Biodistribution of ellagic acid and dose-related inhibition of lung tumorigenesis in A/J mice. Ellagic acid (EA), derived from fruit ellagitannins, is known to be antimutagenic and anticarcinogenic in various animal tumor models. In this study, EA at a dose of 4 g/kg diet inhibited multiplicity of tumors induced by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in A/J mice by 54%. This inhibition was dose related between 0.06 and 4.0 g/kg diet. In contrast, two related compounds, esculin and esculetin, had no effect on lung tumorigenesis. The biodistribution of EA was studied as a function of dose and time after gavage of EA. The levels of EA in the lung were directly proportional to the dose of EA between 0.2 and 2.0 mmol. The maximum level of EA, corresponding to 21.3 nmol/g, was observed 30 minutes after gavage with 2.0 mmol of EA/kg body wt, which corresponds to only 70 ppm of the administered dose. The levels in liver tissues were 10-fold lower and reached a maximum 30 minutes after gavage. At this interval, the blood level of EA was 1 nmol/ml. The inclusion of EA in cyclodextrin doubles the level of EA in lung tissues. These results demonstrate that EA localizes preferentially in lung tissues and confirm that EA administered orally can inhibit lung tumorigenesis.


The carcinogenicity of some antimalarial drugs using the Egyptian toad Bufo regularis as a biological test animal. Feeding Egyptian toads (Bufo regularis) with chloroquine and primaquine separately induced tumor formation in 14% and 19% of the animals, respectively. When chloroquine and primaquine were given in combination, the tumor incidence increased to 23.5%. Chloroquine feeding resulted in tumors located in the liver (lymphosarcomas) and primaquine in tumors in the kidney (histiocytic sarcomas). Toads fed chloroquine plus primaquine developed tumors in the liver, kidney, lung, and urinary bladder, and all the tumors were diagnosed as histiocytic sarcomas. It is speculated that one or more metabolites of chloroquine and primaquine (e.g., quinone) may be responsible for tumor induction in the toads.


Alcohol consumption and the etiology of colorectal cancer: a review of the scientific evidence from 1957 to 1991. The relationship between alcohol consumption and colorectal cancer in humans has been examined in 52 major studies in the past 35 years. An association was found in five of the seven correlational studies. An elevated risk was found in about half of the 31 case-control studies and, of these, in 9 of the 10 studies using community controls but in only 5 of the 17 studies using hospital controls (p = 0.008), suggesting that the absence of association when hospital controls are used is due to a high prevalence of alcohol consumption/alcohol-related illness in the hospital controls. Of the 14 cohort studies, an association with alcohol was found in 10, while in 3 of the 4 cohort studies in which an association was not found the alcohol data obtained were somewhat restricted. A positive dose-response effect was found in two of three cohort studies and in all four case-control studies with community controls in which this effect was examined. In both case-control and cohort studies, the association was found for females and males and for colon and rectal cancer. When the type of alcohol consumed was examined separately, beer was the principal type of at-risk alcoholic beverage, with much less risk for spirits and least risk for wine. Statistically significant elevations of risk were more often found in males than in females and slightly more frequently for rectal than for colon cancer and were related almost entirely to beer, rather than to wine or spirit, consumption. The alcohol risk was independent of the dietary risk in those studies that controlled for this factor. There was some confirmatory evidence for alcohol augmentation in rodent models of chemically induced carcinogenesis in six of nine studies. The hypotheses of alcohol as a direct and specific colorectal carcinogen include increased mucosal cell proliferation, the activation of intestinal procarcinogens, and the role of unabsorbed carcinogens, particularly in beer. Also, five of six other human studies showed an association between alcohol/beer consumption and adenomatous polyps, consistent with the hypothesis that alcohol stimulates the colorectal mucosa. General or indirect carcinogenic effects of alcohol include immunodepression, activation of liver procarcinogens, and changes in bile composition, as well as nitrosamine content of alcoholic beverages and increased tissue nitrosamine levels. With alcohol/beer consumption, the overall conclusion on present evidence is that alcohol, particularly beer consumption, is an etiologic factor for colon and rectal cancer for females and males.(ABSTRACT TRUNCATED AT 400 WORDS)


Use of a new fallback function to prevent endless-loop tachycardias: first clinical results. The Investigators of the Multicenter Study. The methods used for preventing endless-loop tachycardias (ELTs) most often consist of initiating a long postventricular atrial refractory period (PVARP) with the sensing of every event likely to induce ELTs, such as sensed premature ventricular contractions (PVCs). A new fallback function may be useful to prevent the initiation of ELTs. A window of atrial rate acceleration detection (WARAD) is initiated with the sensing of every sinus event and equals 75% of the preceding PP interval. If an atrial event is sensed during this period, as are premature atrial contractions (PACs), no atrioventricular (AV) delay is initiated, but an atrial pulse output is delivered and a subsequent 31-msec AV delay is started. Theoretically retrograde P waves are premature compared to sinus rhythm. They are therefore detected as PACs, and do not initiate AV delay, thus prohibiting the induction of ELTs. This function was tested in six patients, using external or implanted Chorus 2 pacemakers. Short PVARP (203 msec) and high atrial sensibility were programmed. Retrograde conduction was induced either by inefficient atrial pacing or a long programmed AV delay. Two different dual chamber settings were tested: dual chamber pacing with the fallback function On or Off. In every situation, the function proved effective in preventing ELTs: the number of tachycardia episodes went from 124 with the function programmed Off to 5 with the function programmed On for comparable durations. More than 75 ELTs effectively prevented by fallback have been recorded.


Acute renal failure in bone marrow transplantation. Acute renal failure (ARF) is a serious complication in clients who have undergone bone marrow transplantation (BMT). The majority of cases develop as a result of intrarenal damage. Renal ischemia or nephrotoxic drugs, free hemoglobin, and free myoglobin contribute to acute tubular necrosis (ATN), which is the most likely cause of ARF in BMT clients. Nursing care of hospitalized BMT clients is directed toward the prevention of ARF by identifying clients who are at risk, the early diagnosis of renal impairment, and the administration of comprehensive treatment. Nurses play a vital role in the early diagnosis of renal impairment by assessing the client's fluid status, serum and urine electrolyte levels, and daily weights. The nursing role in managing clients with ARF includes preventing drug nephrotoxicity, maintaining fluid and electrolyte balance, preventing infection, and providing emotional support.


Management of neutropenic enterocolitis in the patient with cancer. Neutropenic enterocolitis is a life-threatening condition often seen in patients experiencing prolonged periods of neutropenia from conditions such as leukemia and lymphoma and from aggressive chemotherapy regimens. Its exact pathologic process remains unclear; however, it has been proposed that direct cytotoxic damage occurs to the bowel mucosa with subsequent microbial invasion complicated by the lack of adequate neutrophil response. The damage may progress to bowel perforation and septic shock. Early recognition and management by healthcare team members are crucial for the improved prognosis of these individuals. Controversy continues to exist concerning management options and the timing of these interventions. This article outlines nursing and medical management of the patient with neutropenic enterocolitis.


Unconventional cancer treatments: professional, legal, and ethical issues. A significant number of patients with cancer use or seriously consider using unconventional treatments. When patients or their families seek or use unproven treatment methods, the oncology nurse may face complex professional, legal, and ethical issues. This article addresses the possible reasons why patients and families may choose unconventional treatments. Oncology nurses are challenged to become aware of their many and varied nursing responsibilities. These responsibilities are examined in light of applicable codes and nursing practice standards, the clinical situation, and the values that are unique to each patient and family. Guidelines are offered for the oncology nurse to assist patients and families in choosing among treatment options.


Diagnosis, treatment, and nursing management of the patient with hemochromatosis. Hemochromatosis results when the body's iron stores progressively increase. Surplus iron stored in body tissues leads to organ dysfunction and death. Warnings that elevated iron stores increase the risk of cancer development necessitate a review of this condition. Two types of hemochromatosis, hereditary and secondary, are diagnosed in today's hematology-oncology practices. Distinguishing the differences with respect to etiology and management is essential to the risk assessment and long-term nursing management of this patient population.


The relationship of visual acuity, tactile sensitivity, and mobility of the upper extremities to proficient breast self-examination in women 65 and older. The purpose of this study was to describe the relationship of visual acuity, tactile sensitivity, and mobility of the upper extremities to the performance of proficient breast self-examination (BSE) in women 65 and older. A convenience sample of 32 women, ages 66-89, met with the investigator to have their visual acuity, tactile sensitivity, and upper extremity mobility tested. Their ability to perform the visual, tactile, and upper extremity components of proficient BSE also was tested by using simulated breast models (SBMs). Thirty of the women had adequate visual acuity (< or = 20/40 Snellen equivalent) but were unable to visually detect the abnormalities on the SBM. Thirty of the women had tactile sensitivity of 10 mm (1 cm) or better on the static two-point discrimination test of the second, third, and fourth digits of each hand. Yet, only 13 of these women were able to locate the 1 cm lump; only 12 were able to locate the 5 mm lumps; and none were able to locate the 3 mm lump. The subjects' ability to pass the upper extremity mobility component of proficient BSE was significantly related to their ability to pass the upper extremity range of motion criteria. Limitations and deficits, mostly of the hands and shoulders, were revealed. When teaching BSE to older women, nurses are responsible for assessing limitations and deficits in their ability to perform proficient BSE and, if necessary, for intervening with alternatives. The need for further research in this area is indicated to improve assessment and education of older women regarding the use of proficient BSE for early detection of breast cancer.


Breast biopsy support program: collaboration between the oncology clinical nurse specialist and the ambulatory surgery nurse. Nurses play a vital role in the care of women admitted to an ambulatory unit for a breast biopsy. This paper offers one aspect of a psychosocial model that the oncology clinical nurse specialist and the ambulatory surgery nurse can use collaboratively to meet each woman's needs during this critical period. Goal-directed communications are the focus of this paper. Five specific techniques are described and can be used before biopsy reports are known, after women are informed that results are either negative or pending, and after reports are confirmed as positive. Psychosocial support is recognized as an important aspect of nursing care provided to women diagnosed with breast cancer. Although only 10% of women undergoing breast biopsies are diagnosed with malignant lesions, nurses must provide optimal support and guidance to every woman admitted for this surgical procedure.


The development and testing of a nursing model of morbidity in patients with cancer. Although oncology nurses are concerned about patient morbidity associated with cancer and its treatment, a comprehensive morbidity model from the perspective of nursing has yet to be developed. The purpose of this study was to begin to develop a morbidity model relevant to patients with cancer receiving treatment in the ambulatory care setting. The model was empirically tested with a sample of 100 patients with cancer beginning chemotherapy. Three domains emerged from the model: physiologic/pathophysiologic, functional, and psychological. Indices of morbidity within each domain were tested to establish beginning reliability and validity of the model. The results that were obtained indicate significant correlations among many of the indices within each domain (e.g., performance status, mood disturbance, patients' ratings of their current health); other indices did not contribute significantly to the model (e.g., type of cancer, history of recurrent disease, and patients' assessments of their health prior to developing cancer). Although further testing and refinement of the model is indicated, these preliminary findings reflect the model's potential for significant clinical relevance. By using this model, nurses could more readily profile patients at risk for increased morbidity and target their interventions accordingly.


Gastrointestinal tract cancer: current knowledge, medical treatment, and nursing management. Gastrointestinal (GI) cancer includes primary cancers of the esophagus, stomach, small intestine, large intestine, and rectum. This article presents an overview of the current knowledge, medical treatment, and nursing management for each of the identified sites, with a focus on surgical interventions and subsequent nursing care. Acute and long-term postoperative sequelae are addressed in addition to current state-of-the-art chemotherapeutic and radiation treatment modalities. This compilation of information regarding GI malignancies is useful for nursing as a current reference as well as for specific patient care issues.


Dentin permeability: sealing the dentin in crown preparations. Provisional restorations of full crown preparations may permit more microleakage of bacteria and their products than the final castings do. However, most investigations of the sealing qualities of cemented castings have reported that they too permit dye leakage. One approach to the problem is to seal the dentin with dentin bonding agents at the completion of the crown preparation. This study evaluated the ability of six different dentin bonding agents to seal the dentin of crown preparations of human teeth in vitro using two independent techniques. The first technique quantitated fluid filtration across dentin before and after treatment with dentin bonding agents at one hour, one day, one week, and one month and after thermocycling. The second method measured silver nitrate penetration of the thin veneers of dentin bonding agents into the dentin. Both methods correlated well with each other. The best seals were obtained with Prisma Universal Bond 2 or Superbond powder plus liquid. The worst seals were found using Gluma and Superbond liquid only. Clearfil PhotoBond, Amalgambond, and Scotchbond 2 gave intermediate results. Although the dentin bonding agents tend to accumulate on chamfers, thereby increasing their thickness to 200-300 microns, the method looks promising as a simple way to protect the pulp from the consequences of microleakage.


Leakage patterns associated with glass-ionomer-based resin restorations. This study compared microleakage patterns for glass-ionomer-cement-based resin systems with and without a separating agent placed between the glass ionomer and resin. Results indicated significant leakage (100%) at the dentin glass-ionomer interface for specimens without a separating agent. Those with a separating agent showed almost no leakage between the dentin and glass ionomer (10%) and some leakage at the resin/glass ionomer interface (40%). These results suggest that the forces of polymerization shrinkage are stronger than the chemical bond between glass-ionomer cement and dentin. This bond fails during resin polymerization, eliminating any supplementary retention gained through chemical adhesion to dentin and opening a pathway for microleakage.


Explorer sharpness as related to margin evaluations. Nine experienced operative dentistry faculty each used six different explorers of varying degrees of sharpness ranging from new to well-used to evaluate marginal acceptability on a device used to simulate gradations of vertical opening. In this study, the standard for the sharpest explorer point was determined to be 68 microns in diameter measured 40 microns from the tip. There was a positive correlation between the diameter of the explorer tip at 40 microns and the mean amount of opening that could be detected until the margin was declared unacceptable. Increased explorer dullness significantly handicapped even experienced graders when the explorer alone was used to evaluate visually inaccessible margins.


In vitro marginal leakage of cervical composite restorations lined with a light-cured glass ionomer. The purpose of this research effort was to investigate the microleakage of cervical restorations lined with a light-cured glass-ionomer liner. Wedge-shaped cervical cavities were cut on extracted teeth with the gingival cavosurface margin involving dentin. The cavities were randomly assigned to each of each of three groups: (1) restored with a microfilled composite resin, (2) restored with a light-cured glass-ionomer liner and microfilled resin as in the "sandwich" technique, and (3) restored entirely with the light-cured glass-ionomer liner. Half of the specimens in each group were thermocycled. Microleakage of these restorations was assessed by dye penetration. The results showed that differences were more pronounced at the gingival margin. Composite restorations inserted over the glass-ionomer liner demonstrated significantly less leakage than when the liner was not used.


Effect of grooves on resistance form of conservative Class 2 amalgams. This study evaluated several means of providing retention for the approximal box in very conservative class 2 preparations (occlusal isthmus width 0.7 mm). Sixty class 2 mesio-occlusal cavities were prepared in sound human maxillary premolar teeth. Four types of retention grooves, 0.3-0.5 mm deep, were prepared at the axiofacial and axiolingual line angles and/or occlusal to those line angles. Specimens were loaded at an angle of 13.5 degrees from vertical in an Instron Universal Testing Machine until the restoration failed. Results indicate that grooves located occlusal to the axiopulpal line angle provided more resistance than conventional grooves (gingival to the axiopulpal line angle) or no grooves. The use of a short retention groove or retention point located occlusal to the axiopulpal line angle, but not extending to the occlusal cavosurface margin, provided greater retention while removing minimal tooth structure.


The effect of multiple layers of die-spacer on crown retention. The application of die-spacer to crown preparation dies prior to the fabrication of the cast crown is an acceptable procedure to improve the fit of the restoration. Previous studies have shown that the retention of the restoration will be improved, unchanged, or reduced when an appropriate thickness of die-spacer is used. No studies have determined the effect on retention if excessive die-spacer is used. This study evaluated the effect of increasing die-spacer thickness on the retention of cast full crowns. Cast copings were fabricated on dies coated with either 0, 4, 8, 12, or 16 coats of die-spacer, cemented on the respective teeth, and removed using an Instron Universal Testing Machine. There were no statistically significant differences (P < or = 0.05) between the mean force required to remove the cemented copings. It appears that increasing the application of die-spacer up to 16 coats (151 micrometers) does not adversely affect the retention of cemented cast copings.


Placement and replacement of amalgam restorations in Italy. The reasons for placement and replacement and the longevity of amalgam restorations were recorded by 62 Italian private practitioners. The survey compiled 1935 amalgam restorations inserted due to primary caries (59%) and failed restorations (41%). The clinical diagnosis of secondary caries constituted 59% of failures of amalgam restorations. The age of 46% of the restorations needing replacement was noted. The median longevity was 4.7 years.


Effect of coating materials on restorative glass-ionomer cement surface. Historically glass-ionomer samples have been coated with a varnish to protect the material from the effect of water on the surface. However, varnishes have been shown to peel from this surface. The set cement matrix may become chalky and can erode rapidly. Light-cured glazing agents may demonstrate the ability to limit water movement across the setting-cement surface. In this in vitro study samples were investigated colorimetrically to evaluate the effect of water contamination. Perceivable differences were not found, particularly when a coating of light-cured bonding or glazing agents was applied. We conclude that the color stability of glass-ionomer cements is enhanced with the use of a protective coating of light-cured bonding or glazing agents.


Permeability of root dentin to epinephrine released from gingival retraction cord. The permeation of racemic epinephrine across roots of human molar crown segments was studied in vitro. Permeation was measured in the presence of cementum, with cementum removed (dentin exposed), and with and without dentin smear layers. Epinephrine was initially detected at 10 minutes and reached a steady state in 70 minutes. Epinephrine flux (the product of concentration and the flow rate per unit of dentin surface area) significantly increased when both the cementum and dentin smear layers were removed. The T1/2 (half-time in minutes necessary to reach steady-state diffusion) was zero with intact cementum and increased to approximately 40 minutes in dentin with and without smear layers. This study suggests that the permeation of epinephrine across root surfaces is prevented by the presence of cementum and retarded by the presence of dentin smear layers. Also, the data suggest that root dentin is another source of absorption when epinephrine-impregnated retraction cord is applied to the gingival sulcus.


Enhanced prosthetics using the gingival mask. The removal and trimming of working model dies destroys important soft tissue information. Features such as the gingival sulcus, interdental papilla, and ridge form are often destroyed. The loss of these features makes the fabrication of correct restoration contours difficult. Using the gingival mask will restore vital soft tissue as well as hard tissue information. This paper discusses the gingival mask, its advantages and disadvantages, and describes the direct and indirect methods of fabrication. Whatever method is employed, the gingival mask will prove to be a valuable adjunct for improving the quality and esthetic values of the fixed prosthesis.


Pharmacokinetics of low-dose methotrexate in adult asthmatics. Several reports have been published on the disposition of methotrexate (MTX) when given in low dosages, but none in asthmatic patients. To address this matter, pharmacokinetic studies were performed in nine patients with severe, steroid-requiring asthma (ages 18-76 yrs) after the sixth weekly intramuscular dose of MTX. Theophylline pharmacokinetic studies were also performed at baseline prior to the start of MTX treatment and at the time of the MTX studies. Total systemic clearance of MTX, given as mean (SD), was 122.6 (25.1) ml/minute, volume of distribution at steady state 0.49 (0.2) L/kg, half-life 3.1 (0.3) hours, mean residence time 5.0 (0.6) hours, and renal clearance 89.1 (36.3) ml/minute. These values are similar to those previously reported for other patient populations receiving low-dose MTX. Eight of these patients were evaluated for changes in theophylline pharmacokinetics. Theophylline clearance at week 6 decreased an average of 19% from baseline and correlated inversely with total MTX clearance. Percentage change in theophylline clearance from baseline was inversely correlated with MTX nonrenal clearance, but was not statistically significant. This finding may indicate competition for clearance pathways between MTX and theophylline.


Microleakage of Class 2 glass-ionomer-silver restorations in primary molars. The aims of this study were to assess microleakage at the cervical margins of class 2 "sandwich" restorations placed with two glass-ionomer-silver cements in primary molars, to compare the quality of the occlusal margins of these restorations to those prepared with Miracle Mix and Ketac Silver, and to assess by scanning electron microscopy (SEM) the marginal micromorphology of those restorations. Fifty-two class 2 restorations were prepared in extracted primary molars and were restored as follows: 1) Ketac Silver + Estilux Posterior (sandwich), 2) Miracle Mix + Estilux Posterior (sandwich), 3) Ketac Silver only, and 4) Miracle Mix only. No or minimal leakage was evident in most of the occlusal margins, whereas severe leakage was observed in almost 70% of the cervical margins of the Ketac Silver groups. Scanning electron microscopy evaluation demonstrated good adaptation at the buccal and lingual margins of all the restorations. Sixty-seven percent of the Miracle Mix restorations had no defects at the cervical margins, as opposed to only 17% of those with Ketac Silver.


Bacterial resistance to beta-lactams, and its prevention with combination antimicrobial therapy. The clinical and economic impacts of bacterial resistance are substantial. The development of bacterial resistance during a course of therapy often leads to clinical failure, prolonged hospitalization, increased morbidity, mortality, and increased health care costs. Resistance has been reported to occur most frequently with aminoglycosides, quinolones, and beta-lactam antimicrobials, and often occurs during the course of treatment of gram-negative bacillary infection. Resistance is most commonly due to enzymatic inactivation, permeability changes, or receptor mutation. Strategies for the prevention of resistance include appropriate infection-control practices, judicious use of antimicrobials, enhancement of host defenses, and the use of antimicrobial combinations. Despite success in vitro and in experimental animal models of infection, clinical trials in humans of antimicrobial combinations for the prevention of resistance have yielded mixed results. Use of the most potent agents available, preferably in bactericidal synergistic combinations, may be effective in preventing in vivo emergence of bacterial resistance.


In vitro evaluation of the use of resin liners to reduce microleakage and improve retention of amalgam restorations. This in vitro study evaluated the ability of three commercially available adhesive resins to reduce microleakage and provide retention between amalgam restorations and tooth structure. Results indicated that Amalgambond reduced leakage significantly more than Panavia EX, Prisma Universal Bond 2, and Copalite. In addition Amalgambond and Panavia EX exhibited the ability to bond amalgam to tooth structure. These results suggest that Amalgambond has the potential for serving successfully as a cavity liner with amalgam.


Stress analysis of five prefabricated endodontic dowel designs: a photoelastic study. The stress generated by five prefabricated endodontic dowel designs was evaluated using a two-dimensional photoelastic model. Cemented posts caused the least stress. Of the threaded posts, Flexi-post and Radix Anker produced the least stress; Kurer Crown Anchor produced the most.


Nonprescription ibuprofen: side effect profile. Single doses of nonprescription analgesics are commonly used to treat self-diagnosed conditions. To evaluate the safety of single doses of nonprescription-strength ibuprofen, we examined reported side effects from 15 double-blind, randomized, controlled trials we conducted of the drug to treat various common painful conditions (e.g., headache, sore throat). All studies included placebo and another nonprescription analgesic, acetaminophen. A total of 878 subjects received ibuprofen 200 or 400 mg, 849 acetaminophen 650 or 1000 mg, and 852 placebo. The overall frequency of side effects was comparable: ibuprofen 2.4%, acetaminophen 3.2%, and placebo 2.1%. The frequency of central nervous system symptoms was 0.8%, 2.1%, and 0.9%, respectively. Upper gastro-intestinal upset ranged from 0.8-0.9% of subjects in all groups. We conclude that single doses of nonprescription ibuprofen are well tolerated and demonstrate a side effect profile indistinguishable from that of acetaminophen and placebo.


Regional variation in permeability of young dentin. Variation in the permeability of dentin in people 19 years and less in age was evaluated. The regions compared were the occlusal third versus the middle third versus the cervical third of approximal surfaces. Also compared were the mesial approximal surface versus the distal. The comparison was done by obtaining 1 mm-thick dentin discs from the area of dentin close to the dentinoenamel junction. It was seen that the cervical area was significantly more permeable than the occlusal area. The middle third, though not statistically significant, had mean values almost twice those in the occlusal third and almost half of the values in the cervical third. No difference was seen in permeability between the mesial and distal surfaces. The reasons for these regional variations and their clinical implications are presented.


Exacerbation of congestive heart failure secondary to moricizine. Moricizine, a recently approved phenothiazine antiarrhythmic agent, is reported to be associated with a low frequency of congestive heart failure. A 61-year-old man with a history of congestive heart failure and ischemic heart disease began taking moricizine 250 mg every 8 hours to suppress his monomorphic sustained ventricular tachycardia. After five doses he became progressively short of breath and was in pulmonary edema. Moricizine was discontinued, intravenous diuretics were administered, and the patient's clinical status stabilized. Twelve hours later, however, he developed polymorphic ventricular tachycardia and was not successfully resuscitated. Despite claims as to its safety, limited data strongly suggest that moricizine, like other antiarrhythmics, may be detrimental in patients with preexisting ventricular dysfunction, and should be prescribed with caution.


Placement and replacement of resin-based composite restorations in Italy. The use of resin-based composite restorations, the reasons for failure, and the longevity of these restorations have been surveyed in 62 Italian private practices. Almost two-thirds of the 1025 restorations inserted were class 3 and 5 restorations, while 18% were class 1 and 2 restorations. Secondary caries was the most common reason reported for replacement of resin-based composite restorations (44%), followed by discoloration (21%), and bulk and margin fracture (14%). The age of restorations needing replacement was reported for 53% of the sample. The median longevity in this sample was calculated to be 3.3 years.


Theophylline-mexiletine interaction: a case report. Theophylline and mexiletine can be prescribed in patients with chronic obstructive pulmonary disease with coexistent arrhythmias. The drugs have common metabolic pathways that may result in an interaction. A patient who was taking theophylline became toxic after the initiation of mexiletine. Discontinuation of mexiletine led to an improvement in theophylline clearance.


Structural and functional characterization of neuropeptides involved in the control of male mating behavior of Lymnaea stagnalis. Mating as a male in the simultaneous hermaphrodite freshwater snail, Lymnaea stagnalis, comprises a series of complex behaviors that are a prelude to copulation. Copulatory behavior itself is assumed to be controlled by various types of peptidergic neurons as well as serotonergic cells. Here we report the primary structure of two peptides that were extracted from a cluster of neurons that innervates the penial complex and that is located in the anterior lobe of the right cerebral ganglion. The sequences of the peptides were determined as: Ala-Pro-Gly-Trp-amide and Ser-Gly-Ser-Asp-Tyr-Cys-Glu-Thr-Leu-Lys-Glu-Val-Ala-Asp-Glu-Tyr-Ile-Leu- Leu- Ser-Tyr-Lys-Ile-Glu-Glu-Gln-Arg-Ala-Ala-Asp-Cys-Gly-Gly-Glu-Pro-Pro-Asn- Ser- Gln(amide), respectively. The longer peptide is a homodimer. Both peptides are processed from the recently identified Ala-Pro-Gly-Trp-amide prohormone, which is expressed in the neurons of the anterior lobe of the right cerebral ganglion. Ala-Pro-Gly-Trp-amide could also be recovered from the penial complex. This peptide, when applied in vitro, inhibits the contractions of the penis retractor muscles evoked by serotonin in a dose-dependent fashion.


Isolation of peptides arising from the specific posttranslational processing of chromogranin A and chromogranin B from human pheochromocytoma tissue. An extract of human adrenal medullary pheochromocytoma tissue was fractionated by gel permeation chromatography, and peptides of major abundance in the approximate molecular mass range 1000-4000 were purified to apparent homogeneity by reverse phase HPLC. Determination of the primary structures of four such peptides demonstrated that they were fragments of either chromogranin A or chromogranin B. The peptide WSKMDQLAKELTAE represents chromogranin A(324-337), the peptide LGELFNPYYDPLQWKSSHFE represents chromogranin B(498-517), the peptide NLARVPKLDL represents chromogranin B(568-577), and the peptide QYDRVAQLDQLLHY (isolated as the N-terminal pyroglutamyl derivative) represents chromogranin B(580-593). Analysis of the nucleotide sequences of cDNAs complementary to human chromogranin A and B messenger RNAs indicates that each of these peptide sequences is flanked by pairs or groups of basic residues, suggesting that these fragments are the products of specific posttranslational processing. In addition, a peptide identified as chromogranin B(496-517) was isolated from extract. This component represents the product of incomplete proteolytic cleavage at the Lys494-Arg495-Lys496-Arg497 processing site in chromogranin B. A minor component in the extract was identified as chromogranin B(508-517), but this component probably represents an artifact of the extraction procedure arising from the hydrolysis of the acid labile Asp507-Pro508 bond. The study has shown that chromogranin A and B in pheochromocytoma tissue function as the precursors of several small peptides that may have a regulatory role.


Immunohistochemical localization of delta sleep-inducing peptide (DSIP) in the brain and pituitary of the cartilaginous fish Scyliorhinus canicula. The distribution of delta sleep-inducing peptide (DSIP) in the brain and pituitary of the cartilaginous fish Scyliorhinus canicula was investigated using the indirect immunofluorescence technique. Delta sleep-inducing peptide-like immunoreactive cell bodies were mainly observed in the nucleus lateralis tuberis of the hypothalamus. Immunolabeled perikarya were also distributed in the nucleus lobi lateralis hypothalami and in the dorso-lateral wall of the recessus posterioris. Most of these cells, located in the subependymal layers of the infundibulum and lateral lobes, had the typical aspect of cerebrospinal fluid-contacting elements. The DSIP-like immunoreactive fibers were localized in the basal telencephalon, within the regions of the nucleus interstitialis commissurae anterioris and the nucleus entopeduncularis. A dense network of DSIP-positive fibers was seen throughout the midcaudal hypothalamus, the lateral lobes, and the posterior lobe. In the pituitary, numerous DSIP-like immunoreactive cells were detected in the median lobe of the pars distalis. In particular, a high concentration of cells was seen in the dorsal wall of the median lobe, an area which is known to contain melanin-concentrating hormone (MCH)-producing cells. Comparison of the distribution of DSIP- and MCH-like immunoreactive cells revealed that the two neuropeptides are stored in the same cells of the median lobe of the pituitary. These findings provide the first evidence for the presence of a DSIP-related peptide in fish. The distribution of the immunoreactive material supports the view that DSIP may act as a neuromodulator and/or a hypophysiotropic factor. Moreover, the presence of DSIP-like immunoreactive cells in the pars distalis suggests that this peptide may exert autocrine or paracrine effect in the pituitary.


Bombyxin-II and its disulfide bond isomers: synthesis and activity. Bombyxin-II, an insulin superfamily peptide of the silkmoth Bombyx mori, and its disulfide bond isomers have been synthesized by two ways of stepwise, semi-regioselective disulfide bond formation. The disulfide bond CysA20-CysB22 or CysA7-CysB10 was formed first, and then the two other disulfide bonds were formed by iodine oxidation. The conditions for the iodine oxidation were improved to suppress oxidative degradation of unprotected Trp residues. With these conditions, bombyxin-II was synthesized in high yields (26% and 32%). Its disulfide bond isomers were also obtained. Specific activity of the products indicates that the disulfide bond CysA20-CysB22 is important to the bombyxin activity.


Fluorescent N-methylanthranilyl (Mantyl) tag for peptides: its application in subpicomole determination of kinins. Highly fluorescent N-methylanthranilyl (Mantyl) peptide derivatives were prepared by a one-step reaction with N-methylisatoic anhydride (MIA) for quantitative detection in HPLC. Reactions were carried out in an organic medium of acetonitrile-triethylamine, in aqueous alkaline sodium carbonate and sodium phosphate buffers. 4-Dimethylaminopyridine (DMAP) catalyzed specific mantylation of -NH2 groups of peptides in the organic reaction medium. The DMAP had no effect in the aqueous buffered reaction systems. Proline amino-terminal peptides reacted equally well with MIA. Mantyl-bradykinin had excitation and fluorescence maxima at 350 nm and 426 nm in water and water/acetonitrile (ACN)/trifluoroacetic acid (TFA) solvent mixtures, respectively. Fluorescence intensity increased with an increase in ACN concentration and decreased with an increase in acid content. Mantyl kinins were completely resolved on a C18 reversed phase HPLC column using an ACN-0.1% TFA gradient and their behavior on the column was similar to having an extra amino acid. Di-Mantyl derivatives obtained with Lys-BK and Met-Lys-BK did not exhibit fluorescence appreciably higher than Mantyl-BK. Fluorescence detection of Mantyl kinins was about 50-100 times more sensitive (lower limits of 0.1 to 0.5 picomole) than UV detection of the phenylisothiocyanate-derivatized kinins under typical HPLC conditions.


Insulin in the vitreous of the normal and streptozotocin-induced diabetic rat. Insulin has been detected by ELISA in the vitreous of the normal and streptozotocin-diabetic rat at levels for both about 1% of those in serum. 131I-labeled insulin, administered to conscious rats via an indwelling cannula in the right atrium, was found to cross the blood-ocular barrier into the vitreous. Autoradiographic gel analysis showed the peptide was transferred as an intact molecule. Vitreous insulin levels reflected serum levels as seen in relatively constant vitreous-to-serum insulin ratios over a wide range of serum insulin concentrations. The rate of blood-to-vitreous passage of insulin was about the same in normal as in diabetic rats (fasting serum glucose greater than or equal to 21 mM). At least a portion of vitreous insulin is therefore of pancreatic origin, and retinal tissue in the normal and diabetic animal is thus accessible to circulating hormone. The blood-ocular barrier is unaltered in streptozotocin diabetes with regard to insulin passage.


Distribution and coexistence of urotensin I and urotensin II peptides in the cerebral ganglia of Aplysia californica. Urotensin I (UI) and urotensin II (UII) were demonstrated in the cerebral ganglia of Aplysia californica by applying immunocytochemical and radioimmunoassay procedures. Sequential analysis of adjacent sections of the cerebral ganglia of Aplysia demonstrated that the UI-immunoreactive (UI-IR) neurons of the F cluster of the cerebral ganglia also contained UII immunoreactivity (UII-IR). Both UI-IR and UII-IR were also observed in a cuff-like arrangement of fibers surrounding the proximal portion of the supralabial nerve, as well as in a few fibers in the anterior tentacular nerves. The UI-IR perikarya of the cerebral ganglia appeared to project to the entire CNS of Aplysia, but the UII-IR fibers appeared only in the neuropile and commissure of the cerebral ganglia. The UI-IR staining was abolished by previous immunoabsorption of the UI antiserum with sucker (Catastomus commersoni) UI, but not with ovine corticotropin-releasing factor (CRF), rat/human CRF, or goby (Gillichthys mirabilis) UII. Immunostaining with UII antiserum was quenched by goby UII, but not by sucker UII-A, UII-B, UII-A(6-12), or carp (Cyprinus carpio) UII-alpha and UII-gamma. The UII staining was not abolished by UI or somatostatin. The F cluster was not stained when a somatostatin antiserum was applied. Radioimmunoassay of dilutions of cerebral ganglia extract, using UII antiserum, revealed a parallel displacement curve to synthetic goby UII.(ABSTRACT TRUNCATED AT 250 WORDS)


Catabolism of rat growth hormone-releasing factor(1-29) amide in rat serum and liver. Clinical and veterinary uses of growth hormone-releasing factor [GRF(1- 29)NH2] require the design of analogs that are resistant to proteolysis by serum and liver degrading enzymes. This study investigated rat GRF(1-29)NH2 processing in serum and liver homogenate by means of high pressure liquid chromatography (HPLC). Synthetic rGRF(1-29)NH2 (30 microM) was incubated (0-120 min, 37 degrees C) in serum (49 +/- 8 mg prot./ml). The rGRF(1-29)NH2 (10 microM) was also incubated (0-120 min, 37 degrees C) with liver homogenate (200 +/- 6 micrograms prot./ml). Time course studies of rGRF(1-29)NH2 disappearance showed apparent half-lives of 18 +/- 4 min and 13 +/- 3 min in serum and liver homogenate, respectively. This was accompanied by the appearance of degradation products that were all less hydrophobic than the native peptide. In the serum, two major metabolites were detected and isolated by preparative HPLC. Combined results of amino acid analysis, sequencing, and chromatography with synthetic homologs revealed the presence of rGRF(1-20)OH and (3-20)OH. A small amount of rGRF(12-29)NH2, coeluting with rGRF(3-20)OH, was also found by sequencing. In the liver, rGRF(1-18)OH, (3-18)OH, and (1-10)OH were identified. The peptide bond Ala2-Asp3 (DPP IV cleavage site) was hydrolyzed in both serum and liver. Other tissue-specific cleavage sites were Arg11-Arg12 and Arg20-Lys21 (trypsin-like cleavage site) in the serum, and Tyr10-Arg11 and Tyr18-Ala19 (chymotrypsin-like cleavage site) in the liver.(ABSTRACT TRUNCATED AT 250 WORDS)


A comparison of the effects of mesencephalic injections of neurotensin(1-13) and neuromedin N on brain electrical self-stimulation. Neuromedin N (NM-N), a hexapeptide that shares a four amino acid C-terminal homology with the tridecapeptide, neurotensin (NT), has been suggested as a potential neurotransmitter or neuromodulator that could interact with the NT-sensitive receptors. In this experiment, we compared the effects of an equimolar concentration of NM-N and NT(1-13) injected in the ventral tegmental area (VTA) on brain electrical self-stimulation (SS), a behavior previously shown to be potentiated by VTA injections of NT(1-13). Rats implanted with a stimulating electrode in the mesencephalic central gray and a guide cannula in the VTA were trained to lever press to obtain rewarding electrical stimulations. Functions relating the rate of lever pressing to the stimulation frequency were determined, on separate daily tests, before and after the injection of 3 nmol of NM-N, NT(1-13), or an equal volume of saline vehicle. At this concentration, both NM-N and NT(1-13) produced a significant facilitation of SS when compared to saline vehicle, an effect that was not seen when the peptides were injected outside the VTA. The facilitation of SS by NM-N, however, was much weaker and of a shorter duration than the one produced by NT(1-13). The shorter time course and the weaker behavioral effect of NM-N compared to NT(1-13) are consistent with its lower potency at the NT receptor and its faster rate of enzymatic degradation in the VTA, and suggest that NM-N potentiated the reward-relevant neural signal by acting on mesencephalic NT receptors.


Insulin deficiency is a specific stimulus to hypothalamic neuropeptide Y: a comparison of the effects of insulin replacement and food restriction in streptozocin-diabetic rats. Untreated insulin-deficient diabetes causes hyperphagia and neuroendocrine disturbances that may be partly mediated by increased hypothalamic activity of neuropeptide Y (NPY), a potent central appetite stimulant. The metabolic signal that stimulates hypothalamic NPY is unknown. This study aimed to determine whether insulin deficiency or hyperglycemia was responsible. Regional hypothalamic NPY concentrations were compared in streptozocin-diabetic (STZ-D) rats rendered nearly normoglycemic by either insulin replacement or food restriction. Untreated STZ-D rats were hyperphagic and showed significantly increased (p less than 0.01) hypothalamic NPY concentrations in the arcuate nucleus and lateral hypothalamic area. Once-daily ultralente insulin injections corrected hypoinsulinemia and hyperglycemia, abolished hyperphagia, and normalized NPY concentrations in all hypothalamic regions. By contrast, food restriction effectively lowered glycemia without raising insulin levels. In these underfed diabetic rats, NPY concentrations rose further and were significantly higher than nondiabetic and untreated diabetic levels in most hypothalamic regions. We conclude that insulin deficiency is a major stimulus to hypothalamic NPY in STZ-D, whereas hyperglycemia may exert an inhibitory influence. These findings support the hypothesis that hypothalamic NPY responds to specific metabolic cues and is involved in regulating energy balance and conserving body weight.


Expression of angiotensin II AT2 receptors in the rat skin during experimental wound healing. We localized and characterized angiotensin II AT1 and AT2 receptors in the skin of 2-week-old rats during experimental wound healing. Both AT1 and AT2 were present in the skin. Three days after wounding, the expression of angiotensin II receptors was significantly enhanced in the dermis as well as in a localized band within the superficial dermis of the skin surrounding the wound. The major proportion of this increase was due to angiotensin II AT2 receptors. Our results suggest a physiological role for AT2 receptors in the process of tissue repair.


Synthesis and biological activity of novel C-terminal-extended and biotinylated growth hormone-releasing factor (GRF) analogs. A series of novel hGRF(1-29)-NH2 analogs were synthesized and biotinylated. The immunological and biological activities of these analogs were then characterized. To distance the biotin moiety from the putative bioactive core, a C-terminal spacer arm consisting of -Gly-Gly-Cys-NH2 (-GGC) was added to hGRF(1-29)-NH2 (hGRF29) and analogs, with subsequent biotinylation performed at the cysteine residue. Neither addition of the C-terminal spacer arm nor biotinylation affected affinity of these analogs for GRF antibody. Relative to hGRF(1-44)-NH2 (hGRF44: potency = 1.0), the biotinylated analogs were equipotent in vitro to their nonbiotinylated, parent compounds: [desNH2Tyr1,D-Ala2,Ala15]hGRF29-GGC-(tpBiocyt in)-NH2 (4.7) = [Ala15]hGRF29-GGC-(tpBiocytin)-NH2 (3.9) greater than hGRF29-GGC-(tpBiocytin)-NH2 (0.8). Based upon cumulative GH release data in vivo (0-60 min postinjection), [desNH2Tyr1,D-Ala2,Ala15]hGRF29-GGC-(tpBiocyt in)-NH2, [Ala15]hGRF29-GGC-(tpBiocytin)-NH2, and hGRF29-GGC-(tpBiocytin)-NH2 displayed 8.6, 5.5, and 0.8 times, respectively, the potency of hGRF44. These in vivo potency values were not significantly different from the corresponding parent compounds (i.e., with or without the C-terminal spacer arm). In summary, biotinylated hGRF analogs have been developed that retain full immunoreactivity and potent bioactivity (in vitro and in vivo), thus permitting their use in GRF receptor isolation, ELISA, and histochemical procedures.


Role of tyrosine kinases in bombesin regulation of gastric mucosal proliferative activity in young and aged rats. In vivo and in vitro experiments were performed to examine the responsiveness of the gastric mucosa to the growth-promoting action of bombesin in young (4 months) and aged (22 months) Fischer 344 rats. In addition, the role of tyrosine kinase (Tyr-K) in regulating this action of bombesin was also examined. In young rats, infusion of bombesin (300 ng/kg/h) by osmotic minipump for 2 weeks resulted in a significant 100% increase in mucosal DNA synthesis and ornithine decarboxylase (ODC) activity. These increases were accompanied by a 32% (p less than 0.025) rise in gastric mucosal overall Tyr-K activity and a 71% (p less than 0.001) increase in Tyr-k activity associated with pp60c-src, when compared with the corresponding controls. The bombesin-induced stimulation of pp60c-src Tyr-k activity was also associated with a 25% increase in phosphorylation of this protein. In contrast, in aged rats, none of these parameters were affected by bombesin. A similar phenomenon was also observed when mucosal explants from young and aged rats were exposed to bombesin in an organ culture system. Exposure of gastric mucosal explants from young, but not from aged, rats to 10(-8) M bombesin for 8 h resulted in a 300% (p less than 0.001) increase in ODC activity, a 150% (p less than 0.001) rise in Tyr-k activity, and a marked increase (400-600%) in tyrosine-specific phosphorylation of three membrane proteins with M(r) of 55, 44, and 41 kDa, when compared with the corresponding controls. However, these increases were totally abolished by genistein, a specific irreversible inhibitor of Tyr-k.(ABSTRACT TRUNCATED AT 250 WORDS)


Endorphins do not affect behavioral stress responses in mice. Effects of endorphins on behavioral stress responses were investigated in mice. For this purpose, we used environment-induced conditioned suppression of motility and forced swimming-induced immobility. The cerebral ventricular administration of alpha-endorphin (2.5-10 nmol), beta-endorphin (0.38-1.5 nmol), or gamma-endorphin (2.5-10 nmol) failed to affect either the environment-induced conditioned suppression of motility or the forced swimming-induced immobility. We have indicated previously that enkephalins attenuate both stress responses and, in contrast, dynorphin potentiates them. These findings indicate that the endorphinergic systems are not responsible for behavioral stress responses and that the role played by endorphins in the present stressful situations may be different from that of enkephalin and dynorphin.


Localization of neurokinin B in the central nervous system of the rat. The distribution of neurokinin B (NKB) was determined by immunocytochemistry with antisera directed toward its amino terminus. Immunoreactive perikarya were detected in the main and accessory olfactory bulbs, cortical regions, the olfactory tubercle, the bed nucleus of the stria terminalis, the diagonal band of Broca, the nucleus accumbens, the septum, the neostriatum, several hypothalamic nuclei, the superior colliculus, the central gray, the substantia nigra, the medullary reticular formation, and the external cuneate nucleus. The distribution of NKB-containing perikarya revealed by immunocytochemistry was similar to the distribution of protachykinin B-containing cells previously visualized by in situ hybridization. Immunoreactive nerve fibers and terminals were detected in all major subdivisions of the brain. The levels of NKB measured by radioimmunoassay were highest in the hypothalamus. The distribution of NKB in the rat brain was similar to the distribution of substance P; however, there were several regions where the two distributions were clearly different.


Neuropeptide Y, peptide YY, and pancreatic polypeptide modulate duodenal and colonic motility at a thoracic spinal site in rats. Neuropeptide Y, PYY, and PP (200 pmol) alter intraluminal pressure in the duodenum and colon of rats following their administration into the thoracic (T8-T10) region of the spinal cord. Neuropeptide Y decreases the tone of the duodenum and the colon following intrathecal (T8-T10) administration prior to an increase in tone to baseline or greater. There is no effect on intraluminal pressure of either the duodenum or the colon following intrathecal administration of NPY or PP into the lumbar (L4-L5) region of the spinal cord. Following intrathecal (T8-T10) administration of PYY and PP, increases in intraduodenal pressures are observed (+2.1 and +3.0 mmHg from saline baseline). Phasic contractions of the duodenum are increased following intrathecal administration of PYY into the thoracic spinal cord of rats. Neuropeptide Y, PYY, and PP increase intracolonic pressure +2.2, +3.3, and +3.7 mmHg from saline baseline, respectively. Phasic contractions of the colon are increased following PP intrathecal thoracic administration. Responsiveness of the duodenum or colon to the different ligands of the PP-fold peptide family in the absence of alpha-adrenergic blockade did not vary. The increases in intraluminal pressure of the duodenum and colon following intrathecal administration of the PP-fold peptides are attenuated by both alpha-1 adrenergic (prazosin) and alpha-2 adrenergic (yohimbine) blockade. There is a difference in responsiveness of the colon between the ligands of the PP-fold family in the presence of the alpha-2 adrenergic blockade. The findings of this study indicate that duodenal and colonic motility are modulated by the PP-fold peptides at thoracic spinal sites via alteration of sympathetic outflow.


Behavioral responses elicited by intraperitoneal neurotensin in guinea pigs. The potential behavioral responses to single intraperitoneal (IP) injection of neurotensin (NT) were examined in conscious, freely moving guinea pigs. Most animals injected with NT solvent (i.e., controls) or NT solution with low NT concentration (i.e., 5.4 nM) exhibited little or no particular behavioral reaction. On the other hand, 50 to 75% of the animals given IP injection of NT with 54, 540, or 5400 nM of NT exhibited motor responses characterized by a transient episode of clonic body jerks. Vocalization responses were observed in less than 25% of the animals given IP NT. Animal pretreatment with morphine reduced the incidence of motor and vocalization responses. The results were interpreted as an indication that IP injection of moderately concentrated NT solution (i.e., greater than or equal to 54 nM) is probably a weak noxious stimulus in conscious guinea pigs.


[Epidemic focus of non-A, non-B viral hepatitis in a plasmapheresis unit]. Non-A, non-B hepatitis has been diagnosed in 12 blood donors in a plasmapheresis unit. The course of the disease has been symptomatic, accompanied by jaundice, fatigue, and nausea in 8 cases, and subclinical in the remaining 4 patients. Nine patients were followed-up to 2 years and only 2 patients liver biochemical tests were normalized permanently. The biopsies performed, a year after the acute phase of hepatitis period revealed chronic active disease in patients, chronic persistent hepatitis in 2 patients, acute hepatitis in one, and normal liver in one patient. Repeated liver biopsies, performed one year later, have basically shown similar lesions except one patient in whom chronic active hepatitis progressed to incipient liver cirrhosis. No symptoms of the disease have been usually noted in patients with chronic form of the disease, and liver function tests have occasionally been normal.


[Plasmapheresis in the treatment of hepatic coma]. Fourteen patients, including 6 with viral hepatitis B and 8 with liver cirrhosis were treated with plasmapheresis for hepatic coma. Altogether 29 plasmaphereses were carried out. Complete recovery was achieved in one patient with viral hepatitis B and in 3 patients with liver cirrhosis. Plasmapheresis should be performed in patients with severe lesions to the liver. Classification of patients to the treatment should include clinical examination, biochemical and enzymatic tests, and evaluation of liver reserve with isotope hepatography. In case of the acute poisoning with hepatotoxic agents indications to plasmapheresis should be evaluated from the toxicologic point of view.


[Hepatitis B among drug addicts].

[Hepatitis B among drug addicts]. In the years 1980-1988 twenty five drug addicts were identified among 1841 patients hospitalized for acute hepatitis in the Dep. of Hepatology at the Institute of Infectious and Parasitic Diseases in Warsaw. 15 drug addicts had hepatitis B and 10 had hepatitis A. It was found, that the course of acute type B hepatitis was milder in drug addicts, than among control group consisting of non-addicts.


[Hepatitis B virus infection in alcoholics]. Chromosomal analysis has been carried out in 4 patients with the symptoms of hepatic coma. An analysis included lymphocytes cultured from peripheral blood. Chromosomal disorders have been assessed with two techniques: structural chromosomal aberrations test, and sister chromatid exchange (SCE) test. It has been shown that the extend of chromosomal damage in the form of the gaps, breaks, acentric chromosomes as well as the presence of ring and dicentric chromosomes, and micronuclear cells have been higher in the examined patients. Such changes may evidence DNA repair disorders, and the presence of micronuclear forms may seem an unfavourable prognosis.


[Plasmapheresis in the treatment of hepatic coma complicating viral hepatitis]. Therapeutic plasmaphereses using CS 3000 Fenwal Cell Separator were performed in 4 women and 2 men, aged between 17 and 44 years, with hepatic coma complicating acute viral hepatitis type B. One to four plasma exchanges per patient were performed, usually at the volume of 3000 ml per procedure. Two patients at II and IVa period of the coma, according to Aboun classification, survived. Four patients at II, III and two at III/IV period of the coma died. The authors suggest that in some cases exchange of large volumes of plasma in the treatment of hepatic coma complicating acute viral hepatitis may be a lifesaving procedure.


[Evaluation of cellular and humoral immunity in men after occupational exposure]. Hundred twenty seven adult men have been examined to determine an effect of the occupational exposure to lead on the immunity. A group of 77 men occupationally exposed to lead absorbed by respiratory has been selected on the basis of the determination of exposure to lead in their working places, detection of lead deposits and its metabolites in the body. Fifty men constituted a control group. They were exposed to lead corresponding to an exposure of general population. Immunological studies have shown that high lead levels in the occupational environment produced significant disorders in all stages of both types of immunological response--a decrease in the cellular and humoral immunity.


[Brain stem insufficiency in acute ischemia and cerebral hemorrhage]. Consciousness disorders are closely related to the general dysfunction of the brain stem, and called by some authors brain stem insufficiency. To evaluate the degree of brain stem dysfunction, an original scale has been elaborated. Each group of brain stem functions are scored. Consciousness being the most important symptom of the brain stem insufficiency is scored about 50% in a 63-score scale. Scores are used to achieve the most objectivity in the clinical monitoring of the brain stem insufficiency. Its utility was examined in 75 patients with either ischemia or cerebral hemorrhage. Patients of both groups with severe insufficiency below 33 scores and persisting over 24 hours had no chance to survive. The authors suggest that the scores may successfully be used in the clinical monitoring of all disorders producing consciousness disturbances. Survival of patients with brain stem insufficiency in the course of cerebral ischemia or hemorrhage depends on the degree and duration of the brain stem insufficiency.


[Cerebral infarction--a general-medical problem]. A knowledge of events accompanying the acute coronary failure may help understanding the acute cerebral blood flow insufficiency leading to brain infarction. Cerebral blood flow should be treated as an integral part of the systemic blood circulation. It is of importance when the disease produces lesions to the vascular wall, and the brain looses its autoregulation functions. In such a situation every extracerebral disorders--even slight--may produce extensive lesions to nervous tissue. Therefore, the treatment of the acute cerebral circulation failure requires proper functioning of all factors which may affect hemodynamics and tissue metabolism. Duration of cerebral flow disorders plays an important role in the avoidance of unfavourable complications such as brain infarction. Therefore, every physician is obliged to undertake any possible actions preventing such complications.


[Physical activity in acute cerebrovascular insufficiency]. It was noted that physical activity of 1052 patients hospitalized for the acute cerebral flow failure due to atheromatosis is an important indicator of the cerebral ischemia. Extension of ischemia evaluated on the basis of physical activity enables to foresee possible improvement and survival. Authors' own classification of physical activity may be helpful in the monitoring of cerebral flow failure therapy.


[Diagnosis of progressive open internal hydrocephalus in patients after cranio-cerebral injuries and subarachnoid hemorrhage]. Late internal hydrocephalus has been diagnosed in 68 (44%) out of 154 patients treated for the ruptured cerebral aneurysms, and in 37 (31%) out of 120 patients, who underwent cranio-cerebral trauma. To establish the indications for shunts, CT scans of the skull, tomoventriculography, and infusion tests have been carried out in 38 patients. It has been found, that increased transparency of the areas below cerebral ependyma, the lack of cerebral cortex sulci, and imaging of the temporal horns together with internal hydrocephalus in CT scans indicate an active process and are indications to shunting. If there are no signs of active process in CT scans despite of the presence of hydrocephalus, tomoventriculography should be performed to establish more fully the indications to shunting.


[Accidental fatal poisoning with ethyl fluoroacetate]. Fluoroacetic salts belong to the most toxic chemicals. They are used for various purposes, and form stable compounds in some plants. A case of poisoning with ethyl fluoroacetate is presented in detail. Diagnostic problems and therapy which failed due to the late diagnosis and dramatic progress in the symptoms of poisoning are also discussed. Fluoroacetic ion alone is non-toxic but in vivo forms fluorotricarboxylic acid, which blocks cellular metabolism at the citrate stage. Symptoms occur with a delay but lethal synthesis of fluorotricarboxylic acid leads to the irreversible cellular dysfunction, especially in CNS and circulatory system. Poisoning may be treated with monoacetin and acetamide. An emphasis is on health hazards resulting from the exposure to fluoroacetate and necessity to observe strictly safety regulations.


[The number and affinity of fibrinogen receptors in blood platelets of patients with ischemic stroke]. Parameters of fibrinogen binding with blood platelets (number of receptors and their affinity) have been studied in patients with ischemic stroke. Due to the increased platelet ability to aggregate in the ischemic diseases such studies seem helpful. The studies involved 13 patients with ischemic stroke. Blood platelets collected from younger patients (under 50 years) possessed significantly higher number of receptors binding fibrinogen than blood platelets of healthy individuals (p less than 0.02). These receptors significantly more strongly bound ligand than those in the control group (p less than 0.05), and in the group of older patients with stroke (less than 0.05). Fibrinogen binding to blood platelets in patients over 50 years of age did not differ significantly from that in the control group. These results may indicate, that the increased platelet aggregation might be a significant pathogenic factor of the stroke in younger patients.


[Calcitonin level in cerebrospinal fluid of patients with amyotrophic lateral sclerosis]. Several data indicate that the dysfunction of some neuropeptide function may play a role in the pathogenesis of the amyotrophic lateral sclerosis. Therefore, the authors decide to determine a concentration of one of them in CSF, namely calcitonin. Calcitonin is widely distributed in CNS, including both anterior and posterior horns of the spinal cord. It was confirmed with immunohistochemical assays and an examination of the human CSF. Calcitonin concentration in CSF has been assayed in 12 patients with amyotrophic lateral sclerosis and in 12 patients of the control group. Calcitonin concentrations in CSF have been measured with RIA technique, using appropriate kits manufactured by Mallinckrodt Dgn. Mean calcitonin CSF concentration in patients with amyotrophic lateral sclerosis was 448. +/- 74.3 pg/ml, and was lowered in comparison with that in the control group, i.e. 613.9 +/- 147.2 pg/ml. The results confirm the authors' previous reports on the reduced content of some neuropeptides in CSF of patients with amyotrophic lateral sclerosis and suggest a possible calcitonin role in the pathogenesis of this disease.


[Rheological properties of blood in patients with ischemic stroke in selected clinical groups]. Hemorheological parameters have been analysed in 34 patients with the acute ischemic stroke. The patients have been divided into two clinical subgroups: with accompanying arterial hypertension (group HA), and free of other diseases (group NHA). Comparative studies have not revealed the significant differences between both groups. However, blood viscosity has been significantly higher in the hypertensive patients. It was related to the decrease in the erythrocyte ability to elastic deformation Group NHA has been characterized by the high fibrinogen levels and by the decrease of the cerebral blood flow.


[Relation between resorption resistance of cerebrospinal fluid and the degree of intracranial pressure]. Changes in the CSF resorption resistance in relation to the value of the intracranial pressure have been assessed in 44 cats. Changes in the intracranial pressure have been produced with fluid infusions. Between 1 to 5 infusion tests with the rate 0.012-1.8 ml/min have been performed in each animal. A relationship between CSF resorption resistance and intracranial pressure has been found. With an increase in the intracranial pressure CSF resorption resistance increased to maximum value of 34 kPa/ml per minute (255.6 mm Hg/ml per minute) at pressure 2.96 +/- 0.69 kPa (22.2 +/- 5.2 mm Hg). At the intracranial pressure about 6.7 kPa (50 mm Hg) CSF resorption resistance rapidly decreased to the value of 13.9 kPa/ml per minute (104 mm Hg/ml per minute). Later, changes have been rather slight. It is possible, that the breaking point at 6.7 kPa corresponds to the mobilisation of all ways of CSF evacuation.


[A new model of computerized encephalovolumeter for monitoring of acute cerebrovascular insufficiency]. A new model of the computerized encephalovolumeter (EVM.IR) is presented. Infrared light is used as an information carrier enabling to follow the dynamics of intracerebral equilibrium and blood flow disorders. The authors suggest that this model would help clinical examination in the acute cerebral flow failure, and increase better evaluation of the efficiency of drugs improving cerebral blood flow. It should also help to foresee the outcome and prognosis. A new model of EVM.IR and its programs require further constructional and experimental studies before the routine use at ICUs.


[Cost of the treatment of acute cerebrovascular insufficiency causing cerebral infarction]. Many countries are interested in the cost of therapy of the acute cerebral flow insufficiency leading to brain infarction. Total costs include: drugs, laboratory tests, nursing care, the cost of patients' food, equipment, amortization, hospital administration etc. The total expenditure for a 10-15-day treatment of the acute neurological incident depended on the severity of the disease and was 8 million ++ złoty in case of mildly ill patient, 9 million in case of moderately severe disease, and 21 million złoty in case of severely ill patient. If the costs of such tests as CT and TCD-scanning will be added, total cost will increase significantly.


[Compression fractures of the vertebrae in children with acute lymphoblastic leukemia]. Compression fractures of vertebrae were noted in 20 out of 1,700 children with the acute lymphoblastic leukemia. Usually prognosis in these cases has been favourable (70% of patients are alive from 5 months to 19 years). Percentage of recovery from compression fractures has been relatively high. Lymphoblastic leukemia with infiltrations localized in the spine is relatively non-aggressive, develops slowly, and despite extensive lesions to the bones its outcome results are favourable. Main symptom of spinal involvement include severe and persisting back aches which make walking impossible. Such symptoms should indicate the diagnosis of leukemia and advocate proper hematological examinations.


[Computerized tomography in the diagnosis of hemorrhage caused by ruptured intracranial aneurysm]. The authors presented current views on usefulness of computed tomography (CT) for diagnosing the bleeding from a ruptured intracranial aneurysm. CT should be done in every such case, whereas the lumbar puncture remains the diagnostic method of choice, when CT is not available or in those patients in whom CT shows no haemorrhage. Sensitivity of CT decreases with time that elapsed from the stroke; false negative results are the least likely to occur within the first 48 hours after bleeding episode to subarachnoid space.


[Hybrid leukemia among acute childhood leukemias]. Four children with the acute leukemia are presented. Their blasts shown the presence of 2 cellular lines markers. Coexistence of markers in the blasts was detected with the technique of double staining the blasts from the bone marrow with: alkaline phosphatase-anti-alkaline phosphatase, and peroxidase with the use of monoclonal antibodies series. Analysis of blasts phenotype with monoclonal antibodies confirm the occurrence of leukemias different from the normally programmed cellular line. Deviations of leukemic cells phenotype may be explained with the fact that leukemogenesis is not an absolute block of cells differentiation but combines maturation disorders and proliferation enabling expression normally absent antigens. It confirms the concept of line preservation and presentation of "earlier frozen" phenotype, and explains the occurrence of leukemias in which blasts present phenotype of one line which does not comply with cell differentiation pattern. Further genotypic studies are necessary to clarify pathogenesis and origin of such blasts. Consequently examination of the larger group of patients with hybrid leukemias will enable conclusions concerning prognostic value of such findings and necessity of introduction of the special therapies.


[Recurrences after completion of the treatment of acute lymphoblastic leukemia in children]. Within the past 16 years, 2004 children with the acute lymphoblastic leukemia were treated at the Centres of the Polish Pediatric Study Group. The treatment was completed in 887 patients (44.3%) with the first remission. Recurrence was noted in 180 children (20.3%). This group was analysed in view of the type of therapy and its effect on the survival rate, significance of recurrence following therapy, character and localization of recurrent disease, and further fate of patients. It was found, that patients with isolated late nuclear recurrence have greatest chances to achieve subsequent remission. Most frequent and severe is recurrent bone marrow involvement which requires intensive chemotherapy combined with bone marrow transplantation due to unfavourable prognosis. Patients with the first recurrence of the acute lymphoblastic leukemia have a chance to achieve subsequent remission and long-term survival.


[Mathematical analysis of relations between dose, level or volume of bupivacaine and various hemodynamic parameters in epidural anesthesia]. Changes in the basic, hemodynamic parameters during the first 30 minutes of epidural anesthesia in relation of the dose, concentration, and volume of bupivacaine used are discussed. It was found, that in a proper epidural anesthesia a significant effect on the value of basic hemodynamic parameters was exerted only by a volume of administered bupivacaine solution, whereas its concentration or dose do not play any significant role. However, further prospective studies are necessary to extend this observation on the wider population.


[Spastic paralysis of the lower extremities as the first symptom of acute myeloblastic leukemia]. A case of acute myeloblastic leukemia (AML) with spastic paralysis of the lower extremities caused by a tumor of the spinal cord as the first symptoms of the disease is presented. The tumor consisted of leukaemic cells. A diagnosis of AML type M2, according to FAB classification, was established. A complete remission was achieved after 2 courses of chemotherapy. Patient started to walk after intensive rehabilitation. After 14 months of complete remission, recurrence was observed despite an intensified therapy.


[Prognostic value of the reaction to steroids in the treatment of acute lymphoblastic leukemia in children]. Relationship between the result of therapy in 48 cases of the acute lymphoblastic leukemia in childhood and character of response to corticosteroids, classified according to BMF group, has been assessed. Follow up period ranged from 13 to 75 months (mean 36 months, median 39 months). In was found, that the probability of survival free from any events, probability of complete remission persistence, and probability of survival after diagnosis have been statistically significantly higher in the group of patients with positive response to corticosteroids in comparison with patients non-responding to these agents. However, there was no significant difference in the number of recurrencies with the involvement of CNS. Authors share the opinion that their results confirm an opinion of Riehm et al. that the response to corticosteroids is of prognostic value in the acute lymphoblastic leukemia in childhood.


[Activity of natural cytotoxic cells in non-Hodgkin's lymphoma]. Cytotoxic activity of NK cells in the peripheral blood has been determined in 30 patients with malignant non-Hodgkin lymphomas prior to and following therapy. In the whole group as well as in subgroups classified according to the criteria of Working Formulation as lymphomas of the low, moderate and high degree of malignancy, activity of NK cells has been statistically significantly lower than that in healthy individuals. Marked increase in this activity has been noted in 19 patients in the state of clinical remission after the treatment with cytotoxic agents, and sometimes radiotherapy. The value of mean cytotoxic activity reached normal limits in the lymphoma of high degree of malignancy, and exceeded these limits in the lymphomas of moderate and low malignancy.


[Hyponatremia after subarachnoid hemorrhage caused by ruptured intracranial aneurysm]. Hyponatremia developed both prior to and after surgery in 30.5% and 23.4% out of 164 patients with ruptured intracranial aneurysms. It was more frequent postoperatively in those patients in whom baseline serum sodium levels were lower. Hyponatremic patients were older than normonatremic. The mean difference in age was about 7 years. The authors, basing on CT scans, have found that hyponatremia development has been more likely in patients with blood visible in subarachnoid space, specially chiasmatic cistern, and patients with ventricular bleeding or hydrocephalus. Hyponatremia following subarachnoid hemorrhage seems to result from the ischemic lesions to hypothalamus i may, therefore, be considered as vegetative equivalent of so-called cerebrovascular spasm.


[Health resort treatment of eye diseases caused by ischemia]. The authors discuss the results of ophthalmodynamometric tests used for the assessment of cerebro-retinal vessels reactivity following carbon dioxide baths and "peat collars". An analysis of systemic and local blood pressure in the ophthalmic artery measured with Weigelin and Lobstein technique enables to assess changes in blood pressures following a/m balneologic procedures. It was found that blood pressure does not change parallelly due to the mechanism of cerebral autoregulation. Transient decrease in blood pressure in the ophthalmic artery is produced by the dilatation of the internal carotid artery indicating a potent vasodilating action of carbon dioxide.


[Experience with nimodipine treatment of vascular spasm after subarachnoid hemorrhage]. Pathogenesis of vasospasms following subarachnoid haemorrhage and possible therapeutic efficacy of nimodipine (calcium channel blocking agent) are discussed. The authors present their own experience in the treatment of 209 patients with subarachnoid haemorrhage with nimodipine. Collected clinical results suggest the necessity of the combined treatment of vasospasm following subarachnoid haemorrhage with nimodipine, hypervolemia, and hypertensive agents.


[Treatment of patients with lysosomal storage diseases]. A problem of management of patients with lysosomal storage diseases in own experience with over 100 children with such diseases has been discussed. Symptomatic therapy of carpal tunnel syndrome, Pudenz valves, splenectomies, plasty of hernia, locomotive rehabilitation and various forms of cooperation with patients' families have been used in the treatment. An attempt of the treatment of the storage diseases with implantation of fetal membranes has been undertaken in view of the fact, that such membranes are the source of deficit enzyme.


[A few remarks regarding 421 cases of trigeminal neuralgia]. Referring to the treatment of 421 patients with trigeminal neuralgia, the authors indicate an early alcoholization or exheyresis in case of therapeutical failure of systemic conservative treatment. Such a management prevents transformation of the peripheral into central neuralgia. Emphasis is on more frequent treatment of neuralgia by dental surgeons.


[Results of the treatment of Wilson's disease with zinc sulfate and d-penicillamine]. Nine patients with newly diagnosed Wilson's disease were treated with zinc sulphate for 12 months. Polish preparation Zincteral was administered in doses of 200 mg 4 times daily. The neurological status has improved in five cases. No adverse reactions of zinc sulphate were observed. The results were compared with the therapeutic effect, obtained in the group of 10 patients who received d-penicillamine (Cuprenil-Polfa) 1.0-1.5 g daily from the very beginning. In three cases drug was discontinued due to adverse reactions. In remaining seven cases, in five evidence of the clinical improvement of the neurological status was observed, but in one case during 12 months of observation progressing deterioration was noticed. Neurological state of one patient remained unchanged.


[Time of regression of the Q wave in patients with myocardial infarction]. A rate of Q wave regression was assessed in 72 patients with ischaemic heart disease, including 46 patients after the infarction of the inferior wall and 26 patients after anterior wall infarction. All patients were followed-up for two years. Complete regression of Q wave was noted in 19 patients (41.3%) after inferior wall infarction and in one patient (3.8%) after anterior wall myocardial infarction. Partial regression of Q wave was seen in 9 patients (19.6%) after inferior wall, and in 2 patients (7.6%) of patients with anterior wall myocardial infarction. It seems that the regression of Q wave in ECG does not improve prognosis in these patients. Six out of 10 deaths which occurred in the followed up group of patients involved those in whom no electrographic features of the past myocardial infarction were seen.


[Programmed atrial and ventricular stimulation in patients with mitral valve prolapse--a personal experience]. Electrophysiological tests were performed in 60 patients aged between 18 and 63 years (mean age 38 years), and divided into two groups: with mitral valve leaves prolapse syndrome, and without this abnormality, in whom no other heart disease was diagnosed. Refraction of the right atrium, atrio-ventricular node, and right ventricle was evaluated together with cardiac response to different types of electrostimulation. A supraventricular dysrhythmia (most frequently atrial fibrillation) has been produced in 17 patients (42.5%) with mitral valve leaves prolapse syndrome whereas in the control group the same was produced in 2 patients (10%). Programmed stimulation of the ventricles did not produce ventricular tachycardia in none patient of both groups. Multiple ventricular beats have been produced in 3 patients with mitral valve prolapse syndrome and pairs of ventricular beats in other 3 patients of this group. Results suggest that "arrhythmogenic tendency", especially supraventricular dysrhythmia is more frequent in patients with mitral valve prolapse syndrome than in the general population.


[Usefulness of the measurement of corrected QT (QTc) for the diagnosis of diabetic neuropathy of the autonomic cardiovascular system]. Corrected QT interval was determined in diabetic patients and in a group of obese individuals with glucose intolerance. It was shown that the measurements of corrected QT (QTc) interval may be a reliable test in the diagnosis of the autonomic diabetic neuropathy. Its simplicity enables routine measurements in diabetic patients treated in out-patients clinics.


[Analysis of the causes and clinical course of anemia in elderly patients]. Anamnesis of patients treated for anemia at the Department of Internal and Occupational Diseases in Zabrze in 1984-1988 were analysed. It was found that the incidence of anemia in patients over 60 years of age was significantly higher. Decreased function of hematopoietic system, more frequent deficits of factors indispensable for the normal erythropoiesis, i.e. iron and vitamin B12, and coexisting diseases, especially neoplasms and uremia, predispose to anemia in this age group. Anemia seen in the group of patients with diabetes mellitus type 2 was most probably a result of the chronic treatment with sulfonylurea derivatives.


[Emergency epicardial dissection of the accessory pathway in a patient with atrioventricular nodal reentrant tachycardia]. Diagnostic and therapeutic problems in 14 year old patient with concealed WPW syndrome were presented. Paroxysms of atrio-ventricular reentrant tachycardia 180-220/min were frequently recurring, usually with normal QRS pattern. Tachycardias often had to be terminated by intravenous administration of antiarrhythmic drugs. Long term treatment with various antiarrhythmic agents did not prevent recurrence of tachycardias but they became sustained and were recurring more often. Their other side effects manifested with sinus node disfunction and depression of the heart muscle. The electrophysiologic study revealed right anterior septal accessory pathway. Epicardial dissection of the accessory pathway was urgently performed. The control electrophysiologic study revealed no evidence of conduction through the accessory pathway. The patient did not require antiarrhythmic treatment. During the 12 months follow up no tachycardia occurred.


[Propionibacterium acnes in the etiology of endocarditis]. Propionibacterium acnes is the gram positive anaerobic bacteria belongs to the normal skin and oral microbial flora. The participation of this microorganism in the infective endocarditis is still controversial. The aim of the study was to perform the diagnostic and therapeutic difficulties in 5 patients with infective endocarditis caused by Propionibacterium acnes. In 3 out of 5 patients the infective endocarditis developed after prosthesis valve replacement, in 2 others on the native valves. The inserted prostheses were mechanical ones, propionibacterium acnes was identified as causative organisms in all of the causes (two positive blood and/or valve culture). The bacterial strains were sensitive to the antibiotics as: penicillins, cephalosporins, clindamycin, and vancomycin, however cephalosporins used at the beginning of the treatment in 3 patients and clindamycin in 1 patient had limited clinical efficacy. Later treatment with timentin, augmentin and tienamycin was successful in 3 patients; one patient was cured with vancomycin. One patient died because of septic, embolic complication in early stage of illness. We conclude the effectiveness of penicillins in combination with clavulanic acid and tienamycin in therapy of infective endocarditis due to Propionibacterium acnes. The treatment should be lasted during 4-6 weeks.


[Daily fat consumption by the population of Warsaw]. Fat intake with the diet has been assessed within screening Pol-MONICA--Warsaw Project in randomly selected sample of Warsaw inhabitants aged between 35 and 64 years. Altogether 2571 individuals have been screened. Fat intake in daily diet has been estimated by the 24-hour recall technique. In men, fat intake covered 38.4% of the total energy supply with the diet whereas in female population - 37.7%. Mean contribution of SFA and P/S ratio in both sex groups have been 15.8% and 0.285, respectively. Daily cholesterol intake has been 641 mg (224 mg/1000 kcal) in male and 456 mg (227/1000 kcal) in female population. These values did not change significantly with the age of the screened individuals. Such a diet may be considered atherogenic.


[Anatomic changes in the biliary tract and pancreas in patients with diabetes mellitus diagnosed by endoscopic retrograde cholangiopancreatography]. Structural changes in both biliary tract and pancreas have been assessed with endoscopic retrograde cholangiopancreatography in 100 diabetic patients divided into subgroups depending on the type of diabetes mellitus, i.e. type I, type II and III-pancreatic. Control group included 100 randomly selected patients without diabetes mellitus in whom endoscopic retrograde cholangiopancreatography has been performed for various indications. Structural changes in the biliary tract and pancreas have been more frequent in diabetic patients than in the control group (47 and 75% vs 32 and 30%, respectively). Cholelithiasis has been noted in 27.8% of patients with type II diabetes mellitus and in 11.3% of patients with type I diabetes mellitus; obesity has been found in 57 and 12% of patients, respectively. Other biliary tract disorders, mainly in the form of segmental stenosis or dilatation of the common bile duct, have been more frequent in patients with type II diabetes mellitus. Pancreatic disorders, assessed with the aid of Cambridge classification, have been noted in all patients with pancreatic diabetes and in 80.7% of patients with diabetes mellitus type I. Incidence of so-called doubtful and mild disorders has been more frequent (22.2 and 24.1%, respectively) in patients with diabetes mellitus type II whereas "moderate" and "severe" disorders have been significantly less frequent (7.4 and 1.9% of patients). The results indicate, that endoscopic retrograde cholangiopancreatography is useful in the assessment of bile ducts structure and pancreatic exocrine activity in diabetic patients in whom disorders are more frequent.


[Effect of colloid bismuth treatment on Campylobacter pylori infection of the gastric mucosa and the clinical course of non-ulcer dyspepsia]. There are suggestions, that the idiopathic non-ulcer dyspepsia is related to the chronic gastritis type B coexisting with C. pylori infection. Presented studies were aimed at the assessing of an effect of the treatment with De-Nol on the course of the idiopathic non-ulcer dyspepsia of C. pylori infection. Gastroscopic examination was performed in 52 patients with non-ulcer dyspepsia before and after the treatment with De-Nol administered for 4-8 weeks. Campylobacter pylori was isolated from 71% of patients with idiopathic non-ulcer dyspepsia. An infection was eradicated in 97.4% of patients treated with De-Nol. The number of dyspeptic episodes decreased in by 96% of patients, including 33% of patients in whom total recovery was noted. De-Nol was well tolerated. De-Nol is highly effective in the eradication of C. pylori and produces clinical improvement in the majority of patients with non-ulcer dyspepsia.


[Inflammatory changes in the gastric mucosa of patients with idiopathic non-ulcer dyspepsia and the effect of colloid bismuth treatment on the course of inflammation]. The studies were aimed at the assessment of the coexistence of non-ulcer dyspepsia with chronic gastritis and Campylobacter pylori infection, and of the effect of therapy with De-Nol on the course of such disease. The studies involved 50 patients with non-ulcer dyspepsia. Prior to and after the treatment with De-Nol samples of the mucosa collected from the antrum and corpus of the stomach have been examined histologically with urease test indicating C. pylori infection. Chronic gastritis of the antral mucosa membrane and/or mucosa of the corpus of the stomach has been found in 36 patients, and normal mucosa in 14 patients. Therapy with De-Nol produced statistically significant improvement. Totally histological improvement has been noted in 77.1% of patients with inflammation of the antral mucous membrane and in 64.3% of patients with inflammation of the corporeal gastric mucosa. Campylobacter pylori has been eradicated in all patients with chronic gastritis. De Nol eliminates or significantly lowers an inflammation in the antrum and/or corpus of the stomach. Its action is related to the eradication of Campylobacter pylori infection.


[Effect of the Warren operation on hypersplenism]. The authors present their own comments on the effect of Warren shunt on hypersplenism. Hypersplenism is frequent complication in portal hypertension. The authors estimate its frequency on 64.7% of patients. Spleen size, thrombocyte count, WBC count, and esophageal endoscopy have been carried out prior to and following distal spleno-renal shunt. Surgery produced favourable effect in 70% of patients, i.e. a decrease of hypersplenism symptoms. An increase in blood platelet count may serve as a screening marker of anastomosis patency.


[Alpha 1-antitrypsin as an endogenous marker of protein-losing enteropathies]. A novelty of the present studies is the use of alpha 1-antitrypsin (A-1--AT) as an endogenous marker of enteric protein loss. Enteric clearance of alpha 1-antitrypsin was determined in 10 patients with the symptoms of PLE, and in 6 healthy individuals. Alpha 1-Antitrypsin concentration has been assayed in single, random samples of feces collected from 42 patients and 12 healthy individuals (normal values: 1.31 +/- 0.72 mg/g of feces). Markedly increased enteric clearance and A-1-AT concentrations in single, random samples of feces have been found in patients with enteric lymphangiectasis, Crohn's disease, ulcerative colitis, and constrictive pericarditis, slightly lower in coeliac, chronic diarrhoea, nonspecific hemorrhagic colitis, esophagitis, lambliasis, hypogammaglobulinemia, Wiskott-Aldrich syndrome, Rendu-Osler-Weber syndrome, hepatitis in newborn, and Gilbert's disease. Statistically significant positive clearance has been noted (r = 0.997; p less than .001). A single assay of A-1-AT in feces is simple, repeatable, and sensitive technique in the diagnosis and evaluation of these diseases in which the symptoms of enteric protein loss are seen.


[Serum triiodothyronine and thyroxine levels in children with celiac disease]. The study was aimed at determining relationship between thyroid function and the type and degree of malabsorption. Serum triiodothyronine (T3) and thyroxine (T4) levels were determined in children with celiac disease and the secondary malabsorption. Hundred fifty five children aged between 6 months and 7 years were followed up 3 years. Coeliac disease was diagnosed with classic Interlaken criteria. All children were divided into three groups: group I--57 children aged between 6 months and 3 years with suspected celiac disease; group II--55 children aged between 2.5 and 6 years after gluten-free diet therapy; group III--52 children aged between 3 and 7 years after gluten provocation test. Serum T3 and T4 levels for each group were compared with those in children with normal gut mucous membrane. Blood serum T3 and T4 were assayed with OPIDI kit (manufactured in Swierk). Serum T4 levels were significantly lower in children with mucous membrane atrophy in comparison with dystrophic children and normal gut mucous membrane. Both serum T3 and T4 were significantly lowered in the youngest children upto 12 months of life with mucous membranes atrophy. Serum T3 and T4 concentrations were below the normal values in 4 youngest children. Blood serum T3 and T4 levels did not depend on the morphology of the intestinal villi in children treated with gluten-free diet (some children did not observe the diet and had atrophic lesions to the mucous membrane of the small intestine). Blood serum T3 level was relatively increased in children of group II with mucous membrane regeneration; in comparison with the value determined in the period of active disease.


[Blood coagulation and fibrinolysis in blood donors after plasmapheresis]. Authors were interested in blood coagulation proteins and fibrinolysis in blood donors following several plasmaphereses. This interest was related to the occurrence of thrombo-embolic and hemorrhagic complications in these subjects. Blood morphology, serum protein, blood coagulation and fibrinolysis have been examined in 40 healthy blood donors, aged between 19 and 46 years, who gave blood plasma by plasmapheresis technique for 1-59 times. Results did not show any significant changes in blood morphology and serum protein levels prior to and after consecutive plasmaphereses. No significant decrease in blood coagulation proteins and fibrinolysis has been noted. However, a significant increase in factors VIII and IX activities was noted in several blood donors, who underwent the largest number of plasmaphereses. It may predispose these donors to thrombo-embolic complications.


[Evaluation of loss of active heparin in the peritoneal cavity during intermittent peritoneal dialysis]. Our studies aimed at determining a loss of active heparin from the peritoneal cavity after its intraperitoneal administration (250 JU/l of dialysis fluid) in 16 patients treated because of the end-stage renal failure with intermittent peritoneal dialysis and at comparing heparin influx clearance with that of glucose. It has been shown that heparin used in this dose loses 60-70% of its activity after 20-minute equilibration of dialysis fluid in the peritoneal cavity. Heparin influx clearance is higher than that of glucose but it depends on utilization of heparin in peritoneal cavity rather than on its penetration to the blood circulation.


[Effect of ethyl alcohol on selected parameters of the hemostasis system in vitro]. Alcohol produces several disorders in all components of hemostasis system. However, its mechanism of action is not clear. Therefore, an effect of ethyl alcohol on the selected parameters of both platelet and plasma hemostasis has been examined in vitro. Blood aggregation induced by ADP and PAF and platelet-leucocytic aggregates have been determined in vitro in the group of 45 healthy volunteers. Out of plasma parameters the selected factors of blood coagulation and fibrinolysis have been examined. Results suggest that the examined concentrations of ethyl alcohol mainly affect platelet function decreasing platelet aggregation. Alcohol does not affect significantly blood coagulation and fibrinolysis occurring in vitro.


[Intra-systemic inhibitors of the hematopoietic system]. Physiological, experimental and theoretical aspects concerning haemopoietic inhibitors are reviewed. In the paper there are also discussed future research directions of this branch of haematology.


[Diarrhea caused by Campylobacter in patients with hematologic diseases]. Diarrhoea caused by Campylobacter infection in two adult patients was observed: one with erythroleukemia, and another with non-Hodgkin lymphoma. An infection developed in both cases during the period of agranulocytosis and decreased specific immunologic response to cytostatics. In case of the second patient, it has also been due to the underlying disease. The course of the disease has been different in both patient. It was dramatic with high fever and multiple fetid stools in one patient, and mild, successfully treated within a few days, in the second.


[Pancytopenia as a complication of the treatment of toxoplasmosis]. Therapeutical doses of pyrimethamine are very close to toxic ones. Pyrimethamine is widely used in toxoplasmosis therapy. Hematological complications following pyrimethamine administration were seen in 4 patients treated for toxoplasmosis at our hospital in the last year. Pancytopenic syndrome was diagnosed in all four cases. Three patients recovered completely whereas ITP is persisting in one patient.