Datasets:

ohsumed

like 4

Animal; Glucose/*; Milk Proteins; Osmolar Concentration; Peptides/*; Peritoneal Dialysis/*MT; Protein Hydrolysates/*; Rabbits.

Peptides as substitute osmotic agents for glucose in peritoneal dialysate.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Klein E; Ward RA; Williams TE; Feldhoff PW.

ASAIO Trans 8703; 32(1):550-3

Adult; Heart/*PP; Heart Ventricle/PP; Human; Infusions, Parenteral; Kidney Failure, Chronic/PP/*TH; Myocardial Contraction/*; Peritoneal Dialysis, Continuous Ambulatory/*MT; Posture; Systole/*.

Effect of intraperitoneal infusion volume and posture on left ventricular systolic function in patients on continuous ambulatory peritoneal dialysis.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Franklin JO; Alpert MA; Twardowski ZJ; Khanna R.

ASAIO Trans 8703; 32(1):554-6

Adult; Diabetic Nephropathies/TH; Female; Glomerulonephritis/CO; Human; Kidney Failure, Chronic/ET/*TH; Male; Patient Education; Peritoneal Dialysis, Continuous Ambulatory/AE/*IS; Peritonitis/PC; Quality Control; Support, Non-U.S. Gov't; United States.

A multicenter trial to evaluate the use of the CAPD "O" set.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Lempert KD; Kolb JA; Swartz RD; Campese V; Golper TA; Winchester JF; Nolph KD; Husserl FE; Zimmerman SW; Kurtz SB; et al.

ASAIO Trans 8703; 32(1):557-9

California; Demography; Follow-Up Studies; Human; Kidney Failure, Chronic/*TH; Nevada; Peritoneal Dialysis, Continuous Ambulatory/*/AE; Peritonitis/ET.

Long-term outcome of continuous ambulatory peritoneal dialysis. The Southern California/Southern Nevada experience.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Nissenson AR; Gentile DE; Soderblom RE; Brax C.

ASAIO Trans 8703; 32(1):560-3

Animal; Diltiazem/*PD; Glucose/*ME; Male; Peritoneal Dialysis/*; Proteins/*ME; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Urea/*ME; Verapamil/*PD.

Effects of calcium channel blockers (verapamil, diltiazem) on peritoneal transport.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Lal SM; Nolph KD; Moore HL; Khanna R.

ASAIO Trans 8703; 32(1):564-6

Blood/*; Human; Kidney Failure, Chronic/*TH; Kidney, Artificial/*; Membranes, Artificial; Models, Biological; Nephrons/PH; Ultrafiltration/*/IS/MT.

Continuous arterio-venous hemofiltration in a wearable device to treat end-stage renal disease.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Murisasco A; Reynier JP; Ragon A; Boobes Y; Baz M; Durand C; Bertocchio P; Agenet C; el Mehdi M.

ASAIO Trans 8703; 32(1):567-71

Adolescence; Adult; Aged; Disposable Equipment; Evaluation Studies; Female; Human; Kidney Failure, Chronic/TH; Male; Middle Age; Peritoneal Dialysis, Continuous Ambulatory/*IS; Support, Non-U.S. Gov't.

Multicenter evaluation of a bagless CAPD system.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Suki WN; Walshe JJ; Ashbrook DW; Gentile DE; Tucker CT; Ash SR; Ahmad S.

ASAIO Trans 8703; 32(1):572-4

Adult; Aged; Aged, 80 and over; Comparative Study; Creatinine/ME; Female; Glucose/ME; Human; Kidney Failure, Chronic/*ME/TH; Kinetics; Male; Middle Age; Peritoneal Dialysis/*; Peritoneal Dialysis, Continuous Ambulatory/*; Phosphates/ME; Potassium/ME; Sodium/ME; Support, Non-U.S. Gov't; Urea/ME.

Daily clearances with continuous ambulatory peritoneal dialysis and nightly peritoneal dialysis.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Twardowski ZJ; Nolph KD; Khanna R; Gluck Z; Prowant BF; Ryan LP.

ASAIO Trans 8703; 32(1):575-80

Blood Substitutes/*AD; Half-Life; Hemoglobins/*AD/ME/TU; Human; Kinetics; Liposomes/*AD; Oxygen/BL; Phosphatidylcholines/*; Support, U.S. Gov't, Non-P.H.S..

Liposome-encapsulated hemoglobin as a red cell surrogate. Preparation scale-up.

JOURNAL ARTICLE.

In order to perform quantitative in vitro and clinical studies on the removal of Al by the combined therapy of DFO administration and HD, an HPLC system for measuring DFO was established and a leaky membrane with enhanced permeability to middle molecular substances was developed. The DFO infusion caused rises in plasma Al levels (regarded as indicating the elution of accumulated Al) in patients undergoing HD. Plasma levels increased most in long-term patients and those with bone pain. Examination of Al clearances demonstrated that this increased plasma Al content passed through HD membranes at levels of more than 80 micrograms/l, and that the leaky membrane was more effective for removal of Al as well as DFO than the conventional one. Although a 1:1 complex between DFO and Al in an aqueous solution was confirmed, the formation of Al-rich complexes in vivo was suggested. It is concluded that Al-DFO complex formed in vivo can be effectively removed across the leaky membrane.

Beissinger RL; Farmer MC; Gossage JL.

ASAIO Trans 8703; 32(1):58-63

Air/*; Diaphragm/*RA; Human; Peritoneal Dialysis, Continuous Ambulatory/*/AE; Posture.

Is air under the diaphragm a significant finding in CAPD patients?

JOURNAL ARTICLE.

The incidence of air under the diaphragm in CAPD patients is very low, and causes directly attributable to standard CAPD techniques are even lower. Bowel perforation generally causes a larger volume of air collection under the diaphragm.

Lampainen E; Khanna R; Schaefer R; Twardowski ZJ; Nolph KD.

ASAIO Trans 8703; 32(1):581-2

Antigens, Neoplasm/*IP; Breast Neoplasms/IM; Extracorporeal Circulation/IS/*MT; Female; Human; Immunosuppression; Male; Neoplasms/*IM; Plasmapheresis; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Extracorporeal removal of tumor antigens.

JOURNAL ARTICLE.

The incidence of air under the diaphragm in CAPD patients is very low, and causes directly attributable to standard CAPD techniques are even lower. Bowel perforation generally causes a larger volume of air collection under the diaphragm.

Shettigar UR; Kolff WJ; Gregonis D.

ASAIO Trans 8703; 32(1):583-6

Animal; Calcinosis/PA/*PC; Cattle; Delayed-Action Preparations; Diphosphonates/*TU; Heart Valve Prosthesis/*; Male; Microscopy, Electron, Scanning; Rats; Silicone Elastomers; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Inhibition of bioprosthetic heart valve calcification by sustained local delivery of Ca and Na diphosphonate via controlled release matrices.

JOURNAL ARTICLE.

The incidence of air under the diaphragm in CAPD patients is very low, and causes directly attributable to standard CAPD techniques are even lower. Bowel perforation generally causes a larger volume of air collection under the diaphragm.

Golomb G; Dixon M; Smith MS; Schoen FJ; Levy RJ.

ASAIO Trans 8703; 32(1):587-90

Animal; Blood Platelets/*CY; Cattle; Fibrin/*AN; Fibrinogen/*AN; Heart Valve Prosthesis/*/AE; Indium/DU; Iodine Radioisotopes/DU; Radioisotopes/DU; Support, U.S. Gov't, P.H.S.; Thrombosis/*ET; Time Factors; Tropolone/AA/DU.

Quantitation of platelet and fibrinogen-fibrin deposition on components of tissue valves (Ionescu-Shiley) in calves.

JOURNAL ARTICLE.

With 111In-labeled platelets and 125I-labeled bovine fibrinogen, regional mapping of platelet and fibrinogen deposition on leaflets and sewing rings was obtained. Ten Holstein calves received 25-mm mitral valves (ISLM) and were killed 1, 14, and 30 days after implantation. Twenty-four hours before the calves were killed, 350 to 450 microCi of 111In-labeled platelets and 200 to 250 microCi of 125I-labeled bovine fibrinogen were administered intravenously. The components of the tissue valves, i.e., three leaflets and sewing rings, were separated. Each leaflet was cut into four sections: free edge, central zone, flexion zone, and attachment zone. From the radioactivity in blood, leaflet zones, sewing rings, area of leaflet zones, platelet count, and fibrinogen level in blood, the mean regional density of adherent platelets, fibrinogen-fibrin, and fibrinogen/platelet were calculated. The density of platelets and fibrinogen deposited on the components of the valves decreases with time postimplantation. The number of fibrinogen molecules per platelet is fivefold to 20-fold higher than that of the receptor concentration on platelets on leaflet zones, suggesting the heterogeneity of fibrinogen-fibrin in thrombus and components of the valve.

Dewanjee MK; Solis E; Lenker J; Tidwell C; Mackey S; Didisheim P; Kaye MP.

ASAIO Trans 8703; 32(1):591-6

Adult; Human; In Vitro; Lipid A/*PD; Lipopolysaccharides/*PD; Luminescence; Neutrophils/CY/DE/*PH; Salmonella/*IM; Support, Non-U.S. Gov't.

Neutrophil stimulation by lipid A and lipopolysaccharides from Salmonella minnesota.

JOURNAL ARTICLE.

With 111In-labeled platelets and 125I-labeled bovine fibrinogen, regional mapping of platelet and fibrinogen deposition on leaflets and sewing rings was obtained. Ten Holstein calves received 25-mm mitral valves (ISLM) and were killed 1, 14, and 30 days after implantation. Twenty-four hours before the calves were killed, 350 to 450 microCi of 111In-labeled platelets and 200 to 250 microCi of 125I-labeled bovine fibrinogen were administered intravenously. The components of the tissue valves, i.e., three leaflets and sewing rings, were separated. Each leaflet was cut into four sections: free edge, central zone, flexion zone, and attachment zone. From the radioactivity in blood, leaflet zones, sewing rings, area of leaflet zones, platelet count, and fibrinogen level in blood, the mean regional density of adherent platelets, fibrinogen-fibrin, and fibrinogen/platelet were calculated. The density of platelets and fibrinogen deposited on the components of the valves decreases with time postimplantation. The number of fibrinogen molecules per platelet is fivefold to 20-fold higher than that of the receptor concentration on platelets on leaflet zones, suggesting the heterogeneity of fibrinogen-fibrin in thrombus and components of the valve.

DeBari VA; Uychich PM; Orsini AJ; Ingenito AC; Needle MA.

ASAIO Trans 8703; 32(1):597-600

Animal; Arteries/SU; Blood Vessel Prosthesis/*; Dogs; Femoral Artery/SU; Microscopy, Electron, Scanning; Silicone Elastomers; Support, U.S. Gov't, P.H.S.; Vascular Patency/*.

Maintenance of compliance in a small diameter arterial prosthesis.

JOURNAL ARTICLE.

This study demonstrates that 20 to 30 microns porous, Replamineform silicone rubber prostheses remain isocompliant with adjacent arterial segments up to 8 months following implantation. This finding contrasts with the results of currently available prostheses, including autologous vein, which rapidly become minimally compliant. We conclude that this vascular construction is stable over the long-term following implantation and may improve the success of small internal diameter arterial reconstruction by eliminating failures caused by intimal hyperplasia.

White RA; Klein SR; Shors E.

ASAIO Trans 8703; 32(1):601-4

Animal; Elasticity; Implants, Artificial/*; Microscopy, Electron, Scanning; Polyvinyl Alcohol/*; Prosthesis; Prosthesis Design; Rabbits; Tensile Strength.

A new hydrogel and its medical application.

JOURNAL ARTICLE.

This study demonstrates that 20 to 30 microns porous, Replamineform silicone rubber prostheses remain isocompliant with adjacent arterial segments up to 8 months following implantation. This finding contrasts with the results of currently available prostheses, including autologous vein, which rapidly become minimally compliant. We conclude that this vascular construction is stable over the long-term following implantation and may improve the success of small internal diameter arterial reconstruction by eliminating failures caused by intimal hyperplasia.

Tamura K; Ike O; Hitomi S; Isobe J; Shimizu Y; Nambu M.

ASAIO Trans 8703; 32(1):605-8

Animal; Biopsy; Factor XIII/*; Gelatin/*; Hemostasis/*; Heparin; Liver/CY; Male; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Thrombin/*; Wound Healing/*.

A new hemostatic material, G.T.XIII.

JOURNAL ARTICLE.

This study demonstrates that 20 to 30 microns porous, Replamineform silicone rubber prostheses remain isocompliant with adjacent arterial segments up to 8 months following implantation. This finding contrasts with the results of currently available prostheses, including autologous vein, which rapidly become minimally compliant. We conclude that this vascular construction is stable over the long-term following implantation and may improve the success of small internal diameter arterial reconstruction by eliminating failures caused by intimal hyperplasia.

Sugitachi A; Kato M; Masuzawa M; Terada A.

ASAIO Trans 8703; 32(1):609-11

Adult; Aged; Catheterization/MT; Catheters, Indwelling/*; Comparative Study; Female; Follow-Up Studies; Human; Male; Middle Age; Peritoneal Dialysis/*; Support, Non-U.S. Gov't.

Preliminary experience with the Swan Neck peritoneal dialysis catheters.

JOURNAL ARTICLE.

This study demonstrates that 20 to 30 microns porous, Replamineform silicone rubber prostheses remain isocompliant with adjacent arterial segments up to 8 months following implantation. This finding contrasts with the results of currently available prostheses, including autologous vein, which rapidly become minimally compliant. We conclude that this vascular construction is stable over the long-term following implantation and may improve the success of small internal diameter arterial reconstruction by eliminating failures caused by intimal hyperplasia.

Twardowski ZJ; Khanna R; Nolph KD; Nichols WK; Ryan LP.

ASAIO Trans 8703; 32(1):64-7

Adult; Bilirubin/*BL/IP; Case Report; Female; Human; Infant, Newborn; Infant, Premature/*; Jaundice, Neonatal/BL/*TH; Resins; Support, Non-U.S. Gov't; Ultrafiltration/*MT.

Bilirubin removal from a jaundiced premature infant by resin hemoperfusion.

JOURNAL ARTICLE.

To summarize the results: Bilirubin removal by hemoperfusion was successfully performed for the first time on a premature infant. The hemoperfusion caused no adverse effects on the clinical state of the infant. The bilirubin removed in 90 min--13 mg--indicates the existence of a large extravascular pool. Hemoperfusion is suggested for bilirubin removal from newborn babies, reducing the need for blood exchange with bank blood.

Brandes JM; Mor L; Sideman S; Zeltzer M; Sujov P; Blazer S.

ASAIO Trans 8703; 32(1):68-70

Cellulose/*; Complement Activation; Hemodialysis/*MT; Human; Leukocyte Count; Membranes, Artificial/*; Platelet Count; Surface Properties.

Development of a regenerated cellulose non-complement activating membrane for hemodialysis.

JOURNAL ARTICLE.

We have developed a new cellulose membrane in which the active hydroxyl and carboxyl groups of the original cellulose fibers are masked with cationic synthetic polymers. The membrane was shown by in vitro and clinical tests to affect the activation of the complement system very little, and it retains the high dialysis efficiency, good tolerance to steam autoclave sterilization, and economical production cost characteristics of the original cellulose membrane. It thus appears that the new cellulose provides the optimum combination of qualities needed in a hemodialysis membrane.

Akizawa T; Kitaoka T; Koshikawa S; Watanabe T; Imamura K; Tsurumi T; Suma Y; Eiga S.

ASAIO Trans 8703; 32(1):76-80

Antibodies, Monoclonal/*TU; Antigen-Antibody Complex/*; Autoimmune Diseases/*TH; Human; Kinetics; Membranes, Artificial/*.

A membrane-immobilized monoclonal antibody immunoadsorption system.

JOURNAL ARTICLE.

We have developed a new cellulose membrane in which the active hydroxyl and carboxyl groups of the original cellulose fibers are masked with cationic synthetic polymers. The membrane was shown by in vitro and clinical tests to affect the activation of the complement system very little, and it retains the high dialysis efficiency, good tolerance to steam autoclave sterilization, and economical production cost characteristics of the original cellulose membrane. It thus appears that the new cellulose provides the optimum combination of qualities needed in a hemodialysis membrane.

McManus DE; Randerson DH.

ASAIO Trans 8703; 32(1):81-4

Aged; Ascitic Fluid/*TH; Case Report; Diabetic Nephropathies/TH; Female; Hemodialysis; Human; Kidney Failure, Chronic/ET/TH; Male; Middle Age; Peritoneovenous Shunt/IS/*MT.

External peritoneo-venous shunt for intractable ascites.

JOURNAL ARTICLE.

We have developed a new cellulose membrane in which the active hydroxyl and carboxyl groups of the original cellulose fibers are masked with cationic synthetic polymers. The membrane was shown by in vitro and clinical tests to affect the activation of the complement system very little, and it retains the high dialysis efficiency, good tolerance to steam autoclave sterilization, and economical production cost characteristics of the original cellulose membrane. It thus appears that the new cellulose provides the optimum combination of qualities needed in a hemodialysis membrane.

Inagaki Y; Amano I.

ASAIO Trans 8703; 32(1):93-7

Animal; Disease Models, Animal; Human; Respiratory Distress Syndrome, Adult/DI/*ET/TH; Sheep.

Acute/adult/animal respiratory distress syndrome [editorial]

EDITORIAL.

We have developed a new cellulose membrane in which the active hydroxyl and carboxyl groups of the original cellulose fibers are masked with cationic synthetic polymers. The membrane was shown by in vitro and clinical tests to affect the activation of the complement system very little, and it retains the high dialysis efficiency, good tolerance to steam autoclave sterilization, and economical production cost characteristics of the original cellulose membrane. It thus appears that the new cellulose provides the optimum combination of qualities needed in a hemodialysis membrane.

Royston D.

Br J Anaesth 8703; 58(11):1207-9

Anesthesia, Inhalation; Atracurium/*ME; Child; Child, Preschool; Human; Infant; Isoflurane; Isoquinolines/BL; Kinetics; Liver/PP; Liver Diseases/BL/*ME/PP; Nitrous Oxide; Support, Non-U.S. Gov't.

Pharmacokinetics of atracurium in anaesthetized infants and children.

JOURNAL ARTICLE.

The pharmacokinetics of atracurium were studied in infants and children anaesthetized with isoflurane and nitrous oxide in oxygen. There were no significant differences in volume of distribution (area) (139 v. 152 ml kg-1), clearance (5.1 v. 5.3 ml kg-1 min-1), T1/2 alpha (2.1 v. 2.0 min), or T1/2 beta (19.1 v. 20.3 min) between children with normal hepatic and renal function and those with moderately impaired hepatic function presenting for hepatic transplantation. There were significant differences in volume of distribution (area) (176 v. 139 ml kg-1) and in clearance of atracurium (9.1 v. 5.1 ml kg-1 min-1) between infants and children with normal excretory function. In infants the clearance of atracurium in ml m-2 min-1 (153 v. 133) tended to be greater and the T1/2 alpha and T1/2 beta tended to be shorter (1.0 v. 2.0 and 13.6 v. 19.1) than in children with normal excretory function; however, these trends did not reach statistical significance. Plasma laudanosine concentration was around 100 ng ml-1 greater in patients with liver disease than in normal children from 15-45 min following a bolus of atracurium 0.5 mg kg-1.

Brandom BW; Stiller RL; Cook DR; Woelfel SK; Chakravorti S; Lai A.

Br J Anaesth 8703; 58(11):1210-3

Anesthesia, Intratracheal; Atracurium/AD/*PD; Biliary Atresia/PP/*SU; Drug Administration Schedule; Female; Human; Infant; Infant, Newborn; Intraoperative Care; Liver/*PP; Male; Neuromuscular Blocking Agents/*.

Use of atracurium during major abdominal surgery in infants with hepatic dysfunction from biliary atresia.

JOURNAL ARTICLE.

The use of atracurium during major abdominal surgery was assessed in 20 infants with hepatic dysfunction caused by biliary atresia. An initial dose of 0.6 mg kg-1 provided excellent intubating conditions in all patients. Subsequent neuromuscular blockade was monitored with a peripheral nerve stimulator and incremental doses of atracurium were given on reappearance of a single twitch. Neuromuscular conduction was allowed to return at the end of surgery and by careful timing of increments it was necessary to antagonize the neuromuscular blockade in only two patients.

Simpson DA; Green DW.

Br J Anaesth 8703; 58(11):1214-7

Adolescence; Anesthesia, Inhalation/*AE; Child; Child, Preschool; Female; Halothane/AD/*AE; Hepatitis, Toxic/*ET/PP; Human; Infant; Liver/*DE/PP; Male; Postoperative Period; Prospective Studies; Support, Non-U.S. Gov't; Time Factors.

Prospective study of liver function in children following multiple halothane anaesthetics at short intervals.

JOURNAL ARTICLE.

In the 4 years January 1981 to December 1984, 186 children received 1362 halothane anaesthetics. Twenty-five patients were anaesthetized with halothane at least 10 times in a year. No patient developed postoperative jaundice. Sixty-nine children were exposed to two halothane anaesthetics within 28 days on 149 occasions and serial estimations of serum liver enzyme concentrations were obtained. Minor increases in the concentrations of serum AST and ALT were recorded in 10.6% and 4.7% of patient entries, respectively. Postoperative GGT and SAP concentrations were increased in 2.7% of patient entries. Patients in whom enzyme values were increased before the first anaesthetic were no more likely than other subjects to develop further changes.

Wark H; O'Halloran M; Overton J.

Br J Anaesth 8703; 58(11):1224-8

Atracurium/*PD; Child; Child, Preschool; Female; Histamine/BL; Histamine Liberation/*DE; Human; Infant; Male; Neuromuscular Junction/DE; Time Factors; Vecuronium/*PD.

Histamine release during the administration of atracurium or vecuronium in children.

JOURNAL ARTICLE.

The histamine releasing potential of equivalent bolus doses of atracurium 0.6 mg kg-1 or vecuronium 0.12 mg kg-1 was evaluated in 20 children anaesthetized with halothane. Blood samples were obtained before, and at 2 and 5 min after the administration of the neuromuscular blocker. The twitch response to 0.15 Hz was also evaluated. None of the 10 patients receiving vecuronium had a significant increase in plasma histamine concentration. In two of the 10 children receiving atracurium, the plasma histamine concentration increased markedly, but without any apparent clinical manifestations. Recovery of neuromuscular function (to 95% twitch height) after vecuronium 0.12 mg kg-1 was faster than after atracurium 0.6 mg kg-1 (P less than 0.02).

Goudsouzian NG; Young ET; Moss J; Liu LM.

Br J Anaesth 8703; 58(11):1229-33

Adrenocorticotropic Hormone/BL; Anesthesia, Inhalation; Catecholamines/BL; Child; Child, Preschool; Halothane; Hormones/*BL; Human; Hydrocortisone/BL; Infant; Midazolam/*PD; Postoperative Period; Premedication/*; Pulmonary Gas Exchange; Respiration/*DE; Support, Non-U.S. Gov't; Surgery, Operative.

Ventilation, ventilatory carbon dioxide and hormonal response during halothane anaesthesia and surgery in children after midazolam premedication.

JOURNAL ARTICLE.

In 14 intubated, spontaneously breathing children with body weight (bw) ranging from 8.3 to 25.6 kg, the influence of midazolam 0.1 mg kg-1 i.m. (group M0.1, n = 7) and 0.2 mg kg-1 i.m. (group M0.2, n = 7) as premedication, on sedation, ventilation, ventilatory response to carbon dioxide and hormonal stress response was studied in connection with minor surgical procedures during halothane anaesthesia. The concentrations of catecholamines, ACTH and cortisol were measured immediately after induction, during undisturbed anaesthesia, during surgery and 15 min after the end of the surgical procedure. Sedation was better and plasma catecholamine concentrations during undisturbed anaesthesia were less in children receiving the larger dose of midazolam. During surgery and in recovery there were no differences in hormone concentrations. In recovery, the concentrations of all hormones were significantly greater compared with during undisturbed anaesthesia. During surgery, VE and respiratory rate were somewhat lower in group M0.2 while E' CO2 was similar. A dose dependent depression of the response to carbon dioxide was found. However, clinically, the ventilatory response to carbon dioxide after surgery was considered to be adequate in both groups.

Charlton AJ; Hatch DJ; Lindahl SG; Phythyon JM; Norden NE.

Br J Anaesth 8703; 58(11):1234-41

Adult; Alcuronium/AI/*PD; Atracurium/AI/*PD; Comparative Study; Electromyography; Evoked Potentials/DE; Human; Muscle Contraction/DE; Muscles/*DE; Neostigmine/*PD; Neuromuscular Blocking Agents/*; Toxiferine/*AA.

Evoked electromyographic and mechanical responses of the adductor pollicis compared during the onset of neuromuscular blockade by atracurium or alcuronium, and during antagonism by neostigmine.

JOURNAL ARTICLE.

The effects of atracurium and alcuronium on the evoked mechanical and electromyographic responses of the adductor pollicis were investigated in 30 adult patients. The ulnar nerve was stimulated with trains of four supramaximal pulses of 0.2 ms duration and a frequency of 2 Hz at intervals of 20 s. The mechanical response was measured using a strain gauge force transducer and the evoked compound action potential (ECAP) was recorded simultaneously using a Medelec MS91 electromyography system. Depression of the electromyographic and mechanical responses, caused by atracurium, was similar during onset and antagonism of blockade. During onset of blockade by alcuronium, the mechanical response was depressed to a significantly greater extent compared with the ECAP. This difference was not observed during antagonism with neostigmine. The rates of onset of atracurium and alcuronium were generally similar, but the rate of onset of mechanical fade was greater in the alcuronium group. There was no significant quantitative difference between the rates of antagonism of alcuronium and atracurium when assessed by the mechanical first response ratio. Electromyographic first response and electromyographic and mechanical train-of-four ratios recovered more rapidly in the atracurium group. These findings suggest that the differences between mechanical and electromyographic measurements of neuromuscular blockade are drug-specific and are more pronounced during the onset of blockade than during its antagonism by neostigmine.

Harper NJ; Bradshaw EG; Healy TE.

Br J Anaesth 8703; 58(11):1278-84

Adult; Atracurium/*AI; Comparative Study; Edrophonium/*PD; Human; Middle Age; Muscle Contraction/DE; Neostigmine/*PD; Neuromuscular Blocking Agents/*AI; Time Factors; Vecuronium/*AI.

Antagonism of profound neuromuscular blockade induced by vecuronium or atracurium. Comparison of neostigmine with edrophonium.

JOURNAL ARTICLE.

The effectiveness of neostigmine 0.07 mg kg-1 and edrophonium 0.8 mg kg-1 as antagonists of profound neuromuscular blockade induced by vecuronium 0.1 mg kg-1 or atracurium 0.5 mg kg-1 was studied in 59 healthy patients. The antagonists were administered 5 min after total ablation of the twitch response and the end-point of recovery was a train-of-four ratio of 70%. In 30 patients given vecuronium the mean time to reach this point (duration TOF70) was 66.7 min in the control group (no antagonist), 43.5 min in the group given neostigmine and 59.8 min in the group given edrophonium. The duration TOF70 was shorter in the neostigmine group than in the control (P less than 0.01) and edrophonium (P less than 0.01) groups. The duration TOF70 did not differ from control in the edrophonium group. In 29 patients given atracurium, the durations TOF70 were 66.4, 44.1 and 54.9 min in the control, neostigmine and edrophonium groups, respectively. The durations TOF70 in the neostigmine (P less than 0.01) and edrophonium (P less than 0.01), groups were shorter than control. The duration TOF70 of the neostigmine group was shorter than in the edrophonium group (P less than 0.01). These results show that profound neuromuscular blockade cannot be rapidly antagonized by either of these two agents, but if reversal is required under these circumstances, neostigmine would be the more effective drug.

Caldwell JE; Robertson EN; Baird WL.

Br J Anaesth 8703; 58(11):1285-9

Atracurium/*AI/PD; Comparative Study; Edrophonium/*PD; Human; Muscle Contraction/DE; Neostigmine/*PD; Neuromuscular Blocking Agents/*AI; Time Factors.

Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium.

JOURNAL ARTICLE.

Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium has been studied using the tetanic (50 Hz) and train-of-four (2 Hz) or single twitch responses of the adductor pollicis muscle in 22 anaesthetized patients. A further nine patients not given an anticholinesterase acted as a control group. In two groups (six patients for each anticholinesterase) in whom antagonism was attempted at 95-98% blockade of the tetanic response, recovery of the tetanic response after two or three doses of edrophonium 0.75 mg kg-1 i.v. was not statistically different from that in the control group; recovery after two doses of neostigmine 2.5 mg i.v. was significantly faster (P less than 0.001). Recovery of the single twitch response after antagonism with edrophonium, although longer than that with neostigmine (P less than 0.01), was significantly shorter than in the control group (P less than 0.05). When edrophonium is given at the commencement of recovery, the initial rapid antagonism of tetanic block is not sustained, whereas antagonism by neostigmine is more persistent and the recovery phase is significantly shortened. In a further two groups of patients (n = 5) given atracurium 0.3 mg kg-1 i.v., antagonism was not attempted until the peak height of the tetanic contraction had reached approximately 50% of the control value.(ABSTRACT TRUNCATED AT 250 WORDS)

Astley BA; Hughes R; Payne JP.

Br J Anaesth 8703; 58(11):1290-5

Adult; Atracurium/*PD; Evoked Potentials/DE; Female; Human; Male; Middle Age; Muscle Contraction/*DE; Neuromuscular Blocking Agents/*; Time Factors; Tubocurarine/*PD; Vecuronium/*PD.

Reappearance of the train-of-four after neuromuscular blockade induced with tubocurarine, vecuronium or atracurium.

JOURNAL ARTICLE.

The characteristics of train-of-four recovery after atracurium or vecuronium were studied, under enflurane anaesthesia, and compared with those associated with tubocurarine-induced blockade. Ten patients each received vecuronium 0.1 mg kg-1, atracurium 0.5 mg kg-1 or tubocurarine 0.5 mg kg-1. Neuromuscular blockade was calculated as the percent depression of the first twitch, and was determined at the time of reappearance of the second, third and fourth twitches of the train-of-four. The pattern during recovery from blockade induced by the three neuromuscular blocking agents was similar, with T2, T3 and T4 reappearing at approximately 93%, 89% and 86% residual blockade, respectively. These results are different from those previously reported by Lee (1975) indicating that, under enflurane anaesthesia, the train-of-four count may give an incorrect estimate of the degree of neuromuscular blockade.

O'Hara DA; Fragen RJ; Shanks CA.

Br J Anaesth 8703; 58(11):1296-9

Anesthesia, General/*MT; Anesthesia, Inhalation; Comparative Study; Enflurane; Female; Human; Male; Muscle Contraction/*DE; Neuromuscular Blocking Agents/*; Nitrous Oxide; Thiopental; Transducers; Vecuronium/*PD; Visual Perception.

Comparison of visual and measured train-of-four recovery after vecuronium-induced neuromuscular blockade using two anaesthetic techniques.

JOURNAL ARTICLE.

This study evaluated train-of-four recovery after the administration of vecuronium, comparing measured with visually observed responses. Responses to supramaximal stimuli of the ulnar nerves were measured by a force transducer, and compared with visually observed movements of the contralateral thumb. For the 10 patients anaesthetized with nitrous oxide and enflurane, the second, third and fourth twitches visually reappeared at 84 (+/- 10)%, 76 (+/- 11)%, and 70 (+/- 12)% measured blockade, respectively. For the other 10 patients, anaesthetized with a narcotic-barbiturate technique, the second, third and fourth twitches reappeared at 81 (+/- 8)%, 68 (+/- 9)%, and 59 (+/- 11)%. These results were not different for the two anaesthetic techniques.

O'Hara DA; Fragen RJ; Shanks CA.

Br J Anaesth 8703; 58(11):1300-2

Adult; Aged; Anesthesia, General; Cholinesterase Inhibitors/*ME; Female; Galanthamine/BL/*ME/UR; Human; Kinetics; Middle Age.

Pharmacokinetics of galanthamine (a long-acting anticholinesterase drug) in anaesthetized patients.

JOURNAL ARTICLE.

The pharmacokinetics of the long-acting anticholinesterase drug, galanthamine, were investigated in eight patients. After i.v. injection of 0.3 mg kg-1, the decrease in the serum concentration of galanthamine followed a biexponential curve. The serum concentration decreased rapidly from 543 +/- 47 ng ml-1 to 128 +/- 14 ng ml-1 between 2 and 30 min with a T1/2 alpha of 6.42 +/- 2.15 min, and then declined more slowly with a T1/2 beta of 264 +/- 28 min. Total serum clearance of galanthamine amounted to 5.37 +/- 0.87 ml min-1 kg-1, and the renal clearance was 1.36 +/- 0.10 ml min-1 kg-1. The cumulative urinary excretion of galanthamine between 0 and 48 h after injection amounted to 28.0 +/- 5.4% of the administered dose. The biliary excretion of galanthamine during 24 h amounted to 0.2 +/- 0.1% of the dose. There was no evidence of glucuronide or sulphate conjugation of galanthamine.

Westra P; van Thiel MJ; Vermeer GA; Soeterbroek AM; Scaf AH; Claessens HA.

Br J Anaesth 8703; 58(11):1303-7

Anesthesia, General/*; Anesthesia, Spinal/*; Animal; Cardiac Output/DE; Chlormethiazole/*ME/PD; Hemodynamics/*DE; Intestines/BS; Iodohippuric Acid/ME; Liver Circulation/DE; Regional Blood Flow/DE; Renal Circulation/DE; Sheep; Subarachnoid Space.

A sheep preparation for studying interactions between blood flow and drug disposition. VI: Effects of general or subarachnoid anaesthesia on blood flow and chlormethiazole disposition.

JOURNAL ARTICLE.

Blood flow through and chlormethiazole extraction ratios across lungs, liver, kidneys and gut were measured in awake unrestrained sheep (controls) and with the same animals anaesthetized with 1.5% halothane or whilst undergoing high thoracic subarachnoid blockade with amethocaine. In the control-drug studies, chlormethiazole infused to sub-sedative blood concentrations produced no significant changes in haemodynamics or in the kinetics of iodohippurate (renal and hepatic blood flows). Chlormethiazole was eliminated predominantly by the liver (mean extraction ratio and clearance, respectively, 0.90 and 1.3 litre min-1) and lungs (0.15; 0.6 litre min-1). Renal clearance was absent or negligible (greater than 0.1 litre min-1). Because of pulmonary clearance, mean total body clearance was derived from analysis of pulmonary arterial concentrations. Under general anaesthesia, there were significant reductions in mean cardiac output, hepatic and renal blood flow (to 54%, 63% and 43% of control); chlormethiazole mean hepatic extraction ratios and clearance were reduced, respectively, to 82% and 56% of control, and its pulmonary and renal clearances were abolished. With subarachnoid anaesthesia there were no significant changes in haemodynamics or in chlormethiazole extraction ratios or clearances.

Runciman WB; Mather LE; Ilsley AH; Carapetis RJ; Upton RN.

Br J Anaesth 8703; 58(11):1308-16

Adult; Aged; Bronchi/*; Bronchoscopy; Human; Intubation/AE/*MT; Male; Middle Age.

Placement of double-lumen endobronchial tubes. Correlation between clinical impressions and bronchoscopic findings.

JOURNAL ARTICLE.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Smith GB; Hirsch NP; Ehrenwerth J.

Br J Anaesth 8703; 58(11):1317-20

Anesthesia/*; Anesthetics/*; Animal; Human.

Proceedings of the Anaesthetic Research Society. Leeds meeting. April 11-12, 1986. Abstracts.

JOURNAL ARTICLE.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Smith GB; Hirsch NP; Ehrenwerth J.

Br J Anaesth 8703; 58(11):1321P-1340P

Animal; Dogs; Human; Respiration, Artificial/*; Respiratory Dead Space/*; Tidal Volume.

Deadspace during high frequency ventilation [letter]

LETTER.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Fletcher R.

Br J Anaesth 8703; 58(11):1341-2

Atracurium/*AE; Histamine Liberation/*DE; Human.

Histamine liberation with atracurium [letter]

LETTER.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Owen RT.

Br J Anaesth 8703; 58(11):1342

Analgesia/*MT; Human; Injections, Spinal; Morphine/*AD; Thoracic Injuries/*TH.

Intrathecal morphine and multiple fractured ribs [letter]

LETTER.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Dickson GR; Sutcliffe AJ.

Br J Anaesth 8703; 58(11):1342-3

Animal; Atracurium/*AE; Female; Human; Pre-Eclampsia/*ME; Pregnancy; Rabbits; Seizures/CI.

Use of atracurium in pre-eclamptic patients [letter]

LETTER.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Fujita RA; Choi HJ.

Br J Anaesth 8703; 58(11):1343

Adolescence; Adult; Aged; Calcitonin/BL; Cholecalciferols/*TU; Dihydroxycholecalciferols/BL/TU; Female; Human; Hydroxycholecalciferols/BL/TU; Male; Middle Age; Parathyroid Hormones/BL; Psoriasis/BL/*DT; Support, Non-U.S. Gov't.

An open study of vitamin D3 treatment in psoriasis vulgaris.

JOURNAL ARTICLE.

Active forms of vitamin D3, 1 alpha-hydroxyvitamin D3 and 1 alpha,25-dihydroxyvitamin D3, were administered in an open-design study to 40 patients with psoriasis vulgaris in three ways: to 17 patients 1 alpha-hydroxyvitamin D3 was given orally at a dose of 1.0 micrograms/day for 6 months, to four patients 1 alpha,25-dihydroxyvitamin D3 was given orally at a dose of 0.5 microgram/day for 6 months, and 19 patients were given 1 alpha,25-dihydroxyvitamin D3 applied topically at concentration of 0.5 microgram/g of base for 8 weeks. Improvement was observed at the end of the individual study periods in 13 (76%) patients in Group 1 with a mean period of treatment (+/- SD) of 2.7 +/- 0.6 months, in one patient in Group 2 at 3 months after the start of treatment, and in 16 (84%) patients in Group 3 when the chemical was applied for 3.3 +/- 1.2 weeks. No side-effects were observed in any of these trials. These data suggest that psoriasis may respond to active metabolites of vitamin D3 and that abnormalities in vitamin D metabolism or in responsiveness of the skin cells to active metabolites of vitamin D may be involved in the pathogenesis of this skin disease.

Morimoto S; Yoshikawa K; Kozuka T; Kitano Y; Imanaka S; Fukuo K; Koh E; Kumahara Y.

Br J Dermatol 8703; 115(4):421-9

Adolescence; Adult; Aged; Dihydroxycholecalciferols/*TU; Female; Human; Male; Middle Age; Ointments; Psoriasis/*DT.

Successful treatment of psoriasis with topical application of active vitamin D3 analogue, 1 alpha,24-dihydroxycholecalciferol.

JOURNAL ARTICLE.

We treated 11 psoriatic patients with topical 1 alpha,24-dihydroxycholecalciferol, a new synthetic analogue of active vitamin D3. In 10 of 15 tests the lesions cleared completely within 1-4 weeks, although some relapses occurred shortly after cessation of treatment. There were no side-effects. We suggest that 1 alpha, 24(OH)2D3 merits further investigation as a potentially useful topical therapy for psoriasis.

Kato T; Rokugo M; Terui T; Tagami H.

Br J Dermatol 8703; 115(4):431-3

Antibodies, Fungal/*AN; Antigens, Fungal/*IM; Counterimmunoelectrophoresis; Cross Reactions; Dermatomycoses/*IM; Deuteromycetes/*IM; Human; Hyphomycetes/*IM; Immunoelectrophoresis, Two-Dimensional.

Circulating antibodies and antigenic cross-reactivity in Hendersonula toruloidea and Scytalidium hyalinum infections.

JOURNAL ARTICLE.

Twelve (34%) of thirty-five patients with an active infection on the palms or soles caused by Hendersonula toruloidea or Scytalidium hyalinum were found to have circulating antibodies to these organisms by counter immunoelectrophoresis or immunodiffusion, compared with 9% of uninfected controls. In every instance there was cross-reactivity between the positive patients' sera and the heterologous non-dermatophyte antigen. Using crossed and intermediate gel immunoelectrophoresis it was found that cytoplasmic extracts of H. toruloidea and S. hyalinum showed 34 and 41 precipitin peaks respectively, most of which were shared by both organisms. No cross-reactions were observed between the non-dermatophyte cytoplasmic extracts and hyperimmune animal antisera raised to Trichophyton rubrum, Trichophyton interdigitale, Aspergillus fumigatus or Candida albicans. Exoantigens prepared from the two non-dermatophytes showed similar cross-reactivity between the two species. It appears that H. toruloidea and S. hyalinum are very similar in antigenic structure, a finding which lends support to the view that they may be closely related. They are also antigenically distinct from other pathogenic fungi which commonly infect skin, a fact which may be useful in their cultural identification as well as their recognition in tissue specimens.

Moore MK; Hay RJ.

Br J Dermatol 8703; 115(4):435-45

Administration, Topical; Dose-Response Relationship, Radiation; Erythema/*DT/ET; Human; Indomethacin/*AD/TU; Models, Biological; Skin/RE; Ultraviolet Rays/*AE.

A quantitative study of the effect of topical indomethacin on cutaneous erythema induced by UVB and UVC radiation.

JOURNAL ARTICLE.

The effect of indomethacin gel on UVB and UVC erythema was assessed objectively using a reflectance instrument. When indomethacin was applied immediately after irradiation, UVR (ultraviolet radiation) dose-dependent suppression of erythema was demonstrated for both wavelengths until 36 h after irradiation when both indomethacin and control gel base-treated sites were equally erythematous. Suppression of erythema also occurred when application of indomethacin was delayed until 24 h after irradiation, showing that for both wavelengths prostaglandin synthesis remains increased throughout this period. The degree of suppression at any time, however, was no greater than that achieved by a single application immediately after irradiation, indicating that the eventual equal erythema of indomethacin and gel base-treated sites was not due to tachyphylaxis or inadequate dosage. Construction of dose-response curves for the indomethacin-responsive and indomethacin-unresponsive components of erythema shows that in human skin the difference in erythemal response to UVB and UVC radiation is not due to the formation of different mediators at these wavelengths.

Farr PM; Diffey BL.

Br J Dermatol 8703; 115(4):453-66

Adolescence; Adult; Behavior Therapy/*; Combined Modality Therapy; Dermatitis, Atopic/DT/*TH; Human; Hydrocortisone/TU; Middle Age; Ointments; Pruritus/DT/*TH; Support, Non-U.S. Gov't.

Behavioural treatment of scratching in patients with atopic dermatitis.

JOURNAL ARTICLE.

A behavioural method of habit reversal, in combination with a hydrocortisone cream, was compared with the use of cream alone in the treatment of 17 patients with atopic dermatitis. The patients were assigned randomly to two groups, one of which received the combination treatment and the other regular ointment treatment. The patients' skin status was assessed before and after treatment, and the patients recorded their scratching during the study. Both groups improved, but the group which received habit-reversal therapy improved significantly more. A strong correlation was found between reduction in scratching and improvement in skin status.

Melin L; Frederiksen T; Noren P; Swebilius BG.

Br J Dermatol 8703; 115(4):467-74

Adolescence; Adrenal Cortex Function Tests; Case Report; Child; Child, Preschool; Cosyntropin/DU; Cushing's Syndrome/CI; Dermatitis, Atopic/BL/*ME; Female; Human; Hydrocortisone/BL/*ME; Infant; Male; Seborrhea/BL/*ME; Skin Absorption/*; Support, Non-U.S. Gov't.

Effect of percutaneous absorption of hydrocortisone on adrenocortical responsiveness in infants with severe skin disease.

JOURNAL ARTICLE.

Percutaneous absorption of hydrocortisone was studied in 18 children (aged from 6 weeks to 14 1/2 years) with atopic or seborrhoeic dermatitis, by measuring their serum cortisol before and after application of 1% hydrocortisone cream. Endogenous secretion of cortisol was suppressed with dexamethasone. A 24 h absorption test was performed on nine children. In six, percutaneous absorption was detected. The highest serum cortisol level was reached within the first 6 h. A 4 h absorption test was developed on the basis of the 24 h test. This short absorption test was performed on nine children, and in eight of them absorption of hydrocortisone was detected. The rise of serum cortisol ranged from 98 to 2669 nmol/l. The 2 h ACTH test was performed to evaluate the effect of previous treatment with topical glucocorticoids. Suppressed adrenocortical function was found in five of 13 children, and was associated significantly with high post-application serum cortisol levels. This occurred more often in infants with a severe skin disorder than in older children or in those with mild or moderate skin disease.

Turpeinen M; Salo OP; Leisti S.

Br J Dermatol 8703; 115(4):475-84

Adult; Allergens/*IM; Dermatitis, Atopic/*IM; Human; Immunologic Tests; Male; Mites/*IM; Pruritus/IM; Skin Tests.

Challenge reactions in atopic dermatitis after percutaneous entry of mite antigen.

JOURNAL ARTICLE.

We succeeded in reproducing an eczematous lesion on the apparently normal skin of a patient with atopic dermatitis by scratching and continuous application of an ointment containing ferritin-labelled mite antigen. Percutaneous entry of mite antigen was demonstrated in skin biopsies by Fe-staining. Scratched skin first showed an urticarial reaction typical of type I allergy which later changed into an eczematous reaction typical of type IV allergy. This change was also shown histologically.

Gondo A; Saeki N; Tokuda Y.

Br J Dermatol 8703; 115(4):485-93

Adult; Case Report; Diagnosis, Differential; Female; Human; Neutrophils; Skin Diseases/*DI; Syndrome; Syphilis/*DI.

Secondary syphilis mimicking Sweet's syndrome.

JOURNAL ARTICLE.

We describe a patient with secondary syphilis and facial skin lesions which resembled Sweet's syndrome clinically and histologically. We suggest serological tests for syphilis in patients with Sweet's syndrome.

Jordaan HF; Cilliers J.

Br J Dermatol 8703; 115(4):495-6

Case Report; Child; Ecthyma, Contagious/*CO; Granuloma/*ET/PA; Human; Male; Skin Diseases/*ET/PA.

Giant orf in a normal individual.

JOURNAL ARTICLE.

We describe a patient with secondary syphilis and facial skin lesions which resembled Sweet's syndrome clinically and histologically. We suggest serological tests for syphilis in patients with Sweet's syndrome.

Pether JV; Guerrier CJ; Jones SM; Adam AE; Kingsbury WN.

Br J Dermatol 8703; 115(4):497-9

Blister/*ET/PA; Burns/*CO/PA; Case Report; Cicatrix/PA; Human; Infant; Male; Microscopy, Electron.

Blisters over burn scars in a child.

JOURNAL ARTICLE.

We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.

Pedragosa R; Serrano S; Carol-Murillo J; Hernandez JV; Vidal J.

Br J Dermatol 8703; 115(4):501-6

Aged; Case Report; Female; Human; Killer Cells, Natural/*IM; Lymphomatoid Granulomatosis/*IM; Skin Diseases/*IM.

Natural killer cells and lymphomatoid granulomatosis [letter]

LETTER.

We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.

Rongioletti F; Bernengo MG; Crovato F; Rebora A.

Br J Dermatol 8703; 115(4):514-5

Anti-Inflammatory Agents, Non-Steroidal/*; Human; Photosensitivity Disorders/*ET; Propionates/*AE; Propionic Acids/*AE.

Persistent phototoxicity after benoxaprofen [letter]

LETTER.

We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.

Sneddon IB.

Br J Dermatol 8703; 115(4):515-6

Female; Human; Pregnancy; Propranolol/TU; Puerperal Disorders/*DI; Thyroiditis/*DI/DT; Thyroxine/TU.

Postpartum thyroiditis--an underdiagnosed disease.

JOURNAL ARTICLE.

We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.

Ramsay I.

Br J Obstet Gynaecol 8703; 93(11):1121-3

Adolescence; Adult; Colitis, Ulcerative/BL/*CO; Comparative Study; Crohn Disease/BL/*CO; Female; Hemoglobins/AN; Human; Infant, Low Birth Weight; Infant, Newborn; Labor, Induced; Labor, Premature/ET; Pregnancy; Pregnancy Complications/*ET; Retrospective Studies.

The effects of inflammatory bowel disease on pregnancy: a case-controlled retrospective analysis.

JOURNAL ARTICLE.

Retrospective analysis of 82 pregnancies in women with either ulcerative colitis or Crohn's disease suggested that, in general, neither disease had a major effect on pregnancy outcome. The birth-weights of babies born to women with inflammatory bowel disease were marginally lower than those born to women in a control group matched for age and parity, but the difference was statistically significant only in women with Crohn's disease. In both disease groups there was a higher frequency of low haemoglobin levels in pregnancy than in the matched control groups. There were no statistically significant effects of ulcerative colitis or Crohn's disease on duration of pregnancy, mode of delivery or raised blood pressure and/or proteinuria. In the absence of a relapse, a diagnosis of inflammatory bowel disease should not influence obstetric management.

Porter RJ; Stirrat GM.

Br J Obstet Gynaecol 8703; 93(11):1124-31

Comparative Study; Extraction, Obstetrical/*AE/*MT; Female; Human; Infant, Newborn; Infant, Newborn, Diseases/ET; Labor Complications/*TH; Labor Stage, Second; Obstetrical Forceps; Pregnancy; Puerperal Disorders/ET; Retrospective Studies; Vacuum Extraction, Obstetrical/*AE.

Fetal and maternal effects of forceps and vacuum extraction.

JOURNAL ARTICLE.

Retrospective analysis of 82 pregnancies in women with either ulcerative colitis or Crohn's disease suggested that, in general, neither disease had a major effect on pregnancy outcome. The birth-weights of babies born to women with inflammatory bowel disease were marginally lower than those born to women in a control group matched for age and parity, but the difference was statistically significant only in women with Crohn's disease. In both disease groups there was a higher frequency of low haemoglobin levels in pregnancy than in the matched control groups. There were no statistically significant effects of ulcerative colitis or Crohn's disease on duration of pregnancy, mode of delivery or raised blood pressure and/or proteinuria. In the absence of a relapse, a diagnosis of inflammatory bowel disease should not influence obstetric management.

Punnonen R; Aro P; Kuukankorpi A; Pystynen P.

Br J Obstet Gynaecol 8703; 93(11):1132-5

Amniotic Fluid/AN; Comparative Study; Female; Fetal Blood/AN; Fetal Membranes/AN; Human; Interferon Type I/*AN; Placenta/AN; Pregnancy/BL/*ME; Support, Non-U.S. Gov't.

Alpha interferon in human pregnancy.

JOURNAL ARTICLE.

The concentration of interferon-alpha was measured by a specific two-site immunoradiometric assay in a variety of fluids and tissues collected during human pregnancy. Maternal blood and blood and tissues from non-pregnant adults contained little or no interferon-alpha. Fetal blood, fetal organs, placenta, membranes, amniotic fluid and decidua all contained significant and roughly equivalent amounts ranging from 1.1 to 10 u/ml (or per g of tissue). These findings demonstrate that the fetus and its immediate surroundings are permeated with interferon. It is suggested that this may play a role in regulation of the maternal-fetal graft relation.

Chard T; Craig PH; Menabawey M; Lee C.

Br J Obstet Gynaecol 8703; 93(11):1145-9

Adult; Centrifugation/MT; Comparative Study; Female; Human; Macrophages/MI; Phagocytes/*PH; Phagocytosis/*; Pregnancy/BL/*PH; Staphylococcus epidermidis.

Enhanced phagocytosis of mononuclear phagocytes in pregnancy.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Koumandakis E; Koumandaki I; Kaklamani E; Sparos L; Aravantinos D; Trichopoulos D.

Br J Obstet Gynaecol 8703; 93(11):1150-4

Adult; Female; Heparin/TU; Human; Pregnancy; Pregnancy Complications, Cardiovascular/*DI/DT; Pulmonary Embolism/*DI/DT; Warfarin/TU.

An unusual presentation of pulmonary thromboembolism in late pregnancy. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Hussein IY; Critchley HO.

Br J Obstet Gynaecol 8703; 93(11):1161-2

Case Report; Endometrial Hyperplasia/*CO/PA; Female; Hemangioma/*CO/PA; Human; Middle Age; Ovarian Neoplasms/*CO/PA.

Haemangioma of the ovary with associated endometrial hyperplasia. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Grant JW; Millward-Sadler GH.

Br J Obstet Gynaecol 8703; 93(11):1166-8

Adult; Carcinoma, Squamous Cell/PA/*SC; Case Report; Cervix Neoplasms/*PA; Female; Human; Ovarian Neoplasms/PA/*SC.

Ovarian metastasis from stage 1B squamous carcinoma of the cervix. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Cassidy LJ; Kennedy JH.

Br J Obstet Gynaecol 8703; 93(11):1169-70

Aged; Female; Human; Menopause; Ovarian Neoplasms/BL/*PA; Sertoli Cell Tumor/BL/*PA; Steroids/BL.

A feminizing Sertoli-Leydig cell tumour in a postmenopausal woman. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Dhont M; Vandekerckhove F; Praet M; Vanluchene E; Vandekerckhove D.

Br J Obstet Gynaecol 8703; 93(11):1171-5

Adult; Arteritis/*PA; Case Report; Cervix Diseases/*PA; Female; Human; Middle Age; Necrosis.

Isolated arteritis of the uterine cervix. Three case reports.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Padwell A.

Br J Obstet Gynaecol 8703; 93(11):1176-80

Adult; Case Report; Female; Human; Hydatidiform Mole/*GE/PA; Karyotyping; Mosaicism; Pregnancy; Uterine Neoplasms/*GE/PA.

Diploid complete hydatidiform mole, mosaic for normally fertilized cells and androgenetic homozygous cells. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Ford JH; Brown JK; Lew WY; Peters GB.

Br J Obstet Gynaecol 8703; 93(11):1181-6

Carcinoma, Mucinous/PA/*SC; Case Report; Cervix Neoplasms/PA/*SC; Female; Gallbladder Neoplasms/*PA; Human; Middle Age.

Carcinoma of the gall bladder metastatic to the cervix. Case report.

JOURNAL ARTICLE.

The phagocytic activity of peripheral blood mononuclear phagocytes for Staphylococcus epidermis of healthy non-pregnant and pregnant women throughout pregnancy was examined in relation to gestational age. The study included 30 healthy non-pregnant women and 90 healthy pregnant women equally distributed across the three trimesters. Two variables were investigated: the number of mononuclear cells in phagocytosis and the average number of bacteria per monocyte in phagocytosis. As pregnancy progressed a gradual and significant increase was found in the number of monocytes in phagocytosis and a significantly higher proportion of macrophages with six or more bacteria per phagocyte.

Hall PA; Lemoine NR; Ryan JF.

Br J Obstet Gynaecol 8703; 93(11):1187-90

Convergence, Ocular/*; Electrooculography; Eye Movements/*; Form Perception/*PH; Human; Pattern Recognition, Visual/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Vergence amplitudes with random-dot stereograms.

JOURNAL ARTICLE.

Random-dot stereograms were found to be capable of producing fusional vergence amplitudes in the absence of monocular contours. These vergence amplitudes are not an artefact of monocular contours provided by the target borders or test instrument and are comparable in range to vergence amplitudes measured clinically with second degree fusion targets in an amblyoscope. We conclude that diplopia of monocularly recognisable contours is not necessary for producing fusional vergence amplitudes.

Archer SM; Miller KK; Helveston EM; Ellis FD.

Br J Ophthalmol 8703; 70(10):718-23

Cataract Extraction/MT; Human; Lens Capsule, Crystalline/SU; Lenses, Intraocular/*; Surgical Instruments/*.

Posterior chamber intraocular lens implantation--a new forceps to simplify capsular bag fixation.

JOURNAL ARTICLE.

The case for capsular bag fixation of the Sinsky-Kratz type of posterior chamber intraocular implant lens is presented, and the various methods in use to position implant lenses are outlined. The new forceps are described and the rationale for their adoption and use is given in an illustrated, step-by-step fashion. Their additional use in anterior chamber intraocular lens implantation is mentioned. There is a brief summary of the author's experience with this instrument.

Bates R.

Br J Ophthalmol 8703; 70(10):724-6

Aged; Cataract Extraction/*; Cornea/PA; Corneal Diseases/*ET/PA; Female; Human; Male; Middle Age; Ultraviolet Rays/*AE; Visual Acuity.

Regression of Labrador keratopathy following cataract extraction.

JOURNAL ARTICLE.

Labrador keratopathy (LK) is an acquired corneal degeneration thought to be caused by chronic exposure to solar irradiation. Reports so far suggest that it is a progressive or at least a stationary condition. There are no detailed reports on recommended therapy. A prospective clinical study was conducted to show regression of LK following extracapsular cataract extraction. Seventeen black patients (26 eyes) with LK and mature cataracts underwent extracapsular cataract extraction. The severity of the LK was recorded photographically pre- and postoperatively. The follow-up ranged from 6 to fifteen months. Twenty-four eyes (92%) showed regression of the LK. The reduction in exposure to ultraviolet light as a result of aphakic photophobia could be one of the factors which have led to the regression of the LK.

Dahan E; Judelson J; Welsh NH.

Br J Ophthalmol 8703; 70(10):737-41

Adolescence; Adult; Athletic Injuries/*EP; England; Eye Injuries/*EP; Eye Protective Devices; Female; Human; Male; Soccer; Tennis.

Sussex Eye Hospital sports injuries.

JOURNAL ARTICLE.

To assess the prevalence of sports eye injuries in our area a register was kept over the 18 months from October 1982 to March 1984. Squash, association football, badminton, and tennis were the main offenders. The severest injury was from a golf ball, involving a fractured zygoma. There was one retinal dialysis, and one lens dislocation requiring extraction. Spectacles were broken in six cases and a contact lens in one. Glass fragments needed operative removal in one case, but there were no penetrating injuries. The value of eye protection, not worn by any of our patients, is emphasised.

Gregory PT.

Br J Ophthalmol 8703; 70(10):748-50

Capillaries/PA; Case Report; Choroid Neoplasms/*BS/PA; Fluorescein Angiography; Human; Male; Melanoma/*BS/PA; Middle Age; Neovascularization/PA; Retinal Vessels/*PA; Support, Non-U.S. Gov't.

Inferences from beading of a retinal vein draining a choroidal melanoma.

JOURNAL ARTICLE.

Beading of a retinal vein draining a choroidal melanoma is reported, showing that the endothelial proliferation producing the beading is a response to some blood borne factor(s) traversing the vein and that retinal capillary non-perfusion adjacent to the beaded vein is not a necessary part of the process.

Johnson RN; Irvine AR; Char DH.

Br J Ophthalmol 8703; 70(10):764-5

Fundus Oculi; Human; Lighting; Photography/*; Retina/*PA; Retinal Vessels/PA.

Photographic recording of slit-lamp appearances of the ocular fundus.

JOURNAL ARTICLE.

The four methods of illumination in the use of slit-lamp biomicroscopy of the anterior segment, described first by Vogt, are equally useful in the posterior part of the eye. Examination of the ocular fundus is more difficult. In particular, photography of the central and peripheral parts of the fundus demands additional technical arrangements if all the appearances of biomicroscopy are to be recorded.

Kenyeres P; Slezak H.

Br J Ophthalmol 8703; 70(10):766-8

Dose-Response Relationship, Radiation; Eyeglasses/*; Human; Lens, Crystalline/RE; Pupil; Retina/RE; Sunlight/*AE; Ultraviolet Rays/AE.

Sunglasses--an ocular hazard?

JOURNAL ARTICLE.

A suggestion that protective eye gear can pose a threat either to the crystalline lens or to the retina is examined from an epidemiological point of view. It is concluded that it may accentuate a pre-existing high-risk hazard but has little significance for low-risk hazards.

Weale RA.

Br J Ophthalmol 8703; 70(10):769-71

Adult; Aneurysm/*PA; Blood Coagulation Tests; Case Report; Diabetic Retinopathy/BL/*PA; Female; Fluorescein Angiography; Hemoglobin A, Glycosylated/AN; Human; Male; Middle Age; Retinal Vessels/*PA.

Retinal cotton-wool spots: an early finding in diabetic retinopathy?

JOURNAL ARTICLE.

Five insulin dependent diabetic patients are reported on who had a few small retinal cotton-wool spots or 'soft exudates' either totally isolated or associated with fewer than 10 microaneurysms. These observations suggest that cotton-wool spots may be an early finding in diabetic retinopathy. Significant biological abnormalities in these patients were high levels of glycosylated haemoglobin and mild increases in thrombin generation, indicating slight activation of the coagulation system. The possible significance of these clinical and biological findings is discussed.

Roy MS; Rick ME; Higgins KE; McCulloch JC.

Br J Ophthalmol 8703; 70(10):772-8

Adult; Case Report; Human; Male; Optic Atrophy/*ET; Plant Poisoning/*; Vision Disorders/ET.

The presumed neurotoxic effects of Catha edulis--an exotic plant now available in the United Kingdom.

JOURNAL ARTICLE.

Bilateral optic atrophy is reported in two patients who, although they were long-standing users of the leaves of Catha edulis, had chewed larger quantities than usual. Since the leaves of this plant are used widely throughout its native area as the source of a mildly stimulant narcotic, the effect in these cases may be an idiosyncratic reaction to an unusually large dose.

Roper JP.

Br J Ophthalmol 8703; 70(10):779-81

Case Report; Child; Child, Preschool; Female; Human; Laurence-Moon-Biedl Syndrome/*PA; Male; Microscopy, Electron; Mitochondria/*UL; Pedigree; Pigment Epithelium of Eye/UL; Retina/*UL; Retinal Degeneration/GE/*PA; Rods and Cones/UL; Support, Non-U.S. Gov't.

Histopathology of mitochondrial cytopathy and the Laurence-Moon-Biedl syndrome.

JOURNAL ARTICLE.

Clinical and histopathological studies of two patients with distinctly different inherited juvenile retinal dystrophies indicate that the ocular defect in mitochondrial cytopathy involves the underlying pigment epithelium, whereas in the Laurence-Moon-Biedl syndrome the photoreceptor cells are primarily affected.

Runge P; Calver D; Marshall J; Taylor D.

Br J Ophthalmol 8703; 70(10):782-96

Antibodies, Monoclonal/*IM; Antibody-Dependent Cell Cytotoxicity; Bone Marrow/*IM/PH; Endothelium/*IM; Fibroblasts/*IM; Hematopoiesis; Human; Stem Cells/IM; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Lysis of human fibroblast colony-forming cells and endothelial cells by monoclonal antibody (6-19) and complement.

JOURNAL ARTICLE.

The murine IgG2a monoclonal antibody 6-19 binds to a wide variety of nonhematopoietic cells including human marrow-derived stromal cells but does not bind to marrow or peripheral blood cells. We studied the effects of this antibody and rabbit complement on marrow cells. Fibroblast colonies were eliminated from light density marrow cells by a single incubation with monoclonal antibody 6-19 and complement. The growth and composition of granulocytic and erythroid colonies were unaffected. Specific complement mediated cytotoxicity of the antibody was confirmed on passaged human fibroblasts derived from marrow (more than 99.6% of fibroblasts are killed by a single treatment). Similar results were obtained with human umbilical cord endothelial cells. In addition, such treatment abolished the initiation of Dexter culture stroma. Incubation of bone marrow cell suspensions with this antibody and complement will allow the study of stroma-free marrow cells in long-term liquid cultures.

Abboud CN; Duerst RE; Frantz CN; Ryan DH; Liesveld JL; Brennan JK.

Blood 8703; 68(6):1196-200

Anemia, Macrocytic/*PA/PP; Animal; Bone Marrow/CY/*PH; Cell Differentiation; Cell Division; Colony-Forming Units Assay; Growth Inhibitors/RE; Growth Substances/PD; Hematopoiesis/*; Mice; Mice, Mutant Strains/*PH; Radiation, Ionizing.

Sl/Sld mouse bone marrow stroma in vitro contains an active radiation-sensitive inhibitor of normal hemopoiesis.

JOURNAL ARTICLE.

Sl/Sld mice have a defective hemopoietic microenvironment. It has been assumed, based upon previous studies, that the primary abnormality in these mice is simply lack of a necessary supportive or inductive material within the hemopoietic stroma. We used in vitro long-term bone marrow cultures to characterize further the nature of the hemopoietic microenvironmental defect in Sl/Sld mice. Sl/Sld mouse bone marrow cells consistently produced less than 10% of the total hemopoietic cells and multipotent and unipotent hemopoietic progenitor cells produced in cultures of marrow from normal, congenic +/+ mice. If fresh Sl/Sld and +/+ marrow cells were mixed prior to establishing long-term marrow cultures, there was a direct correlation between number of Sl/Sld cells added and degree of inhibition of +/+ hemopoiesis. A pre-established, confluent Sl/Sld adherent stromal layer inhibited hemopoiesis by fresh +/+ marrow cells by nearly 70%, as compared with dishes with irradiated +/+ or no stroma. This inhibitory effect was abrogated by irradiation of the Sl/Sld stroma prior to addition of the fresh +/+ marrow cells. Similarly, unirradiated, but not 9 to 200 Gy irradiated Sl/Sld stroma inhibited proliferation of the factor-dependent FDC-P1 hemopoietic progenitor cell line. Thus, the Sl/Sld hemopoietic microenvironment actively inhibits hemopoiesis in vitro, and this inhibition can be at least partially eliminated by irradiation of the Sl/Sld stroma.

Zuckerman KS; Prince CW; Ribadeneira M.

Blood 8703; 68(6):1201-6

Antibodies, Monoclonal/DU; Blood Platelets/DE/*ME; Calcium/PH; Epinephrine/*PD; Fibrinogen/ME; Human; Magnesium/ME; Platelet Aggregation/*/DE; Platelet Membrane Glycoproteins/DE/*ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.

Expression of fibrinogen receptors during activation and subsequent desensitization of human platelets by epinephrine.

JOURNAL ARTICLE.

Epinephrine causes platelet aggregation and secretion by interacting with alpha 2-adrenergic receptors on the platelet surface. Platelet aggregation requires the binding of fibrinogen to a specific receptor on the membrane glycoprotein IIb-IIIa complex. Although the IIb-IIIa complex is identifiable on the surface of resting platelets, the fibrinogen receptor is expressed only after platelet activation. The current studies were designed to examine the effect of occupancy of platelet alpha 2-adrenergic receptors by epinephrine on the expression of fibrinogen receptors and on the aggregation of platelets. The ability of epinephrine to induce the expression of fibrinogen receptors was studied under two different conditions: acute stimulation (less than 1 min) and prolonged stimulation (50 to 90 min), the latter of which is associated with a reduction or "desensitization" of the platelet aggregation response. Expression of the fibrinogen receptor was monitored with 125I-fibrinogen as well as with 125I-PAC-1 (PAC-1), a monoclonal antibody that binds to the glycoprotein IIb-IIIa complex only after platelets are activated. Epinephrine caused an immediate increase in PAC-1 and fibrinogen binding that was dependent on occupancy of the alpha 2-receptor by epinephrine and on the presence of extracellular free Ca (KCa = 30 mumol/L). By itself, 1 mmol/L Mg was unable to support induction of the fibrinogen receptor by epinephrine. However, it did decrease the Ca requirement by about two orders of magnitude. Prolonged stimulation of unstirred platelets by epinephrine led to a 70% decrease in the aggregation response when the platelets were subsequently stirred. Despite their decreased aggregation response, desensitized platelets bound PAC-1 and fibrinogen normally, indicating that the loss of aggregation was not due simply to a decrease in fibrinogen receptor expression. Although desensitization was not affected by pretreatment of the platelets with aspirin, it was partially prevented when extracellular Ca was chelated by EDTA during the long incubation with epinephrine. These studies demonstrate that once platelet alpha 2-adrenergic receptors are occupied by epinephrine, extracellular Ca is involved in initiating the aggregation response by supporting the induction of the fibrinogen receptor and the binding of fibrinogen. Furthermore. Ca-dependent reactions subsequent to fibrinogen binding may be necessary for maximal platelet aggregation and are impaired when platelets become desensitized to epinephrine.

Shattil SJ; Motulsky HJ; Insel PA; Flaherty L; Brass LF.

Blood 8703; 68(6):1224-31

Cell Membrane/UL; Fetal Blood/PA; Human; Infant, Newborn; Lymphocytes/*PA; Microscopy, Electron, Scanning; Microvilli/UL; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Wiskott-Aldrich Syndrome/DI/*PA.

Morphological abnormalities in the lymphocytes of patients with the Wiskott-Aldrich syndrome.

JOURNAL ARTICLE.

Lymphocytes from 18 patients with the Wiskott-Aldrich Syndrome (WAS) were examined by scanning electron microscopy (SEM). Most peripheral blood lymphocytes from normal individuals are covered with slender microvillus projections, but a large proportion of lymphocytes from WAS patients were found to be relatively devoid of microvilli. A lymphocyte morphology scoring system was developed to quantify the density of microvilli: Grade 4 classified those lymphocytes with greater than 75% of the surface covered with microvilli with progressive decrements to grade 1, which were those without microvilli. The mean lymphocyte morphology score of eight normal individuals was 3.62 +/- .22. The mean lymphocyte score of WAS patients was substantially lower (2.89 +/- .27, P less than .001). In addition, WAS lymphocytes often were qualitatively abnormal, with short, blunted microvilli. These morphological criteria were used to diagnose WAS from the cord blood lymphocytes of one "at-risk" patient. Thus, WAS is the first primary immunodeficiency in which morphological abnormalities have been identified that can aid in diagnosis.

Kenney D; Cairns L; Remold-O'Donnell E; Peterson J; Rosen FS; Parkman R.

Blood 8703; 68(6):1329-32

Erythrocyte Deformability/*; Erythrocyte Membrane/*PH/UL; Erythrocytes/DE; Heinz Bodies/*/UL; Human; Membrane Proteins/BL; Microscopy, Electron; Molecular Weight; Oxidation-Reduction; Phenylhydrazines/PD; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Quantitative relationship between Heinz body formation and red blood cell deformability.

JOURNAL ARTICLE.

The ultimate cause of destruction of red blood cells (RBCs) after oxidative damage with Heinz body formation is not well understood. We correlated the changes in RBC morphology and membrane protein composition after oxidant treatment with the alterations in deformability of whole cells and cell membranes. The incubation of RBCs with phenylhydrazine concentrations of 0.3 to 100 mg/dL at 37 degrees C for one hour led to a dose-dependent formation of Heinz bodies, ranging from isolated Heinz bodies at 1 mg/dL to a confluent coating of the inner membrane surface at 100 mg/dL phenylhydrazine. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed the presence of a large quantity of hemoglobin bound to the ghost membrane of treated RBCs. Electrophoresis with and without dithiothreitol indicated that disulfide bridges are abundant between hemoglobin molecules and are also present among membrane proteins but are not the major bond between hemoglobin and membrane. Changes of spectrin, ankyrin, band 3, and band 6 and the appearance of a 260,000-dalton complex were also observed. With phenylhydrazine concentrations below 30 mg/dL, even in the presence of multiple Heinz bodies, the RBC deformability measured by filtration through 2.6-, 4.5-, and 6.8-microns pores and the membrane deformability determined by a filter aspiration technique were not altered. With 100 mg/dL phenylhydrazine, when the entire membrane was coated with Heinz bodies, RBC filterability and membrane deformability were drastically reduced. These results indicate that oxidative damage of RBCs with discrete Heinz body formation causes focal membrane rigidification but does not affect the global cellular deformability until the Heinz bodies nearly cover the entire cell endoface.

Reinhart WH; Sung LP; Chien S.

Blood 8703; 68(6):1376-83

Consanguinity; Fetal Hemoglobin/GE; Gene Amplification; Globin/*GE; Haplotypes; Homozygote; Human; Pedigree; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thalassemia/*GE.

Beta zero-thalassemia in association with a gamma-globin gene quadruplication.

JOURNAL ARTICLE.

We have studied the hematology, hemoglobin composition, and globin gene arrangements in one young Turkish boy with a beta zero-thalassemia homozygosity and in 11 of his relatives. Evidence is presented that the chromosome with the beta zero-thalassemia determinant carries a gamma-globin gene quadruplication, perhaps in a -G gamma-G gamma-G gamma-A gamma-gene arrangement. The eight gamma-globin genes in this patient produced G gamma and A gamma chains in a 95 to 5 ratio, and nearly 99% of the patient's hemoglobin was of the fetal type. The clinical condition resembled that of a thalassemia intermedia. HbF levels in eight beta-thalassemia heterozygotes varied between 0.5 and 4.2% and the percentages of G gamma in this HbF averaged at 87% or 95%; this level is to some extent related to the haplotype of the normal chromosome. All subjects carried four alpha-globin genes; a new BglII polymorphism was observed within the psi alpha-globin gene.

Yang KG; Liu JZ; Kutlar F; Kutlar A; Altay C; Gurgey A; Huisman TH.

Blood 8703; 68(6):1394-7

Cell Differentiation/DE; Cell Division/DE; Cell Line; Dimethyl Sulfoxide/PD; Drug Resistance; Granulocytes/*CY; Human; Neuraminidase/ME; Sialic Acids/*PH; Sialoglycoproteins/*PH; Support, U.S. Gov't, P.H.S.; Thioguanine/PD; Tretinoin/PD.

Hyposialylation of differentiation-inducer-resistant HL-60 cells.

JOURNAL ARTICLE.

The total sialic acid concent of retinoic acid (RA)-resistant or 6-thioguanine (6TG)-resistant HL-60 cells was more than tenfold lower and of dimethylsulfoxide (DMSO)-resistant HL-60 cells was approximately twofold lower than that of parental, wild-type (wt) HL-60 cells. Neuraminidase-inaccessible, ie residual cell-associated sialic acid after neuraminidase treatment, was four- to twelvefold lower in the three differentiation-inducer-resistant sublines than in the parent line. Neuraminidase treatment of 125I-labeled surface membrane glycoproteins (SMGs) from wt HL-60 cells converted the two-dimensional gel electrophoretic pattern to one having features in common with RA- and 6TG-resistant cells. However, neuraminidase treatment did not alter the sensitivity of wt HL-60 cells to differentiation induction by RA, hypoxanthine (purine base), or DMSO. These results indicate that differences in peripheral, neuraminidase-accessible sialic acids are important determinants of the gel electrophoretic mobility of the SMGs of the HL-60 line and sublines but are not likely related to the differentiation-resistance mechanism. Further studies are required to determine if hyposialylation of cryptic, neuraminidase-inaccessible sites has functional significance.

Gallagher RE; Giangiulio DA; Chang CS; Glover CJ; Felsted RL.

Blood 8703; 68(6):1402-6

Animal; Blood Proteins/*TO; Cytotoxicity, Immunologic; Drug Synergism; Human; Hydrogen Peroxide/TO; Kinetics; Mice; Neoplasms, Experimental/*IM; Neutrophils/*PH; Rabbits; Species Specificity; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..

In vitro tumor cell cytolysis mediated by peptide defensins of human and rabbit granulocytes.

JOURNAL ARTICLE.

We examined the activity of defensins, cysteine-rich cationic peptides that are abundant in the cytoplasmic granules of human and rabbit granulocytes, against various tumor targets. The three human defensins, HNP-1, HNP-2, and HNP-3, lysed human and murine targets in chromium release and dye exclusion assays. Defensin-mediated tumor cell lysis was concentration-dependent, inhibited by serum, and dependent on temperature-sensitive events. Lysis was first detected by three hours of incubation and it reached a plateau between eight and 14 hours. In vitro exposure of murine teratocarcinoma cells to HNP 1-3 abrogated their oncogenicity in vivo. Nonmalignant target cells were also susceptible to defensin-mediated lysis. Four rabbit granulocyte defensins exerted marked (NP-1, NP-2) or moderate (NP-3a, NP-3b) cytotoxic activity, whereas defensin NP-5 was not cytotoxic. When tumor cells were incubated with human defensins in combination with hydrogen peroxide, synergistic cytotoxicity was detected. As defensins are released from granulocytes by various stimuli, their release could contribute to extracellular cytotoxicity which is independent of reactive oxygen intermediates.

Lichtenstein A; Ganz T; Selsted ME; Lehrer RI.

Blood 8703; 68(6):1407-10

Glycoproteins/*DF; Human; Thrombosis/*GE.

Mode of inheritance of type II protein S deficiency [letter]

LETTER.

We examined the activity of defensins, cysteine-rich cationic peptides that are abundant in the cytoplasmic granules of human and rabbit granulocytes, against various tumor targets. The three human defensins, HNP-1, HNP-2, and HNP-3, lysed human and murine targets in chromium release and dye exclusion assays. Defensin-mediated tumor cell lysis was concentration-dependent, inhibited by serum, and dependent on temperature-sensitive events. Lysis was first detected by three hours of incubation and it reached a plateau between eight and 14 hours. In vitro exposure of murine teratocarcinoma cells to HNP 1-3 abrogated their oncogenicity in vivo. Nonmalignant target cells were also susceptible to defensin-mediated lysis. Four rabbit granulocyte defensins exerted marked (NP-1, NP-2) or moderate (NP-3a, NP-3b) cytotoxic activity, whereas defensin NP-5 was not cytotoxic. When tumor cells were incubated with human defensins in combination with hydrogen peroxide, synergistic cytotoxicity was detected. As defensins are released from granulocytes by various stimuli, their release could contribute to extracellular cytotoxicity which is independent of reactive oxygen intermediates.

Vicente V; Alberca I; Castro M; Lopez Borrasca A.

Blood 8703; 68(6):1415

Anemia, Sickle Cell/*BL; Erythrocytes, Abnormal/PH; Hemoglobin, Sickle/*; Hemoglobins; Human; Polymers.

Deoxyhemoglobin S polymer formation in sickle cells [letter]

LETTER.

We examined the activity of defensins, cysteine-rich cationic peptides that are abundant in the cytoplasmic granules of human and rabbit granulocytes, against various tumor targets. The three human defensins, HNP-1, HNP-2, and HNP-3, lysed human and murine targets in chromium release and dye exclusion assays. Defensin-mediated tumor cell lysis was concentration-dependent, inhibited by serum, and dependent on temperature-sensitive events. Lysis was first detected by three hours of incubation and it reached a plateau between eight and 14 hours. In vitro exposure of murine teratocarcinoma cells to HNP 1-3 abrogated their oncogenicity in vivo. Nonmalignant target cells were also susceptible to defensin-mediated lysis. Four rabbit granulocyte defensins exerted marked (NP-1, NP-2) or moderate (NP-3a, NP-3b) cytotoxic activity, whereas defensin NP-5 was not cytotoxic. When tumor cells were incubated with human defensins in combination with hydrogen peroxide, synergistic cytotoxicity was detected. As defensins are released from granulocytes by various stimuli, their release could contribute to extracellular cytotoxicity which is independent of reactive oxygen intermediates.

Schechter AN; Noguchi CT; Rodgers GP.

Blood 8703; 68(6):1415-6

Arthritis, Rheumatoid/*EP/ET; Great Britain; Human; Time Factors; United States.

Recent trends in rheumatoid arthritis.

JOURNAL ARTICLE.

We examined the activity of defensins, cysteine-rich cationic peptides that are abundant in the cytoplasmic granules of human and rabbit granulocytes, against various tumor targets. The three human defensins, HNP-1, HNP-2, and HNP-3, lysed human and murine targets in chromium release and dye exclusion assays. Defensin-mediated tumor cell lysis was concentration-dependent, inhibited by serum, and dependent on temperature-sensitive events. Lysis was first detected by three hours of incubation and it reached a plateau between eight and 14 hours. In vitro exposure of murine teratocarcinoma cells to HNP 1-3 abrogated their oncogenicity in vivo. Nonmalignant target cells were also susceptible to defensin-mediated lysis. Four rabbit granulocyte defensins exerted marked (NP-1, NP-2) or moderate (NP-3a, NP-3b) cytotoxic activity, whereas defensin NP-5 was not cytotoxic. When tumor cells were incubated with human defensins in combination with hydrogen peroxide, synergistic cytotoxicity was detected. As defensins are released from granulocytes by various stimuli, their release could contribute to extracellular cytotoxicity which is independent of reactive oxygen intermediates.

Silman AJ.

Br J Rheumatol 8703; 25(4):328-30

Aged; Anti-Inflammatory Agents/*AE/TU; Arthritis, Rheumatoid/*CO/DT; Female; Human; Male; Middle Age; Osteoarthritis/CO/DT; Peptic Ulcer/CI/*ET.

Peptic ulcer in rheumatoid arthritis--intrinsic or related to drug therapy?

JOURNAL ARTICLE.

The reported incidence of peptic ulcer disease (PUD) in patients with rheumatoid arthritis (RA) is higher than that of the general population. Unusual susceptibility to PUD in RA, independent of therapy, has been suggested. To compare RA patients with others who had similar drug exposure but no known predisposition to PUD, 120 patients hospitalized for treatment of severe arthritis (65 with RA, 55 with osteoarthritis) were assessed by questionnaire for PUD history, drug history and other relevant variables. The relationship of PUD to sex distribution, smoking, alcohol consumption and anti-inflammatory therapy followed expected patterns. We found high but similar PUD rates in RA and osteoarthritis (OA) patients (RA 15%, OA 18%). This suggests that a common factor (probably drugs) is responsible. We feel that the documented high incidence of PUD in RA is most probably related to drug therapy. Available methods cannot determine if PUD ever occurs as a primary manifestation of RA.

Malone DE; McCormick PA; Daly L; Jones B; Long A; Bresnihan B; Molony J; O'Donoghue DP.

Br J Rheumatol 8703; 25(4):342-4

Adrenal Cortex Hormones/*TU; Adult; Aged; Arthritis, Rheumatoid/BL/*DT; Female; Human; In Vitro; Leukocyte Count/DE; Male; Middle Age; Monocytes/DE/*ME; Prednisolone/PD; Superoxide/*BL.

Effect of corticosteroid therapy on blood monocyte superoxide generation in rheumatoid arthritis: studies in vitro and ex vivo.

JOURNAL ARTICLE.

Rates of superoxide (SA) generation by blood monocytes stimulated ex vivo were studied before and during corticosteroid treatment of rheumatoid arthritis (RA) patients, in control patients and in healthy controls. The direct effect on stimulated SA production of pre-incubating cells with prednisolone in vitro was also studied. Significant inhibition of monocyte SA output stimulated with IgG-treated zymosan (ITZ) and fluoride ion (F), but not serum-treated zymosan (STZ) was demonstrated following steroid therapy in RA. No inhibitory effect of prednisolone could be demonstrated in vitro, using ITZ, STZ and F as stimuli. Our data on blood monocyte yields, size and cytochemistry suggest that the in vivo effect is due to a shift in blood monocyte traffic.

Bell AL; Hurst NP; Nuki G.

Br J Rheumatol 8703; 25(4):366-71

Actuarial Analysis; Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid/*DT; Azathioprine/AD/AE/*TU; Comparative Study; Female; Human; Male; Methotrexate/AD/AE/*TU; Middle Age; Support, Non-U.S. Gov't; 6-Mercaptopurine/AD/AE/*TU.

Comparison of methotrexate with azathioprine or 6-mercaptopurine in refractory rheumatoid arthritis: a life-table analysis.

JOURNAL ARTICLE.

Methotrexate (MTX) appears to be useful in patients with rheumatoid arthritis (RA) refractory to other drugs but its long-term toxicity and efficacy are uncertain. A retrospective study of MTX in such patients in comparison with the purine analogues, azathioprine and 6-mercaptopurine was made using life-table analysis. Eighty-four patients took MTX in a median dose of 7.5 mg/week whilst 55 received purine analogues, 100 mg/day (median). By 12 months, 19.3% of patients had ceased MTX due to toxicity, compared with 29.3% for purine analogues. Toxicity severe enough to warrant stopping therapy was uncommon after 8 months with either drug. At 12 months 61.5% of the MTX patients had achieved defined criteria of improvement compared with 25.6% for the purine analogues (p less than 0.05). The number of patients improving on purine analogues did not increase substantially after 6 months, whereas the number improving with MTX continued to 12 months. MTX in a low-dose regimen is useful in refractory RA and superior to low-dose purine analogues.

Sambrook PN; Champion GD; Browne CD; Cohen ML; Compton P; Day RO; de Jager J.

Br J Rheumatol 8703; 25(4):372-5

Azathioprine/AE/TU; Chlorambucil/AE/TU; Connective Tissue Diseases/*DT/GE; Cyclophosphamide/AE/TU; Drug Resistance; Human; Hypoxanthine Phosphoribosyltransferase/*GE; Immunosuppressive Agents/*AE/TU; Lymphocytes/*DE/EN; Mutation/*.

Thioguanine-resistant mutations induced by cytotoxic drugs in lymphocytes of patients with connective tissue diseases.

JOURNAL ARTICLE.

Cells with mutations at the hypoxanthine-guanine phosphoribosyl transferase (HPRT) locus may be detected in vitro by their resistance to the toxic effects of thioguanine. We have assessed HPRT mutants in peripheral blood lymphocytes of patients with connective tissue diseases who have been treated for long periods with cytotoxic drugs. The results from patients treated with cyclophosphamide were abnormal suggesting the presence of drug-induced mutations. The results from patients treated with chlorambucil or azathioprine did not differ from controls--either these drugs have not induced mutations or, more likely, the technique is not sufficiently sensitive to detect them. These possibilities are discussed. Specific mutations induced by cytotoxic drugs in patients with connective tissue diseases have not been previously recorded.

Palmer RG; Smith-Burchnell CA; Dore CJ; Denman AM.

Br J Rheumatol 8703; 25(4):376-9

Antilymphocyte Serum/*TU; Arthritis, Rheumatoid/BL/IM/*TH; Combined Modality Therapy; Hemoglobins/AN; Human; Immunosuppressive Agents/*TU; Leukocyte Count.

Intensive immunosuppression in intractable rheumatoid arthritis.

JOURNAL ARTICLE.

Twelve patients with intractable rheumatoid arthritis were treated with antilymphocyte globulin (ALG), prednisolone and a cytotoxic agent, usually azathioprine, and were followed for 1 year. There was a significant (p less than 0.05) improvement in the mean score for early-morning stiffness, grip strength and the severity of nodules and vasculitis at 6 weeks and 3 months when compared to the initial visit. However, in most patients, this benefit was not sustained despite continued cytotoxic and steroid therapy. A rise in the haemoglobin and fall in ESR was maintained throughout the study period.

Binder AI; So A; Ansell BM; Denman AM.

Br J Rheumatol 8703; 25(4):380-3

Carpal Tunnel Syndrome/*DI; Electrodiagnosis/*; Human; Median Nerve/PP; Neural Conduction.

Clinical tests for carpal tunnel syndrome: an evaluation.

JOURNAL ARTICLE.

Five clinical tests in common use for diagnosis of carpal tunnel syndromes have been shown to have little diagnostic value, either individually or in various combinations. No physical sign is useful in the diagnosis of this condition, which should be suspected on the basis of presenting symptoms and confirmed by electrodiagnosis using standard median nerve conduction tests.

Golding DN; Rose DM; Selvarajah K.

Br J Rheumatol 8703; 25(4):388-90

Aged; Case Report; Female; Hodgkin's Disease/*CO/PA; Human; Joint Diseases/*ET/PA; Knee Joint/*PA; Synovial Membrane/*PA.

Synovial involvement in Hodgkin's disease.

JOURNAL ARTICLE.

We report a case of monoarthropathy in a patient with Hodgkin's disease, due to invasion of the synovium, with apparently normal juxta-articular bone.

Barton A; Hickling P.

Br J Rheumatol 8703; 25(4):391-2

Adult; Arthritis/*ET; Case Report; Cystic Fibrosis/*CO; Human; Male; Vasculitis/ET.

Episodic arthritis in cystic fibrosis: a case report.

JOURNAL ARTICLE.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Summers GD; Webley M.

Br J Rheumatol 8703; 25(4):393-5

Case Report; Celiac Disease/*CO; Fingers/*RA; Human; Male; Middle Age; Scleroderma, Systemic/*CO/RA.

Sclerodactyly complicating coeliac disease.

JOURNAL ARTICLE.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Zammit-Maempel I; Adamson AR; Halsey JP.

Br J Rheumatol 8703; 25(4):396-8

Carpal Tunnel Syndrome/*ET/PP; Diabetes Mellitus/CO/*DI; Glucose Tolerance Test; Human.

An assessment of glucose tolerance in patients with idiopathic carpal tunnel syndrome [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Pal B; Mangion P; Hossain MA.

Br J Rheumatol 8703; 25(4):412-3

Anti-Inflammatory Agents, Non-Steroidal/*AE/TU; Arthritis, Rheumatoid/*DT; Gastroscopy; Human; Stomach Ulcer/*CI.

Gastric ulceration and NSAIDs in RA [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Collins AJ; Davies J; Dixon AS.

Br J Rheumatol 8703; 25(4):413-4

Adult; Arthritis, Infectious/*ET; Case Report; Coagulase/AN; Human; Male; Middle Age; Staphylococcal Infections/*DI; Staphylococcus epidermidis/EN.

Coagulase-negative Staphylococcus as a cause of joint infection [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Morris IM; Mattingly PC; Gostelow BE.

Br J Rheumatol 8703; 25(4):414-5

Arthritis, Rheumatoid/*PP; Human; Pain Measurement/*MT.

Agreement between horizontal and vertical visual analogue scales [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Dixon JS.

Br J Rheumatol 8703; 25(4):415-6

Adult; Aged; Arthritis, Rheumatoid/*TH; Braces/*; Equipment Design; Female; Human; Knee Joint/*; Male; Middle Age; Osteoarthritis/*TH.

TVS brace in patients with rheumatoid arthritis or osteoarthritis of the knee [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Jawad AS; Goodwill CJ.

Br J Rheumatol 8703; 25(4):416-7