[Training in motor skills and psychopathology. Climbing with psychotic children]. The author investigates learning skills in psychotic and borderline children through the physical activity of climbing. Motor skills are considered as an interaction between the subject and his/her environment. Motor learning skills have been studied throughout 6 training sessions in rock-climbing. Etho-clinical methods of investigation allow to assess behaviors and the meaning given by the subject to different forms of action. The author emphasizes here the pleasure/anxiety dimensions of this activity. Results show remarkable learning skills in these children. Significant increase in motor activity and in the height reached point to an obvious integrity of the mechanisms necessary to motor acquisitions. These results are closely linked with the characteristics of rock climbing, a sport involving clinging behaviors and leading to a mastering of the primary anxiety of loosing support.


[Disease models and models of handicap in psychiatry]. Throughout psychiatric history, the handicap model has been referred to a mineral image as opposed to the vegetal image of disease. The structural model, after Freud, seeks to overcome the opposition between disease and handicap. Present day disregard for this model, especially in the United States, stems from economical and ideological reasons. The come-back of a psychopathology of "faculties" linked to the notion of deficiency and reinforced by fascination with computers, also represents the need of humankind to believe in an incorruptible soul.


[Psychosis, mental handicap, motor handicap]. Child mental disorders have to be considered both in terms of morbid process and handicap, the two aspects entertaining a dialectical relationship. The authors support this opinion through a nationwide epidemiological study of mental deficiency and by a long term follow-up case.


Collagenase activity in oral submucous fibrosis. Oral submucous fibrosis (OSF) is characterized by an abnormal accumulation of collagen fiber in oral submucosa. OSF is a collagen disease and is also regarded as a precancerous lesion. In the previous study, we discovered that the collagen content in oral mucosa of OSF is statistically higher than in normal mucosa. This research examined the relationship between the fibrosis and collagenase activity. Collagenase activity was determined by using soluble 14C-glycine-labeled collagen (9813 cpm/200 micrograms/tube) as a substrate in a solution incubated for 30 hours at 35 degrees C. The results showed that the collagenase activity of the OSF was much lower than that of normal oral mucosa (65.23 +/- 19.49 units/g tissue in normal mucosa vs. 29.48 +/- 5.69 units/g tissue in OSF). Furthermore, the cleavage pattern revealed by SDS-Polyacrylamid gel electrophoresis (SDS-PAGE) confirmed that the partially purified OSF collagenase was likely to be typical mammalian collagenase, with a molecular weight of about 68.0 kDa.


Menadione-induced cardiotoxicity is associated with alteration in intracellular Ca2+ homeostasis. Cardiotoxicity of menadione was elucidated in neonatal rat cardiomyocytes. When incubated with menadione, contraction of myocytes initially slowed down and eventually stopped. Later blebs appeared on the cell surface, leading to cell degeneration. During the time of diminished cellular contraction, a large portion of endogenous ATP was depleted whilst intracellular Ca2+ levels were increased. However, if menadione was washed out prior to termination of contraction, the myocytes survived and most of the cells resumed regular contraction. Preincubation of the cells with diltiazem (a Ca2+ antagonist), or fura-2 acetoxymethyl ester (a chelate for Ca2+), or antipain (a proteinase inhibitor) suppressed menadione's ability for cellular damage. These results indicate that menadione is toxic to cardiomyocytes, and that the increase of intracellular Ca2+ is related to the mechanism of cardiotoxicity of menadione.


Biochemical comparisons of matrix proteins extracted from healthy human alveolar bone, dentin and cementum. Matrix proteins of bone, dentin and cementum have been shown to play a role in bone induction during the mineralization process, and in regulating the activities of several types of mesenchymal cells. Whether these biological functions are mediated through the same mechanism or whether there is specific modulation in each biological process is still open to speculation. The purpose of this pilot investigation was to compare the non-collagenous proteins among these tissues. Bone and teeth, obtained from clinically healthy subjects, were sectioned into 1 mm thick pieces. With the aid of a dissecting microscope, cementum and dentin were separated and collected. Tissue specimens were extracted sequentially in three steps by solutions containing 0.5 M acetic acid, 4 M Guanidine/0.5 M EDTA, and 250 units/ml bacterial collagenase, respectively. Proteins extracted were dialyzed, lyophilized and then further analyzed by both 10% SDS-PAGE (1-D) and two-dimensional (2-D) SDS-PAGE. Comparison showed that the three extraction buffers had relatively different extraction capacities within and among each tissue. The components extracted by acetic acid and Guanidine/EDTA were similar, but seemed different from that extracted by bacterial collagenase as shown by 10% SDS-PAGE. Two-dimensional SDS-PAGE further characterized numerous distinct protein spots from bone (MW of 61, 55, 40, 35, 34, 33 kD and eleven distinct spots which showed MW between 10 and 29 kD, pI range of 5.6-6.4), dentin (MW of 59, 54, 35, 28, 25, 24, 21 kD), and cementum (MW of 71, 64-65, 58, 55, 52, 50, 47, 43, 40, 31, 19 kD).(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of working side interference on nocturnal bruxers. The present study aimed to test the effects of experimentally placed working side interference on nocturnal bruxers with regard to the health and chewing motor behaviors of the masticatory system. Thirteen asymptomatic nocturnal bruxers, nine males and four females, aged 18-31 years old, were selected according to the including criteria. A metal overlay was fabricated and bonded on the tips and lingual inclines of buccal cusps of the upper second premolar and first molar of the habitual chewing side. It discluded the eccentric contacts without disturbing the centric occlusion. A light emitting diode system was used to record the chewing motor behaviors before (W0), immediately after (W1), one day after (W2), one week after (W3), and one month after (W4) placement of the working side interference. The healthy states of masticatory muscles and TMJs were examined at each session. The results showed: 1. High overlay debonding rate (60%). Among five subjects who were observed over 25 days, 80% showed grinding facets, and 40% showed grade I mobility on the overlay opposing teeth. None of the subjects complained of muscle or joint pain in the one month follow-up period. 2. The chewing movements shifted toward the non-interfered side with narrowed and vertical chews after placement of overlays. Two major responded chewing patterns were found according to the results of statistical analysis. 3. Sixty-nine per cent of the subjects showed higher mean closing velocity than the mean opening velocity at the W0 session.(ABSTRACT TRUNCATED AT 250 WORDS)


F. Hegelmaier: on memory for the length of a line. A very early student project undertaken by Friedrich Hegelmaier (1833-1906), published in German in 1852, is republished in English translation. Slight though the experimental work is, it nevertheless occupies a unique place in the history of experimental psychology. It is the source whence Fechner had the method of constant stimuli, a method that continued in use as the preferred psychophysical method, substantially in the form described here, for more than a century. The experiment is arguably the first experiment in the modern sense of a systematic preplanned body of observations and has the glaring faults that one would expect in a very first experiment. Finally, Hegelmaier suggests the use of two simultaneous tasks as a means to investigate human performance, a full hundred years before that idea was realized in practice. If only he had continued in experimental psychology!


Motion aftereffects with rotating ellipses. The perceptual outcome and the motion-aftereffect duration generated by the rotation on the frontal plane of an ellipse with a bar depend on whether the bar is placed along the major or the minor axis. When the bar is placed along the minor axis, a stereokinetic transformation occurs, and the pattern looks like a tilting ring with a perpendicular bar moving rigidly with it. Placing the bar along the major axis prevents the stereokinetic transformation: subjects report deformations and relative motion of the bar with respect to the ellipse. We found that motion aftereffects last longer when the bar is placed along the minor rather than along the major axis. A series of experiments was carried out to investigate whether differences in aftereffect duration are related to the stereokinetic transformation. Results seem to suggest that they are not.


Apparent distance reduction with moving stimuli (Tandem Effect): evidence for an attention-shifting model. When two vertical rods move through a horizontal window in close succession, the Tandem Effect can be observed. It consists of a spatial illusion (distance between the rods looking smaller than it actually is) and a temporal illusion (under certain conditions both rods are seen simultaneously in the window, though the first rod has left the window before the second rod enters it). We report six experiments that explored the distance-reduction illusion and tested an attentional model of the effect. It assumes that attention is initially focused on the first rod and then shifted to the second, when it enters the window. The percept of the pair of rods is integrated from the first rod's position at the beginning, and the second rod's position at the end, of the focus shift. Consequently their subjective distance will be smaller than their physical distance by the distance that they travel during the focus shift. Experiments 1 and 2 established the Tandem Effect as an empirical phenomenon and showed that its size depends on stimulus parameters such as window size and movement speed. Experiments 3-5 tested specific predictions from the attentional model. Experiment 6 examined a further illusion, the Fröhlich Effect, and showed that it can be subsumed under the model. The experiments produced some unexpected effects and some predictions from the model were only partly confirmed. It is shown that the main findings can be combined into two quantitative functions that describe the course of focusing. One implication is that visual attention does not "move" from one object to another; rather all attention shifts originate in the fovea. We discuss several alternative interpretations of our data and show that they are less satisfactory than the attentional model.


A good-continuation model of some occlusion phenomena. Occlusion phenomena raise two questions: (1) When will an occluding and a partly occluded object be seen, as opposed to several nonoverlapping objects? (2) What is seen behind the occluding object? Available theories give no satisfactory description of occlusion data. In our view, this situation is at least partially due to the fact that patterns used in occlusion studies are always regular, whereas it is almost unknown which regularities are actually perceived in occlusion patterns. We have therefore collected a complete set of data for a restricted domain of patterns with minimal regularity. Starting from these data, we have developed a model of the perceptual organization of this class of patterns and tested it in a second experiment. The model is a specification of the Gestalt law of good continuation. It assumes that there is a tendency to describe a pattern by the smallest possible number of contour elements and with the smallest possible changes of direction within and between necessary contour elements. The results fit in well with the predictions of the model. It is further demonstrated that the model also describes the preferred interpretations of many regular patterns, published in other studies.


A critical discussion of Kellman and Shipley's (1991) theory of occlusion phenomena. Kellman and Shipley (1991) recently advanced a new theory to explain the perception of partly occluded objects and illusory figures. The theory is a formalization of the Gestalt law of good continuation. In this paper we describe their account of occlusion when the contour of the occluder is completely specified by a display. Next, we outline some critical objections and present a number of counterexamples. Finally, we compare their theory with Wouterlood and Boselie's (in this issue) model of occlusion phenomena, which might also be considered as a formalization of the law of good continuation.


[Functional stomach and intestinal complaints in young adults: incidence, follow-up, personality and psychosocial factors]. The prevalence rates and the course of functional gastrointestinal disorders in addition to psychopathology and psychosocial factors which are assumed to be associated with functional disorders were longitudinally investigated in an epidemiological cohort study of young adults aged 21-30 from the Canton of Zurich (Switzerland), by means of four interviews. Case definition was based on operational criteria concerning frequency and duration of symptoms reported by the subjects. One-year prevalence rates of (functional) stomach complaints and intestinal complaints were found to vary between 8.7 and 12.7 percent, and 9.1 and 11.1 percent, respectively, depending an the year of the interview. Subjects with stomach complaints scored higher on depression, anxiety and hostility (Hopkins Symptom Check List, Freiburger Persönlichkeitsinventar) then the controls. These associations were less strong among subjects with intestinal complaints. In addition, both complaints were found to be associated with scores on a life events measure, with distress from the social network, and with lack of social support.


[Single case analytic evaluation of inpatient psychotherapy in a patient with ulcerative colitis]. This study outlines a practicable empirical method for the process-accompanying evaluation of the in-patient treatment-process. On the example of an integrative conceptualized psychoanalytic oriented therapy model for psychosomatic patients the treatment-process of a patient with ulcerative colitis is studied.


[Participation refusal by probands in an epidemiologic long-term study--sociodemographic, clinical and psychometric findings]. Usually little is known about probands who participated in an epidemiological longitudinal field survey but refused participation in follow-up investigations. For reasons of data protection and on account of the fact that investigative instruments used in longterm field surveys or panel studies are more focused on well defined issues (opinions, attitudes, assessment of behaviors) and less on personality variables, differentiated statements on probands who explicitly refused cooperation can hardly be made. In our epidemiological longitudinal field study on prevalence and course of psychogenic disorders we have a different situation. Within the limits of our study we had the unique opportunity to gain far-reaching information on probands who refused to participate in preceding investigations in regard to sociodemographic, psychometric and clinical variables. The clientele of refusers we present in our paper mainly comprises elderly, married, rather obsessive-compulsive structured, lower-class females. According to our data interactive aspects are equally responsible for reduced cooperativeness. The significance of our findings for the planning and carrying out of epidemiological longitudinal field surveys is discussed.


[Psychosomatic medicine between natural science and psychological science--tertium non datur?]. Psyche and soma are open to scientific-causal analysis for biomedicine as well as for social-empirical studies. Both are furthermore accessible to the ideographic discourse of subjective meanings and intentional acts. The German language marks this difference with the terms of "Körper" (body) and "Leib" (embodied soul--spirited body). The Bieri-trilemma demonstrates the resulting epistemological calamity. Neither the so-called behavioral medicine as variation of an ontologic-methodological materialism nor pure phenomenology of the sick subject lead the way out of such inconsistencies. Attempts of systemtheoretical mediation usually only prove their poor reviewing of traditional discussion. This paper outlines some of the currently interesting positions towards the so-called body-soul-problem in the field of psychosomatic medicine, at the same time warning against hasty expectations. We discuss the intentional-biographic approach, the biomedical approach (including the simultaneity correlation (Schultz-Hencke) as well as the brain-soul-correlationism (Kurthen and Linke). As our result we maintain the complementarity of a double discourse for psychosomatic medicine, namely the complementarity of hermeneutic analysis of meaningful processes and of bio-psycho-social casualties. The complementary discourse levels occasionally find their counterparts on an intersubjective-objective time-space-axis. For this we suggest the concept of socialempiric and biomedical markers. Attempts of mediation, be it from systemic-emergence-theoretical or from hermeneutic perspective of interaction forms and their interaction engrams corresponding to their central nervous substratum, turn out to be mystifications of actual incompatibilities, namely of the inevitably double discourse. For this the theory of absolute processes (W. Sellars) promises mediation, but so far no more.(ABSTRACT TRUNCATED AT 250 WORDS)


[Emotional helplessness--a risk factor for somatic diseases]. The purpose of this paper is to summarize some findings concerning the relationship between an inability to cope with emotions. Typ A behavior and somatic diseases. Based on those findings it was suggested that different concepts of behavioral medicine may share the similar psychological basis, and an inability to cope with emotions might be a very important characteristic to link those behavioral manifestations.


[Psychological symptoms after immigration: a comparison of various groups of immigrants in Berlin]. In a postal questionnaire we examined three samples of persons seven and a half months after their migration to Berlin: 1. 512 people having left East Germany, 2. 90 Germans who had left Poland, and 3. 283 people who lived in western parts of Germany before. The present study was to investigate social integration and psychic complaints in these groups. In general, all groups reported increased frequencies of unspecific symptoms like inner restlessness, irritability, nervousness, rumination, and sleeplessness. In people from the GDR symptoms decreased significantly during the first seven months after migration. Symptoms of people who had come from western parts of Germany increased within this period. Generally the course of symptoms was more favorable, when people found a satisfactory job.


[Hospital care versus home nursing: on the quality of life of terminal tumor patients]. The present study investigated quality of life in 41 terminally ill cancer patients. Twenty-one of them received hospital care, 20 home-bound hospice care. These groups were comparable with respect to the patients' physical condition. The following variables were chosen as indicators of quality of life: perceived social support and social distress, coping with illness, perceived positive environmental factors, perceived control over daily activities and caring routines, contentedness with medical care and nursing, physical well-being. Assessment was made by means of a semi-structured interview. The data indicate that the home-bound care was superior with respect to the following variables: perceived positive environmental factors, perceived control over daily activities and caring routines, and contentedness with nursing. No differences between groups were found for any of the other variables.


[The psychodynamic aspects of suicidal behavior]. The psychodynamic basis of suicidal behavior is investigated from the standpoint of the psychology of drive, ego, object relations, and self. Each of these four perspectives helps us understand the different aspects of suicidal behavior, the psychodynamics of which cannot be formulated in terms of a unique generally valid and all encompassing concept. The high degree of aggressive potential, the ocnophile personality and the pronounced narcissistic vulnerability appear as central conceptions regarding suicidal behavior.


[Meditative stress coping program with psychosomatic patients]. A stress management training for ambulant psychosomatic patients has been developed. Essential parts of the intervention are meditative body relaxation (Kum Nye) and meditative cognitive restructuring. The training has been applied to psychosomatic patients with various kinds of diagnosis in a total of 14 group sessions. The following indicators of therapy success have been assessed: Positive and negative self-communication, positive and negative emotionality, depression, bodily complaints, number of days with bodily complaints and 12 coping scales. Results are reported in agglomerated single case judgements. In the intervention group 55% of the participants showed improvements vs. 14% in the waiting-list-control group. The significant results are appraised as clinically not fully satisfying; possible improvements of the intervention are discussed. Hints to a contraindication with abdominal complaints are given.


[Lay etiologic theories and coping with illness in severe physical diseases. An empirical comparative study of female myocardial infarct, cancer, dialysis and multiple sclerosis patients]. In a multicenter approach 451 female patients, suffering from severe somatic diseases, were investigated on strains, disease-related attributions, coping and quality of life. Four diagnostic groups were involved, myocardial infarction (MI), Cancer (CA), end-stage renal disease (ESRD), and multiple sclerosis (MS). With respect to coping with the onset of illness or the diagnosis, all four groups accordingly reported placing trust in the doctors, compliance-related strategies, fighting spirit and information seeking as most markedly applied coping modes. But in each group a different predominant causal attribution of the disease was found, heredity in the MS-, pollution in the cancer, stress in the MI- and iatrogenic factors in the ESRD-group. The main influencing factors on the future course of the disease accordingly in all groups were "progress of medicine" and internal cognitive and behavioral factors. After statistical control of age, education, and duration of illness only the score "depressive coping" discriminated between the groups (MS-patients with highest, MI-patients with lowest scores). With respect to life satisfaction, MI- and cancer patients together formed a cluster with higher and ESRD- and MS-patients one with lower satisfaction. Cancer- and MS-patients considered fighting spirit as "most helpful" coping mode, while MI-patients favoured placing trust in the doctors and information seeking. Religion was found as second or third helpful coping mode.


[Psychodynamic aspects of coping with illness in stroke--experiences with a psychotherapy group]. The authors describe their experience of a group--psychotherapy with stroke patients during the phase of inpatient neurological rehabilitation. The process of coping in stroke patients shows similarities with grief reactions following the loss of important objects. But it is usually complicated by the fact that the physical injury is experienced as a narcissistic trauma resulting in low self--esteem and in feelings of anger and despair. Psychotherapeutic interventions can help to deal with such negative affects and should facilitate a mourning process, which is inevitable if adaptation to a life with a physical handicap should succeed.


[Stages of grief in coping with diabetes?]. Forms of coping with diabetes were determined on the basis of self-ratings of emotions (depressive, sad, angry, anxious) and responses on a 30-item "stages of grief" questionnaire by 52 inpatients aged between 25 and 50 (diabetes duration 1 to 35 years) at the beginning of a 12 day diabetes education program. Psychometric qualities of the instruments were evaluated. To test empirically the notion of grief stages in coping with diabetes, the frequency of emphasis on one or more emotional areas or stages of grief was determined and tested to ascertain whether various conditions occurred more frequently than was expected by chance. Results indicated that shortly after diabetes manifestation scores on protest and depression with respect to diabetes were elevated. The majority of cases could not be assigned to a single emotion or stage of grief but displayed negative emotional reactions in different content areas simultaneously. Consequently the concept of grief stages for coping with diabetes as well as recommendations based on this concept are questioned.


[Affective-cognitive coping with attacks and illness behavior in patients with bronchial asthma]. The purpose of this study was to investigate attack-related cognitive coping styles in 80 patients with bronchial asthma and to relate them to outcome parameters of illness behaviour. All patients had participated in a 5-day-lasting asthma treatment and teaching programme (ATTP). Outcome variables to be predicted were: The number of days in hospital due to asthma during the year following the training programme and the patients' adherence to the recommendations of the programme one year later. Independent predictor variables were: pre-training attack frequency, hospitalization due to asthma, medication intensity, pulmonary function, asthma symptom anxiety, trait anxiety and attack-related cognitive coping styles. Multiple regression analyses show the importance of a "minimizing/self-confident" coping style in predicting days in hospital, while a "diverting" style predicts best a poor management of attacks in patients on oral steroids.


[The Giessen Symptom Questionnaire for children and adolescents]. The Giessen Subjective Complaints List for children (GSCL-C) a questionnaire on physical complaints in self-image form, was developed out of the adult GSCL. The questionnaire contains items from the areas; general wellbeing, vegetative complaints, pains, emotionality and children's complaints. The subject is asked to estimate the degree of distress caused by each complaint (never/rarely/sometimes/often/always). Factor analysis based on a sample of 1047 schoolchildren aged 9 to 15 revealed five complaint complexes containing seven items each, which were subsequently grouped into the following scales: (1) Exhaustion, (2) Gastric Complaints, (3) Pains in Limbs, (4) Circulatory Problems, (5) Cold Symptoms. The sum of the five scales makes up the sixth scale score, overall distress. Besides describing the development of the instrument and its scales, sex- and age-related norms are given and the assessment criteria explained. Procedure and areas of application are also discussed.


[Therapeutic factors in psychoanalytic-interactional and depth psychology founded group therapy: an empirical study]. Depth psychology based and psychoanalytic-interactional group therapy were compared with respect to their therapeutic factors. The comparison was performed in patient groups by using a questionnaire asking for the occurrence and helpfulness of specific behaviour of the therapist and of experiences in the group. About 200 questionnaires for each method were analyzed. It could be shown that (1) discrimination between the methods was more marked concerning therapist's behaviour than experiences with the other group members, (2) that the obtained unspecific factors correspond to results in the literature on group and individual therapy and (3) that those items about the therapists behaviour claimed to be specific for each method did not discriminate these methods in the expected direction.


[Differential indications for ambulatory group therapy of obesity--exemplified by "interdisciplinary therapy of obesity"]. The article deals with reflections about the differential indication for out-patient group therapy treatment of patients suffering from a considerable overweight by the example of the "Interdisciplinary therapy of obesity". First the conception of the "Interdisciplinary therapy of obesity" is presented. Within the context of evaluation of the therapy program, especially the results of a long-term follow-up study and the special conditions for severely obese people are dealt with. Empirical results and clinical experiences build the foundations to work out differential indication criteria like therapy motivation, degree of overweight and degree of psychological strain. On this basis modifications of the therapy program are suggested in the form of three different kinds of treatment, taking into account the clinically different groups of obese people.


[Affective experience in the group process and therapeutic outcome]. In this investigation is reported about measurement of affective behavior and feelings during the process of group psychotherapy. Therefore a cluster analysis of 4 parameters about 5 group sessions and 9 members and the group as a whole was made. The hypothesia were that effective feelings concern the group as a whole, that they were changing during the process and that they concern the individual process. It could be shown that in common there was a connection between individual process of affective behavior and outcome. Questions which came from differences of these results concerned the problem of characterizing exactly what going on related changing of attitudes and in which manner we can understand outcome.


[Therapy dropouts in closed groups].

[Therapy dropouts in closed groups]. Drop-outs in group psychotherapy are an everyday clinical problem. A premature quitting by one patient may have great consequences, especially in closed groups, not only for the drop-out but also for the remaining group members. Compared to the clinical relevance, empirical research on the conditions leading to a premature termination is quite meagre. Empirical basis of the study presented here are 58 groups with a total of 445 patients with a variety of symptoms and personality structures. All groups started with a 3 month inpatient period and were continued as a closed outpatient group for about 2 years. 110 patients (24.7%) left the group at least 3 months before the agreed end of the group. Empirical research on conditions leading to the premature drop-out is based on three perspectives: 1. patient-oriented: The values of certain patient variables e.g. symptoms, personality structure, socio-economic status etc. are considered as potential predictors. 2. institution-oriented: Here group characteristics are considered as the pool of potential predictors: e.g. group size, decisions made under time pressure, cotherapy etc. 3. group-oriented: The values of patient variables for one patient in relation to other group members (e.g. "isolated position") is considered here. From each perspective we were able to find potential relevant predictors.


[Phases in the rehabilitation of male and female bone marrow transplant patients]. Teamwork is essential when investigating the long-term adoption of such medical intervention that are highly demanding on patients, physicians and nursing staff. Bone marrow transplantation represent such an intervention for a series of well defined hematological diseases. The contribution demonstrates the multiple perspective approach of the Ulm team. A case report illustrates the multiplicity of clinical issues. The state of research allows the sketching of a process model on rehabilitation.


[Psychosomatic determinants of graphospasm]. As there is a variety of psychic and somatic variables in its genesis, the writer's cramp could be a syndrome of different subtypes. Therefore 62 former psychotherapy-patients with writer's cramp were examined according to a design of several dimensions in order to find out if there were any subtypes. The parts of the examination were exploration, structural interview, neurological examination, psychological examination of the personality, examination of some electrolytes in serum and radiograph of neck spinal column. Different multivariate statistical methods isolated two subtypes of patients with writer's cramp. The first group comprises patients with fine and/or big dysfunctions of motor activity, the symptoms are independent of psychic factors or of psychotherapy. The second group is characterized of a monosymtomatic writer's cramp, of a neurosis and of remissions of motoric symptoms following psychotherapy. The examination shows that fine and/or big dysfunctions of motor activity which often co-occur the writer's cramp are important criteria for differential diagnosis and indications.


[Effectiveness of psychosocial management of cancer patients--a critical review of empirical studies (status: December 1990)]. 41 empirical studies evaluating psychosocial care of cancer patients, published between 1975 and 1990 are presented. Only those studies were selected that examined adult patients and controlled the effects of psychotherapeutic interventions. 35 studies reported significant effects on coping, mood states or quality of life. 6 articles were inquiries into the efficiency of intervention on time of survival, 3 measured the impact on the immune system.


[Psychoanalytically oriented group therapy with psychogenic pain patients. A contribution to the treatment method]. Psychoanalytically oriented therapies are widespread in the treatment of chronic pain patients in Germany but there are still few evaluation studies especially for long-term therapies. Derived from the therapy process of a homogenous pain group and its evaluation modifications from the usual psychoanalytical group therapy method necessary for pain patients are outlined.


[Preliminary comments on existential analytic psychosomatic medicine]. Existential analysis as a personal and meaning orientated psychotherapy describes a person in the performance of its existence. The anthropological and therapeutic concept of the existential analysis are presented in essential points (intentionality, self-transcendence, will to meaning, ability of self-detachment, corporability and responsibility) as a way of approach and interpretation. Psychosomatic illness is understood as a mode of personal existence. The integral "gestalt" of a person in its subjectivity, biography and corporality is reflected on with regard to its abilities and revealing of individual possibilities of meaning. The under determination of psychosomatic phenomena shows itself as an expression of a person's relative freedom to decide about its own development.


[Therapeutic factors of inpatient analytic group psychotherapy]. Several change mechanisms, their interrelationship, and their relation to outcome as well as to long-term follow-ups have been investigated in an inpatient group therapy. Eight of initially ten patients finished a long-term group in an inpatient setting for severe neurotics and personality disorders. Successful patients were able to change significant behavior characteristics, to develop a higher cohesiveness towards the group and especially to use aspects of family reenactment in order to change internalized significant object representations. The results indicate that important changes occur early during the treatment. The contributing change mechanisms and their interdependency are described and discussed in detail.


[The benign chronic pain syndrome. Diagnostic subgroups, screening parameters, biographical disposition]. The concept that all pain must have an organic cause if not the pain is not real, is still very common in medical practice. For chronic pain this leads to big costs by repeated technical examinations and often even to iatrogenic injury to the patient as a result of diagnostic or therapeutic interventions. Psychogenic pain patients are particularly afflicted by this process of chronification. The results of a study investigating 151 chronic patients show, that psychogenic pain patients (PP, n = 75) are significantly different from those whose pain was caused by organic factors (OP, n = 35) regarding their development in childhood and adolescence (in the sense of a marked emotional deprivation). Including additional parameters raised by a structured interview (SBAS) and the trait-score of the STAI an identification of PS is possible with high sensitivity and specificity (about 95 percent). By the aid of the maturity of defence mechanisms three taxonomic subgroups in PP can be differentiated (type A, B, C). Between these types there are significant differences regarding illness behaviour (e.g. medication abuse, "doctor shopping") and responsiveness to a psychological pain interpretation. The results confirm the necessity of a differentiation of chronic pain patients as to the etiology and pathogenesis and furnish even the physician without psychosomatic education with diagnostic criteria relatively simple to raise. By these criteria a prevention of chronification in a lot of pain patients is possible. Derived from the results a pathogenic model for psychogenic pain is developed.


[Familial and pain-related markers from the viewpoint of chronic pain patients and their partners]. Based on a general family model Saile and Schmitz (1991) developed the Pain related inventory of family adaptability and cohesion (SIFAK), which assesses three aspects of family life related to chronic pain: adaptability in dealing with chronic pain, pain related enmeshment and pain related disengagement and alienation. 40 patients with chronic low back pain and their spouses completed a revised version of the SIFAK and measures of pain intensity, pain related disability and marital satisfaction. Patients and spouses agreed more on marital satisfaction than on pain related variables. In multiple regression analyses marital satisfaction and pain related disability--each in the view of patients and spouses--were predicted by pain and family related variables. Implications for future research (other data sources, other measurement methods) and for psychological treatment of chronic pain are discussed.


[Early risk factors in schizoid, neurotic and healthy probands]. The following results were obtained on comparing the genesis of schizoid, neurotic and healthy subjects: 1. The schizoid patients examined by us had experienced a greater total risk-associated stress during childhood and adolescence than the comparative groups. 2. Special risk-associated stress is due to: a) a stress-burdened family atmosphere (laden with conflicts within the family and burdened with diseases), b) stress originating from the mother (risks of old age and diseases), c) stress originating from siblings (large number of siblings, smaller age intervals, etc.), d) stress originating from the parents' low standard of education. 3. Schizoids can be separated from healthy subjects on the basis of the childhood risks assessed above. 4. Schizoids cannot be separated from the group of neurotics by the characteristics listed here. These are not schizoid specific risks but factors of general stress. 5. Marked sex-specific peculiarities were seen. a) These point to a higher degree of diagnostic separation between schizoid and neurotic men than between schizoid and neurotic women. b) Schizoid women cannot be distinguished from neurotic women on the basis of the criteria of genesis covered by our study. c) Schizoid men are easily separated from the two other groups of men. This is mainly due to a genesis of an instability of reference. This, therefore, appears as a genuine schizoid risk.


[Developmental structures in children with perinatal risk factors]. This longitudinal study focuses on the improvement of understanding the development of infants with perinatal complications. 38 infants with perinatal complications requiring intensive care for at least two weeks and their parents were examined shortly after birth and up to the age of 3 years. A number of biological and psychosocial data were collected. By means of cluster analysis based on data collected from children and families during the first three month three groups were obtained. After three years, children differed significantly in many developmental areas according to this grouping. A second cluster analysis based on three years follow-up data yielded four clusters which were characteristically related to the original ones. The results are discussed using a transactional perspective.


[Individual immunological parameters in clean-up team members and patients with sequelae of acute radiation sickness 5 years after the effects of the Chernobyl accident]. A study was made of deviations, beyond 1 sigma and 1.5 sigma of a mean value (M) of a donor group, in individual immunological parameters (for instance, the number of CD5+, CD2+, CD4+, CD8+, CD25+ and B-cells; alpha 1-thymosin concentration; and autoantibody titers to antigens of epithelial reticulum cell cytoplasm) in patients suffered acute radiation sickness (ARS) and liquidators of Chernobyl NPP accident. The radiation damage to the immune system was reliably detected in the affected subjects examined: they exhibited a decrease in the alpha 1-thymosin level below M = -1.5 sigma and in absolute B cellularity below M = -1 sigma; and increase in the number of CD25+ cells and in the level of serum autoantibodies to antigens of thymus epithelial reticulum cell cytoplasm. When several parameters selected were examined simultaneously the frequency of recording the deviations in merely one of them markedly increased.


[Expression of ORIGIN-like sequence in mammalian cells]. There are some genes whose expression increases in non-proliferating hepatocytes after whole-body X-irradiation. We suppose that some of them participate in cell division regulation. To verify our postulate we have studied expression of autonomously replicating sequence pDARC1 in normal, irradiated and dividing rat hepatocytes. We have succeeded earlier in cloning the autonomously replicating sequence pDARC1 and have shown that it could be transcribed in X-irradiated hepatocytes. Here we report on the results of analysis of this sequence expression in dividing mammalian cells. Hybridization with the pDARC1 sequence reveals 4.0 kb mRNA in non-proliferating rat hepatocytes after X-irradiation: this mRNA is absent in normal hepatocytes. Induction of 4.0 kb mRNA is a function of radiation dose; 4.0 kb mRNA content is maximum 6-24 h following whole-body 6 Gy X-irradiation. The 4.0 kb mRNA is also found in dividing rat hepatocytes during the pre-replicative period.


[Identification of a multihit model for nonhomogeneous cell population]. A generalized multihit-multitarget model for a nonhomogeneous, with respect to radiosensitivity, population of irradiated cells is presented. The least squares and the maximum likelihood estimation of the model parameters is given. The estimates quality is evaluated by the computer-based study. The results obtained show the possibility of the parametric identification of cell radiosensitivity distribution according to the "dose-response" data.


[Characteristics of the effect of irradiation at different dose rates on survival, death kinetics and response of critical systems of the C57Bl/6 mice]. A comparison was made of the biological effect on mice of irradiation at different dose rates (70, 5.5 and 1.5 cGy/min) with equally effective, with respect to lethality, doses, or with physically equal doses within the range from 1/4 of LD50/30 to LD99-95/30. Equally effective, with respect to lethality, doses caused similar changes in the intestinal epithelium and in the haemopoietic system. The death rate kinetics was identical with doses of LD80-95/30 within the dose-rate range under study. The equally effective doses caused injuries, different in degrees, to critical systems, including CFUs.


[Effects of single gamma-irradiation on the activity of ornithine decarboxylase in the thymus and pulmonary tissue]. In studying the dose (0.1-6 Gy) and time (2 h to 180 days) dependence of ornithine decarboxylase activity, it was found that deviations from the control were more pronounced in the thymus than in the pulmonary tissue. The radiation effect was a function of dose and time after irradiation. A nonmonotonous type of the dose-response curve was observed 7 days after irradiation: the radiation effect with a low dose (0.1 Gy) was opposite to that with sublethal doses (1-6 Gy).


[Effects of irradiation on fatty acid structure of membrane lipids of the sarcoplasmic reticulum]. It has been shown that single local X-irradiation (0.21 C/kg) of the rabbit hind limb in the early period of acute radiation injury (1 and 14 h) causes a decrease in saturation of sarcoplasmic reticulum membrane lipids. It is mainly connected with a decreased saturation of the total fraction of phosphatidyl serine, phosphatidyl inositol and phosphatidyl choline. The above changes can increase permeability of the sarcoplasmic reticulum membranes for Ca(2+)-ion after X-irradiation.


[Isoenzyme spectrum of lactate dehydrogenase, malate dehydrogenase, esterase and acid phosphatase of rat brain cells at different times after external 1 Gy gamma irradiation]. The influence of external single gamma-irradiation with a dose of 1 Gy on the isoenzyme composition of lactate dehydrogenase, malate dehydrogenase, esterase and acid phosphatase in the cytoplasm of rat brain cells has been investigated. Irradiation was shown to cause differently directed changes in the ratio of the isoenzymes under study at different times after exposure. The isoenzyme spectrum of lactate dehydrogenase and malate dehydrogenase was shown to be normalized on day 30 after irradiation, whereas the isoform composition of esterase and acid phosphatase was not stabilized at that time.


[Early changes in intracellular ATP concentration after 5 Gy irradiation by routine regimen and regimen modified by low doses (0.1+4.9 Gy)]. Comparative studies were made of immediate (within the first minutes) changes in intracellular ATP concentration after irradiation by different regimens. ATP concentration in cells at a stationary phase of growth increased immediately after irradiation with a dose of 5 Gy, reaching its maximum within 30-40 min. Irradiation with the same total dose, by the regimen of 0.1 + 4.9 Gy at a 3-minute interval between the doses, did not cause alterations in the ATP content in cells. It is concluded that the absence of the increase in the parameter under study (ATP) after irradiation by the latter regimen indicates that preirradiation at a dose of 0.1 Gy inhibits the adequate development of an early response to irradiation with a dose of 4.9 Gy.


[Effects of chronic gamma irradiation on the activity of adenylate cyclase in rat lung tissue]. Different phase changes were observed in adenylate cyclase (AC) activity of pulmonary tissue plasma membranes under chronic gamma-irradiation of rats at a dose-rate of 12.9 cGy/day. Comparison of AC basal activity with the data reported earlier on changes in ornithine decarboxylase activity under similar radiation conditions showed unidirectional changes which indicated that cAMP-dependent processes were possibly involved in radiation modification of ornithine decarboxylase.


[The mechanism of action of low doses of gamma radiation connected with the development of human cell resistance to mutagens]. The human fibroblasts were gamma-irradiated with low doses (0.07-0.21 Gy). After a short time interval (3 h), a study was made of the postirradiation viability of cells (by the trypan blue dye exclusion method); post-N-methyl-N'-nitro-nitrosoguanidine-DNA synthesis (by 3H-thymidine incorporation immediately after the mutagen treatment) and postirradiation induction of DNA single-strand breaks (by alkaline elution of cells lysed on the membrane filters). The preirradiation of cells with low doses of gamma-rays was shown to render the cells resistance to induction of DNA breaks by the following exposure to gamma-radiation. The survival rate increased; DNA synthesis was resistant to alkylation damage in these cells, as compared to nonirradiated cells.


[Does ionizing radiation induce an adaptive response in mouse L5178Y lymphoma cells?]. Growth kinetics of LY-S and LY-R cells (radiosensitive and radioresistant sublines of murine lymphoma L5178Y) has been investigated after beta-irradiation at cumulative doses of 1.5 to 20 cGy and dose rates of 0.8-10 mGy/h. It has been found that after 48 h culture in a complete medium the number of cells differed 5 times, whereas after X- and gamma-irradiation, Do values differed 1.62 times. Using the growth rate as the end point in evaluating the combined effect of beta-irradiation (10 cGy) and subsequent X-irradiation with lethal doses, we observed an increased relative cell number, in comparison to that after X-irradiation alone (an "adaptive response", using this criterion), in LY-S cells irradiated with a dose of 2 Gy. In contrast, when reproductive death of LY-S and LY-R cells the end-point analyzed, the lethal effect of consecutive beta- and X-irradiation in LY-S cells was higher than that expected for X-radiation alone (the synergistic effect).


[Radiosensitivity of cells-precursors of hemopoietic stroma (CFU-F) in the rat bone marrow under the effect of 60Co gamma irradiation in various conditions]. Conditions have been developed for cloning cells-precursors of rat bone marrow haemopoietic stroma, that form in culture dense and sparse fibroblast colonies (CFU-F) at a plating efficiency of 10(-4). Radiosensitivity of rat bone marrow CFU-F, with 60Co-gamma-irradiation in vitro, is characterized by the values of Do and n of 1.87 Gy and 1.4 respectively for all clones; 0.65 Gy and 6.7 for dense clones, and 4.27 Gy and 1.0 for sparse clones. This confirms the observed heterogeneity of CFU-F population consisting of highly radiosensitive and radioresistant subpopulations. The parameters of rat bone marrow CFU-F are nearly the same with irradiation both in vivo and in vitro; with in situ irradiation, the oxygen effect comes into play in a radiosensitive subpopulation of CFU-F; the OER values are 1.6, 2.6 and 0.9 for all, dense and sparse clones respectively.


[Postradiation recovery of hemopoietic and stromal precursor cells in mice preinjected with prodigiozan]. Injection of prodigiozan to mice 24 h before irradiation caused, by the time of the radiation effect, a decrease in the number of haemopoietic cells-precursors (CFUs and CFU-HM) in the bone marrow and an increase in the functional activity of stromal cell-precursors--the haemopoietic microenvironment of transfer units (HMTU); in the spleen, the number of CFUs decreased, but the number of CFU-HM increased considerably. During the postirradiation period, the haemopoietic and stromal precursors were damaged to a lesser extent, and CFUs, CFU-HM and HMTU recovered more readily in prodigiozan-protected animals than in unprotected mice; the HMTU restoration preceded the increase in CFUs and CFU-HM levels.


[Incidence of the development of 90Sr-induced osteosarcomas depending on the age of the animals]. In experiments with albino male rats, a study was made of the influence of age on the incidence of osteosarcomas induced by 90Sr. It was shown that the incidence of tumors decreases exponentially with age.


[Changes in the sensitivity of mice to the action of gamma irradiation by Viscum album L. polysaccharides]. The influence of water-soluble polysaccharides of Viscum album L. on the survival of mice subjected to whole-body gamma-irradiation has been investigated. Polysaccharides were shown to exert a radioprotective effect which was a function of both the radiation dose and the drug dose and time of its injection. The maximum radioprotective efficacy of polysaccharides was observed after their injection 15 min before irradiation. A single intraperitoneal administration of polysaccharides (25 mg/kg) before irradiation with LD50/30 and LD100/10-12 increased the 60-day survival rate up to 95% and 27% respectively. The postirradiation injection of polysaccharides prevented death of 80% of mice given LD50 and increased the average life expectancy of animals irradiated with absolutely lethal doses.


[Effects of fungal mycelium extracts on 137Cs accumulation in human embryo cells]. The method is proposed for primary evaluation of the ability of drugs of various genesis to affect the accumulation of radionuclides in cells. Extracts of mycelium of wood-rotting Basidiomycetes were shown to prevent 137Cs accumulation in cultures of human embryo fibroblast.


[Effects of a medium pH on the ability of Chinese hamster cells to repair radiation injuries]. In experiments with Chinese hamster cells at exponential and stationary growth phases, it has been shown that the postirradiation incubation of irradiated cells in a medium with low pH (up to 6.0) promotes the recovery of cells from potentially lethal damages; it has also been found that the recovery from sublethal radiation damages does not depend on the medium pH. The long-term incubation of nonirradiated cells with low pHc causes death of part of cells.


[Comparative analysis of mechanisms of the modification of microorganism viability under the effect of UHF heating and hyperthermia]. In experiments with models of isogenic Escherichia coli strains, a comparative study was made of the effect of SHF of electromagnetic field and hyperthermia. The survival rate of bacteria was determined and, simultaneously, injuries to genetic supramolecular structures were registered through measuring the anomalous time dependence of cell lysate viscosity. The combined effects of the mixture of these factors with H2O2 microconcentrations were studied. The differences observed in their realization were attributed to the different mechanisms of action of these factors on the repair enzyme systems of the studied cells. It has been found that the effect of microwaves on microorganisms causes much severer damages to DNA that hyperthermia does.


[Choice of quantitative characteristics of a radiation modifier affinity and the range of its pharmacological action (minireview)]. On the basis of the literature the necessity of using not only DMF and maximal protective or sensitizing effects, but also the affinity and the range of the pharmacological action of radiation modifiers is argued. The affinity is worth while to expressed as ED50 (the dose that produces a half of the maximal effect), and the range of the pharmacological action as a therapeutic index K = LD50/ED50.


[Vascular radiology and physics of fluids]. In the cardiovascular system, morphology and functionality are closely related. The observation that atherosclerotic lesions appear with different incidence in the various sites and prefer bifurcations, suggested that vascular architecture might be an important pathogenic factor. Vascular geometry deals with the evaluation of the "form" element from a theoretical point of a view, pointing out the angles and diameters which can make the arterial system physiologically more efficient. The key element of the system is the bifurcation: depending on whether bifurcations are considered as a single entity or as a whole, either "local" or "global" geometry is employed. The morphology of the bifurcation directly affects blood flow patterns, influencing both blood flow velocity and wall shear stress. Experimental studies evidenced that high blood flow velocities and low wall shear stress have, respectively, a preventive or favorable role in atheroma development. By observing these altered flow sites, the areas which are most likely to develop atherosclerotic damage have been detected in the various bifurcations; the areas correspond to angiographic and autoptic findings. Based on their experience, the authors discuss the contribution that the different imaging techniques can give to the study of vascular geometry.


[Computerized tomography and conventional radiography in the diagnosis of destructive spondyloarthropathy. Our experience with 30 patients undergoing periodic hemodialysis]. Thirty patients of both sexes (15 males and 15 females) with chronic renal failure who had under gone hemodialysis for 2-184 months (mean 45.1 months) were examined with conventional radiographs of the cervical spine and thin-layer CT of C4-C5-C6 to evaluate the radiographic patterns of destructive spondyloarthropathy. The radiographic patterns obtained with conventional and CT exams were compared with one another and with clinical (carpal tunnel syndrome) and biochemical data (alkaline phosphatase, parathormon, Ca, P, Ca/P, Al, beta 2-microglobulin). DSA (erosion and narrowing of the intervertebral space, collapse of the vertebral body and erosion of the vertebral plates) was recognized in 7 patients with conventional radiographs and in 11 patients with CT thanks to greater CT capabilities to recognize minimal osteolytic lesions of the vertebral body. All the patients with destructive spondyloarthropathy had personal and hemodialysis age higher than those without destructive spondyloarthropathy: 59.3 vs 57.7 years; 49 vs 39 months. Parathormon and alkaline phosphatase were increased while beta 2-microglobulin was normal. Only 2 patients with DSA had carpal tunnel syndrome. In conclusion, CT is a valuable technique for the diagnosis of destructive spondyloarthropathy but it must be performed only after conventional radiographs of the cervical spine or in the presence of clinical signs of destructive spondyloarthropathy (parathormon and beta 2-microglobulin increased, long-term hemodialysis).


[Bone mineral content measurement: reflections on the equipment]. Metabolic bone disorders are extremely interesting from an epidemiological, clinical and social point of view. In particular, some of them are important for they are typical of elderly people--i.e., the portion of population which is on the increase due to the lengthening of the average life. On the other hand, thanks to the current intervention techniques, the number of chronic nephropathics (in whom metabolic bone conditions may develop) has markedly increased. Therefore, sufficiently reliable methods are needed to allow the thorough evaluation of bone mineral components. Unfortunately, these methods are only of quantitative value because they are unable to discriminate the statuses of the two essential bone components--i.e., cortex and spongiosa--; we all know that bone mineral loss can currently be quantified only when amounting to < 20% of the total value, due to the addition of the mineral contents of the two components. In this paper the authors briefly report on the noninvasive techniques currently in use for the measurement of bone mineral components, especially relative to their physical bases, the knowledge of which is essential for a correct evaluation. The authors accurately reviewed the literature data relative to the various techniques and compared the results obtained by the different authors. Thus, no personal experience is reported, since this paper is aimed at being considered as a reference mark for the reader to be helped in the choice of the equipment suiting him most. However, as to preventing metabolic osteopathies, quantitative methods cannot yield absolute data, which addresses the current research to densitometry by means of the Compton method. The latter may finally lead to the development of operative equipment allowing not only the separate measurement of cortical and spongiose values, but also the qualitative evaluation of bone status--i.e., not limited to mineral loss but including also the determination of the protein, fat and water components.


[Dual-energy X-ray absorptiometry of the vertebrae: determining which vertebrae should be scanned]. This study was aimed at verifying whether bone mineral density (BMD) and its loss with aging are different in the lumbar vertebrae and whether the region of interest--which is usually limited to the L2-L4 segment--may be extended to L1-L4. BMD was measured by means of dual-energy X-ray absorptiometry (Hologic QDR 1000) in 74 women, aged 37 to 78 years, not affected with any disease or subjected to any treatment known to interfere with bone metabolism. The relationship between age and BMD was expressed by the following equations for L1, L2, L3: BMD-L1 = 1181.68-7.85 x age, BDM-L2 = 1251.57-7.70 x age, BMD-L3 = 1231.66-6.57 x age, as shown by linear regression analysis. The behavior of the bone density of L4 with age appeared to be different and could not be described by linear regression curves and was therefore not comparable with that of the other vertebrae. BMD was different in the four lumbar vertebrae as shown by: a) the diversity of the intercept of the regression lines describing age-bone density relationships (F = 7.7, p < 0.001); b) the bone density of L1 being lower than the mean bone density of the L2-L4 region (p < 0.005); c) the bone density of L4 being higher than the mean bone density of the L1-L3 region (p < 0.001). In order to evaluate the effect of senile degenerative changes of the vertebrae on the relevant bone density, two groups of women were considered, according to age--i.e., pre- or iuxtamenopausal and late postmenopausal. It appeared that the BMD of L1 was always more correlated to the bone density of L2 and L3 than the BMD of L4. Our results suggest that L1 is homogeneous to the L2-L3 region, relative to both bone density and its loss with aging. Therefore, L1 should be included in the region of interest during the examination. Even though the bone mineral content of L4 and its loss with aging seem to be different, our results do not allow the exclusion of L4 from the scanned area.


[Platyspondylisis+ in beta-thalassemia major]. Platyspondylia was observed in 14 patients affected with thalassemia major (7 males and 7 females, age range: 10-18 years) who received an intensive transfusion regimen combined with continuous chelation therapy (desferrioxamine: 50-80 mg/kg daily). Height/width ratio was decreased at all the investigated tracts--i.e., cervical and/or dorsal and/or lumbar spine. The range of height/width ratio values was 0.41-0.55 at the 5th cervical body, 0.33-0.53 at the 8th dorsal body, 0.43-0.56 at the 12th dorsal body and 0.47-0.62 at the 2nd lumbar body. The flattening of the vertebral bodies seems to be due to the depletion of hematopoetic tissue determined by the high transfusion regimen. The reduced intramedullary pressure is thought to counteract neither weight-bearing nor other biological stresses, which might ultimately provoke the thinning of vertebral bodies.


[Comparative study of echography and conventional radiology in the evaluation of the Insall-Salvati index]. For the study of painful patello-femoral syndromes, the authors suggest the use of US for the evaluation of the so-called Insall-Salvati ratio--i.e., length of patellar ligament/patellar length--whose alteration is suggestive of vertical patello-femoral malalignement (patella alta and patella infera). Ten normal volunteers (20 knees) were examined by means of both US and conventional radiology, and the Insall-Salvati ratio was calculated for each knee. US and radiologic measurements were statistically compared by the correlation-coefficient method: the result was 0.802. US measurements were repeated twice with 0.778 interobserver variability according to the Spearman correlation index. Based on their results, the authors conclude that, in the evaluation of the Insall-Salvati ratio, the diagnostic accuracy of US is almost the same as that of conventional radiology; the former method may even be preferred for it is a simple, quick and repeatable technique not needing ionizing radiations.


[Echography in the study of lipomas of superficial soft tissues]. High-resolution sonography (US) was used to evaluate 47 superficial soft tissue lipomas. Forty-one lesions were found in subcutaneous tissues and 6 in superficial muscles. The lipomas were classified by location, shape, echotexture, homogeneity and US beam attenuation values. Moreover, 21 lipomas underwent histology and histologic patterns were correlated with echogenicity. Most lesions were elongated and their greatest diameter was parallel to the skin. Eighty-four percent exhibited well-defined margins. Twenty-six percent of the lipomas were hypoechoic, 24% were isoechoic, 34% hyperechoic and 16% exhibited a mixed pattern. In 27% of cases, a hypoechoic capsule was present. Superficial soft tissue lipomas exhibit unsteady echotexture: most of them are hyperechoic. The correlation between echotexture and histology showed that no typical and steady patterns can be identified, since lipomas vary from a histologic point of view. The clinical diagnosis of superficial lipomas is based on clinical history and the palpation of a well-defined, mobile and soft superficial mass. When palpation is not diagnostic, US can be used to rule out a cyst. An elongated isoechoic or hyperechoic mass in the subcutaneous tissue should suggest a lipoma, whereas a hypoechoic mass is associated with a broader range of differential diagnoses, including malignant tumors. However, malignant masses are not likely to have an elongated or flattened shape. Even though tissue characterization is less specific with US than with CT and MRI, the former method is quick, easy and less expensive and, thanks to high-frequency transducers, is also well-suited to diagnose soft tissue lipomas.


[Pulmonary tuberculosis and other mycobacterial infections in patients with AIDS]. Nowadays, the acquired immune deficiency syndrome (AIDS) is most certainly the major cause of the increased incidence of tuberculosis (TBC). A total of 138 patients (pts) with AIDS were referred to the Department of Infectious Diseases of the Hospital of Pisa, 1990-1991; 14 of them (10.1%) presented pulmonary TBC. In our study, we analyzed the chest films of the latter group of patients. Based on the X-ray patterns, the findings were classified as follows: hilar lymph nodes were observed in 4 pts (28.6%), isolated lymph nodes in 2 cases; associated with parenchymal involvement in 2 pts; acute alveolar TBC was seen in 4 cases (28.6%), with escavations in 3/4 (21.4%). Linear and reticular TBC were found in 4 pts (28.6%), and miliary interstitial involvement in 1 case (7%), extrapulmonary adenopathy in 4 pts (28.6%). In 4 pts (28.6%) chest X-ray findings were negative. All pts underwent serial chest X-rays in the course of therapy. HRCT was performed in 6 patients: our results are in agreement with those reported in literature. Thus, we can conclude that the major diagnostic findings in our series were: frequent isolated involvement of hilar lymph nodes, as observed in primary TBC; the infiltrates are most frequently located in the middle and basal lobes; escavations are uncommon; pleural effusion is unusual; in some pts chest X-ray findings may be negative.


[High-resolution computerized tomography. Staging of lobular lesions in cystic fibrosis]. Forty-four patients affected with cystic fibrosis (CF) were examined by means of high-resolution Computed Tomography (HRCT) of the chest; the sensitivity of this technique was evaluated in identifying small pulmonary structure alterations, and its role outlined. In all cases, HRCT scans allowed early lobular shape anomalies to be detected and secondary pulmonary lobular lesions to be correlated with disease evolution. A classification for lobular lesions was proposed: Stage I - Thickening of the bronchovascular bundle and/or intralobular septa and/or middle interstitial compartment. Unessential changes in lobular ventilation. Preservation of lobular shape. Stage II - Intralobular emphysema. Acinar filling with normal ventilation (A) or diffuse hypoventilation of the lobule (B). Preservation of lobular shape. Stage III - Lobular consolidations. Preservation of lobular shape. Stage IV - Patch distribution of lesions characterized by derangement of lobular structures. Changes in normal lobular shape. The identification of these lesions confirms HRCT as the most sensitive technique for the early visualization and localization of signs of CF bronchopneumonopathy. A broader experience coming from the systematic use of HRCT in chronic inflammatory lung diseases would increase our knowledge of pathogenetic processes and allow therapeutic perspectives to be improved.


[Magnetic resonance imaging of the esophagus with lumen opacification using a specific contrast agent]. A new contrast agent has been developed for the opacification of the esophageal lumen in Magnetic Resonance (MR) Imaging. The contrast agent consists of an emulsion of low-density and high-viscosity barium paste employed for the CT study of the esophagus (E.Z.E.M., Westbury, USA) and a small amount of Gadolinium-DTPA (Magnevist, Schering, Germany), diluted in 3 ml of saline solution. In vitro evaluation of the contrast solution showed high-signal intensity on T1-weighted SE sequences. The study was subsequently performed on 5 healthy volunteers and 30 subjects with clinical indication for MR Imaging of the chest. The complete opacification of the esophagus was obtained in 12 of the 16 patients (75%) who presented no pathological involvement of the esophagus. The esophageal lumen was completely opacified in 8 patients with esophageal carcinoma and in 1 case of esophageal leiomyoma. In the cases with esophageal carcinoma, lumen opacification allowed the evaluation of tumor growth (concentric or eccentric), a more detailed definition of tumor extent, with assessment of neoplastic wall thickening, and the evaluation of the possible infiltration of adjacent organs. Lumen opacification was obtained in 8 of 10 patients (80%) affected with other chest conditions secondarily involving the esophagus. In these cases, lumen opacification helped to localize the esophagus and to evaluate its involvement by adjacent tumors.


[Oral contrast media in the study of the esophagus with magnetic resonance. Proposal of a new preparation]. The major problem in MRI of the esophagus is the lack of a reliable oral contrast agent. To determine the value of Gd-DTPA as an oral contrast medium for the esophagus as a part of phase III clinical trial, 17 patients (10 esophageal neoplasms, 4 neoplasms of the pharyngo-laryngeal tract, 3 Zenker's diverticula) underwent MRI. The oral contrast medium is proposed in a new preparation: 5 cc of oral Gd-DTPA were emulsionated with 30 g of a low-density barium paste for esophageal CT (3% p/v). High signal intensity in the esophageal lumen was observed in all patients and in all sequences. In neoplastic lesions, the c.m. improved the definition of both the level of stenosis and the longitudinal extent of the lesion. In diverticula, the real and the false lumen could be demonstrated. In one patient the exam could not be completed. No adverse reactions were observed.


[Ultrasonic diagnosis of gastroduodenal perforation]. Ultrasonography (US) is routinely used as a diagnostic approach in the surgical acute abdomen, even though its major limitation is the demonstration of the hollow viscus. In the present paper, the results obtained with US in 12 cases of gastric or duodenal perforations are reported. The diagnosis, of gastroduodenal perforation was correctly made in 58% of cases by means of US; in 91.7% of cases, at least one US finding correlable with gastroduodenal perforation was observed. Even though US exhibits poorer diagnostic sensitivity than conventional radiology, it can be considered a valuable diagnostic tool in the early diagnosis of gastroduodenal perforation especially when radiographic findings are negative.


[Role of echography in the differential diagnosis of accessory lobulations and small capsular traumatic fissures of the spleen]. Emergency US in patients with abdominal trauma has become a routine diagnostic exam thanks to both its high reliability and its short acquisition time. US allows the overall evaluation of the patient, relative to both the localization of even very small fluid collections and the evaluation of traumatic changes in parenchymatous abdominal organs, especially the spleen which is often injured. Twelve patients were selected of all the cases submitted to emergency abdominal US between February 1989 and March 1992. All the cases with evident traumatic lesions of the spleen were excluded. In 10 cases US demonstrated interrupted splenic parenchyma, which was highlighted by intraperitoneal fluid collections; the interruption of splenic parenchyma is also evidenced by a thin hyperechoic capsular line with no changes in the echopattern of deep parenchyma. Surgery in 6 patients--4 of them as an emergency for hemoperitoneum and 2 operated subsequently--and US monitoring in the extant cases confirmed the diagnosis of simple accessory splenic lobulations. On the contrary, in 2 patients hospitalized in emergency, US showed no evident traumatic splenic alterations but only interruption of the hyperechoic capsular line with low hypoechogenicity in the splenic parenchyma below and a small fluid collection next to the lower splenic pole. Splenectomy confirmed a limited marginal tear of about 1.5 cm. The misdiagnosis of traumatic tears can be avoided if congenital splenic lobulation--evidenced by hemoperitoneum--is considered. US must also be employed to demonstrate minimal alterations in the hyperechoic capsular line of the spleen, in order to point out possible small tears and, if necessary, to suggest the need for clinical monitoring.


[Role of echo-Doppler in the screening of renal artery stenosis in children with kidney transplants]. Renal artery stenosis (RAS) in renal transplanted pediatric patients is a long-term complication. The clinical suspicion must be considered when patients exhibit signs of impaired renal function or refractory hypertension, not associated with other complications of renal transplantation -i.e., acute or chronic rejection, glomerulonephritis, cyclosporine toxicity. The intermediate step between clinical suspicion and angiography is represented by Doppler US. The authors report their experience with Doppler US in the screening of RAS in a pediatric series of transplanted patients. The incidence of RAS in our series (54 transplanted kidneys, 46 of them included in the study) was 4.3%. A severe stenosis was demonstrated by both Doppler US and angiography in 2 patients, with 100% Doppler sensitivity. In both stenoses, Doppler US showed high systolic peaks (blood flow velocity > or = 2.5 m/s) and post-stenotic turbulence. Thanks to its high sensitivity, Doppler US is considered to be very useful in the screening of vascular complications in renal transplanted children.


[Renal artery stenosis. Doppler color study before and after angioplasty]. Doppler flowmetry can be successfully employed to assess arterial patency after percutaneous transluminal angioplasty (PTA). The aim of this study was to assess color Doppler sensitivity in detecting renal artery stenosis prior to percutaneous angioplasty (PTRA) and vessel patency after it. Eleven patients (7 males and 4 females) affected with renal artery stenosis, unilateral in 9 cases and bilaterally in 2, underwent color-Doppler evaluation 1 day before and 7 days after PTRA. The operator was unaware of dilatation results. A total of 13 stenoses were treated. The qualitative and quantitative parameters we employed were: a) broadening of the spectrum, b) peak systolic frequency > 4000 Hz, c) stenosis index > 50%. Before PTRA, mean systolic peak at the stenosis was 7978 (range 4050-12500 Hz), while stenosis index was 71.9% (range 48-89%). After PTRA complete recovery was observed in 5 cases, no improvement in 1 and incomplete recovery in 7. Doppler results were in agreement with those of angiography in 6/13 while partial agreement only was seen in 7/13. Our results, although obtained in a small and highly selected group of patients, would seem to support the value of color-Doppler for the follow-up of patients after PTRA.


[Color-Doppler echography of the testis. Study technique and vascular anatomy]. Color-Doppler sonography has recently made it possible to image scrotal vascularity non-invasively. This study was undertaken to determine the normal color-Doppler appearance and distribution of scrotal vessels and to define the technical principles of the examination. Color-Doppler imaging was effective in detecting both funicolar and testicular vessels. Among these, capsular (25/25), trans-testicular (10/25), centripetal and recurrent (25/25) arteries were easily identified. Waveforms analysis allowed to differentiate veins from arteries within testis and to distinguish (8/10) supratesticular (high impedance pattern with absent diastolic flow) from intratesticular arteries (low impedance pattern with high levels of diastolic flow). The optimal color depiction of scrotal vascularity needed the appropriate selection of several imaging parameters to increase detection of low-velocity, low-volume flows within the small testicular vessels. Such parameters included: PRF (ranging 1500 to 600 Hz), wall filters (ranging 25 to 50 Hz), color gain (maximized for optimal sensitivity while avoiding excessive color noise), color vs. echo priority (ranging 70 to 90%) and color persistence (adjusted to high values). In conclusion, color-Doppler imaging is capable of reliably showing the normal anatomy of testicular vessels. It could make a reliable substitute for scintigraphy and continuous wave Doppler in diagnosing scrotal conditions that alter blood flow.


[Experimental study of primary fixation of screw-ring acetabular components. Role of initial screw-cutting]. Three types of screw-ring acetabular components were implanted to determine the characteristics of their holding power and to study the influence of screw-cutting. The acetabular components were screwed into vinyl polychloride foam. Their resistance was measured. The optimal value of the locking screw couple and the value of the couple beyond the one at which the acetabular component loosened were determined. One of acetabular components was screwed in with and also without preliminary screw-cutting. Its resistance to wrenching was measured in both situations. The resistance curve at wrenching was characteristic of each screw-ring acetabular component. The resistance to wrenching was significantly higher (p < 0.01) for a given acetabular component if it was screwed into a largely open block of foam at its bottom. The screw-cutting allowed for a significantly higher resistance to wrenching (p > 0.05). It allowed for the screwing in with the least effort and for a better perception of the tightening. Knowledge of the comportment of screw-ring acetabular components once installed, usage of preliminary screw-cutting and recourse to a dynametric key are the means of improving the installation of screw-ring acetabular components.


[Surgical treatment of spondylolisthesis with mild displacement by pedicular fixation and posterolateral fusion in adults]. Thirty-two consecutive adults with low-grade spondylolisthesis treated by stabilisation with the AO Internal Fixator and posterolateral fusion have been retrospectively reviewed with a mean follow-up time of 4 years (range, 24 to 71 months). There were 17 grade I and 15 grade II spondylolisthesis. Eight patients had degenerative and 24 patients had isthmic spondylolisthesis. An unisegmental fusion was performed in 4 cases, a bisegmental fusion in 25 cases and 3 patients had a multisegmental fusion. There was one deep infection and one nerve root compromise (3 per 100). Satisfactory results were achieved in 84 per 100 of the patients. There was non-union. This study suggests that transpedicular fixation and posterolateral fusion significantly enhances the rate of solid union to an extent which outweighs the risk of neurological complications due to the screw insertion. Fusion in situ in patients with low-grade spondylolisthesis is recommended as well as nerve root revision for all adults with concomitant radioculopathy. However, this review does not specifically support the use of the AO-internal fixator, but rather that of transpedicular fixation in general.


[Plexus nerve blocks for postoperative analgesia after orthopedic surgery of the lower limbs]. In our institution, plexus nerves blocks have been performed in seventy patients after lower limb surgery. The technique is considered as simple and reliable. The administration of a 0.375 per cent bupivacaine epinephrine containing solution allows to obtain analgesia longer than 15 hours in 45 p. 100 of the patients, devoided of side effects. Lower limb plexus nerves blocks appear as an efficient technique for postoperative analgesia following orthopaedic surgery.


[Atlanto-axial instability in children with trisomy 21: atlanto-axial (C1-C2) or occipito-axial (O-C2) arthrodesis?]. A retrospective study involving seven cases of operated atlantoaxial (C1-C2) instability in patients with Down Syndrome prompted the authors to raise the following question: which kind of arthrodesis is to be performed for these patients? The possibility of an occipito-atlantal (O-C1) instability, is in fact relatively frequent in this condition, as the authors have observed themselves and in a literature survey; this is an argument for performing an occipito-axial (O-C2) arthrodesis. The difficulties met to reduce the C1-C2 luxation, the frequent pseudarthroses (3 cases in our series) and a tetraplegia following a re-operation for non-union are as many other arguments to perform a O-C2 arthrodesis rather than a C1-C2 arthrodesis.


[Rupture of the pectoralis major muscle: diagnosis and treatment. Apropos of 3 cases]. Rupture of pectoralis major tendon is a rare lesion, often undiagnosed. We present 2 cases of complete rupture and one case of partial rupture. The 2 complete ruptures were treated surgically with, at follow up, a normally strong, painless shoulder and improved esthetics. The partial rupture remained nearly asymptomatic after conservative treatment. We recommend surgical repair of pectoralis major rupture, a lesion that remains symptomatic in the long term. Surgery should be done early, late repairs being technically more difficult and esthetic result less convincing.


[Lipoma responsible for tarsal tunnel syndrome. Apropos of 2 cases]. Two cases of tarsal tunnel syndrome caused by lipoma are reported. Both patients had ankle pain that radiated to the sole for years. On physical examination, localized swelling behind medial malleolus was found. Tinel's sign was provoked by gentle percussion on the posterior tibial nerve and its branches. Electrophysiological study showed fibrillation in foot intrinsic muscles or prolongation of motor and sensory latency of plantar nerves. Computed tomography of the tarsal tunnel demonstrated areas of low density indicating masses of high lipid content. Exploration of tarsal tunnel revealed compression of the medial plantar nerve by a lipoma. After excision of the lipoma, both patients had complete relief of ankle and foot pain. Computed tomography is helpful in delineating the nature and extent of lipoma within the tarsal tunnel.


[Necessary hip disarticulation in extended echinococcosis of the femur]. The authors have studied one case of pathological fracture of the femoral shaft related to hydatid disease. The diagnosis was based on the presence of whitish vesicles at the surgical procedure. Despite extensive, curettage and a number of other surgical procedures, infected drainage was persisting. The outcome was poor and a hip disarticulation had to be done.


[Mathematical modelling of open-wedge tibial osteotomy and correction tables]. This study analyzes mathematically the orientation of the superior tibial epiphysis in frontal and sagittal planes for knees with genu varum arthrosis. The assessment of the opening is determined mathematically for the osteotomies; this leads to the establishment of tables which can be used in practise during upper tibial osteotomies.


[Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery]. The authors describe a lateral approach to the knee associated with a tibial tubercle osteotomy and a plasty using the fat pad to provide a complete closure of the wound. This lateral approach has been performed successfully in 98 cases, with only 3 skin necrosis. It offers a large exposure of the joint, facilitates placement of tibial component trial fit, and allows the self centering of the quadriceps patellar-tendon mechanism at the end of the intervention. The lateral approach disputable in case of genu varum is recommended in all cases of genu valgum or important deformities.


[Changes in the heart rhythm and slow-release beta-2 agonist therapy (peroral) in asthmatic patients. A Holter study]. Slow-release formulations of salbutamol, used in asthmatic patients, may have few effects on cardiac rhythm. This study was designed to compare incidence and type of cardiac arrhythmias in a group of ten patients with stable bronchial asthma before and after 6 weeks treatment with a slow-release formulation of salbutamol. After a baseline spirometric and electrocardiographic evaluation, patients received placebo for a two-weeks period. At the end of this period patients repeated spirometry and carried out a 24-hour-ambulatory-E-Holter-monitoring. Subsequently, patients received for 6 weeks a treatment with a slow-release formulation of oral salbutamol. At the end of this period patients repeated spirometry, a 24-hour-ambulatory-EG-Holter-monitoring and potassium serum levels were controlled. We concluded from our study that, in patients with moderate bronchial asthma the treatment with an oral formulation of slow-release salbutamol may carry out a significant and durable bronchodilator effect, without causing important cardiac arrhythmias.


Salivary testosterone as an index of antiandrogen therapy in hirsutism. The purpose of this study is to examine whether salivary testosterone (ST) in hirsute women treated with antiandrogen therapy can be considered a good parameter for the evaluation of clinical response. Twenty-three hirsute women, four with polycystic ovarian disease and 19 with idiopathic hirsutism were treated with cyproterone acetate and ethynyl-oestradiol with levonorgestrel in a reverse sequential regime for three months. Basal ST from hirsute women was 0.18 +/- 0.11 nmol/L (normal values 0.03-0.17) and a decrease to 0.11 +/- 0.06 was observed in the first month of treatment, to 0.1 +/- 0.059 after two months and to 0.11 +/- 0.06 after three months, all of them significantly different from basal values (p < 0.05). We found a relationship between ST decrease and the clinical response to antiandrogen therapy. On the basis of these results we suggest that ST values could be a good index for the follow-up of antiandrogen therapy in hirsute women.


[Disability in rheumatoid arthritis: the predictive value of age and depression]. Fifty rheumatoid patients were given the Health Assessment Questionnaire (HAQ) and the Arthritis Impact Measurement Scales (AIMS) in order to determine the contribution of clinical and demographic variables to the overall disability. Among the clinical variables, pain intensity and depression were carefully assessed along with the classic morning stiffness and the joint count and tenderness/Ritchie's index. Two main findings arose: age contributed on its own to the overall disability, while disease duration had no significant effects; joint count and tenderness (Ritchie's index) correlated in a highly significant manner with depression as derived from the AIMS subscale and the Zung Depression Inventory (ZDI). ZDI items were separated into a "somatic factor" and a "dysphoric factor", showing a clear-cut influence of the somatic factor on the disability score. Our results suggest that age of the patient, pain intensity and a depressive mood related to physical impairment are chief predictive factor of the overall disability in rheumatoid arthritis.


[An in-vivo and in-vitro study of phagocyte migration in patients with AIDS]. Polymorphonuclear leukocytes (PMN), are considered the first line of host defense. The PMN defects were related with an increase susceptibility to infections. We studied the neutrophil chemotactic function in 20 patients suffering from AIDS. The results of in vivo study demonstrated the decrease of chemotactic activity at 6 hour (p < 0.001) in the patients respect to control. The data of in vitro studies confirmed the granulocyte chemotactic defects, statistically significant, in the patients compared to the control subjects, when we used all chemotactic factors. These results showing the profound immune disturbances characteristic of the disease can favour infective susceptibility and complicate follow-up of AIDS.


[Pulmonary embolism. A case report of right atrial thromboembolism treated by thrombolysis]. This case report describes a 40-years-old man affected by fracture of leg and pulmonary embolism. Two-dimensional echocardiography showed a large right atrial migrant thromboembolus prolapsing into tricuspid valve during diastole. The patient was treated with rt-PA through right atrial venous catheter and underwent to serial echocardiographic examinations. The rt-PA determined the dissolution of the thrombo-embolus at the 2nd hour of infusion. It is concluded that early two-dimensional echocardiography might be a very helpful technique to diagnose and follow-up therapy of pulmonary embolism.


[Platelet hyperaggregation induced by an antiplatelet monoclonal antibody in a female patient with essential thrombocythemia of childhood]. Essential thrombocythemia (ET) is a chronic myeloproliferative disease, rarely observed in pediatric age, characterized by a persistently increased platelet count. Abnormalities of platelet function observed in ET patients may be, at least in part, responsible for the thrombohemorrhagic complications. The authors report about a pediatric patient affected by ET, showing an abnormal platelet response following stimulation by anti-platelet monoclonal antibody. Such finding may be attributable to a structural abnormality of the platelet fibrinogen receptor or to post-receptor alterations.


[The general practitioner and clinical records: a survey of the knowledge of users of a software package]. The FATMA project--subproject 6, Line of Research 2--aims at implementing a new computerized information network for general practitioners using the same kind of software and homogeneously located throughout Italy. Thus, patients' case form data can be collected for public health purposes. After a study of literature in order to check whether other countries had implemented similar projects and what they consisted of, a survey based on a computerized questionnaire was carried out on a group of g.p.s. who had already received a software for the management of their clinical and professional activities from Janssen Informedica. This survey aimed at judging some aspects of users in order to select potential monitors of the information network who would test a new software. The analysis regards both g.p.s' social and professional data and the use of a computer package with reference to the quality and quantity of the clinical data they input. 2,010 questionnaires were filled in all their parts and mailed back to Informedica. It came out that g.p.s. believe more and more they can improve the organization and management of their work by using a software equipped with routines and easy access procedures so that clinical data, diagnostic reports and treatment can be collected, placed on files and updated. Thus, a new software should be developed. While meeting g.p.s' needs, it must overcome the limits of packages now available concerning the possibility of carrying out epidemiological studies. The software can become a tool to collect clinical data of patients, diseases and diagnostic procedures through standard protocols directly from g.p.s records.


[Paget's disease: the prospects with ipriflavone]. Paget's disease is a bone disorder characterized by high rates of bone remodelling. We have evaluated the efficacy of the new drug, ipriflavone, which has a double effect on the inhibition of bone reabsorption and on the activation of bone neodeposition. We studied 20 patients with active Paget's disease: 10 have been treated with 600 mg/die and 10 with 1200 mg/die of ipriflavone, for six months. In pharmacological wash-out, we have measured alkaline phosphatase, plasmatic BGP, the urinary hydroxyproline/creatinine ratio and the urinary calcium (Nordin Test). These valuations have been repeated after three and six months from the beginning of the administration of the drug. We have verified a propitious and speedy effect on pain, independent of dosage, and efficacy of treatment in function of bone turn-over parameter changes, by using no parametric statistical tests. In all subjects favourable effects have been found after three months treatment with 1200 mg/die. These have shown a greater efficacy than the lower dosage. After six months treatment we have not found significant differences as regards the efficacy of both dosages. These results may suggest to start therapy with higher initial doses and to carry-on with lower supporting doses. It's necessary to investigate further confirmation regarding the consolidation and perseverance of obtained favourable results, even after interruption of the treatment.


[The diet therapy of rheumatic diseases]. In the last decade the possible role of dietary therapy in the treatment of different rheumatic diseases has undergone serious reconsideration. Elimination diets may be useful in a subgroup of patients with rheumatoid arthritis, in whom food antigens probably play an important role in the onset and perpetuation of the inflammatory process. In mixed cryoglobulinemia a low-antigen-diet might reduce the amount of macromolecular food antigens which cross the mucosal barrier of the gut and cause either an immune response and/or compete with the immune complexes in the mononuclear phagocytic system. Supplementing the diet with essential fatty acids (omega-3 and/or omega-6) may inhibit the production of some of the mediators of inflammation, such as leukotriene-B4 and interleukin-1. However, currently employed doses often result in only modest or moderate clinical improvement. Controlled studies in a larger number of patients and with differentiated treatment protocols are needed to establish to what extent dietary therapy may improve the course of different rheumatic diseases, and to determine whether this therapy might be used in association with or even substitute for other well recognized treatments.


[Isosporiasis and sarcocystosis. The current findings]. A review on infections by Isospora belli and Sarcocystis spp. both in healthy and in AIDS patients is done on the basis of literature and personal data. In this view a special focus is made on isospora belli infection in AIDS because of its high recurrence after successful attack therapy. Consequently the most recent protocols for maintenance and attack therapy in these patients are reported. At the end, concerning ultrastructural pathology, the features of some Isospora belli developing stages are described by means of electron microscopy on duodenal biopsy specimens from a patient.


Effects of cardiac oscillations on acinar gas mixing during pulmonary edema. We used a previously reported technique (Mackenzie et al., J. Appl. Physiol. 68: 2013-2018, 1990) to measure the effects of severe pulmonary edema on acinar cardiogenic gas mixing in anesthetized dogs. We also tested how increases in lung volume affected gas mixing in healthy lungs and during pulmonary edema. Cardiogenic gas mixing was evaluated by measurement of the rate of washout of xenon133 injected into an occluded pulmonary artery during apnea. The rate constant of xenon133 washout was 0.40 min-1 (+/- 0.06 SE) in the healthy lung at functional residual capacity. It decreased (P < 0.05) to 0.08 min-1 (+/- 0.03) when lung volume was raised 500 ml. Pulmonary edema was induced by injection of oleic acid (0.06 mg.kg-1) into the right atrium over a 4-min period; clinical signs of severe pulmonary edema were present after 90 min. The rate constant for xenon133 washout (0.07 +/- 0.03 min-1) was less than in the healthy lung (P < 0.05), and was not changed after lung volume was increased (P > 0.05). We conclude that, in the presence of severe pulmonary edema: (1) acinar resistance is increased and/or magnitude of cardiogenic oscillations is decreased; and (2) salutary effects of increased lung volume are not due to enhancement of cardiogenic gas mixing.


Collateral ventilation and the sloping alveolar plateaus of He and SF6: a model study. In case of intralobular airway obstructions in dog lungs and in human lungs, ventilation of the regions distal to the obstructions appears to be surprisingly effective. In general, this is attributed to collateral ventilation which takes place between obstructed and adjacent, non-obstructed air spaces. In this paper we investigate the contribution of collateral ventilation to the distribution of gases in the lung and to the slopes of the alveolar plateaus (S) of the expirograms of He and SF6. To that end, we have simulated single-breath washout experiments with a mathematical lung model in which a fraction of the total acinar space was obstructed. The obstructed part was collaterally ventilated via the non-obstructed part by convection where both parts distended and retracted isotropically during the breathing maneuver. Collateral diffusion was assumed to be negligible during inspiration and expiration, but was taken into account for periods of post-inspiratory apnea (tA). With 20% of the total acinar space obstructed and tA = 0 sec, S(He) = 3.3%.L-1 and SSF6 = 4.7%.L-1. For both gases S increased with increasing degree of airway obstruction, and decreased with increasing tA and with increasing degree of collateral diffusion. For all simulated maneuvers the alveolar plateau was rectilinearly shaped. We conclude that in case of airway obstructions collateral ventilation may substantially contribute to the slope of the alveolar plateaus of the expirograms of He and SF6.