Antibiotic susceptibility of group A streptococci: a 6-year follow-up study

The susceptibility patterns of group A streptococci over the last 6 years in our hospital were determined. Since our last study, carried out in 1987, all isolates have remained very susceptible in vitro to penicillin and all of the other beta-lactam agents tested. We observed resistance to erythromycin, clindamycin, tetracycline, and ofloxacin. The prevalence of erythromycin-resistant group A streptococci did not change appreciably throughout the study period.

Effects of meso-2,3-dimercaptosuccinic acid (DMSA) on methyl mercury-induced teratogenesis in mice

Methyl mercury has been reported to be embryotoxic and teratogenic in numerous systems such as fish, birds, and mammals. meso-2,3-Dimercaptosuccinic acid (DMSA) has been useful for prevention and treatment of mercury poisoning. In this study, the protective activity of DMSA on methyl mercury-induced embryo/fetotoxicity was evaluated in mice. A series of four DMSA injections was administered subcutaneously to pregnant Swiss mice immediately after oral administration of 25 mg/kg methyl mercury chloride (MMC) given on Day 10 of gestation, and at 24, 48, and 72 hr thereafter. DMSA effectiveness was tested at 0, 80, 160, and 320 mg/kg/day. Oral administration of MMC resulted in a high rate of resorptions and dead fetuses as well as a reduced fetal body weight. Moreover, cleft palate (46.9%) and various developmental variations were found in the positive control group. Treatment with DMSA at 160 and 320 mg/kg/day significantly decreased the embryolethality of MMC, whereas at 320 mg DMSA/kg/day the incidence of skeletal anomalies and cleft palate (2.8%) was also significantly reduced. According to these results, DMSA offers encouragement with regard to its therapeutic potential for pregnant women exposed to methyl mercury.

Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures

To determine the effects of limb positioning on Baumann's angle, we made a controlled radiographic study of a 6-year-old cadaver upper extremity specimen. Radiographic measurement of Baumann's angle was obtained at 10 degrees increments of humeral rotation from 40 degrees of internal rotation to 40 degrees of external rotation. These measurements were obtained with the humerus parallel to the x-ray cassette and with the humerus flexed 30 degrees from the cassette. Measurement of Baumann's angle with radiographs obtained with the humerus parallel to the x-ray cassette was associated with less variation in the measured angle (6 degrees of change for every 10 degrees of rotation). The relevance of these findings in management of supracondylar fractures is discussed.

Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with and without cement

Eleven patients who had a femoral component inserted with cement and twenty-three who had a femoral component inserted without cement were studied prospectively for changes in the pulmonary shunt associated with total hip replacement. The levels of oxygen in the arterial blood and the platelet counts were measured preoperatively and each morning for three days after the arthroplasty. Levels of oxygen in the arterial blood were determined intraoperatively, once before and once after the femoral component was inserted. Intraoperative shunt values increased 28 per cent when a femoral component was inserted with cement (p < 0.05), but they did not change when cement was not used. The average postoperative shunt values were higher than the average preoperative shunt values for both groups of patients, but only the values on the second postoperative day after a procedure with cement were significantly higher (p < 0.05). The ability of the patient to tolerate an increase in pulmonary shunt should be assessed when the femoral component is to be cemented during total hip replacement.

Effect of various dietary constituents on gastrointestinal absorption of aluminum from drinking water and diet

The influence of some frequent dietary constituents on gastrointestinal absorption of aluminum from drinking water and diet was investigated in mice. Eight groups of male mice received lactic (57.6 mg/kg/day), tartaric (96 mg/kg/day), gluconic (125.4 mg/kg/day), malic (85.8 mg/kg/day), succinic (75.6 mg/kg/day), ascorbic (112.6 mg/kg/day), citric (124 mg/kg/day), and oxalic (80.6 mg/kg/day) acids in the drinking water for one month. At the end of this period, animals were killed and aluminum concentrations in liver, spleen, kidney, brain, and bone were determined. All the dietary constituents significantly increased the aluminum levels in bone, whereas brain aluminum concentrations were also raised by the intake of lactic, gluconic, malic, citric, and oxalic acids. The levels of aluminum found in spleen were significantly increased by gluconic and ascorbic acids, whereas gluconic and oxalic acids also raised the concentrations of aluminum found in kidneys. Because of the wide presence and consumption of the above dietary constituents, in order to prevent aluminum accumulation and toxicity we suggest a drastic limitation of human exposure to aluminum.

Use of exposure databases for status and trends analysis

Exposure databases are useful for monitoring status and trends in environmental health. However, other supporting data are usually needed to infer human exposure or internal dose. Program planning and evaluation, environmental health surveillance, epidemiologic research, and contributions to international efforts are four major purposes for monitoring environmental exposure status and trends. Although databases play an important role in monitoring human exposure, certain methodological problems need to be overcome. The work group developed six criteria for meeting information needs for human exposure assessment. Areas that need attention are (1) specification of location, (2) specification of facility and chemical identifiers, (3) documentation of special populations at risk, (4) provision of early warning of new problems, (5) monitoring changes over time, and (6) enhancement of documentation. We tested these criteria by examining six available databases that might be used for monitoring exposure to contaminants in drinking water. Available data fell short of information needs. We drew four conclusions and offered several recommendations for each. First, available data systems lack adequate measures of human exposure. Second, data for monitoring exposures for many important population subgroups and environmental settings are inadequate. Third, an "early warning" system that monitors human exposures is needed. Fourth, designers of data-collection systems should consider the needs of users who monitor status and trends of human exposure.

Occupational risk factors for multiple myeloma among Danish men

A large population-based case-control study evaluated occupational exposures in 1,098 Danish males diagnosed with multiple myeloma from 1970 to 1984 and in 4,169 age- and gender-matched controls alive at the time of case-diagnosis. Industrial histories were obtained from the Supplementary Pension Fund which, since 1964, has recorded employments of adult Danes; occupation came from subjects' most recent tax records. Four industrial hygienists created a job-exposure matrix for 47 substances based on 15,000 unique industry/occupation combinations in subjects' histories. Risk of myeloma was significantly elevated among road and railroad workers, precision metalworkers, and workers in the transportation and communication industries. Risk increased significantly with duration of employment in: production of synthetic yarns, plastic packaging, and miscellaneous chemical compounds; fabricating structural metal and stationary tanks; body factories; electrical plants; and retail sale of paint and wallpaper. Risks of myeloma were elevated, though statistically nonsignificantly, in all categories of exposure to gasoline and engine exhausts. Risks rose with likelihood and duration of exposure to phthalates, and were statistically significant and nearly fivefold with probable exposure to vinyl chloride for five or more years. After adjusting for multiple exposures and disregarding exposures within 10 years of diagnosis (or selection as a control), probable exposure to vinyl chloride was associated with increased risk of myeloma, which rose to fivefold with longer exposure. Associations with gasoline, engine exhausts, and phthalates persisted, but were inconsistent with duration and probability of exposure. Previously reported associations with agriculture were not confirmed by these data.

Expression of syndecan in transformed mouse keratinocytes

BACKGROUND

Malignant transformation is frequently associated with altered behavior of cells, a phenomenon that also suggests changes in cell-matrix interactions. We have studied expression of syndecan, a cell surface proteoglycan that binds extracellular matrix components and growth factors, in various chemically transformed mouse keratinocyte cell lines that differ in their morphology and tumorigenicity.

EXPERIMENTAL DESIGN

A monoclonal antibody, specific for mouse syndecan, and a cDNA clone for mouse syndecan, were used to detect syndecan in seven different keratinocyte cell lines. The glycosaminoglycan composition of syndecan was studied using differential digestions of heparan sulfate and chondroitin sulfate chains.

RESULTS

In general, the tumorigenic cells were found to express lower amounts of syndecan, both at protein and mRNA levels, than the nontumorigenic cells. The most tumorigenic cell line CarC revealed barely detectable syndecan expression. Also, molecular polymorphism of syndecan was observed, as three forms of syndecan with different molecular weights appeared on the surfaces of different keratinocytes. The highly tumorigenic cells, that expressed low amounts of syndecan, expressed syndecan with the largest molecular weight. The different molecular weights were shown to reflect an increased amount of both heparan and chondroitin sulfate chains attached to the core protein. An increased shedding of syndecan ectodomain from the membrane-associated domain was observed in cells that express high amounts of mutated Ha-ras p21.

CONCLUSIONS

The results suggest, that transformed epithelial cells can modulate the appearance of syndecan on the cell-surface by at least two ways: (a) by altering its glycosylation or (b) by increasing its shedding from the cell surface. These modulations, together with overall suppression of syndecan expression, could be associated with malignant transformation of keratinocytes.

Evaluation of ground ambulance, rotor-wing, and fixed-wing aircraft services

It is hoped that this article has offered insightful suggestions and criteria in choosing the most appropriate method to transport patients. Ground ambulances, rotor-wing, and fixed-wing aircraft each have advantages and disadvantages in particular circumstances. The advantages and disadvantages of any mode of transport must be considered to best meet the needs of the patient. In the twentieth century alone, great strides have been made in the field of emergency stabilization and transport. An efficient, well-trained ground ambulance program remains the backbone of prehospital and interhospital transport systems. Helicopters and fixed-wing transports must be integrated into the EMS system. One advantage of the helicopter and fixed-wing aircraft is rapid travel times when time is critical. As Hicks et al said, "early resuscitation and timely transfer of selected patients are critical factors in reducing morbidity and mortality." The future holds many possibilities for enhanced patient transport. Hospitals may be able to use tilt-rotor, vertical landing, fixed-wing aircraft to combine the advantages of helicopter and fixed-wing aircraft. After all, our primary goal is to get the right patient, with the right personnel, to the right place in the right amount of time.

Changes in the susceptibility of Bacteroides fragilis group organisms to various antimicrobial agents 1979-1989

The in vitro activity of metronidazole, chloramphenicol, clindamycin and 11 beta-lactam antibiotics against 135 clinical isolates of the Bacteroides fragilis group was compared. In addition, changes in the resistance patterns of members of the Bacteroides fragilis group isolated at the Hospital Universitario San Carlos in Madrid, Spain, between 1979 and 1989 were documented. The most active beta-lactam drugs were imipenem and beta-lactamase inhibitor combinations. In 1989, however, two strains were found to be resistant to imipenem and to all other beta-lactam agents tested. There was no emergence of resistance to metronidazole. Chloramphenicol was very effective: only one resistant strain was detected in 1979 and no chloramphenicol-resistant isolates were found during the rest of the study period. An outbreak of clindamycin resistance was noted in 1982, and the first cefoxitin resistant strains were recovered in 1985. The changing patterns of susceptibility of anaerobic bacteria to antimicrobial agents and the emergence of Bacteroides fragilis strains resistant to new beta-lactam agents suggest that periodic antimicrobial susceptibility tests should be performed in order to guide the selection of antimicrobial agents for therapy.

Administration of vanadyl sulfate by gavage does not normalize blood glucose levels in streptozotocin-induced diabetic rats

Vanadyl sulfate trihydrate was given by gavage to streptozotocin-induced diabetic rats for 21 days at doses of 0, 25, 50, or 75 mg/kg/day. In marked contrast to the reduction in plasma glucose observed in diabetic animals given vanadyl sulfate via drinking water, diabetic rats given vanadyl by gavage were not characterized by normoglycemia. Similarly, in contrast to the normalizing effect of vanadyl in drinking water, vanadyl by gavage had only a minimal influence on diabetes associated hyperphagia and polydipsia. Despite the lack of marked effect of vanadyl by gavage on the above parameters, tissue vanadium accumulation in the gavaged rats was similar to that reported for rats given vanadium by drinking water. The present results (taken together with previous data) show that the administration of vanadium by gavage is not a viable alternative to the use of insulin in diabetes treatment.

Tiron administration minimizes the toxicity of vanadate but not its insulin mimetic properties in diabetic rats

Although it has been reported that vanadate is effective in diminishing the expression of diabetes in the rat, the severe toxic side effects noted in the vanadate-treated animals suggest that chronic oral administration of vanadate argues against its use in human diabetes. The present study was conducted to evaluate the effects of the chelator Tiron on the mobilization of vanadium after administration of sodium metavanadate in the drinking water (0.20 mg/ml) of streptozotocin-induced diabetic rats for 35 days. Intraperitoneal treatment with Tiron (300 or 600 mg/kg) was initiated after three weeks of vanadate administration and continued for two weeks. The ameliorative effects of vanadium with respect to diabetes were not diminished by the administration of Tiron, but the accumulation of vanadium in kidney and bone was significantly decreased in the Tiron-treated groups and diabetes associated increases in serum GOT, GPT and cholesterol were diminished with Tiron treatment. It is concluded that the coadministration of metavanadate and Tiron may be of potential value for treatment of diabetes mellitus.

Evaluation of the efficacy of various chelating agents on urinary excretion and tissue distribution of vanadium in rats

The effect of repeated intraperitoneal administration of Tiron (4,5-dihydroxy-1,3-benzenedisulfonic acid), ascorbic acid, deferoxamine (DFOA) or 2-mercaptosuccinic acid on urinary excretion and tissue distribution of vanadium was assessed in rats which had previously received 12 intraperitoneal injections of sodium metavanadate (1.84 mg/kg per injection) or vanadyl sulphate trihydrate (6.35 mg/kg per injection) during a 4-week period. Chelating agents were administered daily for 5 days at doses equal to one-eighth of their respective LDSO. Only Tiron significantly decreased the tissue concentration of vanadium, whereas DFOA and Tiron significantly enhanced the urinary excretion of vanadium after repeated parenteral administration of sodium metavanadate. Again, only Tiron significantly increased the urinary elimination of vanadium following vanadyl sulphate administration. The results of this study show that Tiron has potential beneficial effects in the treatment of repeated intraperitoneal vanadium poisoning, while the effectiveness of DFOA is very uncertain. 2-Mercaptosuccinic and ascorbic acids were not effective as antidotes for parenteral vanadium intoxication.

Developmental toxicity evaluation of oral aluminum in rats: influence of citrate

To evaluate the influence of citrate on the potential developmental toxicity of high doses of aluminum (133 mg/kg/day), three groups of pregnant Sprague-Dawley rats were given by gavage aluminum hydroxide (384 mg/kg/day), aluminum citrate (1064 mg/kg/day), or aluminum hydroxide (384 mg/kg/day) concurrent with citric acid (62 mg/kg/day) on gestational days 6 through 15. Control animals received distilled water. At termination on gestation day 20, live fetuses were examined for external, visceral, and skeletal alterations. There were no significant differences between controls and Al-treated rats on pre- or postimplantation loss, number of live fetuses per litter, or sex ratio. Fetal body weight was significantly reduced in the group treated with Al(OH)3 and citric acid. Although no increases in the incidence of malformations were observed, the incidence of skeletal variations was significantly increased in the group given Al(OH)3 concurrent with citric acid. In summary, although the administration of citric acid did not modify the lack of embryotoxicity and teratogenicity of Al(OH)3 in rats, some signs of maternal toxicity and fetotoxicity could be observed in this group.

Influence of some dietary constituents on aluminum absorption and retention in rats

Eight groups of female Sprague-Dawley rats were treated with 281 mg Al(OH)3/kg/day by gastric intubation five times a week for five weeks. Concurrently, animals in seven groups received ascorbic acid (56.3 mg/kg/day), citric acid (62 mg/kg/day), gluconic acid (62.7 mg/kg/day), lactic acid (28.8 mg/kg/day), malic acid (42.9 mg/kg/day), oxalic acid (28.8 mg/kg/day), and tartaric acid (48 mg/kg/day) in the drinking water. The eighth group did not receive any dietary constituent in the water and was designated as the control group. Animals were placed in plastic metabolic cages and urine was collected during the treatment period. The liver, spleen, kidney, brain and bone aluminum levels of each rat were measured, as well as the total amount of aluminum excreted into urine. All the dietary constituents significantly increased the aluminum concentrations in most of the tissues, with ascorbic and citric acids showing the highest rate of aluminum accumulation. In contrast, no significant differences between control and treated rats were observed in the concentrations of aluminum excreted into urine. In view of these results, we suggest that the effects of the simultaneous ingestion of aluminum hydroxide and those dietary constituents in uremic animals should be evaluated. Meanwhile, the diet of uremic patients should be carefully monitored.

Oral vanadium administration to streptozotocin-diabetic rats has marked negative side-effects which are independent of the form of vanadium used

In the present investigation, the effects of oral administration of sodium metavanadate, sodium orthovanadate and vanadyl sulphate to alleviate some signs of diabetes in streptozotocin-treated rats have been evaluated. Streptozotocin-induced diabetic rats drank aqueous solutions (NaCl, 80 mM) containing sodium metavanadate (0.15 mg/ml), sodium orthovanadate (0.23 mg/ml), or vanadyl sulphate pentahydrate (0.31 mg/ml) for 28 days. The vanadium-treated animals were compared to controls, either diabetic or nondiabetic, receiving drinking water containing NaCl (80 mM) only. Daily food and fluid intake were significantly decreased in the vanadium-treated animals relative to diabetic controls. Also, vanadium treatment reduced the level of hyperglycemia in diabetic rats, with sodium metavanadate being the most effective of the vanadium compounds tested. However, daily vanadium intake was significantly lower in the animals receiving sodium metavanadate. Signs of toxicity were observed in all vanadium-treated animals as evidenced by some deaths, decreased weight gain, and increased serum concentrations of urea and creatinine. Moreover, vanadium was detected in all tissues analyzed. Although some signs of diabetes were improved by vanadium treatment, because of the severe toxic side effects noted in all of the vanadium-treated animals, it seems evident that oral vanadium administration is not a suitable therapy of diabetes mellitus in streptozotocin-diabetic rats.

Occupation and risk for testicular cancer: a case-control study

A case-control study of 271 testicular cancer cases aged 18-42, including 60 seminomas and 206 other germinal cell tumours, and 259 controls was carried out to study the association between occupation and testicular cancer risk. Study subjects were identified at three medical centres, two of which treat military personnel. Controls were men diagnosed with a cancer other than of the genital tract. Associations were identified between professional employment (administrators, teachers and other professionals) and risk for testicular seminoma, OR = 2.8 (95% Cl: 1.4-5.4) and between employment in production work and risk for other germinal cell tumours, OR = 1.8 (95% Cl: 1.1-2.7). No specific occupations within these broad groups were responsible for observed increases. Self-reported exposure to microwave and other radio waves was associated with an excess risk for both seminomas and other germinal cell tumours. However, an assessment of radio wave exposure based on job title did not support this finding. Although testicular cancer has been increasing in recent decades among young males, occupational factors did not appear to account for a substantial proportion of testicular cancer occurrence in the population studied.

Evaluation of the maternal and developmental toxicity of aluminum from high doses of aluminum hydroxide in rats

The potential of aluminum hydroxide [Al (OH)3] to induce developmental toxicity in rats was evaluated in the present study. Al (OH)3 was given by gavage at dose levels of 192, 384, and 768 mg/kg/day to groups of pregnant rats from day 6 through day 15 of gestation. Control animals received distilled water. Pregnant rats were evaluated for body weight, weight gain, food consumption, appearance, behavior and reproduction data. Cesarean sections were performed on gestation day 20, and the fetuses were removed for teratological evaluation. No significant maternal or developmental toxicity was observed at any Al (OH)3 dose level. Consequently, the no-observed-effect level (NOEL) for Al(OH)3 maternal or developmental toxicity would be greater than or equal to 768 mg/kg/day, which was the highest dose tested. This dose would be equivalent to a 60 kg person ingesting 16 g Al/day.

Vaginal gamete intrafallopian transfer. Experience with 14 cases

A procedure utilizing transvaginal aspiration of stimulated gametes followed by transcervical, ultrasound-guided catheterization of the tubal ostia was performed as a modification of the standardized gamete intrafallopian transfer (GIFT) technique. Among 14 patients with 16 cycles there were four normal, intrauterine pregnancies and one ectopic pregnancy. In two patients the beta-human gonadotropin level rose significantly and then started to fall; the patients aborted spontaneously. The procedure can be performed with a higher degree of patient acceptance than can traditional GIFT, and the success rate in this small series was promising.

Chelating agents in the treatment of acute vanadyl sulphate intoxication in mice

Eighteen chelating or reducing agents were tested to determine their relative efficacy as antagonists in acute intramuscular vanadyl sulphate intoxication in mice. The chelating or reducing agents were administered intraperitoneally to male Swiss mice at doses equal to one-fourth of their respective LD50. Therapeutic effectiveness (TEF) was calculated. In a subsequent experiment, the effect of EDTA, glutathione, DFOA, ascorbic acid, succinic acid, monosodium phosphate, Tiron, DTPA, and 2-mercaptosuccinic acid on the excretion, and distribution of vanadium was determined. Of the compounds examined, Tiron followed by ascorbic acid, and 2-mercaptosuccinic acid were effective in increasing the urinary excretion of vanadium. Tiron, and 2-mercaptosuccinic acid were also effective in reducing the concentration of vanadium found in kidney, the main target organ of vanadium accumulation. Tiron appears to be the most effective agent of those tested in the prevention of acute vanadium (IV) intoxication in mice.

Comparative study of 5% permethrin cream and 1% lindane lotion for the treatment of scabies

A multicenter, randomized, investigator-blind controlled trial was conducted to compare the safety and efficacy of a single, whole-body application of 5% permethrin cream with that of 1% lindane lotion for the treatment of scabies in 467 patients. At 14 +/- 3 days after treatment, the mean active lesion count decreased from pretreatment levels of 85 (range, 4 to 600) in both treatment groups to 14 (range, 0 to 133) in the permethrin group and to 15 lesions (range, 0 to 500) in the lindane group. At 28 +/- 7 days after treatment, complete resolution had occurred in 181 (91%) of 199 patients treated with permethrin and in 176 (86%) of 205 patients given lindane. Pruritus due to scabies persisted at 28 +/- 7 days in 14% of the permethrin group and in 25% of the lindane group. The most frequent adverse effects were new or increased pruritus and mild, transient burning or stinging; the latter was slightly more frequent following permethrin treatment and appeared to be related to severity of infestation. Because of a lower potential for neurologic toxicity, permethrin may be preferable to lindane for the treatment of scabies particularly in children.

Thermochemotherapy for B16 melanoma: combination therapy of hyperthermia, melphalan, and CCNU in mice

We studied, by means of quantitative histopathological methods, the changes that took place in B16 melanoma implanted into C57BL/6J mice after combination treatment of hyperthermia, melphalan, and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU). The studies were made on animals sacrificed on days 11, 18, and 25 after implantation. Tumors in treated animals showed a progressive delay in growth, a noticeably reduced number of metastases, and diminution of proliferative capacity. However, this treatment did not affect necrosis, stroma, capsule, or cell infiltration. Ultrastructurally, signs of cell damage were constantly present.

Incised wound margins caused by steel blades. Scanning electron microscopy to determine wound direction

The aim of this paper has been to check the diagnostic ability of Scanning Electron Microscopy (S.E.M.) to determine wound direction. We have studied incised wound margins caused by steel blades in human skin samples from cadavers by S.E.M. It was found that a lateral accessory tail existed in 65% of the entrance edges. This finding was recorded in all the cases when wound direction was perpendicular to Lancer's lines of the skin area in which the wound was located. No similar finding in the exit tails was noticed. The depth and length of the wound margins was less accurate an index of the wound direction than a lateral accessory tail. We think that this finding could be useful in determining the entrance margin in incised wounds.

A new beta-lactam-binding protein derived from penicillin-binding protein 3 of Escherichia coli

In this paper we describe a new beta-lactam-binding protein from the cell envelope of Escherichia coli. It can be detected in cells grown at either 37 or 42 degrees C in medium containing glucose but not in cells grown at 30 degrees C. This novel component has an apparent molecular size that is 2.0 kilodaltons larger than that of penicillin-binding protein 3 and is derived from the latter through a divalent-cation-mediated process probably catalyzed by components located in the periplasmic space. The significance of this protein with regard to regulation of the amount of functional penicillin-binding protein 3 in the cell is discussed.

Vaginal intratubal insemination (VITI) and vaginal GIFT, endosonographic technique: early experience

A new technique for vaginal intratubal insemination (VITI) and transvaginal gamete intra-Fallopian transfer (TV-GIFT) using endosonography has been developed. A total of 47 infertile couples were treated using a K-JITS 1000-1100 catheter (William Cook, Australia; Jansen Anderson Intratubal Transfer Set) introduced by Jansen and Anderson in Sydney, Australia, and endosonographic control with a Kretz Combison 310 echograph and a 5/7.5 MHz vaginal sectorial transducer. In 40 couples, the VITI technique was used, and in the other seven couples, TV-GIFT was used. Fifteen pregnancies (37.5%) were obtained in 63 VITI cycles (23.8% per treatment cycle) and three with TV-GIFT (42% per treatment cycle). A review is also presented of the migration--sedimentation technique used for management of male factor in an artificial insemination programme.

Hepatic artery anastomotic stenosis after transplantation: treatment with percutaneous transluminal angioplasty

Two orthotopic liver transplant recipients underwent percutaneous transluminal angioplasty (PTA) for stricture of the hepatic arterial anastomosis. In both, arterial revascularization was effected by end-to-end anastomosis between the donor common hepatic artery and the recipient's hepatic artery. Both patients had elevated liver enzyme levels, abnormal results on duplex Doppler images, and severe stricture on angiograms. In one patient, percutaneous biopsy revealed graft ischemia. PTA was performed successfully without complications. PTA produced substantial improvement in biochemical, duplex Doppler, histologic, and angiographic patterns. Both patients were asymptomatic 5 and 6 months after PTA.

Long esophagoplasty: functional study

The functional results of different types of plasty were evaluated in 46 patients who had undergone esophageal replacement for different pathologies. The patients were classified into three groups according to the type of plasty: I) 19 ileocecocolonoplasties (ICC), II) 11 left colonoplasties (LC), III) 16 gastroplasties (GP). The postoperative studies made were: a) clinical evaluation, b) radiological barium contrast study, c) isotopic transit of semisolid food marked with 99m-Tc colloidal sulfur and d) manometry. The clinical evaluation disclosed no significant differences between the three groups. Isotopic scans revealed more rapid emptying of the ICC, with elimination by the ileal segment in the first minute of 76.3 +/- 3.3% of the isotope, and by the entire plasty of 79.4 +/- 4.2% in 15 minutes (p less than 0.001). The manometric study showed non-response by the GP. The motor activity of the terminal ileoplasty was greater than that of the other plasties studied, and that of the right colonoplasty was greater than that of the left (p less than 0.01). Likewise, the clearance of acid (HCl 0.1N) by the ICC was more rapid than that of the LC (p less than 0.01). It is concluded that, functionally, the ICC is a better long esophagoplasty than the other procedures studied.

Managing healthcare costs, Part 1: The dilemma of AIDS

The costs of AIDS care can be reduced through individual case management, but first employers, insurers, and society in general must learn to deal with the disease and its victims rationally and compassionately.

Aerosol-perfusion lung scintigraphy: value of ventilation subtraction

99Tcm-labelled aerosol ventilation and 99Tcm-macroaggregate albumin (99Tcm-MAA) perfusion can be performed in the diagnosis of pulmonary embolism (PE). If both examinations are performed on the same day, the superposition of activity from the first scintigraphic examination might mask defects in the second. In this study, 106 examinations were carried out for suspected PE. Aerosol ventilation was performed first with 20 to 30 mCi 99Tcm-labelled rhenium sulphur (four views, 200,000 counts). Immediately afterwards, with the patient remaining in the same position, 5 to 7 mCi of 99Tcm-MAA were injected (four views, 400,000 counts). After normalization, aerosol activity was subtracted from perfusion images and unprocessed perfusion (UP) and ventilation subtraction perfusion (SP) images were compared. Interobserver diagnostic reproducibility between three readers was calculated both for UP and SP images. Intraobserver reproducibility between UP and SP images was calculated for each reader. Interobserver reproducibility was comparable for SP and UP images. Intraobserver reproducibility was good. Thus, whether ventilation was subtracted or not from perfusion images, there was no appreciable effect on perfusion defect detection. However, some perfusion abnormalities showed up more clearly on SP images. Perfusion can be performed immediately after aerosol ventilation; the images thus obtained are reliable for interpretation, and subtraction of ventilation is not necessary.

Atypical germ cells in prepubertal cryptorchid testes

Four cases of prepubertal cryptorchid testes with atypical germ cells were studied. These cells were characteristically large, showing a wide, pale cytoplasm and a large nucleus with both fine and coarse granular chromatin. Ferritin was shown to be absent. It is possible that these cells are dysplastic in nature and that they could form the basis of a premalignant intratubular lesion. Thus periodic follow-up of these patients is recommended.

Subacute spongiform encephalopathy with periodic paroxysmal activities: clinical evolution and serial EEG findings in 20 cases

Evolution of both clinical and EEG abnormalities was analyzed in 20 (16 pathologically confirmed) patients suffering from subacute spongiform encephalopathy with periodic paroxysmal activities (PPA) on the EEG. Illness duration was less than 4 and greater than 17 months in 65% and 10% of cases, respectively. All data but EEG were utilized to assess 3 conventional clinical stages in 20 patients. The early clinical stage was characterized by gradual presentation of gait disturbances, mental deterioration, sensory or autonomic disorders. In contrast with other reports, no PPA were observed in 10 EEG recordings from 7 patients examined at the early clinical stage. Both clinical and EEG findings were not in contrast with a hypothetic subcortical onset of disease. Similar to recent data in the literature, early PPA appeared within 12 weeks of disease evolution in 88% of patients who underwent EEG recordings in the first 3 months of disease. Nonetheless, these early PPA always occurred at an intermediary stage, when our patients showed a marked worsening of the clinical picture. Focal, segmental and/or generalized myoclonic jerks were observed in 15%, 53% and 100% of cases at prodromal, intermediary and terminal stages respectively. Different kinds of PPA were observed: bi-tri-phasic periodic complexes (PC), periodic complexes with multiphasic configuration (PPC) and periodic polyspiking discharges (PPD). Abnormal "pacing" of PC by slowly repeated flashes was found in 4 patients presenting visual hallucinations or cortical blindness. Burst-suppression activity was frequently found at the terminal stage in decorticate patients.

Bone disease induced by anticonvulsant therapy and treatment with calcitriol (1,25-dihydroxyvitamin D3)

To evaluate the effects of calcitriol (1,25-dihydroxyvitamin D3) therapy for the bone disease induced by long-term treatment with anticonvulsants, we reviewed the medical records of 330 institutionalized oligophrenic children and young adults under 26 years of age to identify the 144 children who required anticonvulsant therapy. Of this latter group, 52 children were found to have serum alkaline phosphatase levels elevated more than 2 SDs above normal and were enrolled into this prospective three-year study. To achieve rapid resolution of the bone disease, we elected to use calcitriol at 0.25 to 0.75 micrograms/d. After 1195 patient-months of treatment, our data suggest that the dystrophic process was reversed in 42.3% of the cases, as judged by decreases in serum alkaline phosphatase levels at six months, 65.4% of cases at 12 months, and 83.3% of cases at 13 to 18 months. By 30 months of follow-up, all patients showed significant lowering of serum alkaline phosphatase levels. The improvements were slow and gradual. Twenty-six patients in the treatment series of 52 patients initially showed signs of rickets or osteomalacia on roentgenograms of the wrists. Of these 26 patients, 12 (46%) showed improvement on roentgenograms within 24 months of the beginning of treatment. With reference to complications, hypercalcemia (calcium level, greater than 11 mg/dL [2.74 mmol/L]) was encountered at the rate of one episode per 44 patient-months of treatment. Our results strongly suggest that calcitriol is effective in healing anticonvulsant-related osteomalacia among children and youths, with a low incidence of complications.

Heterogeneity of the expression of class I and II HLA antigens in human breast carcinoma

HLA class I and II antigen expression was studied in 19 cases of primary infiltrating ductal carcinoma of the breast. An indirect immunofluorescence technique was used on cryostat sections with monoclonal antibodies directed against HLA class I and II monomorphic determinants. Of the 19 cases studied, 17 were positive for class I antigen expression and two were negative. Class I HLA antigen expression was found to be clearly heterogeneous: in ten of these tumours more than 75% of the cells were class I positive; in two the percentage was decreased to between 50% and 75%; in five tumours it was less than 50%. With respect to class II HLA antigen expression, eight breast tumours were totally negative while two were strongly positive (50-75%) and the nine remaining cases were less than 25% positive. In addition, radioassay techniques were employed to determine the presence of oestrogen and progestagen receptors. The distribution of these receptors was not correlated with HLA class I or II antigen expression, nor could any relationship be demonstrated between the degree of histological differentiation of the tumours and their invasiveness.