nucleotide of codon 190 in the rhodopsin gene that resulted in an aspartate-to-tyrosine change. Three members from a third family with autosomal dominant retinitis pigmentosa were also found to have a mutation in codon 190; however, this guanine-to-adenine mutation in the first nucleotide of codon 190 resulted in an aspartate-to-asparagine change. The relatively less severe functional retinal impairment in our patients with a transmembrane codon 267 rhodopsin gene mutation is generally comparable with that observed in a previously described codon 58 transmembrane mutation. The two families with different intradiscal codon 190 mutations showed a considerable difference in severity of their disease.


Procollagen II gene mutation in Stickler syndrome. Four affected members of a family with Stickler syndrome were found to have a single base-pair deletion resulting in a translational frameshift in exon 40 of the procollagen II (COL2A1) gene on chromosome 12. This mutation was not seen in any of five clinically unaffected family members or in any of 15 unrelated control patients. All affected members had distinctly abnormal vitreous syneresis and all had retinal perivascular pigmentation. Retinal detachments occurred in three of the four affected patients. Three of the four affected patients had peripheral cortical "wedge" cataracts, and the fourth had extensive nuclear sclerosis. Abnormalities of the soft palate were found in all four affected patients. All patients reported severe joint pains, and epiphyseal dysplasia was found radiographically in all patients.


The absorption of mixtures of air and perfluoropropane after pars plana vitrectomy. The duration of mixtures of perfluoropropane and air (0% to 20% C3F8) were analyzed in 206 eyes following pars plana vitrectomy for a variety of vitreoretinal disorders using a noninvasive model for calculating the intraocular gas bubble volume. The accuracy of the noninvasive model was tested by comparing the estimated bubble volume with the actual volume withdrawn from 12 eyes with intraocular gas bubbles undergoing a subsequent vitrectomy. The method for estimating intraocular bubble volume had a mean difference between the actual and estimated bubble volume of 0.1 +/- 0.35 mL. The half-life of air (0% C3F8) was 1.3 +/- 0.1 days; 5% C3F8, 4.2 +/- 0.1 days; 10% C3F8, 6.5 +/- 0.2 days; 15% C3F8, 8.0 +/- 0.6 days; and 20% C3F8, 12.5 +/- 1.1 days. The difference between each half-life was statistically significant (P < .01). Linear regression analysis of the half-lives of C3F8 mixtures of up to 20% C3F8 showed a linear increase in half-lives with increasing concentrations of C3F8. The duration of intraocular gas tamponade can be controlled by selecting the appropriate concentration of air and C3F8.


Eyelid anatomy revisited. Dynamic high-resolution magnetic resonance images of Whitnall's ligament and upper eyelid structures with the use of a surface coil. We used a new radiofrequency surface coil and complementary software in eyelid magnetic resonance imaging. This custom-designed coil allows visualization of the eyelid structures in submillimeter resolution, providing detailed delineation of such structures as the orbital septum, levator aponeurosis, Müller's muscle, and orbital septa. The effect of Whitnall's ligament on the levator aponeurosis can be observed as a "tenting" of the aponeurosis; the change in vector force is persistent in upgaze and downgaze. This technology will allow accurate dynamic studies of eyelid anatomy in patients with various anatomically based eyelid diseases, before and after surgery, making it possible to test in vivo longstanding theories of normal and pathologic eyelid physiology.


Nonulcerative complications of contact lens wear. Relative risks for different lens types. A case-control study was used to evaluate the relative risk (RR) of acute contact lens-related disorders. The study sample comprised new patients wearing contact lens presenting at the accident and emergency department at Moorfields Eye Hospital, London, England, in 12 months. Disorders were classified by pathogenesis. Compared with gas-permeable hard contact lenses (the referent), extended-wear soft contact lenses were related to the largest overall RR for any complication (2.7 [95% confidence limits, 1.73, 4.16]), whereas for daily wear soft contact lenses the overall RR was 1.3 (confidence limits, 1.0, 1.72). Relative risks were greatest for extended-wear soft contact lens wearers with metabolic disorders (2.1 [confidence limits, 1.28, 3.4]) and for such wearers with sterile infiltrates (2.4 [confidence limits, 1.22, 4.84]). Among those using daily wear contact lenses, RR was highest for those with toxic/hypersensitivity disorders (5.9 [95% confidence limits, 3.27, 10.49]). Severe complications involving greater morbidity occurred more frequently with extended-wear soft contact lenses. This could be reduced by selecting a more appropriate lens type to correct low refractive errors.


Binocular fusion and stereopsis associated with early surgery for monocular congenital cataracts. Despite improved visual acuity results in infants undergoing early surgery for monocular congenital cataracts, virtually all reports indicate a lack of binocular vision and the presence of strabismus in these patients. We report herein the presence of motor fusion and stereopsis in patients who have undergone early surgery for monocular congenital cataracts. Of 13 patients with congenital cataracts who were operated on by age 9 weeks, five (38%) had essentially straight eyes and evidence of motor fusion with a minimum of 1 year of follow-up. Three (60%) of five patients demonstrated sensory fusion, two with Titmus testing and one with Randot Stereo Acuity (Stereo Optical Co Inc, Chicago, Ill) of 250 seconds of arc. We conclude that binocular fusion and stereo visual acuity are obtainable in patients with monocular congenital cataracts.


Optic nerve aplasia.

Optic nerve aplasia. Optic nerve aplasia is a rare congenital defect invariably associated with other ocular or systemic disorders. We examined a 3-year-old girl with monocular microphthalmos who had optic nerve aplasia on histopathologic examination of the eye after enucleation. Magnetic resonance imaging verified the presence of unilateral optic nerve aplasia, and demonstrated hemichiasmal hypoplasia on the affected side and bilateral optic tracts. The visually evoked cortical response revealed increased signals over the occipital cortex ipsilateral to the aplastic nerve, suggesting misdirection of axons from the temporal retina of the normal eye. The visual pathway in unilateral optic nerve aplasia may assume a primitive form of neuronal organization characterized by an increase in contralateral retinogeniculostriate projection.


Toxicity of intravitreous ceftazidime in primate retina. Squirrel monkeys were anesthetized and given intravitreous injections of 0.1 mL of balanced salt solution containing 0 mg (two eyes), 1 mg (three eyes), 2.25 mg (three eyes), or 10 mg (three eyes) of ceftazidime, a third-generation cephalosporin that provides excellent coverage for gram-negative infections. Ophthalmoscopic examinations were performed 48 hours after the injections and results were completely normal in all eyes except for those that were injected with 10 mg of ceftazidime, all three of which showed the appearance of cystic change in the macula. The monkeys were killed and the eyes were removed and examined by light and electron microscopy. All eyes were normal by light microscopy except for those injected with 10 mg of ceftazidime, which showed disruption of photoreceptors (primarily outer segments) in the foveas with cystic changes in all three and macular holes in two of three. Electron microscopy showed mild swelling of mitochondria and perinuclear halos around photoreceptor nuclei in both control eyes and in eyes injected with 1 and 2.25 mg. An eye injected with 10 mg showed severe damage to central photoreceptor outer segments consisting of disruption of plasma membranes and accumulation of intracytoplasmic granular material. Inner segments showed mild changes and there was loss of apical microvilli of the retinal pigmented epithelium. The inner retina was normal. These data suggest that high doses of intravitreous ceftazidime show toxicity primarily to photoreceptor cells, but a dose of 2.25 mg is safe as studied in this model and can be used instead of intravitreous aminoglycosides that have a narrow therapeutic window.


Histopathologic characteristics of diode laser-induced chorioretinal adhesions for experimental retinal detachment in rabbit eyes. A retinal break and localized retinal detachment were induced in 10 rabbit eyes. The retinal break was treated within regions of detached retina using diode laser transscleral retinopexy (four eyes), diode laser indirect ophthalmoscopy (two eyes), or retinocryopexy (two eyes). Two eyes were left as untreated controls. The clinical and histopathologic effects were studied 1 day and 3 weeks after initial treatment. Suitable chorioretinal adhesions were induced with all treatment modalities. The extent of tissue effects was greater in cryopexy and smaller in laser treatment. The histopathologic characteristics of the lesions induced by diode laser indirect ophthalmoscopy were similar to those seen with transscleral diode treatment and were more focal than those seen with cryopexy. Transscleral and transpupillary diode laser photocoagulation were effective in inducing chorioretinal adhesions in detached retina in this experimental model in rabbits.


Morphometric analysis of macular photoreceptors and ganglion cells in retinas with retinitis pigmentosa. There have been a number of histopathologic studies of retinas that were taken post mortem from patients with retinitis pigmentosa (RP), but few have addressed the question of transneuronal degeneration of ganglion cells secondary to photoreceptor death. We studied sectioned maculae that were obtained from 41 patients with different genetic forms of RP: autosomal dominant (n = 11); X-linked (n = 9); and simplex (n = 21). We also studied sectioned maculae that were taken from 20 age-matched normal subjects. We counted cell bodies in the photoreceptor and ganglion cell layers at 100-microns (0.35 degrees) intervals from the foveola to 1500-microns eccentricity and compared the mean cell counts among each group with RP. Each RP type had significantly fewer (P < .05) photoreceptors than those of the control group at each 100-microns interval. At eccentricities of 700 to 1500 microns, the retinas with X-linked and autosomal dominant RP had significantly fewer (P < .05) ganglion cells than those of the control group; the simplex RP mean ganglion cell counts were significantly lower (P < .05) than those of the control group, from 1000 to 1500 microns. The mean photoreceptor and ganglion cell counts had a .43 correlation (P < .001) in the zone of 700 to 1500 microns, consistent with transneuronal ganglion cell degeneration. Current experimental attempts to restore vision in diseased retinas by simulating or replacing photoreceptors are based on the premise that ganglion cells are retained after photoreceptor death. Our findings support this assumption.


Cataract extraction in eyes filled with silicone oil. A surgical technique for cataract extraction in eyes filled with silicone oil was developed that has two major objectives: removal of the entire cataractous lens and complete preservation of the silicone oil volume. A regular extracapsular cataract extraction or phacoemulsification is performed, and the incision is closed with the final sutures. All steps are performed under continuous positive pressure achieved with an anterior chamber maintainer connected to a bottle of balanced saline solution. An inferior basal iridectomy is created with a vitrectomy probe, and the posterior capsule is then slowly pulled out through the limbal incision with intraocular forceps, again under positive pressure, in an eye that is actually a closed system, without any loss of silicone. This step results in transformation of the extracapsular cataract extraction condition into an intracapsular cataract extraction condition. The described technique was successfully performed in nine eyes. In the younger patients, the whole procedure was completed through two very small limbal openings.


Repair of inadvertent conjunctival filtering blebs with a scleral flap. We describe a new technique to correct inadvertent conjunctival filtering blebs. This method creates a partial-thickness scleral flap to seal the region of the excised fistula. Closure of this flap with sutures permanently covers the fistula and eliminates any route for recurrence of the bleb or downgrowth of epithelium. No complications have been associated with this procedure, which has been used in more than 10 cases during the last 3 years.


The mouse as a model for human audition. A review of the literature. The mouse has several distinct advantages as an experimental model for human audition. Mice and humans express a similar presbyacusic and ototraumatic pattern. Several genetic mouse models also exist for conditions resembling human auditory disorders, such as otosclerosis. This paper reviews the strains of inbred mice (e.g. the CBA/J) which have recently been used as models for the normal human auditory system, describing their deficiencies. It is suggested that the F1 offspring of CBA/CaJ and AU/SsJ inbred mice would have advantages over existing models.


Auditory brainstem function of the F1 offspring of the cross of CBA/CaJ and AU/SsJ inbred mice. Inbred strains of laboratory mice have several distinct advantages as models for examining conditions that influence the human auditory system, but the CBA/J mouse which has most often been used as a normal model has recently been found to have several disadvantages. This paper is the first report of the auditory brainstem responses (ABRs) of the F1 offspring of CBA/CaJ and AU/SsJ parents. At midlife, high-frequency ABR thresholds are lower in the F1 than in either parental genotype. Tuning curves obtained by forward masking of the ABR also display heterosis, i.e. they are narrower in the F1 than in either parental strain.


Influence of masker bandwidth on binaural masking level differences. Masking level differences (MLDs) were investigated using masking noise with 160 Hz (amplitude-modulated noise) and 600 Hz (filtered-random noise) bandwidth. One hundred normally hearing subjects received the MLD test under both types of noise. Significant differences between noise types were observed in both N0S pi and N pi S0 conditions; MLDs were larger in amplitude-modulated noise. Consideration of these differences would indicate that older MLD norms based solely on filtered-random noise are invalid for amplitude-modulated noise especially where bandwidth differences in the noise exist. Were the norms for 600-Hz-wide filtered-random noise to be applied to results of MLD testing performed using 160-Hz-wide amplitude-modulated noise, patients with lesions in the central auditory pathway might exhibit normal or borderline normal results. Clinical MLD norms established on one type of noise should not be used to interpret MLD results obtained using a different type of noise.


Effect of hearing aids on speech perception in noisy situations. Hearing-impaired people often complain about poor speech intelligibility when they are in noisy surroundings. Several authors have published data suggesting that hearing aids add distortion to the signal and thus make speech less intelligible. Given the tendency of people to speak louder in competing noise, it means that some patients might understand better in such circumstances without an aid than with an aid. The present study investigated the effect of modern commercial hearing aids on the ability of patients to understand speech monaurally in noisy circumstances. The results in general showed speech to be equally understandable with and without an aid if the effects of presentation level (amplification) are excluded. The results, however, varied considerably between patients. Statistical analysis showed that the variance could be explained primarily by the degree of high-frequency loss and the slope of the audiogram. Patients with steep sloping audiograms understand better and patients with a conductive hearing loss component understand less in noisy circumstances with a hearing aid. Speech intelligibility in noisy situations did not correlate at all with the hearing loss averaged over the mid-frequencies (500, 1,000 and 2,000 Hz) but it did correlate with the high-frequency hearing loss (2,000 and 4,000 Hz) and the slope of the audiogram, indicating the importance of high-frequency emphasis in hearing aids.


Cooperation of hearing-impaired elderly subjects for participation in a hearing screening program. Presbyacusis, the auditory disorder which accompanies the aging process, is well known. However, the practical assistance available to alleviate the breakdown in the communication ability of the older person is unsatisfactory, and provision for public awareness of a rehabilitation strategy has not yet been established in many countries. Four hundred and ninety-eight elderly subjects, aged 65-94 years, were hearing tested in different setups, a geriatric nursing home and in the community. It was found that the need for rehabilitation was high and the willingness to participate in a hearing screening program was low even though the rehabilitation treatment was provided without charge.


Natural vowel perception by patients with the ineraid cochlear implant. Vowel recognition was tested in 10 patients using the Ineraid cochlear implant. The vowels were produced by a male speaker in the context 'heed, hid, head, had, hawed, hood, who'd, hud' and 'heard'. Performance varied from 34 to 93% correct. A descriptive feature system for the vowels was determined from an acoustic analysis. An information transfer analysis of these features suggested that information about the first formant frequency, vowel duration and fundamental frequency was transmitted. Information about the second and third formant frequency was transmitted less well. A sequential information transmission analysis suggested that the features of the first formant and duration accounted for nearly 80% of the information transmitted. The fundamental frequency and second formant frequency information accounted for an additional 8%. Information provided by the third formant frequency was largely redundant.


Medical record content: recurring area of concern in hospital analysis. This article reports on an analysis of 109 hospitals that received recommendations for improvement within their Medical Record Service when surveyed by the Australian Council on Health Care Standards (ACHS) in 1990. Seventy-five per cent of Medical Record Service recommendations made at an earlier survey had been fully implemented and 17% partially implemented by hospitals at the time of their next survey in 1990. The major area receiving recommendations for improvement was medical record content. Other areas of concern were quality assurance, organization and administration, and space for research and work within the service. Certain aspects of medical record content also appeared to be resistant to change from one survey to the next.


Trends and projections for day only admissions in NSW acute hospitals. The rapid increase in the number of day only admissions during the last decade has led to an increased awareness of this type of hospital admission. Health planners are now interested in which procedures are causing the increase in the day only activity and how best to accommodate it in the future. To address these issues, routinely collected hospital data were used to analyse trends in day only admissions and to extrapolate future demand via regression models. The results suggest that day only admissions will constitute 45% of all admissions to NSW acute hospitals by the year 2001. Detailed review of patient caseloads suggest that 13.5% of all patients will be potentially treatable through day surgery units, as opposed to general wards, by 2001. Assuming 80% of these potential patients actually do get treated in day surgery units, then the workload generated could be accommodated within 30 day surgery facilities.


Medical audit of hysterectomy in the Hunter Area of New South Wales. A computer search in the New South Wales (NSW) Department of Health statistical data base was made to obtain the medical record numbers of patients who had had hysterectomies in the public or private hospitals of the Hunter Area of the State during the years 1987-89. The medical records of patients so identified were then extracted and reviewed by a medical team. The age at and the principal indication for hysterectomy were noted in each case and these data were then compared with those for the rest of NSW. The hysterectomy rate in the Hunter Area was 66.5 per 10,000 women aged 15 years or more, compared with a rate of 33.8 per 10,000 in the rest of NSW. When the 9.04% of hysterectomies performed on patients whose domicile was outside the Hunter Area were excluded, the corrected hysterectomy rate for the area was 57.46 per 10,000 women. The commonest indications for hysterectomy were menorrhagia (25.4%) and fibroids (15.32%). The limitations of this kind of retrospective study are discussed and suggestions are made for an improved methodology to be used in a future study.


Introducing a quality of service programme to hospital orderly staff. Recent reshaping of health provision throughout New Zealand has brought many changes to virtually every area of the service. In some instances this has required a totally fresh approach with a different way of thinking. In others, it has meant the adaptation and remodelling of existing structures and approaches. This paper gives a brief overview of the West Auckland Health District Quality of Service Programme and, in particular, its introduction to the orderly service at Waitakere Hospital.


Windows of opportunities available in tight economic times. The Royal Victorian Eye and Ear Hospital has developed a culture around the Accreditation process and quality assurance. All staff members are regularly challenged to ask themselves the question, 'What are we doing now that we could do better?' During the financial year 1990-91, over 350 quality assurance programmes were undertaken addressing more than 150 individual issues. Many aspects of a clinical nature were addressed and these will be dealt with briefly. The main focus of this paper is to indicate the windows of opportunity available to hospitals in tight economic times. Programmes were undertaken in every department throughout the hospital and, in the financial year under review, savings of $351,589 were not only identified but accomplished. These savings are ongoing during the next 5 years and will amount to approximately $1.75 million. The Auxiliaries of The Royal Victorian Eye and Ear Hospital have assisted the hospital and over the last 10 years have raised $2.5 million without any direct public appeals.


Use of the Injury Severity Score to monitor diagnostic accuracy in the early assessment of road trauma. A retrospective review of 279 hospital admissions at two Melbourne hospitals was conducted to develop a method for identifying diagnostic error using the Injury Severity Score (ISS) as a model for clinical audit. Two scores were calculated for each patient, the first according to injuries diagnosed on initial assessment in the Emergency Department and the second according to final, confirmed diagnoses upon discharge from hospital. Diagnostic errors were identified as discrepancies between the initial and final scores. ISS discrepancies were found in 48 cases (17.2%). Some were clinically significant errors of diagnosis while others reflected inaccurate injury description or record keeping. Abdominal injuries were the most frequently missed, followed in decreasing order by spinal, thoracic, extremities (limbs), head/face and external injuries (skin and subcutaneous tissues). The frequency and pattern of injury misdiagnosis concurs with the findings of other studies. The diagnostic error rate was found to increase with injury severity and with the number of anatomic body regions involved. The authors suggest that comparing initial and final ISS provides a convenient mechanism for the audit of early diagnosis in trauma cases.


The tunnel restoration--nine years of clinical experience using capsulated glass ionomer cements. Case report. The clinical potential of the tunnel restoration is restrained by perceived difficulties of access to proximal caries and lack of long-term clinical data. This paper describes a technique that affords proximal access similar to that of a standard Class II cavity preparation and provides an evaluation of a technique, using capsulated glass ionomer cements. It is supported by more than nine years of clinical experience that confirms the viability of this procedure as an alternative to conventional Class II cavity restorations for initial proximal lesions.


Microsurgical repair of nerves injured during third molar surgery. The inferior dental and lingual nerves are in close proximity to the mandibular third molar. In approximately 5 per cent of cases of the surgical removal of this tooth one or other of these nerves may be injured. In most cases the injury is reversible but in 1 per cent a distressing dysaesthesia may occur. The diagnosis of the sensory deficit is made by repeated sensory testing. If there is no improvement by six to nine months then complete spontaneous recovery will not occur. These irreversible nerve injuries can be successfully treated microsurgically.


Facial palsy in the dental surgery. Case report and review. Facial palsy is a relatively uncommon condition with a variety of causes including dental intervention. A brief history of two cases of facial palsy with dental implications is presented. The aetiology of facial palsy is reviewed and the management of such cases is discussed. The option of immediate treatment of Bell's palsy with prednisone is stressed.


A clinical evaluation of three topical anaesthetic agents. This study compared the efficacy of EMLA 5% Cream, Xylocaine 5% (lignocaine 5 per cent) and NUM (benzocaine 15 per cent, amethocaine 1.7 per cent) to a placebo in reducing the pain experience during needle insertion. In a random, double blind study three groups of twenty volunteers each had a paired topical anaesthetic/placebo placed bilaterally in the buccal sulcus of the upper premolar regions for two minutes, followed by the insertion of a standard 27 gauge needle to a depth of 5 mm. Pain experience was measured with visual analogue scales. Results showed that all three agents significantly reduced pain when compared with the placebo--EMLA (p less than 0.002); Xylocaine (p less than 0.05); NUM (p less than 0.005).


Some parameters for testing deformation of elastomeric impression materials. Because of conflicting published data, the temperature rise in four elastomeric materials was measured with a thermistor during setting in the oral cavity and in metal and plastic moulds of varying shapes and volumes for 'elastic set' specimens. The clinical temperature rise was 2-3 degrees C higher in the molar region than anteriorly, except for the polysiloxane. The temperature range attained in the set materials varied from 29 degrees C to nearly 35 degrees C for clinical and in vitro specimens. The average time taken by a group of operators to remove this type of impression from the mouth was five seconds. In a custom tray with light and heavy viscosity materials, the syringe material layer was only 0-0.15 mm thick and, essentially, the heavy viscosity material provided the elastic components for the impression.


The effect of interface adhesion, water immersion and anatomical notches on the mechanical properties of denture base resins reinforced with continuous high performance polyethylene fibres. Previous work has presented a study of the mechanical properties of denture base resins reinforced with a new type of high performance fibre. It is now shown that the substantial improvements demonstrated in those composites remain largely unaffected by a watery environment, anatomical notches, moulding pressure and other factors of denture construction. The understanding of the reinforced resins is here complemented with a detailed study of the interface strength, taking into account the various couplings occurring within the system.


Choice of toothbrush: a survey of dentists' personal preferences and recommendations for patients. Data on dentists' choice of toothbrush brand/type for personal use and their recommendations for patients were obtained by means of a questionnaire. Seventy-nine per cent of dentists surveyed received free samples, with Oral-B comprising 33 per cent of all such samples, followed by Colgate (16 per cent) and Tek (13 per cent). Fifty-three per cent of dentists surveyed indicated they used all free samples received. Sixty-two per cent of dentists do not consider that different brushes differ significantly in their plaque-removing ability. Therefore, while an effective toothbrushing technique is important, selection of the 'correct toothbrush' from the wide range available may not be critical. The results of the present investigation provide information that is relevant to dental health education and can be applied at the chairside as well as at the broader community level.


Survey of continuing dental education attendance in Western Australia. A survey of attendance at continuing dental education courses convened by the University Postgraduate Dental Education Committee, University of Western Australia, and the Australian Dental Association. Western Australian Branch was collated for one calendar year. Attendances were compared relating to the number of dentists registered in the State, ADA membership, metropolitan versus rural dentists and the number of courses attended. The mandatory and voluntary options for continuing dental education are discussed in the light of the survey findings.


Finishing techniques for amalgam restorations: clinical assessment at three years. Use of the optimum finishing technique for an amalgam restoration may enhance the marginal integrity of the restoration and discourage its unnecessary early replacement. Two hundred and twenty-eight high copper amalgam restorations in 56 patients were evaluated, using clinical assessment criteria, up to three years after placement. Each patient had received at least one carved-only amalgam, at least one immediately finished restoration, and at least one amalgam that was polished at a subsequent appointment. Regardless of the finishing technique, the restorations exhibited similar marginal integrity up to three years after placement. Polished restorations were found to have substantially superior surface texture and less likelihood of surface discoloration. No evidence was found to support the use of immediate finishing techniques. The clinical significance of these findings, with respect to the need to polish amalgam restorations, is discussed.


Complications associated with maxillary nerve block anaesthesia via the greater palatine canal. This paper documents the type, frequency and duration of complications associated with regional anaesthesia of the maxillary nerve via the greater palatine canal in a series of 101 patients treated in the Oral Surgery Department, United Dental Hospital of Sydney.


Comparative elasticity tests for elastomeric (non putty) impression materials. This study was conducted to evaluate the methods used for measuring the elastic recovery of various elastomeric impression materials. One brand from each chemical group was selected to allow relative ranking of the results from each deforming test mode. For compression tests, the polysulphide and silicone specimens made in metal moulds gave significantly less set than those made in acrylic moulds; this was not so for the polysiloxane and polyether specimens. For polysulphide and polyether materials, the set in compression was greater using the BSI balanced beam method than for an optical method without inertia or load effects; this was not so for silicone or polysiloxane materials. The elastic recovery of the materials did not alter significantly after ten minutes of strain release, except in tensile tests, where the elastic recovery continued to change for twenty minutes. The rank ordering of the deformation set showed a relative correlation for the compression test, a new tensile test method, and bend and torsion testing methods. Thus only one method is needed to determine set per cent.


Prosthodontic procedures for implant reconstruction. 1. Diagnostic procedures. The University of Sydney Dental School and more recently the Implant Centre have been treating patients with the Brånemark Osseointegration Implant System since 1981. Success depends on close cooperation between surgeon and prosthodontist. This paper describes specific prosthodontic treatment planning procedures based on a general knowledge of prosthodontics, and detailed methods for determining the position, length and alignments of the implants for a specific case by the use of radiographic and surgical templates.


The adverse effects of dental restorative materials--a review. Several materials used in dentistry are described as biomaterials. Owing to the intimate contact of these materials with the oral tissues, they should possess a high degree of biocompatibility. However, some materials may exhibit adverse effects, causing both local and general pathological changes, even though the occurrence seems to be relatively low. It is, therefore, the dentist's responsibility to be aware of the potential adverse effects of these materials and to take precautions to protect the patient form such effects. The purpose of this article is to review the potential adverse effects of some commonly used restorative materials, mainly with regard to patients.


Effect of gels containing stannous fluoride on oral bacteria--an in vitro study. The purposes of this investigation were to evaluate and compare the antimicrobial effect of (1) twelve 0.4 per cent stannous fluoride (SnF2) commercial products and (2) different concentrations of SnF2 (range = 0.02 to 3.28 per cent). The antibacterial inhibitory effect of various SnF2 gels was evaluated as to their effectiveness against oral plaque bacteria including strains of S. mutans, S. sanguis, S. sobrinus, A. viscosus, A. actinomycetemcomitans, and B. intermedius. When twelve different commercial preparations of 0.4 per cent SnF2 were compared for inhibitory effect on plaque bacteria, several of the SnF2 preparations were significantly more effective in inhibiting oral bacteria (p < 0.05). With increasing concentration of SnF2, there was a comparable increase in the inhibitory effect on the oral bacteria tested (r2 ranged from 0.867 to 0.996). SnF2 at a concentration of 0.4 per cent had a similar antibacterial effect to 0.12 per cent chlorhexidine. This in vitro study demonstrated that certain SnF2 products are highly effective in inhibiting the growth of bacteria often found in plaque, and this inhibitory effect is directly related to the concentration of the SnF2.


The grading of practical examinations in complete denture technology. The problems associated with the grading of practical examinations are discussed and statistical analyses of two gradings are presented. Consideration is given to the difficulties of failing students who may wish to transfer to another faculty and a recommendation is made for the introduction of non-graded passes.


Some social characteristics and background of first-year dental students, University of Sydney, 1976-85. This paper presents some information, derived by questionnaire, on the social characteristics and background of 1148 first-year dental students at the University of Sydney for the years 1976-1985. Student entry age was 19.4 years; 27 per cent were female; 36 per cent of fathers and 24 per cent of mothers were professionals and 37 per cent of fathers and 11 per cent of mothers had attended university; parents of female students had higher educational levels than parents of male students; 55 per cent had medicine as the course of first preference. Eighty-five per cent of students entered dentistry from high school with 78 per cent from Sydney. Characteristics of students showed little change over the period 1976-1985. Some changes noted were an increase in the number of female students with fewer living in their parents' home; increase in number of students from government schools; decrease in foreign students but an increase in students (Australian citizens, or residents) born overseas, and of different ethnic backgrounds.


Dental caries and periodontal disease in Fiji. A national oral survey was conducted in Fiji in 1985/86. The results showed that the prevalence of caries was generally low and most commonly affected pit and fissure surfaces. Comparisons with previous surveys in 1948 and 1965 showed that the prevalence had fallen in primary teeth but remained relatively constant in permanent teeth. There were significant variations in prevalence between residential locations but not between ethnic groups. Periodontal disease was found to be a major public health problem. Except for the percentage of young children with caries-free dentitions, the current status of oral health in Fiji was generally better than that proposed in the WHO goals for the year 2000. The training of dental hygienists to help in the prevention of both dental caries and periodontal disease is discussed.


Acrylic resins reinforced with highly drawn linear polyethylene woven fibres. 1. Construction of upper denture bases. This paper presents a detailed description of the construction of complete acrylic upper dentures reinforced with highly drawn linear polyethylene fibres. The work forms part of a continuing project to elucidate the properties and potential of the new system.


Multiple sclerosis--making the diagnosis. Although intensive research into all aspects of MS in the past 50 years has led to a great deal of information about pathological processes that may relate to its causation and expression, the disease is still an enigma--one of the greatest unsolved problems in medicine. Recent advances in neuroimaging and the ability to measure conduction in CNS pathways (evoked potentials) reveal subclinical effects, complementing clinical examination and frequently enabling a firm diagnosis in earlier phases of the disease than hitherto. In some situations earlier conclusive diagnosis facilitates management. But this is by no means invariably so. Clinical criteria continue to be paramount; investigative findings are supportive rather than being primarily diagnostic in their own right. Integrating this information at any one time for the maximum benefit of the patient tests knowledge and judgement.


Is it Parkinson's disease?

Is it Parkinson's disease? The diagnosis of idiopathic Parkinson's disease is based on clinical assessment and is also a diagnosis of exclusion. A number of neurodegenerative disorders have signs in common with Parkinson's disease and are referred to as parkinsonisms. The physical findings that help to make an early diagnosis of Parkinson's disease and the atypical features that make another disease more likely are presented.


Dizziness--organic or functional?

Dizziness--organic or functional? The author discusses a specific case to illustrate the problem of chronic, uncompensated asymmetrical vestibular function, which can present with seemingly bizarre symptoms. Simple guidelines to distinguish between organic and functional dizziness are offered.


Gait disturbances.

Gait disturbances. Walking is a complex motor skill and is governed by a number of interlinked pathways from the cortex above to the muscles below. The author outlines some of the important features in the history and examination of the patient with a gait disorder.


Diabetes in an elderly population. A controlled study of morbidity and outcomes. To determine in an elderly diabetic population the frequency of vascular and related disorders, the mortality, and outcomes compared with a matched control group. The Queen Elizabeth Geriatric Centre, Ballarat, Victoria. The medical records of all diabetics admitted between 1982 and 1987 inclusive, and a control group matched for age, sex and ward of admission were studied retrospectively. The presence of associated conditions and outcome parameters were entered in to a database and analysed statistically. Increased prevalence in individuals with diabetes of ischaemic heart disease (2.0:1.0), cerebrovascualr accident (1.9:1.0) and hypertension (1.5:1.0). Similar death rate, cumulative bed days, discharge destination and use of discharge services. Despite the more frequent presence of clinical vascular disease, an elderly population with diabetes had the same outcomes as matched controls and did not require more bed occupancy or use of community based services.


An analysis of funding for general practice research in Australia. To describe the current status of funding for general practice research in Australia. A descriptive survey analysing funding arrangements of research projects included in a national research database, established by the Royal Australian College of General Practitioners. Research projects involving, or directly related to, general practice that had commenced in Australia since 1 January, 1989. Responses were specifically sought from all universities, the Family Medicine Programme and the Royal Australian College of General Practitioners. Extent and source(s) of funding received or requested, or both; relationship of funding received to the following: qualification and affiliations of the principal investigator; submission of the research project towards a higher degree; subject area(s) covered by the research; study design method used; and duration of project. A total of 237 projects from 130 principal investigators were included in the analysis. Of these, 149 (63%) had been submitted for funding and 98 (66%) had been successful. The amount of funding ranged between $300 and $855,600. The most common source of funding was the General Practice Evaluation Programme. Research contributing towards a higher degree was associated with successfully receiving funding. Other variables, including the study design and study area, were not significantly associated with an increased success of funding. The total amount of funds spent on general practice research is still small, relative to the size of the workforce. However, over half of general practice research undertaken in Australia is not submitted for funding. Of the research that is submitted, the success rate of receiving funds is high.


Fit-ins. Even a bad day has lessons for us. It is a bad day at the office. Four patients present with intractable dilemmas: two exhibit self abusing behaviour, and the other two behave in ways that affect others. What can the GP do in these circumstances?


Endotracheal and intraosseous drug administration for paediatric CPR. The endotracheal and intraosseous routes are alternatives to the intravenous route of access to the circulation during emergency resuscitation. Adrenaline, lignocaine and atropine are readily absorbed from the respiratory tract via an endotracheal tube. All drugs and resuscitative fluids can be infused into the tibial bone marrow using an intraosseous needle.


Clinical nutrition in primary health care. Nutritional diagnosis and management are important aspects of general practice. This information, which is presented in two parts, offers the general practitioner a practical framework and an approach to nutritional advice. Part 1 outlines the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. This material is based on a seminar organised by Kellogg (Australia) Pty Ltd in Melbourne in 1989 and the material is reproduced with the kind permission of Kellogg (Australia) Pty Ltd.


Andrew Pattison meeting the challenge of medicine today. The common thread of medical education tends to tie up the many diverse interests that constitute Andrew Pattison's working week. Although he has diversified into health education for the masses through his Doctor Toby books and his talkback radio segments, he maintains contact with his grassroots through his general practice patients.


Common non pigmented skin cancer.

Common non pigmented skin cancer. The scope of this article does not include many other non melanocytic skin cancers such as angiosarcoma, B cell lymphoma and atypical fibroxanthoma. These are the less common skin cancers, but no less important. If there is any doubt whether a lesion represents a skin cancer, biopsy is mandatory to establish a histopathological diagnosis so that treatment can ensue.


Systemic diseases and the skin.

Systemic diseases and the skin. Skin lesions often give important diagnostic clues to underlying systemic disorders. A brief overview is given of the types of cutaneous presentations that may be related to an underlying organic disease.


Cottonwool babies. A case history.

Cottonwool babies. A case history. Although the adage 'common things occur commonly' is certainly true, especially in a general practice situation, there are occasions when rare or uncommon problems present themselves. In these situations the learning curve of the patient and doctor may be parallel but there is still a lot the family doctor can do to ease the suffering of the family and help in the adjustment phase. Epidermolysis bullosa can be a cruel, disfiguring and at times lethal disease, however, as Michael's case illustrates, patients deserve assessment on their own merits and with the right support and care 'cottonwool' babies can lead full and purposeful lives.


Paediatric dermatology.

Paediatric dermatology. The format of this collection of skin conditions allows for only a brief discussion of the aetiology and appearance of each entity. Most of them are common skin conditions. Referring to a dermatology reference book will make this presentation more valuable.


New approaches to acne.

New approaches to acne. In recent years, a greater understanding of the pathogenesis and improved treatment regimens have enhanced our ability to control this common and often distressing condition. The author presents a brief outline of its pathogenesis followed by a systematic approach to treatment.


Psoriasis--treatment options.

Psoriasis--treatment options. Psoriasis can be a disfiguring and psychologically disturbing condition. Although a cure is not possible, treatment options offer relief and often remission for the patient willing to comply with them. The author looks at those options.


Clinical nutrition in primary health care. Part 2: Assessment, diagnosis, presentation and management. Nutritional diagnosis and management are important aspects of general practice. This information, presented in two parts, offers the general practitioner a practical framework and a approach to nutritional advice. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. (Part I, outlining the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity, appeared in the October issue of Australian Family Physician.)


Whiplash injury: misconceptions and remedies. Misconceptions about whiplash injury and its common course are discussed. Different patient populations appear to suffer to varying degrees and social copying is evident in certain groups--features shared with the Australian 1983 to 1985 'epidemic' of 'repetitive strain syndrome'. Psychosocial factors and overtreatment delay recovery. Family physicians have the opportunity to properly assess and manage most patients. Wasteful therapy must be discouraged, and self care and patient responsibility encouraged.


An interpractice visit study.

An interpractice visit study. In general terms the tests are performed to monitor disease or therapy, to help in reaching or excluding a diagnosis, and to screen for significantly treatable abnormalities in apparently healthy people either in the population at large (as in hyperlipidaemia) or in a specific risk group, for example, relatives of colorectal cancer sufferers. The result of the test gives some indication of its value in diagnosis. A preponderance of abnormal results suggest that it adds little to the clinical acumen of the observer, while in the opposite situation a high proportion of normal results suggest that it is being wrongly applied. Where the purpose is monitoring, the survey should throw some light on the value and frequency of use of the test. How often does the discerning general practitioner order routine electrolytes, serum digoxin levels, thyroid function tests? And, more significantly, how often should this be done? General practitioners are the appropriate people who can find out and establish an accepted standard. In screening it should be possible to demonstrate both the value of the test in terms of detection rate (ratio of normal to abnormal results) and the efforts of an individual practitioner in preventive medicine expressed as proportion of total work load. Suitably expanded it could be extended to discover the proportion of the total population at risk that is being reached by screening. This writer believes that general practice lacks a published body of knowledge culled from its collective experience on which it can call when challenged by colleagues, government or even hostile barristers.(ABSTRACT TRUNCATED AT 250 WORDS)


Easy bruising and bleeding.

Easy bruising and bleeding. The first steps in the identification of the cause of a bleeding disorder is careful evaluation of the patient's haemostatic competence and an assessment of the personal and family histories. Laboratory assessment should be guided by the clinical impression.


Hugh Carpenter. International general practitioner. Hugh Carpenter's interests in general practice have been cosmopolitan and challenging. After seven years as a solo country general practitioner in Tasmania and then as State Director of the Family Medicine Programme in Tasmania, he was appointed to positions in China (1987-1990) and Moscow. His special interests are medical education and bilateral international medical relations, especially between China and Australia, and Great Britain with Russia, Bulgaria and Romania.


Lipoprotein(a) concentration in diabetes: relationship to proteinuria and diabetes control. Diabetic patients are at increased risk of cardiovascular disease, particularly when proteinuria is present. Lipoprotein(a)[Lp(a)] levels were assessed in 37 patients with insulin dependent (IDDM) and in 75 patients with non-insulin dependent (NIDDM) diabetes who showed varying degrees of proteinuria and glycaemic control. Median Lp(a) in 112 diabetic patients was significantly greater than in 116 healthy controls (113 vs 48 mg/L; p less than 0.01). 86 of the patients had first morning urine albumin concentration less than 30 mg/L (normoalbuminuria = NA), 16 patients 30-200 mg/L (microalbuminuria = MA) and ten patients greater than 200 mg/L (albuminuria = ALB). There was no significant difference in median Lp(a) concentration between the three groups (NA = 108, MA = 163, ALB = 98 mg/L; p greater than 0.5). No significant difference in median Lp(a) or NIDDM treated with oral agents and/or diet (120, 98, 115 mg/L respectively; p greater than 0.7). When the 86 NA patients were divided on the basis of median fructosamine concentration (357 mumol/L), no significant difference was found in median Lp(a) levels between those grouped below or above this median (98 mg/L vs 118 mg/L; p greater than 0.5). Across all diabetics studied there was no significant correlation present between Lp(a) and urinary protein or glycaemic control. These cross-sectional results suggest that median Lp(a) concentration is increased in both IDDM and NIDDM patients, but this increase is not related to the degree of proteinuria or short-term glycaemic control.


Semi-quantitative determination of microalbuminuria by urinary dipstick. Microalbuminuria predicts subsequent clinical nephropathy and mortality in diabetic patients. This study was undertaken to determine the usefulness of a new immunochemical urinary dipstick test (Micral-Test, Boehringer Mannheim, GmbH Mannheim, Germany) in identifying urinary albumin concentrations within the microalbuminuric range (urinary albumin concentration 20-200 mg/L). Twenty-four hour urine specimens were collected from 298 consecutive diabetic outpatients. Micral-Test was performed by two laboratory scientists blinded to each other's results and those of radioimmunoassay (RIA) and immunoturbidimetry on the same specimen. When compared with RIA, Micral-Test had an overall sensitivity of 92.2%, specificity of 92.3% and positive predictive value of 86.4%. However, at the threshold value of 20 mg/1 Micral-Test showed false positive results in 37.8% of samples when compared with RIA. Similar results were obtained when Micral-Test was compared with immunoturbidimetry. We conclude that Micral-Test is a useful screening method for the detection of microalbuminuria. We suggest that positive tests be confirmed by a timed urine collection using established methodology and that patients whose Micral-Test is negative be subjected to annual retesting.


The value of complement measurements in the assessment of lupus activity. The complement system was studied prospectively in 29 patients, predominantly renal (25), with systemic lupus erythematosus (SLE) to examine the value of complement assays in the distinction between active and inactive disease. Disease activity was evaluated primarily by clinical, biochemical and histological parameters which were obtained at the time of assessment. Fourteen patients had active disease, as assessed by clinical and laboratory criteria. C1q, C4, C4a, C2, C3, C3a, C5, total haemolytic activity (CH50) and complement inhibitors were measured in each patient. The ratios of C4a:C4 and C3a:C3 were also calculated. Values for all components except C5 were different between control subjects and active patients while only CH50 was different between inactive patients and controls. All parameters except C4a:C4 and C5 were different between active and inactive patients. There was a highly significant difference in the number of active patients with reduced levels of C2, C3 and C3a:C3 compared to inactive patients (i.e. p less than 0.001) whereas lesser or no difference was observed for other parameters. The concentration of complement inhibitors was elevated in both groups. We conclude that, among readily available complement parameters, C2 and C3 provide the best assessment of disease activity in patients with SLE.


Coronary artery disease in Asians.

Coronary artery disease in Asians. From available studies, there appears to be a racial preponderance of coronary artery disease (CAD) among Indians when compared to other ethnic groups. We found that this racial difference exists even in a young Asian population with premature atherosclerosis. In this small series, these racial differences could not be explained by the commonly known risk factors for coronary artery disease--smoking, hypertension, diabetes and hypercholesterolaemia, findings similar to those found in older patients elsewhere. Only fasting triglyceride levels were significantly higher among young Indians compared to non Indians (p less than 0.02) although the importance of this finding as a risk factor for CAD remains controversial. The majority of these young patients were treated medically and their one year survival was good.