Commonsense design of patella implant: four years of clinical experience with 124 patients

BACKGROUND

Patella resurfacing in Total knee Arthroplasty still is an issue of controversy, that results from the statistically poor performance of patella implants. Since the basic fault of conventional designs, in our opinion, is the inadequate thickness of the polyethylene, an innovative patella was designed and rules of technique were set to optimize the surgical procedure.

METHODS

Since July 1998 we have employed the new patella in 124 consecutive patients undergoing total knee arthroplasty. They had the patella routinely resurfaced with an implant of a special design of a concave undersurface and a convex (dome) articulating surface. The thickness of the entire implant was uniform at all areas of contact. The bony patella was prepared with a concave reamer and shaped into a dome with a shallow central hole. Fixation with cement gave an optimally stable implant to shear forces and resistance to wear.

RESULTS

All patients were studied prospectively and followed up to five years. Results were related specifically to performance of the patella as a part of the entire joint. Two patients died from unrelated causes. Four patients had delayed wound healing. One sustained a transverse fracture of the patella already healed with minimal displacement when she came to our attention. One sustained avulsion of the patella tendon from the tuberosity, which underwent surgical reattachment. Rest pain score (10-0) improved from 5.2 to 0.5. Activity pain score (10-0) improved from 9.0 to 1.4. Walking score (0-10) improved from 3.2 to 8.2. Stairs negotiation (0-10) improved from 2.8 to 8.0 and ADL Function (0-10) improved from 4.3 to 8.2.

CONCLUSION

The special technique of resurfacing of the patella was developed during a short learning period. The new design of the patella implant, eight mm thick at any point of contact gave excellent and good results in 91%. There were no intra operative complications. During five years of follow up two complication were encountered and treated successfully: a minimally displaced transverse fracture and an avulsion of the patella tendon from the tuberosity. None of the patellae components required replacement. In our opinion the new design of bio-mechanically reliable patella implant will regain confidence of surgeons who presently refrain from patella resurfacing.

[Feminine pseudo-hermaphroditism and ovarian polycystic syndrome: the role of hydrocortisone]

We report the case of a patient who was initially assigned as a male, and in whom the diagnosis of CAH was delayed (17 years of age). He was shown to have female pseudohermaphrodites. Before treatment, plasma testosterone level was: 15 ng/mL (N: 0.1-0.7), 17 OH progesterone (17 OHP): 45 ng/mL (N: 0.1-1.1) and FSH, LH values were below the normal range. While taking hydrocortisone, a rapid onset of new clinical, biological and radiological findings were observed after three months: rapid menarche and thelarche occurred, plasma testosterone and 17 OHP levels decreased, respectively 1 and 3.7 ng/mL, plasma FSH and LH were respectively 4.1 mUI/mL (N: 1.5-7) and 14.3 m UI/mL (N: 1.1-11.7). Polycystic ovaries were shown at sonography. Authors try to discuss the mechanism of the new events observed and specially those related to the polycystic ovarian disease. In a female with untreated CAH at adult age, menarche can rapidly occur once appropriate treatment was started.

Ibn-Sina's concept of cardiovascular diseases

Ibn-Sina's description of cardiac diseases has been logically and scientifically presented perhaps for the first time in the history of medicine through a classified description of cardiac diseases. The terminology employed by him is basically Greco-Arabic. Ibn-Sina with his logical mind, classified drugs according to their potency of overcoming malhumours. He is the first physician to correlate the diseases of the heart with the temperament and psychic make up of an individual.

Long-term changes in Serengeti-Mara wildebeest and land cover: pastoralism, population, or policies?

Declines in habitat and wildlife in semiarid African savannas are widely reported and commonly attributed to agropastoral population growth, livestock impacts, and subsistence cultivation. However, extreme annual and shorter-term variability of rainfall, primary production, vegetation, and populations of grazers make directional trends and causal chains hard to establish in these ecosystems. Here two decades of changes in land cover and wildebeest in the Serengeti-Mara region of East Africa are analyzed in terms of potential drivers (rainfall, human and livestock population growth, socio-economic trends, land tenure, agricultural policies, and markets). The natural experiment research design controls for confounding variables, and our conceptual model and statistical approach integrate natural and social sciences data. The Kenyan part of the ecosystem shows rapid land-cover change and drastic decline for a wide range of wildlife species, but these changes are absent on the Tanzanian side. Temporal climate trends, human population density and growth rates, uptake of small-holder agriculture, and livestock population trends do not differ between the Kenyan and Tanzanian parts of the ecosystem and cannot account for observed changes. Differences in private versus state/communal land tenure, agricultural policy, and market conditions suggest, and spatial correlations confirm, that the major changes in land cover and dominant grazer species numbers are driven primarily by private landowners responding to market opportunities for mechanized agriculture, less by agropastoral population growth, cattle numbers, or small-holder land use.

[Pneumatic dilatation of caustic esophageal stenosis in children. Report of five cases]

The ingestion of caustic substances is a frequent accident in the child. The treatment of caustic strictures of the esophagus, which constitute the most frightening complication, varies from conservative treatment to esophageal replacement. We report the preliminary results of a prospective work established since July 1998 and aimed at evaluating the role of pneumatic dilatation in the treatment of these injuries.

STUDIED POPULATION

The series included five boys with an average age of six years. Two children were neurologically handicapped.

RESULTS

The caustic product was soda (three cases), a dishwasher solution (one case) and bleach (one case). Dysphagia was constant and concerned the semi-fluids in four cases. The stricture was extended over an average length of 4 cm. The total number of dilatations was 36, with an average of seven sessions/patient. No complication was noted. The result was good in four cases. The only failure was noted in a child who presented a gastroesophageal reflux secondary to the scarring phenomena.

CONCLUSION

Pneumatic dilatation constitute a therapeutic mean whose results are attested. The best treatment remains, however, preventive: it is the setting out of reach of the child the dangerous products.

The biomechamcal and surgical solutions for patella implant in total knee arthroplasty

A basic fault in designs of patella implants that calls for a prompt remedy is the inadequate polyethylene thickness in contact areas. The requirement for thickness of patella implants should be similar to the requirement set up by the FDA in 1993 regarding the tibial implants, that is, a minimal thickness of 8 mm. A solution is presented for the optimal design of the patella implant and for the appropriate surgical technique. The implant's undersurface that fixes to bone is concave and has a 1-cm wide but 5 to 6 mm short central peg that does not risk the integrity of the bone. Fixation of the concave aspect to the convex aspect of the bony patella strongly enhances resistance to medio-lateral and supero-inferior shear forces. The circumferential facet of the implant 8 mm thick assures uniform thickness of the entire implant and assures optimal mechanical properties of the polyethylene. The articulating surface is tailored to conform to the corresponding femoral trochlear groove and condyles. It can be made to fit any femoral component of any knee implant.

Large bilateral adrenal incidentalomas complicating untreated 11B hydroxylase deficiency in the third decade of life. A case report

The occurrence of bilateral giant adrenal incidentalomas is reported in a 22-year-old man who was evaluated for urinary tract infection. The right gland measured 16 cm, the left one 6 cm at computed tomography. Height was 145 cm, blood pressure 190/100 mm Hg. Testes were not palpable. Laboratory investigations revealed elevated levels of 17 hydroxyprogesterone:>50 ng/ml (n<1,1); 11 desoxycortisol: 919 nmol/l (n<30); testosterone: 19 ng/ml (n<0.7) and ACTH: 1 402 ng/l (n<48). Karyotype was 46 XX. The patient was a female pseudohermaphrodite with congenital adrenal 11 B hydroxylase deficiency. Adrenal masses responded to glucocorticoid therapy with marked reduction of their size after six months. We confirm previous recommendations that patients with adrenal incidentaloma should be checked for congenital adrenal hyperplasia.

Mechanism of inhibition of rat liver bilirubin UDP-glucuronosyltransferase by triphenylalkyl derivatives

A series of potent and competitive inhibitors of UDP-glucuronosyltransferase derived from 7,7,7-triphenylheptanoic acid has been synthesized in order to probe the active site of the isozyme involved in the glucuronidation of the endogenous toxic compound, bilirubin IX alpha. Like triphenylalkylcarboxylic acids, triphenyl alcohols were found to be very effective competitive inhibitors of the reaction (Ki 12 to 180 microM). Superimposition of the best inhibitors with bilirubin by computer modeling showed a marked spatial similarity, which accounts for the observed competitive-type inhibition. The bulky triphenylmethyl moiety of the inhibitor superimposed well on the part of the bilirubin molecule containing three of the four pyrrole rings. In agreement, substitution of the triphenylmethyl moiety by planar structures such as fluorenyl or indenyl rings completely suppressed the inhibition. In addition, the weak inhibition exerted by the shortest carboxylic acids could be related to the higher acidity of these molecules. The inhibition potency depended on the acidity of the molecules; the more acidic, the less inhibitory, suggesting that the presence of a negative charge on the inhibitor molecule prevents bilirubin glucuronidation. Based on these results, a reaction mechanism for bilirubin glucuronidation is postulated.

Endoplasmic reticulum contribution to the relaxant effect of cGMP- and cAMP-elevating agents in feline aorta

The contribution of endoplasmic reticulum (ER) and phosphorylation of phospholamban (PLB) to the relaxant effect of cGMP- and cAMP-elevating agents was studied in feline aorta. Sodium nitroprusside (NP, 100 microM) completely relaxed contracture induced by 10 microM norepinephrine. This NP-induced relaxation was partially prevented by tetraethylammonium, suggesting that a fraction of NP-induced relaxation was mediated by activation of K(+) channels. In the absence and presence of tetraethylammonium, the relaxant effect of NP was associated with a significant increase in Ser(16) phosphorylation of PLB immunodetected by phosphorylation site-specific antibodies. The relaxant effect of NP on aortic strips precontracted with 80 mM KCl was significantly reduced by 1 microM thapsigargin. This decrease, which represents the ER contribution to the relaxant effect of NP, reached 23 +/- 9% at 100 microM NP and was closely associated with a dose-dependent increase in Ser(16) phosphorylation (128 +/- 49% over control at 100 microM NP). Effects of NP were associated with a significant increase in activity of protein kinase G and were mimicked by 8-bromo-cGMP. Forskolin produced a dose-dependent relaxant effect on KCl-induced contracture, which reached 64 +/- 8% at 50 microM and was associated with an increase in phosphorylation of Ser(16) residue of PLB (88 +/- 18% over control). Thapsigargin reduced this relaxant effect by 38 +/- 9%. 8-Bromo-cAMP mimicked effects of forskolin. The ER-mediated relaxant effect and the increase in Ser(16) phosphorylation produced by forskolin were partially blocked by the protein kinase A inhibitor H-89 (5 microM). The results indicate that ER partially contributes to the relaxant effect of NP and forskolin in feline aorta. This effect may be mediated by the associated increase in Ser(16) phosphorylation of PLB.

Caffeine and theobromine levels in chocolate couverture and coating products

Thirty-two samples of chocolate products were analysed by HPLC for caffeine and theobromine contents. Defatted residues of samples were extracted with 80% aqueous acetone. After extraction into boiling water, the methylxanthines were identified and quantified with the use of μ-Bondapak column and mobile phase of methanol:water:acetic acid (20:79:1). Levels of caffein and theobromine in 32 samples of chocolate products averaged 0.62-1.14 mg/g and 0.026-0.153 mg/g respectively. Mean values for theobromine and caffeine content for chocolate coating were 0.82 and 0.07 mg/g respectively. The chocolate coating made from fat substitute had theobromine and caffeine levels ranging from 0.36-0.70 mg/g and 0.027-0.061 mg/g respectively, with mean values of 0.49 mg theobromine/g and 0.039 mg caffeine/g. In local chocolate, the mean theobromine and caffeine levels respectively were 0.72 mg/g and 0.04 mg/g in milk chocolate, and 0.85 mg/g and 0.06 mg/g in dark chocolate. Meanwhile, for imported chocolate, the mean theobromine and caffeine levels respectively were 1.05 mg/g and 0.12 mg/g in dark chocolate; 0.76 mg/g and 0.04 mg/g in milk chocolate; and 0.74 mg/g and 0.03 mg/g in white chocolate. Compared with the local chocolates, imported chocolates had higher levels of theobromine and caffeine at 1.141 mg/g and 0.1533mg/g. The average theobromine and caffeine concentrations in local chocolate were 0.082mg/g and 0.066mg/g. Theobromine concentration in chocolate samples is within the range of 0.62mg/g-1.141mg/g and the range of caffeine concentration is 0.026mg/g-0.153mg/g respectively. Bittersweet chocolates were found to have higher theobromine and caffeine concentrations than normal sweet chocolates and milk chocolates.

Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography

Spontaneous portosystemic venous shunts (SPVSs) within the hepatic parenchyma are rare. Fewer than 50 cases have been reported, and most of them were diagnosed by angiography. We present a case of SPVS diagnosed by color Doppler sonography in a 5-year-old boy admitted for bleeding due to rupture of esophageal varices. Conventional color and power Doppler sonography as well as CT showed a large shunt between the posterior branch of the right portal vein and the inferior vena cava. We believe that accurate diagnosis and follow-up of SPVS can be done with color Doppler sonography without resorting to angiography.

[Testicular microlithiasis]

Testicular microlithiasis is an uncommon condition in which calcified concretions fill the lamina of seminiferous tubules. It has a specific appearance on sonography with diffuse intra testicular echogenic foci without acoustic shadows. Testicular microlithiasis can be associated with various entities and frequently with primary testicular neoplasm. The authors report a new case of testicular microlithiasis diagnosed by sonography in a 14-year-old boy with epididymo-orchitis. Based on a review and discussion of the literature, the authors emphasize the importance of regular and protracted ultrasound follow-up and monitoring of serum tumour markers to allow early detection of primary testicular neoplasm.

Mechanisms involved in the acidosis enhancement of the isoproterenol-induced phosphorylation of phospholamban in the intact heart

Previous experiments have shown that acidosis enhances isoproterenol-induced phospholamban (PHL) phosphorylation (Mundiña-Weilenmann, C., Vittone, L., Cingolani, H. E., Orchard, C. H. (1996) Am. J. Physiol. 270, C107-C114). In the present experiments, performed in isolated Langendorff perfused rat hearts, phosphorylation site-specific antibodies to PHL combined with the quantitative measurement of 32P incorporation into PHL were used as experimental tools to gain further insight into the mechanism involved in this effect. At all isoproterenol concentrations tested (3-300 nM), phosphorylation of Thr17 of PHL was significantly higher at pHo 6.80 than at pHo 7.40, without significant changes in Ser16 phosphorylation. This increase in Thr17 phosphorylation was associated with an enhancement of the isoproterenol-induced relaxant effect. In the absence of isoproterenol, the increase in [Ca]o at pHo 6.80 (but not at pHo 7.40) evoked an increase in PHL phosphorylation that was exclusively due to an increase in Thr17 phosphorylation and that was also associated with a significant relaxant effect. This effect and the phosphorylation of Thr17 evoked by acidosis were both offset by the Ca2+/calmodulin-dependent protein kinase II inhibitor KN-62. In the presence of isoproterenol, either the increase in [Ca]o or the addition of a 1 microM concentration of the phosphatase inhibitor okadaic acid was able to mimic the increase in isoproterenol-induced Thr17 phosphorylation produced by acidosis. In contrast, these two interventions have opposite effects on phosphorylation of Ser16. Whereas the increase in [Ca]o significantly decreased phosphorylation of Ser16, the addition of okadaic acid significantly increased the phosphorylation of this residue. The results are consistent with the hypothesis that the increase in phospholamban phosphorylation produced by acidosis in the presence of isoproterenol is the consequence of two different mechanisms triggered by acidosis: an increase in [Ca2+]i and an inhibition of phosphatases.

[Imaging of meconium peritonitis of pseudotumor clinical presentation]

An unusual case of meconium peritonitis is reported. A neonate presented with a huge multiseptate effusion in the peritoneal cavity in relation with a small bowel perforation. No calcification was visible. Such a presentation cannot be included in one of the classical types of meconium peritonitis. It could be due to a bowel perforation occurring immediately before birth and could therefore be related to a mixed fibroadhesive and generalized form.

The descending septal branch (Bonapace's branch). A case report and literature review of this often forgotten branch. First description in vivo

We present a 51-year-old female with exertional angina pectoris and a normal coronary angiogram who had a prominent descending septal branch originating from the proximal right coronary artery. This branch was perfused in the antegrade direction and did not show the tortuosity typical of coronary collaterals. The branch was almost 1 mm in diameter and supplied the middle third and basal two-thirds of the interventricular septum. The right coronary artery and this branch were free of coronary obstructions. The descending septal branch, described in 1921 by Crainicianu in a postmortem study, occurs in 12 to 85% of human hearts, but is still widely unknown. A review of the literature is also provided with special consideration of the functional importance of the condition and its prevalence in human and animal hearts. As far as we are aware, such a well developed descending septal branch in human hearts has not been described before. This is also the first description of a descending septal branch in vivo.

Colonoscopic diagnosis and treatment of acute appendicitis

An atypical case of acute appendicitis is reported, in which the initial presentation was not suggestive of this diagnosis. A routine work-up revealed elevated levels of inflammatory markers, an ultrasonographically normal abdomen and normal endoscopic findings in the upper gastrointestinal tract. During colonoscopy, performed 3 days after admission, the inflamed appendiceal orifice was localized and intubated using an endoscopic retrograde cholangio-pancreatography (ERCP) catheter; pus was aspirated. Elective appendectomy was carried out 5 months later on the asymptomatic patient. Histological analysis revealed fibrous thickening of the appendiceal wall, correlating with an old inflammatory process, along with changes typical for acute ulcerophlegmonous appendicitis. To the best of our knowledge, this is the first case of an endoscopically diagnosed and treated acute ulcero-phlegmonous appendicitis. We draw the following conclusions: (1) Acute appendicitis may present atypically, leading to an extensive clinical work-up including gastroscopy and colonoscopy. (2) This condition may be effectively treated, at least temporarily, by colonoscopic suction of appendiceal pus, provided that clinical urgency for laparotomy is absent. (3) Histological changes typically associated with acute ulcero-phlegmonous appendicitis may be present in asymptomatic patients and in patients without fever and with normal erythrocyte sedimentation rates and blood leucocyte counts. (4) Elective appendectomy should be considered in patients with conservatively healed acute appendicitis or periappendiceal abscess.

The effects of exercise induced tachycardia on the maternal electrocardiogram

OBJECTIVE

To determine whether pregnancy has an effect on the maternal electrocardiographic response to stress.

DESIGN

Eight maternal ECG parameters were screened before, during and after exercise induced tachycardia at 29 and 37 weeks gestation and at 6 weeks post partum for each participant.

SETTING

General Hospital in Safed, Israel.

SUBJECTS

Fifteen healthy, pregnant women aged 22 to 34 years with singleton pregnancies volunteered from the peripheral antenatal clinics.

INTERVENTION

Exercise stress tests were performed on a Quinton 3000 treadmill stress test system according to a Modified Bruce Protocol, producing a heart rate of 85% of age predicted maximum.

MAIN OUTCOME MEASURES

The ST-segment, T-wave, QRS complex, axis, rhythm, disorders of impulse conduction, the P-Q and Q-T intervals were screened before, during and after the exercise test.

RESULTS

The study results suggest an increase in the ST-segment changes induced by stress at 37 weeks of pregnancy compared to 29 weeks (ST-depression in 6 women out of 15 versus 2, P = 0.125, McNemar's Test for Correlated Proportions-Exact Test, two tailed; 95% CI, 0.042-0.492, 0.01 < P < 0.05) and to the post partum test (ST-depression in 6 women out of 15 versus 1, P = 0.125; 0.029-0.637, 0.01 < P < 0.05). No significant alteration of the other ECG parameters. No significant correlation between blood haemoglobin level, serum levels of sodium, potassium, calcium, glucose and 17 beta-oestradiol with the appearance of the ECG change.

CONCLUSIONS

The increase in the exercise induced ST-segment abnormalities at 37 weeks of pregnancy may be another physiological effect of late pregnancy which has not been demonstrated previously.

Selective and potent inhibition of different hepatic UDP-glucuronosyltransferase activities by omega,omega,omega-triphenylalcohols and UDP derivatives

A homologous series of omega,omega,omega-triphenylalcohols and corresponding omega,omega,omega-triphenylalkyl-UDP derivatives was synthesized and tested as inhibitors of UDP-glucuronosyltransferase (UGT) activity in rat liver microsomes, with 1-naphthol, testosterone and bilirubin as substrates. Introduction of the UDP moiety in the triphenylalcohols increased their inhibition potency markedly toward the isoforms which glucuronidate 1-naphthol and testosterone, but strongly decreased that toward bilirubin. The inhibiting potency of the UDP-derivatives increased as a function of the length of the hydrocarbon chain. The best inhibitor 7,7,7-triphenylheptyl-UDP showed an I50 of 30 and 10 microM for 1-naphthol and testosterone glucuronidation, respectively; even a 1 mM concentration of the compound had little, if any, effect on bilirubin glucuronidation. The inhibition by 7,7,7-triphenylheptyl-UDP was mixed-type toward 1-naphthol, and non competitive toward testosterone (apparent K(i) 30 microM and 1.7 microM, respectively); on the other hand, the inhibition was competitive toward the common substrate UDP-glucuronic acid (apparent K(i) 1.9-1.2 microM). In addition, 7,7,7-triphenylheptyl-UDP (0.25-0.50 mM) almost inhibited glucuronidation of 1-naphthol and testosterone catalyzed by the recombinant rat liver UGT-2B1 and human liver UGT-1A1, whose cDNA has been expressed in V79 cells. In conclusion, the data indicate that 7,7,7-triphenyheptyl-UDP interacted competitively with the UDP binding site of UGT. The results also indicate that it is possible to design transition state analogue inhibitors with specificity for different UGT forms.

[Peripelvic tumors: approach and management]

The peripelvic area consists of the bony pelvis, hip joints and adjacent mesenchymal soft tissues. Malignant lesions in this area present unique diagnostic and therapeutic problems, in particular when tumor removal is involved. Between 1986 and 1988 we treated 7 females and a male, aged 8-75 years, for malignant tumors of this area. Diagnoses (histologic) included 4 cases of malignant fibrous histiocytoma, a malignant schwannoma, a Ewing sarcoma, a chondrosarcoma, and an osteosarcoma. Operations included marginal resection (4 cases), radical resection and reconstruction (2), radical resection (1), and modified hemipelvectomy (2). Adjuvant therapy consisted of radiotherapy in 1 case, chemotherapy in 2, and a combination of both in another 2. A patient who underwent radical resection and reconstruction of his left hemipelvis and hip joint died of local infection that progressed to generalized sepsis 2 months after operation. 2 patients died of recurrent disease, 3 and 30 months, respectively, after primary therapy. 1 died of myocardial infarction 20 months after the first and 3 months after the last of a series of marginal resections. 3 patients are alive and well 3-24 months following their first operation, and the fourth is doing well 24 months following first operation and 23 months after resection of lung metastases. Soft tissue sarcomas and osteosarcomas are the most frequent malignant tumors encountered in the pelvis and peripelvic areas. Their varying grades of malignancy and metastatic potential influence the approach on the one hand, while invalidity and compromised quality of life associated with tumor resection, influence it on the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Dot-ELISA, a potential immunoassay for the detection of Plasmodium falciparum antibodies

The dot enzyme-linked immunosorbent assay (dot-ELISA) was compared to the indirect immunofluorescent assay (IIFA) and radioimmunoassay (RIA) for the detection of malaria antibodies. Of 281 sera tested by dot-ELISA, 220 were from Ethiopia, 11 from the Sudan, and 50 from Egypt. A close correlation between the dot-ELISA and RIA results was observed in 92% of the 220 Ethiopian cases. Of the remainder, 6% gave positive RIA and negative dot-ELISA results, and 2% gave positive dot-ELISA and negative RIA results. Antibody titres determined by dot-ELISA and RIA were positively correlated in 10 of the 11 Sudanese cases tested by direct microscopical examination. The eleventh case was positive by dot-ELISA at 1:1000 dilution, but negative by RIA and direct examination. With the 50 Egyptian sera, the dot-ELISA results showed close correspondence to the IIFA results, but the dot-ELISA was 20-40 fold more sensitive than the IIFA. To test specificity, 62 samples from patients with 11 different diseases and conditions were examined by dot-ELISA. No malaria antibodies were detected in any of these or in sera from healthy controls. Dot-ELISA is a potentially useful method for sero-epidemiological studies of malaria.

Ketotifen in the treatment of infants and young children with wheezy bronchitis and bronchial asthma

Ketotifen, an orally-administered anti-anaphylactic and antihistamine compound, was given in a dose of 0.06 mg/kg to 142 infants and young children presenting either with non-infected wheezy bronchitis or bronchial asthma to an allergy out-patient department. Treatment continued for 12 weeks. At the end of this time, ketotifen was considered to be very effective or effective in 70% of the children. The effect was more marked in non-infected wheezy bronchitis (83.55% response) than in bronchial asthma (56.5% response), perhaps because factors such as leukotrienes, prostaglandins and thromboxanes tend to produce a sustained bronchoconstriction in the latter condition. Ketotifen was not associated with any adverse effects and did not cause behavioural problems. Patients found it palatable and acceptable. The main disadvantage was that symptoms recurred within days of stopping treatment. Especially in non-infected wheezy bronchitis, ketotifen should be given for a year or longer to older children (older than 30 months) who have shown an initial good response to the drug.

Recent results of the German Thorotrast study--dose relevant physical and biological properties of Thorotrast equivalent colloids

As a prerequisite for quantifying the non-radiation effect of Thorotrast, nonradioactive and radioactive aquasols with identical physicochemical properties and with biophysical behavior comparable to that of Thorotrast were developed and produced for a second long-term animal experiment. Comparative investigations with hafnium and zirconium (zirconotrast) dioxide aquasols showed the latter to be most appropriate considering the size of both the dispersoids and the aggregates in the liver tissue. The average particle diameters of ThO2, ZrO2 and HfO2 proved to be values of 9.3 nm, 15 nm and 45 nm, respectively. The size of the aggregates shows a slight dependence on the applied amount but no dependence on the duration of body burden of the colloid. The aggregate diameters in the 600 microliters group turned out to be 9.6 microns, 14.4 microns and 5.3 microns, respectively. Radioactive zirconotrast was prepared by radiochemical incorporation of 230Th and 228Th at dose rates which produce accumulated doses in the liver of rats equivalent to those of commercial 230Th enriched Thorotrast after 1.5 yr. Five different colloids were prepared with alpha-energy emission rates increased by factors of 1, 2.5, 5, 10 and 25 compared to Thorotrast and then injected into rats.

[Varying utilization of glucose and sorbitol in drug-induced hypercortical metabolism]

Utilisation of glucose and sorbitol in medically induced hypercorticalic states was investigated by means of the steroid-glucose-tolerance-test (SGTT) in 9 children, aged 6-16 years suffering from obesity and prediabetes. Prednisolone (1 mg/kg up to 20 mg) was applied 9 and 3 h prior to the loading tests. Blood samples were taken 0, 2, 5, 30, 60, 90, 120, 150 and 180 min after the onset of the loading tests. During the intravenous infusion of glucose (initial 0,33 g/kg followed by 12 mg/kg/min through 2 h) the mean blood glucose values increased from 103 +/- 15,5 to 388 +/- 96,6 mg/100 ml. Decrease of glycemia began delayed after 90 min, and did not approach the 180 min normal values in 3 of 9 patients. In analogous sorbitol-loading tests performed 2 to 6 days later blood glucose rose from 93 +/- 16,6 mg/100 ml to 129 +/- 28,7 mg/100 ml only. There was a significantly higher blood glucose level on SGTT as compared to steroid-sorbitol loading through the whole test period. Renal losses of glucose after SGTT as well as sorbitol losses after steroid-sorbitol loading amounted to approximately 14% of the doses supplied. The resulting data point to the advantages of combined glucose and non-glucose carbohydrate application for parenteral nutrition in medically induced and postoperative hypercorticalic states of metabolism.

Cell mediated immune (CMI) responsiveness to soluble egg antigen (SEA) and its relation to the occurrence of schistosomal hepatosplenic disease in patients with schistosomiasis mansoni

The delayed intradermal test and migration inhibition tests were used to assess the delayed hypersensitivity in patients with BHF and simple intestinal bilharziasis using SEA. All bilharzial patients gave a positive intradermal test. The specificity of the intradermal test using SEA is demonstrated clearly by the negative response in all control groups.

The treatment of tuberculous meningitis in children with a combination of isoniazid, rifampicin and streptomycin--preliminary report

Twenty two children with tuberculous meningitis were treated with isoniazid, streptomycin and rifampicin and 19 were treated with isoniazid, PAS and streptomycin for at least 18 months. Both groups received corticosteroids at the beginning of treatment. The 2 groups were compared for clinical and neurological improvement, rate of recovery, the presence of neurological sequelae and for mortality. The drug toxicity of both regimens was also compared. The rate of recovery in the first 2 months of treatment was slightly more rapid in group I than in group II and neurological sequelae were less frequent in group I than in group II, but the differences between the groups were not statistically significant. There was very little difference in the death rate in both groups. A high incidence of jaundice was found amongst the children who received rifampicin.

The treatment of tuberculous meningitis in children with A combination of isoniazid, rifampicin and streptomycin (a preliminary report)

Twenty-two cases of tuberculous meningitis have been treated with isoniazid, streptomycin and rifampicin and 19 cases with isoniazid, P.A.S. and streptomycin. Both groups received corticosteroid at the beginning of the treatment. The 2 groups were compared on the clinical and neurological improvement, duration of necessary hospitalization, the presence of sequelae, and the death rate. Also the tolerability of both regimens was compared.

Thyroid function in hepatic schistosomiasis

Serum thyroxine (T4), serum tri-iodothyronine (T3-uptake) and the free thyroxine index in 17 men suffering from hepatosplenic schistosomiasis did not differ significantly from those of ten healthy male controls. There was no correlation between these values and serum protein levels or liver function tests.

Intravenous fat tolerance in hepatic schistosomiasis

The elimination rate of lipid after a single intravenous dose of an artificial fat emulsion was studied in 13 schistosomal patients and 13 controls. A strikingly significant lower level was found in the mean incremental values of TG ten minutes after injection in the schistosomal patients than the controls. The shape of the curve up to 120 minutes after injection was of zero order in the controls but exponential in the schistosomal patients. The possible factors responsible for these differences are discussed.

Portal hypertension

A case of portal hypertension in a 9-year-old Indonesian female child is presented. The diagnosis was made by demonstrating oesophageal vanices radiologically and surgically, and by measuring the portal venous pressure. Portocaval side to side shunt was done resulting in diminishing of the oesophageal varices, disappearance of hypersplenism, and a normal portal venous pressure. Continuous observation is recommended despite the relative good prognosis.