Cooperation of the family physician with the oncology center in the care of the children with tumors

With a cure rate of over 50% pediatric oncology contrasts with the adult oncology. The success is the result of a multimodal approach with surgery, radiotherapy and chemotherapy to almost all forms of childhood cancer as outlined in various national and international protocols. These are evaluated permanently concerning efficacy and toxicity at one organisation (in Switzerland: the pediatric section of the "Schweizerische Arbeitsgruppe für klinische Krebsforschung"). For the care of the children with malignancy however a specialist physician team at a tumor center is not enough. Without the cooperation of the family doctors of the area proper referral of the patients and long term treatment can not be realized. Good information and adequate teaching appears to be necessary to give these patients optimal care.     

Changes in the functional status of the hemostatic system with the administration of heparin combined with aspirin to animals with experimental diabetes

It was shown that in the case of regular intragastric introduction of heparin combined with aspirin to rats with insulin-dependent experimental diabetes, enzymatic and nonenzymatic fibrinolysis of blood plasma was enhanced. The blood level of sugar was normalized in these animals.     

紫外可见分光光度法测定不同年份黄精中多糖含量

[目的]测定九华山地区所产不同育成年份黄精中多糖含量,为九华山地区黄精的产品分级和种植研究提供参考.[方法]采用苯酚-硫酸法对九华山地区产不同年份黄精中多糖含量进行测定.[结果]不同年份的黄精中多糖含量变化较大,随着种植年限的增加,多糖含量呈现升高趋势.其中,1年生黄精中多糖含量最少,为13.02%;9年生多糖含量达到最大,为18.44%;10年生多糖舍量出现下降,为15.64%.[结论]可以在实际采收中,通过不同育成年份对黄精进行分级.     

Optimization of fluorination of the tungsten powder with fluorine in a reactor with an immobile layer with the provision of green requirements

The computational procedures to model the fluorination of the tungsten powder with fluorine and condensation of formed WF₆, which describe the available experimental data satisfactorily, are developed using physicochemical foundations of processes. With their help, the equipment sizes and process parameters of the two-stage fluorination of the tungsten powder with fluorine with the condensation of liquid WF₆ after each stage at 2.5–3.0°C are optimized. The possibility of fabricating WF₆ with productivity of 5.23, 6.53, and 7.83 kg/h in reactors 200, 300, and 360 mm in diameter, respectively, at 300–350°C without the forced cooling of the highest heat-beat first fluorination setup is shown. The completeness of fluorine usage higher than 99.99% is attained in this case, while the amount of harmful gases (F₂, WF₆) leaving the process chain does not exceed their maximal permissible concentrations already in the vent gas volume. Recommendations for the organization of the fluorination production process of the tungsten powder are given.     

Evaluation of the degree of diabetic dysautonomy with the analysis of heart rate measured at rest with the FINAPRES system

In this work, we developped the ERK (Eckmann, Ruelle and Khamporst) method of recurrent plots to analyse Heart Rate Variability (HRV), measured by the FINAPRES system in diabetic subjects. Our aim was to search some indices that might characterize the degree of dysautonomy detected in diabetic subjects, using the Ewing tests. The idea was to analyze the recurrences of the HR to previously observed values. When a value of HR, xi measured at the j-th beat come back to an already observed value, we compare the distances between the following measures (xi + 1 to xj + 1), (xj + 2 to xj + 2)... If the distances are under a given criteria during k beats, xi is deterministic of order k. Let n1 be the number of recurrent points and nk the number of k-order deterministic points, with k = 2, 3, 4... We defined the index of determinism nk + 1/nk and the Shannon entropy of the Nk = nk-nk + 1. These indices will be correlated to the total score of the 5 Ewing tests, which represent the standard measure to evaluate the diabetic dysautonomy. Blood pressure (BP) and HR were measured during about 30 minutes using the FINAPRES system in 44 healthy subjects and 60 non-hypertensive diabetic subjects. In the diabetic subjects, the age, the body weight and systolic and diastolic BP were 56 +/- 13 years (mean +/- standard-deviation), 79 +/- 14 kg, 80 +/- 10 mmHg and 137 +/- 20 mmHg. HR was weakly correlated to age (r = 0.29; p = 0.02) and the Ewing score (r = 0.31; p = 0.01). Its standard-deviation is also weakly correlated to age (r = 0.32; p = 0.01) and to the Ewing score (r = 0.34; p = 0.01). Using the ERK method, we obtained indices which are much more correlated to the Ewing score. In particular, the ratio n2/n1 and Shannon entropy were correlated to the Ewing score with r = 0.51 and r = 0.53, respectively (p < 0.0001 in both cases). These indices are also correlated to age (r = 0.40; p = 0.003) in both cases. The ERK method give some indices which are easy to obtain (measurement of HR during a rest period) and easy to interpret. These indices are strongly linked to the dysautonomy score which required a good cooperation of the patient and a great vigilance during its execution. This method could be applied to BP to explore BP regulation in hypertensive subjects.     

Rewarming of infusions with the haemotherm

A rewarming device for blood called Haemotherm from the firm Bosch was proofed for efficiency. This device working on the base of microwaves was able to warm up cold solutions to a certain temperature within two to three minutes. The effect of rewarming disappeared during the passage through the infusion tube. To get bodywarm solutions at the end of the infusion tube was impossible with this arrangement.     

Survival of patients with carcinoma of the esophagus treated with combined-modality therapy

Since 1985, 229 cases of carcinoma of the esophagus have been considered for entry into a protocol with the use of preoperative chemotherapy and radiation therapy followed by surgical intervention as the primary element of treatment. One hundred sixty-five patients (93 with adenocarcinoma and 72 with squamous cell carcinoma) had esophagogastrectomy. The 5-year survival of the protocol patients who underwent resection was 25% for both groups--squamous cell carcinoma and adenocarcinoma. Of the protocol patients with squamous cell carcinoma who underwent resection, 40% had a sterilized specimen, whereas of those with adenocarcinoma, 20% had a sterilized specimen. If the patient had a sterilized specimen, the 5-year survival was approximately 60% for adenocarcinoma and 40% for squamous cell carcinoma. Those patients with adenocarcinoma and Barrett's esophagus had a 5-year survival of 55%. Of the patients who underwent only esophagectomy and esophagogastrectomy and had not been entered into the protocol, none lived beyond 3 years. The operative mortality rate for those who had esophagogastrectomy was 5%. Sixty-four patients completed the radiation therapy and chemotherapy but did not undergo surgical procedures because of progressive disease or refusal. Of those patients who completed chemotherapy and radiation therapy without surgical intervention, 5-year survival was 18% in patients with squamous cell carcinoma, whereas no patients with adenocarcinoma survived beyond 3 years. The finding of a sterilized specimen after esophagectomy is a favorable prognostic factor in patients with adenocarcinoma or squamous cell carcinoma. The finding that patients with Barrett's esophagus and adenocarcinoma have an improved chance for survival is perhaps related to an earlier diagnosis. It is clear that some patients with squamous cell carcinoma who did not undergo surgical procedures did have a sterilized specimen, because the survival in this group approached 20% at 5 years.     

Treatment of patients with psychogenic amnesia with the help of therapeutic anamnesis

Psychogenic (dissociative) amnesia is a psychiatric disorder characterised by a sudden loss of memory which is too extensive to be explained by ordinary forgetfulness, but which has no organic disease or explanation. Psychogenic amnesia is categorised among the dissociative disorders in DSM-IV and ICD-10 and begins suddenly, usually after severe psychosocial stress. The prognosis is good with complete recovery, and there is seldom relapse. This article describes a man, 45 years of age, who developed severe depression and amnesia following a very troublesome divorce. He did not talk, he communicated by signs and gestures, and he isolated himself in his mother's home. After being admitted to a psychiatric ward he became anorectic and developed erosive eoesophagitis/gastroduodenitis. Initially he was given perfenazin (Trilafon) 24 mg/day. The psychiatric treatment produced no results for the first three weeks, but the patient gradually recovered when the therapist and the patient recapitulated the conflicts associated with the divorce, using documents from the patient's lawyer as a guide. This method is called "therapeutic anamnesis" and is similar in many ways to psychiatric treatment of post-traumatic stress reactions.     

On the constraint factor associated with the indentation of work-hardening materials with a spherical ball

It is generally accepted that the constraint factor (CF) associated with the indentation of metallic materials by a much harder indentor is in the range of 2.8 to 3.0. Invariably, the CF is assumed to have a constant value in the above range irrespective of the material indented while correlating the hardness of the material indented with its uniaxial strength properties. The objective of the present investigation is to assess the above assumption by evaluating the CF associated with the indentation process as a function of strain in the case of metallic materials exhibiting a wide range with respect to elastic modulus, strength, and strain-hardening rate. The results indicate that the CF is not really a constant but is dependent on the various material properties. The experimental CF-strain relationship observed in all of the test materials has been rationalized on the basis of elastic-plastic and fully plastic indentation models. While the theoretical models can explain the trend of the data, they are not capable of making adequately accurate quantitative predictions.     

Assessment of accelerography with the TOF-GUARD: a comparison with electromyography

The effects of age were studied on a new animal model of tardive dyskinesia, i.e., the quantification of oral dyskinesia in rats repeatedly treated with reserpine. Adult and old rats received two injections of reserpine (0.5 or 1.0 mg/kg s.c.) or vehicle, separated by 48 h. One, 10, 25 and 40 days after the second injection of reserpine or vehicle, the animals were observed for quantification of the behavioral parameters of oral dyskinesia: tongue protrusion and vacuous chewing movement frequencies and duration of twitching of the facial musculature. Phenomenologically, control old rats and reserpine-treated adult animals showed very similar oral dyskinesia. When compared to control adult rats, the significant increase in tongue protrusion frequency induced by reserpine treatment was more persistent in the old rats than in the adult animals. Because it is well known that age increases the persistence of tardive dyskinesia, our data provide further support for the validation of reserpine-induced oral dyskinesia as an animal model of tardive dyskinesia. In addition, the possibility is raised that a common pathophysiological mechanism may underlie tardive dyskinesia and age- and reserpine-induced oral dyskinesia.     

Experience with segmental reconstruction of the radiated mandible with alloplastic prostheses

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high-risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time-efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.     

Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws

We retrospectively reviewed the results for thirty-four patients in whom a non-union of the scaphoid had been treated with bone-grafting and internal fixation with use of one of two types of screws as well as the temporary placement of Kirschner wires parallel to the screw to prevent rotation. The patients were divided into two groups: Group 1 contained sixteen patients who had been managed with a Herbert screw from 1986 through 1989 and Group 2, eighteen patients who had been managed with a 3.5-millimeter cannulated AO/ASIF screw from 1990 through 1992. There were no clinical or radiographic differences between the two groups. The time to union, confirmed with tomography, was 7.6 +/- 3.6 months for Group 1 and 3.6 +/- 1.2 months for Group 2. This difference was significant (p < 0.01). Both screws significantly improved the alignment of the scaphoid and decreased carpal collapse (p < 0.05). Regardless of the type of screw used, the time to union was significantly shorter when the screw had been placed in the central one-third of the scaphoid (p < 0.05). Seventeen of the eighteen cannulated screws had been placed centrally, compared with seven of the sixteen Herbert screws (p < 0.01).     

Interaction of Neisseria maningitidis with the components of the blood-brain barrier correlates with an increased expression of PilC

A fatal untreated case of fulminant meningococcemia was examined to investigate the crossing of the blood-brain barrier (BBB) by Neisseria meningitidis. Microscopic examination showed bacteria in vivo adhering to the endothelium of both the choroid plexus and the meninges. Comparison of the isolates cultivated from the blood and the cerebrospinal fluid (CSF) revealed no antigenic variation of the pilin or the class 5 protein, whereas the expression of the PilC protein was greater in the CSF and the choroid plexus than in the blood. This was due to an increased activity of one of the pilC promotors. This higher expression of PilC correlated in vitro with greater adhesiveness to endothelial cells. A mutation in the single pilC locus of this strain abolished in vitro pilus-mediated adhesion to endothelial cells. These data suggest that PilC plays an important role in the crossing of the BBB, likely through pilus-mediated adhesion.     

Echotomography of the liver with three-dimensional representation of the organ

Three-dimensional representation facilitates the reading of ultrasonic seriographs of the liver. It uses a conducing wire to provide a correspondence between the xipho-umbilical line and the information collected on the seriographic polaroids. Proceeding from image to image, a more thorough interpretation is possible. This analytical study provides a synthetic representation of the organ. When present lesions are seen on these diagrams and their location and dimensions clearly defined. A precise indication of the height, breadth and thickness of the organ is given, which makes it possible to obtain an accurate approximation of the hepatic volume, taking the morphotype into consideration.     

Cellular inflammatory response to fungal antigen studied with the skin window technique--correlation of the exudate with the evolution of the mycotic infection

The skin window technique, using a coverslip, was applied to study the inflammatory exudate induced by killed pathogenic yeasts in patients with mycotic infections. The presence of eosinophils in the specific exudate after 3 hours seems to indicate specific IgE fixed in the tissues. This was demonstrated by the correlation of this specific eosinophilia with the eosinophilia induced by an anti-IgE serum and with the positive immediate intradermal reactions and by the correlation with serum-specific IgE detected with an immunoenzymatic technique. Increased eosinophilia is related to the active phase of the disease. The eosinophilia in the specific exudate seems to be more reliable than an in vitro technique for the detection of the specific IgE against fungal antigen. In this material, the eosinophilia demonstrated that yeast-specific IgE may be responsible for both immediate and delayed intradermal reactions.     

Two fetal deaths associated with maternal sepsis and with thrombosis of the intervillous space of the placenta

The placental pathology in two second trimester fetal losses associated with mild maternal disseminated intravascular coagulation are reported. Case one had a dental abscess, a leukocytosis of 36300 white blood cells/m, and evidence of mild consumptive coagulopathy at 20 weeks. Case two had septic findings including disseminated intravascular thrombosis associated with pyelonephritis. The placentae had extensive intervillous thrombosis at the periphery of spiral arterial flow. It is hypothesized that in mild disseminated intravascular coagulation, the trophoblast inhibits fibrinolysis, favouring thrombosis perhaps due to production of plasminogen activator inhibitor.