Development and Optimization of Tin/Flux Mixture for Direct Tinning and Interfacial Bonding in Aluminum/Steel Bimetallic Compound Casting.

Interfacial bonding highly affects the quality of bimetallic bearing materials, which primarily depend upon the surface quality of a solid metal substrate in liquid-solid compound casting. In many cases, an intermediate thin metallic layer is deposited on the solid substrate before depositing the liquid metal, which improves the interfacial bonding of the opposing materials. The present work aims to develop and optimize the tinning process of a solid carbon steel substrate after incorporating flux constituents with the tin powder. Five ratios of tin-to-flux-i.e., 1:1, 1:5, 1:10, 1:15, and 1:20-were used for tinning process of carbon steel solid substrate. Furthermore, the effect of volume ratios of liquid Al-based bearing alloy to solid steel substrate were also varied-i.e., 5:1, 6.5:1 and 8.5:1-to optimize the microstructural and mechanical performance, which were evaluated by interfacial microstructural investigation, bonding area determination, hardness and interfacial strength measurements. It was found that a tin-to-flux ratio of 1:10 offered the optimum performance in AlSn12Si4Cu1/steel bimetallic materials, showing a homogenous and continuous interfacial layer structure, while tinned steels using other percentages showed discontinuous and thin layers, as in 1:5 and 1:15, respectively. Furthermore, bimetallic interfacial bonding area and hardness increased by increasing the volume ratio of liquid Al alloy to solid steel substrate. A complete interface bonding area was achieved by using the volume ratio of liquid Al alloy to solid steel substrate of ≥8.5.

Flaxseed oil supplementation manipulates correlations between serum individual mol % free fatty acid levels and insulin resistance in type 2 diabetics. Insulin resistance and percent remaining pancreatic ß-cell function are unaffected.

OBJECTIVES: Elevated total serum free fatty acids (FFAs) concentrations have been suggested, controversially, to enhance insulin resistance and decrease percent remaining ß-cell function. However, concentrations of individual serum FFAs have never been published in terms of their relationship (correlation) to homeostatic model assessment-insulin resistance (HOMA-IR) and percent remaining ß-cell function (HOMA-%ß) in the type 2 diabetics (T2Ds). Alpha-linolenic acid consumption has a negative correlation with the insulin resistance, which in turn is negatively correlated with the remaining ß-cell function. The primary objective was to test the hypothesis that there would be different relationship (correlation) between the blood serum individual free FFA mol % levels and HOMA-IR and/or HOMA-%ß in T2D. The secondary objective was to test the hypothesis that flaxseed oil, previously being shown to be ineffective in the glycemic control in T2Ds, may alter these correlations in a statistically significant manner as well as HOMA-IR and/or HOMA-%ß. METHODS: Patients were recruited via a newspaper advertisement and two physicians have been employed. All the patients came to visit one and three months later for a second visit. At the second visit, the subjects were randomly assigned (double blind) to flaxseed or safflower oil treatment for three months, until the third visit. RESULTS: Different statistically significant correlations or trends towards among some serum individual free FFA mol % levels and HOMA-IR and HOMA-%ß, pre- and post-flaxseed and safflower oil supplementation were found. However, flaxseed oil had no impact on HOMA-IR or HOMA-%ß despite statistically significant alterations in correlations compared to baseline HOMA-IR. CONCLUSIONS: The obtained data indicate that high doses of flaxseed oil have no statistically significant effect on HOMA-IR or HOMA-%ß in T2Ds, probably due to the additive effects of negative and positive correlations.

Associations of pain and depression with marital status in patients diagnosed with Parkinson's disease.

BACKGROUND: Depression and pain are significant clinical problems that are comorbid with Parkinson's disease (PD). However, the relationship of these variables with the marital status of patients with PD has not been explored in previous studies. Therefore, the goal of this study was to assess the possible relationship between depression prevalence, depression severity, and pain interference with the marital status of the sufferers of PD. METHODS: This study included 40 patients and 40 healthy control participants who were assessed for depression prevalence and severity using The Hospital Anxiety and Depression Scale (HADS). The same individuals were also assessed for pain interference using the Brief Pain Inventory (BPI). RESULTS: When compared to the control groups, the PD (Single) group was found to have the highest prevalence of depression, followed by the PD (Married) group whereas the Control (Single) group was found to have a higher prevalence than the Control (Married) group (P < 0.0001). A main effect was found on depression severity (P < 0.0001), but no significant differences were observed between the PD groups. Lastly, PD (Single) patients had significantly greater pain interference scores than the PD (Married) patients (P < 0.05) with no other significant case-control or control-control group differences. CONCLUSION: Patient-spouse relationship, which indicates physical and emotional support may have a mitigating effect on patient outcomes of depression prevalence and pain interference.

Laparoscopic intracorporeally constructed ileal conduit after porcine cystoprostatectomy.

PURPOSE: We present our technique of laparoscopic ileal conduit creation after cystoprostatectomy in a porcine model performed in a completely intracorporeal manner. METHODS AND METHODS: After developing the technique in 5 acute animals laparoscopic cystoprostatectomy with intracorporeally performed ileal conduit urinary diversion was performed in 10 surviving male pigs. A 5-port transperitoneal technique was used. All steps of the technique applied during open surgery were duplicated intracorporeally. Specifically cystectomy, isolation of an ileal conduit, restoration of bowel continuity and mucosa-to-mucosa stented bilateral ileoureteral anastomosis formation were performed by exclusively intracorporeal laparoscopic techniques. RESULTS: Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and average operative time was 200 minutes. Stenosis of the end ileal stoma specifically at the skin level was noted in 6 animals. Three deaths occurred 2 to 3 weeks postoperatively. At sacrifice renal function was normal in all surviving animals. No ileo-ureteral anastomotic strictures were noted on pre-sacrifice radiography of the loop or at autopsy examination of the anastomotic sites. CONCLUSIONS: Laparoscopic ileal conduit urinary diversion after cystoprostatectomy may be performed completely intracorporeally in the porcine model. Clinical application of this technique is imminent.

Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue.

OBJECTIVES: To analyze the quality of life and psychological adjustment after surgical therapy for localized renal cell carcinoma. METHODS: Postal questionnaires including measures of quality of life (SF-36) and the impact of the stress of cancer (Impact of Events Scale) were completed by 97 patients who had undergone radical or partial nephrectomy for localized renal cell carcinoma. Data were analyzed for the group as a whole and comparing the partial nephrectomy and radical nephrectomy groups. The variables examined included the impact of the type of partial nephrectomy (elective versus mandatory) and the amount of self-reported renal tissue remaining. RESULTS: The quality of life for the group as a whole was good, with no significant differences between the sample and U.S. norms for an age and sex-matched community sample on both the mental and physical health composite scores. Having undergone a partial versus a radical nephrectomy did not influence the patients' overall quality of life. Multiple linear regression modeling demonstrated that having more remaining renal parenchyma was an independent predictor of better self-reported physical health on the SF-36 (P <0.001). The entire sample had low mean scores on both avoidance and intrusion on the Impact of Events Scale, suggesting a lack of daily anxiety about cancer. Multiple linear regression modeling showed that patients who reported having more remaining renal parenchyma had lower intrusion and avoidance scores (P = 0.002 and 0.01, respectively). Multiple logistic regression modeling also demonstrated that the patients' perception of their remaining renal parenchyma was associated with less concern about cancer recurrence (P = 0.018) and less impact of cancer on patients' overall health (P <0.001). CONCLUSIONS: Most survivors of localized kidney cancer have normal physical and mental health regardless of the type of nephrectomy performed. The quality of life is better for patients with more renal parenchyma remaining after surgery for localized renal cell carcinoma.

Management of synchronous renal neoplasm and abdominal aortic aneurysm.

OBJECTIVES: Renal neoplasm (RN) and abdominal aortic aneurysm (AAA) are occasionally discovered concurrently. The approach to synchronous malignancy and aortic aneurysm is controversial. METHODS: Between 1981 and 1999, concurrent RN and AAA were diagnosed in 50 patients at the Cleveland Clinic Foundation. Twenty-three patients were managed conservatively because of small asymptomatic AAA or metastatic disease; these patients were excluded from the study. The remaining 27 patients underwent operative management of both entities with a staged or simultaneous approach, and they form the basis of this article. RESULTS: AAA diameter ranged from 4.8 to 13 cm (mean, 6.0+/-1.8 cm). RNs were managed with radical nephrectomy in 11 patients (41%), partial nephrectomy in 10 patients (37%), or both in 6 patients with bilateral renal tumors (22%). The AAA repair was performed at the time of the urologic procedure in 11 patients (41%), before the urologic procedure in 13 patients (48%), or after the urologic procedure in 3 patients (11%). The AAA was addressed with open surgical repair in 24 patients (89%); recently, three patients (11%) underwent endovascular repair of the aneurysm and staged partial nephrectomy. The incidence of major perioperative complications was 23% (6 patients). Acute renal failure was the most common complication (3 [11%]) followed by acute respiratory failure (2 [7.4%]), pulmonary embolism (1 [3.7%]), and stroke (1 [3.7%]). At the mean follow-up of 57 months, there were no graft infections reported. The 5-year overall and cancer-specific survival rates were 62% and 81%, respectively. There was a significant difference in 5-year cancer-specific survival when comparing patients managed simultaneously versus staged (80% versus 35%, P =.007). CONCLUSIONS: The concurrent presentation of RN and AAA should not discourage one from treating both entities simultaneously because long-term survival is common. Endovascular repair of AAA holds promise as an attractive strategy in these complex patients.

Contemporary management of renal cell carcinoma with coexistent renal artery disease: update of the Cleveland Clinic experience.

OBJECTIVES: To treat concurrent renal cell carcinoma (RCC) and renal artery disease (RAD), which pose an unusual and challenging management dilemma. METHODS: Before June 1998, 48 patients presented with localized RCC and RAD affecting all the functioning renal parenchyma. These patients were grouped into four distinct categories: group 1, a solitary kidney with RCC and RAD (n = 8); group 2, bilateral RCC and coexistent RAD (n = 9); group 3, unilateral RCC and contralateral RAD (n = 15); and group 4, unilateral RCC and bilateral RAD (n = 16). The most common cause of RAD was atherosclerosis (n = 40), followed by medial fibroplasia (n = 5), renal artery aneurysm (n = 2), and arteriovenous malformation (n = 1). RESULTS: All patients underwent complete surgical excision of RCC. A nephron-sparing operation was performed preferentially (44 patients), and bilateral renal cancer operations were staged. Eleven patients underwent surgical renal vascular reconstruction in conjunction with either partial (n = 9) or radical (n = 2) nephrectomy. In 2 patients, renal revascularization was accomplished by percutaneous transluminal angioplasty before tumor excision. No perioperative deaths occurred. Postoperatively, preservation of renal function was achieved in 47 patients; 1 patient required chronic dialysis. The overall and cancer-specific 5-year patient survival rates in this series were 66% and 90%, respectively. At a mean follow-up of 58 months, 28 patients were alive with no evidence of malignancy. Six patients died of metastatic RCC, and 14 died of unrelated causes with no evidence of malignancy. CONCLUSIONS: Nephron-sparing surgery combined with selective renal arterial reconstruction can yield gratifying results in this complex patient population.

Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup.

PURPOSE: Partial nephrectomy is effective for renal cell carcinoma when preservation of renal function is a concern. We present the 10-year followup of patients treated with nephron sparing surgery at our institution. MATERIALS AND METHODS: Partial nephrectomy was performed in 107 patients with localized sporadic renal cell carcinoma before December 1988. Tumors were symptomatic in 73 patients (68%) and indications for surgery were imperative in 96 (90%). Of the patients 42 (39%) had renal insufficiency preoperatively. All patients were followed a minimum of 10 years or until death. RESULTS: At the end of the followup interval 32 patients (30%) had no evidence of recurrence, 28 (26%) died of metastatic renal cell carcinoma and 46 (42%) died of unrelated causes. Cancer specific survival was 88.2% at 5 and 73% at 10 years, and was significantly affected by tumor stage, symptoms, tumor laterality and tumor size. Long-term renal function was stable in 52 patients (49%). CONCLUSIONS: Partial nephrectomy is effective for localized renal cell carcinoma, providing long-term tumor control with preservation of renal function.

Comparison of direct hospital costs and length of stay for radical nephrectomy versus nephron-sparing surgery in the management of localized renal cell carcinoma.

OBJECTIVES: Recent work has demonstrated comparable surgical results and 5-year cancer-specific survival rates between radical nephrectomy and nephron-sparing surgery (NSS) in the treatment of patients with small (4 cm or smaller) solitary renal cell carcinomas (RCCs). However, differences exist in the intraoperative management and postoperative care of patients undergoing NSS versus radical nephrectomy, and we sought to compare direct hospital costs and length of stay (LOS) between these two groups to determine whether either treatment imparts a specific cost advantage. METHODS: Data were retrieved from medical records and administrative data sets containing billing encounters for all costs incurred during hospitalization at the Cleveland Clinic Foundation. Individual costs were grouped together using nine cost center categories encompassing every aspect of direct hospital care, including anesthesiology, laboratory, radiology, nursing, pharmaceutical, and emergency services, and medical care, surgical care, and miscellaneous costs. Each cost center was further subdivided, and a total of 52 cost subcategories were assessed. The total direct costs of hospitalization were compared using a multivariate regression model in which patient demographics and tumor characteristics, type and year of surgery, LOS, and cost center categories were assessed as single and interactive factors. Postoperative complication and cancer-specific survival rates were also compared to identify any potential therapeutic differences between the two groups. RESULTS: Between 1991 and 1995, 80 patients underwent surgery at the Cleveland Clinic Foundation for solitary RCCs 4 cm or smaller, including 52 partial and 28 radical nephrectomies. We found no difference in the postoperative complication rate or cancer-specific survival rate between the two surgical groups. Total direct hospital costs and LOS were not statistically different between the NSS and radical nephrectomy groups (P >0.05). This was further supported by our multivariate model, which accounted for 61% of the observed variance in the total costs (F = 12.11, P = 0.0001). The type of surgery was not associated with total cost when controlling for all other factors, including age, sex, year of surgery, tumor size, grade, and stage, and postoperative complications (P = 0.7). There was no significant interaction between the type of surgery and the LOS (P = 0.5). CONCLUSIONS: This study demonstrated that elective NSS can be performed with equivalent direct hospital costs and LOS when compared with patients undergoing radical nephrectomy for small solitary RCCs. These data have significant economic implications for the comparison of competing surgical treatment strategies for localized RCC.

Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging.

PURPOSE: We studied the impact of tumor size on patient survival and tumor recurrence following nephron sparing surgery for localized sporadic renal cell carcinoma. In addition, we evaluated the usefulness of the new TNM staging system in which T1 versus T2 tumor status is delineated by tumor size 7 or less versus more than 7 cm., respectively. MATERIALS AND METHODS: The results of nephron sparing surgery for localized sporadic renal cell carcinoma in 485 patients treated before 1997 were reviewed. Patients were divided into groups according to tumor size as 1--2.5 or less (142), 2--2.5 to 4.0 (168), 3--more than 4 to 7 (125) and 4--more than 7 cm (50). Mean postoperative followup was 47 months. RESULTS: Overall and cancer specific 5-year survival for the entire series was 81 and 92%, respectively. Of 44 patients with recurrent renal cell carcinoma 16 (3.2%) had local recurrence and 28 (5.8%) had metastatic disease. There was no difference in 5-year cancer specific survival or tumor recurrence between groups 1 and 2 or groups 3 and 4. However, these outcome measures were significantly more favorable in groups 1 and 2 combined (tumors 4 cm. or less) compared to groups 3 and 4 combined (tumors more than 4 cm.) (p = 0.001). CONCLUSIONS: Following nephron sparing surgery for localized sporadic renal cell carcinoma cancer-free survival is significantly better in patients with tumors 4 cm. or less compared to those with larger tumors. The usefulness of the current TNM staging system can be improved by subdividing T1 tumors into T1a (4 cm. or less) and T1b (4 to 7 cm.).

School mental health screening: a model for developing countries.

Using the experience derived from a screening programme of all school-going children in the Al Ain District, United Arab Emirates, this article reports on a cost-effective model that can be used in other developing countries. The need for training child health and school professionals in identifying mental and developmental disorders is discussed.

Management of small solitary unilateral renal cell carcinomas: impact of central versus peripheral tumor location.

PURPOSE: Recent studies have suggested that nephron sparing surgery and radical nephrectomy provide equally effective therapy for patients with small (less than 4 cm.), solitary, unilateral renal cell carcinoma and a normal contralateral kidney. We evaluate whether central versus peripheral tumor location in the involved kidney is a significant factor affecting treatment outcome in these patients. MATERIALS AND METHODS: Patients with a single, small (less than 4 cm.), localized, unilateral, sporadic renal cell carcinoma were identified from our institutional registry. From 1972 to 1995, 145 patients fulfilling these criteria were treated with either nephron sparing surgery (86) or radical nephrectomy (59). Mean postoperative followup was 51.4 months. Tumor characteristics and outcome measures were analyzed in 35 patients with central versus 110 with peripheral renal cell carcinomas according to the type of treatment. RESULTS: We detected 27 central (77%) and 75 peripheral renal cell carcinomas (68%) incidentally. Nephron sparing surgery was used to treat 19 central (54%) and 67 peripheral (61%) carcinomas. Pathological tumor stage was T1 to 2 in 33 central (94%) and 91 peripheral (82%) cases. Grade 1 to 2 renal cell carcinoma was present in 28 central (80%) and 85 peripheral (77%) tumors. Postoperatively, when comparing patients with central versus peripheral renal cell carcinomas there was no difference in 5-year cancer specific survival (100 versus 97%), tumor recurrence (5.7 versus 4.5%) or renal function (mean serum creatinine 1.43 mg./dl. in both groups). These parameters were also equivalent in patients treated with nephron sparing surgery versus radical nephrectomy overall and within the central versus peripheral renal cell carcinoma subgroups. Nephron sparing surgery was technically more complicated in central renal cell carcinomas with a longer renal ischemia time (55 versus 34 minutes, p <0.05) and more frequent entry of the collecting system (74 versus 47%, p <0.05) compared to peripheral carcinomas. Two patients (2.3%, 1 central, 1 peripheral) had local tumor recurrence after nephron sparing surgery. CONCLUSIONS: There were no significant biological differences between centrally versus peripherally located small solitary unilateral renal cell carcinomas. Nephron sparing surgery is technically more demanding in patients with central tumors. However, treatment with nephron sparing surgery or radical nephrectomy is equally effective regardless of tumor location.

Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma.

PURPOSE: We delineated patterns of tumor recurrence and developed guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. MATERIALS AND METHODS: Before December 1994, 327 patients underwent nephron sparing surgery for sporadic localized renal cell carcinoma at our clinic. Mean postoperative followup was 55.6 months. The course and outcome for patients with postoperative recurrent renal cell carcinoma were reviewed in detail. RESULTS: Renal cell carcinoma recurred after nephron sparing surgery in 38 patients (11.6%), including 13 (4.0%) who had local tumor recurrence with (7) or without (6) metastatic disease and 25 (7.6%) who had metastatic disease without local tumor recurrence. Recurrent renal cell carcinoma was detected by associated symptoms in 25 patients and by a followup chest x-ray or abdominal computerized tomography (CT) in 13. The respective incidences of postoperative local tumor recurrence and metastatic disease according to initial pathological tumor stage were 0 and 4.4% for stage T1, 2.0 and 5.3% for stage T2, 8.2 and 11.5% for stage T3a, and 10.6 and 14.9% for stage T3b disease. The peak postoperative intervals until local tumor recurrence were 6 to 24 months (7 of 10 patients with stage T3 renal cell carcinoma) and longer than 48 months (all 3 with stage T2 disease). Patients with isolated local tumor recurrence had better survival compared to those with local tumor recurrence and metastatic disease or metastases only. CONCLUSIONS: Followup for recurrent malignancy after nephron sparing surgery for renal cell carcinoma can be tailored according to the initial pathological tumor stage. All patients should be evaluated yearly with a medical history, physical examination and select laboratory studies. Patients with stage T1 renal cell carcinoma require no additional monitoring, while those with stage T2 disease should also undergo a yearly chest x-ray and abdominal CT every 2 years. The same recommendations are offered for patients with stage T3 renal cell carcinoma except that abdominal CT should be done every 6 months for the first 2 years postoperatively.

Renal hemodynamic effects of lovastatin in a renal ablation model.

OBJECTIVES: Patients with renal mass reduction of more than 50% are at increased risk for progressive renal failure. Lipid-lowering agents have been shown to preserve renal function in various models of chronic renal failure. This study was performed to evaluate the hemodynamic effects of lovastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor, in the remnant kidney model. METHODS: Two groups of animals were studied. Group 1 (n = 9) served as controls and group 2 (n = 14) received lovastatin, 15 mg/kg/day orally, for 2 weeks after renal ablation. Glomerular filtration rate (GFR, inulin clearance), renal blood flow (RBF, ultrasonic flow probe), and 24-hour protein excretion were measured in anesthetized rats. RESULTS: Two weeks after renal ablation, GFR was 0.28 +/- 0.09 mL/min/gkw (gram kidney weight) in group 1, whereas in group 2, lovastatin preserved GFR at 0.58 +/- 0.3 mL/min/gkw (P < 0.05). RBF in group 1 was 1.2 +/- 0.2 mL/min/gkw and increased to 2.1 +/- 0.4 mL/min/gkw in group 2 (P < 0.05), representing a 43% increase. Protein excretion decreased significantly to 13 +/- 1.7 mg/24 hr in group 2. The lovastatin-treated group had a lower serum cholesterol (59 +/- 3 mg/dL versus 71 +/- 2 mg/dL, P < 0.05), but serum triglyceride levels were not different between the two groups. CONCLUSIONS: Lovastatin preserves renal function in a renal ablation model after 2 weeks of treatment. It specifically increased total RBF. Therefore, in addition to its known cholesterol lowering effect, lovastatin also has the direct renal hemodynamic effect of increasing RBF and maintaining GFR.

Conception rates and assisted reproduction in subfertility due to unilateral cryptorchidism.

During 774 spontaneous cycles and 87 cycles of assisted reproduction, the conception rates were evaluated in 48 infertile couples in whom unilateral cryptorchidism was the causal factor. In spite of adjuvant therapy of the male partner, the spontaneous conception rate was very low (1% per cycle). Intra-uterine insemination (IUI) and conventional in vitro fertilization (IVF) resulted in similar success rates of 6.1 and 8.7% per cycle/attempt respectively. After intra-cyto-plasmic sperm injection (ICSI), 46.7% pregnancies were obtained per attempt, and sperm requirements for the latter treatment to be successful were lower than for IUI. It is concluded that subfertility in men with unilateral cryptorchidism is severe, conventional IVF has little advantage, but ICSI is highly successful.

Inhibin and steroid response to testicular stimulation with pure FSH (Metrodin) in infertile men with unilateral cryptorchidism.

Static measurements of immunoreactive inhibin have proven of little relevance in the diagnosis of testicular disorders. Dynamic evaluation of the inhibin secretory reserve might detect a specific Sertoli cell defect in a subgroup of infertile men. We compared the response of inhibin and steroids to an intravenous injection of pure FSH (Metrodin, Serono, 300 IU) in 13 infertile men with unilateral cryptorchidism to that in eight normal fertile men. Blood was aspirated before, 24, 48, and 72 h after the FSH injection. Two subgroups of patients with unilateral cryptorchidism were detected: those who responded by secreting inhibin in a pattern similar to normal men (seven patients), and those who responded poorly or not at all (six patients). The presumed cause of this difference is a defect of Sertoli cell reserve function due to a combination of insults to the testes, and not to cryptorchidism itself. The difference in response to FSH cannot be predicted from semen analysis nor from static hormone measurements. Overall, inhibin levels correlated significantly with the serum concentrations of FSH (r = -0.36, P < 0.05), testosterone (r = 0.37, P < 0.05), and 17-hydroxyprogesterone (r = 0.66, P < 0.001). It is concluded that, in infertile men with unilateral cryptorchidism, Stimulation of Sertoli cells by FSH can identify a subgroup of patients with Sertoli cell malfunction involving inhibin synthesis.

Pityriasis rosea. An immunologic study.

Some immunologic studies were carried out for 31 patients with pityriasis rosea. Normal levels of serum IgG and IgA but higher levels of IgM were obtained. Serum C3 values were decreased while C4 values were normal. B lymphocytes showed no difference from the controls, whereas T-cell counts were significantly lower in the patients. The migration inhibition indices were higher in the patients than the controls. Direct immunofluorescence tests were negative in the studied three cases. The possible implication of a viral infection in the production of the reported changes was discussed.

4-Keto niridazole: a major niridazole metabolite with central nervous system toxicity different than niridazole.

4-Keto niridazole, isolated by high-pressure liquid chromatography, was identified by high resolution electron impact mass spectral analysis as a major drug metabolite of niridazole in the serum or plasma of rats and mice treated orally or i.p. with niridazole. This metabolite has a pKa of 5.8 and is approximately 40% bound at physiologic pH to serum proteins of mice receiving therapeutic doses of niridazole. After i.p. injection of niridazole (160 mg/kg), peak serum levels of 4-keto niridazole (10.4 micrograms/ml) were reached within 6 hr in DBA/2J mice. The acute LD50 for 4-keto niridazole i.p. was 55 mg/kg in DBA/2J mice and 51 mg/kg in C57BL/6J mice; the comparable value for niridazole was 220 mg/kg in DBA/2J mice. Signs of acute 4-keto niridazole toxicity were different from those of niridazole toxicity and consisted of profound sedation and labored, irregular breathing terminating in respiratory arrest. Daily i.p. injection of 30 mg/kg of 4-keto niridazole for 5 days into DBA/2J mice resulted in no evidence of cumulative toxicity. The serum and brain concentrations of 4-keto niridazole after a 70-mg/kg i.p. LD90 dose of this compound were 93 micrograms/ml and 7.5 micrograms/g just before death. If an LD90 dose of niridazole (285 mg/kg) was injected into DBA/2J mice, the serum and brain concentrations of 4-keto niridazole just before death were 15 and 5%, respectively, of those found after an LD90 dose of 4-keto niridazole. Thus, 4-keto niridazole does not appear to account for the central nervous system toxicity of niridazole.

Bacterial meningitis in Egypt: analysis of CSF isolates from hospital patients in Cairo, 1977-78.

Bacterial meningitis remains a major cause of mortality and morbidity in many countries of the world despite effective antimicrobial therapy. Studies of the etiology and some laboratory characteristics of bacterial meningitis in Egypt were conducted during 1977-1978. All patients suspected of having bacterial meningitis were studied at the time of admission to the two fever hospitals of Cairo. Direct culture, serological identification of the capsular type, and countercurrent-immunoelectrophoresis of 1627 CSF specimens were done. Of these, 276 had bacteria identified either by culture or Gram stain. Pneumococci were the most common and the serotype distribution was similar to that reported from other parts of Africa; second were meningococci with groups C and B predominating; in third place was Haemophilus influenzae type b which caused the highest mortality and had an unusually young age distribution. There were 77 bacterial isolates (22%), including 11 species, designated as "other" because there was no predominant species. There were many "clear" CSF specimens that were found to contain pneumococci, meningococci or H. influenzae type b, confirming the need for more comprehensive laboratory facilities for accurate diagnosis of the etiology of bacterial meningitis.