Vertical transmission of HIV: parameters which might affect infection of placental trophoblasts by HIV-1: a review. Biomed Group on the Study of in Utero Transmission of HIV 1

PROBLEM

To understand the mechanisms preventing and/or facilitating maternofetal transmission of human immunodeficiency virus (HIV)-1 across the placenta during pregnancy.

METHODS OF STUDY

Current experimental data were reviewed.

RESULTS AND CONCLUSIONS

The data about the production of cytokines by placental cells and explants, taken together with information indicating selective passage of certain HIV-1 variants across the placental trophoblast, suggest an intricate regulatory network operating at the fetomaternal interface. The data show a differential differentiation of early and late trophoblasts, as far as HIV entry routes are concerned. We believe this explains the relative predominance of the early infection window, as far as in utero infection is concerned. Whether such a differentiation state can be transiently induced on term placental trophoblasts by several differentiation agents, including cytokines, is being investigated. Whatever the results may be, it is obvious that infection of placental cells is an excellent model of passage infection by HIV of/through a mucosal barrier.

Diminished CYP2E1 expression and formation of 2-S-glutathionyl acetate, a glutathione conjugate derived from 1,1-dichloroethylene epoxide, in murine lung tumors

We hypothesized that resistance of lung tumors to the cytotoxic effects of xenobiotics is associated with loss of cytochrome P-450 expression, leading to defective formation of reactive intermediates. To test this hypothesis, we investigated 1,1-dichloroethylene (DCE), a chemical that causes Clara cell damage, in a urethane-induced model of lung tumorigenesis. Lung metabolism of DCE yields 2-S-glutathionyl acetate (conjugate [C]), a glutathione conjugate derived from DCE-epoxide, believed to be the ultimate toxic species. We used immunohistochemistry to investigate CYP2E1 expression in nontumor- and tumor-bearing lung to identify cells capable of generating [C]. CYP2E1 and [C] were colocalized in adjacent tissue sections to determine coincidence between CYP2E1 and [C] in lung cells. CYP2E1 was highly localized to the bronchiolar epithelium of nontumor-bearing lung and in uninvolved tissue of tumor-bearing lung and was concentrated in the Clara cells. In contrast, tumor foci including hyperplasias, adenomas, and carcinomas were deficient in CYP2E1 in both untreated and DCE-treated mice. Immunoreactivity for [C] was also detected in the bronchiolar epithelium in nontumor-bearing lung and uninvolved tissue of tumor-bearing lung of DCE-treated mice and was reduced in hyperplasias, adenomas, or carcinomas. Thus, there was a coincidence between the sites of CYP2E1 expression and [C] formation. Conjugate [C] accumulated only in lung cells in which CYP2E1 was expressed. Histochemical staining for glutathione confirmed its presence in tumor foci. Thus, bioactivation and conjugation of DCE occur in structurally normal tissue from both nontumor- and tumor-bearing lung but was lost in tumor tissue, irrespective of the stage of tumor development.

Non-insulin-dependent diabetes in Kuwait: prevalence rates and associated risk factors

Non-insulin-dependent diabetes mellitus (NIDDM) is a major clinical and public health problem in Kuwait. The objective of the study was to determine prevalence rates of NIDDM among a representative sample of the Kuwaiti adult population aged 20 and older in two out of five governorates and identify the associated risk factors for the disease. A total of 3003 subjects (1105 men and 1898 women) were interviewed and examined by the research team during the period September 1995 to June 1996. A specially designed questionnaire was completed and the physical examination included height, weight and blood pressure measurements. Fasting blood samples were withdrawn, centrifuged immediately and refrigerated. Interpretation of oral glucose tolerance tests were based on the World Health Organisation diagnostic criteria for diabetes mellitus (1985). The denominator used for computing the prevalence was obtained from the 1995 Kuwait census. The overall prevalence of NIDDM in this study was found to be 14.8% (14.7% in men, 14.8% in women). Diabetic subjects presented at a relatively young age, prevalence rate in the age group 20-39 was 5.7% (95% confidence interval, 4.4-7.0) and in the age group 40-59 was 18.3% (95% confidence interval, 16.1-20.6). Obesity was found to be a significant risk factor, P < 0.001. The strong association of family history of NIDDM (adjusted odds ratio = 1.80, P < 0.001) suggests a genetic component. Hypertension was markedly associated with NIDDM and IGT (P < 0.001). With the demographic transition which already started among the Kuwaiti population and if the prevalence of NIDDM remains the same, aging of the population will contribute to even more upward trends in prevalence of abnormal glucose tolerance with its serious impact on morbidity and mortality among the Kuwaiti population. The strong association between hypertension and NIDDM may suggest a common approach to the prevention and control of these two conditions.

Metallothionein expression in renal cancer

OBJECTIVES

To assess metallothionein (MT) expression with immunohistochemical localization in human renal cell carcinoma and to determine whether a possible relationship with the histopathologic findings, tumor grade, or pathologic tumor stage is demonstrable, because MT may have a role in carcinogenesis.

METHODS

Archival pathologic specimens and medical records were reviewed for 28 patients with renal cell carcinoma. Immunohistochemical localization of MT was performed with a polyclonal-antibody-to-rat-liver MT, an anti-rabbit IgG linking antibody, and an avidin-biotin horseradish peroxidase complex. Correlation was sought between immunohistochemical data (MT staining intensity, extension, and subcellular site) and clinical data (histologic cell type, tumor grade, and pathologic stage).

RESULTS

The mean patient age was 61.7 years (range 42 to 86). The predominant histologic cell type was the clear cell variant. Three, sixteen, and nine tumors were pathologically staged as 1, 2, and 3, respectively. There were 1, 13, 10, and 4 tumors with grades 1, 2, 3, and 4, respectively. Among the independent variables, greater immunoreactivity was observed in Stage 2 tumors (P = 0.028). A significant inverse relationship between tumor grade and MT staining intensity was also observed (P = 0.007).

CONCLUSIONS

The inverse relationship in renal cell carcinoma between MT immunoreactivity and tumor grade may indicate a role for MT in tumor growth and dedifferentiation. Increased MT immunoreactivity in lower stage tumors may be related to rapid tumor growth during their growth cycle. Further study is required to elucidate the role of MT in renal cell carcinoma oncogenesis and its possible use as a clinical prognostic parameter.

Invasive carcinomas and fibroadenomas of the breast: comparison of microvessel distributions--implications for imaging modalities

PURPOSE

To compare spatial patterns of blood vessels between invasive breast carcinomas and fibroadenomas to improve the diagnostic specificity of noninvasive vascular magnetic resonance imaging and color Doppler ultrasound.

MATERIALS AND METHODS

Nineteen invasive ductal carcinomas and 20 fibroadenomas from 39 patients were stained for factor VIII-related antigen. Vessels smaller than 40 microns were counted in x200 fields defined in peripheral and central areas of the tumor and in normal tissue adjacent to fibroadenomas. Significant differences in vessel density were determined with Student t tests and one-way analyses of variance. Distributions of vessels 40 microns or larger were qualitatively evaluated.

RESULTS

There were 9-105 vessels (mean, 31.4 vessels) smaller than 40 microns per x200 peripheral and 4-57 vessels (mean, 20.1 vessels) smaller than 40 microns per x200 central carcinoma field. There was no significant difference in vessel density between the two groups. Peripheral microvessel density was significantly higher (P < .01) than central microvessel density in 15 (79%) of the 19 carcinomas and in three (16%) of 19 fibroadenomas. (A Student t test could not be performed in one case of fibroadenoma; size permitted only one countable field according to the authors' criteria.) The 18 cases with normal tissue had 21-229 vessels (mean, 80.5 vessels) per field; in 16 (89%) of the 18 cases, these vessel counts were significantly higher (P < .01) than those in the fibroadenoma cases. Vessels 40 microns or larger were found mainly in the periphery of carcinomas and were more uniformly distributed in fibroadenomas.

CONCLUSION

Evaluation of the spatial distribution of vessels and the ability to resolve vessel sizes may add valuable information to the imaging-based diagnostic work-up of indeterminate solid breast lesions.

A simple outpatient test for proprioception in the anterior cruciate ligament-deficient knee

Proprioception was quantified in 32 patients who had an arthroscopically documented complete anterior cruciate ligament tear using a simple single-limb standing test. An age-matched control group underwent identical testing. Control subjects demonstrated identical values between their two limbs, with the mean variation being 4.8%. The test group, however, showed significantly higher mean values for the injured compared with the noninjured limb, the mean variation being 43.8%. Patients who have a complete tear of the anterior cruciate ligament may experience a decline in proprioceptive function of their knees. This can be tested clinically using a simple single-limb standing test in an outpatient setting.

The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo-Doppler

Cardiovascular changes due to pneumoperitoneum during laparoscopic surgery are established in adult patients, but not known in infants. We investigated the hemodynamic effects of laparoscopy during general anesthesia in 12 ASA physical status I infants by using noninvasive continuous esophageal aortic blood flow (ABF) echo-Doppler monitoring. During the laparoscopic procedure, intraabdominal pressure was maintained automatically at 10 mm Hg by a CO2 insufflator, and minute ventilation was adjusted to avoid hypercapnia. Hemodynamic changes were continuously recorded on soft magnetic support and assessed at three time intervals: t0 (after the initiation of anesthesia), t1 (5 min after peritoneal insufflation), and t2 (5 min after exsufflation). The induction of pneumoperitoneum resulted in a significant decrease in ABF and stroke volume, and in a significant increase in systemic vascular resistance, compared with control values: 67% +/- 9% (P < 0.001), 68% +/- 10% (P < 0.001), and 162% +/- 34% (P < 0.001), respectively. These changes were completely reversed after peritoneal exsufflation. Pneumoperitoneum caused no significant changes in mean arterial pressure or in end-tidal CO2 pressure. These findings demonstrate that laparoscopy is associated with hemodynamic changes without clinically deleterious consequences in healthy infants during a short duration of pneumoperitoneum.

IMPLICATIONS

The peritoneal insufflation achieved during laparoscopic surgery is associated with cardiovascular impairments (decrease in cardiac performance and increase in vascular resistance). We found that these changes had no clinically deleterious effects in healthy infants.

Metallothionein expression in prostatic carcinoma: correlation with Gleason grade, pathologic stage, DNA content and serum level of prostate-specific antigen

OBJECTIVE

To determine the expression of metallothionein (MT) in prostatic carcinoma by immunohistochemical staining. Several lines of evidence have indicated that MT may play a role in carcinogenesis and in drug resistance of tumours.

DESIGN

Retrospective pathologic study.

INTERVENTIONS

Formalin-fixed, paraffin-embedded archival tissues from 39 radical prostatectomies were analysed. All tumour foci were stained by ABC technique using a primary polyclonal rabbit antibody against rat liver MT. The staining intensity for MT was graded on a scale of 0 to 2+, and the histologic grading was done by the scheme of Gleason.

OUTCOME MEASURES

Correlation of MT expression with Gleason grade, preoperative serum prostate-specific antigen (PSA) levels, pathologic stage and DNA content, including S-phase fraction (SPF) and proliferative index (PI).

RESULTS

Most of the epithelium of normal prostate tissue had patchy, intense MT staining. All the grade II tumours foci showed intense (2+) staining for MT, while all grade IV and V foci were persistently negative. The grade III tumours foci were heterogeneous. The MT-positive foci showed both nuclear and cytoplasmic staining of variable extent. There were 9, 15, 13 and 2 tumours with pathologic stage B, C1, C2 and D1, respectively. The serum PSA levels ranged from 1 to 16 ng/mL. No apparent correlation existed between the MT staining pattern and the pathologic stage or preoperative PSA level. Thirty-four of the tumours were diploid and 5 were tetraploid. There were significantly higher SPF and PI mean values in the MT-stained tumour cells (p < 0.05), suggesting that MT preferentially stains an epithelial subpopulation, possibly the proliferating cell compartment.

CONCLUSION

The positive correlation of MT expression with Gleason grade in prostatic adenocarcinoma suggests a possible role for MT in oncogenesis in prostate cancer.

Insights into the mechanisms of vertical transmission of HIV-1. BIOMED2 Working Group on the in utero transmission of HIV-1

This paper is a summary of three oral presentations, as well as the ensuing discussion, at the Rijeka/Opatija 3rd Alps Adria Immunology meeting by three members of the European Biomed group on vertical transmission of HIV (G. Chaouat, F. Barre-Sinoussi, G. Scarlatti). This group also involves the laboratories of D. Dormont (CEA, Fontenay aux roses, France), P. Gounon (Electron Microscopy, the Pasteur Institute, France; Irène Athanassakis, University of Crete, Greece; Eva Maria Fenyö, Karolinska Institute, Sweden; and Larry Guilbert, Canada). As such, this paper intends to be neither a review, nor an original article, but rather is an opinion paper discussing the working hypothesis of this network, as well as some of their recent results, which were presented at this meeting. The paper was issued at the request of the organizers of the meeting.

Large cell calcifying Sertoli cell tumor of the testis: contrasting features of six malignant and six benign tumors and a review of the literature

We report six malignant and six benign large cell calcifying Sertoli cell tumors of the testis and compare the features of malignant and benign cases based on these cases and those in the literature. All the tumors in this report consisted of sheets, nests, solid tubules, and cords of eosinophilic cells, with focal calcifications, as well as a substantial neutrophilic infiltrate in 11 of them. Analysis of our cases and those in the literature showed that the malignant tumors were unilateral and solitary and occurred at a mean age of 39 years (range 28-51 years), whereas the benign neoplasms were bilateral and multifocal in 28% of cases and occurred at a mean age of 17 years (range 2-38 years). Only one malignant tumor occurred in a patient with evidence of a genetic syndrome (Carney syndrome), whereas 36% of benign tumors had various genetic syndromes or endocrine abnormalities. Most of the tumors in the latter cases were bilateral and multifocal. There were strong associations of malignant behavior with size >4 cm, extratesticular growth, gross or microscopic necrosis, high-grade cytologic atypia, vascular space invasion, and mitotic rate greater than three mitoses per 10 high-power fields. All malignant cases exhibited at least two of these features, whereas all benign cases lacked any of them. The presence of any one of these features in a solitary large cell calcifying Sertoli cell tumor, especially in a patient >25 years of age, should be viewed as suspicious for malignant behavior, whereas the presence of two or more of these features indicates a strong probability of a malignant course. "Low" percentages (< or =35%) of tumor cells staining for proliferating cell nuclear antigen (PCNA) also may correlate with benign behavior, but some benign tumors have high PCNA values. Ki-67 values (MIB-1 antibody) did not correlate with biologic behavior, nor did immunostains for p53 protein.

Phospholipid fatty acid composition affects enzymatic antioxidant defenses in cultured Swiss 3T3 fibroblasts

The aim of this work was to study the adaptation of enzymatic antioxidant cell defense to the nature of the membrane polyunsaturated fatty acids (PUFA). 3T3 Swiss fibroblasts were grown for 5 days in a medium supplemented with 50 microM linoleic acid (LA) or eicosapentaenoic acid (EPA) and compared to control cells (C). The phospholipid fatty acid content was evaluated: LA were enriched in n-6 PUFA (27.8%) in comparison to C (6.7%) or EPA (5.6%); EPA were enriched in n-3 PUFA (26.2%) in comparison to LA (4.4%) or C (4.6%). The fatty acid double bond index (DBI) increased from C to LA and EPA. The activities of the three key enzymatic antioxidant defenses, SOD, GPx and GST, increased with the degree of unsaturation of the phospholipid fatty acids. In the cells with fatty acids that are very sensitive to oxidative stress, the higher activities of SOD and GPx might act to limit the initiation of lipid peroxidation and the higher activities of GST and GPx to decrease the toxic effects of the various species produced from lipid degradation.

Continuous oesophageal aortic blood flow echo-Doppler measurement during general anaesthesia in infants

PURPOSE

Invasive haemodynamic monitoring during general anaesthesia in infants is usually limited to very high risk operations, such as cardiac surgery. Nevertheless, different surgical procedures and/or anaesthetic techniques justify additional monitoring for children, as for adults. The aim of this preliminary study was to evaluate the feasibility of using a new echo-Doppler device (Dynemo 3000) capable of measuring continuous aortic blood flow during general anaesthesia in infants.

METHODS

Aortic blood flow (ABF) was measured with a small oesophageal probe designed for newborns and infants. The aortic flowmeter was connected with satellite devices to visualise the haemodynamic profile which included ABF, pre-ejection period (PEPi), left ventricular ejection time (LVETi), mean arterial pressure, heart rate, stroke volume and systemic vascular resistance. Twelve infants, aged 8-26 mo, undergoing surgery under general anaesthesia were successively included in the evaluation of this device. Isoflurane (1% end-expired concentration) was introduced to maintain anaesthesia after induction with halothane, midazolam, fentanyl and atracurium.

RESULTS

Correct positioning of the probe was easily obtained in all cases and the recording quality was excellent, whatever the operative position. Recordings of haemodynamic data showed some myocardial depression from isoflurane: decreased ABF (indexed to body surface area) and lengthened PEP/LVET (2.24 +/- 0.53 L.min-1.m-2 and 0.32 +/- 0.05 respectively, before introduction of isoflurane and 1.71 +/ 0.53 L.min-1.m-2 (P = 0.027) and 0.39 +/- 0.06 (P = 0.007) with isoflurane).

CONCLUSION

These preliminary results suggest that this continuous ABF echo-Doppler device may be valuable for peri anaesthetic monitoring in infants.

Frequency of pathogenic and enteroadherent Escherichia coli in patients with inflammatory bowel disease and controls

AIMS

To determine whether inflammatory bowel disease (IBD) is associated with pathogenic or enteroadherent Escherichia coli.

METHODS

A least two stool specimens and one rectal biopsy were taken from 30 patients with IBD and from 20 controls. A large number of E coli-like colonies cultured from each stool sample and biopsy was tested, using DNA probes, for the presence of genes encoding shiga-like toxins, invasiveness, attachment-effacement and the ability to adhere to HEp-2 cells. Similarity among isolates from stool samples and rectal biopsies was determined by random amplified polymorphic DNA (RAPD) analysis.

RESULTS

Enterohaemorrhagic and enteroinvasive E coli were not found in samples from either patients or controls. No significant difference in the detection rate of enteroadherent E coli between patients and controls was found. Rectal biopsies from 11 of 28 patients with IBD and 4 of 18 controls contained E coli, which hybridised with probes for detection of genes encoding diffuse adherence to HEp-2 cells, or encoding P-pili (p = 0.2). Enteroadherent E coli isolated from two or three stool specimens from the same patient or control appeared to be identical by RAPD analysis, and are considered to be residents in the colon. Probe positive isolates obtained from stool specimens and corresponding rectal biopsies were always identical on RAPD analysis.

CONCLUSIONS

E coli strains possessing adherence factors reside in the large intestine and adhere to the rectal mucosa, irrespective of the presence of colitis.

DNA cytometric proliferative index predicting organ confinement in clinical stage-B prostate cancer

PURPOSE

To assess nuclear activity by DNA flow cytometry (FCM), Gleason score and serum prostate-specific antigen (PSA) levels in predicting extracapsular tumour involvement in patients with prostate cancer.

DESIGN

Retrospective pathologic study.

PATIENTS

Forty patients with clinical stage-B prostate cancer who underwent radical prostatectomy.

INTERVENTIONS

The relationship between the pathologic state and each of the proliferative index (PI). Gleason score and PSA level was analysed retrospectively with the use of archival specimens. Preoperative serum PSA levels, were measured by the Hybritech assay. Gleason score was determined by 2 of the authors. Tumours were classified as stage B (confined to prostate), C1 (focal capsular penetration) or C2 (involvement of seminal vesicles or capsular perforation). FCM PI measurements were performed on deparaffinized tumour specimens.

RESULTS

All 40 specimens were diploid. There were 9 pathologic stage-B, 16 stage-C1 and 15 stage-C2 tumours. The serum PSA level was 20 ng/mL or less for all patients except 2, for whom the levels were 27.8 ng/mL and 45.9 ng/mL, respectively. A Gleason score lower than 7 had a 76.0% sensitivity and 53.5% specificity in predicting organ confinement. In contrast, a PI of 21 or lower had a 84.0% sensitivity and a 73.0% specificity in predicting organ confinement, with a positive predictive value of 84.0%. Of the 17 tumours with both "favourable" features (Gleason score lower than 7 and PI of 21 or lower), only 1 (5.9%) had extracapsular involvement (stage C2). Of the 6 tumours with both "unfavourable" features (Gleason score higher than 7 and PI of 21 or higher) 5 of 6 were stage C2 and 1 was stage C1.

CONCLUSION

The single most consistent predictor of organ confinement was PI alone.

Dietary essential fatty acid deficiency differentially affects tissues of rats

Quantitative variations of polyunsaturated fatty acids (PUFA) were studied in various tissues: red blood cells (RBC), hepatic microsomes, kidney, skeletal muscle and heart of young rats fed either a control diet (n = 7) or an essential fatty acid (EFA)-deficient diet (n = 7). After 4 wk, the EFA-[deficient rats had significantly lower proportions of (n-6) and (n-3) fatty acids in RBC, hepatic microsomes and kidney than the control group. Paradoxically, normal proportions of arachidonic acid [20:4(n-6)] and 5,8,11,14,17-eicosapentaenoic acid [20:5(n-3)] were retained in heart and skeletal muscle despite generally lower proportions of the precursors, 18:2(n-6) and 18:3(n-3). Moreover, absolute levels of 20:4(n-6) and 20:5(n-3) in skeletal muscle of the EFA deficient group were significantly higher than in controls and 22:5(n-3) and 22:6(n-3) levels were comparable. This suggests that fatty acid proportions alone, without any consideration of long-chain polyunsaturated fatty acid quantities, may not reflect the (n-6) and (n-3) PUFA status of individual tissues. This study indicates that diet-[induced changes in the PUFA composition of RBC, which are often used in clinical investigations, do not fully reflect the changes in the fatty acid composition of organs, and that individual tissues respond differently to EFA deficiency. The conservation of proportional and absolute levels of 20:5(n-3) and 20:4(n-6), and the decrease in the more unsaturated homologues in the heart, suggest that this organ may avidly retain 20:5(n-3) and 20:4(n-6) in order to maintain eicosanoid production.

Effect of polyunsaturated fatty acids deficiency on oxidative phosphorylation in rat liver mitochondria

Liver mitochondria isolated from controls or polyunsaturated fatty acid (PUFA) deficient rats were studied for oxidative phosphorylation. A PUFA-deficient diet led to a dramatic change in the fatty acid composition of mitochondrial lipid content, similar to that reported in the literature. Besides the changes in lipid composition, mitochondrial volume was enlarged (+45% in state 4 and two-fold in state 3). State 4 respiration was increased together with a decrease in protonmotive force. The non-ohmicity of the relationship between non-phosphorylating respiration and protonmotive force was more pronounced in the PUFA-deficient group. State 3 oxygen consumption as well as the rate of ATP synthesis showed no difference between the two groups, whereas the protonmotive force decreased substantially in mitochondria from PUFA-deficient animals. In contrast, ATP/O ratios were decreased in the PUFA-deficient group when determined at subsaturating ADP concentration. Taken together, these results are in agreement with both an increased non-ohmic proton leak and an increased redox slipping. The relative importance of these two effects on the overall efficiency of oxidative phosphorylation depends on both the rate of oxidative phosphorylation and the maintained protonmotive force. Hence, in isolated mitochondria the respective role of each effect may vary between state 4 and state 3.

Introduction of exogenous antigens into the MHC class I processing and presentation pathway by Drosophila antennapedia homeodomain primes cytotoxic T cells in vivo

The homeodomain of the Antennapedia molecule (AntpHD) spontaneously crosses cellular membranes and can be used to deliver up to 50 additional amino acids to the cytoplasm. We exploited this approach to deliver antigenic peptides to the MHC class I processing and presentation pathway. AntpHD-based fusion peptides expressing the 170-179 HLA-Cw3 CTL epitope (pCw3) were produced in bacteria. Incubation of these fusion peptides with H-2d target cells resulted in efficient delivery to the cytosol as indicated by protease resistance and confocal microscopy. Moreover, this introduction of an exogenous Ag resulted in sensitization of the cell to lysis by a CTL clone specific for the 170-179 HLA-Cw3-derived peptide. Sensitivity of the Ag processing to brefeldin A but not to chloroquine is consistent with the delivery of AntpHD fusion peptides to the conventional class I-associated processing pathway. Immunization of DBA/2 (H-2d) mice with AntpHD pCw3 fusion peptide in the presence of SDS primed H-2Kd-restricted HLA-Cw3-specific CTL. Similar results were obtained with AntpHD fusion peptides expressing the 147-156 influenza nucleoprotein peptide. The strategy outlined in this paper provides a new approach for introducing molecules into the MHC class I Ag-presenting pathway. This approach has clear relevance to the design of synthetic peptide-based vaccines.

Introduction of exogenous antigens into the MHC class I processing and presentation pathway by Drosophila antennapedia homeodomain primes cytotoxic T cells in vivo

The homeodomain of the Antennapedia molecule (AntpHD) spontaneously crosses cellular membranes and can be used to deliver up to 50 additional amino acids to the cytoplasm. We exploited this approach to deliver antigenic peptides to the MHC class I processing and presentation pathway. AntpHD-based fusion peptides expressing the 170-179 HLA-Cw3 CTL epitope (pCw3) were produced in bacteria. Incubation of these fusion peptides with H-2d target cells resulted in efficient delivery to the cytosol as indicated by protease resistance and confocal microscopy. Moreover, this introduction of an exogenous Ag resulted in sensitization of the cell to lysis by a CTL clone specific for the 170-179 HLA-Cw3-derived peptide. Sensitivity of the Ag processing to brefeldin A but not to chloroquine is consistent with the delivery of AntpHD fusion peptides to the conventional class I-associated processing pathway. Immunization of DBA/2 (H-2d) mice with AntpHD pCw3 fusion peptide in the presence of SDS primed H-2Kd-restricted HLA-Cw3-specific CTL. Similar results were obtained with AntpHD fusion peptides expressing the 147-156 influenza nucleoprotein peptide. The strategy outlined in this paper provides a new approach for introducing molecules into the MHC class I Ag-presenting pathway. This approach has clear relevance to the design of synthetic peptide-based vaccines.

Down-regulation of metallothionein expression in human and murine hepatocellular tumors: association with the tumor-necrotizing and antineoplastic effects of cadmium in mice

Previously, we found that oral cadmium (Cd) treatment either prevented or substantially reduced N-nitrosodiethylamine (NDEA)-induced tumor formation in B6C3F1 mouse liver or lung regardless of exposure interval and even when the Cd was given well after tumors were formed. Because Cd salts are powerful emetics, oral exposure would probably be impractical in humans. Thus, we studied suppression of NDEA-initiated tumors in male B6C3F1 mice by a single i.v. dose of Cd. NDEA (776 mumol/kg i.p.) was given at time 0 followed by CdCl2 (16 mumol/kg i.v.) 40 weeks later. This dose of Cd had no effect on body weights through the conclusion of the study at 52 weeks. The NDEA-induced increase in hepatic tumor incidence (19 tumor-bearing mice/22 mice at risk, 86%) over control (5/24, 21%) was remarkably reduced by Cd treatment (13/27, 48%, P < or = .05). Multiplicity and size of liver tumors induced by NDEA (2.18 tumors/liver; 31.6 mm3 mean volume) were also substantially reduced by the Cd exposure (0.96 tumors/liver; 17.1 mm3 mean volume). NDEA-induced lung tumor incidence (22/22, 100%) and multiplicity (5.09 tumors/lung) were modestly, but significantly, reduced by Cd treatment (21/27, 78%; 3.89 tumors/lung). Clear evidence of tumor-specific cytotoxicity was observed as Cd treatment induced a necrotizing effect that was localized only within the hepatic tumors. Metallothionein (MT), an inducible metal-binding protein associated with tolerance to many metal including Cd, was not detected immunohistochemically in mouse liver tumors, even those undergoing Cd-induced necrosis, whereas the surrounding normal liver cells expressed high levels of MT after Cd exposure. Likewise, in human hepatocellular carcinomas MT was only poorly or erratically expressed relative to normal tissue. These results indicate that a single, nontoxic dose of Cd dramatically reduces liver tumor burden through tumor cell-specific necrosis due to a down-regulation of MT expression in hepatic tumors of murine origin and furthermore indicate that a similar down-regulation of MT occurs in human hepatocellular carcinomas.

Inhibition of human breast cancer cell proliferation and delay of mammary tumorigenesis by flavonoids and citrus juices

Two citrus flavonoids, hesperetin and naringenin, found in oranges and grapefruit, respectively, and four noncitrus flavonoids, baicalein, galangin, genistein, and quercetin, were tested singly and in one-to-one combinations for their effects on proliferation and growth of a human breast carcinoma cell line, MDA-MB-435. The concentration at which cell proliferation was inhibited by 50% (IC50), based on incorporation of [3H]thymidine, varied from 5.9 to 140 micrograms/ml for the single flavonoids, with the most potent being baicalein. IC50 values for the one-to-one combinations ranged from 4.7 micrograms/ml (quercetin + hesperetin, quercetin + naringenin) to 22.5 micrograms/ml (naringenin + hesperetin). All the flavonoids showed low cytotoxicity (> 500 micrograms/ml for 50% cell death). Naringenin is present in grapefruit mainly as its glycosylated form, naringin. These compounds, as well as grapefruit and orange juice concentrates, were tested for their ability to inhibit development of mammary tumors induced by 7,12-dimethylbenz[a]anthracene (DMBA) in female Sprague-Dawley rats. Two experiments were conducted in which groups of 21 rats were fed a semipurified diet containing 5% corn oil and were given a 5-mg dose of DMBA intragastrically at approximately 50 days of age while in diestrus. One week later, individual groups were given double-strength grapefruit juice or orange juice or fed naringin or naringenin at levels comparable to that provided by the grapefruit juice; in the second experiment, the rats were fed a semipurified diet containing 20% corn oil at that time. As expected, rats fed the high-fat diet developed more tumors than rats fed the low-fat diet, but in both experiments tumor development was delayed in the groups given orange juice or fed the naringin-supplemented diet compared with the other three groups. Although tumor incidence and tumor burden (grams of tumor/rat) were somewhat variable in the different groups, rats given orange juice had a smaller tumor burden than controls, although they grew better than any of the other groups. These experiments provide evidence of anticancer properties of orange juice and indicate that citrus flavonoids are effective inhibitors of human breast cancer cell proliferation in vitro, especially when paired with quercetin, which is widely distributed in other foods.

[Pain in hospitalized children]

Pain is present in many hospitalized children and this requires from every physician a constant attention to its recognition, evaluation and treatment. The semeiology of pain differs whether it is acute or chronic. Acute pain can be recognized from its various behavioural, motor and neurovegetative manifestations. Pain evaluation must be adapted according to age: autoevaluation procedures for children older than 5 years, behavioural scales for children younger than 5 years. One must know that there is an appropriate and efficient treatment for each stage of pain intensity. For a better recognition and management of pain in hospitalized children, the organization of teams specialized in the evaluation and treatment of pain in children is to be encouraged.

Lens-sparing vitrectomy with perfluorocarbon liquid for the primary treatment of giant retinal tears

PURPOSE

To evaluate the surgical success of vitrectomy without initial lensectomy in the primary treatment of retinal detachment associated with giant tears without proliferative vitreoretinopathy.

METHODS

Thirty-four consecutive phakic eyes with idiopathic giant retinal tears underwent vitrectomy, injection of perfluorocarbon liquid, endolaser, and gas tamponade. Encircling scleral buckling was performed in 14 of 34 patients. Preoperative visual acuity ranged from 20/25 to hand motions. Giant tear size ranged from 90 degrees to 330 degrees. Follow-up ranged from 10 to 64 months.

RESULTS

Anatomic retinal re-attachment was achieved intraoperatively in all eyes. The re-operation rate was 14% for eyes that underwent scleral buckling with the initial vitrectomy and 45% in eyes without primary scleral buckling. In 59% of eyes with cataract formation, 32% underwent cataract surgery with or without intraocular lens implantation. Best-corrected final visual acuity ranged from 20/15 to 20/400.

CONCLUSION

Most phakic eyes with giant retinal tear not associated with proliferative vitreoretinopathy can be re-attached successfully with initial preservation of the lens.

A retrospective analysis of pathological placental implantation--site and penetration

OBJECTIVES

To determine the incidence of pathologically implanted placenta, i.e. placenta previa and accreta, at the Maternity Hospital of Kuwait. In addition the study aimed to identify the risk factors for such conditions, and test the hypothesis that previous cesarean section increases the likelihood of abnormal placentation.

METHODS

Analysis of all deliveries in the Maternity Hospital of Kuwait with identification of cases of placenta previa, placenta accreta, previous cesarean section and manual removal of placenta. Information was obtained from the medical records of the hospital between 1981 and 1992 except for the period 1990-1991 due to incomplete information as a consequence of the Iraqi invasion. The incidences of these conditions were calculated followed by identification of risk factors for placenta accreta and previa.

RESULTS

The incidence of placenta previa was 0.5% and that of placenta accreta 9.5 per 100,000 deliveries. Placenta previa and previous cesarean section were found to be significant predisposing factors for placenta accreta. The increased risk for placenta accreta in the presence of these factors was much less than that reported in the international literature. Abnormal placentation was responsible for 34% of peripartum hysterectomies.

CONCLUSIONS

Placenta accreta and previa are major causes of massive obstetric hemorrhage. They are interrelated with a common predisposing factor, cesarean section. Even though the rate of cesarean section and placenta previa is increasing, the incidence of placenta accreta remains stable in Kuwait.

Rotational malalignment and femoral torsion in osteoarthritic knees with patellofemoral joint involvement. A CT scan study

Forty-five osteoarthritic knees in 25 patients with patellofemoral joint involvement were examined preoperatively by computed axial tomography (CT scan) for measurement of femoral torsion, rotation of the knee, and tibial torsion. Rotational alignment of the affected lower extremities was determined as the angle between the femoral neck axis and the transmalleolar axis. The results were compared with a control group of 23 asymptomatic knees. Femoral torsion was significantly lower in the arthritic knees than in the control group (p < 0.05). A compensatory mechanism involving the three components of rotational alignment of the lower extremities in the arthritic knees was identified. Multiple regression analyses using a stepwise method showed that femoral torsion was the first significant predictor in this mechanism. This relationship between femoral torsion and the arthritic knee has not been previously reported.

The scud missile disaster in Al-Khobar, Saudi Arabia, 1991: the orthopaedic experience

The orthopaedic experience of the scud missile disaster in Al-Khobar, Saudi Arabia during the Gulf war is reviewed. This was by far the most severe of 70 scud attacks. The majority of casualties had 'orthopaedic' injuries, fractures and soft tissue lacerations of the extremities and the back. Our experience confirmed the importance of the principles of planning triage beforehand and open wound treatment with secondary suture. Repeated ward rounds with reassessment of the patients proved beneficial. The ready availability of hospital beds in high-risk situations of regional war highly facilitated the management of mass casualties.

McMurray's test tested

We studied the validity of McMurray's test for a torn meniscus in 93 patients. The clinical test results were compared with arthroscopic and/or arthrotomy findings as reference. The clinical test had a sensitivity of 58.5%, a specificity of 93.4%, and the predictive value of a positive result was 82.6%. The test therefore seems to be of limited value in current clinical practice.

Temporal effects of 1,1-dichloroethylene on nonprotein sulfhydryl content in murine lung and liver

Administration of 1,1-dichloroethylene (DCE) to mice evokes cytotoxicity involving Clara cells in lung, and at higher doses, centrilobular hepatocytes in liver. Our objective is to investigate temporal alterations in nonprotein sulfhydryl [glutathione (GSH)] content in lung and liver after administration of a dose of DCE (125 mg/kg). Contribution of GSH from whole blood comprised 54% and 14% of the amounts found in lung and liver, respectively, of DCE-treated mice, and were taken into account to determine tissue content of GSH. In lung, a significant decrease in GSH (60% of control) was first detected at 6 hr, and levels remained low from 8 to 12 hr. In liver, a 50% decrease was initially detected at 1 hr after DCE treatment. Progressive increases were found thereafter, with a return to the control level at 24 hr. Histochemical staining for GSH in liver revealed homogeneous labeling in hepatocytes across the lobule; DCE treatment diminished staining uniformly in all hepatocytes. In control lung, histochemical reactivity was exhibited in bronchiolar epithelium and alveolar septa. Clara cells were stained to the greatest extent and with considerable variability, whereas staining was more uniform in alveolar septa. Staining was markedly diminished by DCE treatment, and was initially abolished in the alveolar septa, but retained to a limited extent within a small number of Clara cells. These findings suggest that susceptibility of a subpopulation of Clara cells to cytotoxicity may be associated, in part, with low expression of nonprotein sulfhydryl content at the time of DCE treatment.

A neural model for nonassociative learning in a prototypical sensory-motor scheme: the landing reaction in flies

Nonassociative learning is an important property of neural organization in both vertebrate and invertebrate species. In this paper we propose a neural model for nonassociative learning in a well studied prototypical sensory-motor scheme: the landing reaction of flies. The general structure of the model consists of sensory processing stages, a sensory-motor gate network, and motor control circuits. The paper concentrates on the sensory-motor gate network which has an agonist-antagonist structure. Sensory inputs to this circuit are transduced by chemical messenger systems whose dynamics include depletion and replenishment terms. The resulting circuit is a gated dipole anatomy and we show that it gives a good account of nonassociative learning in the landing reaction of the fly.

Perforating eye injuries due to intraocular foreign bodies

The results of sixty-four perforating eye injuries with intraocular foreign bodies (IOFB) treated at University Hospital over ten years were reported. Compared to an earlier report we found that the population at risk was the same and consisted of patients under 35 years (70%), males (95.3%) and work related (86%). The commonest causes of IOFB were hand hammer (64.1%) and grass cutting (20.3%). We also noted that while the incidence of cases had increased by 23%, the final visual outcome has improved significantly due to advances in preoperative diagnosis and surgical techniques. Preoperative factors found to have a statistically significant effect on the final visual outcome were the size of the IOFB, poor initial visual acuity, and the presence of the following complications: cataract, iris damage and vitreous haemorrhage. The outcome was also worse in posterior segment IOFBs but this was not statistically significant.

The search for the new pineal gland. Brain life and personhood

The concept of "brain life," sometimes offered as the criterion for determining when personhood begins, cannot tell us what we want to know about persons. Neurological facts will not automatically yield ethical conclusions.

1,1-Dichloroethylene-induced alterations in glutathione and covalent binding in murine lung: morphological, histochemical, and biochemical studies

Non-ciliated Clara cells of the pulmonary bronchiolar epithelium are preferentially damaged by administration of 1,1-dichloroethylene (1,1-DCE) to mice. In this study, an in vivo system was utilized to investigate the dose-dependent effects of 1,1-DCE (75, 125, 175, and 225 mg/kg) on covalent binding and on reduced glutathione (GSH) in murine lung. Treatment of mice with each dose level of 1,1-DCE elicited significant decreases in GSH content and resulted in covalent binding of [14C]1,1-DCE in a dose-dependent manner. Histochemical staining for GSH in lungs of control mice revealed positive cellular sites in alveolar septa and bronchiolar epithelium, with the highest staining intensities in Clara cells. Staining was reduced after exposure to 75 and 125 mg/kg 1,1-DCE, and at higher doses it was abolished in alveolar septa and retained in bronchiolar epithelium, albeit at considerably reduced intensities. Heterogeneity with respect to staining intensities was consistently observed in the Clara cell population in both control and 1,1-DCE-treated mice. Progressive increases in covalent binding and decreases in GSH content correlated with increasing severities of Clara cell injury. These results show a dose dependence in regard to the magnitudes of [14C]1,1-DCE binding, the alterations in cellular GSH, and the severities of Clara cell necrosis.

[Gastroesophageal reflux with combined caudal and halothane anesthesia in children]

Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

1,1-Dichloroethylene elicits dose-dependent alterations in covalent binding and glutathione in murine liver

Dose-response studies have been performed using the hepatotoxin 1,1-dichloroethylene (1,1-DCE) to investigate effects of its administration on covalent binding, content of reduced glutathione (GSH), and structural alterations in murine liver. Additionally, these studies have determined if the sites of cellular damage coincided preferentially with the sites of GSH depletion. Treatment with 1,1-DCE evoked dose-dependent alterations in both covalent binding and tissue GSH content. Progressive increases in covalent binding (2.8 +/- 0.8 to 12.5 +/- 1.9 nmol/mg protein) were found within the range of doses tested (75-225 mg/kg). Tissue GSH content (86.4 +/- 6.1 to 35.9 +/- 2.4 nmol/mg protein) declined significantly after 1,1-DCE treatment when compared to that in control mice (128.0 +/- 3.6 nmol/mg protein). Alterations in GSH content due to 1,1-DCE treatment included those associated with significant increases (34-81% of control) in blood volume. Concomitant increases in vascular GSH were observed, and at 225 mg/kg, GSH content comprised 190% of that found in controls. Histochemical staining for GSH exhibited dose-related decreases in staining intensities that were not concentrated in any particular region, but, rather, were uniformly distributed throughout the liver lobule. Liver injury involving centrilobular and midzonal hepatocytes was absent at 75 mg/kg, mild at 125 and 175 mg/kg, and was most severe at 225 mg/kg. The results from these experiments demonstrate dose-dependent relationships between the magnitude of covalent binding of 1,1-DCE metabolite(s), diminished levels of tissue GSH, and hepatocellular necrosis.

Exercise time relationship to coronary risk factors in Kuwaiti adult males 1985-1986

Two hundred and sixty-nine apparently healthy Kuwaiti men, aged 20-49, from 800 randomly selected Kuwaiti families, were examined for cardiovascular fitness and risk factors for coronary heart diseases (CHD). The risk factors were examined by exercise stress test on Quinton-2000 ECG monitor and treadmill Q-model 24-26, Bruce protocol, along with Ergo-oxyscreen, by laboratory tests of fasting blood lipid levels, and by interview using a questionnaire. The sample was stratified into three age groups, 20-29, 30-39, and 40-49. For the entire sample, the results showed that a number of the investigated factors were significantly correlated with the duration of treadmill exercise time. Univariate analysis indicated that performance was inversely correlated with age, cholesterol levels, cholesterol:HDL ratio, triglycerides and uric acid, weight, body-build indexes, body density, resting heart rate, blood pressure (BP), personal history of CHD, and smoking habits. Most of the observed significant correlations were particularly pronounced in the younger age groups, 20-39 years. In this group, significant results in the analysis of variance were found between the treadmill performance time and a number of risk factors, including: cholesterol levels, age, cholesterol:HDL ratios, triglycerides, uric acid, heart rate, elevated systolic blood pressure, and obesity.

Oxyphilic granular cell adenoma (oncocytoma)--a histochemical and ultrastructural study

Oxyphilic granular cell adenoma (oncocytoma) is extremely rare usually benign neoplasm. Specimens from four oncocytomas of the parotid gland were studied by light microscopy using different histochemical stains, and by electron microscopy. The haematoxylin and eosin stained sections revealed large cells with eosinophilic granular cytoplasm. These granules appear blue with phosphotungstic acid haematoxylin stain, purplish blue with mallory aniline blue stain and are moderately reactive to alcian blue and PAS. No elastic fibers could be seen in the intercellular substance using Verhoeff's stain. At the ultrastructural level, the tumour cells were characterized by great numbers of mitochondria. Many of the mitochondria contained glycogen granules. Dividing mitochondria were also observed.

A scanning electron microscopic study of exfoliated malignant oral epithelial cells

Investigators disagree regarding the value of exfoliative cytology in the diagnosis of oral cancer. The objective of the present study was to examine exfoliated oral epithelial cells from malignant lesions of the oral mucosa by means of Scanning electron microscope (S. E. M.) in order to determine whether SEM surface characteristics might be useful and specific to predict more accurately the nature of these lesions. Twenty cases of squamous cell carcinomas of non keratinized sites of the oral mucosa (Cheek and floor of the mouth) were selected for this study. Exfoliated cells were collected by scraping by means of modified Ayre's spatula and spread over a standard glass microscope slide for light microscope examination, while those for SEM were spread evenly on a plastic square (1 cm2) cut from a polyester sheet of Melinex "O" (Firket 1966). Altered tissue architectures and cell surface architectures were demonstrated in malignant oral lesions. Bizarre cell forms often showing an absence of close cell-cell contact relationships were seen. The observed cell surface patterns were apparently not related to the degree of keratinization when compared to normal surface patterns of corresponding areas of oral mucosa studied in a previous work. These changes appeared to some extent to be related to the clinical diagnosis and to the degree of epithelial atypia observed by the lesions. In conclusion the observations made in this study demonstrate that surface structural differences exist between exfoliated cells from malignant lesions of the oral mucosa and those from corresponding normal non keratinized sites and that the SEM might be of a diagnostic value.

The anatomical pattern of gonarthrosis in Saudi Arabia

Fifty patients in Saudi Arabia with primary gonarthrosis were randomly selected in order to study the anatomical pattern of the disease. Anteroposterior and lateral radiographs were taken with the patients nonweight-bearing and weight-bearing; axial projections of the patello-femoral joint were also taken. Involvement of more than one compartment was significantly more common than it was in a Swedish series. The patello-femoral joint was affected in 80% compared with 48% of the Swedish knees. Different living habits are suggested as a contributory cause for the different patterns of gonarthrosis in the two countries.

Pattern of obesity and insulin, glucagon, sex hormone binding globulin and lipids in obese Arab women

A standard oral glucose tolerance test was performed in 86 healthy premenopausal obese Arab women (BMI greater than or equal to 30) Glucose, insulin and glucagon were measured at 0, 30, 60, 90 and 120 min. Sex hormone binding globulin (SHBG), plasma lipids and uric acid were also estimated. Waist-hip circumference ratio (WHR) had significant positive correlation with age, triglycerides (TG), uric acid, fasting and 120 min glucose, and 120 min insulin and significant negative correlation with SHBG. Body mass index (BMI) had significant correlation with uric acid, fasting and 120 min insulin, and significant negative correlation with high density lipoprotein cholesterol (HDL Chol). When separated in two subgroups, with WHR greater than 0.80 (41), and less than or equal to 0.80 (45 cases), plasma glucose was in the diabetic range in seven; and impaired glucose tolerance (IGT) in 11 women in the former subgroup. Only three with IGT but no diabetics, were in lower WHR subgroup. WHR in diabetics (0.93), and in IGT cases (0.90) was significantly higher than in other women (0.80). Fasting insulin was not different, but at 90 and 120 min, insulin was higher in the high WHR subgroup who had also higher fasting, 90 and 120 min glucose. Glucagon level, though slightly higher in the higher (WHR) subgroup, may indicate relative hyperglucagonaemia because of the associated significantly higher glucose. Compared with age matched non-obese controls, obese women in both subgroups had significantly higher insulin, uric acid and significantly lower HDL Chol and lower glucagon (insignificant). Obese women in the higher WHR subgroup (greater than 0.80) had also significantly higher systolic blood pressure, TG and lower SHBG.

Erythrocyte protoporphyrin screening for lead poisoning in Bedouin children. A study from Kuwait

Screening for lead poisoning can be performed by measuring either blood lead (PbB) or a haematological indicator such as erythrocyte protoporphyrin (EP). We have screened 902 infants and children aged from 3 months to 5 years amongst those attending three primary health care centres in AI Jahra governorate of Kuwait. Blood specimens were collected by finger prick on Guthrie filter paper and the dried blood samples were mailed to the Central Laboratory of the Children's Hospital, Buffalo, USA. One hundred and eighty-four (20 per cent) had an elevated EP (greater than 50 micrograms/dl). Of those 11 had values above 159 micrograms/dl; 140 children were further tested for blood lead levels (PbB) haemoglobin, mean cell volumes, and percentage of transferrin saturation; 41 had blood lead levels greater than 25 micrograms/dl which is the current definition of elevated blood lead levels. Two children (2 per cent) were in Class IV, 17 (15 per cent) and 16 (14 per cent) were in Class II and Class III, respectively. There was a significant correlation between EP and PbB (r = 0.686; P = less than 0.001). Of 72 children with elevated EP and normal PbB, 32 were anaemic (Hb less than 11 g/dl) and 20 had iron deficiency. The role of tribal practices using lead contaminated preparations and their contribution to elevated blood lead levels is discussed.

On geographical variations in the normal range of joint motion

Fifty Saudi Arabian men 30 to 40 years of age without present or previous history of injury or disease related to the lower extremities were randomly selected for measurement of the range of motion in the basic planes of hip, knee, and ankle joint. The results were compared to a similar study from Scandinavia. There was a highly significant difference in external rotation of the hip, flexion of the knee, and dorsiflexion of the ankle. Cultural differences in the activities of daily life are suggested to explain the differences in the range of motion.

Evaluation of febrile patients in Port Sudan, Sudan: isolation of dengue virus

One hundred consecutive patients admitted to the Port Sudan Hospital with a temperature greater than or equal to 100 degrees F were evaluated. Enteric fever was diagnosed in 19 patients and malaria in 13. Virologic studies identified 21 cases of dengue infection. One dengue 1 and 17 dengue 2 infections were diagnosed by viral isolation. Three untyped dengue infections were identified serologically. The clinical presentation and course of patients infected with dengue virus were most consistent with classic dengue fever. There was no evidence of hemorrhagic phenomena or shock in any of the dengue-infected patients. Both dengue 1 and 2 must be considered causes of acute fever in East Africa.

[Severe postpartum hemorrhage]

The authors report 95 cases of post-partum haemorrhage estimated at one litre or more seen in the Department of Obstetrics between 1979 and 1982 for 11 662 deliveries. Classical treatment combining artificial delivery or uterine manual evacuation-oxytocics led to the arrest of bleeding in 73 cases. Severe haemorrhage persisted in 22 cases, including 13 patients who were found to be suffering from a coagulopathy. Treatment of these severe forms is based upon: local haemostasis (in the presence of inertia, prostaglandins must be used before surgery) and correction of the coagulation disorder by substitution therapy providing the missing factors.