Eradication of brucellosis from a cattle herd in the Amazonian region (short communication)

The authors intend to elaborate a brucellosis eradication program which could be used in the Amazonian region, an area characterised by extremely extensive animal husbandry practices. Under such conditions, eradication by selection is the only feasible approach. Brucellosis has been successfully eradicated from a herd with 22.1% prevalence of infection by two serological surveys using an indirect ELISA and the complement fixation test.

[Iron deficiency anemia caused by an arteriovenous malformation in the distal ileum]

The case of a young woman with chronic iron deficiency anemia is described. Her consequent guaiac-positive stool suggested a gastrointestinal bleeding behind her anemia. The use of the conventional diagnostic techniques did not result in a definitive diagnosis. The source of the hemorrhage was later detected by the aid of selective mesenteric arteriography as an unusual form of arteriovenous malformations localized to the small intestine. 20 months passed since the resection of the affected intestinal segment. During this period of close follow up no clinical signs of recurrent gastrointestinal hemorrhage was observed. The authors briefly review the relevant literature.

[Striking increase in mortality from venous diseases in Hungary]

The statistical data of the World Health Organisation were studied from 1970 to 1990 to evaluate changes in mortality caused by venous diseases in 9 European countries and in the USA. The data were analysed in process and mortality rates in Hungary and in other countries were compared. In 1970 data based on general population of Hungary indicated medium incidence of mortality due to vein pathology (10.8/100,000) compared to the economically more developed countries. Unfortunately by 1990 mortality due to venous diseases almost had doubled (19.8/100,000). During this 20 years period mortality rates caused by venous diseases gradually decreased in the USA and in most European countries, e.g. by 80% in Austria and by 70% in Finland. Even the relatively high mortality caused by venous diseases in Switzerland (10/100,000) comprises only 50% of that demonstrated in Hungary. While the significance of modern thromboprophylaxis was recognised in the Western European countries and the USA in the early seventies, a delay of the introduction of prophylaxis with low-dose heparin was observed in Hungary. Socio-economic and nutritional causes could have been contributed to the high mortality rates caused by venous diseases as well. Further epidemiologic investigations focusing on venous morbidity factors and wide scale application of organised preventive programme are suggested.

Effect of i.v. dipyridamole on cerebral blood flow, blood pressure, plasma adenosine and cAMP levels in rabbits

In response to intravenous administration of dipyridamole, the quantitative and temporal changes in plasma adenosine and cyclic AMP (cAMP) levels in relation to the changes in cerebral blood flow (CBF) and mean arterial blood pressure (MABP) have not been studied. Therefore, we investigated simultaneously the changes in CBF (hydrogen and thermal clearance methods), MABP, plasma adenosine (HPLC) and cAMP (radioimmunoassay) levels for 1 h after intravenous injection of 0.7 and 1.4 mg/kg dipyridamole in rabbits. In separate experiments, only plasma adenosine concentrations were measured to determine how and for how long intravenous administration of 0.7 mg/kg dipyridamole is able to inhibit the removal of plasma adenosine. Dipyridamole decreased MABP, increased plasma adenosine and cAMP levels in a dose-dependent manner. The dose-dependency of increases in CBF could not be demonstrated owing to the marked hypotension. The increase in plasma adenosine concentrations was biphasic. The first peak could be detected at the end of the dipyridamole injection. The second peak occurred 20 min after drug administration, simultaneously with the maximal increases in plasma cAMP level and CBF, whereas the maximal fall in MABP developed earlier. Intravenous administration of 0.7 mg/kg dipyridamole inhibited adenosine uptake only by 25%, which lasted less than 10 min. We concluded that intravenously given dipyridamole is responsible only for the initial short-lasting elevation of plasma adenosine concentration, and is able to induce vasodilation without either dipyridamole itself or adenosine necessarily gaining access to the muscular layer.

Sensitivity of strains of Serpulina hyodysenteriae isolated in Hungary to chemotherapeutic drugs

The sensitivity of 332 strains of Serpulina hyodysenteriae isolated in Hungary between 1978 and 1992 was tested against seven chemotherapeutic drugs frequently used for the treatment of swine dysentery, and the changes in the patterns of resistance were also monitored. All the strains remained sensitive to carbadox, with minimum inhibitory concentrations (MIC) of only 0.05 to 0.40 microgram/ml at present. The susceptibility of the strains to dimetridazole has gradually decreased, but about half of the strains are still sensitive, with large numbers of "moderately sensitive' strains; the MIC values varied within wide limits (0.1 to 50 micrograms/ml). Most of the strains were resistant to tylosin, with MIC values from 0.1 to 100 micrograms/ml. The number of strains resistant to lincomycin has gradually increased, but about half of the strains remain sensitive; the MIC values ranged from 0.2 to 100 micrograms/ml. Recently, tiamulin has proved the most effective antibiotic, but some resistant strains have already emerged (MIC values 0.05 to 50 micrograms/ml). Monensin was good for the prevention of swine dysentery, but resistance may evolve quickly; the MIC values ranged from 0.4 to 25 micrograms/ml. For sedecamycin, the MIC values (6.25 to 100 micrograms/ml) were much higher than expected.

[Social and behavioral factors influencing caries intensity and oral hygiene in an adult population in Budapest (sociological implications of a dental-sociological survey)]

Authors examined 868, 15-69 age old, non-selected patients. The findings of dental aspects of the investigation were reported in this periodical (88, 95-112, 1995). The sociological analysis verified strong connection between oral status and social stratification. The authors found that differences in oral status on the basis of educational qualification are larger than the differences on the basis of occupations. The effects of social factors on oral health behaviour are stronger than on oral status. The authors found strong connection between patients' oral health behaviour and parents motivations for patients' body culture.

[Bronchiolitis obliterans organizing pneumonia: survey based on two cases]

Authors offer a survey about an aspect forming a clinical entity called bronchiolitis obliterans organizing pneumonia, by two of their patients' presentation. In Case 1 the process manifested in form of a disseminated, small spotted, diffuse shadow, causing serious resting hypoxia. Diagnosis was supported by histological examination of a substance obtained by small surgical thoracotomy. Five months' therapy of Imuran and altogether 15 months' therapy of Prednisolon resulted in recovery. Second patient's symptoms and the shadow representated in the left upper lung field on chest X-ray, proposed the probability of a tumour. The lesion removed surgically, together with the left upper lobe, proved to be the clinical appearance that constitutes histologically the subject of this paper. Surgery alone resulted in definitive recovery. Disease can be proved on the basis of histological picture and it's important to sunder it primarily from bronchiolitis obliterans as well as from other interstitial pulmonary diseases.

Beneficial vascular and metabolic effects of cobalt-ATP in spontaneously hypertensive rabbits with diffuse chronic cerebral ischaemia

The in vivo effects of adenosine triphosphate (ATP) have not been investigated in cerebrovascular diseases. The use of the long-acting cobalt-ATP complex (Co-ATP) permits us to observe the effects of ATP without the influence of its metabolites. This study was designed to compare the effects of intravenous Co-ATP on the cerebral blood flow (CBF), polarographically detected oxygen currents (O2a), mean arterial blood pressure (MABP), heart rate, respiration rate, cerebral electrical activity, arterial blood gases, pH, and glucose in 13 normotensive (NT) rabbits to those in 14 stroke-prone spontaneously hypertensive (HT) animals. CBF was measured by the hydrogen and heat clearance methods. In response to Co-ATP, MABP decreased and CBF increased significantly in both groups. The decrease in MABP was more marked in HT rabbits, while CBF response was 25% smaller than in NT animals. The ratio of O2a to CBF diminished moderately and simultaneously with the CBF increase in NT rabbits. In HT rabbits, the decrease in O2a/CBF was larger and began when CBF response reached its maximum. We suggest that despite the restricted CBF response, long-acting ATP should still be taken into consideration as a supplementary treatment of hypertensive encephalopathy because of its beneficial effects on cerebral metabolism and hypertension.

[Caries intensity and oral hygiene in adult dental patients in Budapest]

Authors examined 868, 15-69 age old, non-selected patients. DMF-T scores were between 7.8 and 24.69, DMF-S scores were between 14.78 and 67.39. Both data increased according to the age of the patients. The scores of the Periodontal Index (PI) were between 0.47 and 1.32, and the scores of the OHI-S between 1.10 and 1.59. Among those patients, who were non-smokers, and regularly visited their dentist, better dental status and oral hygiene could be observed.

[Dental status of 14-18-year old secondary school students in Budapest (VIII. District) in 1991. (Implications of a dental-sociological study)]

In this dento-sociological examination the dental status of 1623 secondary-school-students living in the capital of Hungary, was found better than that of the same-aged students examined previously. The number of decayed teeth was higher than the number of filled teeth. The average level of oral hygiene was found between "good" and "middle" levels. Among the three types of secondary schools the best oral hygiene status was found in the secondary grammar school.

[Aspiration of barium contrast medium and its prevention]

The authors have been noted aspiration bronchograms associated with barium-filling study of the upper gastrointestinal tract in 58 patients involving basal medial, anterior, lateral and posterior segments of the lower pulmonary lobes, mammary segment of the middle lobe, moreover inferior lingula. In 75.9% of patients (44 cases) the barium meal got to bilateral basal medial, anterior and lateral segments. The 34 men and 24 women had a mean age of 69 years (range, 29-88 years). The aspiration was found 3.8-times more frequent after completion of patient's 50th year than before it observed. A transient tertiary mobility disorder of the esophagus, extrasystoles and tendency for collapse were on barium-filling of bronchi. In 15 of the 18 patients the Valsalva's maneuver proved a pharyngomyodystonia. Carrying out of endoradiography depended on function of the lateral pharyngeal wall. The bronchi with physiological saline following aspiration of the contrast medium within 30 minutes were lavaged.

Effects of dipyridamole in spontaneously hypertensive rabbits with diffuse chronic cerebral ischemia

The effect of intravenous dipyridamole (0.7 mg/kg) on cerebral blood flow (CBF), mean arterial blood pressure (MABP), heart rate, respiration rate, cerebral electrical activity, arterial blood gases, pH, and glucose was investigated in 14 normotensive and 14 stroke-prone spontaneously hypertensive anesthetized rabbits. CBF was measured by hydrogen and heat clearance. In both groups, MABP decreased (normotensive: -24 mm Hg, hypertensive: -47 mm Hg; ANOVA: P < 0.0001) and CBF increased (normotensive: +59 ml/100 g/min, hypertensive: +72 ml/100 g/min; ANOVA: P < 0.0002). CBF returned to the initial level 21 min later in hypertensive than in normotensive rabbits. Changes in other parameters were insignificant. In additional experiments, 30 mg/kg theophylline entirely prevented the cerebral vasodilator and systemic hypotensive effects of dipyridamole in both normotensive and hypertensive rabbits. We conclude that, in stroke-prone spontaneously hypertensive rabbits, the longer-lasting and larger CBF increase in response to dipyridamole may be attributed to reversible functional changes in the cerebral vasculature resulting from hypertension.

[Breast-preserving operations in surgically treatable breast cancer]

Since 1980, based on international experience, breast conserving operations have been introduced at the Surgical Department, in the National Oncological Institute, Budapest. In 12 years, out of 4622 primary breast cancer operations, 1055 breast preserving interventions were carried out. For all patients adjuvant radiotherapy was indicated. In lymph node positive premenopausal cases chemo-radio-chemotherapy, for postmenopausal patients radiotherapy with tamoxifen has been provided. The first 604 patients (10 years) have been evaluated and 489 of them could be followed. The mean follow-up time was 49 months. During this period of time metastases have developed in 61 patients (12.5%); 26 (5.3%) of them died with the disease. Local recurrences occurred in 29 patients (5.9%). For small recurrences reexcision, for the others mastectomy or/and radiotherapy was carried out. Critical evaluation of the local recurrences was done.

[The effect of breach presentation on the development of the hips]

Authors examined, using sonographic methods in 100 children with breech-presentation, which of the intrauterine postures means a major danger in the development of hip dysplasia. It was found that acetabular alterations, requiring therapy or not, develop more frequently in groups in which the hips were in total flexion, the knees in semiflexion and the lower extremities in major external rotation. Based on their results they state that not the simple breech position is the greatest danger in the development of dysplasia and dislocation in babies born with breech presentation.

[Hand fractures and epiphyseal injuries in childhood]

Anatomic features of the hand in childhood are presented that are responsible for the types of certain injuries. On the basis of the data in the literature and of the authors' own experience of 92 cases the main points of the diagnosis and therapy of metacarpal and phalanx fractures are summarized. The possibility of finger-replantation is also mentioned. Their statements are illustrated by their own cases. In order to recognize late growth disturbances, the necessity of the follow up is emphasized.

Effects of carbon dioxide inhalation on cerebral blood flow and oxygen tissue level in spontaneously hypertensive rabbits

BACKGROUND AND PURPOSE

Because previous studies have yielded conflicting results, this study was designed to investigate the efficiency of cerebrovascular reactivity to carbon dioxide in hypertension associated with moderate diffuse cerebral ischemic lesions.

METHODS

The effects of carbon dioxide inhalation on mean arterial blood pressure, heart and respiration rates, cerebral cortical blood flow, polarographically detected oxygen currents (oxygen availability), and cerebral electrical activity were compared in 14 spontaneously hypertensive and 16 normotensive rabbits anesthetized with urethane and alpha-chloralose. Blood flow was measured with the hydrogen clearance and thermal clearance methods.

RESULTS

In the resting state the frequency of electrical activity shifted to slower components, the levels of oxygen availability and cerebral blood flow were lower (p less than 0.01), and the ratio of the two latter parameters was greater (p less than 0.01) in hypertensive rabbits than in normotensive animals. Carbon dioxide inhalation induced more marked increases in cerebral blood flow, respiration rate, and oxygen availability in hypertensive (p less than 0.01) than in normotensive (p less than 0.05) rabbits. The ratio of oxygen availability to cerebral blood flow decreased (p less than 0.01) in the former and did not change significantly in the latter group. The carbon dioxide-induced rise in blood flow was also slower and more protracted in hypertensive rabbits (p less than 0.01). Histological investigation revealed groups of neurons with ischemic changes in the cortex of the hypertensive rabbits.

CONCLUSIONS

We suggest that in hypertensive rabbits the mild multiple ischemic lesions are the basis of functional disturbances, including reduced resting cerebral blood flow, greater oxygen tissue level, slower response to carbon dioxide, and greater vasodilatory capacity.

[Experience with the surgical management of childhood fractures and epiphyseal injuries]

Authors analyse 1792 fractures in children, treated during 10 years in their Department and distributed in age groups. They take the part of conservative treatment of the majority, about two third, of fractures in childhood. They consider as operative indication certain forms of epiphyseal injuries, the dislocated intraarticular fractures, the unstable fractures, certain cases of polytrauma and the open fractures.

Difference between the cerebrovascular effect of purinergic Co-ATP and that of the cholinesterase inhibitor, physostigmine, in vivo

Development of the cerebrovascular effect of cobalt-ATP was compared to that of physostigmine in 34 anesthetized rabbits. The resting cortical cerebral blood flow (CBF) was estimated from the H2 clearance and the CBF changes by the heat clearance method. Systemic blood pressure, heart and respiratory rate and cerebral electrical activity were recorded simultaneously. In addition, we measured arterial glucose concentration, pH, PaO2 and PaCO2. Both drugs were found to induce a significant increase in CBF. However, the degree of the CBF increase induced by Co-ATP was inversely related, while that induced by physostigmine was directly related to both the baseline level of CBF and the value of PaCO2. We conclude that the cerebrovascular effect of ATP depends mainly on vessel tone, while the effect of physostigmine is related to the level of PaCO2.

[Immunologic studies in myelodysplastic syndrome]

Myelodysplastic syndrome is a clonal stem-cell disease, which predominantly involves myeloid cell lines. However, several observations refer to a possible pathological condition of the lymphoid system as well. Because of these controversial data, we investigated 25 patients with MDS at our clinic. Absolute lymphocyte counts, lymphocyte subpopulations (using methods of mAT, OKT 3, 4, 8, Leu7), T and B rosette tests and quantitative tests of immunoglobulins were made possibly during diagnosis or breaks in treatment. A significant ratio of our patients had lymphopenie. Using both rosette tests or mAT methods, the ratio of T-cells (primarily of T4-cells) reduced, and the decrease of NK-cells characterized with Leu7 mAT was also marked. Polyclonal hypergammaglobulinaemia could frequently and significantly be observed during immunoglobulin identification. All the observed abnormalities were rather marked in the group of patients with excess of blasts.

[Bronchoscopic appearance of the bronchial mucosa in pulmonary venous hypertension]

The authors studied the bronchoscopic appearance of bronchial mucosa's vessel contour in pulmonary venous hypertension in 20 patients with mitral stenosis and in 20 with cardiomyopathy and/or aortic vitium. The submucous venous congestion was scored on the base of its extent and severity according to Ohmichi. They have observed a linear relation between the PPA (wedge) and PPA values in patients with mitral stenosis and the total scores indicatory of submucous venous congestion. The mean total scores of patients with mitral stenosis as well as cardiomyopathic patients showing volume-loading of the pulmonary circuit and/or aortic vitium differed to the benefit of the former. Mucosa's vessel contour of grade 3 was found in 12 patients with mitral stenosis and only in 4 cases of cardiomyopathy and/or aortic vitium, so that is more characteristic of mitral stenosis. In spite of this, condition of patients with cardiomyopathy and/or aortic vitium are considered more severe on the base of NYHA values. Taking both patient populations into consideration relation between NYHA-phase and the degree of total scores could not have been proved. Venous congestion on lower part of the left main bronchus was observed in every patient. Appearance of congestive bronchial mucosa has not occurred in pure precapillary pulmonary hypertension.

[Data on possibilities of rehabilitation of lower limb amputees]

The authors investigated ways to improve the results of rehabilitation during the course of their clinical practice. During the last 2 years, amputation was performed on 136 patients and 50 patients were supplied with temporary protheses. 38 patients out of 50 answered the question form supplied. After analysis of the question form, the authors summarized the possibilities to improve the results of prolonged mobilisation and rehabilitation. This programme stresses the need for 1. early mobilisation-teaching to walk and 2. care of body and soul.