[Debates on religion among Montreal physicians]

This article discusses the debate which took place at the beginning of the 20th century on the relationship between Church and State, and reveals the resulting ideological schisms among members of the Montreal medical leadership. These divisions explain, at least in part, the delayed application of health policies and professionalization evolution of physicians and the configuration of the medical institutional framework. Its broader implications relate to the influence of external forces upon medical practice.

LIVE/DEAD BacLight : application of a new rapid staining method for direct enumeration of viable and total bacteria in drinking water

A rapid epifluorescence staining method using the LIVE/DEAD Bacterial Viability Kit (BacLight) was applied to estimate both viable and total counts of bacteria in drinking water. BacLight is composed of two nucleic acid-binding stains: SYTO 9 and propidium iodide. SYTO 9 penetrates all bacterial membranes and stains the cells green, while propidium iodide only penetrates cells with damaged membranes, and the combination of the two stains produces red fluorescing cells. Optimal incubation conditions were found to be 15 to 20 min, at room temperature in the dark. Total (red + green) and viable (green) cells can hence be counted simultaneously. Factors affecting the staining procedure were tested (addition of glutaraldehyde, staining time, chlorine impact). In the absence of stress, BacLight viable counts were comparable and to 5-cyano-2,3-ditolyl tetrazolium (CTC) counts. BacLight total counts were comparable to acridine orange counts (differing by <0.1 log/ml). However, the increase in environmental stresses (chlorine, growth rate or temperature) induced a decrease in viability that was more pronounced for CTC and plate counts than for BacLight viable counts.

Mismatch negativity to speech stimuli in 8-month-old infants and adults

The mismatch negativity (MMN) was measured in 15 normal awake 8-month-old infants and 10 adults to the speech consonants /da/ and /ta/. ERPs were analyzed at 11 electrodes (Fz, Cz, Pz, C3, C4, T3, T4, T5, T6, P3, P4). Four-hundred trials were presented: the /da/ standards with 80% probability and the /ta/ deviants with 20% probability. The ISI was 600 ms. An MMN was observed for both adults and infants but with different scalp distributions. A clear infant MMN was observed only at C3 and T3 electrodes, whereas the adult MMN was present at Fz, Cz, C3, C4 and Pz. A repeated-measures ANOVA on the normalized summed area between 200 and 250 ms revealed an age (adult vs. infant) x electrode interaction. Paired t-tests indicated that adults and infants showed significant differences at the C3, Cz, T3, Pz and T6 electrodes. The adult MMN was largest at Cz and C3 whereas the infant MMN was largest at T3. These data are discussed in terms of possible maturational changes in the MMN.

In vitro lymphotoxicity and selective T cell immunotoxicity of high doses of acyclovir and its derivatives in mice

The antiviral drug acyclovir [9-(2-hydroxyethoxymethyl)guanine (ACV)], its 7-isomer (7-ACV) and its two derivatives: N2-acetyl ACV (ac-ACV) and N2,O-diacetyl ACV (diac-ACV) were examined for their potential in vitro lymphotoxicity and in vivo immunotoxicity in mice. In vitro lymphotoxicity of ACV and its acetylated derivatives was low, whereas the 7-ACV isomer enhanced the in vitro cell proliferation in PHA-stimulated cultures. Addition of 2'-deoxyguanosine (dGuo) did not exhibit any inhibitory potential of ACV. However, reduction in the absolute number of CD3+, CD8+, and CD25+ cells, but not Ig+ cells, was noted at high concentrations of ACV and its derivatives, suggesting a selective T cell cytotoxicity. Similarly, the in vivo exposure revealed selective T cell immunotoxicity of ACV and its derivatives since the reduced number of Thy 1.2+ and CD8+ cells was not accompanied with any marked changes in the Ig+ population. The CD4+/CD8+ ratio was affected both in vitro and in vivo by high concentrations of ACV.

Immunoactivating potential of multilamellar liposome vesicles (MLV) in murine popliteal lymph node (PLN) test

Immunoactivating properties of subcutaneously injected small unilamellar vesicles (SUV) and multilamellar liposome vesicles (MLV) were studied in relation to different transition temperatures (Tc) of phospholipids. Liposome-induced proliferative reaction in the popliteal lymph node (PLN) was quantified by subsequent cytometric assay. Early cell activation during the onset of PLN reaction was monitored by immunophenotyping of lymphocyte subsets stained with a panel of monoclonal antibodies (mAbs) and gating the subset-specific large/activated cells. Injection of MLV liposomes containing distearoyl phosphatidylcholine (DSPC) and dipalmityl phosphatidylcholine (DPPC), characterized by relatively high Tc, resulted in a marked PLN reaction, increased numbers of CD4+, CD8+, Ig+ subsets and increased proportions of large/activated EAM+ (CD69+) and CD25+ (IL-2 receptor+) cells. The reaction was dose and time dependent. In contrast, injection of MLV liposomes containing lipids of low Tc, such as egg phosphatidylcholine (egg PC) and dimyristoyl phosphatidylcholine (DMPC), did not show any immunoactivation. In addition, there was a highly reduced immunoactivating potential of small-size SUV liposomes over large-sized MLV of identical phospholipid composition. Generally, both lipid composition and vesicle size appeared to be essential for the immunoactivating potential of liposomes. The data suggest a possible correlation between the Tc of the phospholipid and the immunoactivating potential of the large-sized MLV liposomes.

Different T-cell activation by streptozotocin and Freund's adjuvant in popliteal lymph node (PLN)

A popliteal lymph node (PLN) test was further validated for predictive screening of autoimmunity-inducing drugs. Autoimmune-like T-cell activation of streptozotocin (STZ) was compared with the effect of Freund's complete adjuvant (FCA), injected locally into the foot pad of BALB/c mice. Early cell activation in enlarged PLN was monitored by flow cytometry. Injection of both STZ and FCA markedly increased the absolute PLN cell number as well as specific T-helper (CD4+), T-suppressor/cytotoxic (CD8+), and B (Ig+) subsets. However, quantitative analysis of early T-cell activation revealed important differences between STZ-induced PLN reaction and FCA-related lymphoproliferation. At 72 h, the number of cells stained with anti-early activation marker (EAM+; CD69+) increased over 10 times in STZ-enlarged nodes and only 3 times in the FCA-inflamed nodes. Furthermore, different cytometric profiles were noted for STZ-activated and FCA-activated cells stained with anti-interleukin-2 receptor (IL-2R) (CD25+). The data suggest the applicability of early cytometric screening of enlarged PLN for predictive analysis detection of chemicals inducing an autoimmune-like reaction.

Lymphocyte activation by liposome-trapped streptozotocin in murine popliteal lymph node (PLN) test

The lymphoproliferative potential of liposome-trapped streptoztocin (STZ) was compared to the effect of saline-dissolved STZ injected locally into the foot pad of CD-1 mice. Popliteal lymph node (PLN) enlargement and early cell activation of lymphocyte subsets were monitored during the onset of STZ-induced autoimmune-like reaction. Injection of the optimal STZ dose, 0.5 mg/foot pad, markedly increased the absolute PLN cell number as well as specific T-helper (CD4+), T-suppressor/cytotoxic (CD8+), and B-(Ig+) cell subsets stained with fluorescent monoclonal antibodies. Furthermore, there was a marked increase in the number of large/activated CD4+ and CD8+ cells and subsets bearing specific markers of early activation. These included cells stained with fluorescein-conjugated monoclonal antibodies against interleukin-2 receptor (CD25+) and early activation marker (EAM+) (CD69+), and with fluorescein-conjugated peanut agglutinin (PNA+). Surprisingly, the injection of liposome-trapped STZ, at a 1/10 of the optimal dose only, induced a marked PLN enlargement comparable to the effect of optimal STZ dose. The effect of liposome-STZ could be dissociated from the non-drug-containing MLV-related lymphocyte activation. The data suggest several possible advantages from the introduction of chemicals by the liposome route and the subsequent PLN test for chemical-induced autoimmunity. Toxicological advantages could involve better control of chemical exposure, controlled exposure to the water-insoluble substances, drastic reduction of xenobiotic dose, a stronger, clear PLN response and possible elimination or at least restriction of false-negative results, due to the liposome adjuvancity. Overall, application of liposomes as an exposure route potentialized the STZ-induced early lymphocyte activation.

Dose proportionality of bisoprolol enantiomers in humans after oral administration of the racemate

Dose proportionality of racemic bisoprolol and the stereoselectivity of its enantiomers were studied after single oral dosing of 5 to 40 mg of bisoprolol hemifumarate in eight healthy male volunteers in an open-label, randomized, four-way cross-over trial. There were dose-proportional increases in mean peak plasma concentration (Cmax) and area under the plasma concentration versus time curve (AUC) values for the racemate and the individual enantiomers. No statistically significant differences were detected between the mean half life (t 1/2), Cmax, and time to reach Cmax (tmax) of the R- and S-isomers at each of the four dose levels studied. These findings support dose proportionality and absence of stereoselective pharmacokinetics for bisoprolol in the dose range studied.

Immunosuppression by chronic exposure to N-nitrosodimethylamine (NDMA) in mice

Immunosuppression of humoral and cellular responses following chronic oral exposure to 1, 5, 10, and 20 ppm N-nitrosodimethylamine (NDMA) was examined in CD-1 mice. Monitoring of cumulative mortality and the incidence of peritoneal ascites in animals showed an NDMA dose-related mortality and hepatotoxicity. No visible changes in immunological parameters were noted at the 1 ppm NDMA dose. Immunosuppression of immunoglobulin M (IgM) antibody response by NDMA to sheep red blood cells (SRBC) was time-related, dose-related, and could be reversed within 30 d by removal of the chemical from the drinking water. Cellular immune response, monitored by allogeneic stimulation of cells in mixed lymphocyte reaction (MLR), was markedly suppressed by 10 and 20 ppm NDMA. Thus, chronic exposure to NDMA, except for the low-hepatotoxic doses of nitrosamine, resulted in a marked and persistent immunosuppression of cellular and humoral responses in CD-1 mice. In conclusion, chronic exposure to the hepatotoxic (ascite-inducing) doses of NDMA suppressed humoral and cellular immunity. The persistent immunosuppression could be reversed after the removal of NDMA from the drinking water. Although no direct NDMA-related cancer was reported in humans, our data point to a potential epigenetic carcinogenicity of nitrosamines due to chronic immunosuppression.

Comparative effects of intravenously administered alizapride and prochlorperazine in cisplatin-induced emesis

A randomized, double blind crossover trial compared the antiemetic effects of alizapride, a benzamide, and prochlorperazine, a phenothiazine, both administered intravenously to 32 patients treated with chemotherapy combinations containing cisplatin. The total dose of alizapride administered to each patient was 14 mg/kg, and of prochlorperazine .56 mg/kg, divided in five doses. Although alizapride resulted in complete protection against emesis in 31% of the patients during their first course of cisplatin therapy, 42% of those who received alizapride had five or more episodes of emesis. Although prochlorperazine was less effective in offering complete protection against emesis, only 15% of the patients receiving this drug vomited more than five times. The duration of emesis during prochlorperazine treatment was also significantly shorter than during alizapride therapy (p less than 0.02). Optimal dosage and pharmacokinetic distribution of both drugs should be investigated further.

Post-myringotomy care: a prospective study

Children with tympanostomy tubes have always been considered somewhat handicapped in regard to swimming and bathing. Their parents had to maintain constant surveillance to prevent then from getting water in their ears. A prospective study involving more than 1,000 children was conducted between June 1981 and August 1982 on two groups of randomly selected patients to determine the prevalence of suppurative otitis media and its relationship to bathing and swimming. One group had to follow strict rules to prevent water entering the ear (bathing caps, earplugs) whereas the other group was allowed to bathe and swim without any precaution upon the condition of using a polymyxin B/gramicidin ear drop combination at bedtime on the day they swam. The study shows no increase in prevalence of suppurative otitis media in the "open canal" group as compared to the "closed canal" group. Furthermore, the monthly distribution of infections shows a relatively evan distribution throughout the year. This study implies that swimming and bathing are safe for the vast majority of children with tympanostomy tubes and thus simplifies enormously the post-myringotomy care for the child, the parents, and the physician.

Determination of d-isoproterenol sulphate by high-performance liquid chromatography with amperometric detection

The application of reversed-phase high-performance liquid chromatography (HPLC) to the determination of isoproterenol sulphate in human plasma and urine was investigated. Sulphoconjugation of the inactive isomer of isoproterenol was chosen as an experimental model to study individual variations in the rate of sulphation of phenols in man. This approach allowed the ingestion of relatively large amounts of drug and detection of the conjugated material after acid hydrolysis, using alumina clean-up and HPLC with amperometric detection. This method was found to be rapid, sensitive, precise and suited to pharmacokinetic studies in man.

Influence of chronic obstructive lung disease on the disposition of an acidic drug (sulfamethazine)

The influence of chronic respiratory failure (CRF) on the pharmacokinetics of an acidic drug has been studied in 11 patients and in eight normal volunteers who received 10 mg/kg of oral sulfamethazine. Blood and urine samples were collected for 24 and 48 hours, respectively. No differences were observed in the rate of sulfamethazine absorption, but bioavailability was decreased when compared with control subjects. Sulfamethazine volume of distribution (Vd) was larger in patients than in control subjects. These differences in Vd may be secondary to an increase in sulfamethazine unbound fraction. No differences were observed in sulfamethazine elimination. It is concluded that in patients with CRF sulfamethazine bioavailability decreases, and Vd increases secondary to a decrease in binding. Despite the fact that plasma concentrations of the test drug will be decreased, the administration of higher doses may not be advisable.

Meningitis and congenital fistula of the internal ear

Congenital CSF otorrhea is seldom the cause of meningitis but has to be looked for especially if associated with a dead ear or with recurrent meningitis. Polytomograms of the mastoids are essential to rule out any abnormality of the internal ear. Three patients with a congenital CSF otorrhea and associated meningitis are reviewed. They all presented a Mondini type of dysplasia and had an oval window fistula. They were treated successfully with fascia and muscle obliteration of the vestibule.

Pre-anaesthetic medication in paediatric day-care surgery

Pre-anaesthetic medication has the primary aim of making the whole process of anaesthesia smooth and agreeable. This prospective blind study was planned to compare the efficacy of three active drugs and a placebo as premedication in a paediatric population undergoing operation on a day care basis. One hundred and fifty-nine patients between one and 12 years of age were assigned randomly to one of four groups who received either hydroxyzine 0.5 mg . kg-1 (n - 43) promethazine 0.5 mg . kg-1 (n 40) diazepam 0.1 mg . kg (n - 378) or placebo (n - 36) by mouth, 60 minutes before operation. Observations in the operating room included the emotional state of the patient on arrival, quality of induction and complications. In the recovery room time for emergence from anaesthesia, complications and requirements for analgesia were recorded. The parents were asked for return a questionnaire detailing psychological and physical complications during three postoperative days. There was no difference between the groups in any of the factors examined. From this study we conclude that children undergoing surgical operations and anaesthesia on a day care basis should not receive pharmacological premedication, not because of overwhelming risk from its use, but because of the absence of any benefit.

[Facial paralysis in children--study of 99 cases]

Ninety-nine cases of peripheral facial paralysis in children treated at Ste. Justine's Hospital over a 10 year period were reviewed. Sexes were nearly equally affected with a slightly higher incidence in female. Cases were distributed quite evenly throughout childhood except for a definitely higher incidence in the 0--2 year old group. Trauma, Bell's palsy, and otomastoid inflammation were found to be the most frequent causes of facial palsy in that group of cases. Cases of otomastoid inflammation did generally well on antibiotics and nearly 70 per cent so recovered completely. Twenty per cent only had to undergo simple mastoidectomy and two cases a decompression. Out of 25 cases of Bell's palsy, 18 recovered totally without surgery and four were decompressed with total or partial recovery. Following this study, the need for a more complete evaluation and somewhat more standardized treatment became obvious. This may permit in the future a more adequate knowledge of the problem and likely a better management.

Acute epiglottitis in children: management of 27 consecutive cases with nasotracheal intubation, with special emphasis on anaesthetic considerations

Twenty-seven consecutive cases of acute epiglottitis in children were treated by nasotracheal intubation during a 25-month period. The duration of intubation averaged 44.2 hours. No mortality or morbidity occurred. Mean hospitalization was 4.5 days. Anaesthetic techniques are discussed. Ketamine is a somewhat controversial choice for these patients as it can enhance excitement, restlessness, and accidental extubation. This study reconfirms the ease of maintaining an assured airway by nasotracheal intubation in cases of acute epiglottitis.

Acute epiglottitis in children-treatment with nasotracheal intubation: report of 14 consecutive cases

Fourteen consecutive cases of acute epiglottitis were treated by nasotracheal intubation during a ten-month period. The duration of intubation averaged 47.2 hours. No mortality or morbidity occurred. Mean hospitalization was 4.6 days. This study demonstrates the ease of maintaining an assured airway by nasotracheal intubation in cases of acute epiglottitis.