Pneumomediastinum in labor

We describe pneumomediastinum in a primigravida with delay in the second stage of labor. The pathophysiology, clinical presentation, and management are reviewed.

[Pulmonary hamartomas--apropos 3 clinical cases]

The study starts with presentation of present day knowledge of the disease. Its features are predominantly X-ray images consisting mainly in a round or ovular, usually solitary formation ("coin lesion"). The clinical expression of the disease is usually very discrete, the general state unmodified. The X-ray evidencing follows a routine examination. 3 cases of personal observations are presented. All cases were solved by surgery, by removal of tumour. Etiology is fixed by histological examination of surgery specimen. All aspects risen by the differential diagnosis are largely discussed focusing on lung granuloma (e.g. tuberculoma) lung abscess, limited pneumonia, lipoid pneumonia a.o. Hamartomas are of mesenchymal origin, they are not considered just as tumours but very similar to "tumour-like", without invasive evolution.

Ultrastructural modifications in mice spleen after "Imunotim' treatment

Imunotim, a polypeptidic extract from bovine thymus, induces the appearance of barrier cells in the spleen; these cells form a syncytial network and play an important role in blood cleaning. They are of fibroblastic origin. The cytoplasm of the cells in the network is dense and contains vesicles that seem to be detached from the nucleolemma. The nuclei are of small sizes. Cells (maybe lymphocytes) in different stages of disintegration can be seen in the network.

Histochemical demonstration of folic acid metabolism, some lysosomal activities and NADH2-cytochrome-C-reductase in corpora mammillaria in the ageing process

In bovine corpora mammillaria of young animals, a folic acid positive reaction was found in the neurons and in the neuroglia, in parallel with high dihydrofolate-reductase activity in the nerve cells. In old animals, folate and lysosome enzymes were different in the lateral and in medial nucleus, the highest amount being observed in the lateral nucleus; in the glial cells the lysosomal enzymes increased and in the nerve cells the concentration of folic acid increased. In the medial nucleus only relatively few enzyme modifications in the process of senescence were noticed.

[Cytomegalovirus retinitis in AIDS. Effectiveness and complications of long-term therapy]

In a retrospective study of the records of 64 patients with AIDS and cytomegalovirus (CMV) retinitis, 47 patients were evaluated regarding the effectiveness of initial virustatic therapy, and 41 patients regarding the anatomical and functional long-term development (maintenance therapy, rate and intervals of recurrences, complications, adverse drug reactions, time of survival, and visual outcome). The average survival time of 45 treated patients was 226 days (31-717 days). More than 90% responded to initial therapy with ganciclovir or foscarnet. Forty-four percent remained free of recurrences until they died (for up to 15 months); 56% had 1 to 4 recurrences, altogether 35 episodes, of which 14 occurred after withdrawal of therapy. Recurrences were treated with high-dose reinduction therapy with good or partial response in more than 80% of cases. Nine patients showed "smouldering retinitis" at a late stage. Two out of 45 patients became blind shortly after diagnosis despite therapy; both showed a course mimicking acute retinal necrosis syndrome with histologically proven CMV disease. None of the 43 patients on maintenance therapy for up to 2 years became blind in both eyes. Only 2 out of 43 patients had a poor visual outcome < 40/100 in the better eye at a late disease stage. Of 60 affected eyes, 11 showed retinal detachment, 14 eyes developed optic atrophy and 12 eyes became blind. Our retrospective study shows that consistent maintenance therapy of patients with CMV retinitis prevents severe deterioration of visual acuity in most cases even in long disease courses and thus maintains quality of life.

[Incidence of psychiatric syndromes and the psychosocial functional level of patients with HIV-1 infection]

There are not yet unselected studies on psychopathological syndromes in the course of HIV-infection in German-speaking countries. In a group of 55 patients in different stages of the infection two psychiatric explorations were done within an interval of about one year. The findings were analysed by the Brief Psychiatric Rating Scale (BPRS). The degree of psychosocial functioning was estimated using the GAF-scale (axis 5 of DSM-III-R). The diagnosis of dementia was based on DSM-III-R-criteria. Most of the patients (72%) showed normal or only slightly remarkable psychopathologic findings at both times. A significant increase in psychopathologic conspicuousness in the course of the disease was only found for the subscore BPRS 2 ("anergia"). Dementia was seen in five patients (9%) and only in the stage of manifest immune deficiency syndrome (WR 6). All-together there was only a slight decrease of psychosocial functioning detectable (median on the GAF-scale 75), which only in dementia showed a significant reduction.

[HIV-associated lymphomas]

Forty-one HIV-positive homosexual men (mean age 39.8 [23-72] years) with malignant lymphomas were examined with the object of exploring the clinical and pathological spectrum of HIV-associated lymphomas in Central Europe, and their therapeutic aspects. There were 33 patients with non-Hodgkin lymphoma of high malignancy and four with non-Hodgkin lymphoma of low malignancy; four further patients suffered from Hodgkin's disease. 27 patients died during the period of observation. The mean survival period after diagnosis was 5.5 months. It depended on the stage reached by the lymphoma at the time of diagnosis: 11.8 months in stage I, 10.6 months in stage II, 7 months in stage III, 3.3 months in stage IV and 1.3 months in patients with primary involvement of the central nervous system by the lymphoma. Eight out of nine patients with highly malignant non-Hodgkin lymphoma in stage I or II attained complete and lasting remissions after chemotherapy or irradiation. However, only minimal prolongation of life was achieved in the 16 patients with lymphomas in stages III or IV. The response rate among all patients treated (complete and partial remissions) was 75%; 45% achieved complete remission. Hodgkin's disease responded well to standard therapy, but the disease rapidly recurred in every case.

Ultrastructural localization of Ca2+ in the Golgi apparatus of two different cell types

The precipitation reaction with potassium oxalate was used to investigate the subcellular localization of Ca2+ in atrial myocardocytes and in Schwann cells of non-myelinated nerve fibers. Chelation with EGTA was used to prove the presence of Ca2+ in the electronoopaque deposits. In both cell types the oxalate reaction was intense in the classically described Ca2+ deposits: the perinuclear cisterna, the endo (sarco) plasmic reticulum, the mitochondrial matrix, but also in a novel localization: the cisternae of the Golgi stack in all cis to trans positions, suggesting that Golgi Apparatus is a major intracellular Ca2+ pool.

Circadian, weekly, and seasonal variations in cardiac mortality, blood pressure, and catecholamine excretion

Time of occurrence of cardiac death due to arrhythmia, heart failure, or acute myocardial infarction was recorded in 86 elderly subjects, belonging to a group in whom circadian and circannual rhythms in blood pressure and urinary catecholamine excretion had been studied previously. All patients were retired, with no work responsibilities, and lived--closely-supervised in a home for the aged--on a routine that provided little differences between weekdays and weekends. Cardiac mortality showed a circadian variation, with a peak in the early morning hours, coinciding with the circadian peak in systolic and diastolic blood pressures. A weekly (circaseptan) variation in cardiac mortality was found, with the greatest number of patients dying on Mondays and the least on Thursdays. There were seasonal differences in cardiac mortality, with a peak in July and a broader peak during the cold season (December to February). The former coincides with the circannual peak in diastolic blood pressure, but is unrelated to the seasonal variation in norepinephrine excretion. Circadian, circaseptan, and circannual variations in cardiac mortality appear to be the expression of time-dependent, transient risk states for catastrophic cardiac events, which may lend themselves to preventive treatment.

Immune activation markers to predict AIDS and survival in HIV-1 seropositives

Neopterin concentrations in body fluids of HIV-1 seropositives provide predictive information. In 1986, we examined serum and urine neopterin concentrations in 29 HIV-1 seropositives. Serum levels of soluble IL-2 receptor (sIL2R), soluble CD8 (sCD8), tumour necrosis factor alpha (TNF-alpha) and circulating immune complexes (CIC) were retrospectively analysed in 1989. All individuals had increased serum and urine neopterin, sIL2R and CIC concentrations, 27/29 had increased sCD8 concentrations, whereas all had normal TNF-alpha levels. During a 3-year follow-up, high urine and serum neopterin concentrations were significantly associated with progression to AIDS and with the occurrence of AIDS-associated death. Both neopterin variables were of similar predictive value (p less than 0.001, generalized Wilcoxon test). sIL2R concentrations were of borderline significance in predicting the onset of AIDS (p = 0.05). All other parameters lacked predictive information in our study. We conclude, that chronic immune activation is detectable in almost all HIV-1 seropositives. Chronic immune activation may be associated with HIV-1 replication and may contribute to the immunopathology of HIV-1 infection.

Comparison of serum and urine neopterin concentrations in patients with HIV-1 infection

Urine and serum neopterin concentrations are now widely used to monitor patients with HIV-1 infection. However, there are no published studies comparing the levels in urine and serum, and relating both to the patients' immune status. Urine and serum neopterin concentrations correlated closely in our study population of 37 HIV-1 seropositive patients (34 homosexuals, 3 drug addicts) and 10 HIV-1 seronegative homosexuals. Our data further show that urine and serum neopterin concentrations correlate almost identically with the clinical and immunological presentation of HIV-1 infected individuals, as expressed by the Walter Reed Staging classification. In addition, there was no difference between the correlation of neopterin concentrations in either serum or urine with the Quetelet indices. It will depend on the clinical situation whether blood or urine sampling is preferred. Collection and handling of urine samples from HIV infected patients is less risky to health care personnel in HIV settings.

[The ergo-ophthalmological problems raised by work at video terminals]

The paper reports a study on the involvement of the visual system during work at video terminal. The results of the investigations on a group of operators in a computation centre were used for describing an optimum anatomicofunctional visual type for work at video terminal and the hygiene rules to be observed during work at the computer screen.

[Electrocardiographic and arterial pressure changes in the acute phase of subarachnoid hemorrhage]

A prospective study was made of 30 patients, admitted to the neurology ward with subarachnoidal hemorrhage (SAH), at its onset. The diagnosis was established on the basis of anamnesis, clinical examination, spinal puncture, anatomopathological examination. The patients with other cerebrovascular affections or with antecedents of ischaemic cardiac affections were excluded. ECG tracings, serum ionogram, AT and VA at the onset and in evolution, and their modifications were followed and assessed in all the patients. The conclusion is reached that SAH in acute phase is associated with transitory ECG and pressure anomalies which become elements of unfavourable prognosis when persistent and deeply altered. They are valuable, at hand, elements in the differential diagnosis, and in the opportune therapeutical intervention.

Studies of water permeability and proteins of erythrocyte membranes in patients with Duchenne muscular dystrophy

The characteristics of water permeability of erythrocytes from 54 Duchenne muscular dystrophy (DMD) patients and age-matched controls have been determined by a pulse nuclear magnetic resonance (NMR) technique. A decreased permeability of erythrocyte membrane in DMD was definitely found at all temperatures between 15 and 42 degrees C, with normal values for the activation energy of water diffusion. No differences between DMD and control subjects in the pattern of erythrocyte membrane polypeptides separated by two-dimensional electrophoresis could be detected. The findings are discussed in relation to the molecular mechanisms of water diffusion across erythrocyte membrane and the problem of erythrocyte membrane abnormalities in DMD. A new interpretation of erythrocyte membrane alterations is proposed based on the recent findings regarding the molecular pathology of DMD.

[Importance of apical instrumentation limit in the endodontic technique]

An improved knowledge of anatomy and psysiology of the apical radicular region has made mandatory a better classical endodontic technique concerning the apical limit of instrumentation, and has stressed the importance of a precise determination of the cemento-dentinal junction as the apical limit of canal obturation. On the basis of these orientations a clinical and radiographic study was carried out on 120 teeth extracted form humans, in which the frequency was determined of the excentric position of the cement conus with regard to the apex, and the distance between the cemento-dentinal junction and the apex. In 45 teeth in situ, with pulpar inflammation, gangrene and apical parodontitis a clinical and radiological appraisal was done of the cemento-dentinal junction, and evolution was followed after canal obturation.

Cystic parathyroid cancer. Case report

A patient hospitalized for the assessment of a "thyroid nodule" is presented. Scintigraphically the nodule was cold. Thin needle aspiration biopsy by which 50 ml of a clear fluid was drawn, proved the nodule to be of cystic nature. Phospho-calcium findings allowed the diagnosis of primary hyperparathyroidism though the patient presented no subjective complaints. Histologic examination of the tissue removed intraoperatively revealed a cystic parathyroid neoplasm.

Chronobiology of serum iron concentration in subjects of different ages at different geographic locations

The circadian rhythm in serum iron concentration was studied in 61 elderly men (74 +/- 6 years of age) and 93 women (78 +/- 8 years of age) in Bucharest, Romania, in 81 clinically healthy boys and 103 girls (11 +/- 1.5 years of age) in Tîrgovişte, Romania, in 4 elderly men and 19 women (71 +/- 5 years of age) and in 75 young-adult men (24 +/- 11 years of age) and 52 women (24 +/- 9 years of age) in St. Paul, Minnesota, USA. Six samples were obtained from each subject around a 24-hour span. The sampling sessions in the elderly subjects in Romania and in the children extended over all four seasons. A circadian rhythm statistically verified by Cosinor analysis was evident in all groups in both locations. A statistically significant sex difference with lower circadian mean (mesor) and a lower amplitude in the women was found in the Romanian elderly subjects. The children in Romania showed no sex difference in any circadian rhythm parameters. The young adult subjects in Minnesota showed a significantly higher mesor and a phase delay in the men as compared with the women. The elderly subjects of both sexes at both geographic locations had a lower circadian mesor than the young adults and the children. In the Romanian elderly subjects also the circadian amplitude was lower, which was not the case in the Minnesotans. While the acrophase in the elderly subjects and in the children in Romania was comparable (0928 and 0932 local time resp.), the young adults in Minnesota showed in comparison to the Romanians a phase delay (1132 local time) and the elderly in Minnesota showed a phase advance (0732 local time) in comparison to all other groups. The latter finding will have to be confirmed by more extensive studies. In the elderly subjects in Romania the circadian rhythm in serum iron concentration was in phase with the circadian rhythms in total serum bilirubin and alkaline phosphatase but showed significant phase differences from the circadian rhythms in serum albumin, urea nitrogen (BUN), gammaglutamyl transferase (Gamma-GT), serum globulins, glucose, insulin and total serum proteins. The elderly subjects in Romania showed a statistically significant circadian phase delay in summer as compared to fall but showed no seasonal variation of the mesor. The children showed a circadian phase advance in fall as compared to the other seasons and a seasonal variation of their mesor with higher values in spring and summer as compared with winter and fall.(ABSTRACT TRUNCATED AT 400 WORDS)

Phospholipase C contracts visceral smooth muscle

Phospholipase C added into the muscle bath (0.2-1.5 units/ml) contracted the guinea-pig taenia coli in a concentration-dependent manner. The fully developed contraction appeared within second, like the contractile effect evoked by 5 microM acetylcholine. Pharmacochemical dissection (using phospholipase D, indomethacin, neomycin, Li+, phorbol ester and oleoyl-acetyl-glycerol) showed that the contractions induced by exogenous phospholipase C are mediated by inositol trisphosphate, not by diacylglycerol. Thus, direct evidence is provided for the key role of the phospholipase C/inositol-trisphosphate system in smooth muscle contraction.

Circadian rhythm of beta-endorphin in the plasma of clinically healthy subjects and in patients with adrenocortical disorders

Immunoreactive beta-endorphin was determined in the plasma of 37 elderly subjects (73 +/- 7 years of age), in 3 young or young adult subjects without adrenal disease, in 4 women with clinical adrenogenital syndrome, in 1 man with Cushing's disease. Immunoreactive beta-endorphin in plasma was measured by radioimmunoassay in six samples of each subject collected at 4-hour intervals over a 24-hour span. The observation of a circadian rhythm in circulating immunoreactive beta-endorphin with highest values during the late night and early morning hours is extended to elderly subjects in the 8th decade. The beta-endorphin plasma concentrations in the few clinically healthy young adult subjects studied fell within the same range. The circadian variation of the group of elderly subjects was used as reference in the clinical evaluation of plasma beta-endorphin concentrations in patients with pituitary-adrenocortical disorders. The need for circadian rhythm qualified reference values is shown by the observation of the circadian variations of circulating immunoreactive beta-endorphins in the patients with adrenogenital syndrome and Cushing's disease in whom abnormalities in the concentration of circulating beta-endorphin were found at certain circadian stages but not at others.

Circadian and circannual variations of FSH, LH, testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and 17-hydroxy progesterone (17 OH-Prog) in elderly men and women

A group of 63 men and 86 women 77 +/- 8 years of age institutionalized at the Berceni Clinical Hospital, Bucharest, Romania, on a diurnally active living schedule with rest at night, eating 3 comparable but not identical meals a day, were investigated over a 2-year span in 278 profiles extending over a 24-hour span each and distributed over all our seasons. On each day of sampling six samples of blood were collected at 4-hour intervals beginning at 0800 of the first day of the study to 0400 of the next. Plasma testosterone, dehydroepiandrosteronesulfate (DHEA-S), 17-hydroxyprogesterone (17-OH Prog), FSH and LH concentrations were determined by radioimmunoassay. Statistically significant circadian rhythms were detected and quantified by population mean cosinor for the men and women of the entire group and for the age groups of 51 to 70 (I), 71 to 80 (II) and above 80 years of age (III) separately. Circannual rhythms of the circadian means were sought and evaluated by one way analysis of variance. Statistically highly significant circadian rhythms were found in plasma testosterone, 17-OH Prog and DHEA-S, concentrations in men and women of all three age groups with a phase advance of over 2 hours in DHEA-S with advancing age. Circannual cycles were found for plasma testosterone concentration and for DHEA-S in men and women, with a likely phase difference between men and women in testosterone. In LH a circadian rhythm was found in the women and in FSH in men only and a circannual variation in LH only in men.

Alkaline phosphatase activity improved by the addition of zinc in granulocytes from leukemic subjects (in vitro study)

Granulocyte alkaline phosphatase (GAP) was extracted from the leukocyte suspensions of 15 subjects with chronic myeloid leukemia (CML), determining the Zn content by atomic absorption spectrophotometry. The purified enzymatic preparation was dialyzed against a ZnCl2 solution (.01 mg%) in TRIS-HCl 0.1 M, pH 7.5, for 48 hours. After dialysis Zn concentration and GAP activity reached normal values. This suggests that the GAP molecule isolated from CML subjects is not altered as it is able to receive at most 2 Zn moles responsible for the enzymatic function.

Drug allergy: incidence in terms of age and some drug allergens

The authors studied the incidence of drug allergy in 3 groups of subjects. In the first group the incidence was established in terms of the subjects' age: 1.8% in children up to 14 years old (323 subjects), 5.8% in middle-aged subjects (389 subjects) and 2.9% in the elderly (243 subjects). In the second partly selected group, drug allergy was studied in patients admitted to the 3rd Medical Clinic--Craiova between 2 Jan. 1981 and 31 Dec. 1982; 103 of the 8,760 patients admitted presented allergic reactions, a relatively high incidence rate (1.01%) as compared to other published reports. The third group of previously selected cases consisted of 197 patients who had come to the allergology service with complaints of present or past sensitivity to drugs. The total number of patients was 336 selected or preselected from about 10,000 subjects, to which 17 patients with a diagnosis of "asthmatic triad" must be added. Drug allergy in terms of the drug used was dominated by penicillin, pyramidon-algocalmin, aspirin, iodine preparations, etc.; foremost among the clinical syndrome were the dermatologic syndromes types I, III and IV; syndromes of the "anaphylactic shock" type, "serum sickeness" bronchial asthma, angioneurotic oedema.

The frequency of allergens implicated in bronchial asthma in different areas of Romania

The study carried out on 582 asthma patients and 164 healthy controls, ranging in age from 5 to 60 years, dwelling in four different towns ( Sibiu , Mediaş, Baia Mare, Sighetul Marma tiei ) showed that the most frequently involved antigen in allergic bronchial asthma was house dust (50.3 to 86%), followed by Dermatophagoides pteronissinus and atmospheric fungi, and the most frequently encountered associations were likewise between these allergens, hence the orientation towards a specific hyposensitizing therapy. In these localities with a rich gramineous vegetation there was a high per cent of sensitization to the polen of these plants. Sensitization to woollen hairs has been reported in a high percent in the region of Maramure ş and is linked to its ethnical characteristics. In many cases the patients also exhibited hypersensitiveness to bacteria, associated with environmental allergens, the vicious circle realized by an allergic-infectious mechanism being known. The conclusions of the study on the etiology of bronchial asthma in these geographical areas will be used as a basis for the treatment and its orientation.

Circadian and circannual variations in plasma immunoreactive insulin (IRI) and C-peptide concentrations in elderly subjects

Groups of 49-51 elderly men and women 77 +/- 8 years of age, institutionalized at the Berceni Clinical Hospital, Bucharest, Romania, were studied over a 24 hour span in spring, summer, fall and winter. All subjects followed a diurnal activity pattern with rest at night and ate three meals per day with breakfast at about 08:30, lunch at about 13:00, dinner at 18:30. The meals were similar, although not identical for all subjects during all seasons. On each day of sampling, blood was collected at four hourly intervals over a 24 hrs span. Immunoreactive insulin (IRI) and C-peptide were determined in plasma and glucose (during fall and winter only) in serum. Circadian variations of all three parameters were found and the rhythm parameters were determined statistically by cosinor analysis. The acrophases of the circadian rhythm of IRI and C-peptide were the same during all four seasons. The circadian acrophase of plasma IRI and C-peptide precedes that of serum glucose. The circadian mean concentrations of IRI and C-peptide show a circannual variation with higher values in winter and fall than in spring and summer for plasma insulin and with higher values for summer and fall than in spring for C-peptide. Sex differences in IRI and C-peptide concentrations with higher values in men are manifested during certain circadian and circannual stages but not during others.