Quantitative Phase-Contrast MR Angiography to Measure Hemodynamic Changes in Idiopathic Intracranial Hypertension

BACKGROUND AND PURPOSE

Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure of unknown etiology. Few MR imaging-based studies have investigated arterial and venous blood flow in these patients. Results are inconclusive, and to our knowledge, no comparison of the hemodynamic parameters before and after CSF pressure reduction has been published. The aim of this study was to assess the short-term effects of normalizing CSF pressure on intracranial flow to better understand the pathophysiology of idiopathic intracranial hypertension.

MATERIALS AND METHODS

In this study, we performed quantitative MR imaging-derived flow measurements of brain-supplying arteries and draining veins/dural sinuses to visualize hemodynamic changes in patients with idiopathic intracranial hypertension before and after therapy by lumbar puncture in comparison with a healthy control group.

RESULTS

We found differences in patients before and after lumbar puncture in the calculated resistance and pulsatility indices in the superior sagittal sinus. Venous pulsatility showed a negative correlation with CSF pressure in untreated patients. Additionally, there was a trend toward lower flow in the superior sagittal sinus in patients compared with healthy controls. Flow in the internal jugular veins was significantly reduced by lumbar puncture, and the resistance and pulsatility indices differed in patients and controls. The arterial flow was not influenced by pressure normalization.

CONCLUSIONS

The results of the present study indicate that venous but not arterial blood flow differs in patients compared with controls and that calculating resistance and pulsatility indices may contribute to assessing short-term hemodynamic changes in patients with diagnosed idiopathic intracranial hypertension before and after CSF diversion.

Effect of genetic and nongenetic factors on chemical composition of individual milk samples from dromedary camels (Camelus dromedarius) under intensive management

The aims of the present study were to monitor the changes in gross chemical composition of individual dromedary camel milk over a 5-yr period, to provide reference values, and to determine the effect of genetic and nongenetic factors influencing camel milk composition under intensive management. A total of 1,528 lactating dromedary camels were included in the study. Animals were fed a constant diet and were milked twice a day in a herringbone parlor. Milk samples were collected at monthly intervals using a sampling device and then fat, protein, lactose, total solids (TS), and solids-nonfat (SNF) concentrations of raw camel milk were determined with an automatic milk analyzer. For each milk sample, production parameters were recorded and quantities (grams) of milk constituents were calculated. The overall mean quantity and fat, protein, lactose, SNF, and TS concentrations of the morning milk were 4.0 kg, 2.58%, 2.95%, 4.19%, 8.08%, and 10.46%, respectively. Milk quantity showed a positive correlation with lactose and a negative correlation with all other components. Parity exerted a strong effect on all milk parameters. Primiparous dromedaries (n = 60) produced less milk with higher concentrations of components than did multiparous animals (n = 1,468). Milk composition varied among the 7 breeds tested, but none of the genotypes was found to be superior to the others in this respect. We detected a significant, yet small calf sex-biased difference in milk yield and composition. Stage of lactation and season strongly influenced milk yield and all milk components. We also found a significant interaction between month postpartum (mPP) and month of the year. The concentration of all milk components decreased from 1 to 5 mPP. Later, lactose concentration and quantity continued to decrease parallel with decreasing milk production. The concentration of other components showed a temporary increase in mid lactation, from 6 to 11 mPP, and in late lactation, from 18 to 23 mPP. Mean fat, protein, SNF, and TS concentrations showed a high seasonal variation (9.5 to 28.7%), with the lowest and highest values being measured during summer and winter, respectively. This seasonal variation was independent of nutrition and may reflect an endogenous circannual rhythm. We observed a noticeable variation among years. Dromedary camels could provide a useful in vivo model to study the homeorhetic regulation of mammary cell function by endogenous and environmental factors.

Sleep disordered breathing in medically stable patients with myasthenia gravis

We investigate sleep and breathing in clinically stable myasthenia gravis (MG) patients and ask weather sleep disordered breathing (SDB) is causally linked with MG. Nineteen MG patients with a mean disease duration of 9.7 years underwent sleep studies in two consecutive nights. The primary outcome measure was the respiratory disturbance index (RDI) in terms of snoring and apneas/hypopneas. Further outcome measurements were total sleep time, sleep stage distribution and the number of arousals. A clinically relevant SDB in terms of obstructive sleep apnea (OSA) (defined as RDI > 10/h) was found in four patients. There were only a few central apneas (central apnea index: 0.19 +/- 0.4/h). We did not find a relationship between maximum inspiratory pressure and SDB (r = -0.03). There is no evidence for a causal relationship between medically stable MG and SDB in terms of OSA. The extent of respiratory muscle weakness failed to correlate with SDB. Furthermore, our study does not confirm the high occurrence of central respiratory events during sleep in patients with well-controlled MG.

Factors affecting plasma progesterone concentration and the retrospective determination of time of ovulation in cyclic mares

Factors influencing plasma progesterone concentration were investigated in seven mares. Two-phase logistic curves were fitted (r=0.98) to plasma progesterone concentrations of blood samples collected once daily. In addition to the effect of time (P<0.001), there were differences (P<0.01) among mares in the peak height of the progesterone plateau and in the (area under the curve) AUC. Plasma progesterone concentrations were higher (P<0.001) after a multiple versus single ovulation. There was an effect of season (P<0.001), but no significant effect of luteal morphology. The retrospective determination of time of ovulation was carried out using a linear model on the seven mares and 25 additional mares. Linear regression on the measured values or on the ratio to the average concentration from D5 to D10, was calculated with the day of cycle between D0 and D4. The ovulation date was then calculated using both of these equations, whether blood sampling was performed twice or thrice weekly on 25 postpartum mares. The accuracy to predict day of ovulation (+/- 1 day) ranged from 88 to 97%. In conclusion, the retrospective estimation of time of ovulation in mares was possible, although the technique had some limitations.

Effect of low-dose zearalenone exposure on luteal function, follicular activity and uterine oedema in cycling mares

The effect of 10-day zearalenone administration starting 10 days after ovulation was studied in 6 cycling trotter mares in the summer period. After an entire oestrous cycle (Cycle 1), mares were given 7 mg purified zearalenone per os daily (1 mg/ml in ethyl alcohol) beginning on Day 10 of Cycle 2. Toxin exposure was continued until the subsequent ovulation. Luteal function and follicular activity were monitored daily by rectal palpation, ultrasonography and blood sampling for progesterone. During toxin exposure, all animals were in good physical condition. The toxin had no effect on the length of the interovulatory intervals, luteal and follicular phases. It did not influence significantly the plasma progesterone profiles (logistic curve parameters A1 to A6), the follicular activity (growth rate, maximum size of the ovulatory follicles, maximum number and the time of first increase in the number of large follicles) and the uterine oedema. It is concluded that in cyclic mares the methods used in this study could not detect any adverse effect of zearalenone (administered at a low dose similar to natural exposure) on reproduction.

Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea

Proportional positive airway pressure (PPAP) was designed to optimize airway pressure for the therapy of obstructive sleep apnoea (OSA). In a randomized crossover prospective study, the clinical feasibility of PPAP and its immediate effects on the breathing disorder and sleep in comparison with continuous positive airway pressure (CPAP) was evaluated. Twelve patients requiring CPAP therapy underwent CPAP and PPAP titration in a random order. Obstructive and mixed respiratory events could be completely abolished with both forms of treatment. This efficacy could be achieved at a significantly lower mean mask pressure during PPAP titration (8.45+/-2.42 cmH2O) compared to CPAP (9.96+/-2.7 cmH2O) (p=0.002). The mean minimal arterial oxygen saturation (Sa,O2) (82.8+/-6.5%) on the diagnostic night increased significantly (p<0.001) to an average Sa,O2 of 93.35+/-1.71% and 93.19+/-2.9% during CPAP and PPAP titration. Total sleep time, slow wave sleep and rapid eye movement (REM) sleep increased significantly by the same amount during both CPAP and PPAP titration (p<0.001), while sleep stage nonrapid eye movement (NREM) 1 and 2 decreased. Six patients preferred the PPAP titration night, four patients did not have a preference, and two patients preferred CPAP. The present data show that proportional positive airway pressure is as effective as continuous positive airway pressure in eliminating obstructive events and has the same immediate effect on sleep. The lower average mask pressure during proportional positive airway pressure implies potential advantages compared to continuous positive airway pressure. Proportional positive airway pressure presents a new effective therapeutic approach to obstructive sleep apnoea.

Sodium lauryl sulfate increases the efficacy of a topical formulation of foscarnet against herpes simplex virus type 1 cutaneous lesions in mice

The influence of sodium lauryl sulfate (SLS) on the efficacies of topical gel formulations of foscarnet against herpes simplex virus type 1 (HSV-1) cutaneous infection has been evaluated in mice. A single application of the gel formulation containing 3% foscarnet given 24 h postinfection exerted only a modest effect on the development of herpetic skin lesions. Of prime interest, the addition of 5% SLS to this gel formulation markedly reduced the mean lesion score. The improved efficacy of the foscarnet formulation containing SLS could be attributed to an increased penetration of the antiviral agent into the epidermis. In vitro, SLS decreased in a concentration-dependent manner the infectivities of herpesviruses for Vero cells. SLS also inhibited the HSV-1 strain F-induced cytopathic effect. Combinations of foscarnet and SLS resulted in subsynergistic to subantagonistic effects, depending on the concentration used. Foscarnet in phosphate-buffered saline decreased in a dose-dependent manner the viability of cultured human skin fibroblasts. This toxic effect was markedly decreased when foscarnet was incorporated into the polymer matrix. The presence of SLS in the gel formulations did not alter the viabilities of these cells. The use of gel formulations containing foscarnet and SLS could represent an attractive approach to the treatment of herpetic mucocutaneous lesions, especially those caused by acyclovir-resistant strains.

Relationship between thyroid function and seasonal reproductive activity in mares

The relationship between thyroid function and seasonal reproductive activity in mares was investigated by comparing plasma triiodothyronine and thyroxine concentrations in anoestrous mares and in mares with cyclic ovarian activity during the anovulatory season. In study 1, the diurnal changes in plasma triiodothyronine and thyroxine concentrations on a single day were compared in anoestrous and cyclic mares. The mean thyroxine concentrations were significantly higher (P < 0.001) in the cyclic mares than in the anoestrous mares, whereas mean triiodothyronine concentrations were similar in both groups. In study 2, plasma thyroid hormone concentrations were monitored in mares that foaled before the vernal equinox. Nine mares resumed cyclic ovarian activity shortly after parturition and ten mares remained in anoestrus. Mean plasma triiodothyronine and thyroxine concentrations were significantly lower in the first 60-90 days after foaling in the mares undergoing anoestrus than in the mares undergoing normal ovarian activity after parturition (P < 0.001). In these mares, the increases in triiodothyronine and thyroxine concentrations were associated with the first ovulation after parturition. In study 3, thyroid hormone concentrations were monitored in adult (n=14) and young (n=14) mares. Mean thyroxine concentrations were significantly lower in adult anoestrous mares during the anovulatory period than in cyclic mares and in anoestrous mares before and after the anovulatory period (P < 0.01). Mean plasma triiodothyronine concentrations were also significantly lower (P < 0.001) in anoestrous mares from December until March. There were no significant differences between the plasma triiodothyronine and thyroxine concentrations in young cyclic and anoestrous mares. This relationship between thyroid function and expression of seasonal reproductive activity does not indicate that the thyroid gland is involved in the control of seasonality in horses. The decreased triiodothyronine and thyroxine concentrations in anoestrous mares may be the result of a hypothalamic control similar to that described for seasonal reproductive activity.

In vitro and in vivo evaluations of sodium lauryl sulfate and dextran sulfate as microbicides against herpes simplex and human immunodeficiency viruses

The efficacy of sodium lauryl sulfate (SLS), a sulfated anionic chaotropic surfactant, and dextran sulfate (DS), a polysulfated carbohydrate, against herpes simplex virus (HSV) and human immunodeficiency virus (HIV) infections was evaluated in cultured cells and in different murine models of HSV infection. Results showed that both SLS and DS were potent inhibitors of the infectivities of various HSV-1 and HSV-2 strains. Pretreatment of HIV-1 (strain NL4-3) with SLS also reduced its infectivity to 1G5 cells. DS prevented the binding of HSV to cell surface receptors and therefore its entry into cells. Pretreatment of HSV-1 (strain F) with 50 microM SLS resulted in a complete loss of virus infectivity to Vero cells. However, viruses were able to enter into cells and to produce in the nuclei capsid shells devoid of a DNA core. The amount of the glycoprotein D gene produced in these cells remained unchanged compared to controls, suggesting that SLS could interfere with the maturation of the virus. At a higher SLS concentration (100 microM), HSV was highly damaged by SLS pretreatment and only a few viral particles could enter into cells to produce abnormal capsids. Although DS was a more potent inhibitor of HSV infectivity in vitro, it was unable to provide any protection in murine models of HSV infection. However, SLS conferred a complete protection of animals infected cutaneously with pretreated viruses. In addition, skin pretreatment of mice with a polymer formulation containing SLS completely prevented the development of cutaneous lesions. More interestingly, intravaginal pretreatment of mice with SLS in a buffered solution also completely protected against lethal HSV-2 infection. Taken together, our results suggest that SLS could thus represent a candidate of choice as a microbicide to prevent the sexual transmission of HIV, HSV, and possibly other pathogens that cause sexually transmitted diseases.

Efficacies of topical formulations of foscarnet and acyclovir and of 5-percent acyclovir ointment (Zovirax) in a murine model of cutaneous herpes simplex virus type 1 infection

The topical efficacies of foscarnet and acyclovir incorporated into a polyoxypropylene-polyoxyethylene polymer were evaluated and compared to that of 5% acyclovir ointment (Zovirax) by use of a murine model of cutaneous herpes simplex virus type 1 infection. All three treatments given three times daily for 4 days and initiated 24 h after infection prevented the development of the zosteriform rash in mice. The acyclovir formulation and the acyclovir ointment reduced the virus titers below detectable levels in skin samples from the majority of mice, whereas the foscarnet formulation has less of an antiviral effect. Reducing the number of treatments to a single application given 24 h postinfection resulted in a significantly higher efficacy of the formulation of acyclovir than of the acyclovir ointment. Acyclovir incorporated within the polymer was also significantly more effective than the acyclovir ointment when treatment was initiated on day 5 postinfection. The higher efficacy of the acyclovir formulation than of the acyclovir ointment is attributed to the semiviscous character of the polymer, which allows better penetration of the drug into the skin.

Protective effect of a thermoreversible gel against the toxicity of nonoxynol-9

BACKGROUND AND OBJECTIVES

One major problem associated with the use of nonoxynol-9 is that it can induce local inflammation and ulceration of the vaginal and cervical mucosa that might favor the entry of pathogens. With the aim of developing a gel formulation that could be effective in preventing sexually transmitted infections, the authors have evaluated the capacity of a polyoxypropylene/polyoxyethylene polymer to reduce or eliminate the toxicity of nonoxynol-9.

STUDY DESIGN

The cytotoxicity of nonoxynol-9 alone or incorporated into the gel was investigated in human cervical and colon epithelial cells and after daily intravaginal application for 2 weeks in rabbits.

RESULTS

In vitro experiments showed that nonoxynol-9 was highly toxic to human cervical and colon epithelial cells in a dose-dependent manner. However, the incorporation of the spermicide into the gel markedly reduced its toxicity under the same experimental conditions. In vivo studies showed that in animals treated with nonoxynol-9, the spermicide was very toxic to the vaginal and cervical mucosa as evidenced by the presence of bleeding, irritation, epithelial disruption, necrosis, the accumulation of leukocytes in the submucosa, and the loss of integrity of the epithelial cells. Of prime importance, the incorporation of nonoxynol-9 into the gel markedly reduced the toxicity of this potent spermicide/microbicide.

CONCLUSION

The gel formulation could be used as an interesting approach to eliminate the toxicity of potent spermicides/microbicides such as nonoxynol-9.

Factors influencing ovarian activity and sexual behavior of postpartum mares under farm conditions

Management of the postpartum period is one of the most important factors of stud farm medicine. In horses, owing to the long gestation period, the time from parturition to repeat conception needs be short to maintain an optimal yearly foaling interval. For this reason the features of postpartum ovarian activity and sexual behavior were studied under farm conditions. During 2 consecutive breeding seasons, 107 mares on 5 commercial horse farms were monitored after parturition by regular teasing, transrectal ultrasonography and blood sampling for progesterone. Foalings took place from January 1 to June 15. Body condition scoring was carried out within 5 d and at 60 to 65 d after parturition. The first ovulation occurred within 20 d after foaling in 84.1% (90/107) of the mares. The mean intervals from foaling to the first and second ovulations were 17.8 +/- 1.6 d (+/- SEM) and 40.9 +/- 2.7 d (+/- SEM), respectively. The mean intervals from parturition to the first and second ovulation (P < 0.001), the interovulatory interval (P < 0.01), the second follicular phase (P < 0.001), and the time until the first overt estrus (P < 0.01) were significantly longer in mares foaling before the vernal equinox. In the beginning of the breeding season the intervals from parturition to the first ovulation (P < 0.01), to the second ovulation (P < 0.01), and to the first overt estrus (P < 0.001) were significantly longer for primiparous mares than for multiparous animals. There was a tendency for an increased interovulatory interval and for a longer second follicular phase in mares with decreased body condition after parturition (P = 0.069, P = 0.089, respectively). Suckling and breed had no effect on postpartum ovarian activity. We concluded that under field conditions the resumption of cyclic ovarian activity and sexual behavior in mares after foaling are strongly affected by the season of parturition and parity. In some cases, body condition change and other factors may also play a role in influencing postpartum reproductive function.

Long term exposure to T-2 Fusarium mycotoxin fails to alter luteal function, follicular activity and embryo recovery in mares

The effect of long term administration of T-2 toxin was studied in 6 Trotter mares during the summer and early autumn. After one complete oestrous cycle (Cycle 1) each mare was given 7 mg purified T-2 toxin per os daily (1 mg/ml in ethyl alcohol) beginning on Day 10 after ovulation in Cycle 2. Exposure to toxin was continued for 32-40 days, until Day 7 of Cycle 4. During this period all the animals remained in good physical condition, but skin lesions were observed around the mouth in 3 cases. Toxin administration had no effect on the length of the interovulatory interval or on the lengths of the luteal and follicular phases. It also had no effect on peripheral plasma progesterone profiles or follicular kinetics, including the growth rate and maximum size of ovulatory follicles and the maximum number, and time of first increase in number, of follicles larger than 1 and 2 cm. Uterine flushing was attempted in 5 mares and yielded 3 embryos (60%). These were of normal size and morphology and one was transferred nonsurgically to a recipient mare; a conceptus developed initially but it subsequently died and was resorbed. The results of the study allowed the conclusion that the administration of 7 mg/day T-2 toxin to mares in good body condition has no detrimental effect on ovarian activity, fertilisation or oviductal transport.

[Work of breathing in noninvasive proportional assist ventilation in patients with respiratory insufficiency]

BACKGROUND

The aim of the present study was to evaluate if Proportional Assist Ventilation (PAV), when applied noninvasively via face mask, can reduce ventilatory effort in patients with respiratory failure. We present preliminary results of an ongoing study.

PATIENTS AND METHODS

In 5 patients with respiratory failure due to different underlying disorders (pulmonary fibrosis, bilateral diaphragm paralysis, COPD) we compared the transdiaphragmal pressure-time integral. PTdi (integral off Pdi dt) after 15 minutes of noninvasive PAV to the baseline values without ventilatory support.

RESULTS AND CONCLUSION

Four patients showed reduction of PTdi to various extend. One patient who presented low diaphragmal activity at baseline due to diaphragmal paralysis showed a slight increase in PTdi during ventilation. Mean PTdi decreased by 26.7%. PaCO2 in the 5 patients showed no significant change after 15 minutes of ventilation, thus indicating that with noninvasive PAV patients can maintain constant ventilation with reduced effort.

Unattended continuous positive airway pressure titration. Clinical relevance and cardiorespiratory hazards of the method

The high cost of in-laboratory sleep studies and the insufficiency of available nights in most sleep laboratories has prompted clinical trials in an attempt to find an effective and safe method for continuous positive airway pressure (CPAP) titration in the unsupervised home environment. Earlier publications focused on the effectiveness of this new method but did not indicate the potential hazard and the selection criteria of patients. We accomplished a prospective study to evaluate a machine-controlled CPAP titration method in an unselected group of 21 patients with obstructive sleep apnea (OSA) requiring CPAP therapy. Unattended CPAP titrations were completed in the sleep laboratory, followed by conventional CPAP titration night. The CPAP levels assessed through automatic titrations showed strong agreement with those from the control nights. Fifteen patients had no pathologic cardiorespiratory events during machine-controlled titration. Undesirable cardiorespiratory complications developed in six patients with underlying cardiorespiratory disorder. Two patients had to stop the procedure. Two patients needed a reset of the actual pressure to baseline because of central apneas and one patient because of high-grade arrhythmia. The machine-controlled CPAP titration enabled reliable assessment of an effective pressure and appeared to be safe in selected patients with OSA. However, because the method caused significant adverse effects in some patients, we recommend that unattended CPAP titration not be attempted in patients with underlying cardiorespiratory disease.

[Long-term analysis of respiration in sleep]

We completed polysomnography and complementary measurement of the oesophageal pressure and airflow in 6 subjects (2 volunteers, 4 patients with sleep-related breathing disorder). The evaluation of the physiological parameters of the breathing over the whole night showed a strong correlation between the pressure-time product and the work of breathing. Our results revealed distinct differences between the parameters of the breathing mechanics in volunteers versus in patients. The continuous long-term analysis of respiration during sleep may contribute to reveal further pathological mechanisms of the respiratory system.

[Machine-assisted detection of individually effective minimal CPAP pressure using the Vitalog HMS 5000 monitor]

Continuous positive airway pressure ventilation (CPAP) has been proven to be highly effective in the elimination of sleep-related breathing disorders (SRBD) in the last couple of years. The titration of the effective airway pressure should be carried out under continuous polysomnographic supervision in the sleep laboratory. The CPAP ventilation may result in potential hazards through the positive airway pressure and each patient needs an individually adjusted pressure for therapy. In a prospective study we investigated under polysomnographic supervision the effectivity and the hazards of a machine-controlled CPAP calibration in 22 male patients (pts) (age: 53.6 +/- 8.9 years, BMI: 29.9 +/- 5.0 kg/m2) with obstructive SRBD (RDI: 50.6 +/- 1/h). Automatic CPAP-calibrations were carried out using the Vitalog HMS-5000 monitor and the Respironics BiPAP-STD ventilator. An algorithm determined the cyclical changes of the airway pressure. The following night we controlled the assessed pressure through manual adjustment during conventional polysomnography.

RESULTS

The CPAP-levels assessed through the automatic calibrations (8.36 +/- 2.36 cmH2O) showed in 19 pts a good agreement with the CPAP-levels of the control nights (8.15 +/- 2.36 cmH2O), the difference was statistically nonsignificant (p < 0.5). The CPAP-levels of the automatic titrations and the control nights agreed exactly in 12 pts (63%). 3 pts of the 22 failed the automatic CPAP-titration process because of functional or psychical reasons. 14 pts (64% of 22 pts) showed a good functional tolerance to the cyclical changes of the airway pressure. 3 pts were unable to fall asleep under the increasing airway pressure, but after falling asleep at a constant pressure of 2 or 4 cmH2O they could tolerate the automatic pressure titration. A reset of the actual pressure to the baseline was necessary in 13 pts to enable them falling asleep, in 2 pts because of increase of the airway pressure due to movement artifacts, in 2 pts because of central apneas and in one patient because of ventricular extrasystoles. 35 increases of the baseline level (48% of altogether 73 increases) occurred due to clinically irrelevant desaturations. We found a direct hazardous effect of the machine-controlled CPAP-titration (central apneas, secondary alveolar hypoventilation, ventricular extrasystole) in 7 pts with chronic obstructive pulmonary disease and/or cardiovascular disorder.

CONCLUSION

The machine-controlled CPAP-titration should be carried out only in a selected group of patients. Nevertheless, despite of the good agreement of the assessed pressure levels with the polysomnographic controls, this method seems to be not suitable for the clinical routine because of its potential hazards and contraindications in high risk patients.

Transurethral Treatment of Benign Prostatic Hyperplasia by Means of Neodym-YAG Laser. Preliminary Report

The Authors are the first in Hungary to report on laser therapy in BPH according to their experience gained in connection with 5 cases. They have verified that operations performed by means of the Nd-YAG laser and specific (SideFire) laser thread may offer a beneficial choice in the initial phase of BPH.

[The use of endoprostheses (stents) in airway stenosis]

Six patients with obstruction of the trachea were treated with silicone rubber endothracheal stents implanted with flexible bronchoscope. In every case the stent caused significant clinical improvement of the ventilation. At the postintubation stenosis the stent can result a final recovery, at the malignant processes the implantation seems to be a new palliative method.

[First experiences with neodymium-YAG laser treatment of tracheal and bronchial diseases]

The authors describe their first three years experiences with the Neodymium-Yag Laser in tracheobronchial diseases. The treatments were performed with the MEDI-YAG equipment constructed in Hungary. According to the indication, local and/or general anaesthesia and generally the rigid bronchoscope was used. 38 tracheal, 34 main bronchial, 5 lobar and 2 distal alterations were treated. In case of tracheobronchial malignancy 3 complete and 20 partial recoveries were registered out of 45 patients; among benign tumours 7 complete and 4 partial recoveries out of 14 patients. In tracheal stenosis cases 12 complete and 4 partial recoveries came out of 18 patients. It can be stated that the Yag Laser treatment completes the bronchologist's instrumentation. The treatment may be curative in tracheal stenosis and benign tumours and palliative in malignancy by setting free the tracheobronchial system for ventilation. It may also prepare the patient for surgery and complete the complex treatment.

Contralateral approach to bilateral and ophthalmic aneurysms

In a previous survey, we found a high incidence of fatal rupture of an unclipped aneurysm in patients with multiple aneurysms. To deal with this problem, we introduced a more vigorous technique that accesses aneurysms previously considered unapproachable during one operating session. Attempts were made to clip middle cerebral and ophthalmic aneurysms contralateral to the operative exposure. We have successfully clipped contralateral aneurysms of the posterior communicating artery when bilateral aneurysms were present. We have also used this contralateral approach successfully with single ophthalmic and proximal carotid aneurysms that pointed medially. We review the cases of 39 patients with 43 intracranial aneurysms operated from the contralateral side and present the surgical technique in relation to the angiographic findings.

Influence of ambroxol on tracheobronchial clearance in simple chronic bronchitis

The influence on tracheobronchial clearance of ambroxol, a metabolite of bromhexine, was investigated by measuring the lung retention of inhaled 6 micron monodisperse Teflon particles labelled with 99mTc. Fourteen subjects with simple chronic bronchitis, who belonged to a "responder" group in an earlier study on the subjective effects of ambroxol, were examined using a double-blind cross-over design comparing 120 mg ambroxol daily and placebo. On commencing the study and after each 2-week treatment period, the subjects were examined for mucociliary clearance and clearance by voluntary coughing. Treatment did not influence mucociliary clearance or clearance by cough. There is still a possibility that phlegm loosening by cough is enhanced in situations with more hypersecretion.

Ambroxol therapy in simple chronic bronchitis: effects on subjective symptoms and ventilatory function

Ambroxol, a metabolite of bromhexine, was investigated in a double-blind, controlled trial using parallel groups. We studied the effects of 60 mg and 120 mg daily versus placebo in subjects with simple chronic bronchitis. Possible therapeutic effects were evaluated by means of interviews on subjective drug effects and current respiratory symptomatology, patient diary cards, and lung function tests. Ninety-seven subjects entered the study and 92 completed satisfactorily. Comparison with the placebo group at the end of the study showed that significantly more subjects in the 120 mg ambroxol group reported improvement in respiratory symptoms, principally improved expectoration. Subjects in the 120 mg group tended to prefer the treatment period when compared to placebo but the diary cards did not indicate significant changes. Lung function values were mainly normal and did not change during treatment. We conclude that the drug had a symptomatic effect and that further studies in more severely affected patients would be worthwhile.

The surgery of middle cerebral artery aneurysms

Aneurysms of the middle cerebral bifurcation represent an interesting entity among intracranial saccular aneurysms. Their shape, size, situation, and in particular their relation to the middle cerebral trunk and its branches show wide variations. Topographical analysis of the angiograms offers a great deal of interest in planning surgery. Our experience with 289 patients with middle cerebral artery aneurysms operated on since 1977 are presented. Factors such as number of previous haemorrhages, timing of surgery, preoperative condition, major intraoperative bleeding or brain oedema and delayed postoperative deterioration play a major role in the outcome. Others such as severity of the subarachnoid bleed, age, size of the sac seem to have much less influence.

Surgical treatment of multiple intracranial aneurysms

Patients with multiple intracranial aneurysms present a great challenge to neurosurgical practice. The presence of one or more additional aneurysms, whether recognized or unrecognized, along with the source of the haemorrhage profoundly changes the outcome. It also alters the timing and strategy of surgery. In this study the experiences gained from 138 cases with a total of 317 aneurysms are discussed. The analysis of the clinical data, our results and the factors influencing the outcome suggest that the risk of clipping all aneurysms simultaneously are less than the risk of a rebleed from an untreated, previously silent sac even in the early postoperative period.

Testicular germ cell tumours. Current problems of histogenesis and classification

Testicular germ cell tumours, owing to their variety in biological behaviour and morphological appearance, claim a place of their own in clinical oncology and tumour research. Much of the histogenesis has remained unexplained, as reflected by the different systems of pathological classification. This report sums up, on basis of the literature, the current pathologic views on the question of testicular tumour genesis. Data obtained from immune histochemical examinations, animal experiments, ultrastructure studies, together with clinical observations, suggest that differentiation of the carcinomatous stem cells are apt to produce forms, transitional between seminomatous and non-seminomatous types of tumour. The possibility to set up a uniform, clinically appropriate nomenclature depends on the progress in histogenetic knowledge.

Ipratropium in the treatment of patients with perennial rhinitis

Rhinorrhea is due to increased parasympathetic activity. This study was undertaken in order to study the applicability and efficacy of ipratropium, an anticholinergic drug, in patients with perennial rhinitis seen in an allergy clinic. Thirteen patients were included in the double-blind, cross-over study following screening with methacholine test. The number of paper tissues used during the period with active drug decreased significantly. Other variables did not change significantly. Eight patients preferred the active drug. The findings of this study suggest that ipratropium bromide is a valuable addition in the treatment of patients with perennial rhinitis with rhinorrhea.

A contribution to the pathology and clinical features of granulomatous prostatitis

Two cases of granulomatous prostatitis are reported. The essential pathological and clinical features of the syndrome are discussed. It is emphasized that in case of enlargement and induration of the prostate and fusion of the organ with adjacent structures, differentiation of granulomatous prostatitis from prostatic cancer is not possible without biopsy.

[Nephropathies associated with monoclonal gammopathies--a clinico-pathological study (author's transl)]

The subjects of this paper proves unequivocally that the excretion of lambda light chains must be considered a nephrotoxic process. It should be stressed, that although only a relatively small number of cases are known, this view is justified. According to our present knowledge, the process is irreversible and lethal. That the time required for the development of renal insufficiency is long can be established even without objective measurements. Under these circumstances it is justified to apply every available treatment that promises the reduction of the concentration of nephrotoxic substances, and their effects. A technical solution for treatment is plasma exchange. Although it is no definite therapeutic factor, if applied repeatedly the administration of drugs, - sufficient care being taken to avoid excessive load on the patient, it may prolong his life (49).

Renal actinomycosis associated with bilateral necrosing renal papillitis

A rare case of renal actinomycosis with bilateral necrosing papillitis resulting in uraemia is reported. The part played in the process by the infection with Proteus vulgaris and the additional role of acute pancreatitis are discussed.

Serum 25-hydroxycalciferol concentrations in normal subjects and in haemodialysed patients with chronic renal failure

The serum 25-OHD3 concentrations were measured in 16 normal subjects and in 12 haemodialysed patients with chronic renal failure. The mean values found in the two groups were 27.8 +/- 17.8 ng/ml and 23.9 +/- 12 ng/ml, respectively. The difference between the two values is not significant.

Ultrastructure of different clinical forms of oral leukoplakia

Twelve cases of oral leukoplakia were studied at the light and electron microscopic levels. In clinical leukoplakia simplex and verrucosa, both light and electron microscopic investigations revealed evidence of increased keratinization. Clinically erosive and histiologically dysplastic leukoplakias showed ultrastructural alterations characteristic of oral carcinomas in some instances.

Secondary malignant tumors accompanied by primary hepatocellular carcinoma

The occurrence of liver cirrhosis and PHC cases were analyzed from the autopsy material of three hospitals. In the course of this work 13,369 autopsy reports were examined. In 339 cases liver cirrhosis was established, the frequency of association with PHC was 19.4% (66 cases). Out of 66 PHC cases 17 (25.6%) were associated with a secondary malignant tumor. This number is 10 times greater than that of other tumors of epithelial origin. It also exceeds the enlarged number of linked secondary tumors as shown in the case of certain lymphoproliferative diseases.

Lymphocyte activation and the increase of nuclear birefringence

Nuclear birefringence of neutral red or rivanol stained cell suspensions from rat spleen has been investigated. Polyclonal or monoclonal mitogens produced an increased birefringence of the nucleus following 30 min in vitro stimulation at 37 degrees C. The nuclear birefringence increased by 62.2% [p less than 0.001], when the cells were incubated in the supernatants of a previously phytohemaglutinin stimulated culture. Amantadine, a potent phytohemagglutinin inhibitor, was unable to prevent the effect of the supernatant, but heating for 1 h at 56 degrees C destroyed its activity. The results suggest that increase in nuclear birefringence is mediated by a soluble factor which is released in the course of lymphocyte activation. The nuclear birefringence of surviving cells from human spleens obtained within 6 to 24 h post mortem increases after in vitro stimulation.

Factors influencing the prognosis of acute renal failure. (Analysis of 228 cases)

Two hundred and twenty-eight patients were treated for acute renal failure between October, 1964, and December 31, 1976. Complex antiuraemic therapy has been applied in 96, and haemodialysis or peritoneal dialysis in 132 cases. The overall mortality rate was 40.7%. The part played by age, primary process and possible complications of acute renal failure in the mortality figures is examined. From the analysis of clinical features, infections and septicaemia emerge as primary factors responsible for the high mortality. In conclusion the therapeutic measures which may minimize the hazard of inflammatory complications are summed up.

A hitherto undescribed case of "collision" tumour: liposarcoma of the seminal vesicle and prostatic carcinoma

A hitherto undescribed type of the rare "collision" tumours is reported: necropsy in a 77-year-old male patient revealed liposarcoma of the right seminal vesicle in association with anaplastic carcinoma of the prostate. The carcinoma was fused with the liposarcoma as a result of its invasive local growth and had formed deposits in the lymph nodes, bones and lungs. The left seminal vesicle showed localized amyloidosis. A review of the published cases of mesenchymal tumours of the seminal vesicles is presented.