Doppler duplex color localization of osteoid osteomas

We present two cases of osteoid osteoma in adolescent boys. The lesions were located in the proximal metaphysis of the right tibia and left femoral diaphysis respectively. Doppler duplex color study demonstrated clearly the highly vascular nidus and its feeding artery in one case and only the feeding artery in the second. We believe these are the first descriptions of osteoid osteomas assessed with Doppler duplex color, which was also used as guidance for the percutaneous localization and biopsy.

Simple variant t(8;21) acute myeloid leukemias harbor insertions of the AML1 or ETO genes

We report on the molecular characterization of two acute myeloid leukemias (AML), one AML-M1 (patient 1) and one AML-M2 (patient 2) with t(8;21)(p21;q22) and t(8;20)(q22;p13), respectively, at diagnosis. The locations of the breakpoints, 21q22 in patient 1 and 8q22 in patient 2, prompted us to search for a cryptic t(8;21)(q22;q22) and involvement of the AML1 and ETO genes. Dual-color fluorescence in situ hybridization (FISH) using whole chromosome painting probes for chromosomes 8, 20, and 21 confirmed the conventional cytogenetic karyotypes. However, dual-color FISH using appropriate ETO and AML1 probes disclosed an insertion of AML1 into 8q22 on the derivative chromosome 8 in patient 1 and of ETO into 21q22 on one chromosome 21 in patient 2, leading to AML1-ETO fusion signals. Both cases expressed an AML1-ETO transcript, shown by reverse transcriptase polymerase chain reaction and cDNA sequencing. Creation of functional AML1-ETO fusion genes in these two simple variant t(8;21) probably occurred through complex mechanisms, combining translocation and insertion of chromosomal segments.

Contribution of cosmic ray heavy ions to the radiation hazard in manned space flights

Primary cosmic radiation arriving near the Earth may be classified into two general categories: the gamma component and the hadronic component. The hadronic component contains mainly protons, a small amount of alpha particles and a smaller amount of heavier charged nuclei (ions). Although the fluxes of these heavier ions are very small in comparison to those of protons, they are able to originate a huge linear energy transfer (LET). This work studies the contribution of heavy ions from cosmic rays to the radiation hazard to which the crew of a manned long duration space flight might be exposed. The geometry of the energy deposition by a heavy ion is studied, and it is found that energies of the order of up to 10(23) J kg-1 are deposited.

Prognostic factors in supraglottic laryngeal carcinoma

We carried out a retrospective study of patients with supraglottic carcinomas who were treated surgically at the Marques de Valdecilla Hospital (Santander, Spain) between 1978 and 1987 and who were followed up for at least 5 years. The Kaplan-Meier survival curves were calculated for 24 clinical, histologic, and morphometric parameters. Multivariate analysis was then performed by means of the Cox regression model. In the univariate analysis, survival was related to presence of capsule rupture of the involved lymph nodes (p = 0.00001), number of metastatic lymph nodes (p = 0.0002), postoperative TNM stage (p = 0.004), grade of cell differentiation (p = 0.001), presence of intratumoral necrosis (p = 0.01), and type of invasion (p = 0.04). The nuclear area did not have an influence on survival. Only the presence or absence of capsule rupture of the metastatic lymph nodes and the grade of cell differentiation were included in the final Cox model and proved to be parameters with independent prognostic significance.

In vitro response to all-trans retinoic acid of acute promyelocytic leukemias with nonreciprocal PML/RARA or RARA/PML fusion genes

Acute promyelocytic leukemia (APL) is characterized by the t(15;17) cytogenetic abnormality leading to the expression of two fusion genes, PML/RARA and RARA/PML, and by its sensitivity to all-trans retinoic acid (ATRA) differentiating treatment. Rare APL cases lacking the t(15;17) have been described. We have previously reported two cases presenting with submicroscopic insertions of RARA or PML into chromosome 15 or 17, respectively. These insertions lead to the formation of potentially functional, nonreciprocal, PML/RARA or RARA/PML fusion genes, providing the unique opportunity to investigate in a human noncell-line model the respective role of PML/RARA or RARA/PML in retinoid signaling. Here, we report the in vitro response to ATRA of these two cases as well as of a third case presenting with submicroscopic insertion (15;17) and expressing exclusively PML/RARA, by morphological, functional, and immunological assays. The two cases expressing PML/RARA presented with an immunostaining pattern typical of APL and a positive response to ATRA, whereas the APL case expressing only a RARA/PML fusion transcript exhibited an immunostaining pattern typical of non-APL cells, and was resistant to ATRA. Our results confirm that sensitivity to ATRA requires expression of PML/RARA and strongly correlates with immunostaining, and demonstrate that expression of RARA/PML alone is sufficient for a cytological APL phenotype, but does not confer sensitivity to ATRA.

Effects of radiation on endothelial function

PURPOSE

The response of endothelium to ionizing radiation was studied.

METHODS AND MATERIALS

The abdominal aorta in different experimental groups of rats was irradiated, and the response of arterial rings from the irradiated segments to norepinephrine, acetylcholine (ACh), and nitroglycerin (NTG) was studied. Nonirradiated thoracic segments in the same experimental animals were used as as a control for comparisons. Two age-matched nonirradiated control groups were also studied.

RESULTS

A poor endothelium-dependent vasodilator response was obtained with ACh in the irradiated rings and also in those not directly irradiated; the endothelium-independent vasodilator response to NTG was preserved during the first 3 days after irradiation. By 6 months, both the endothelium-dependent response and endothelium-independent response were impaired.

CONCLUSIONS

Alterations in nitric oxide synthesis and/or release by the endothelium were observed during the early phase of radiation in irradiated and nonirradiated segments. In the delayed phase of radiation, endothelium-independent muscular relaxation was also affected.

Prevention of rotavirus diarrhoea in foals by parenteral vaccination of the mares: field trial

Many countries have reported rotavirus diarrhoea in foals. In Argentina it causes important economic losses to the horse industry. In this work we present the results obtained using an experimental vaccine in a farm with enzootic infection of rotavirus. A hundred mares were vaccinated 60 and 30 days before foaling with inactivated rotavirus SA11 (G3P2), H2 (G3P12), Lincoln (G6P1), with aluminum hydroxide as adjuvant; 65 mares were included in the unvaccinated, control group. To evaluate the vaccine, morbidity, duration of the diarrhoea and rotavirus shedding were recorded. Antibody levels were established in serum, colostrum and milk of the vaccinated mares, and also in serum from the foals. In foals from vaccinated mares the morbidity was 30%, clinical signs were observed during 1.8 days, and rotavirus shedding was not detected. In the control group the morbidity reached 80%, the clinical signs lasted 7.3 days and rotavirus shedding was detected in 80% of the diarrhoeic foals. At foaling the serum antibody levels were 15 times higher with a mean neutralizing titre (NT) of 3.5 logs than before vaccination (2.4 logs), in colostrum 5.00 logs, and in milk at 90 days post partum 1.7 logs. In foals from vaccinated mares the level of neutralizing antibodies was 3.8 logs at 48 days of age, going down to 2.2 logs at 90 days of age. Immunization of the pregnant mare would be a good method for preventing diarrhoea in foals.

[Use of improved magnetic resonance tomography in vascular surgery with reference to efficiency and economy]

The technique of Gadolinium-enhanced MR-angiography has become much better over the past year. The quality of the method is equal to conventional angiography. The advantages of MRA in comparison to conventional angiography today are: less strenuous for the patient, faster, CT or ERCP can be saved, MRA can be more economic.

Askin tumor and acute myeloid leukemia in a patient with constitutional partial Y disomy

We report the case of a young adult male carrying a constitutional unbalanced t(Y;13)(q11-12;p13) leading to a partial Y disomy, and presenting successively, in a 39-month interval, with an Askin tumor and a t(8;21) acute myeloid leukemia. The origin of the two neoplasias in this patient is discussed.

Evaluation of the influence of supplementing the diet with mannose or palm kernel meal on Salmonella colonisation in poultry

1. The dietary inclusion of 15 and 25 g/kg mannose was associated with a reduction in the numbers of Salmonella enteritidis (PT4) in the caecal contents of chicks challenged by the food. The same benefit was not recorded for S. infantis, possibly because this strain, unlike S. enteritidis PT4, lacked mannose-sensitive fimbriae. 2. The addition of 25 g/kg palm kernel meal (PKM), but not 20 g/kg desiccated coconut, to the food reduced the degree of salmonella colonisation in the intestinal tract of broiler chicks given diets contaminated with S. kedougou or S. enteritidis from the day of their arrival from the hatchery. 3. The beneficial effect of PKM was also demonstrated at an inclusion rate of 5 g/kg and was similar for preparations with a particle size of either < 150 microns or < 300 microns. 4. Day-old birds challenged orally with S. enteritidis and given food supplemented with 25 g/kg PKM, became clear of infection by 3 weeks of age while birds given unsupplemented food remained infected. 5. These preliminary results suggest that the inclusion of PKM, which contains inter alia, oligosaccharides containing mannose, in the diet of chicks may reduce the extent to which the intestine is contaminated with salmonellas.

The influence of diet on the mucin carbohydrates in the chick intestinal tract

The presence of nutrients in the intestinal lumen is a major factor influencing bacterial colonization in poultry. This study was conducted to investigate the effects of poultry feed on viscosity of intestinal contents and on mucin carbohydrates by comparing jejunal supernatants and the histochemical composition of goblet cells in chicks reared to 5 weeks of age on either a conventional maize-based diet or a wheat-based diet or a wheat diet supplemented with 0.1% xylanase. Regional differences in the distribution of the neutral, carboxylated and sulphated mucins were demonstrated using conventional histochemical techniques, while a panel of lectins was used to study alterations in glycoconjugate synthesis of mucins in chicks fed different diets. 1) Feeding a diet supplemented with xylanase lowered the viscosity but increased the amount of neutral, carboxylated and sulphated mucins in the jejunum. 2) In chicks fed a maize-based diet, neutral mucins increased in the surface and upper crypt goblet cells of the small and large intestines but decreased in the caecum. 3) Feeding a diet supplemented with xylanase modified crypt-surface glycosylation of N-acetylglucosamine residues and resulted in loss of sialic acid residues in the small and large intestines. These results indicate that the constituents of poultry feed, in particular the consumption of a diet supplemented with xylanase, lead to changes in intestinal viscosity and mucin composition which are associated with alterations in the goblet cell glycoconjugates of the chick intestinal tract.

Psychiatric perspective of pediatric human immunodeficiency virus infection

BACKGROUND

Infection due to human immunodeficiency virus (HIV) has become a chronic disease of childhood, with increasing rates among adolescents and longer survival of those infected. This illness and its victims present a continuing challenge to the medical community.

METHODS

We used computerized literature searches (MEDLINE and AIDSline) to identify research and review papers from medical, psychiatric, and psychology journals; we obtained statistics directly from the Centers for Disease Control and Prevention, National AIDS Clearinghouse.

RESULTS

This overview of the topic includes epidemiology, transmission, diagnosis, psychiatric and neuropsychiatric manifestations, intervention, and the impact on families, caretakers, and health care workers.

CONCLUSIONS

To psychiatrists, this disease presents the epitome of the biopsychosocial model, encompassing the biology of a viral disease with psychiatric manifestations, complicated by the societal place in which it has become entrenched.

Urovirulence determinants in Escherichia coli strains causing prostatitis

To define the urovirulence properties of Escherichia coli strains producing prostatitis, E. coli strains isolated from men with acute (7 strains) or chronic (23) prostatitis were compared with E. coli isolates from women with pyelonephritis (30), acute cystitis (60), or complicated urinary tract infection (UTI; 30). Strains from prostatitis patients were significantly more likely to express hemolysin than were strains causing complicated UTI (73% vs. 43%; P = .02) and more often demonstrated hybridization with the cytotoxic necrotizing factor-1 (CNF-1) probe (63%) than did strains from women (44%-48%). P fimbrial expression was highest among pyelonephritis (73%) and prostatitis strains (53%) and lowest among E. coli from women with complicated UTI (23%) and cystitis (30%; P < .05, prostatitis strains vs. either of the latter 2 groups). Results suggest that E. coli strains producing prostatitis generally possess urovirulence profiles similar to those of strains from women with acute uncomplicated pyelonephritis and that hemolysin and CNF-1 are especially prevalent in prostatitis strains.

Source abundances of ultra heavy elements derived from UHCRE measurements

A total of 205 tracks have been located, measured, and positively identified as originating from Ultra Heavy (Z > or = 65) cosmic ray ions with energies over 2 GeV/amu in the 10 UHCRE plastic track detector (mainly Lexan polycarbonate) stacks studied by our Group. About 40 values of reduced etch rate S have been obtained along each of these tracks. A method based on determining the gradient of S, together with calibration in accelerators, is used to determine the charge of each ion resulting in one of such tracks to obtain the charge spectrum of the recorded Ultra Heavy ions. The abundance ratio of ions with 87 < or = Z < or = 100 to those with 74 < or = Z < or = 86 as well as that of ions with 81 < or = Z < or = 86 to those with 74 < or = Z < or = 80 are calculated at 0.016 and 0.32, respectively, which agree with the values obtained from measurements in the HEAO-3 and Ariel-6 experiments. The abundance ratio of ions with 70 < or = Z < or = 73 to those with 74 < or = Z < or = 86 is also calculated, but its value (0.074) did not seem to be significant because of our detectors' low registration efficiency in the charge range 70 < or = Z < or = 73. A computer program developed by our Group, based on the Leaky Box cosmic ray propagation model, has been used to determine the source abundances of cosmic ray nuclei with Z > or = 65 inferred from the abundances measured in the UHCRE. It appeared that r-process synthesized elements were overabundant compared to the Solar System abundances, as predicted by other authors.

A new stress protein: synthesis of Schizosaccharomyces pombe UDP--Glc:glycoprotein glucosyltransferase mRNA is induced by stress conditions but the enzyme is not essential for cell viability

We have identified and begun the characterization of the gene encoding UDP-Glc:glycoprotein glucosyltransferase in Schizosaccharomyces pombe. This gene, here designated gpt1, codes for a polypeptide having a signal peptide of 18 amino acids followed by 1429 amino acids with no transmembrane domain, as expected for a soluble protein of the endoplasmic reticulum (ER). The C-terminal tetrapeptide PDEL most probably corresponds to a novel ER retention signal in this fission yeast. Synthesis of the corresponding mRNA was induced 2- to 9-fold by conditions known to affect glycoprotein folding in the ER (e.g. heat shock, culture in the presence of a Ca2+ionophore, 2-mercaptoethanol or inhibitors of protein N-glycosylation such as tunicamycin or 2-deoxyglucose). This is the first evidence obtained in vivo that supports the proposed involvement of the enzyme in the quality control of glycoprotein folding in the ER. Thus far, the said involvement was inferred solely from the ability of the enzyme to glucosylate misfolded but not native glycoproteins in cell-free assays. The gpt1 gene was disrupted and gpt1- cells were found to be viable. Moreover, no significant differences in the growth rate patterns at 18, 28 or 39 degrees C or in cell morphology between gpt1+ and gpt1- cells were observed, although they differed slightly in size.

Prevalence of abnormal levels of serum tumour markers in elderly people

The study was conducted to evaluate the prevalence of abnormal levels of several serum tumour markers in an institutionalized elderly population. Serum tumour markers assay of carcinoembryonic antigen (CEA), the carbohydrate antigens CA 19-9, CA 72-4 and CA 15-3 (Enzymun-test, Boehringer Mannheim GmbH Diagnostic), alpha-fetoprotein (AFP) and prostate specific antigen (PSA) (Abbot Diagnostic Division) were performed in 228 unselected, institutionalized elderly subjects, whose mean age (SD) was 82.4 (5. 79) range (66-99 years). Patients with acute or neoplastic diseases were excluded from the study. The serum markers were also measured in 52 healthy young adults (controls). Using the established threshold values, 92 subjects (40%) were found to have at least one elevated marker. PSA was elevated in 33%, CA 19-9 in 16%, CEA in 11. 5%, CA 15-3 in 11%, CA 72-4 in 8% and AFP in 3%. We found a significant difference in the serum levels between the two groups for CEA, CA 19-9. CA 15-3, and PSA (p < 0.0001). Healthy aged people appear to have an elevated prevalence of elevated levels of serum tumour markers. The results suggest that apart from PSA, elevated antigen levels in elderly subjects are related to the ageing process itself rather than to occult pathology.

Liver transplantation for fulminant hepatic failure: importance of renal failure

One hundred eighty-one consecutive patients with fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality and morbidity following orthotopic liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19-65 years) underwent OLTx. FHF was due to idiosyncratic drug reaction (n = 4), paracetamol overdose (n = 3), seronegative hepatitis (n = 17), hepatitis B (n = 1), veno-occlusive disease (n = 1), and Wilson's disease (n = 1). Renal failure was present in 14 patients, 7 of whom died (whereas there was 100% survival in patients without renal failure). Pretransplant renal failure was associated with prolonged mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged intensive care stay (17 days vs 8 days, P = 0.01) and prolonged hospital stay (27 vs 21 days, P = NS). Pretransplant renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic liver disease (67% vs 88% 1-year survival in Birmingham). For patients with FHF undergoing transplantation, pretransplant renal failure strongly predicts poor outcome with significantly greater consumption of resources.

Rotavirus subunit vaccines

We evaluated rotavirus subunit vaccines for use in humans and animals. Insect cells were co-infected with combinations of individual baculovirus recombinants expressing human, bovine or simian rotavirus VP2, VP4, VP6 or VP7 to produce virus-like particles (VLPs). To determine whether immunization with VLPs could induce active protective immunity, VLPs were administered parenterally to rabbits, and the immune response and protection from rabbit ALA rotavirus challenge were evaluated. Complete or partial protection was attained, showing that parenteral immunization with VLPs induces active protective immunity. We also examined whether heterotypic immune responses could be induced with a limited number of broadly reactive VP7 proteins or with chimeric particles (multiple VP7 types on individual particles). The feasibility of this approach was determined by immunizing mice with VLPs containing a G3 VP7 or G1 VP7 and chimeric G1/G3 VLPs. Broadly reactive neutralizing antibody was induced by the G1 VLPs. VLPs also have been successfully used to boost lactogenic (colostral and milk) immunity in dairy cows. Taken together, these results show that VLPs can be effective immunogens in rabbits, mice and dairy cattle when administered parenterally, a limited number of VLPs may be sufficient to produce a broadly protective vaccine, and G3 VLPs may serve as an effective subunit vaccine for use in bovines.

Clinical study of the effects of latissimus dorsi muscle flap stimulation after cardiomyoplasty

BACKGROUND

Beneficial hemodynamic effects after dynamic cardiomyoplasty have been inconsistently demonstrated, and the effects seen may be due to the wrap itself, to flap stimulation, or both. The aim of this study was to determine whether flap stimulation per se acts as a systolic active process after cardiomyoplasty.

METHODS AND RESULTS

Catheterizations were performed in 13 patients 14.4 +/- 7 months after cardiomyoplasty. New York Heart Association functional class decreased from 3.3 to 2.1 after the procedure (P = .0005). Hemodynamic evaluations were first performed with the stimulator on in the 2:1 mode and then after the stimulator had been off for at least 24 hours. Left ventricular (LV) ejection fraction increased from 25.1 +/- 6% before surgery to 28.2 +/- 6.7% with the stimulator on after cardiomyoplasty (P = .04). When stimulation was stopped, there was no change (P > .05) in indexes of systolic or diastolic LV function (peak systolic LV pressure, LV ejection fraction, peak positive dP/dt, peak negative dP/dt, or tau). Pulmonary capillary wedge pressure and cardiac index were unchanged when stimulated and nonstimulated settings were compared (P > .05). However, a remarkable heterogeneity of individual responses was observed. Ejection fraction and cardiac index decreased with the stimulator off in 3 patients, but peak positive dP/dt decreased in 6 patients; diastolic function deteriorated in 2 patients, but a slight improvement was noted in 3 patients. Cardiothoracic ratio, echocardiographic LV end-diastolic dimension, and fractional shortening remained unchanged between immediate (< 1 month) and long-term (36.7 +/- 25.9 months) postoperative evaluations.

CONCLUSIONS

In the majority of our patients, there was no short-term hemodynamic benefit of flap stimulation; therefore, we conclude that the efficacy of cardiomyoplasty may be a consequence of a passive "girdling effect," which limits the progression of ventricular enlargement and further deterioration of ejection fraction.

Laparoscopic procedure for suspected appendicitis. A prospective study in 283 consecutive patients

Between September 1990 and December 1993, 283 consecutive patients were admitted with clinical symptoms of acute appendicitis. These patients underwent primary laparoscopic approach so that an appendicectomy could be performed by this method. In 49 cases (17.3%), primary laparoscopic examination corrected the preoperative diagnosis and the appendix was left in situ. Appendicectomy was performed in 234 cases (149 women, 85 men) with a mean age of 30 years. Requirement for open surgery occurred in 29 cases. The main cause of unsuccessful procedures was inflammation due to local or generalized peritonitis. Median operative time for a successful procedure was 60 min (range, 25-160). Four postoperative complications (one related to laparoscopic procedure), one case of wound infection, and no mortality resulted. After laparoscopic appendicectomy, the median hospital stay was 3 days (range, 1-16). These results suggest that a laparoscopic approach for suspected appendicitis is reliable, allowing abdominal exploration and safe appendicectomy.

[Restenosis: physiopathology, treatments and prevention]

Despite fifteen years of extensive research, we still do not know how to predict or prevent restenosis. Angioplasty induces lesions in the intima, media and sometimes adventitia, resulting in a cicatricial process comprising proliferation and migration of smooth muscle cells towards the intima and secretion of extracellular matrix, leading to the formation of a neointima. Since angioplasty is associated with the simultaneous development of neointimal hyperplasia and restenosis, a cause and a effect relationship has therefore been proposed between neointimal hyperplasia and restenosis. All the restenosis prevention strategies based on inhibition of smooth muscle cell proliferation, which successfully limited restenosis in animal models have failed in man, due to the hazardous extrapolations from experimental models which are very different from the atheromatous lesions observed in man, rather than to the use of animal models in general. It is reasonable to wonder whether we have not selected the wrong target: is smooth muscle cell proliferation really responsible for restenosis? Experimental results supported by histological and ultrasonographic data in man, show that the cicatricial process which induces restenosis consists of constrictive remodelling, which decreases the perimeter of the external elastic lamina and the lumen. The use of stents appears to be the primary strategy designed to limit restenosis and prevent constrictive remodelling in man, even if it stimulates neointimal hyperplasia. Progress in the understanding of the mechanisms of postangioplasty remodelling open new perspectives in the prevention of restenosis.

Therapeutic effect of early thymic irradiation in (NZB x NZW)F1 mice, associated with a selective decrease in the levels of IgG3 and gp70-anti-gp70 immune complexes

The lupus-prone (NZB x NZW)F1 female mice (NZB/W) develop an autoimmune disease characterized by production of autoAb and fatal glomerulonephritis. Since it has been previously shown that total lymphoid irradiation has a beneficial effect in this model, we have analyzed whether early thymic irradiation (ETI) could improve the course of the lupus-like syndrome in these mice. NZB/W mice received thymic irradiation (4500 rads) beginning at 10 weeks of age, prior to the onset of autoimmune manifestations. Then, they were evaluated for survival, renal histology, and serological markers of autoimmunity, in comparison to nonirradiated NZB/W females. The treatment with ETI improved nephritis and survival in NZB/W mice: 50% mortality was observed at 12 months in irradiated mice and at 9 months in untreated mice. This improved survival could not be attributed to a reduction in the titers of anti-dsDNA Ab nor in the levels of total immune complexes which were essentially identical in both groups. By contrast, this improvement was related to a selective normalization in the serum levels of IgG3 and gp70-anti-gp70 immune complexes (gp70IC) in ETI NZB/W female mice as compared to that seen in nonirradiated NZB/W females. These data show the therapeutical effect of ETI and support the pathogenic role of IgG3 and gp70IC in the development of glomerulonephritis in NZB/W mice.

Role of laparoscopic surgery in the management of acute abdomen in the HIV-positive patients

Emergency open laparotomy in patients infected with HIV is accompanied by high mortality. The authors investigated the potential role of a laparoscopic approach for the management of acute abdomen in such patients. Prospectively, 10 patients with HIV disease (9 with AIDS) underwent laparoscopy for acute abdomen. The treatment was exclusively laparoscopic in 6 patients. A conversion to laparotomy was necessary in 4 patients but through guided elective incision in 3 of them. The postoperative course was uneventful in all patients but 1, who died. We advocate a laparoscopic approach, when feasible, as an initial step in the management of acute abdomen in HIV-positive patients.

Effects of methylphenidate in HIV-related depression: a comparative trial with desipramine

This report is a randomized, double-blind, comparative trial of desipramine with the psychomotor stimulant methylphenidate. Twenty HIV antibody-positive patients with depressive symptoms were randomly assigned to either drug. After individual dose titration, the mean daily dose of desipramine was 150 mg. and methylphenidate 30 mg. daily. The differences in responses between desipramine and methylphenidate were not statistically significant on various measures of depression. The antidepressant effect of methylphenidate did not occur any faster than that of desipramine. Both significantly reduced depressive and anxious symptomatology over the blinded portion of the treatments. Thus, methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy. The dopaminergic effects of methylphenidate are likely to mediate its antidepressant effects.

The management of depression and anxiety in the elderly

The most common psychiatric disorders in later life, with the exception of dementia, are depression and anxiety. Often underdiagnosed or simply accepted with resignation as an inevitable part of aging or as an unavoidable complication of other constitutional illnesses, these disorders contribute to excess disability in older patients and further compromise their quality of life. This report discusses depression and anxiety in the growing elderly population--its prevalence, detection methods, diagnostic considerations, and present interventions.

[Results of a prospective study of laparoscopic appendectomy]

Laparoscopic appendicectomy for acute appendicitis is being increasingly criticized, because of the possible complications, the technical effort required and the high costs. The results of the present prospective study performed between May 1992 and March 1994 on 222 appendectomies (110 conventional and 112 laparoscopic) are intended to serve as a tentative guide. The use of endoscopic stapling and cutting devices, as well as the observance of exclusion criteria make laparoscopic appendicectomy a safe operation. It can be employed routinely and shows certain advantages for the patient e.g. fewer disturbances of wound healing and shorter postoperative hospitalization. Although laparoscopic appendicectomy has brought us valuable experience, it is by no means the method of choice and for the time being, it is unlikely to replace conventional appendicectomy.

Epidemiological markers of Acinetobacter baumannii clinical isolates from a spinal cord injury unit

During a period of 28 months, 114 isolates of Acinetobacter baumannii obtained from urine samples of 57 patients, were recovered in a Spinal Cord Unit; an unusual increase in the number of A. baumannii isolates was observed between February 1991 and January 1992. Six different typing methods [biotyping, antimicrobial susceptibility, whole cell and cell-envelope protein analysis, plasmid analysis and chromosomal DNA analysis by pulsed-field gel electrophoresis (PFGE)] were used to study the isolates to establish any potential relationships among them. Chromosomal DNA analysis by digestion with ApaI and separation of the fragments by PFGE was the most powerful tool to determine the relatedness of isolates. The results suggest that the isolates from 1991 and 1992 may have originated from strains present in 1990 that subsequently acquired resistance to amikacin and tobramycin during the epidemic.

Human immunodeficiency virus and the substance abuser: public policy considerations

Until recently, the abuse of intravenous drugs was perceived as a problem of the United States, and the acquired immunodeficiency syndrome (AIDS) epidemic was seen mainly as a sexually transmitted disease that tended to affect homosexuals from industrialized nations. However, these perceptions are no longer valid. At present, the abuse of intravenous drugs constitutes the second most common cause of AIDS in the United States and in Europe. This trend has led to a review of the current strategies in the fight against infection with the human immunodeficiency virus (HIV). We analyzed the current epidemiologic trends regarding infection with HIV; we examined the behavioral manifestations of intravenous drug users, particularly from a sexual point of view; and finally, we reviewed the most relevant governmental public policy positions related to drug abuse, specially that focusing on "damage control."

Psychopharmacology in HIV spectrum disorders

The psychiatric complications of HIV spectrum disorders are common and diverse in nature. HIV itself undermines the individual's psychological functioning by attacking the CNS and further compromises the patient's psychosocial and coping capacity. Psychopharmacologic strategies are vastly underutilized in the management of these psychiatric complications but often must be innovative, given the complexities of medical management in most of these cases. Conventional and innovative psychopharmacologic interventions when used as part of an integrated comprehensive biopsychosocial approach are effective adjuvants that help patients achieve the greatest functional adaptation possible.

[Coronary angioplasty combining rotational atherectomy and balloon dilatation. Results in 67 complex stenoses]

The treatment of complex coronary stenoses by conventional angioplasty is limited by a relatively low angiographic success rate, associated with a high risk of major complications. The role of new angioplasty techniques in the treatment of these lesions has not yet been determined. The aim of this prospective study was to evaluate the systematic association of rotational atherectomy (Rotablator) with balloon angioplasty on coronary stenoses characterised by at least 2 type B criteria of the ACC/AHA classification (type B2 lesions). The procedures was begun with rotational ablation with a medium-sized burr (50 to 70% of the reference diameter of the artery) and completed systematically by balloon angioplasty (balloon/artery ratio = 1), using the lowest possible inflation pressures for successful dilatation. This technique was used in 61 patients who had 67 coronary stenoses with a primary success rate (residual stenosis < 50% and no major complications) of 93.4% (57 patients). One emergency coronary bypass procedure was necessary and another patient developed transmural infarction on the 3rd day after the procedure. There were two technical failures (3.3%). The mean inflation pressure of the balloon was 4.1 +/- 1.2 atmospheres. There were no fatalities. During atherectomy, transient conduction defects were observed in 4 patients (6.6%): severe hypotension in 2 patients (3.3%) and complete spasm in 3 stenoses (4.5%). A significant increase in cardiac enzyme levels was observed in 4 patients (6.6%). The authors conclude that rotational atherectomy with a medium-sized burr, followed by systematic low pressure balloon dilatation allows treatment of certain complex coronary stenoses with a high primary success rate and few major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Coagulation, fibrinolytic and kallikrein systems in neonates with uncomplicated sepsis and septic shock

This study evaluates the contact system, coagulation inhibitors and fibrinolysis in 23 full-term newborns with sepsis (8 with septic shock). The results were compared with a group of 20 healthy newborns. Blood samples were obtained at the time of clinical diagnosis and 3 days after the antibiotic therapy was started. The results showed that: severe infection was associated with activation of the contact system, depletion of anticoagulant proteins and elevation of C4b-binding protein levels. There was a shift in protein S to the complexed inactive form, and the thrombin-antithrombin complexes increased. These changes occurred in parallel to both activation and inhibition of fibrinolysis. These changes were more pronounced in the septic shock patients than in nonshock neonates. After therapy, this procoagulant state decreased among survivor patients while in those who died, the abnormalities in coagulation did not improve. Our study suggests that neonatal sepsis induces a hypercoagulable state that persists in nonsurvivor neonates despite a correct treatment.

Serum TNF levels in neonatal sepsis and septic shock

Tumor necrosis factor (TNF-alpha) has been implicated as a principal mediator in the pathogenesis of septic shock. TNF-alpha was measured by immunoradiometric assay in serum samples from 23 full-term infants with sepsis (15 with severe infection and 8 with septic shock) and in 20 healthy full-term newborns. Serum TNF-alpha levels were significantly higher in the group with sepsis, at the time of admission to the neonatal intensive care unit, than in the healthy neonates. The highest TNF levels were found in those newborns with septic shock, particularly in those who died. Although the method is far too slow for any clinical routine work, our results suggest that the presence of elevated serum TNF-alpha levels could be considered a sensitive and specific test for predicting septic shock and its clinical outcome.

Balloon mitral valvotomy by using the Twin-AT catheter: immediate results and complications in 110 patients

Balloon mitral valvotomy, using a new Twin AT catheter (two balloons attached side by side over one shaft), was performed in 110 consecutive cases. The age of the patients ranged from 19-78 yr (mean 46 +/- 15). From a total of 94 females and 16 males, 23 of the patients (22%) had mitral valve calcification, 47 patients (46%) had atrial fibrillation, and 39 patients (37%) had mitral regurgitation (< +2). Twenty patients (18%) presented with restenosis following surgical commissurotomy. Total catheterization time was 101 +/- 26 min and the duration of the valvotomy procedure was 37 +/- 21 min in these cases. For the entire population, there was a significant reduction in mitral valve gradient (15 +/- 6 to 4.8 +/- 2.6 mmHg, p < .001), an increase in mitral valve area (MVA) (1.1 +/- 0.3 to 2.35 +/- 0.7 cm2, p < .001), and a decrease in mean pulmonary arterial pressure (31 +/- 12 to 26 +/- 11, p < .002) after the balloon mitral valvotomy. Sixteen patients (14%) developed significant left to right shunt, and in 22 patients (20%) mitral regurgitation increased moderately but without resulting in emergency valve replacement. There was one incidence of embolic episode and one pericardial tamponade. Adequate hemodynamic results (MVA > 1.5 cm2 and % increase in MVA > or = 50%) without major complications were obtained in 99 cases. In 9 patients with severely diseased valve (2 previous commissurotomy, one restenosis after balloon valvotomy), or small left ventricular cavity, insufficient results were obtained by the Twin-AT catheter.(ABSTRACT TRUNCATED AT 250 WORDS)

Depression and its treatment in cardiac patients

In general medical-surgical hospital services, depression is the most common reason for seeking psychiatric consultation in behalf of patients with cardiovascular disease. The nontreatment of depression or the use of a psychotropic agent mismatched to a patient's particular cardiac condition or individual sensitivities has considerable negative impact. Therefore, a systematic approach should be used in the differential diagnosis of depression in cardiac patients, to eliminate other psychiatric disorders and to assure the correct treatment strategy. Physicians can develop an appropriate rationale for the use of a psychopharmacologic regimen in cardiovascular settings through recognition of the diagnostic criteria for depression and through comprehensive knowledge of the pharmacologic properties and possible cardiovascular effects of these vital treatments. Standard and alternative pharmacotherapies for depression in cardiac patients are reviewed.

The use of molindone in the treatment of psychotic and delirious patients infected with the human immunodeficiency virus. Case reports

Four patients with HIV infection and psychosis from various etiologies, refractory to standard treatments, and suffering from severe extrapyramidal symptoms (EPS), had a marked beneficial response to molindone. There was significant control of neuropsychiatric dysfunction without major adverse side effects. The results suggest that further evaluation is warranted of the use of molindone in treating severely ill, psychotic, or delirious HIV-infected patients.

Pseudomonas vesicularis bacteraemia

A case of repeated episodes of Pseudomonas vesicularis bacteraemia, in a 54-year-old woman with a past history including systemic lupus erythematosus and chronic active autoimmune hepatitis is reported. She was treated with tobramycin and ceftazidime but bacteraemia persisted until surgical resection of the infected tissue was performed.

Enzyme immunoassay for Q fever: comparison with complement fixation and immunofluorescence tests and dot immunoblotting

Enzyme-linked immunosorbent assays (ELISA) for the detection of specific immunoglobulin G (IgG) and IgM antibodies were developed by using purified Coxiella burnetii cells. Variables, including type of microtiter plate, blocking agent, incubation conditions, antigen stability, and substrate type, were examined to achieve optimal ELISA performance. The reliabilities of the assay systems were compared with those of complement fixation (CF) and enhanced immunofluorescence (EIF) tests with 600 human serum samples from defined clinical cases of Q fever, routine samples, and serum specimens from farmers. ELISA and EIF test results agreed in all cases. Dot immunoblotting was also used to test some of these sera and gave a rapid, qualitative result, which agreed with ELISA and EIF test results in all cases. No instances were found in which both ELISA and EIF test results were negative and the CF test results was positive. However approximately 5% of the sera were positive by ELISA and the EIF test while the CF test result was either negative or unreadable because of serum anticomplementary activity. We conclude that dot immunoblotting is a useful screening test, whereas ELISA and the EIF test are both rapid and sensitive tests when used for the serodiagnosis of Q fever and should be considered to be replacements for the CF test.