[Antiphospholipid syndrome and resistance to replacement therapy in hemophilia]. The paper described the appearance of lipoid anticoagulant (LA) in the presence of hepatitis B virus in the blood of hemophilia A patient. Profuse and long-term bleeding after the extraction of the tooth that failed to be treated with big doses of cryoprecipitation was noted. Intense replacement therapy resulted in the appearance of factor VIII inhibitor in a titre of 4.5 units per ml in the patient's blood. Big-dose prednisolone therapy helped an immediate arrest of the bleeding and a rapid decrease in LA titration. The levels of factor VIII inhibitor preserved in the same values. The study exhibited the ability of LA to impede the arrest of the bleeding and the response to the replacement treatment in hemophilic patients.


[Megakaryocytopoiesis in patients with acute infectious destruction of the lungs]. Partial megakaryocytograms were studied in patients with acute infectious destructions of the lungs. Acid phosphatase and glycogen megakaryocytic levels, overall number of megakaryocytes elucidated the role of the central link of the system megakaryocyte--platelet in the onset of thromboembolism and hemorrhagic complications arising in the above patients. Inefficiency of megakaryocytopoiesis in pulmonary and pleural acute pyo-destructions is under discussion.


[Ultrasonography of the gallbladder in patients with hemoblastoses]. A total of 402 patients with acute or chronic leukemia and chronic cholecystitis and 100 healthy controls were exposed to ultrasonic biliography. It was revealed that leukemic infiltration of the bladder wall, increased pressure in the portal system, hypoalbuminemia and the concurrent diseases of the bladder could be the main causes of the alterations in the size and form of the bladder and the width of its walls in hemoblastosis patients. It was stated as well that the thickening of the bladder wall was an obligatory diagnostic criterion for not only chronic cholecystitis but various patterns of hemoblastoses as well. The authors suggested that echolocation of the gall bladder should be done in combination with clinical and morphological verification of the tumor process and its stages that undoubtedly would be of significant value in the choice of therapeutic policy.


[Intensive plasmapheresis: complications and their prevention]. Upon the analysis of 246 plasmapheresis sessions performed for autoplasma provision, the correction of the blood rheology and the decrease in endogenic intoxication of 216 patients, it was stated that the frequency of various reactivity and complications comprised 12.9%. The causes of these complications and the means of their prevention were analyzed.


[Comparative assessment of various programs of plasmapheresis in the combined treatment of patients with rheumatoid arthritis]. Therapeutic efficacy of various plasmapheresis (PA) programmes was comparatively studied in 92 patients with rheumatoid arthritis. PA performed as a placebo (the control group) confirmed the efficacy of PA in the patients with rheumatoid arthritis. The choice of a particular regimen of the procedure depended on the health status of the patient. The programme of PA with the elimination of one volume of the circulating plasma (VCP) turned to be the most effective in the patients with highly active course of the disease while the procedures with the elimination of 1/2 and 1/4 VCP should be used in those with moderate or minimal activity of the disease. The assessment of the therapeutic response should be based on the clinical data, ESR and the contents of circulating immune complexes--the most dynamic laboratory tests.


[Effects of hemosorption on the regulation of calcium metabolism in patients with rheumatoid arthritis]. A clinical response to hemosorption and the alterations in the calcium regulatory systems associated with the treatment mentioned were studied in 42 patients with rheumatoid arthritis. The use of hemosorption in the multiple modality treatment resulted in a manifest clinical and laboratory positive effect featured by the improvement of the general condition of the patient, a decrease in the values of the joint syndrome and the activity of the inflammatory processes as it was evidenced by routine laboratory tests and the time-course of the contents of beta 2-microglobulin in the blood and synovial fluid. Hemosorption helped the correction of the performance of the systems of calcium regulation: a decrease in parathyrin contents, an increase in the contents of calcidiol, osteocalcin, and ionized calcium.


[Clinical effectiveness of plasmapheresis and lymphocytoplasmapheresis in patients with systemic scleroderma]. Clinical effect of plasma- and lymphoplasmapheresis in patients with various patterns of sclerodermia systematica was studied in 12 females with subacute and chronic course of the disease. The failure of the drug therapy preceded, the complications associated with corticosteroid treatment performed were the indications to the aforementioned procedures. The treatment course comprised 3-5 procedures with an interval of 2-3 days. During 1 plasmapheresis session 1000-1200 ml of the plasma were removed and 1100-1250 ml of the plasma and 4.5.10(9)-7.0.10(9) lymphocytes were removed by a session of lymphoplasmapheresis. The results obtained evidenced a positive influence of plasma- and lymphoplasmapheresis on the course of sclerodermia systematica, contributed to a decrease in the clinical manifestation of the disease and laboratory data indicating the activity of inflammation, led to a more rapid regression of the main symptoms of the disease than it was recorded during the routine treatment, promoted a longer remission and a significant reduction of the hormone dosage.


[Amyloidosis in systemic lupus erythematosus]. Based on the authors' experience from 1982 to 1990 it was noted that out of 26 cases of renal amyloidosis in the presence of nonpurulent and purulent conditions 2 patients (7%) demonstrated the association with systemic lupus erythematosus (SLE). It was also noted that amyloidosis developed in the patients with a long history of the disease. Long-course immunosuppression treatment could be regarded as the other factor-of-risk for amyloidosis development. Histochemical examination of both patients demonstrated that amyloid deposits in the renal glomeruli were resistant to the potassium permanganate effect and consisted of AL-protein. The results obtained indicated the possibility of appearance of immunoglobulins AL--the proteins of the primary amyloidosis--synthesized in the spectrum in the SLE presence as well as their deposition in the renal glomeruli. As a possible cause of proteinuria and the nephrotic syndrome in SLE patients amyloidosis should be diagnosed in the life time and be regarded in the choice of therapeutic policy as well as in the assessment of pulse immunosuppressive therapy practicability.


[Cardiolipin antibodies in acute rheumatic fever]. The paper presented the results obtained in studying the patients with acute rheumatic fever for antibodies to cardiolipin (ACL). The study resulted in the establishment that the development of immunopathies in the presence of acute rheumatic fever combined with the acute streptococcal infection was accompanied by hyperproduction of ACL (more common IgG versus IgM isotypes). The phenomenon mentioned widened the spectrum of acute infectious diseases associated with an increase in ACL synthesis. It was also stated that increased ACL contents were closely related with the involvement of the cardiac valves. Authentic clinical and echocardiological signs of the heart disease were mainly revealed in the patients with high contents of IgG and IgM isotypes of ACL. A certain relationship between the laboratory activity of the disease and ACL hyperproduction was noted as well. The latter permitted the discussion on the impact of streptococcal infection initiating the development of acute inflammation on the hyperproduction of ACL.


[Lipid peroxidation in the blood and tissues of patients with peptic ulcer]. Investigation of 67 patients with peptic ulcer revealed a reliable activation of lipid peroxidation processes both in the blood of the patients and in the mucous membrane in the area of the ulcer location immediately. The activation of lipid peroxidation resulted in a decrease in the contents of phospholipids in the biological membranes of the mucosa cells. The alterations revealed occurred in the presence of inhibition of the antioxidant system of the body. The authors proved the efficacy of the use of antioxidant formulations and ultraviolet irradiation of the blood in the treatment of patients which resulted in acceleration of the ulcer cicatrization and the reduction of the inpatient period as well as the improvement of surgical results.


[Evaluation of the effectiveness of laser and drug therapy of patients with duodenal ulcer]. The paper presents clinical and morphological assessment of therapeutic response in 97 patients aged from 20 to 65 years with the diagnosis of duodenal ulcer from 1 to 15 years. Routine treatment was performed in 32 and drug therapy in combination with local He-Neon radiation of the ulcer was performed in 65 patients. Higher therapeutic response especially in those with the disease duration not longer than 5 years was revealed in case of laser therapy versus the routine drug treatment. The effect of laser radiation either on the ulcer mucous coat or far from it resulted in a moderation of inflammatory and an increase of reparative processes. More rapid terms of ulcer healing is of a certain time-saving effect.


[Theory of universal functional blocks and fundamental biomedical problems]. The paper presents the main aspects of the theory of elementary functional blocks. In accordance with the theory considered high specialization of the complex functions could be reached due to the recombination and transposition of a large though limited set of molecular machines realizing elementary biological operations. The authors proved that the theory of universal functional blocks became a fundamental aspect of the medical theory as it permitted one not only to explain and classify a certain part of clinical and clinicophysiological phenomenology but was of significant prognostic value.


[Possibilities of prognostication of complications in duodenal ulcer]. The authors investigated a prognostic value (with respect to the complications) of certain laboratory parameters used in the examination of the gastric juice in patients with duodenal ulcer (DU) as well as the prognostic value of certain anamnestic data. A total of 100 patients with DU who had been followed up for 5-6 years were under study. The results obtained demonstrated the most informative values for the DU-related complications turned to be the parameters of the performance of the defense mechanisms of the gastroduodenal area (the contents of mucous proteins, the coefficient of the gastric juice defense), the levels of gastric secretion and acidification (the quantity of the juice, the per hour discharge of hydrochloric acid) as well as the ratio between the coefficient of the defense and the coefficient of the pepsin aggression that reflected the ratio between the aggressive and defensive factors of the gastric juice. Defined discriminant functions permitted the prognostication of complications appearance correct within 80-90%.


[Duodenal ulcers that do not heal for a long time]. The investigations of 43 duodenal ulcer cases in the patients whose ulcers failed to cicatrize after a 8-week treatment with almagel and vicalin or cimetidine monotherapy revealed the role of the hereditary load, smoking intensity, initial ulcer dimensions, the presence of antral erosions and a pronounced periulcerous duodenitis in the phenomenon of slow healing duodenal ulcer. There was no statistical difference between the values of the basal and pentagastrin-stimulated levels of hydrochloric acid secretion in the morning, partial alkaline gastric secretion, gastrinemia, the rate of evacuation of the gastric contents into the duodenum, the outcome of pancreatic bicarbonates in the sample with exogenic secretin in those whose ulcers cicatrized after a 6-week therapy and those who failed to be cured after being exposed to the same therapy during 8 weeks. The production of hydrochloric acid in the evening and the incidence of manifest duodenal reflux were significantly higher in the patients with slowly healing ulcer. They also had a decreased sensitivity to the intraduodenal inflow of the hydrochloric acid that resulted in the increase of endogenic secretin (stimulating the production of pancreatic bicarbonates and their transport into the duodenum). In case the combination treatment with almagel and vicalin failed, the therapy with gastrocepin or sucralfate was employed. A supplementary course of sucralfate helped to reach a complete healing of noncomplicated ulcers even in the patients in whom the preceding cimetidine treatment failed.


[Improvement of treatment results in patients with peptic ulcer]. A total of 980 patients operated on for peptic ulcer of the stomach and duodenum were followed up. Out of them 784 (80%) patients had complications: 273 (27.9%)--perforations, 263 (26.8%)--bleedings, 165 (16.8%)--stenosis, 67 (6.8%)--penetration, 16 (1.6%)--malignant transformation of the ulcer, the rest of them, 19 (20%) patients, had chronic callous ulcers. Factors of risk for complications associated with peptic ulcer were indicated. Timely planned surgical intervention advancing the development of severe complications is found to be necessary for the improvement of the therapeutic response.


[Pathogenesis of anemia in abdominal typhus]. Morphological parameters of the red cells were studied in 121 patients with typhoid-paratyphoid conditions. To obtain objective clinical data the authors studied the effect of LPS S. anatum on the intact red cells of healthy persons. The correlation of morphological disorders in the red cells of the patients and the controls revealed a significant role of intoxication in their origin. The research conducted revealed a relationship between the disorders in the erythrocyte membranes and the development of anemia in the patients.


[Differential diagnosis of dilated cardiomyopathy]. Diagnostic criteria for dilated cardiomyopathy and those for its differential diagnosis with coronarogenic and non-coronarogenic (nonrheumatic myocarditis and other patterns of cardiomyopathy) as well as infiltrative myocardial lesions and some acquired and congenital heart diseases, pericarditis and cardiac tumors (myxomas) were presented. Emphasis was given to the analysis of the informative value of the current instrumental, mostly noninvasive, techniques.


[Adult respiratory distress syndrome in patients with infection]. A grave complication of sepsis is a respiratory distress in adult persons observed by the authors in 11.3% of the examinees. The syndrome of respiratory distress could develop in the presence of toxico-infectious (septic) shock or severe allergic immediate responses to the administration of certain drugs. The main approaches to the treatment of respiratory distress in adult septic patients turned to be glucocorticoids, heparin and recurrent sessions of hemosorption.


[Use of the expired air condensate in the study of biochemistry of bronchial contents in patients with bronchial asthma]. A total of 7 patients with premorbid adjustment (PA) and 13 patients with bronchial asthma (BA) were comparatively studied for the content of calcium, magnesium and biogenic amines (histamine, serotonin) which were assessed with atom absorption spectrophotometry and fluorimetry in the condensate of expired air (CEA), fluid of the bronchial wash-off (FBW) and bronchoalveolar lavage (BAL). It was revealed that the studied values in CEA were similar to those in FBW and BAL. The results obtained indicated that CEA adequately demonstrated the biochemical composition of bronchial contents in various generations and alveoli. CEA availability and high informative value permitted it to be employed in the research into the mechanisms of bronchial obstruction as well as in the control for the efficacy of BA and PA treatment.


[Clinical effectiveness and potential hazards of combined kordaron and quinidine therapy of patients with atrial fibrillation]. Clinical efficacy of and potential risk for complications from combined cordarone+quinidine treatment were studied in 52 patients with atrial fibrillation (AF). Out of 32 patients with a persistent pattern of the disease the sinus rhythm was recovered in 28 (87.5%) of the patients; out of 20 patients with paroxysmal pattern of AF resistant to routine anti-arrhythmic treatment, the sinus rhythm was recovered in 14 (70%) patients. Almost 50% Q-T prolongation was recorded in one patient with paroxysmal AF. Despite the withdrawal of the medication, 4 hours later ventricular tachycardia of the "pirouette" type arose that 2-3 minutes later was followed by ventricular fibrillation with clinical death. After effective electric defibrillation in the presence of lidocaine treatment ventricular fibrillation repeated 7 times. A total of 32 cardiac defibrillations were performed for 6 hours. The normalization of the Q-T interval was observed on the fourth day only. The patient was discharged from the hospital in a satisfactory condition.


[Systolic and diastolic arterial blood pressure in patients with angina pectoris (a long-term study)]. The prospective follow-up of 190 patients with angina pectoris (males, aged 40-59 years) which lasted for 26 years revealed that only 37 (19.5%) persons survived. Out of 153 patients who expired, 76% were subjected to pathoanatomical or medicolegal examination. It was revealed that cardiovascular lesions were responsible for 71.9% death cases in patients with angina pectoris. The elevation of both systolic and diastolic arterial pressure corresponds with a general tendency to the rise of lethality from ischemic cerebral or heart disease though the impact and character of their influence is different.


[Possibility of the evaluation of right ventricular failure in ischemic heart disease based on pulse Doppler ultrasonography of large hepatic veins]. Pulse dopplerography examination of the blood flow rate in the large hepatic veins evidenced the possibility of the assessment of the right ventricular failure. Systolic blood flow appeared to be slow in case of sinus rhythm right ventricular failure, while the acceleration of the blood flow occurred in case of atrial fibrillation. Absolute ratio between the maximal rate of the systolic blood flow and the maximal rate of the diastolic flow of the spectrum of Doppler's frequency of pulse dopplerography of large veins in case of the right ventricular failure was lowered irrespective of the pattern of the cardiac rhythm.


[Tactics of management of patients with stomach deformities]. Analysis of gastroscopy in 8781 patients revealed the deformities of the stomach in 1249 (14.2%) patients. Patients younger than 30 had a kink of the stomach and exogastric deformity in 75.5 and 17.7%, respectively. In patients who were older than 70 the respective values were 52.2 and 46.4%. The cause of gastric deformities was stated in 65% of cases (the diseases and specific forms of the adjacent organs). Computed tomography helped to reveal the cause of the deformity in 54% of the cases and ultrasonic investigation in 26% of the cases. The informative value of the used combination of computed tomography and esophagogastroduodenoscopy comprised 75%.


[Post-transfusion viral hepatitis B and C and criteria of their differentiation]. Two groups of adult patients suffering from posttransfusion viral hepatitis (PTVH) were examined. Group I included 179 patients with PTVH B, group 11 72 patients with PTVH C. Both types of the disease exhibited similar epidemiological, clinical and biochemical serum characteristics, seemed to arise against preexisting diseases. Type C occurred more frequently among females, had shorter latent period, ran a light course. To differentiate between PTVH types B and C, practitioners are recommended to regard duration of the latent period, incidence of acute period HBsAg, anti-HBs, anti-HBc, IgM in the serum, HBs-antigenemia occurrence in donors suspected of PTVH induction, history of serologically confirmed viral hepatitis B.


[Serum neopterin in hepatitis B].

[Serum neopterin in hepatitis B]. Activation of the immunity system commonly followed the development of viral diseases. Neopterin is evidently a marker of the activation. Elevation of neopterin levels in AIDS and tumor patients correlates with the severity of the disease. Radioimmunoassay of neopterin content was performed in the sera of 11 patients with virus B hepatitis (6 patients with its acute pattern, 3 with its acute pattern concurrent with delta-infection and 2 subjects with chronic active virus B hepatitis). Mean neopterin content in the sera of virus B hepatitis patients was 19.9 +/- 5.7 nM/l being significantly higher than that in donors (5.0 +/- 0.8 nM/l) (p less than 0.001). In this line neopterin levels higher than 9 nM/l (the upper normal limits) were identified in 63% of the patients. Mean content of beta-2-microglobulin in hepatitis patients was 3.3 +/- 0.53 mg/l being significantly different from that in donors (1.8 +/- 0.3 mg/l) (p less than 0.05). Association between higher neopterin levels and the severity of the disease was fully proved clinically, with the exception of the two expired persons whose neopterin levels were within normal limits. The data obtained evidenced an increase in neopterin levels associated with virus B hepatitis. It widened the understanding of the disease pathogenesis and permitted the determination of neopterin levels be used in correlation with clinical data as a prognostic value for the course of the disease.


[Pulmonary diffusing capacity in patients with chronic renal failure treated by hemodialysis]. Forty-eight patients with chronic renal insufficiency (CRI) receiving hemodialysis (24 males and 24 females) aged 17-62 underwent bicycle exercise to measure diffuse capacity of the lungs (DCL) before and after the test. DCL components (membraneous and blood volume in pulmonary capillaries, Vc) were defined in 33 out of 48 patients. DCL appeared to reduce significantly (up to 65 +/- 2%) at the expense of Vc fall to 51 +/- 4.5% and membraneous component decline, to 65 +/- 4%. DCL depended on severity of anemia, hemodialysis efficiency, electrolyte metabolism activity and CRI gravity. Performance status in CRI patients is limited by DCL value responsible for maximal oxygen consumption under exercise being independent on duration and type of hemodialysis.


[Extracorporeal shockwave nephro-uretero-lithotripsy]. Extracorporeal shock-wave lithotripsy (ESWL) has been widely introduced in the treatment of nephro-uretero-lithiasis during the last decade as it provides a noninvasive removal of the stones from the upper urinary tracts. The paper covers the history, techniques, indications, contraindications, anesthesia, complications and results of the method. Positive and negative characteristics of ESWL equipment (lithotriptors) are considered. The experience with 5000 lithotripsies led the authors to the conclusion that ESWL does not solve all the problems in the treatment of nephro-uretero-lithiasis and should be introduced only in large clinics practicing actively x-ray endoscopy and equipped with modern endoscopic and ultrasonic urologic units.


[Long-term results of dispensarization of patients with chronic glomerulonephritis]. The results of long-term follow-up (from 4 to 25 years) were studied in 1420 patients with chronic glomerulonephritis registered in the city nephrologic service of Leningrad. The relapses ceased in 45.8% and became less frequent in 16% of cases. The survival rate of long-term follow-up patients was significantly higher than of those observed for 2-3.5 years. Long remissions and slowing down of the disease progression were obtained mostly in cases with mild or moderate process activity and seldom in patients with frequent and persisting relapses: Long-term results did not significantly depend on hypertension or nephrotic syndrome but worsened in membrano-proliferative, sclerotic glomerulonephritis and focal glomerulosclerosis due to their inclination to relapse.


[A case of malignant course of pulmonary tuberculosis developing presumably on the background of pneumocystis pneumonia]. The paper presents literature data and a clinical case of a rare disease--a malignant run of pulmonary tuberculosis which developed in a prisoner (male, aged 35) with a suspected pneumocystis pneumonia. A fatal outcome terminated fulminant progression of the disease treated with the use of modern effective antituberculosis modalities.


Is board certification necessary for school health educators? Voluntary certification through the National Board of Professional Teaching Standards currently is being promoted as a mechanism for achieving higher quality instruction in the nation's schools as well as raising the prestige of the teaching profession. This article examines controversies surrounding this movement, including the Board's decision that a teacher's eligibility to be "board certified" in school health does not depend on prior completion of a health education major. The National Board of Professional Teaching Standards believes their assessment approach will be superior to current quality controls. An analysis of existing certification, accreditation, and external review mechanisms, however, does not support this view. Policy formation strategies to ensure continued viability of Certified Health Education Specialist certification mechanisms are offered.


[Features of correction of phosphate-calcium metabolism disorders in terminal renal failure]. Mineral metabolism was studied in 27 hemodialyzed patients with terminal chronic renal failure (CRF). Because of progressing hyperparathyroidism the initial treatment included calcium drugs, active forms of vitamin D (videchol, oxidevit), almagel, bicarbonate hemodialysis and hemosorption. The condition improved in 8 and stabilized in 12 patients. Conservative treatment was ineffective in 7 patients who consequently underwent total (4 cases) or subtotal (3 cases), parathyroidectomy. The response was achieved in 3, stabilization in 3, the disease advanced in 1 patients.


[Peculiarities and complexities of questioning the patient in myocardial infarct]. The author depicted several cases of myocardial infarction which onset or preinfarction angina symptoms were taken by the patients for a catarrhal disease. The signs enabling the doctor to exclude the "catarrhal" origin of patient's feelings were indicated. The author suggested that the term of "catarrhal" variant of myocardial infarction onset" should be used as a pattern of its atypical onset.


Multiple correlates of cigarette use among high school students. A cross-sectional survey research design measured factors related to cigarette use among 2,212 senior high school students. Results showed 14.3% of the sample smoked cigarettes at least occasionally, with 5.3% reporting they were daily smokers. About 12.8% indicated they were ex-smokers. Males and females smoked at almost equal rates, and the percentage of 10th grade student smokers was slightly higher (16.4%) than the percentage of juniors and seniors who smoked. Approximately 22% of Hispanic students, 15% of Caucasian students, and 4.5% of African-American students reported smoking cigarettes at least occasionally. An initial regression analysis used 21 variables to predict cigarette smoking. A more parsimonious regression model (R2 = .28), using variables from the initial regression analysis with significance levels of .01 or less, indicated the most important predictors of cigarette use were ethnic group, attitude toward females who smoke, close friends' use of cigarettes, personal use of marijuana, best friend's use of cigarettes, personal use of alcohol, and school self-esteem. Implications for school health programs are addressed.


The development of reactions of the public to warning and emergency situations in France, Greece, and the Netherlands. This article describes the different reactions to emergency warning messages among residents living within a 3-km radius of a hazardous chemical complex and by people living at least 10 km from an industrial site in France, Greece, and the Netherlands. Belief in warning, primary and secondary appraisal, emotional response, and adherence to normal routine were assessed by conducting face-to-face interviews in which a four-phase scenario simulating a credible industrial accident was presented. The results showed that respondents who did not reside in the neighborhood of the hazardous site were, in general, more inclined to trust the warning messages than respondents who resided in the neighborhood were. With the exception of primary appraisal, the warning phases evoked very distinct reactions in the respondents from all three countries with regard to warning belief, secondary appraisal, emotional response, and adherence to normal routine.


Subjective underemployment and psychosocial stress: the role of perceived social and supervisor support. The purpose of this study was to examine the effects of subjective underemployment on psychosocial stress. The moderator effects of perceived social and supervisor support were also investigated. Data were collected during the summer of 1987 in a public utility governmental agency in the United States. The sample size was 212 with a 71% response rate. Multiple regression analysis was used to examine the relationship between subjective underemployment and psychosocial stress. As expected, the results revealed a significant positive relationship between subjective underemployment and five indexes of psychosocial stress. The interactions between subjective underemployment and social and supervisor support were not significant; however, the relationships were in the expected directions. Supervisor support was positive and significantly related to psychosocial stress, but social support was not.


Self-esteem agreement in the marital relationship. With the use of the circular-causal model of relationship development, this study examined the convergence of the self-esteem of marriage partners over four martial life stages. Three hundred thirty-six married couples in the United States were randomly selected and divided into four life stage groups: younger couples with a child (or children) under age 6; couples with children in school; empty nest couples, in which the wife is in the age range of 45-59 years; and retired couples. Measures of a partner's self-esteem and his or her evaluation of the spouse's self-esteem were taken. The findings demonstrated a convergence of the partners' self-esteem across life stages.


Crowding effects of density and interpersonal distance. In this study, Turkish teenagers were the subjects in an investigation of the effects of spatial and social variables on perceived crowding. In Study 1, male and female subjects were presented with diagrams that simulated social situations in which (a) distance between the subject and other persons, (b) number, or density, of subjects, (c) sex, and (d) friendship were systematically varied. Results indicated a significant crowding effect for interpersonal distance but not for density. In Study 2, data from Turkish college students showed that the lack of effect for density on crowding was stable. Friendship and sex of others had significant main and interaction effects.


Euthanasia and abortion: personality correlates for the decision to terminate life. The study addresses three research questions: (a) How well do level of conservatism and religiosity predict attitudes toward passive and active euthanasia? (b) What is the relationship between attitudes toward abortion and attitudes toward euthanasia? (c) How do personality variables relate differentially to these attitudes? Subjects were 168 Australian adults (68 men, 100 women). Initial analysis indicated no sex differences in attitudes toward the study's criterion variables. Descriptive statistics indicated general support for active and passive euthanasia and for abortion, although the majority of the respondents were found to be more accepting of passive than of active euthanasia. Multiple regression analyses indicated that level of conservatism was the most consistent predictor of attitudes toward euthanasia and abortion, whereas religiosity was found significantly to predict attitudes toward abortion only.


Success strivings and their relationship to affective work behaviors: gender differences. Gender differences in the importance of six life success dimensions and their relationships to job satisfaction, job involvement, and propensity to stay on the job were examined among 756 working women and men in southeast Florida. Results showed that the female participants rated family relationships, personal fulfillment, and security as more important success measures than their male counterparts did, and they rated status/wealth as less important. Professional fulfillment and security were not significantly different. The relationships between measures of success and work behaviors also varied significantly by gender, even after controlling for demographic and job position variables.


[Prevalence of HIV-1 and other sexually transmitted diseases among Spanish prostitutes]. Many studies in Western countries point to the high prevalence of HIV infection in groups of prostitutes especially among those using intravenous drugs (IVDA). Furthermore, there appears to be a low but increasing number of heterosexually infected prostitutes. A cross-sectional study was carried out in a sample of 374 prostitutes selected by collaborating groups in 11 provinces with the aim of studying the prevalence of HIV and its associated risk factors in Spanish prostitutes. Furthermore, the prevalence of other sexually transmitted diseases (HIV-2, HTLV-I/II, hepatitis B and syphilis), the frequency of different sexual activities and the use of condoms were investigated in this group. The data were collected by interview using a previously tested questionnaire. Serological analysis demonstrated that 54 persons were positive for HIV-1 (16%), none for HIV-2, 1 for HTLV-I/II, 113 for hepatitis B (46%) and 84 for syphilis (25%). The main risk factor for HIV infection was IVDA; 60% of this group was positive vs 3% of the non IVDA (OR = 47.6; confidence interval 18.4-128.0). Consistent condom use in this population is low, although it varies according to the type of relation and sexual partner. Forty-nine percent of the women having vaginal relations with their customers reported using condoms at all times or almost all times vs 36% for anal relations and 22% for oral relations. These percentages were reduced to 10%, 6% and 3%, respectively with private sexual partners. Studies concerning HIV prevalence and its associated risk factors in Spanish prostitutes should be continued in order to monitor trends in HIV infection and the use of protective measures.


[Hepatic changes in patients with isolated immunodeficiency virus infection and AIDS]. The aim of the present study was to describe the spectrum of liver disease in isolated infection by the human immunodeficiency virus and in the acquired immunodeficiency syndrome as well as evaluate whether clinical and/or biological data exist to permit specific diagnosis in liver biopsy. Liver biopsy was performed in 39 patients with the human immunodeficiency virus (34 via parenteral drug addicts), 22 of whom had established acquired immunodeficiency syndrome. In 29 cases (74%) a specific histologic diagnosis was obtained with the changes most frequently found being the presence of granulomas (11 patients), mainly in patients with stablished AIDS, and chronic active hepatitis non A non B (10 patients), specially in the cases with isolated infection by the human immunodeficiency virus. Obtaining of a specific diagnosis was associated with an increase in GOT and a decrease of the CD4 lymphocytes and the CD4/CD8 quotient (p = 0.002 in all cases). The existence of established AIDS or prolonged fever was associated with the finding of hepatic granulomas (p = 0.02 and p = 0.002, respectively). The increase in GPT, the absence of stablished AIDS and the absence of prolonged fever was associated to the presence of chronic active hepatitis (p = 0.01, p = 0.002 and p = 0.0002, respectively). In patients with infection by the human immunodeficiency virus liver biopsy provides diagnostic information in a high percentage of cases. The presence of established AIDS, prolonged fever, and hypertransaminasemia may point towards possible histologic diagnosis.


[Plasma concentrations of fibronectin in septic, hypovolemic, and cardiogenic shock. Prognostic usefulness of their variation]. Fibronectin is a protein with opsonic capacity. Its plasma level is diminished in septic shock. The aim of the present was to study its behavior in other types of shock. A prospective study of 60 patients in shock (septic, hypovolemic and cardiogenic) was carried out. Serial plasma levels of fibronectin were determined in these patients over a period of 72 hours. The values of the cases which evolved favorably were compared with the values of those which did not. In all the cases, the plasma levels of fibronectin were diminished within a minimum of approximately 12 hours with a tendency to recovery of initial values being observed within 72 hours, except in cases in which the evolution of the patient was poor. In these cases fibronectin values remained diminished in such statistical significant. Plasma levels of fibronectin behave similarly in the three types of shock studied (septic, hypovolemic and cardiogenic). Serial determination of fibronectin provides a good prognostic index in patients with shock.


[Different etiology of thyrotoxicosis as a function of previous prevalence of goiter]. The high incidence of goiter is believed to modify the characteristics and etiology of thyrotoxicosis. The aim of the present was to study the etiologic types and clinical characteristics of thyrotoxicosis of patients from two areas of different endemic goiter. Two hundred twelve patients (184 women and 28 males) were studied with clinical and analytical data of thyrotoxicosis. The patients were consecutively seen in the endocrinology units of two different hospitals over the last 4 years. One hundred eight patients pertained to the area of the Xeral Hospital in Lugo (inland zone) and 104 pertained to the area of the Juan Canalejo Hospital from La Coruña (coastal zone). The clinical data of thyrotoxicosis, thyroxin concentration and thyroid gammagraphies were evaluated. The different etiological types were: Graves disease (GD): Lugo: 20 (19%), La Coruña 57 (55%; p less than 0.001). Toxic multinodular goiter (TMG): Lugo 53 (49%), La Coruña 29 (28%; p less than 0.001). Toxic adenoma (TA): Lugo 23 (21%), La Coruña 13 (13%). Hyperthyroidism by iodine: Lugo: 8 (7%), La Coruña 3 (3%). Other diagnosis: Lugo: 4 (3%), La Coruña 2 (2%). Although the frequency of thyrotoxicosis was much greater in women the percentage distribution of the etiologic types was similar in the two sexes. Symptoms were more frequent in patients with GD with respect to TMG. The presence of auricular fibrillation was more frequent in patients with TMG (38%) than in those presenting GD (4%; p less than 0.01). Toxic multinodular goiter is the most common cause of thyrotoxicosis in the zones of high endemic goiter. On lowering endemic goiter the percentage of TMG is lowered and that of Graves disease is raised. The symptomatology of thyrotoxicosis is more evident in GD with relation to other etiologic types, but auricular fibrillation is more frequent in TMG. The high prevalence of toxic nodular goiter and hyperthyroidism by iodine suggests the important pathogenic role of the increase of the ingestion of iodine in the form of iodized salt or drugs with iodine.


[Pyomyositis caused by Staphylococcus aureus]. An evaluation of the clinical characteristics and profitability of the diagnostic methods of myositis by Staphylococcus aureus was undertaken in favor of earlier diagnosis and treatment. Twenty-eight cases of pyomyositis by S. aureus attended over the last nine years were studied. Inclusion criteria were: 1) compatible clinical manifestations, 2) demonstration of an abscess in CT and/or surgery, 3) isolation of S. aureus in abscess, hemoculture and/or neighboring tissue. Age: 36 +/- 18 years (limits 9-70). Sex: 23 males (82%). Neighboring pathology existed in 11 cases (39%). 5 sacroiliitis (18%), 4 spondyliodiscitis, 2 osteomyelitis. Favoring/predisposing factors: intravenous drug addiction in 11, staphylococcal sepsis in 6, diabetes mellitus in 4, previous surgery in 3, penetrating muscle injury in 3, and parametritis in 1. Fourteen cases (50%) corresponded to primary pyomyositis. The muscle most frequently involved was the psoas/iliacpsoas, followed by near the forearm muscle, spinal, gluteal, and upper pectoral muscles. In 16 cases (57%), only one muscle was involved, in 10 two muscles, and in 2 three groups. The time of clinical manifestation prior to consultation oscillated between 1.5-30 days, being less in cases of primary pyomyositis (p less than 0.0005). All the patients referred fever and local pain, with functional impotence in 26 (93%), general involvement, shivering and perspiration in 24 (86%). All the patients presented pain upon palpation. In 19 (68%) there was an increase in local temperature and in 18 a palpable mass. S. aureus was isolated in 16 hemocultures (sensitivity 57%), in 12 of 13 cultures of neighboring tissue (92%) and in all those aspirated from abscesses (100%). CT demonstrated muscular (thickening and/or destructuration or abscess) and neighboring pathology (if existent) in all cases. All the patients received medical treatment. Evacuating puncture was carried out in 7 cases, and surgical drainage in 23 (82%). Two cases were cured exclusively with medical treatment. Complications were seen in 8 cases (29%) and two patients died of staphylococcal sepsis. 1) In myositis by Staphylococcus aureus the percentage of primary pyomyositis is considerable. 2) In secondary pyomyositis the most frequent neighboring processes were sacroiliitis and spondylitis. 3) intravenous drug addiction was the most frequent predisposing factor. 4) The time of clinical evolution is variable although less in case of primary pyomyositis. 5) The performance of hemocultures was found to be greater than described and even greater in primary pyomyositis. 6) Abscess cultures and CT are the most efficient microbiological and imaging techniques in the early diagnosis of myositis by S. aureus.


[Concentrations of 25-hydroxyvitamin D3 in Antarctica]. Ultraviolet B radiation decidedly influences the synthesis of vitamin D and therefore mineral and bone metabolism. It must also be taken into account that a normal unsupplemented diet is usually deficient in this vitamin. Two groups of subjects pertaining to the Spanish Antarctic Expedition 1988-1989 were studied to determine whether special conditions of irradiation and solar exposure found in Antarctica induce alterations in the abovementioned metabolism. Each group consisted of 11 healthy males with ingestion of less than 500 mg/day of calcium. The second group was administered vitamin D3 supplements of 1,000 UI/day. Two blood samples were performed at an interval of 22 days during the Antarctic summer to determine calcium, phosphorus, magnesium, parathormone (PTH) and 25-hydroxycholecalciferol [25(OH)D]. Neither group varied in calcemia, phosphoremia or magnesemia. In the first group the 25(OH)D decreased markedly (p less than 0.01) with no variations being observed in PTH. In the supplemented group, and insignificant increase of 25(OH)D was observed which was significant enough to cause a marked decrease in PTH (p less than 0.01). Subjects passing periods of time in Antarctica should receive vitamin D3 supplementation at doses less than 1,000 UI/day.


[Latex myoglobin: a fast early marker in acute myocardial infarction]. To evaluate the diagnostic power of serum myoglobin (Mgb) by latex agglutination as a marker in the first hours of acute myocardial infarction (AMI). Two hundred forty-eight serum samples from 53 patients admitted to the Coronary Unit (CU) from the Emergency Department (ED) for suspected AMI were studied. The extractions were carried out upon admission and at 4, 8, 12, 18, 24 and 36 hours after the initiation of symptoms. Myoglobin was analyzed by radioimmunoassay (RIA) and by a semiquantitative method of latex agglutination (Rapitex), in addition to creatine kinase (CK) and MB fraction (CK-MB). Sensitivity (S), specificity (E), positive and negative predictive value (PPV) (NPV) and standard efficacy (SE) of the different markers were measured along with the correlation between RIA and latex methods for Mgb. For a prevalence of 83%, the latex test provided S = 81%, E = 8%, PPV = 97%, NPV = 50%, ES = 0.85; CK S = 43% (*), E = 88%, PPV = 97%, NPV = 24% (*) and ES = 0.31 (*) (* = p less than 0.01) and CK-MB S.63% (*), E = 100%, PPV = 100%, NPV = 34% (*) and ES = 0.31 (*) (* = p less than 0.05). The correlation between latex and RIA in the first 4 hours was r = 0.8243 (p less than 0.0001). On performing the 2 tests separated by 2 in the first 4, latex NPV was 100%. Mgb - latex is the earliest AMI indicator and has greater diagnostic strength in the first hours than CK and CK-MB. It has a good correlation with Mgb-RIA and is simple and rapid to carry out making it specially useful in Emergency Departments and Coronary Units.


[Acquired immunodeficiency syndrome and T-cell non-Hodgkin's lymphoma]. The clinical observation of a 40 years old male presenting acquired immune deficiency syndrome and T-cell non Hodgkin's lymphoma is presented. The patient was treated with COMET-A regimen (cyclophosphamide, vincristine, methotrexate, etoposide and cytarabine) and a complete remission was obtained.


In vitro magnesium absorption and the role of intestinal motility. Magnesium (Mg) is known as an inhibitor of spontaneously contracting muscular tissues. To increase extracellular Mg in vivo, high doses of Mg must be given orally. Therefore, we investigated the effect of different doses of Mg given from the mucosal side of the small intestine of rats. According to the model of Trendelenburg, a system for the perfusion of isolated small intestine was developed, which allows the simultaneous recording of absorption and muscle contractions. Increasing doses of Mg were applied serosally or intraluminally. Intramulinal Mg did not affect intestinal motility. In contrast, increasing concentrations of serosal Mg resulted in a 50% inhibition of motility at 2.9 mmol/l Mg. This indicates no influence on intestinal motility of high doses of Mg acting from the mucosal side. In further studies, the addition of citric acid or taurocholic acid did not alter Mg absorption. Serosally applied amiloride (1 mmol/l) inhibited absorption, but also resulted in complete loss of motility. Since in this model passive diffusion is the most important mechanism of Mg transport, a direct influence of amiloride on Mg absorption can be excluded. From these data, we conclude that intestinal motility influences absorption--also of ions in aqueous solution--and should therefore be taken into account in absorption studies.


Pharmacokinetics of magnesium salts.

Pharmacokinetics of magnesium salts. Due to the widespread use of magnesium (Mg) in human medicine, interest in quantitative enteral absorption rates arose more than 100 years ago. The introduction of the AAS technique and of radioisotopes has stimulated research. Slowly exchanging compartments have not, however, been accessible up until now, and the exact mechanism(s) of enteral Mg absorption is still unclear; hence, the fate of orally administered Mg cannot be followed in detail. The capacity of skeletal Mg stores varies with exogenous Mg supply, consumption, excretion and age. In otherwise healthy subjects, urine Mg levels correlate with exogenous supply. Neglecting the fact that exogenous Mg exchanges with deep Mg stores to a considerable degree, it makes sense to qualitatively study the availability of Mg compounds by relating the amount administered to the amount excreted in the urine, especially after filling deep compartments. Since renal Mg excretion patterns are known to change when tubular reabsorption capacity is exceeded or when pH alterations occur, these parameters must be monitored and taken into account at the quantitative evaluation of data.


Renal elimination of magnesium as a parameter of bioavailability of oral magnesium therapy. Magnesium is an important cation in human physiology, especially in the regulation of membrane proteins, as a cofactor for various enzyme systems and in neuromuscular transmission. Magnesium deficiency leads to severe impairment in muscle function, particularly in cardiovascular diseases. Classical bioavailability studies with magnesium cannot be carried out for several reasons. As the magnesium concentration in plasma is extraordinarily well regulated, renal elimination proves to be the best method to determine the absorption of orally administered magnesium. Magnesium pools must first be filled, and the saturation phase of renal elimination then equals the degree of absorption. This parameter of bioavailability shows the percentage of eliminated magnesium in comparison to the administered dose. Eighteen healthy male volunteers were included in this study to compare 5 mg magnesium-DL-hydrogen aspartate with magnesium-L-hydrogen aspartate. After a saturation phase, the test substances were administered in random order. Blood samples for determination of magnesium concentrations were taken, but no typical pharmacokinetic concentration curves were obtained. The areas under the concentration-time curves were equal for both formulations (x = 40.22 [mval*h/l]). The bioavailability of both substances was determined from the renal elimination. No significant difference was found between both treatments. Bioavailability of 5 mg magnesium-DL-hydrogen aspartate was 44.5% and for magnesium-L-hydrogen aspartate 41.7%. It is evident that this method of magnesium determination is practical, comfortable for volunteers and gives reliable results in comparing the absorption of magnesium formulations.


Water: mechanism of oral rehydration, water deficiency = deficiency in salt. UNICEF, the United Nations International Children Emergency Funds, has staged an enormous program to improve children's health conditions in the developing countries. One extremely fruitful field of engagement was, and still is, the treatment of dehydration. Oral rehydration therapy (ORT) has reluctantly been accepted in the industrialized countries. From clinical observations, we have gained a new understanding of known pathophysiological principles. Dehydration most often is a result of diarrhea, and therefore oral rehydration therapy is mostly referred to in the context of infections of the digestive system. We discuss additional causes of dehydration and its immediate and secondary consequences. We demonstrate not only that, but why and how, a very simple, inexpensive regimen is beneficial and effective in the treatment of dehydration. Without consideration of sodium deficit, understanding will fail, and treatment will remain ineffective.


A new method for the rapid determination of ionized Mg2+ in whole blood, serum and plasma. A novel ion selective electrode (ISE) for ionized magnesium (IMg2+) in whole blood (WB), plasma (PL) and serum (S) has now been designed and characterized in normal human subjects, diseased and pregnant subjects. Using this ISE on various levels of aqueous Mg2+ solutions (0.1-3.0mM), mean Mg2+ values are within 94.6 and 99.2% of their targets. The linearity of the ISE (0.1-3.0mM) in aqueous solution and human PL and S ranges between 92.0 and 99.3%. The ISE is highly selective for IMg2+, yielding measurements in less than 2 min, and exhibiting no or negligible effects from physiologic concentrations of Ca2+,Na+,K+ or H+. Ligand binding studies indicate that pathophysiologic concentrations of most smaller molecular weight anions fail to interfere with IMg2+ measurements in aqueous solution, PL or S. Likewise, pathophysiologic concentrations of heavy metals or lipids do not interfere with measurements for IMg2+. Comparison of healthy, normal WB, PL and S IMg2+, using the ISE, with measurements of ultrafilterable Mg by atomic absorption spectroscopy (AAS) are excellent. The mean value for IMg2+ in normal WB, PL and S is 0.58-0.60mM (range = 0.53-0.67mM). Compared to total Mg (TMg) (0.75-0.96mM) and ICa2+ (1.10-1.30mM), IMg2+ is held in a narrow, tight range, representing 71% of TMg. Preliminary studies on plasma and serum IMg2+ during open heart surgery and term pregnancy demonstrate significant abnormalities in IMg2+ and % IMg2+. The new ISE for IMg2+ should prove invaluable and revolutionary in studies of Mg metabolism in both healthy and diseased states.


A new method of in vitro prescreening evaluation of several Mg salts. The human amniotic membrane may be considered a model for the prescreening evaluation of the membrane effects of several Mg salts because it is an asymmetrical membrane (polarity of the 2 sides: the ratio between the total ionic conductance Gt both ways and the ratio between the ionic flux from the mother to the fetus (F1) and the ionic flux from the fetus to the mother (F2) are different from 1), samples of which can be obtained without ethical problems, and which is easily usable. Whatever the tested salt, the ratio F1/F2 must be constant or increased without alterations of the ionic fluxes (+/-20%), because a toxic metal (As) has no effect on F1/F2, but strongly decreases the ionic fluxes. To apply this model to the study of the effects of Mg salts, two conditions should be considered: 1) Mg oral therapy: Mg deficit increases the membrane fluidity and the increase of Mg concentration rigidifies the membrane, i.e. decreases Gt; the plasma level of Mg being equal to 1 mM, Mg salts would be tested at 1 mM and Gt should be decreased; and 2) Mg parenteral therapy: the Mg effects should be opposite to those of pollutants and alcohol, which reduce Gt; a dose of 3 mM is chosen and Gt should be increased. The general scheme to study Mg salts is the following: observation of the variation of F1/F2 at 1 mM and of the evolution of Gt, and identical observations at 3 mM. This in vitro prescreening method, indirectly applicable to in vivo effects, gives a classification of Mg salts which may be completed by a study of the 10 components of Gt in the case of identical results for Mg salts.


A new method of in vitro prescreening evaluation of the relationship between toxic and common metal ions. The human amniotic membrane, an asymmetrical and nonexcitable epithelium with sites differently situated on the fetal and maternal sides, may be considered a model for investigating the relationship between toxic and common metal ions. The method is based on the observation of the ionic transfer across the amnion, estimated by measuring the total ionic conductance Gt from the mother to the fetus and from the fetus to the mother. It is important to note that opposite effects between two ions are not necessarily correlated with antagonism; indeed, pollutants decrease ionic conductance Gt and Mg increases it, but Mg is not an antagonist of all pollutants. To define antagonism between two ions, the Dixon curves theory should be applied. These curves represent the variation of Gt when the concentration of common metal increases (1 mM, 3 mM), while the concentration of toxic metal is maintained constant (3 concentrations of toxic metal are used). The straight lines obtained are either parallel to each other (noncompetitive inhibition), parallel to the x axis (no interaction between common and toxic metals), or the 3 lines intersect at a common point equal to the inhibition constant. At pharmacological doses, there is competitive inhibition (specific antagonism) between Mg and Cd, Zn and Cd, Ca and Cd, and Mg and Pb, and noncompetitive inhibition between Mg and Hg. This method may rapidly indicate a membrane interaction between common and toxic metals.


Heart failure and electrolyte disturbances. Electrolyte abnormalities are a frequent and potentially hazardous complication in patients with heart failure. This may be due to the pathophysiological alterations seen in the heart failure state leading to neurohumoral activation (stimulation of the renin-angiotensin-aldosterone system, sympathoadrenergic stimulation), and due to the complications of therapy with diuretics, cardiac glycosides or ACE inhibitors. Patients with heart failure may exhibit hyponatremia due to a decrease in water excretion, which may be related to the enhanced release of both angiotensin and vasopressin and can be exaggerated by diuretic therapy. Along with potassium and calcium, magnesium influences cardiovascular function. Magnesium and potassium deficiencies play an important role in the development of cardiac arrhythmias. Magnesium is essential for the maintenance of intracellular potassium concentration. Although there are conflicting data regarding the prevalence of hypomagnesemia in patients with chronic heart failure (the values range from 7-37%), multiple studies have documented lower magnesium concentrations in patients with heart failure than in normal controls. As magnesium and potassium are mainly intracellular ions, measurements in serum or plasma are of limited value to assess magnesium status. There was no correlation between the intracellular electrolyte content and the electrolyte levels in plasma, either for mononuclear cells or erythrocytes or for myocardial and skeletal muscle. Loop diuretics (e.g. furosemide) are supposed to cause a substantial loss of both magnesium and potassium in the plasma and intracellular space. The potassium-sparing diuretics amiloride and triamterene are reported to also exert magnesium-sparing effects. Recently, ACE inhibitors have been documented to have important magnesium-conserving actions, possibly via their effect on glomerular filtration. Hyperkalemia, secondary to the use of ACE inhibitors in patients with heart failure, is well documented. Digoxin directly limits the renal tubular reabsorption of magnesium, therefore increasing magnesium excretion. Low magnesium and potassium concentrations increase cardiac glycoside toxicity. In contrast, elevated levels of magnesium decrease the sensitivity of human myocardium to antiarrhythmogenic actions of cardiac glycosides, without affecting maximally developed tension. Moreover, magnesium increases binding affinity of cardiac glycosides to the receptor. The antiarrhythmic action of magnesium is suspected to be mediated by a reduced sensitivity to electrophysiological changes induced by Ca2+, thus indicating Ca2+ antagonistic properties of magnesium. Magnesium deficiency has also been implicated in sudden death, notably in patients with congestive heart failure. Therefore, when treating congestive heart failure, one must consider how to prevent depletion of electrolytes or how to replete potassium and magnesium in deficiency states.


[Anal condylomata acuminata in HIV positive patients]. Since July 1986 we started with following all patients with condylomata acuminata including HIV-testing and human papilloma virus (HPV) identification by DNA-DNA-hybridisation (southern blot). Seventy patients are included, 39 of them are seropositive. The ratio male to female is 59 to 11, in seropositives 35 to 4, in negatives 24 to 7. The average age is 28 and 31 years respectively. The number of homosexuals and junkies is significantly higher in seropositives. Seventeen patients are in HIV-stage II, 11 in stage III and 10 in stage IV according to CDC-classification. Characteristic for the seropositives was an extensive growth on the rectal mucosa and the very rapid growth of initially subtotally resected lesions in order to prevent stenosis. Sixty-five patients were treated by one stage radical operation with electrocauter. Surprisingly recurrency is more frequent in seronegatives, however, the lesion is much smaller in this group. A hypothesis to explain this observation is brought forward. Postoperative complications occurred only in HIV-stages III and IV. We therefore recommend single shot antibiotic prophylaxis in these patients. The HPV-identification showed no malignancy associated HPV-types in both groups but a higher incidence of HPV 11 in higher HIV-stages which we cannot explain. We conclude from our series that, if operation is indicated, one stage radical electrocoagulation of condylomata acuminata is a necessary procedure in seropositive patients and a save one in negative patients but antibiotic prophylaxis should be given in stage III and IV. Anal condylomata acuminata are a hint for possible HIV-positivity.


[How much experience is required for ultrasound diagnosis of blunt abdominal trauma?]. Between July, 1st 1989 and June, 30th 1991, 312 patients were entered into a prospective study concerning the reliability of sonographic evidence in blunt abdominal trauma. There were 231 male and 81 female patients aged between 15 and 88 years (mean: 39.9 years). The sonographic team consisted of one experienced sonographer/surgeon (greater than 4000 examinations) and 3 sonographic beginners (less than 200 examinations at the start of the study). The experienced sonographer and the beginners examined 168 and 144 patients, respectively. Patient distribution to the two groups was done according to the sonographic duty roster without consideration of injury severity. The examination was performed with a mobile ultrasound unit at the surgical intake as part of the primary diagnostic work-up. It consisted of four sonographic views (right and left lateral longitudinal, suprapubic and epigastric transverse view) and took about 2 min. Clinical evidence supporting blunt abdominal trauma could only be found in 64 cases, while in 153 patients physical examination was equivocal due to assisted ventilation or paraplegia. Sensitivity and specificity for the clinical examination amounted to 80.6% and 44.5%, respectively. Sensitivity and specificity for the sonographic finding of intraabdominal liquid were 100% each for the experienced sonographer and 96% and 100%, respectively for the beginners. Organ lesions were demonstrated with a sensitivity and specificity of 45% and 99% by the experienced and 36% and 100% by the beginners. The experienced sonographer misdiagnosed one case of free intraabdominal gas, which could not be corroborated both by clinical and radiological evidence.(ABSTRACT TRUNCATED AT 250 WORDS)


[Traumatic rupture of a kidney transplant in chronic lymphocele]. The lymphocele is a seldom complication after kidney transplantation (2.2% of our patients). This manifestation occurs typically 3-4 months after transplantation, as a late complication it's a rarity. The rupture of a kidney graft because of a trauma is unique in our clinical experience, which contains more than 1200 kidney transplantations. We report the case of a 28-year-old man who had 19 years after transplantation a traumatic rupture of the kidney graft. Because of the trauma a preexistent chronic lymphocele got clinically manifest. The histology of the lymphocele wall shows fatty and collagen tissue with a strong fibrosis. The diagnostic and therapeutic procedure is described. There are different possible relations between the rare problems:--the tight lymphocele carries over the force on the graft--the lymphocele has grown together with the graft at the lower pole and ruptures in this place--a little graft rupture makes a clinical manifest bleeding in the lymphocele because the deficiency of perirenal tissue.


[2 cases of life threatening gastrointestinal hemorrhage from Meckel's diverticulum]. Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at 2 and 3 years of follow-up respectively. The genesis of diverticular bleeding, the difficulties of the preoperative diagnosis of the complicated diverticulum and the uncertain indication for operation in cases of uncomplicated diverticulum are discussed and the literature is reviewed.


[The arterial blood supply of the tibial and practical consequences]. In the periosteum of the human tibia, the arterial blood supply shows a general sectorial angioarchitecture. There are 4 segments: proximal and distal 1/5, proximal and distal diaphysis. The proximal 1/5 of the tibial periosteum is supplied with blood by the aa. recurrentes tibiales anterior et posterior and the aa. inferiores medialis et lateralis genus. At the proximal diaphysis (next 3/10 of the tibia) periosteal branches arise from the a. tibialis anterior and the a. tibialis posterior. The distal diaphysis (following 3/10 below the middle of the tibia) is nourished exclusively by semicircular rami periostales of the a. tibialis anterior, which move around the bone from both sides and join with each other at the facies medialis. It is the only sector, which is supplied by a single main artery. Concerning the periosteal blood supply of the distal 1/5 of the tibia 2 different types are found. In 2/3 of the cases the lateral side is nourished by a great vessel of the a. fibularis, which is supported by branches arising from the a. tibialis anterior. In 1/3 of the cases this vessel of the a. fibularis is absent and rami periostales of the a. tibialis anterior nourish the lateral aspect of the distal tibia alone. The dorsal region is supplied in all cases by rami of the a. fibularis and a. tibialis posterior. On the medial side the periosteal nourishment is ensured only by anastomoses. Both the facies lateralis and the facies posterior are supplied by direct branches, which arise from the main arteries of the lower leg.(ABSTRACT TRUNCATED AT 250 WORDS)


Complications after an unusual procedure in the treatment of a cervical spine burst fracture. A case report. A 21-year-old man sustained a burst fracture of the 7th cervical vertebral body complicated by a complete loss of sensory and motor functions. He was treated with a pedicled greater omentum flap interposed between the cervical and thoracic spine in a Latin American country. The purpose of this paper is to point out the atypical way of the initial mismanagement. By applying basic principles of fracture management, open reduction and internal fixation was performed resulting in spinal stability which should enhance any chance of recovery of the patient.


[Prognostically relevant factors in intra-abdominal infection]. From 1.1.1982-30.9.1989 280 patients were treated for intraabdominal infection at the clinic for general and abdominal surgery. With regard to their prognostic significance, the extent and localization of the peritonitis, abscess formation, the number of failed organ system, patients' age, total protein, thrombocytes and leucocytes were examined in these patients. The most unfavorable prognosis showed diffuse peritonitis with a mortality rate of 47.2%. Subsequent abscessing worsened the prognosis of the illness. There was a close correlation between the number of failed organ systems at the time of hospitalization and mortality. Low total protein content or more so a necessary substitution therapy were linked to a high mortality (less than 4 g%: 81.2% mortality). A low number of thrombocytes and leucocytes and a low total protein in the serum were a sure sign for a complicated process of the illness, with these 2 situations combined, mortality was 100%. The indication for laparotomy and most of all for relaparotomy can be facilitated, if these factors are included in the decision, as their negative change are an indicator for a further existing or imminent postoperative peritonitis.


[Electromyography and functional analytic findings in obstructive disorders of defecation. A contribution to the differentiation of neurogenic and myogenic sphincter damage]. The aim of this study was to get further information about functional results in patients with outlet obstruction. We investigated 27 patients (age between 42 and 74 years) by electromyography (EMG), manometry and radiology with contrast-solution. The electromyography, a dynamic investigation method, allows the differentiation between neuronal and muscular malfunctions of the voluntary controlled pelvis muscles. Patients with outlet obstruction should be divided into three groups by EMG diagnosis: One group with neuronal alterations, another group with muscular alterations and one group with neuro-muscular alterations. We obtained marked statistical differences between patients with neuronal or muscular malfunctions in the mean amplitude, the turns per second and the integration of the mean amplitude compared to the control group (14 patients). Patients with only neuronal alterations showed furthermore statistically significant distinctions of the action potential duration from control, whereas the data of patients with muscular malfunctions were significantly different from control in the peak amplitude of the action potentials. 77% of all investigated patients were not able to relax the pelvis muscles during defecation.


Intravascular ultrasound guided holmium:YAG laser recanalization of occluded arteries. Current angioplasty devices are limited by arterial wall dissection and perforation, and by early recurrence from inadequate debulking of lesions. This study evaluated intravascular ultrasound (IVUS) as guidance for concentric laser recanalization of arterial occlusions. Twelve, 2-4-cm-long canine iliac artery occlusions were treated at 2 weeks (organizing thrombus) to 12 weeks (firm fibrous lesions) using a Holmium:YAG laser (2,100 nm wavelength) in free running mode, FRM, (250 musec pulse, 5 Hz), n = 9; and Q-switched mode, QSM (200 ns pulse, 6 Hz), n = 3. A 200 microns (n = 2) or 600 microns (n = 10) optic fiber was centered in the artery coaxial to a 5Fr rotating A scan IVUS probe. The fiber was positioned in the center of the artery distal to the lesion and slowly advanced through the obstruction. In 8 occlusions the same fiber was used as a guidewire for passage of either a 1.6-mm-(n = 2) and/or 3.0-mm (n = 6) diameter multifiber catheter (19 x 100 and 19 x 200 microns fibers, respectively) using FRM energy to further debulk the lesion. In all cases, IVUS guidance enabled concentric initial recanalization of occlusions, although 3 vessel perforations resulted from fiber deviation off the center of the lumen at a distance of 2 to 4 cm from the IVUS imaging element. Both QSM and FRM modes ablated tissue, with FRM modes producing more tissue fragmentation and thermal effect. IVUS images accurately diagnosed the location of lesions compared to angioscopic views and pathologic analysis of the specimens.(ABSTRACT TRUNCATED AT 250 WORDS)


Laser treatment of premalignant and malignant squamous cell lesions of the penis. Thirty men with biopsy-proven premalignant or malignant squamous cell lesions of the penis were treated. All had subclinical aceto-white lesions with histologic evidence for human papilloma virus infection. Nineteen patients had penile intraepithelial neoplasia (PIN I and II) and 11 had squamous cell carcinoma. Of these 11 patients, 6 had noninvasive penile intraepithelial neoplasia--carcinoma in situ (PIN III/Tis)--and 5 had invasive squamous cell carcinoma (4 stage T2 and 1 T3). All were treated with laser: CO2 was used for low-stage lesions, Nd:YAG was used alone or in combination with CO2 laser for more histologically advanced lesions, and KTP/532 was used in one patient with squamous cell carcinoma (Tis). Follow-up in 23 patients for up to 2 years showed that all but 1 (stage T3) remained free from penile malignancy. Appropriate laser therapy for all but deeply invasive (T3) tumors controls local disease, producing results that are clinically equal and cosmetically and functionally far superior to partial penectomy.


Pathologic changes occurring in the prostate following transurethral laser prostatectomy. Serial gross and histopathologic examinations of the prostate following transurethral laser prostatectomy in the canine model demonstrated an immediate well-demarcated sphere of thermal necrosis measuring 2.7 cm in diameter, which, within 24 hours, had begun liquefaction and was showing multiple areas of cavitation. By the end of the 1st week, the areas of cavitation had coalesced to form a central cavity lined by a narrow layer of necrotic tissue clinging to the thin surviving peripheral belt of prostatic glandular parenchyma. At 3 weeks, the bluish-black discoloration resulting from breakdown of blood in the necrotic tissue had subsided, leaving masses of coagulonecrotic tissue within the central cavity. Within 5 weeks, the ectatic central cavity was lined by transitional epithelium. These postmortem pathologic observations confirm our surgical and clinical impressions of being able to satisfactorily perform an effective transurethral prostatectomy using neodymium:YAG (Nd:YAG) laser photoirradiation.


CO2 laser annular thermokeratoplasty: a preliminary study. Since most techniques of refractive surgery currently in use or being developed have the potential for significant side effects, there is a need for investigating alternative procedures. We herein report on the use of a pulsed CO2 laser beam delivered through a pair of complementary axicons to produce a ring of stromal collagen contraction resulting in the flattening of the corneal apex of cadaver eyes. Irradiances of 29 W/cm2 and 23 W/cm2 were used for rings of 5.5 mm and 7.0 mm, respectively. The creation of a ring of 7.0 mm in diameter did not affect the corneal curvature significantly but when the diameter was reduced to 5.5 mm, substantial flattening proportional to the dose of radiation took place. In our system, it was possible to achieve up to 11.3 diopters of mean keratometry flattening (90 joules, 5.5 mm of diameter). In addition, a 1 mm posterior displacement of the corneal dome without histological evidence of closure of the iridocorneal angle was observed. Annular thermokeratoplasty (ATK) may minimize side effects encountered with other refractive procedures since it does not require ablation, incisions, or interaction with the central optical zone.


Mid-infrared laser ablation of the cornea: a comparative study. The ablation thresholds and patterns of collateral damage in cornea produced by Er:YAG (2.94 microns) and Er:YSGG (2.79 microns) lasers were measured. Two different pulse durations, 200 microseconds (normal spiking mode) and 100 ns (Q-switched mode), were used at both wavelengths. In the normal spiking mode, damage zones of 16 +/- 2 microns and 39 +/- 7 microns and ablation thresholds of 250 +/- 20 mJ/cm2 and 420 +/- 35 mJ/cm2 were measured at 2.94 microns and 2.79 microns, respectively. In the Q-switched mode, damage zones of 4 +/- 2 microns and ablation thresholds of 150 +/- 10 mJ/cm2 were found irrespective of the laser used. The similarity between the results using the Er:YAG and Er:YSGG lasers in the Q-switched mode suggest that either laser can be used with equal effectiveness for corneal trephination.


Pulse duration effects on cutaneous pigment. Melanin, an endogenous chromophore in pigment containing cells in skin, is being specifically altered by lasers using the principle of selective photothermolysis (SPT). This implies that a combination of specific laser parameters of wavelength, pulse duration, spotsize, and energy density are required to confine the delivered laser energy to the targeted cells alone. Because the bulk of cutaneous pigment is localized to epidermal basal cells, pigmentary incontinence has been found to occur in skin exposed to laser irradiation. This study demonstrates that pulse duration or exposure time of the laser affect the severity of pigmentary incontinence induced. Pigment granules are more abundant, aggregated, and located deeper in the dermis following exposure to 500 nsec pulse duration than 100 nsec at a wavelength of 504 nm. This relationship appears to be independent of the laser energy density used.


Prevention of X-ray-induced late dermal necrosis in the pig by treatment with multi-wavelength light. Low-level light from a multi-wavelength array of light sources has been used to prevent late X-ray-induced dermal necrosis in the pig. Skin fields, measuring 4 x 4 cm on the flank, were irradiated with a single dose of 23.4 Gy of X-rays. This X-ray dose was associated with the development of a 100% incidence of dermal necrosis, 10-16 weeks after irradiation. These irradiated skin sites were subsequently exposed to light of 660, 820, 880, and 950 nm wavelengths from a gallium aluminium arsenide multiple wavelength multidiode cluster probe (Biotherapy Medical Laser, 3ML), three times a week, from 4 to 16 weeks or 6 to 16 weeks after X-irradiation. The skin fields were exposed to the light pulsating at either 2.5 Hz or 5 kHz. With light pulsating at 5 kHz, energy densities of 0.22, 0.54, 1.08 2.16, 4.32, and 10.8 J/cm2 were used. Treatment with light pulsating at 2.5 Hz, 6-16 weeks after X-irradiation, or treatment with light pulsating at 5 kHz, 4-16 weeks after X-irradiation, did not have a significant effect on the incidence or the latency for the development of ischemic dermal necrosis irrespective of the exposure time to light at each treatment. With light pulsating at 5 kHz, no effect of light dose was observed. However, the overall incidence of dermal necrosis was significantly reduced (P = 0.001) to 52% in the X-irradiated fields receiving treatment with 5 kHz light, 6-16 weeks after X-irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)


Exogenous chromophores for the argon and Nd:YAG lasers: a potential application to laser-tissue interactions. Chromophore dyes can be employed to modify laser-tissue interaction. A number of dyes have been investigated for their effect on the absorption and transmission of argon and Nd:YAG laser energy by vascular tissue in vitro. Three histological dyes have been assessed as potential chromophores for the argon laser and four infrared dyes for the Nd:YAG. Segments of porcine coronary artery to which dye had been applied were lased (1,064 nm, 2.5 W, 83 W/cm2, 60 s and 488/514 nm, 400 mW, 10.5 W/cm2, 60s) and the tissue temperature measured remotely using an infrared thermometer. In addition, energy transmission was measured with a photodiode and tissue morphological changes assessed histologically. All three argon dyes significantly increased energy absorption (typically 60 degrees C v. 20 degrees C at 60 s, P less than 0.001, 2-way ANOVA). Three of the four infrared dyes behaved similarly (40-70 degrees C v. 20 degrees C, P less than 0.001). All dyes significantly increased the initial rate of rise in tissue temperature during lasing. A reduction in energy transmission was observed for each of the Argon dyes but not for the Nd:YAG dyes. Histological evidence of thermal damage in control tissue first occurred for the argon and Nd:YAG lasers at 800 mW and 7.5 W without chromophore and at 400 mW and 2.5 W with the chromophore, respectively. A number of effective chromophores have therefore been identified at each wavelength.


Reduced tumor cell transfer with contact neodymium-yttrium-aluminium garnett laser scalpels. The local recurrence of tumor growth after surgery is thought, in part, to be a consequence of seeding of tumor cells from the primary lesion. This study was directed at determining if the contact Nd:YAG laser provides any advantage over the use of traditional scalpel dissection for tumor resection. Five human tumor tissue culture cell lines were studied in this report. They included MCF-7 (breast), HeLa (cervical), SW-780 (bladder), HT29 (colon), and A549 (lung). Using a scalpel blade or contact laser scalpel (with or without laser energy), the ability to transfer viable cells from dense cell stocks to new tissue culture wells was tested. Using the A549 cell line, the extent that these instruments were able to "seed" tumor cells was also assessed in a soft agar, in vitro, "incision" model. Results from these studies suggest that the contact laser scalpel has a significantly lower potential to transmit tumor cells, when compared to traditional scalpel blades.


Laser endoscopic sympathectomy for palmar hyperhidrosis. Hyperhidrosis palmaris is a common disorder among the Orientals. Despite numerous therapeutic modalities in practice, none has proved entirely satisfactory. With the introduction of video-endoscopic surgery, we combined this system with a fiber optic Nd-YAG laser unit, electrocautery, and a laser Doppler flowmeter to design a new and promising therapeutic technique for palmar hyperhidrosis. General anesthesia with alternating one-lung ventilation is essential for a safe and smooth endoscopic sympathectomy. An operating endoscope was introduced into thoracic cavity via the second intercostal space and then attached to a CCD camera video system, which provided clear visibility of the sympathetic trunk in most cases. The proper level of the sympathetic trunk was further confirmed with the aid of vasomotor response of the palmar skin resulting from electric stimulation on the related sympathetic trunk. Finally, the confirmed target was precisely vaporized with a low power Nd-YAG laser through an endoscope. Twenty patients underwent bilateral sympathectomy, mostly on T2 and its adjacent trunk. This technique did not cause any injury to the lung or bleeding. No Horner's syndrome was produced. It provided a precise ganglionectomy on a confirmed target under clear magnified vision. Consequently, a definite and long-lasting therapeutic effect seemed warranted. It was considered to be a relative minor and safe procedure causing minimal discomfort and an almost invisible scar without producing serious complications. It also shortened the operation time and hospital stay remarkably in comparison with other open sympathectomy procedures.


Augmentation of the systemic host anti-tumor response through laser excision. This study examines whether primary laser excision results in augmentation of the systemic host anti-tumor response to tumor rechallenge. Single R3230AC mammary tumor implants, (0.5 x 0.5 x 1.0 mm), were grown in 112 female Fisher 344 rats. The animals were randomized. Group S tumors were excised by scalpel. Group E was excised with a Surgistat electrocautery (Valley Labs, Boulder, CO). Group CS was excised with a Sharplan 1100 CO2 laser (Sharplan, Allendale, NJ) at 25 watts (W) continuous wave (CW) (0.2 mm spot size) and the wound was "sterilized" with a 5-mm spot size by gently heating the tissue without blanching. Group K was excised with a KTP/532 laser (Laserscope, San Jose, CA) at 17 W CW using a 400 microns fiber. Group Y was excised with a Sharplan 2100 Nd:YAG laser set at 15W CW using a 0.2 mm clear sapphire tip. A second tumor implant, (0.5 x 0.5 x 1.0 mm), was placed at a remote site 14 days postoperatively. An unoperated control group was implanted. Secondary tumor volumes were measured for 36 days and the mean tumor volumes (MTV) were statistically compared. The MTV in groups CS, K, Y, and E was less than control (P less than 0.01). The MTV in groups CS, K, Y, and E was less than group S, although this was not statistically different. Lasers and cautery appear to increase the host response against subsequent tumor challenge. This study corroborates earlier studies of other modalities. Further studies to determine whether this host sensitization is an immune response and to elucidate the mechanisms of this effect are warranted.


Effect of tissue pressure on contact laser insults. The effect of variations in tissue pressure transmitted through contact laser probes during tissue ablation has been investigated. Weights of 10 and 50 g were transmitted through the tip of the probes onto the gastric and colorectal wall. At all laser energies the depth of tissue vaporization was significantly greater at the higher tissue pressure with perforation of the viscus occurring at laser energies above 10 J. The lateral zones of thermal tissue necrosis were not influenced by tissue pressure. Deformation of the wall of the viscus under the pressure of the probe was identified as a sign of excessive tissue pressure likely to result in perforation of any tissue of similar thickness to the normal gastric or colorectal wall.


He-Ne laser irradiation of single identified neurons. Silent (LPa2 and LPa3) and spontaneously active (V3, V5, V17) neurons of subesophageal ganglia of Helix pomatia were irradiated via a 125-mm fiber probe with a 10-mW He-Ne laser (lambda = 632.8 nm), and the rate of membrane depolarization, duration of latent period, and probability of spike activity were measured as the functions of light intensity. It was found that silent neurons can not be activated by He-Ne laser irradiation. When the spontaneously active neurons generating spikes every 7-10 min were irradiated in between their spontaneous spikes, the depolarization of membrane and generation of action potentials occurred as a function of light intensity, I. The probability of spike generation increased until the intensity reached 1 W/cm2, and when I = 4 W/cm2 was equal to 1. The depolarization of the membrane had a threshold at I = 0.1 W/cm2, then increased with increasing the intensity, and reached a plateau at I = 0.7 W/cm2 (depolarization rate 0.18 mV/s). Duration of the latent period decreased from 28 s to 17 s when the intensity was increased from 0.05 to 0.3 W/cm2. Further increase of the light intensity, from 0.3 to 1.5 W/cm2, caused a less pronounced change in the duration of the latent period (e.g., latent period equal to 11 s at I = 1.5 W/cm2).


Massive air embolism complicating Nd-YAG laser endobronchial photoresection. A 63 year old male underwent 6,900 rads of external radiation for a squamous cell carcinoma of the left main bronchus. Recurrence of the tumor 8 months later was treated with 6,618 joules and patency of the left main bronchus was restored. Four months later, he developed complete atelectasis of the left lung requiring repeat laser. During the procedure he became hypotensive, bradycardic, and hypoxic due to a tension pneumothorax. Although treated promptly with thoracostomy tube drainage, the patient never awakened. CT scan of the brain demonstrated anoxic encephalopathy with air present in the right frontal lobe. Brain death was confirmed by an EEG and cerebral angiogram. Air embolism has been reported in conjunction with diagnostic procedures including therapeutic pneumothorax for tuberculosis, transthoracic needle biopsy of the lung, and positive pressure ventilation with or without pneumothorax. The only reported case of air embolism associated with laser was a small middle cerebral artery cerebro-vascular accident which was self limited. Its mechanism is unclear, but it is suspected to be due to a communication between a pulmonary vein and the atmosphere. A greater volume of air will enter the damaged vessel in the setting of positive pressure ventilation and/or a tension pneumothorax. When neurologic manifestations are present, hyperbaric oxygen therapy is the treatment of choice. Prompt institution in hemodynamically stable patients can minimize neurologic sequelae.


DNA twist as a transcriptional sensor for environmental changes. A variety of reports describe shifts in the environment which cause a corresponding change in the measured linking number of plasmid DNA isolated from bacterial cells. This change in linking number is often attributed to a change in superhelical density. This, coupled with the observation that transcription is often dependent upon the superhelical density of the DNA template seen in vitro, has led to the suggestion that superhelical density may control expression of certain genes. However, since many environmental changes could, in principle, influence DNA twist itself, then the measured differences in linking number, delta Lk, may simply be a consequence of variation in twist according to the relationship delta Lk = delta Tw + delta Wr, where delta Tw and delta Wr are changes in twist and writhe, respectively. In fact, we show that when an environmental change causes a change in the helical pitch of the DNA, and if the superhelical density of DNA is regulated to remain constant according to the homeostatic model of Menzel and Gellert, then delta Lk approximately delta Tw. We have found that there are a number of published reports describing variation in promoter activity as a function of linking number that can be explained by considering twist. We suggest that there are classes of sigma 70 promoters whose ability to be recognized by RNA polymerase is exquisitely sensitive to the relative orientation of the -35 and -10 regions, and environmental conditions can control this relative orientation by changing DNA twist.(ABSTRACT TRUNCATED AT 250 WORDS)


Representing medical knowledge: reconciling the present or creating the future? Modern technology has sparked the creation of computing systems that perform many medically related tasks, but communication between these systems is limited, in part by differences in the terminology used for various purposes and in part by the changing nature of medical concepts. The Unified Medical Language System represents an attempt to find a means of translation between diverse knowledge systems. An alternative, which we propose, is to agree on a knowledge base for the future and make use of present accomplishments in moving toward that goal.


Two linked genes for outer membrane proteins are absent in four non-disease strains of Haemophilus somnus. Linked genes encoding two outer membrane proteins (p76 and a family of proteins, p120) of the bovine pathogen, Haemophilus somnus, were investigated. The p120 group was previously shown to have immunoglobulin-binding activity and to react with polyclonal antiserum specific for a 270 kDa antigen (p270) which also had immunoglobulin Fc-binding activity. By Western blotting we showed that the p76 antigen also reacted with this antiserum. The p270, p120, and p76 antigens were undetectable in four serum-sensitive isolates from asymptomatic carriers but were present in the two serum-resistant virulent strains tested. Genes for p120 and p76 were subcloned on non-overlapping pUC plasmids from a cosmid (pHS1) originally cloned from a serum-resistant strain. In Escherichia coli, plasmid pHS138 expressed p76, while the p120 antigens were produced by pHS140. Southern blots of DNA from the above six strains of H. somnus using probes derived from pHS1 subclones showed that a 13.4 kb sequence was missing from the four serum-sensitive strains, but not the two serum-resistant strains. This segment included most of the insert in pHS138 and all of the pHS140 insert. The data indicate that p76 and the p120 proteins are absent from serum-sensitive strains because the coding sequences are missing, raising the possibility of insertion of these genes into the chromosome of both serum-resistant strains, or deletion from the four serum-sensitive strains.


Pneumocystis carinii shows DNA homology with the ustomycetous red yeast fungi. Pneumocystis carinii causes life-threatening pneumonia in T-lymphocyte-immunodeficient subjects in transplant and oncology units or with acquired immune deficiency syndrome (AIDS). Recent DNA homology studies show P. carinii to be a fungus. To investigate the biology and epidemiology of this parasite further, we elected to determine for it a more precise taxonomic assignment within the fungal kingdom. We screened a wide range of organisms representing the major orders of fungi using DNA amplification and subsequently sequenced a portion of the mitochondrial gene encoding the large subunit ribosomal RNA. Our data show that the opportunistic pulmonary pathogen P. carinii is closely related to the ustomycetous red yeast fungi, a group which includes organisms that are extensively distributed throughout the environment and which release many widely dispersed airborne spores.


Identification and characterization of narQ, a second nitrate sensor for nitrate-dependent gene regulation in Escherichia coli. In response to nitrate availability, Escherichia coli regulates the synthesis of a number of enzymes involved in anaerobic respiration and fermentation. When nitrate is present, nitrate reductase (narGHJI) gene expression is induced, while expression of the DMSO/TMAO reductase (dmsABC), fumarate reductase (frdABCD) and fermentation related genes are repressed. The narL and narX gene products are required for this nitrate-dependent control, and apparently function as members of a two-component regulatory system. NarX is a presumed sensor-transmitter for nitrate and possibly molybdenum detection. The presumed response-regulator, NarL, when activated by NarX then binds at the regulatory DNA sites of genes to modulate their expression. In this study a third nitrate regulatory gene, narQ, was identified that also participates in nitrate-dependent gene regulation. Strains defective in either narQ or narX alone exhibited no nitrate-dependent phenotype whereas mutants defective in both narQ and narX were fully inactive for nitrate-dependent repression or activation. In all conditions tested, this regulation required a functional narL gene product. These findings suggest that the narX and narQ products have complementary sensor-transmitter functions for nitrate detection, and can work independently to activate NarL, for eliciting nitrate-dependent regulation of anaerobic electron transport and fermentation functions. The narQ gene was cloned, sequenced, and compared with the narX gene. Both gene products are similar in size, hydrophobicity, and sequence, and contain a highly conserved histidine residue common to sensor-transmitter proteins.


A developmentally regulated cysteine proteinase gene of Leishmania mexicana. We have isolated a gene encoding a previously unreported class of trypanosomatid cysteine proteinase (CP) from the protozoan parasite Leishmania mexicana. The single-copy gene (lmcpa) [corrected]. has several unusual features that distinguish it from CP genes cloned from the related species Trypanosoma brucei and Trypanosoma cruzi. These include a shorter C-terminal extension of only 10 amino acids and a three-amino-acid insertion, GlyValMet, close to the predicted N-terminus of the mature protein. Northern blot analysis showed that the gene is expressed in all life-cycle stages but at higher levels in the amastigote stage in the mammal and in stationary phase promastigote cultures which contain the infective metacyclic form of the parasite. A precursor protein of 38 kDa was detected in amastigotes and stationary phase promastigotes with antisera specific to the LmCPa pro-region, but was barely detectable in early log-phase promastigotes. Anti-central domain antisera recognized the 38 kDa precursor and 24 and 27 kDa proteins. The major CPs of L. mexicana amastigotes, previously designated types A, B and C, were not detected with the antisera, suggesting that the gene codes for a previously uncharacterized CP in L. mexicana. The 24 kDa protein detected by the antiserum has no activity towards gelatin but apparently hydrolyses the peptide substrate BzPheValArgAMC. The relative levels of the 24 and 27 kDa proteins vary between the different life-cycle stages. The results indicate that expression of this CP is regulated at both the RNA and protein level.


Evasion of type I and type II DNA restriction systems by IncI1 plasmid CoIIb-P9 during transfer by bacterial conjugation. Transmission of unmodified plasmid CoIIb-P9 by bacterial conjugation is markedly resistant to restriction compared with transfer by transformation. One process allowing evasion of type I and II restriction systems involves conjugative transfer of multiple copies of the plasmid. A more specialized evasion mechanism requires the Ard (alleviation of restriction of DNA) system encoded by CoIIb. The ard gene is transferred early in conjugation and specifically alleviates DNA restriction by all known families of type I enzyme, including EcoK. CoIIb has no effect on EcoK modification but this activity is impaired by multicopy recombinant plasmids supporting overexpression of ard. Genetic evidence shows that Ard protects CoIIb from EcoK restriction following conjugative transfer and that this protection requires expression of the gene on the immigrant plasmid. It is proposed that carriage of ard facilitates transfer of CoIIb between its natural enterobacterial hosts and that the route of DNA entry is important to the restriction-evasion mechanism.


NADH formation by Na(+)-coupled reversed electron transfer in Klebsiella pneumoniae. Citrate is fermented by Klebsiella pneumoniae to 2 acetate, 0.5 formate and 1.2 CO2. The formation of less than 1 formate and greater than 1 CO2 per citrate can be accounted for by the oxidation of formate to CO2 in order to provide reducing equivalents for the assimilation of citrate into cell carbon. A membrane-bound electron transport chain is apparently involved in NADH synthesis by these cells. The electrons from formate oxidation to CO2 are used to reduce ubiquinone to ubiquinol by membrane-bound formate dehydrogenase and ubiquinol further delivers its electrons to NAD+, if this endergonic reaction is powered by delta mu Na+. The endogenous NADH level of K. pneumoniae cells thus increased in the presence of formate in response to a delta pNa+ greater than -100 mV. NADH formation was completely abolished in the presence of oxygen or after addition of hydroxyquinoline-N-oxide, a specific inhibitor of the Na(+)-translocating NADH:ubiquinone oxidoreductase. The increase of endogenous NADH was dependent on the delta pNa+ applied to the cells. Inverted membrane vesicles of K. pneumoniae catalysed the reduction of NAD+ to NADH with formate as electron donor after application of delta mu Na+ of about 120 mV consisting of delta pNa+ of 60 mV and delta psi of the same magnitude. Neither the delta pNa+ nor the delta psi of this size alone was sufficient to drive the endergonic reaction. Strictly anaerobic conditions were required for NADH formation and hydroxyquinoline-N-oxide completely inactivated the reaction.(ABSTRACT TRUNCATED AT 250 WORDS)