Effect of a zinc-fortified formula on immunocompetence and growth of malnourished infants

This study attempted to define the possible contribution of zinc nutrition to immunocompetence and growth in severely malnourished infants. The effect of zinc supplementation was evaluated in marasmic infants during nutritional rehabilitation by using a controlled double-blind design in which 19 infants fed a zinc-fortified formula were compared with 20 infants fed the same non-supplemented formula. Evaluation of immunocompetence, growth, and zinc, copper, and iron status was performed on admission and at 30, 60, and 105 d of nutritional rehabilitation. Although energy intake was similar in both groups, the zinc-supplemented infants had significantly higher linear growth gain, and their immune function improved as demonstrated by conversion of their delayed hypersensitivity skin reactions, enhanced lymphoproliferative response to PHA, and increased salivary IgA concentrations. Thus, the use of a zinc-fortified formula during nutritional rehabilitation can prevent the development of zinc deficiency and improve growth and immune function.

Somatosensory evoked potentials in juvenile myoclonic epilepsy

We analyzed the somatosensory evoked potentials (SEP) of 35 patients with juvenile myoclonic epilepsy (JME), 26 patients with idiopathic generalized epilepsy (IGE), and a control group consisting of 24 healthy people. The N19-P25 interval was significantly prolonged in the IGE group both as compared with the JME and control groups. This finding may be related to antiepileptic drug (AED) treatment, principally phenytoin (PHT). No differences were noted in N19 amplitude in any group. The P25 and N33 amplitudes were significantly higher in the JME group. In 5 patients of the JME group (14%) "giant SEP" were observed, but no differences were evident in the electroclinical characteristics with respect to the other JME patients. JME is one of the causes of giant-SEP.

A Pan-American 5-year study of fluconazole therapy for deep mycoses in the immunocompetent host. Pan-American Study Group

Eighty-eight immunocompetent patients with deep mycoses from eight countries were evaluated with the same protocol for efficacy of fluconazole monotherapy. Entry doses were raised from 100 to 400 mg as safety was shown in initial cohorts, and dosages up to 2,400 mg daily and durations up to 44 months were studied. Results were very similar in different countries. Twenty-seven of 28 evaluable patients with paracoccidioidomycosis, 13 of 19 with sporotrichosis, 14 of 16 with coccidioidomycosis, and eight of eight with histoplasmosis demonstrated objective responses to therapy, as did one patient each with zygomycosis and alternariosis. For these patients, relapses have been unusual thus far. In contrast, one patient with chromoblastomycosis responded but relapsed, and six did not respond; one patient with mycetoma responded but relapsed, and two did not respond. The drug was well tolerated by patients, including six who received intravenous therapy. In vitro susceptibility tests suggested that clinical response was correlated with susceptibility but that resistance did not preclude clinical response. Fluconazole therapy appears efficacious for several deep mycoses; dosages of greater than 200 mg daily may be needed for some diseases. The further evaluation of fluconazole for these entities is warranted.

Prediction of malignant hyperthermia susceptibility in low-risk subjects. An epidemiologic investigation of caffeine halothane contracture responses. The North American Malignant Hyperthermia Registry

The most commonly used laboratory test for predicting malignant hyperthermia susceptibility is the caffeine halothane contracture test. However, the specificity and sensitivity of proposed North American diagnostic guidelines for this test have never been evaluated in a large, human study population. Therefore, the authors conducted a multiinstitutional, prospective study of skeletal muscle contracture responses in a subject population at low risk for malignant hyperthermia susceptibility to help determine the specificity of the proposed guidelines. Subjects were selected arbitrarily from a population of patients undergoing surgery unrelated to performance of a diagnostic muscle biopsy. Subjects were admitted to this study and were presumed nonsusceptible if there was no evidence of any of the following malignant hyperthermia risk factors: prior abnormal response to triggering anesthetic agents, myopathy, or family history of malignant hyperthermia susceptibility. The authors suggested rejection of the proposed diagnostic guidelines if an 85% specificity estimate among subjects could not be obtained. The authors analyzed the responses of 1,022 muscle fascicles, derived from 176 subjects, to the following: 1) separate administration of 3% halothane or incremental caffeine concentrations, or 2) the joint administration of 1% halothane and incremental caffeine concentrations. The following contracture results were obtained. First, for individual fascicles, 9.2% exceeded a greater than 0.7 g threshold for 3% halothane, 15.2% exceeded a greater than or equal to 0.2 g threshold for 2 mM caffeine, 32.4% exceeded a 1-g increase for less than 4 mM caffeine, 2.6% had a greater than 7% maximal increase in tension at 2 mM caffeine, and 63.5% had a "halothane caffeine-specific concentration" at less than or equal to 1 mM caffeine. Second, the percentages of subjects with 1 or more fascicles exceeding the proposed threshold were as follows: 45.8% for the four-component, 28.8% for the three-component, and 32.7% for the two-component contracture test. Third, the percentages of subjects with 1 or more fascicles exceeding the proposed threshold for both halothane and caffeine were as follows: 9.5% for 3% halothane and 2 mM caffeine, 2.0% for 3% halothane and 7% maximal increase in tension at 2 mM caffeine, and 11.0% for 1% halothane and 2 mM caffeine. Fourth, center-to-center differences were the major source of variation in the rate that subjects exceeded proposed thresholds. These data demonstrate that proposed diagnostic guidelines must be modified to improve specificity estimates before adoption by diagnostic centers.(ABSTRACT TRUNCATED AT 400 WORDS)

Itraconazole in the treatment of coccidioidomycosis

Sixteen patients with coccidioidomycosis were treated with itraconazole for one year. Sixteen suffered from pulmonary coccidioidomycosis, two of them had associated mediastinal lesions, and one suffered from skin coccidioidomycosis. The daily dose used was 400 mg during the one-year period. Patients were clinically evaluated every month and tested for mycosis every three months. All patients except for one showed negative cultures on the third month after treatment began. Effectiveness achieved was excellent in eight patients (50 percent); a very good response was found in seven patients (44 percent); no response was seen in one patient (6 percent). There were four (25 percent) relapses and one dropout. Side effects seen were high blood pressure (19 percent) and lower limb edema (6 percent), which was temporary and at no time required discontinuing the drug therapy. We believe that itraconazole is an effective drug to treat coccidioidomycosis with a wide safety margin. It is well tolerated, and the incidence of relapses was low.

Isolation and characterization of Schizosaccharomyces pombe mutants defective in cell wall (1-3)beta-D-glucan

Schizosaccharomyces pombe thermosensitive mutants requiring the presence of an osmotic stabilizer to survive and grow at a nonpermissive temperature were isolated. The mutants were genetically and biochemically characterized. In all of them, the phenotype segregated in Mendelian fashion as a single gene which coded for a recessive character. Fourteen loci were defined by complementation analysis. Studies of cell wall composition showed a reduction in the amount of cell wall beta-glucan in three strains (JCR1, JCR5, and JCR10) when growing at 37 degrees C. Galactomannan was diminished in two others. Strains JCR1 and JCR5, with mutant alleles cwg1-1 and cwg2-1, respectively, were further studied. The cwg1 locus was mapped on the right arm of chromosome III, 18.06 centimorgans (cM) to the left of the ade5 marker; cwg2 was located on the left arm of chromosome I, 34.6 cM away from the aro5 marker. (1-3)beta-D-Glucan synthase activities from cwg1-1 and cwg2-1 mutant strains grown at 37 degrees C were diminished, as measured in vitro, compared with the wild-type strain; however, Km values and activation by GTP were similar to the wild-type values. Mutant synthases behaved like the wild-type enzyme in terms of thermostability. Analyses of round shape, lytic behavior, and low (1-3)beta-D-glucan synthase activity in cultures derived from ascospores of the same tetrad showed cosegregation of all these characters. Detergent dissociation of (1-3)beta-D-glucan synthase into soluble and particulate fractions and subsequent reconstitution demonstrated that the cwg1-1 mutant was affected in the particulate fraction of the enzymatic activity while cwg2-1 was affected in the soluble component. The antifungal agents Papulacandin B and Aculeacin A had similar effects on the enzymatic activities of the wild type and the cwg2-1 mutant strain, whereas the cwg1-1 mutant, when growing at 37 degrees C, had a more inhibitor-resistant (1,3)beta-D-glucan synthase. It is concluded that the cwg1+ and cwg2+ genes are related to (1,3)beta-D-glucan biosynthesis.

Choledochoduodenal fistulas

In 2,012 ERCP studies reviewed in the period between 1976 and 1989, we observed 14 choledochoduodenal fistulas found in the upper portion of the papilla of Vater. Two fistulas occurred spontaneously due to necrosis of the duodenal wall caused by stones located in the distal common bile duct above the sphincter of the papilla. In these two cases the stones were removed endoscopically. The twelve remaining cases were iatrogenic, caused during surgical papillotomy which resulted in a false tract. All patients showed raised AP and gamma GT. Eight had acute cholangitis, 7 were jaundiced, there was one case each of acute pancreatitis and chronic recurrent pancreatitis. Nine patients had stones located in the distal common bile duct. In eight cases it was possible to cannulate the papillary opening and do a papillotomy thereby connecting the fistulous orifice with the opening of the papilla. The other patient was treated surgically. Two patients had papillary stenosis. One was successfully treated with papillotomy through the papillary opening. In the other, the fistulous orifice was joined with the papillary opening using a diathermy scalpel. This patient suffered a posterior duodenal wall perforation. One patient with acute pancreatitis and common bile duct stones distal to the fistula improved with papillotomy and stone removal. The patient with chronic recurrent pancreatitis without lithiasis refused any form of treatment.

Acyclovir resistant genital herpes virus infection in a patient with AIDS

Three acyclovir resistant strains of HSV-2 were isolated from mucoulcerative lesions in a patient suffering from AIDS in whom the oral and intravenous acyclovir treatment was unsuccessful. All the isolates were classified by monoclonal antibodies and showed no differences in DNA restriction patterns.

[Hygiene habits at the family level and typhoid]

We studied the relation of habits related to the fecal-oral cycle and incidence of typhoid fever in children attending the school system for 1 to 2 years and in their families. The goal was to identify a predictor to detect families at risk for typhoid fever. A sample of 80 school-mother dyads, 40 of high and 40 of low socio-economic status was studied. 20 children in each group had had typhoid fever. Logistic regression analysis allowed to identify dirty edges of the toilet bowl and nail eating habits as highly specific (97%) and sensitive (82%) index of risk. The predictor held both in high and low socio-economic groups and could be used to identify families at risk of developing typhoid fever.

Changes in xanthophyll-cycle components and in fluorescence yield in leaves of a crassulacean-acid-metabolism plant, Clusia rosea Jacq., throughout a 12-hour photoperiod of constant irradiance

The content of the xanthophylls violaxanthin, antheraxanthin and zeaxanthin, which are interconvertible in the so-called xanthophyll cycle in the chloroplasts, was determined in leaves of the crassulacean-acid-metabolism plant, Clusia rosea, at the end of a 12-h dark period and at three times during a 12-h photoperiod of constant illumination (200 μmol photons·m(-2)·s(-1)). Whereas the level of violaxanthin was high at the end of the dark period and that of zeaxanthin low, zeaxanthin increased and violaxanthin decreased during the early light period, when atmospheric CO2 was taken up rapidly by the leaves. In the middle of the light period, when net uptake of atmospheric CO2 was not observed, yet when decarboxylation of malic acid allowed for high rates of CO2 reduction in the chloroplasts, zeaxanthin was low and violaxanthin was high. At the end of the light period, when uptake of atmospheric CO2 re-occurred, zeaxanthin increased again and violaxanthin decreased. Measurements of chlorophyll-a fluorescence with a modulated fluorometer showed that the increases in the level of zeaxanthin during the early and late light period were paralleled by decreased rates of electron transport and by increased rates of nonradiative dissipation of excitation energy.

Hemolytic uremic syndrome and diarrhea in Argentine children: the role of Shiga-like toxins

Shiga-like toxin-producing Escherichia coli have been associated with hemorrhagic colitis and the hemolytic uremic syndrome (HUS). Because Argentina has the highest reported frequency of HUS in the world, Argentine children were prospectively studied during the HUS seasons for evidence of Shiga-like toxin-related diseases. On the basis of serology, fecal cytotoxin neutralization, stool cultures, and DNA hybridization of colony lysates, most children with HUS had evidence of infection with Shiga-like toxin-producing organisms. Children with spring-summer diarrhea also commonly (32%, confidence interval 18%-46%) had clear-cut evidence of such infection. No controls (children without gastrointestinal, renal, or hemolytic disease) had free fecal cytotoxin, positive cultures for E. coli O157:H7, or DNA probe-positive organisms; 20% of them had low serum titers of antibodies to Shiga-like toxins. E. coli O157:H7 was not common in either HUS or diarrhea patients. The high frequency of Shiga-like toxin-induced diarrhea in young children in Argentina probably explains the high incidence of HUS in this country and suggests that HUS is a relatively uncommon complication of Shiga-like toxin-related disease.

Cord blood lipoprotein-cholesterol: relationship birth weight and gestational age of newborns

Umbilical plasma levels of lipoproteins-cholesterol were measured in 60 premature (less than 37 weeks), 60 small for gestational age (SGA, greater than 37 weeks), and 60 full term newborns (greater than 37 weeks) to ascertain the relationship between gestational age, infant's weight and concentration of plasma lipoprotein cholesterol. Umbilical levels of total cholesterol (TC), unesterified cholesterol (UC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in premature newborns were significantly higher (P less than .001) than in term infants. The levels of TC, UC, HDL-C and very low density lipoprotein cholesterol (VLDL-C) were substantially higher (P less than .05) in umbilical cord plasma of SGA newborns than in cord plasma of full term newborns. Lecithin:cholesterol acyltransferase activity in cord plasma was indirectly assessed by measuring the ratio of esterified cholesterol to unesterified cholesterol (CE/UC). This ratio was significantly lower (P less than .01) in preterm and SGA than in full term newborns. In addition, plasma TC, UC, LDL-C and HDL-C levels were inversely correlated with gestational age of newborns. By contrast, CE/UC ratio had an inverse correlation with gestational age and HDL-C of the newborns. These findings suggest that the levels of TC in newborns are regulated by the uptake of LDL-C by the fetal adrenal and, additionally, by the lecithin:cholesterol acyltransferase (LCAT) activity of newborn plasma. Only by careful follow-up of hyperlipidemic neonates can the true incidence of familial hyperlipoproteinemia and the value of early diagnosis be assessed.

Ecophysiology of xerophytic and halophytic vegetation of a coastal alluvial plain in northern Venezuela: IV. Tillandsia flexuosa Sw. and Schomburgkia humboldtiana Reichb., epiphytic CAM plants

A comparison of the performance of two epiphytes with crassulacean acid metabolism (CAM) was made during the rainy season and dry season at the Ciénega el Ostional, Chichiriviche in northern Venezuela. The epiphytic bromeliad, Tillandsia flexuosa has water-retaining tanks and leaf trichomes, and propagates mainly vegetatively to produce large populations in the shrubby island vegetation. The epiphytic orchid, Schomburgkia humboldtiana formed smaller populations, and had large succulent leaves with uniform chlorenchyma and no distinct water-storage parenchyma, unlike T. flexuosa. Both epiphytes were myrmecophilous. Leaf succulence (kg m^-2 ) declined by ∼ 10% in the dry season for both plants. Both epiphytes showed reduced CO₂ uptake during Phase I (dark period) and (dawn-dusk) titratable acidity (ΔH⁺ ) in the dry season. Water-use efficiency (WUE) was higher for S. humboldtiana (16.0 × 10^-3 mol CO² per mol H² O compared with 5.0 × 10 ^-3 for T. flexuosa) although WUE remained constant during rainy and dry season for each species. Sixty to seventy per cent of the dawn dusk titratable acidity was derived internally from respiratory CO₂ (recycling) for both species, and in absolute terms, recycling decreased in the dry season, in contrast to the expected progression under drought stress. Recycling is an important facet of carbon balance for both species in both rainy and dry seasons. Leaf Na⁺ concentration was higher than values quoted for terrestrial salt stressed CAM plants. Fructose and glucose declined in leaf bases of T. flexuosa during the dark period, but not in the more distal regions of the leaf. S. humboldtiana showed a decrease in sucrose at night, and mannitol was also an important constituent of the leaves. Xylem sap tension maxima increased from 0.38 ± 0.09 MPa (rainy season) to only 0.55 ± 0.06 MPa (dry season) for T. flexuosa, these values being much lower than those found for terrestrial shrubs and herbs at the same site, the two epiphytes use CAM in conjunction with differing morphological adaptations to maintain growth throughout the year at the Ciénega el Ostional, but it would seem that T. flexuosa has better physiological characteristics for maintenance of carbon acquisition during the dry season.

Ecophysiology of xerophytic and halophytic vegetation of a coastal alluvial plain in northern Venezuela: V. The Batis maritime-Sesuvium portulacastrum vegetation unit

The perennial halophytes, Batis maritima L., Sesuvium portulacastrum L., and Portulaca rubricaulis H.B.K. which inhabit the extreme environment on parts of the salt plain and at the edges of the vegetation islands of Ciénega el Ostional were examined to determine their strategies for growth and survival in the rainy and dry seasons. All of the three species are leaf-succulents. High leaf-sap osmotic pressures, xylem tensions and Na⁺ and Cl^- levels indicated that S. portulacastrum and B. maritima are salt-accumulating halophytes. Succulence, leaf-sap osmolalities and Na⁺ and Cl^- levels increased in the dry season in B. maritima by a factor of 1.5-2.0 and in S. Portulacastrum by a factor of 1.9-2.7. B. maritima also accumulated sulphate with a two-fold increase of concentrations in the dry season. In S. portulacastrum Na⁺ accumulation much exceeded Cl^- accumulation and oxalate synthesis was found to serve charge balance. In this species the compatible solutes, proline and pinitol, were clearly detectable in both seasons; their levels increased by a factor of about 6 in the dry season. Exchange of water vapour and CO₂ was measured with a portable steady-state porometer. Photosynthesis in B. maritima showed little response to the transition from the rainy to the dry season while S. portulacastrum was severely impaired in the dry season, showing pronounced midday depressions of gas exchange and about 40% inhibition of light-saturated rates of CO₂ uptake. P. rubricaulis shed its leaves in the dry season. According to carbon isotope ratios (δ¹³ C), B. maritima (δ¹³ C =-26.4‰) and S. portulacastrum (δ¹³ C =-25.8 ‰) are C₃ plants while P. rubricaulis (δ¹³ C =-12.3‰) performed C⁴ photosynthesis.

Ecophysiology of xerophytic and halophytic vegetation of a coastal alluvial plain in northern Venezuela: III. Bromelia humilis Jacq., a terrestrial CAM bromeliad

The terrestrial CAM plant Bromelia humilis was examined in the salinas of the Ciénega el Ostional, on the north coast of Venezuela, in the rainy and dry seasons. Three colour forms were distinguished; yellow (in full sun), green exposed (also in sun) and green shaded (beneath woodland). Plant size decreased with increasing irradiance. An examination was made of the three phenotypes in terms of CO₂ exchange (J_co2 ), dawn-dusk changes in titratable acidity (ΔH⁺ ) and malate and citrate levels, osmotic pressure, xylem tension, sugar and amino acids levels, nitrogen and ion concentrations and ambient temperature fluorescence. All phenotypes exhibited lowered J_co2 and ΔH⁺ in the dry as compared to the rainy season. Citrate, as well as malate, showed dawn-dusk fluctuations. Soluble sugars were the major source of carbon skeletons for nocturnal organic acid production. The dawn-dusk changes in osmotic pressure were negligible. Yellow plants performed poorly in contrast to shaded plants in both seasons. The former showed higher dawn-dusk changes of citrate levels and contained much less nitrogen than shaded plants. Nocturnal recycling of respiratory CO₂ was more important in yellow plants and, in the dry season, reached 87%. These differences were reflected in the overall productivity, shaded plants showing increases in size whereas yellow plants utilized energy mainly for leaf replacement. Water availability and nitrogen supply appear to be the overriding factors determining higher productivity and CO₂ assimilation in partially shaded plants as compared with plants in full sun.

Ecophysiology of xerophytic and halophytic vegetation of a coastal alluvial plain in northern Venezuela: I. Site description and plant communities

This paper describes the ecology of a coastal alluvial plain at Chichiriviche in northern Venezuela. The area supports a great diversity of plant communities, ranging from mangroves on the seaward edge of the plain to non-halophytic, fresh-water communities on the landward side. Small differences on topography result in a mosaic of saline and less-saline environments. Rainfall is strongly seasonal, causing superficial flooding of the alluvial plain in the rainy season and the creation of a hypersaline Substratum during the dry season. As a consequence, much of the plain is devoid or vegetation. Towards the landward side of the plain there are numerous small 'vegetation islands', fringed by halophilic succulent herbs, and made up of deciduous and semi-deciduous shrubs and trees together with non-halophytic CAM plants such as cacti and bromeliads. In subsequent papers the results of ecophysiological studies of these diverse plant species are presented.

Ecophysiology of xerophytic and halophytic vegetation of a coastal alluvial plain in northern Venezuela: VI. Water relations and gas exchange of mangroves

Seasonal effects on leaf gas exchange and water relations were compared for Avicennia germinans, a true mangrove, and Conocarpus erectus, a mangrove associate, at coastal sites in northern Venezuela. On the Ciénega el Ostional at Chichiriviche, A. germinans was most abundant around lagoons on the seaward side of the vegetation-free alluvial sand plain. C. erectus was the dominant shrub in inland communities, but the two species co-occurred on vegetation islands at the landward edge of the alluvial plain. On the vegetation islands of the Ciénega el Ostional, gas exchange in A. germinans (a species with foliar salt glands) was less severely curtailed in the dry season compared with the rainy season than was gas exchange in C. erectus (a species lacking salt glands). Average rates of photosynthesis at near-saturating light intensities and total diurnal CO₂ uptake were reduced in the dry season to 69 and 61%, respectively, of their values in the rainy for A. germinans, but to 48 and 30%, respectively, of their rainy-season values for C. erectus. Similarly, stomatal conductance and transpirational water loss were more reduced in the dry season for C. erectus than for A. germinans, with the result that C. erectus showed a 3.4-fold increase in water-use efficiency in the dry season compared with the rainy season. The importance of the soil environment in determining plant gas-exchange Patterns was evidenced by large seasonal shifts in dawn xylem tension for the two species (which increased from 1.34 MPa in the rainy season to 5.50 MPa in the dry season for A. germinans, and from 0.40 to 5.78 MPa for C. erectus). These values reflected changes in the soil environment caused by inundation of the upper soil layers by fresh water in the rainy season and a progressive increase in salt concentrations (to almost twice those in sea water) by evaporation from the soil in the dry season. Large changes in xylem tension were observed for both species during individual day-night cycles, reaching a maximum of 2.36 MPa for A. germinans. For C. erectus, the magnitude of these day-night changes was greatly reduced in the dry season, consistent with its very low transpiration rates at this time of year. Leaf-cell osmotic pressures also tended to be higher in A. germinans than C. erectus (attaining a maximum of 8.3 MPa for A. germinans in the dry season), and were related to the more seaward distribution of the true mangrove on the alluvial plain. Whereas leaves of A. germinans did not show any changes in succulence, leaf succulence in C. erectus increased with leafage and was slightly higher in the dry season than the rainy season. The more succulent leaves also had higher cell-sap osmotic pressures and NaCl concentrations. The most succulent leaves of C. erectus were observed for exposed shrubs growing on the shoreline. During the dry season, these shoreline plants showed high rates of gas exchange and low values for dawn xylem tension (0.89 MPa), indicating that they had access to relatively non-saline water from the shallow water table. On individual plants, exposed shoots had more succulent leaves and higher osmotic pressure and NaCl concentrations than sheltered leaves, demonstrating the importance of foliar absorption of salt borne in sea spray for the ionic relations of C. erectus. Thus, although the distribution of C. erectus is centred on brackish-water zones, this species can apparently extend from habitats with permanent access to a shallow water table through to areas where it is seasonally exposed to low soil water potentials and high salt concentrations in the substratum.

Growth failure prediction in Chile

The purpose of this investigation was to develop screening instruments for the prediction of infants' growth failure. Biological and social variables of subjects attending public clinics in Santiago, Chile, were prospectively collected and screened as possible risk factors of being underweight/age at the end of the first year of life using three methodologies. Methodologies used were: simple relative risk, logistic regression, and classification and regression trees. As judged by sensitivity and specificity properties, the screening instrument developed by the latter methodology is much better than the other two.

Prenatal lidocaine and the auditory evoked responses in term infants

We examined the effects of maternal lidocaine hydrochloride anesthesia on the brain-stem auditory evoked responses (BAERs) in neonates born by cesarean delivery. Sixteen term neonates were enrolled in the study. Eight neonates were delivered by cesarean section following lidocaine anesthesia, and eight were delivered by spontaneous vaginal delivery without maternal anesthesia. A BAER was obtained on all of the neonates on the first day of life. A significant delay was noted in the central neural component of the BAER at 90 dB. The wave I through V interpeak latency for both ears was noted to be 5.3 ms for the neonates exposed to lidocaine and 4.9 ms for the controls.

The role of aldosterone in water and electrolyte transport across the colonic epithelium of the lizard, Gallotia galloti

1. The effects of D-aldosterone on the electrical properties and ionic transport have been analysed (in vitro) in the colonic epithelium of the lizard, Gallotia galloti. 2. The injection of 30 g of D-aldosterone induced a significant rise of plasma aldosterone concentration, sustained for 4 hr after administration. 3. Intraperitoneal injections of D-aldosterone caused a slight reduction of transmural potential difference (PD) and short-circuit current (Isc). 4. Net absorption of Na+ across the colon from aldosterone-treated lizards did not increase when compared to colon from normal lizards. Cl- absorption was increased in treated lizards. 5. Addition of mucosal barium to treated tissues brought about a sustained increase of PD and Isc. 6. The absorption of fluid in normal lizards was reversed to fluid secretion in treated lizards. 7. The effects of D-aldosterone on lizard colon are compared with those reported for the colon of mammals and birds.

Cytogenetic evaluation of 163 azoospermics

A constitutional chromosomal aberration was diagnosed in 38/163 (23.3%) azoospermic patients. Whereas the 47,XXY complement was the commonest (31/38 cases), the following abnormal karyotypes were also found: 46,XX; 46,X,del(Y) (q11); 46,X,r(Y); 46,XY,inv(1) (p3500q21.3)mat; and 46,Y,t(X;3) (q26;q13.2)mat (both the deleted and the annular Y were observed twice). Pooled data from the literature showed that the frequency of chromosomal abnormalities is higher in azoospermic (150.4/1000) than in infertile (55.3/1000) males, which in turn is higher than in newborns (less than 6/1000). The observed different frequency between azoospermic and infertile individuals is given by several types of chromosomal abnormalities, mainly by the complement 47,XXY. The analysis also showed that the male infertility secondary to rob translocations and supernumerary marker chromosomes is usually not related to azoospermia. The contrary occurs in certain rcp and gonosome;autosome translocations and in autosome inversions.

Compliance measurement in respiratory distress syndrome: the prediction of outcome

Dynamic compliance (Cdyn) measurements within the first three days of life predicted survival in 60 preterm infants suffering from respiratory distress syndrome. Cdyn was measured in 47 survivors at 2.3 +/- 1.4 days of life and in 13 nonsurvivors on 2.7 +/- 1.7 days. All nonsurvivors died from respiratory failure within the first two weeks of life. Mean Cdyn of the survivors was 0.83 +/- 0.33 ml/cm H2O and of the nonsurvivors 0.35 +/- 0.19 ml/cm H2O (p less than 0.001). Cdyn values below 0.45 ml/cm H2O predicted 11 of 13 deaths in infants, and Cdyn measurements above this value predicted 45 of 47 survivals, with a specificity of 81% and a sensitivity of 89%. Eleven of the survivors, who subsequently developed bronchopulmonary dysplasia (BPD), had a mean Cdyn of 0.56 +/- 0.23 ml/cm H2O. When these infants were matched with infants of comparable weight without evidence of BPD, the BPD group had a significantly lower Cdyn (p less than 0.05). Cdyn measurements during the first three days of life are useful in predicting outcome of respiratory failure secondary to respiratory distress syndrome.

Ventilatory responses to carbon dioxide in infants at risk for sudden infant death syndrome

We examined the ventilatory response to inhaled CO2 in 77 infants at postconceptional ages ranging from 31 to 50 wk, 43 of whom were also evaluated with a 12-h pneumocardiogram (PCG). Infants were tested after sedation with chloral hydrate, and monitored with ECG and transcutaneous oxygen and CO2 monitors. Sleep state was evaluated by visual inspection of the infant's behavior. Among the 43 infants examined with the PCG, 22 had abnormal PCGs. Of these, 27% had significantly (p less than .05) abnormal CO2 response slopes, compared to 9% of those with normal PCGs. Breathing frequency did not change after CO2 inhalation in 82% of the abnormal PCG and in 33% of the normal PCG groups.

Single-dose pharmacokinetics of oral ciprofloxacin in patients with cystic fibrosis

The single-dose pharmacokinetics of oral ciprofloxacin were studied in ten patients with cystic fibrosis aged 18 to 34 years. Each patient received three different drug doses (500 mg, 750 mg, and 1,000 mg) at successive one-week intervals. Dosing and drug assays were double blinded. Blood and urine were assayed over the 48 hours following each dose. Ciprofloxacin was absorbed from the gastrointestinal tract. Peak serum concentrations averaged 2.8, 4.5, and 4.6 micrograms/mL respectively at the three doses, well above the mean inhibitory concentrations of most isolates of Pseudomonas aeruginosa. Time to peak concentration was approximately two hours. The range of sputum levels in three patients was 1.1-2.1 micrograms/mL at four hours after the three doses. The serum elimination half-life was 3.7 hours and was independent of dose. Urinary recovery was 26%; greater than 90% of urinary excretion occurred within the first 12 hours. The results of this study indicate that ciprofloxacin has potential for use in the treatment of P aeruginosa infections in patients with cystic fibrosis.

In vitro study of Fc-receptor function in autoimmune diseases

A simple test for studying in vitro Fc-receptor function of mononuclear phagocytes is described. Immune phagocytosis is analyzed as a dynamic phenomenon by using nearly pure suspensions of monocytes incubated for diverse times with autologous erythrocytes sensitized with highly purified IgG. In a series of normal volunteers and patients with vasculitis a strict correlation has been found between this in vitro assay and the measure of splenic clearance of IgG-coated red blood cells (RBC), the classical approach for studying in vivo macrophage Fc-receptor function by using sodium chromate 51Cr as tag. The use of this in vitro assay appears to be valuable mainly in cases requiring repeated measurements of Fc-receptor function for monitoring the course of disease or the effects of therapy.

Bedside blood glucose determinations in critical care medicine: a comparative analysis of two techniques

The accuracy of a new reagent test strip (Chemstrip BG) for the quantitative estimation of whole blood glucose concentration was compared to that of a widely used test strip (Dextrostix). To perform the comparative study, venous blood specimens were obtained from 133 patients. Interpretations of reagent strip glucose readings were made by three observers who separately recorded their impressions from the two strips on each patient. These estimated levels were compared to quantitative (glucose oxidase) concentrations measured from the same specimen. Although there were significant correlations (p less than 0.001) between both reagent strips and the measured values, the Chemstrip BG results more closely approximately measured values for the range of glucose concentrations encountered (10-600 mg/dl). In addition, Chemstrip BG was easier to read and measured a wider range of values than Dextrostix and, unlike Dextrostix, Chemstrip BG strips could be stored for review at a later time. This new glucose test strip accurately and rapidly determines whole blood glucose concentration at the bedside.

ADH-dependent nephron heterogeneity in rats with hereditary hypothalamic diabetes insipidus

Single nephron glomerular filtration rates (SNGFR) were measured by the [14C]sodium ferrocyanide infusion technique in superficial (S) and juxtamedullary nephrons (JM) of anesthetized Brattleboro rats with or without diabetes insipidus (DI and HZ, respectively). Glomerular volumes (GV) and proximal tubular lengths (PTL) were measured in the same nephrons after microdissection. Glomerular volumes were also assessed in Wistar, HZ, and DI rats in Microfil-injected kidneys. The well-known nephron heterogeneity of the mammalian kidney was absent or greatly reduced in DI compared to HZ rats. S/JM ratios for SNGFR, GV, and PTL averaged 0.71, 0.50, and 0.73 in HZ and 1.04, 0.77, and 0.90 in DI rats. This reduced nephron heterogeneity was due only to reduced dimensions and filtration rates in JM nephrons. The chronic administration of antidiuretic hormone (dDAVP or vasopressin tannate), begun at 2 wk of age and maintained until adulthood (8-10 wk), significantly decreased the S/JM ratios, i.e., restored a nearly normal nephron heterogeneity in DI rats. These results suggest that nephron heterogeneity in the rat kidney is dependent on the presence of antidiuretic hormone, and, more specifically, that ADH and/or its functional consequences can selectively induce an increase in size and filtration rate in deep nephrons.

Temporal lobe epilepsy -- not a consequence of childhood febrile convulsions in Denmark

Temporal lobe epilepsy in particular has been considered a consequence of childhood febrile convulsions. Previous studies have dealt with populations of epileptic children. This retrospective, follow-up study concerns 362 children with a primary diagnosis of febrile convulsions. 4% developed epilepsy. When followed into early adulthood one half of those remitted. The incidence of temporal lobe epilepsy among the none-remitters did not differ from that of a random population of epileptics.

Therapeutic evaluation of ketoconazole in patients with coccidioidomycosis

Eleven adult patients (seven men and four nonpregnant women) with coccidioidomycosis were treated orally with ketoconazole (R41,400). Two patients presented with disseminated coccidioidomycosis, six with pulmonary coccidioidomycosis, and three with the chronic cutaneous form of the disease. Diagnosis was established by culture of Coccidioides immitis and/or histopathologic identification of the fungus. All patients received 400 mg of ketoconazole per day for the first 10 days; afterwards four of them received 200 mg per day. Evaluation indicated that nine patients improved, one did not, and one could not be assessed. Treatment of coccidioidomycosis with ketoconazole appears to be reasonably effective and produces fewer adverse effects than does amphotericin B; however, further studies of the efficacy of this new drug are needed.

[A control trial of home I.P.P.B. therapy in patients with chronic obstructive respiratory insufficiency. Protocol and state of the study (author's transl)]

Because a previous retrospective study did not allow any conclusion as to the efficacy of home IPPB therapy in patients with chronic airflow obstruction, a control trial has been started. The protocol includes definition of patients, modalities of treatment, criteria for evaluation. Among criteria for a patient to enter the trial is a chronic hypercapnia (with PaCO2 greater than or equal to 48 mmHg) observed over a preliminary period of 4 months. At the end of this period patients are allocated at random into two groups with and without IPPB at home (at least 1 to 2 hours daily through a mouthpiece); medical prescriptions are same in the 2 groups so as surveillance which is planned for 2 years. Evaluation should be based upon 5 predetermined criteria. This trial is in progress.

[Percutaneous cholangiography with the Chiba method (author's transl)]

In 92 patients with cholestasis a percutaneous cholangiography was performed. The bile duct could be visualized in 75 cases (81.5 percent). When the bile ducts were dilatated, the investigation succeeded in 94 percent, whereas in patients with normal bile ducts the rate was 65 percent. Complications occurred only in 2 cases. In one patient surgery was necessary due to biliary peritonitis. In another patient a discrete hemobilia without clinical symptoms could be found during laparotomy.

Disorganization of myelinogenesis in tissue culture by anti-CNS antiserum

The presence of decomplemented anti-CNS antiserum profoundly affects myelinogenesis in cultured mouse embryo spinal cord. Light and electron microscope study has shown that oligodendroglia differentiate and produce an abundance of cell processes which surround the oligodendrocytes in a chaotic, disorganized array. Where the cell processes chance to meet, they form a kind of aberrant swollen myelin. Rarely, the oligodendroglial processes ensheath axons. For the most part, the available axons remain unmyelinated. On removal of the decomplemented antiserum, oligodendroglia differentiate and form normal myelin around the available axons. Myelination of peripheral nervous system (dorsal root ganglion) axons in the same preparations is unaffected by the presence of the antiserum. Thus, under these circumstances, the message from the neuron to the oligodendrocyte to make myelin is apparently intact, yet there is interference with the ability of the oligodendroglial cell process to find, attach to and encircle CNS axons with a normal myelin sheath.

Antiserum-induced dissociation of myelinogenesis in vitro. An ultrastructural study

Mature, myelinated cultures of mouse spinal cord tissue exposed to heated (decomplemented) sera from animals suffering from experimental allergic encephalomyelitis demonstrate a unique pattern of myelin swelling without demyelination. In the present study, three concentrations of heated experimental allergic encephalomyelitis sera (5, 15, and 25 per cent) were applied to spinal cord cultures from the time of explantation and continued for 33 days therafter. The sera were obtained from rabbits with the exposed cultures, glial cell differentiation occurred at timepoints comparable to those in normal unexposed sister cultures. Oligodendroglia produced a profusion of cytoplasmic processes which compacted to form aberrant myelin with a periodicity double that of normal myelin, containing four leaflets in the position of the normally bilamellar intraperiod line. The degree of the oligodendroglial abnormality was dose dependent, 25 per cent heated experimental allergic encephalomyelitis serum being the most potent. Frequently, in older cultures, large diameter axons, which under normal circumstances would have been well myelinated, were devoid of myelin sheaths although abundant aberrant myelin could be seen around nearby oligodendroglial cells. Rarely similar aberrant myelin was deposited around axons. It appeared, therefore, that the oligodendroglial cells had proliferated myelin which was unable to reach axons, possibly reflecting a failure in recognition between the two.

Vertical transmission of the virus of hepatitis B and neonatal hepatic cirrhosis in an Argentine family

In a family in which the mother was a healthy HBsAg and anti HBc carrier, and the father had a chronic persistent hepatitis with anti HBs and anti HBc positive, the development of neonatal cirrhosis in two of the children was proved to be present. One of the girls was an anti HBs carrier (anti HBc was not determined) and the other had positive anti HBs and anti HBc. Both died and the diagnosis of cirrhosis was confirmed. The two healthy daughters were anti HBc carriers.

Growth in experimental renal failure: role of calorie and amino acid intake

In order to evaluate the role of calorie and protein intake in growth impairment due to chronic renal failure (CRF), a subtotal nephrectomy was performed in weanling Wistar rats. A two-thirds reduction of renal function was obtained, which induced a marked growth retardation. Growth retardation was identical in nephrectomized and in pair-fed controls, and thus appeared to be entirely due to a deficient food intake. Using low protein diets, administration of a supplement with small amounts of essential amino acids (EAA) resulted in accelerated growth associated with a higher calorie intake, a better utilization of ingested calories for growth and a greater fall of blood urea nitrogen concentration.

Aminoacridine dyes and the secondary structure of DNA in situ

A new method is proposed to study the secondary structure of deoxyribonucleic acid (DNA) in situ in fixed chromatin. It is based on acriflavine staining and on differentiation with a nitrous acid solution of the fixed cytologic preparation. The presence of green fluorescence after this treatment is regarded as indicative of double stranded DNA. Experiments are described with DNA-acriflavine mixtures in solution, DNA-agar models and cytologic preparations submitted to different pretreatments. The feasibility and limitations of the method are discussed in the light of the results reported upon.