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8040954 | Early endarterectomy for severe carotid artery stenosis after a nondisabling stroke: results from the North American Symptomatic Carotid Endarterectomy Trial. | The timing of carotid endarterectomy (CE) after a recent nondisabling stroke remains controversial. Delaying surgery in such cases may needlessly place patients at risk for a recurrent stroke that may be major and disabling. This study examines the prognostic implications of performing early endarterectomy compared with delayed endarterectomy in patients from the North American Symptomatic Carotid Endarterectomy Trial. This retrospective, subgroup analysis involved 100 surgical patients with severe (70% to 99%) angiographically defined carotid artery stenosis, who were diagnosed with a nondisabling hemispheric stroke at entry into the trial. Forty-two CEs were performed within 30 days (early group, ranging 3 to 30 days), and 58 were performed beyond 30 days (delayed group, range 33 to 117 days) after stroke. The risk of subsequent stroke after CE was compared between the two groups. Baseline clinical characteristics were comparable in both the early and delayed groups. In the delayed group more lesions were identified ipsilateral to the symptomatic side on the preoperative computed tomography scans. The postoperative (30 days after endarterectomy) stroke rate was 4.8% in the early group and 5.2% in the delayed group, yielding a relative rate of 0.92 (95% confidence interval, 0.16 to 5.27; p = 1.00). No deaths occurred after operation in either group. At the end of 18 months, the rates of any stroke or death were 11.9% and 10.3% for the early and delayed groups, respectively, resulting in a relative rate of 1.15 (95% confidence interval, 0.38 to 3.52; p = 1.00). No association was found between an abnormal preoperative computed tomography scan result and the subsequent risk of stroke when early operation was used. Early CE for severe carotid artery stenosis after a nondisabling ischemic stroke can be performed with rates of morbidity and mortality comparable to those who receive delayed endarterectomy. Delaying the procedure by 30 days for patients with symptomatic high-grade stenosis exposes them to a risk of a recurrent stroke, which may be avoidable by earlier surgery. |
8040953 | Effectiveness of fragmented autologous adipose tissue as a sealer of porous textile grafts: effect on endothelial development. | This study is designed to develop a sealing method for fabric vascular prosthesis with chopped tissue fragments. A highly porous fabric vascular prosthesis was invaginated, and a suspension of chopped autologous adipose connective tissue fragments was injected repeatedly until the pores were enmeshed with the fragments. Small tissue fragments oozed out from and firmly anchored within the interstices of the fabric, which made the outer surface smooth. The graft was then invaginated to bring the smooth surface into the luminal side. No blood leakage was observed in an extracorporeal in vivo shunt load test with heparin (total 1400 IU/kg, actinomycin > 1500), whereas a continuous bleeding was seen in a preclotted control graft (400 IU/kg, actinomycin 657 +/- 341). The sealed in a preclotted control graft (400 IU/kg, actinomycin 657 +/- 341). The sealed grafts were implanted in the descending thoracic aorta of 40 dogs, and an equal number of control grafts was used. The grafts were removed at selected time intervals up to 738 days. No bleeding was observed with the sealed grafts, and a thin layer of neointima was observed at 30 postoperative days. Eight (20%) of the control dogs bled to death within 24 hours of implantation. The neointima in the control animals extended from the anastomotic sites slowly with complete healing observed at 217 postoperative days. The autologous adipose tissue fragments could reliably seal the highly porous fabric prosthesis while allowing rapid and complete neointima healing in dogs. |
8040952 | The use of arterial allografts for vascular reconstruction in patients receiving immunosuppression for organ transplantation. | This study was undertaken to assess the biologic behavior of arterial allografts used for vascular reconstruction in patients undergoing immunosuppression therapy because of a previously transplanted organ. Thirteen patients with a transplanted kidney and receiving azathioprine, cyclosporine, and prednisone therapy, received 16 ABO-compatible arterial allografts to treat vascular complications of the kidney transplantation, popliteal aneurysms, and chronic or critical ischemia of the lower extremities. One aortoiliac, one iliorenal, two iliofemoral, three femorofemoral, one femoroperoneal, and eight femoropopliteal grafts were used in this particular group of patients. The arteries were retrieved from a donor whose diagnosis was cerebral death and, after careful preliminary studies, were stored cold, with use of liquid nitroxide vapor. The patients were monitored up to 45 months, mean 20 months. Graft tolerance was good, there were no signs or symptoms of acute rejection, and there was no perturbation of the immunologic tolerance of the transplanted kidney. During the follow-up period, two grafts occluded. On the basis of the histologic studies, it was not possible to relate the occlusion to rejection. This clinical study, undertaken for the first time in human beings, seems to confirm that immunosuppression modifies host tolerance to arterial allografts, improving their biologic behavior, a fact that was already documented in animal experimentation. |
8040951 | Toe pressure determination by audiophotoplethysmography. | The purpose of this study was to evaluate the performance of audiophotoplethysmography as a modality to measure toe pressure without the requirement of a recorder. A portable photoplethysmograph with an audio output was used to determine toe pressures, and the results were compared with those obtained by a commercial photoplethysmograph with a recorder. Thirty-one measurements in control subjects and 62 measurements in patients with arterial occlusive disease were performed. The average toe pressure recorded with oscillography with standard photoplethysmography was 103.5 mm Hg +/- 14.7 SD and 95.9 mm Hg +/- 13.4 SD with audio-photoplethysmography. In the patient group the pressure recorded with a commercial photoplethysmograph was 65.3 mm Hg +/- 34.9 SD compared with 61.6 mm Hg +/- 34.8 SD obtained with audio-photoplethysmography. The difference in both groups was insignificant, and the correlation between both methods was very good. A portable hand-held photoplethysmograph equipped with an audio output was used to measure toe pressure in control subjects and in patients with arterial occlusive disease. The results have been compared with the oscillometric method by a standard commercial photoplethysmograph connected to a recorder. The correlation was very good in the control and patient groups, and the difference between both methods was below the level of statistical significance. The fact that no recorder is needed may help in introducing toe pressure measurement into everyday office diagnostic practice. |
8040950 | Ultrasonic carotid artery plaque structure and the risk of cerebral infarction on computed tomography. | The North American and the European Symptomatic Carotid Endarterectomy Trial investigators reported a conclusive benefit of carotid endarterectomy for patients with symptomatic 70% to 99% internal carotid artery (ICA) stenosis. However, it has been suggested that plaque structure may be an even more important factor in producing stroke than the degree of stenosis. The aim of this study was to test the hypothesis that the ultrasonic characteristics of carotid artery plaques were closely related to symptoms and to the prevalence of cerebral infarcts on computed tomography (CT). One hundred five carotid artery plaques causing greater than 70% stenosis in the ICA in 83 consecutive patients who underwent brain CT were characterized into four ultrasonic types: echolucent plaques, predominantly echolucent plaques, predominantly echogenic plaques, and echogenic plaques. Patients with permanent neurologic deficit were excluded. There was a significant ipsilateral association between type 1 plaques and symptomatic hemispheres (p < 0.002). Twenty-six of the 105 cerebral hemispheres assessed by CT had infarcts. There was an increased incidence of brain infarcts in type I plaques (37%) compared with 18% in types II, III, and IV combined (p < 0.02). Our results support the hypothesis that echolucent plaques are more frequently associated with symptoms and cerebral infarctions and provide further evidence that these plaques are unstable and tend to embolize. Studies on the natural history of asymptomatic carotid artery stenosis should investigate whether plaque characterization could identify a high-risk group. |
8040949 | Influence of segmental arteries, extent, and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations. | The purpose of this article was to study the influence of either reattachment or oversewing of patient segmental intercostal or lumbar arteries, extent of aneurysm, and atriofemoral bypass on the incidence of postoperative paraplegia/paraparesis in patients at high risk with type I or II thoracoabdominal aneurysms. Data were prospectively collected on 99 patients undergoing type I or II thoracoabdominal aneurysm repairs, including exact extent of repair and whether atriofemoral bypass ws used. Patency of intercostal arteries from T3 to T12 and lumbar arteries from L1 to L4 were checked by intraoperative inspection. If the arteries were patent, note was taken of whether they were reattached to the new aortic prosthesis. Postoperative neurologic motor function was graded daily for the first 5 days, and the worst score in the first 30 postoperative days (POD) was used for analysis. Ninety-five of 99 (96%) patients were 30-day survivors. By POD 30, 31 of 98 (32%) patients had had a neurologic deficit. There was no difference in the incidence of deficits according to whether lumbar or intercostal arteries were reattached, ignoring the effect of patency of the arteries. Of greater importance, however, was whether patent segmental arteries were oversewn at specific levels. Thus, for patients who had one or more arteries at T11, T12, or L1 oversewn (often because they could not be reattached), a deficit developed in 11 of 23 (48%) patients versus 20 of 75 (27%) patients who did not have patent arteries or had all patient arteries reattached (p = 0.05, odds ratio = 2.5). More specifically, if all arteries at this level were oversewn, a neurologic deficit developed in 63% of patients versus 23% if all their arteries were reattached (p = 0.01). Reattachment of patent arteries at individual levels from T7 to L4 showed a trend toward a lower risk of deficits but did not reach statistical significance. On multivariate analysis, atriofemoral bypass was associated with a lower risk of paralysis (p = 0.068), and significantly so when controlled for age (p = 0.0329, odds ratio 0.287). Subgrouping of extent type I thoracoabdominal aneurysms resulted in an incidence of paralysis of 14% (3/22) for subgroup A and 23% (5 of 22) for subgroup B compared with 43% (23 of 55) for type II thoracoabdominal aneurysms (type I [8 of 44 18%], versus type II [p = 0.0097]). Patients with no or few patent segmental arteries in the aortic segment being replaced have a lower risk of neurologic deficits, compared with those with patent arteries. Every effort should be made to reattach all arteries at T11, T12, and L1 and, when possible within the constraints of technical feasibility and time, also those from T7 to L4. Preoperative angiography or intraoperative hydrogen testing may better identify the arteries that need to be reattached. When feasible, atriofemoral bypass appears to be protective, particularly when sequential clamping and segmental repairs can be performed. |
8040948 | A strategy of aggressive regional therapy for acute iliofemoral venous thrombosis with contemporary venous thrombectomy or catheter-directed thrombolysis. | Occlusive iliofemoral venous thrombosis is associated with morbid short- and long-term consequences. Having been disappointed with standard anticoagulant therapy and systemic fibrinolysis, we embarked on an aggressive multidisciplinary regional approach to treat these patients, with the goals of therapy being (1) to eliminate iliofemoral venous thrombus, (2) to provide unobstructed venous drainage from the affected limb, and (3) to prevent recurrent thrombosis. Twelve consecutive patients were treated for extensive iliofemoral venous thrombosis. Each had thrombus from their infrapopliteal veins through their iliofemoral system, and four had vena caval involvement. The conditions of 11 patients failed to improve when the patients were given anticoagulants, and prior systemic fibrinolysis failed in five patients. The treatment strategy includes catheter-directed thrombolysis with intrathrombus infusion of the plasminogen activator or operative thrombectomy or venous bypass with a permanent 4 mm arteriovenous fistula (AVF). Nine of 12 patients had a good or excellent clinical outcome (mean follow-up 25 months), which correlated with restored unobstructed venous drainage from the affected limb. Seven patients had catheter-directed lytic therapy attempted. In five patients the catheters were appropriately positioned, and lysis was successful. Five of the eight patients who underwent operations had successful procedures. Two of the three patients with poor operative outcomes had residual thrombus in their iliac veins or vena cava after thrombectomy (without bypass). The third patient, in whom anticoagulation was contraindicated, had an initially successful thrombectomy and AVF; however, vena caval thrombosis developed 2 months after operation. No patient had symptomatic pulmonary emboli, and routine posttreatment ventilation/perfusion lung scanning was not performed. An aggressive multidisciplinary regional approach to patients with obliterative iliofemoral venous thrombosis, designed to remove thrombus and provide unobstructed venous drainage, offers substantially better clinical outcome compared with systemic fibrinolysis and standard anticoagulation. Catheter-directed thrombolysis is successful if the catheter is appropriately positioned within the thrombus. Contemporary venous thrombectomy, which includes thrombus removal, completion phlebography, AVF, and cross-pubic bypass when necessary, is associated with high success rates. Failures can be anticipated and avoided in most patients. |
8040947 | Detection of active cytomegalovirus infection in inflammatory aortic aneurysms with RNA polymerase chain reaction. | We previously reported the possible role of human cytomegalovirus in the pathogenesis of inflammatory aortic diseases. To further analyze the viral cause of human aortic diseases, in this study we examined the presence and the replication of human Herpesviridae in 60 aortic tissues, including 7 inflammatory aneurysms, 37 atherosclerotic aneurysms, and 16 normal aortas. To detect the genome of herpes simplex virus (type 1, type 2), cytomegalovirus, and Epstein-Barr virus, DNA polymerase chain reaction for each virus was performed. To analyze these herpesviral replications, the viral transcript was detected with RNA polymerase chain reaction. The DNA polymerase chain reaction showed that either herpes simplex virus or cytomegalovirus was present more frequently in inflammatory (29% or 86%, respectively) and atherosclerotic aneurysms (27% or 65%, respectively) than in normal aortic tissues (6% or 31%, respectively), whereas the Epstein-Barr viral genome was not detected in any aortic tissue specimens. By the use of RNA polymerase chain reaction, only the cytomegaloviral transcript was recognized in 71% of the inflammatory aneurysms but was not recognized in any other tissue specimens. No other herpesviral transcripts were detected in any tissue specimens examined in this study. Our results thus suggest that the human herpesviruses may play various roles in the pathogenicity of aortic diseases, in particular the replicating infections of the cytomegalovirus might potentially cause the formation of inflammatory aneurysms. |
8040946 | Preoperative duplex venous mapping: a comparison of positional techniques in patients with and without atherosclerosis. | Preoperative duplex venous mapping is the preferred modality to measure the diameter of the greater saphenous vein and its suitability as an arterial conduit for infrainguinal bypass. We wanted to determine the optimal mapping technique and maximal venous diameter in patients with and without atherosclerosis. Three groups of patients were prospectively studied: younger control subjects (n = 20), preoperative atherosclerotic patients (n = 10), and older control subjects (n = 10). All patients underwent greater saphenous vein duplex mapping in a standardized manner. Maximal internal vein diameters were measured with the subjects in the supine position in bed, in the 20 degree reversed Trendelenburg position, sitting on the edge of the bed, standing, and in the supine position with a high-thigh, low-pressure tourniquet. Measurements were taken just beyond the saphenofemoral junction, in the distal thigh, below the knee, at midcalf, and superior to the medial malleolus. In younger control subjects an increasingly more erect position resulted in progressively larger measured vein diameters at all levels along the length of the leg. Both patients with atherosclerosis and older control subjects had no such increase in venous diameter with any positional change from the supine position to standing. Patients with atherosclerosis also had significantly smaller measured veins than either younger or older control subjects. A high-thigh tourniquet significantly increased vein diameters in the atherosclerotic group to the size of vein diameters in the older control group, although the absolute size differences were not large. The optimal position for venous mapping is with the patient in a supine position. If the internal vein diameter is below an acceptable minimum size, a high-thigh tourniquet will maximally distend the vein in patients with atherosclerosis. Vein diameter decreases with age and is less distended in patients with atherosclerosis compared with older patients without atherosclerosis. |
8040945 | Differences in mechanical properties of the common carotid artery and abdominal aorta in healthy males. | Vascular disease is differentiated throughout the vascular regions, with central arteries more prone to dilation and with peripheral arteries more prone to occlusive disease. In this study we investigated the diameter and compliance in the common carotid artery and abdominal aorta in healthy males at varying ages to assess potential differences in the aging process. An ultrasound phase-locked echo-tracking system was used to determine differences in diameter and pulsatile diameter changes of the common carotid artery and abdominal aorta in 56 healthy Caucasian males ages 10 to 74 years. Pressure strain elastic modulus (Ep) and stiffness (beta) were calculated from diameter, pulsatile diameter change, and blood pressure obtained by the auscultatory method. Compliance was defined as the inverse of Ep and stiffness. The diameter of both common carotid artery and abdominal aorta increases not only when a person is a child, but also when they are between 25 and 70 years old. The dilation in adults seems to be more accentuated in the abdominal aorta (27%) than in the common carotid artery (17%). Ep and stiffness (beta) are higher in the common carotid artery when a person is 10 years of age (p < 0.01 and 0.05). However, during aging, Ep and stiffness (beta) increase to a higher extent in the aorta than in the common carotid artery, with a significantly higher Ep and stiffness (beta) in the aorta when a person is 45 years and older (45 years: p < 0.05 and p = NS; 60 years: p < 0.001 and p < 0.001; 70 years: p < 0.01 and p < 0.01). This investigation demonstrates regional differences in diameter change and compliance in the common carotid artery and abdominal aorta and implies that the abdominal aorta is more prone to degenerative changes than the common carotid artery. This may be one etiologic factor for the regional differences in vascular disease. |
8040944 | Matrix metalloproteinases of vascular wall cells are increased in balloon-injured rat carotid artery. | Although matrix metalloproteinase (MMP) expression has been correlated with proliferation and migration of various tumor cells, the relation between MMP expression and smooth muscle cell (SMC) proliferation and migration has not been established. We measured MMP expression (gelatin, casein, and elastin zymography) by vascular wall cells in balloon-injured carotid artery during the period of medial SMC proliferation, migration of SMC from the media to the intima, and subsequent intimal SMC proliferation. The 72 and 64-kd gelatinases (presumably 72 kd type IV collagenase or MMP 2) were constitutively expressed in normal carotid arteries, and the activated (59 and 54 kd) forms of this enzyme were increased at 5 days when SMCs start to migrate. A 92 kd gelatinase (presumably 92 kd type IV collagenase or MMP 9) was increased at 24 hours, when SMCs entered the growth cycle, and decreased thereafter. A low-molecular-weight metalloproteinase with elastolytic activity was present in the adventitia, and the activity was increased at 5 days after surgery. These results suggest that the 72 kd and 92 kd gelatinases may be involved in basement membrane and matrix degradation in the media in relation to SMC proliferation and migration, whereas the low-molecular-weight metalloproteinase may have a role in elastin turnover in the adventitia. |
8040943 | The isolation of a fibroblast growth inhibitor associated with perigraft seroma. | Perigraft seroma is a rare complication of reconstructive vascular surgery characterized by a clear, sterile fluid collection confined within a fibrous pseudomembrane around a prosthetic graft. The exact cause of this disease is unknown but involves failure of surrounding connective tissue to incorporate the graft. To understand why this occurs, we studied sera from patients with perigraft seroma for their effect on human fibroblasts. Sera from control subjects, patients with uninfected prosthetic grafts, and patients with prosthetic grafts were tested for comparison. Fibroblast growth was measured by radioactive thymidine uptake and hexosaminidase colorimetric cell proliferation assays. We fractionated sera with gel filtration columns and measured each fraction's effect on fibroblast growth. Serum samples from patients with perigraft seroma inhibited fibroblast growth in a dose-dependent manner. In contrast, a postseroma sample, normal human sera, and sera from patients with infected and uninfected grafts showed no significant fibroblast inhibition. An inhibitory factor with a molecular weight of 2000 d was isolated from serum of patients with perigraft seroma. Perigraft seroma is associated with a fibroblast inhibitor with a molecular weight of 2000 d. Further identification and characterization of this protein may lead to clinical applications in preventing and treating perigraft seroma. |
8040942 | Axillofemoral bypass: compromised bypass for compromised patients. | The procedure of axillofemoral bypass (AXF) grafting has generally been used in the past for patients with serious contraindication to certain reconstructive procedures involving the abdominal aorta. Because some recent series have noted improved results, it has been suggested that the indications for this bypass may be extended. We reviewed our experience with AXF to identify which factors affect outcome, to determine whether recent results have improved, and to determine whether an extension of the use of the procedure is justified by the observed results. One hundred fifty-three AXF, including 80 axillobifemoral bypasses and 73 axillounifemoral bypasses performed between October 1974 and December 1992 were reviewed. Three-year primary and secondary patency rates for the entire group were 49.4% and 65.7%. Primary patency was adversely affected (p < 0.05) by superficial femoral artery occlusion, use of externally supported polytetrafluoroethylene, distal endarterectomy, distal anastomosis to the deep femoral artery, and year of surgery after 1984, but not by use of unifemoral or bifemoral outflow, side of graft origin, or concomitant distal procedure. The operative mortality rate of bypasses performed for claudication and the limb salvage rate was 8.3% overall and 5.9% after 1984. Limb salvage rates were 74.8% and 74.8% at 3 and 5 years. The patient survival rate for all AXF was 55.8% and 39.2% at 3 and 5 years. AXF for acute ischemia carried a high rate of mortality and limb loss. Bifemoral outflow, external support, and more recent surgery were not associated with improved patency rates. Our results do not support extended indications for AXF. |
8040941 | A compliant tubular device to study the influences of wall strain and fluid shear stress on cells of the vascular wall. | Cellular constituents of the blood vessel wall are continuously subjected, in vivo, to both mechanical and hemodynamic forces, which elicit structural and biologic responses. We have developed a compliant tubular system, the vascular simulating device (VSD), that reproduces these forces, while supporting the attachment and the experimental manipulation of endothelial and smooth muscle cells. The VSD consists of a compliant silicone rubber tube coupled to a pump system, which permits the simultaneous application of known levels of pressure and flow, to vascular wall cells cultured on the inner surface of the tube. Seeded cells can be monitored visually under phase contrast or fluorescent optics, as well as harvested and analyzed for biologic responses. The elastic modulus and compliance of the silicone rubber tube are similar to those of canine and human arteries. Endothelial and smooth muscle cells cultured on the lumenal surface of the tubes remain attached and viable after subjecting them to physiologic pulsatile flow and cyclic strain. The VSD makes it possible to approximate, in vitro, those forces encountered by vascular wall cells, in vivo and therefore may make it possible to determine whether specific combinations of mechanical and hemodynamic forces are causally associated with specific vascular diseases. |
8040940 | Expansion of aortic aneurysms is reduced by propranolol in a hypertensive rat model. | It has been suggested that propranolol has unique effects that slow aneurysm expansion by remodeling the structural proteins of the aorta. These effects are believed to be independent of blood pressure reduction, a hypothesis we tested in this investigation with a rat model of abdominal aortic aneurysm (AAA). With an established model, AAA were induced in normotensive Wistar-Kyoto (WKY) rats and genetically hypertensive Wistar-Kyoto (WKHT) rats by perfusing an isolated segment of the infrarenal aorta with elastase. A propranolol dose-response was studied for each strain: (1) saline solution controls (n = 18); (2) propranolol, 10 mg/kg subcutaneously (n = 18); (3) propranolol, 30 mg/kg (n = 14). Systolic blood pressure was determined by tail plethysmography before operation and on day 14, as well as by direct recording at surgery and on day 14. Rats were killed at 14 days, and aneurysm diameter was measured. The initial tail BP was 129 +/- 22 mm Hg in WKY animals and 158 +/- 21 mm Hg in WKHT animals (p < 0.0001). Tail BP and intraaortic systolic, diastolic, and mean blood pressure (BP) were not significantly decreased by propranolol treatment in either strain of rats. However, BP tended to rise in WKY rats, whereas it fell slightly in WKHT rats. Initial aortic size in all animals was 1.06 +/- 0.12. The final aortic size in untreated, hypertensive rats was more than twice that of untreated normotensive controls: 1: WKHT, 3.0 +/- 0.73 mm, 1: WKY, 6.9 +/- 3.5 mm (p < 0.01). After treatment with both doses of propranolol, hypertensive aneurysms were significantly smaller than the untreated WKHT group (p < 0.05) and not significantly different from aneurysms in all groups of normotensive animals: 2: WKY, 3.1 +/- 1.13 mm, 2: WKHT, 4.0 +/- 1.81 mm; 3: WKY, 4.1 +/- 0.41 mm, 3: WKHT, 2.9 +/- 1.24 mm. There was no significant difference in aortic size between the three normotensive WKY groups. Hypertension increases the size of aortic aneurysms in this experimental model. Propranolol significantly reduces the size of experimental AAA in hypertensive animals independently of the dose and by a mechanism that may be unrelated to simple BP reduction. |
8040939 | A multicenter study of popliteal aneurysms. Joint Vascular Research Group. | The purpose of this study was to determine current practice in the treatment of all categories of popliteal aneurysms (PA) in light of the efficacy of intraarterial thrombolysis in PA presenting as acute ischemia. Prospective data collected from 19 vascular surgeons from 200 PA in 137 patients during a 4-year period from 1989. The most common presentation (125 PA) was leg ischemia, with the most severe symptom being claudication in 58, acute limb-threatening ischemia in 56, and digital atheroembolism in 11 limbs. The nonischemic group (75 PA) included 43 symptom-free cases and 32 cases with local symptoms arising from the popliteal fossa. Of 62 patients requiring emergency treatment, bypasses were done in 56, 10 of whom had early occlusion. Thrombolysis was used alone or in combination with bypass on 23 occasions, with 16 successful outcomes. Of 138 PA presenting electively, 80 underwent bypass, with one early occlusion, and 58 were observed. In the observed group, 18 later underwent bypass during a median follow-up of 22 months. The indications for late bypass were expansion of a small (< 2 cm) asymptomatic PA and the development of distal ischemia. There were 18 deaths in the observed group because of medical unfitness; limb ischemia did not develop during follow-up. Intraarterial thrombolysis is of value in restoring the distal run off before bypass in PA presenting as acute limb-threatening ischemia. However, the results do not justify an expectant policy for asymptomatic aneurysms. |
8040938 | Nonruptured abdominal aortic aneurysm: six-year follow-up results from the multicenter prospective Canadian aneurysm study. Canadian Society for Vascular Surgery Aneurysm Study Group. | Based on the prospective analysis of data on 680 patients undergoing surgery for nonruptured abdominal aortic aneurysm (AAA) and recorded in the Canadian Society for Vascular Surgery Aneurysm Registry, this study determines the late survival rate by comparison to an age- and sex-matched population, the causes of late death, the effect of heart-related death on late survival, and the prognostic variables that are associated with late survival. To identify the variables that were associated with survival, statistical methods included Kaplan-Meier analysis and Cox regression analysis. The Canadian Society for Vascular Surgery Aneurysm Registry provided ongoing current follow-up of patients. The survival rate was 94.6% at 1 month, 90.7% at 1 year, 87.1% at 2 years, 81.0% at 3 years, 74.0% at 4 years, 67.7% at 5 years, and 60.2% at 6 years. The late survival rate of patients with AAA is significantly less than the age- and sex-matched normal population (60.2% versus 79.2%). In the AAA group, heart-related causes of late death (44.4% versus 34.1%) and cerebrovascular causes (8.3% versus 5.8%) were more frequent. The calculated 5-year heart-related mortality rate is 14.3%. This is higher than the heart-related mortality rate for the age- and sex-matched population, which is 6.4%. Hence, the risk of heart-related death for patients who have undergone AAA repair is increased by 1.6% per year. Vascular complications from aortic aneurysm repair or recurrent aneurysmal disease were an uncommon cause of late death: ruptured thoracic aneurysm, 1.5%; ruptured aortic false aneurysm, 1.5%; and aortoenteric fistula, 0%. This incidence appears to be less than reported in earlier series. By Cox regression analysis, the variables that were significant predictors of a lower late survival rate were increased age, preoperative electrocardiogram indicating a previous myocardial infarction, and elevated serum creatinine levels. Because cardiac complications accounted for 68.8% (22/32) of the 4.7% in-hospital mortality rate (i.e., a heart-related mortality rate of 3.2%), it seems reasonable to develop a strategy to reduce the cardiac operative risk by identifying and treating patients at high risk before operation. However, it is doubtful that a preoperative program that screens and treats all patients can be cost-effective in preventing late heart-related deaths. |
8040934 | Bioavailability and pharmacokinetics of metoclopramide in cattle. | The bioavailability of metoclopramide was investigated in three steers following administration of 8 mg/kg by the oral, abomasal (cannula), and intravenous routes, using a Latin square design. The mean (+/- SD) oral and abomasal bioavailabilities were 51.3 +/- 30.7% and 76.2 +/- 15.5%, respectively. The mean value for clearance (Cl) was 20.1 +/- 5.9 ml/min and the volume of distribution (Vd) was 0.51 +/- 0.19 l/kg. Additional pharmacokinetic parameters for metoclopramide were determined following intravenous administration to seven cows. A predominate two-compartment model of distribution was found in six cows with a t 1/2 alpha harmonic mean of 24.2 min and a range of 11.2-72.4 min, a t 1/2 beta harmonic mean of 53.1 min and a range of 31.1-134.1 min, a Cl of 42.2 +/- 8.7 ml/min, and a Vd of 2.1 +/- 0.8 l/kg. To better define the relationship between metoclopramide concentration and release of prolactin, a treatment-by-subjects infusion study was conducted in which four different loading doses followed by constant infusion were used. A steady-state metoclopramide concentration (MCPss) of 8.8 +/- 2.6 ng/ml was associated with a three-fold elevation of prolactin to a mean value of 12.1 +/- 3.1 ng/ml in six yearling steers. Steady state serum prolactin concentrations (PRLss) did not rise significantly above 23.3 +/- 6.9 ng/ml, even when MCPss reached a concentration of 518.5 +/- 151.2 ng/ml. The short half-life, moderate Vd, low minimum pharmacologically effective concentration, and rapid Cl found for metoclopramide in cattle in this study, suggest that a continuous release device could potentially be useful in the application of this drug in the prevention and treatment of fescue toxicosis. |
8040933 | Bioavailability of levamisole administered by subcutaneous and oral routes in rabbits. | The bioavailability of levamisole in rabbits was determined after subcutaneous and oral administration at three dose levels of 12.5, 16.0 and 20.0 mg/kg. After non-compartmental analysis the mean values obtained were: Cmax = 3.54, 4.51 and 5.39 micrograms/ml; tmax = 12.0, 22.0 and 20.0 min; F = 134.8, 105.4 and 124.1% after subcutaneous administration for each dose, respectively, and Cmax = 0.71, 1.32 and 1.77 micrograms/ml; tmax = 46.0, 96.0 and 84.0 min; F = 53.0, 62.0 and 80.7% after oral administration. The extent and rate of absorption from the two routes differed significantly, except for tmax at the 12.5 mg/kg dose. After compartmental analysis the pharmacokinetics of levamisole was characteristic of a two-compartment open model in 13 rabbits and of a one-compartment open model in two rabbits after subcutaneous administration, while it was two compartmental in nine and one compartmental in six rabbits after oral administration. The ka values were 0.321, 0.145 and 0.145 min-1 after subcutaneous administration and 0.054, 0.023 and 0.027 min-1 after oral administration. There were no significant differences between the values of Cmax, tmax and AUC calculated by compartmental and non-compartmental analysis. |
8040932 | Pharmacokinetic-pharmacodynamic modelling of meperidine in goats (II): Modelling. | Simultaneous pharmacokinetic-pharmacodynamic (PK-PD) models of meperidine in goats were established by utilizing the P3 wave of the cerebral evoked potentials as an analgesic measurement. An effect compartment linked to the central compartment was postulated in the models. The hypothetical drug amount in the effect compartment was related to the observed analgesia through the Hill equation. After intramuscular (i.m., n = 16) and intravenous (i.v., n = 13) dosing (5 mg/kg), the elimination rate constants of meperidine in the effect compartment (Ke0) were 0.3744 +/- 0.2546 and 0.1123 +/- 0.0428 min-1, drug concentrations in the effect compartment generating half maximal analgesia (EC(50)) were 0.70 +/- 0.33 and 0.41 +/- 0.26 microgram/ml, the maximal effects (Emax) were 89.63 +/- 15.63 and 85.92 +/- 9.64%, and the Hill coefficients (S) were 2.61 +/- 1.21 and 2.37 +/- 1.15, respectively. Ke0 and EC(50) with i.m. dosing were significantly greater than with i.v. injection. However, administration route had no influence on S, Emax and the total amount of effect (AUE). The predicted peak effect (Emax) of 64.44 +/- 14.64 and 66.02 +/- 11.51% were achieved at 14.7 +/- 7.4 and 8.5 +/- 2.2 min after i.m. and i.v. dosing, respectively. Peak analgesia appeared much later than peak plasma concentration, but simultaneously with peak CSF level both after i.m. and i.v. dosing. An obvious hysteresis was demonstrated between plasma concentration and analgesic effect. This study demonstrates that meperidine analgesia can be predicted using a PK-PD model, but not by PK data alone. Both i.m. and i.v. administration routes were evaluated kinetically and dynamically. |
8040931 | Mycobacterium smegmatis keratitis after radial keratotomy--a case report. | A 42-year-old woman who developed a corneal ulcer in the left eye after radial keratotomy. The acid-fast stain showed that numerous clusters of acid-fast bacilli and Mycobacterium smegmatis were isolated on the culture. To the best of our knowledge, this is the first documented case of Mycobacterium smegmatis keratitis in the world literature. The sensitivity test showed that this organism resistant to all the anti-tuberculous agents and antibiotics we test. An initial response to amikacin and kanamycin was found, but relapse of infiltrate was noted one month later. The regimen was therefore changed to a combination of amikacin with ofloxacin. This patient had a favorable response to the topical therapy with amikacin and ofloxacin. |
8040930 | Discrepancy between gallium-67 citrate scans and chest X-rays in patients with miliary tuberculosis. | Two patients were admitted to our hospital with a diagnosis of miliary tuberculosis (TB). Gallium-67 citrate (Ga) scans and chest X-rays were used to localize the TB lesions. One case showed normal chest X-ray with significant gallium uptake in the lung while the other showed diffuse interstitial infiltrations of both lungs in chest X-ray with negative result in gallium scan. We suggest that the combination of Ga scans and chest X-rays might be indicated to avoid the discrepancy between the two images and missing early diagnosis of miliary TB. |
8040929 | [Metastasis involving the leptomeninges and ventricles of the brain--CT evaluation]. | The diagnosis of leptomeningeal or ventricular metastasis by cranial computerized tomography (CT) contributes to earlier treatment and sometimes alters the management of patients with intra- or extra-cranial malignancy. In 20 cases whose metastasis were spreaded via CSF seeding, the abnormal CT findings were 1) mass or nodule in the ventricles or subarachnoid space, 2) ependymal, subependymal enhancement, 3) sulcal, gyral or cisternal enhancement, 4) hydrocephalus not related to the obstruction of primary tumor, 5) falx or tentorial enhancement. In another 8 cases, the metastasis developed through hematogeneous spreading to the choroid plexus or paraventricular parenchyma. The mass or nodule within the ventricles could be well identified with enhanced CT scan. The involved ventricles, in order of frequency, were lateral, 3rd, and 4th ventricles in our series. |
8040928 | [The correlation between cytology and histopathology of primary adenocarcinoma of the uterine cervix]. | Cytodiagnosis is a simple, non-invasive and economical screening method for uterine cervical malignancy. Adenocarcinoma as a primary tumor of uterine cervix, although relatively rare, is increasing recently. The first part of the study consisted of 113 patients, seen during a 10-year period, with adenocarcinoma of the uterine cervix proven by tissue diagnosis with prior and/or coincident Papanicolaou smears available in our hospital. Their cytology were as follows: positive/suspicious for adenocarcinoma in 72 cases (63.7%) and incorrect diagnosis for adenocarcinoma in 41 cases (36.3%). These included epidermoid carcinoma, 21 cases (18.6%); atypia, 8 cases (7.1%); negative smears, 8 cases (7.1%); inadequate specimens, 3 cases (2.7%) and radiation effect, 1 case (0.8%). The second part of the study is concerned with the 82 cases whose smear diagnosis was adenocarcinoma in the same period. The results of their tissue diagnosis and accuracy were as follows: adenocarcinoma in 62 cases (75.6%); epidermoid carcinoma in 9 and epidermoid carcinoma in situ in 3 cases totalling 12 cases (14.6%); and false positive in 8 cases (9.8%). The cytomorphology and its correlation to underdiagnosis and overdiagnosis is discussed. Our data revealed that cervicovaginal smears served as a routine for the screening of primary adenocarcinoma of the uterine cervix and for follow-up and detection of recurrence. In order to increase the accuracy, screening cytotechnicians and cytopathologists should acquaint themselves with the morphology of cervical adenocarcinoma by comparing cervicovaginal smear with histopathology. |
8040927 | [Application of a human immortalized fibroblast cell line in laboratory diagnosis of autoimmune diseases]. | Many autoantibodies reacting with cellular and nuclear components have been described in sera of patients with autoimmune diseases. The most important diagnostic markers for those diseases are antinuclear antibodies (ANA). The first choice for laboratory diagnosis of autoimmune diseases is to use cultured monolayer cells as a nuclear substrate. Up to now the HEp-2 cell line derived from a human carcinoma of the larynx, appears to be the most sensitive and specific nuclear substrate. The cultured fibroblast monolayer cells have also been applied to detect the ANA, although the application was not recommended by one study. Thus to evaluate the applicability of our immortalized human fibroblast cell line (CCFS-1/KMC) as a nuclear substrate, commercial HEp-2 MBL monolayer cells was used as the standard substrate. The results of this report showed the applicability of the CCFS-1/KMC cell line as a nuclear substrate to detect the ANA of autoimmune diseases. The sensitivity of this fibroblast cell line was the same as both of the HEp-2 nuclear substrates (HEp-2 and HEp-2 MBL). The specificity of the CCFS-1/KMC cell line was similar to the HEp-2 substrate. Since the specificity of both of the above substrates were lower than the standard nuclear substrate HEp-2 MBL, therefore, if the specificity can be improved by changing the protocols of the substrate preparation, the CCFS-1/KMC cell line will be a good nuclear substrate for detecting the ANA of autoimmune diseases. |
8040926 | Rheumatoid factor in hepatitis B virus surface antigen positive patients. | Rheumatoid factor (RF) is often found in the sera of patients with nonrheumatic diseases in comparison with normal individuals. We collected 95 healthy HBs antigen positive adults and 98 healthy HBs antigen negative adults. RF was present in 14.74% (14/95) of the HBs antigen positive group while it was present in 3.06% (3/98) of the HBs antigen negative group (p < 0.05). RF was positive in 15.38% (2/13) of the HBe antigen positive patients whereas it was positive in 14.63% (12/82) of the HBe antigen negative patients (p > 0.05). RF was found positive in 16.90% (12/71) of the anti-HBe antibody positive group while it was positive in 8.33% (2/24) of the anti-HBe antibody negative group (p > 0.05). We conclude that the positive rate of RF in HBs antigen positive patients is significantly higher than in that of HBs antigen negative patients. The incidence of RF positivity of the HBe antigen positive group is not higher than that of the HBe antigen negative group. The positive rate of RF in anti-HBe antibody positive group has a tendency to be higher than in that of their negative counterparts though there was no significant difference between them. |
8040925 | An exploration of postpartum depression model using LISREL. | The purpose of this study was to examine whether the postpartum depression model fits the data. A total of 129 Chinese women at 6 weeks postpartum were recruited to participate in this study from the Kaohsiung City area, Taiwan, Republic of China. Five instruments were used to collect data: the Demographic Data Form, the Cohen's Perceived Stress Scale, the Cohen's Interpersonal Support Evaluation List, the Coopersmith's Self-Esteem Inventory, and the Beck Depression Inventory. In testing the postpartum depression model, tests of covariance structures for type of delivery (vaginal delivery vs. Cesarean delivery) by LISREL (LInear Structural RELations) indicated that covariance matrices for the two groups were significantly different. Therefore, multi-sample LISREL analysis was used to analyze data from the two groups simultaneously and it demonstrated that the basic model of the two groups fit the data well. In all, 54% of variance in postpartum depression for the vaginal delivery group and 44% of variance in postpartum depression for the Cesarean delivery group was explained. |
8040924 | Relationship between pituitary reserve and efficacy of bromocriptine in women with euprolactinemic ovulatory dysfunction. | To evaluate the relationship between pituitary reserve and efficacy of bromocriptine therapy in patients with euprolactinemic ovulatory dysfunction, the responses of prolactin (PRL) to thyrotropin-releasing hormone (TRH) and luteinizing hormone (LH), follicle-stimulating hormone (FSH) to gonadotropin-releasing hormone (GnRH) provocation in 46 anovulatory patients were compared with 15 normally cycling ovulatory women. After provocation, the patients were treated with bromocriptine 2.5 mg twice a day for two weeks from the day of menstruation or withdrawal bleeding. Within 12 weeks, 29 of 46 (63.0%) patients had resumption of ovulatory menstruation, and 11 of them became pregnant. There were a significantly (P < 0.001) exaggerated responses of PRL to TRH in bromocriptine responders compared to controls and nonresponders. Also, LH responses to GnRH were higher in responders than in controls and nonresponders, although there was no significant differences. However, FSH responses to GnRH were significantly (P < 0.005) lower in bromocriptine nonresponders, as compared with the controls and responders. These results demonstrate that pituitary reserve of PRL and gonadotropin may correlate with the efficacy of bromocriptine and aid to predict the outcome of therapy in patients with euprolactinemic ovulatory dysfunction. |
8040921 | How AA works and why it's important for clinicians to understand. | Alcoholism is associated with tremendous suffering, psychological denial, and physical and emotional debilitation. Much of the suffering that plagues alcoholics is rooted in core problems with self-regulation involving self-governance, feeling life (affects), and self-care. Alcoholics Anonymous is effective because it is a sophisticated group psychology that effectively accesses, corrects, or repairs these core psychological vulnerabilities. The traditions of storytelling, honesty, openness, and willingness to examine ("take inventory") character defects allow people to express themselves who otherwise do not feel or speak and help those who otherwise are deceitful (to self and others) and would deny vulnerability and limitation to openly admit to it. |
8040919 | Understanding and helping the children of problem drinkers: a systems-psychodynamic perspective. | A brief overview of some of the psychological sequelae associated with parental alcohol abuse emphasises the variety of coping mechanisms utilised by children. In order to understand the experience from the child's perspective and assess possible effects on development, a psychodynamic-systems model is introduced. In-depth case material is then presented which attempts to utilise the proposed theoretical integration. The paper concludes with a discussion of some of the possible implications of the psychodynamic-system viewpoint for effective treatment. |
8040918 | The Alcohol Skills Training Program: a group intervention for young adult drinkers. | Development, content, and evaluation of the Alcohol Skills Training Program (ASTP) is described. Patterned after strategies for relapse prevention, the ASTP is a cognitive behavioral approach to the secondary prevention of alcohol problems. Format and context of the six group sessions are detailed, and process considerations are discussed. Results are summarized for two controlled investigations of the ASTP with young adult drinkers. The psychoeducational approach of the ASTP is recommended as an effective means for changing drinking patterns among young adults who are at risk for alcohol-related problems. |
8040916 | Emergency physicians' ratings of alcoholism treaters. | The purpose of this study is to identify treaters whom emergency physicians perceive to offer effective treatment of alcoholism. A random sample of 2,500 emergency physicians received a questionnaire comparing attitudes toward Alcoholics Anonymous (AA) and professional alcoholism treaters. Physician agreement on the efficacy of alcoholism treaters was greatest for AA (87%), moderate for mental health professionals (including psychiatrists and psychologists, 55%) and least for physicians and surgeons (excluding psychiatrists, 23%; chi-square = 1,024, p = .000000005, df = 2). Physician education about other alcoholism treaters may be necessary if all types of treatment are to be considered for the emergency room patient. |
8040915 | Protracted alcohol withdrawal delirium. | Protracted alcohol withdrawal delirium is infrequent, but when it occurs significant morbidity can be anticipated. In this report, a case of protracted alcohol withdrawal delirium is presented. The patient's course was complicated by intracerebral and subdural hemorrhages, sedative-hypnotic drug synergism resulting in respiratory compromise, the failure of benzodiazepines to prevent delirium or shorten its duration, and the onset of Wernicke's encephalopathy. |
8040914 | The disease concept of alcoholism: its impact on women's treatment. | The disease concept of alcoholism has had a dynamic impact on attitudes, policies, and treatment orientations. Despite its demonstrable effects on changing behaviors and belief systems, it remains both an acceptable and controversial entity amongst researchers and treatment personnel alike. This report provides a current focus of the disease concept as its applies to the characteristics and experiences of women alcoholics and their treatment. It especially targets the need for empowerment in this population and questions whether this important trait can be developed by the disease concept's emphasis on illness and the sick role, which inadvertently validates the feelings of powerlessness and helplessness of these women who already have been intensively socialized in dependent and subordinate roles. |
8040913 | Physicians with substance abuse problems and their recovery environment: a survey. | Given the importance of social support to recovering chemically dependent individuals at risk of relapse and the concerns of treaters that professionals may avoid affiliation with 12-step groups, the authors sought to confirm the results of an earlier study in which a sample of recovering physicians in Atlanta identified 12-step programs as their most important source of support. Because the Atlanta cohort might have self-selected to favor 12-step programs, the authors studied a physician group that was more heterogeneous relative to treatment experience. The questionnaire used in the Atlanta study was sent to recovering physicians in Colorado. Like their Atlanta counterparts, many Colorado physicians identified the 12-step programs as more important to their recoveries than treating professionals and family members. Affiliative feelings toward 12-step program members equalled those toward close nonmembers. The 12-step programs provide some, but not all, chemically dependent physicians a source of social support during recovery. |
8040909 | Eikenella corrodens endocarditis in an intravenous drug user: case report and literature review. | A rare case of Eikenella corrodens endocarditis in an intravenous drug user is reported. Repeated blood cultures from the patient established the diagnosis of this infection. However, evaluation of the cardiac function using two-dimensional echocardiography with Doppler flow demonstrated a large pedunculated tricuspid vegetation. Also evident on this study was a dilated right ventricle with diminished contractility and regurgitation. Complete sterilization of the blood was achieved after a 2-week course of intravenous penicillin and gentamicin followed by an additional 4-week course of intravenous penicillin alone. Clinicians treating suspected IV drug users should be aware of the potential pathogenicity of this rare, facultative, anaerobic gram-negative bacillus (E corrodens). A combination of intravenous penicillin and aminoglycoside should be considered as the initial treatment followed by an additional course of intravenous penicillin for such patients with valvular vegetation. |
8040908 | Video-thoracoscopy in the definitive management of a bronchogenic cyst. | Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient who presented with a chronic cough and a right hilar mass. |
8040907 | Microorganisms and psoriasis. | It has been suggested previously that psoriasis is best explained as a distinctive inflammatory response to a variety of microbial stimuli, all acting primarily through activation of the alternative complement pathway. For the past several years we have conducted a "Problem Psoriasis Clinic" based on that premise. Patients are questioned, examined, and subjected to microbiologic laboratory investigations in an attempt to identify possibly relevant microorganisms, and then are treated with antibiotics. This article lists the most commonly found microorganisms in psoriasis patients and describes the usual treatment for each. Results obtained with this approach compare favorably with those achieved with more usual anti-psoriasis treatments. We recommend that a microbiologic investigation and a trial of antimicrobial treatment should precede any plan to treat psoriasis patients with anything more than the simplest topical agents. |
8040905 | Gestational age, birthweight, and neonatal mortality for extremely premature inner-city African-American and Latino infants. | This article analyzes birthweight, gestational age, and inhospital survival for 233 extremely premature infants born at an inner-city hospital over the past 5 years. Results for gestation-specific birthweights and survival did not differ between inner-city Hispanic and African-American infants born at 24 to 28 weeks of gestation. For infants with gestation of 23 to 28 weeks, weight at birth increased by approximately 100 g/week gestation. Survival rates increased from 15% at 23 weeks to 75% by 28 weeks gestation. Survival in this sample was strongly affected by respiratory distress syndrome, air leak, and birthweight. Prenatal steroids administered to the mother had a significant effect on improving survival using univariate analysis and was at the limits of statistical significance using logistic regression. Other maternal, obstetric, and neonatal factors had little or no effects on survival in this group of very immature infants. |
8040904 | Hypertension in pregnancy. | Hypertension, which is the most common complication of pregnancy, is a leading cause of both maternal and perinatal morbidity. Advances in research related to hypertensive disorders in pregnancy have facilitated a better general understanding of the pathophysiologic processes associated with this disease. Strategies of prevention, early diagnosis, and newer treatments have contributed to a more favorable outcome for mothers and their babies. The exact cause of preeclampsia remains elusive; however, recent investigations suggest that endothelial cell injury due to free radical-mediated lipid peroxidation may be the initiator of the pathophysiologic events of preeclampsia. Future challenges in this area should include efforts to elucidate mechanisms involved in free radical cell-mediated vascular disturbances and antioxidant defenses. |
8040903 | Evaluation of the relationship between cocaine and intraventricular hemorrhage. | To evaluate the relationship of cocaine to intraventricular hemorrhage in preterm (< or = 37 weeks gestation) infants, the charts of infants admitted to an intensive care nursery over a 2-year period were reviewed. Data were extracted regarding intrauterine exposure to cocaine, head ultrasonography, and specific independent variables: gestational age, 5-minute Apgar score, and the presence of pneumothorax. These variables were classified into high-, moderate-, and low-risk groups for the development of intraventricular hemorrhage. Analysis was done using chi-square, Mantel-Haentzel tests, crude odds ratio with 95% tests, crude odds ratio with 95% confidence intervals, and stepwise multiple logistic regression analysis. Intraventricular hemorrhage developed in 24 (22%) cocaine-exposed infants versus 49 (20%) nonexposed infants. Thirteen (12%) infants exposed to cocaine developed grades I to II and 11 (10%) developed grades III to IV intraventricular hemorrhage. The figures in the nonexposed infants were 29 (12%) and 20 (8%), respectively. Intraventricular hemorrhage was more likely to occur in infants who belonged to the high-risk groups: gestational age < or = 30 weeks, 5-minute Apgar score < or = 5, and the presence of pneumothorax. Pneumothorax was the single most significant factor associated with intraventricular hemorrhage grades III to IV. Intrauterine exposure to cocaine does not seem to influence the prevalence or severity of intraventricular hemorrhage in the preterm infant. |
8040902 | Intact splenic function in cystic fibrosis. | Patients with cystic fibrosis (CF) suffer from severe chronic pulmonary infections but rarely develop bacteremia/septicemia suggestive of an intact splenic mononuclear phagocyte function. The splenic function of 25 patients diagnosed with CF, aged 2 to 37 years, was evaluated using erythrocyte pit count by direct interference contrast microscopy. Results were compared with patients with sickle cell disease and normal individuals. All CF patients displayed normal splenic function by pit count. The mean percentage of pitted erythrocytes was 0.20 +/- 0.28 (range: 0.0% to 1.0%) versus 0.19 +/- 0.33 (range: 0.0% to 1.4%) in normal eusplenic controls. There were no episodes of bacteremia or septicemia despite recurrent acute exacerbations of chronic bacterial bronchitis and the use of central lines. We conclude that splenic function in CF is unabridged and may account for the rarity of bacteremia/septicemia in patients with CF despite the high prevalence of chronic bronchial infection in this population. |
8040901 | Pattern of childhood pleural disease in Benin City, Nigeria. | Pleural disease is a frequent finding in childhood, occurring with a frequency of 12.8% in all childhood radiographs or 1.48% of all pediatric hospital admissions in the University of Benin Teaching Hospital in Nigeria. Pleural disease was found more frequently in males with a male:female ratio of 1.9:1. Pleural disease also occurred twice as commonly in the right hemithorax. Pleural calcification is uncommon in childhood. There was a seasonal variation in the occurrence of pleural disease with the highest numbers being seen in the month of July, which is the wettest month of the year in Benin. Pyogenic pneumonia and measles-related pneumonia remain the more frequent causes of pleural disease in childhood. |
8040900 | Three open-label studies of oral interferon alpha in the treatment of HIV disease. | Three open-label studies were conducted in which natural human interferon-alpha (nHuIFN-alpha) was given orally to human immunodeficiency virus (HIV)-infected patients at a daily dosage of 150 IU for 12 months in an attempt to assess the effects of this treatment on their CD4+ cell counts. In the first study, 110 patients received nHuIFN-alpha, and 142 patients received nHuIFN-alpha and azidothymidine (AZT). At 12 months, patients given nHuIFN-alpha alone had a mean increase of 14% in their CD4+ counts, although the mean increase in absolute CD4+ count was similar between the groups. Blacks in this study were more likely to experience an increase in CD4+ count than other ethnic groups (P < 0.001). In the second study, 40 black, male homosexuals with CD4+ count between 350 and 500/mm3 were enrolled in groups of 10 to receive either nHuIFN-alpha or AZT, or both nHuIFN-alpha and AZT, or nothing (untreated controls). At 12 months, the mean CD4+ counts of the patients in the group given nHuIFN-alpha alone were significantly higher than the mean CD4+ counts in both the group given AZT alone and the untreated controls (P < 0.01). In the third study, 38 patients with CD4+ cell counts > 700/mm3 were enrolled in groups of 19, matched by gender and ethnic group, to receive nHuIFN-alpha or nothing (untreated controls). Patients given nHuIFN-alpha experienced a mean increase of 12% in their CD4+ counts by the end of the 12-month study.(ABSTRACT TRUNCATED AT 250 WORDS) |
8040892 | Topoisomerase II inhibition and cytotoxicity of the anthrapyrazoles DuP 937 and DuP 941 (Losoxantrone) in the National Cancer Institute preclinical antitumor drug discovery screen. | The cumulative cardiotoxicity of anthracyclines is thought to result from the generation of free radicals. New DNA topoisomerase II inhibitors less prone to redox reactions, such as mitoxantrone and more recently the anthrapyrazoles, were developed to circumvent this toxicity. Two anthrapyrazoles currently in clinical evaluation, DuP 941 (Losoxantrone) and DuP 937, were compared to other topoisomerase II inhibitors with respect to their cytotoxic potency and selectivity and with respect to topoisomerase II inhibition. Cytotoxicity was tested in the 60 cell lines of the National Cancer Institute preclinical antitumor drug discovery screen (NCI screen). The potency of anthrapyrazoles to inhibit purified topoisomerase II was determined. The specificity of drug-induced topoisomerase II pattern of cleavage, one of the cellular determinants of cytotoxicity, was investigated in human c-myc DNA. Using the COMPARE analysis, we found that the most closely related cytotoxic profiles in the NCI screen were between the anthrapyrazoles and mitoxantrone. Among topoisomerase II inhibitors, the cytostatic potency was by decreasing order: mitoxantrone; doxorubicin, which was slightly greater than DuP 941, azatoxin; DuP 937; and amsacrine, which was much greater than VP-16. The potency of mitoxantrone and anthrapyrazoles to generate DNA double-strand breaks, by induction of the topoisomerase II cleavable complexes in nuclear extracts, was in agreement with cytotoxicity. Sequencing of drug-induced topoisomerase II cleavages in c-myc DNA showed a common cleavage pattern for anthrapyrazoles and mitoxantrone. This pattern was different from the patterns obtained with other topoisomerase II inhibitors. At the molecular and cellular levels, anthrapyrazoles are potent topoisomerase II inhibitors closely related to mitoxantrone. These results validate the COMPARE analysis using the NCI screen to predict molecular mechanisms of drug action. Anthrapyrazoles, which are unlikely to produce free radicals, might be useful in the same indications as mitoxantrone, especially for patients with cardiac risks, for pediatric patients, and for patients treated with intensified protocols. |
8040890 | Chronic active hepatitis and associated liver tumors in mice caused by a persistent bacterial infection with a novel Helicobacter species. | In the autumn of 1992, a novel form of chronic, active hepatitis of unknown etiology was discovered in mice at the National Cancer Institute-Frederick Cancer Research and Development Center (NCI-FCRDC), Frederick, Md. A high incidence of hepatocellular tumors occurred in affected animals. The disease entity was originally identified in A/JCr mice that were untreated controls in a long-term toxicologic study. Our original purpose was to determine the origin and etiology of the chronic hepatitis and to quantify its association with hepatocellular tumors in mice of low liver tumor incidence strains. After a helical microorganism was discovered in hepatic parenchyma of diseased mice, we undertook characterization of the organism and investigation of its relationship to the disease process. Hepatic histopathology of many strains of mice and rats, as well as guinea pigs and Syrian hamsters, in our research and animal production facilities was reviewed. Steiner's modification of the Warthin-Starry stain and transmission electron microscopy were used to identify bacteria in the liver. We transmitted the hepatitis with liver suspensions from affected mice and by inoculation with bacterial cultures. Bacteria were cultivated on blood agar plates maintained under anaerobic or microaerophilic conditions and characterized morphologically, biochemically, and by 16S rRNA sequence. We report here the isolation of a new species of Helicobacter (provisionally designated Helicobacter hepaticus sp. nov.) that selectively and persistently colonizes the hepatic bile canaliculi of mice (and possibly the intrahepatic biliary system and large bowel), causing a morphologically distinctive pattern of chronic, active hepatitis and associated with a high incidence of hepatocellular neoplasms in infected animals. The novel Helicobacter is a likely candidate for the etiology of hepatocellular tumors in our mice. The Helicobacter-associated chronic active hepatitis represents a new model to study mechanisms of carcinogenesis by this genus of bacteria. Adenocarcinoma of the stomach, the second most prevalent of all human malignancies world-wide, is associated with infection at an early age with Helicobacter pylori. Infection leads to several distinctive forms of gastritis, including chronic atrophic gastritis, which is a precursor of adenocarcinoma. H. hepaticus infection in mice constitutes the only other parallel association between a persistent bacterial infection and tumor development known to exist naturally. Study of the H. hepaticus syndrome of chronic active hepatitis and liver tumors in mice may yield insights into the role of H. pylori in human stomach cancer and gastric lymphoma. |
8040891 | Complete regression of human neuroblastoma xenografts in athymic mice after local Newcastle disease virus therapy. | Neuroblastoma is the most common pediatric extra-cranial solid cancer. Using conventional therapies, children older than 1 year of age with advanced neuroblastoma have a poor prognosis. The development of new approaches for treating such children with neuroblastoma continues to be one of the most important goals today in pediatric oncology. Despite numerous anecdotal reports of human tumor regression during viral infections, the use of viruses to directly lyse neuroblastoma cells has never been reported as a potential therapy. Newcastle disease virus (NDV) has been shown to replicate in and kill cultured human and rat neuroblastoma cells but not normal human fibroblasts. Our purpose was to determine if this selective killing of human neuroblastoma (IMR-32) cells is maintained during the in vivo treatment of established tumors. Two experiments were performed using NDV strain 73-T. Athymic mice with subcutaneous IMR-32 human neuroblastoma xenografts (6-12 mm) were treated intralesionally with live NDV, UV-inactivated NDV, or phosphate-buffered saline (PBS). To study virus replication in situ, mice were given intratumoral or intramuscular injections of NDV. These mice were then killed at various times, and the amount of infectious virus present in tumor or muscle was determined. After one injection of live NDV, 17 of 18 tumors regressed completely, whereas rapid tumor growth occurred in all 18 mice treated with PBS and in all nine mice treated with UV-inactivated NDV (P < .0001). The one tumor that showed only a partial response to a single injection regressed completely after a second NDV treatment. Six months following virus-induced regression, only one tumor had recurred. No significant acute or chronic side effects of live NDV were noted in athymic mice given doses up to 500 times that used in this study. Virus levels increased more than 80-fold between 5 and 24 hours in virus-injected tumors (P < .04), while no infectious virus was produced in NDV-injected muscle tissue. NDV 73-T appears to replicate selectively in human IMR-32 neuroblastoma xenografts, leading directly to a potent antitumor effect as demonstrated by long-lasting, complete tumor regression occurring after a single local injection of virus. These experiments may provide an important step in the development of new therapeutic approaches to challenging cancers such as neuroblastoma. |
8040889 | Microsatellite instability in sporadic endometrial carcinoma. | Recent studies have demonstrated ubiquitous somatic microsatellite mutations in some cancers of the colon, endometrium, stomach, and pancreas. Our purpose was to characterize the frequency and nature of this replication error (RER) or mutator phenotype in sporadic endometrial carcinoma. Formalin-fixed, paraffin-embedded normal and tumor tissues from 45 patients with sporadic endometrial cancer were screened for the RER phenotype at three microsatellite loci. To further characterize when these alterations were acquired relative to clonal expansion, the sizes of the altered microsatellites in different tumor and normal regions were determined using selective UV radiation fractionation. Approximately 150-300 histologically defined cells on stained tissue sections were covered with small ink dots, and UV irradiation was used to destroy the DNA of cells not covered by ink. Undamaged DNA from seven to 25 spots per section were extracted, then analyzed at the Mfd27, Mfd41, and Mfd47 microsatellite loci and also at the c-K-ras gene locus with individual polymerase chain reactions. Radioactively labeled amplified DNAs were analyzed by electrophoresis and autoradiography. Fisher's exact test and the logrank test were used for statistical analysis. The RER positive (RER+) phenotype was detected in nine (20%) of 45 sporadic endometrial carcinomas. The topographic tissue distributions of the altered microsatellites revealed clues to their pathogenesis. The RER+ phenotype was homogeneously present in the primary tumors and their metastases and was absent from adjacent normal and hyperplastic endometrium. The altered microsatellites were predominantly the same sizes throughout five tumors but demonstrated greater intratumor heterogeneity in three tumors. In one case, the primary tumor was stable but its metastasis was unstable. Mutant c-K-ras alleles were significantly more frequent in RER+ (56%) than in RER negative (RER-) (14%) tumors (P = .0165) and appeared to be acquired after the RER+ phenotype in one tumor. There were no significant clinical differences between the RER+ and RER- tumors. The RER+ phenotype is frequently present in sporadic endometrial cancers and is expressed before and during clonal expansion. The underlying mutator mutations are probably heterogeneous, since the RER+ phenotypes were diverse. The absence of altered microsatellites in adjacent normal endometrium demonstrates that the expression of the RER+ phenotype is limited to neoplastic tissue. The bulk of the microsatellite alterations appeared to be acquired prior to clonal expansion, suggesting that expression of the underlying genomic instability contributes to, and is not a consequence of, transformation. |
8040888 | Selective destruction of gliomas in immunocompetent rats by thymidine kinase-defective herpes simplex virus type 1. | Thymidine kinase-deficient herpes simplex virus type 1 [tk(-) HSV-1] replicates well in dividing cells but not in nondividing cells such as neurons, suggesting a potential use in the treatment of brain tumors. We attempted to examine the efficacy of using tk(-) HSV-1 for treating brain tumors in immunocompetent animals. 9L glioma cells were cultured and subsequently implanted intracerebrally in immunocompetent, adult male Long-Evans rats. A thymidine kinase-defective HSV-1 virus, KOS-SB, was used to infect 9L cells in culture, and the viability of the infected cells was compared with that of mock-infected (i.e., uninfected) cells. We also injected the virus intratumorally and determined the mortality of the tumor-bearing animals. Tumor regression and viral spread following virus injection were examined by histologic and immunocytochemical assays. In vitro, the tk(-) virus destroyed cultured 9L cell monolayers at multiplicities of infection of 0.1 and 1.0 within 48 hours. With the same quantity of virus, no remarkable difference in survival of neural cells was found. Foscarnet, an antiviral drug that acts independently of tk activity, blocked viral replication by greater than 99% at a concentration of 100 micrograms/mL. The mortality of animals bearing tumors declined with an increase in the amount of virus injected. Histologic examination showed that the HSV-1 treatment caused severe tumor regression. Immunocytochemistry using an anti-HSV-1 antibody revealed only a weak staining within the regressing tumors, and few immunopositive neurons were evident in the surrounding brain tissue. The results indicate that tk(-) HSV-1 mutants can selectively and effectively destroy glioma cells both in vitro and in vivo in normal, immunocompetent animals. Our failure to detect viral spread associated with regressing tumors suggests that some other cytopathic factors might be involved in the tumor regression. Regardless of the precise mode of tumor cell killing, HSV-1 may be useful for treating brain tumors. |
8040887 | Statutory requirements for disclosure of breast cancer treatment alternatives. | Therapeutic options for breast cancer, particularly for early-stage disease, and increased patient participation in medical decision-making have oriented state legislatures toward ensuring that women with breast cancer have adequate information about treatment alternatives. Currently, 18 states have enacted statutes regarding physician disclosure of treatment alternatives to breast cancer patients. This paper reviews these statutes in the context of the requirements imposed on the physician as health care provider and the content of medical information presented to the patient as a consequence of the laws. State statutes were identified through the National Cancer Institute's State Cancer Legislative Database, and the statutory requirements were analyzed. For statutes requiring development of a written summary of treatment alternatives, the most recent summary was obtained through the responsible state agency, and informational content was analyzed for relevance to treatment decisions in early-stage disease. As a group, these laws address informed consent for treatment, physician behavior within the patient-physician relationship, and the medical information upon which treatment decisions are based. Individual statutes vary in the scope of the issues addressed, particularly in the responsibility placed on physicians, and treatment option summaries developed in response to this legislation vary widely in content and scope. Despite broad implications of these statutes in oncology practice, little is known about their effects on breast cancer care. Additional research is needed to define the impact of these statutes on breast cancer care, as such legislation is considered by other states for this and other diseases. |
8040886 | New avenues of translational research in leukemia and lymphoma: outgrowth of a Leukemia Society of America-National Cancer Institute workshop. | The workshop was organized on the premise that truly innovative approaches are needed if we are to significantly change the clinical outcomes for leukemias and lymphomas. Several new concepts and pioneering approaches surfaced during the workshop discussions, as summarized above. The design and implementation of translational clinical trials that emphasize these innovative strategies were encouraged as a way to test the concepts put forward at the workshop. Representatives of the Leukemia Society of America and the National Cancer Institute plan to continue their dialogue to develop recommendations regarding the priorities for linked clinical-laboratory investigations on the hematopoietic malignancies and the optimal ways in which to foster such translational research. To this end, the explosion in basic science discoveries during the last two decades and especially during the last 5 years is producing a critical mass of knowledge. This knowledge, in turn, allows us to view leukemia from new perspectives that span molecular pathogenesis, epidemiology, early detection of minimal disease, and the selective targeting of critical leukemogenic mechanisms for therapeutic and ultimately preventive purposes. As in previous decades, during which leukemia has served as the testing ground for precedent-setting concepts of curative therapy (dose-intensity, non-cross-resistance-inducing combinations and aggressive therapy in the minimal residual disease state), leukemia should again serve as a clinical beacon for the identification and exploitation of new molecular targets for therapy. Any impact on curability and duration and quality of survival will be achieved only by building on the cumulative knowledge accrued at multiple levels--molecular and cellular levels as well as in the intact patient--and augmenting the momentum of the bidirectional exchange of information between the laboratory and the clinic that has characterized leukemia research from its incipience. The challenge is formidable and worthy of our most creative and concerted efforts. |
8040853 | Maternal transposition of the great arteries in pregnancy. A case report. | We present a rare case of successful pregnancy completion in a patient with D transposition of the great arteries corrected by the Mustard procedure. Cardiac performance during pregnancy was followed by echocardiography. |
8040852 | Chorioamnionitis and appendiceal abscess. A case report. | A rare case occurred of chorioamnionitis complicating a smoldering periappendiceal abscess. Neonatal death and maternal morbidity occurred. Direct spread of infection from the abscess to the fetal membranes is hypothesized. |
8040851 | Left ovarian cyst and right streak ovary in a neonate with a normal karyotype. Report of a case of neonatal Slotnick-Goldfarb syndrome or recessive gonadal dysgenesis. | A female neonate with a streak ovary on one side and huge ovarian cyst on the other side is presented. Her karyotype was 46,XX. Adnexectomy was mandatory, leaving the patient with a single streak gonad. Whether this infant has the recessive form of gonadal dysgenesis with one ovary, streak or hypoplastic, replaced by a cyst or the Slotnick-Goldfarb syndrome is impossible to elucidate at present. The potential implications of a streak gonad, either related to gonadal dysgenesis or as a possible source of neoplasia, are reviewed. Current approaches to an ovarian cyst and streak ovary in the neonatal period are discussed. |
8040850 | Acyclovir for disseminated herpes simplex virus in pregnancy. A case report. | Seventeen cases of disseminated herpes simplex virus (HSV) infection have occurred during pregnancy. Acyclovir therapy was associated with prolongation of the time from admission until spontaneous rupture of the membranes or delivery and an improved maternal outcome. This life-threatening condition has a typical presentation, which includes a nonspecific viral prodrome. During pregnancy, fever and anicteric hepatitis unresponsive to empiric antibiotics should prompt an evaluation for disseminated herpes simplex. Pharyngitis or skin lesions with a positive herpes simplex culture are common, specific signs associated with dissemination. The fever resolves within 48 hours in response to acyclovir therapy. One case of maternal disseminated HSV occurred at 22 weeks' gestation and resolved with acyclovir therapy; a healthy neonate was delivered vaginally at term. |
8040849 | Cervical cytology with the Papette sampler. | The most reliable cervical smears for the detection of cervical cancer and its precursors are those which contain cells from the transformation zone and endocervical canal. To verify that these regions have been sampled, the cytologist must recognize either endocervical cells or immature squamous metaplastic cells on the smears. We performed an open clinical trial with a new device, the Papette, which simultaneously samples both the exocervix and endocervix. The overall cytologic quality of the smears and the device's acceptability to physicians were assessed in 1,000 women seen consecutively. The smears were compared with those collected from 1,000 women immediately after the trial using the Ayre spatula-Zelsmyr Cytobrush technique. Both the Papette and the spatula-Cytobrush obtained satisfactory smears in 91.4% and 96.0% of cases, respectively. Cell transfer onto glass slides was easier and bleeding observed less frequently with the Papette than with the spatula-Cytobrush, but the latter was more suitable for patients with a retroflexed uterus and narrow external os. Overall, the Papette harvested high-quality cellular samples and may be an option for cervical cytology. |
8040848 | Histopathologic adequacy of office endometrial biopsies taken with the Z-sampler and Novak curette in premenopausal and postmenopausal women. | This study compared the adequacy of office endometrial biopsies taken with the Novak curette and a disposable, flexible polypropylene biopsy device, the Z-sampler, in premenopausal and postmenopausal women. Between September 1988 and November 1991, 407 women had paired office endometrial biopsies with the Z-sampler followed by the Novak curette. Overall, 83.0% of endometrial biopsies obtained with the Z-sampler were adequate for histopathologic diagnosis as compared to 84.5% obtained with the Novak curette (P = .53). In 181 (44.5%) premenopausal women, 94.5% of Z-sampler biopsies were adequate as compared to 95.6% of Novak curette biopsies (P = .80). In 226 (55.6%) post-menopausal women, 73.9% of Z-sampler biopsies were adequate as compared to 75.7% of Novak curette biopsies (P = .66). The Z-sampler biopsies were adequate in 94.5% of premenopausal women as compared to 73.9% of postmenopausal women (P < .0001). The Novak curette biopsies were adequate in 95.6% of premenopausal women as compared to 75.7% of post-menopausal women (P < .001). While we did not demonstrate a significant difference in the adequacy of endometrial samples taken with the Z-sampler and Novak curette in premenopausal and postmenopausal women, postmenopausal women had a significantly lower rate of adequate samples obtained with either device as compared to premenopausal women. |
8040847 | Pregnancy outcome after hydatidiform mole, initial and recurrent. | Pregnancy outcome after complete and partial hydatidiform mole was evaluated in 170 patients. Of the 170 patients, 143 became pregnant a total of 250 times. Patients with incomplete hydatidiform mole had 232 subsequent pregnancies that resulted in 169 (72.8%) term deliveries, 30 (12.9%) spontaneous abortions, 7 (3.0%) induced abortions, 6 (2.6%) stillbirths, 13 (5.6%) preterm deliveries, 6 (2.6%) recurrent moles and one (0.4%) ectopic pregnancy. Of the subsequent pregnancies in patients with partial hydatidiform mole, full-term delivery, spontaneous abortion and recurrent mole occurred in 10 (55.6%), 5 (27.8%) and 3 (16.7%) of the patients, respectively. Among the 9 patients with recurrent hydatidiform mole, viable term pregnancy was achieved in 4. Even patients with recurrent hydatidiform mole can be assured that they can have a normal subsequent pregnancy. |
8040846 | Antibiotic regimens for treating acute pelvic inflammatory disease. An evaluation. | A statistical analysis of 58 reports involving 101 clinical trials and over 4,000 patients revealed that there was no statistically significant difference in the cure rates between single-agent and combination therapy. Also, there was no difference in the cure rates between antibiotic regimens that cover Chlamydia trachomatis and those that do not. However, there was a difference in cure rates when regimens with good antianaerobe activity were compared to those with poor coverage of anaerobes. There was a statistically significantly higher cure rate when "newer" regimens (mainly the second and third generations of cephalosporins and newer penicillins) were compared to "older" regimens (mainly penicillin and tetracycline). In 91 comparisons there were no statistically significant differences between regimens with a > 90% cure rate. Optimum therapy is discussed in terms of the cure rate, coverage of known pathogens and antibiotic toxicity. The original and revised recommendations of the Centers for Disease Control for the treatment of acute pelvic inflammatory disease are also reviewed. |
8040845 | Obstetric and gynecologic dysfunction in the Ehlers-Danlos syndrome. | Women members of the newly formed Ehlers-Danlos National Foundation (EDNF) were surveyed with a very detailed questionnaire with 50 questions concerning family history and inheritance, past medical history, and obstetric and gynecologic problems. They entailed the largest extant database on Ehlers-Danlos Syndrome (EDS) patients. The mean age of the 68 women who responded to the survey was 42 years; most had EDS types I, III, IV and unknown. Forty-three women had 138 pregnancies; 13 women never married. The stillbirth rate was 3.15% (3/95); the preterm delivery rate was 23.1% (22/95), and the spontaneous abortion rate was 28.9% (40/138). There was a cesarean delivery rate of 8.4%, with 14.7% having perinatal bleeding problems. One woman (EDS type IV) had congestive heart failure. Common gynecologic problems were recurrent anovulation (41.3%), recurrent vaginal infections (53%), abnormal cytologic smears (19%), sexual dysfunction (61%), irregular menses (28%), endometriosis (15.8%), vaginal dryness (25%) and a need for hysterectomy (19.1%). In this largest series of pregnancies with EDS, we found relatively high rates of abortion, preterm delivery, pregnancy-related bleeding and stillbirth. Women with EDS also seem to have high frequency of anovulation, vaginal infections, abnormal cytologic smears and dyspareunia. |
8040844 | The placenta as the third brain. | The placenta has enormous genetic endowments, comparable to those of the brain and ovary. The molecular, cellular and vascular arrangements are designed for directing the traffic of biochemical and nutritional flow preferentially to the fetus. The architect and landscape of this powerful organ, with a predetermined life span of 40 weeks, serves as a modulator between compartments via local, nearby and long-distance communications through its hormonal signals. Thus, the placenta may be viewed as the third brain, which links the developed (maternal) and developing (fetal) brains. |
8040843 | Role of endogenous estrogen in the hirsutism paradigm. | The study of women with androgen excess as a biologic experiment in nature may improve our understanding of hormonal determinants of cardiovascular risk. These women, who have androgen and estrogen excess, also have altered apolipoprotein metabolism, which correlates with insulin resistance. They often have android obesity, which appears to aggravate their metabolic alterations. Insulin resistance seems to have more of an influence on altered apolipoprotein metabolism than does endogenous ovarian androgen or estrogen, at least in hirsute women who are obese. It is hypothesized that adrenal dehydroepiandrosterone sulfate may modify the effects of insulin resistance, as reflected in androgen and apolipoprotein lipid metabolism. These hormonal interactive influences, which require further investigation, may hold clues to why men and women differ in the time of onset of the multifactorial problem of coronary vascular disease. |
8040842 | Obstetrically important lesions of the umbilical cord. | Many pathologic features of the umbilical cord affect fetal well-being adversely. Excessively long or short umbilical cords may be the cause of hematomas and thrombosis of cord vessels and the placental surface, thus causing fetal death and/or thrombocytopenia. In other cases, fetal hypoxia and central nervous system damage are possible outcomes. Thrombosis is also frequently induced by velamentous insertion of the cord, as are hemorrhages when the membranous vessels rupture during parturition. Entangling and knotting of the cord, especially of excessively long cords, may lead to similar lesions and fetal death. It was recognized recently that prolonged meconium exposure to the surface of the cord can cause partial necrosis of umbilical vessels and cord ulceration. The noxious moiety of meconium also causes contraction of the umbilical vessels, leading to fetal hypoperfusion and hypoxia. A stricture at the fetal end of the cord and excessive spiralling of a very long umbilical cord are often present in cases of unexplained fetal demise, especially in early pregnancy. Less common abnormalities are obstruction of the circulation by amnionic bands and varices. |
8040841 | Brain aromatization of androgens. | Although the observation that the brain can form estrogens from androgens was made nearly 25 years ago, the details and implications of this autocrine/paracrine neuroendocrine system are still being discovered. The presence in the brain of the enzyme estrogen synthetase (aromatase) has been documented by biochemical, molecular biologic and morphologic techniques. The system has been shown to be autoregulating--i.e., brain aromatase is induced by the same androgens that it uses as the substrate for the formation of estrogens. Aromatase was first found in the hypothalamus and associated with reproductive neuroendocrine development (the aromatase hypothesis of brain sexual differentiation); however, recent immunohistochemical studies have indicated that aromatase is more widely spread throughout the brain. There apparently are two, separable brain aromatase systems in mammals, a gonad-sensitive hypothalamic system and a gonad-insensitive limbic system. These systems appear during prenatal development and are also found in adults. The aromatase is distributed throughout the neuron, including projective fibers: axons, boutons and synaptic vesicles. Thus, additional actions of locally formed estrogen in these areas of the brain and beyond are likely to be found in the near future. |
8040840 | Insulinlike growth factors. Their regulation of glucose and amino acid transport in placental trophoblasts isolated from first-trimester chorionic villi. | The transport of glucose and amino acids from the maternal to fetal circulation through the placenta is critical to the delivery of fuel for normal fetal growth and development. Little information indicates that transplacental glucose or amino acid transport is influenced by hormones or polypeptide growth factors. We developed a continuous cell line of cytotrophoblastlike cells derived from first-trimester human chorionic villi as a model system to study the regulation of glucose and amino acid transport by insulinlike growth factors (IGFs). Using immunocytochemical and biochemical criteria, the cells were shown to manifest a trophoblastlike phenotype. The cells were maintained in serum-supplemented medium until confluent, at which time they were shifted to serum-free medium for one day. Experiments were initiated by transferring the cells to glucose-free assay buffer and incubating them with IGF-I, IGF-II or insulin. Glucose uptake was measured by the transport of 2-deoxy-D-[1,2-3H]glucose (2[3H]DG) in the presence or absence of cytochalasin B, which has been shown to competitively inhibit glucose uptake. IGF-I, IGF-II and insulin each enhanced 2[3H]DG transport in a dose-dependent fashion. Amino acid transport was measured by incubation of the cells with IGF-I for 60 minutes, followed by a 5-minute challenge with alpha-[methyl-3H]aminoisobutyric acid. IGF-I caused a dose-dependent increase in uptake of the amino acid analog. Radioreceptor assays using [125I]insulinlike growth factor I ([125I]IGF-I) demonstrated that the trophoblast-derived cells contained high-affinity, saturable receptors for IGF-I that also bound IGF-II.(ABSTRACT TRUNCATED AT 250 WORDS) |
8040839 | Molecular and biologic factors in the pathogenesis of ovarian cancer. | The development and progression of epithelial ovarian cancer can be correlated with various biologic and molecular factors. Tumor growth has been associated with aberrant and dysfunctional expression and mutation of various genes. These genetic defects include oncogene overexpression, amplification or mutation, aberrant tumor suppressor gene expression or mutation, and the inappropriate expression of cytokines and growth factors and/or the cellular receptors for these molecules. Dysregulation of host immune responses may also play a permissive role in the pathogenesis of the disease. Since ovarian cancer has been associated with the frequency of ovulation, the repeated proliferation of epithelial cells may increase the chance of a genetic accident that could contribute to the activation of an oncogene or inactivation of a suppressor gene. These events, combined with the inherent ability of ovarian epithelial cells to respond to and produce various cytokines and growth factors, could promote oncogenesis. |
8040838 | Immunocytochemical localization of nonluteal ovarian relaxin. | Relaxin has been demonstrated to be produced by the corpus luteum of the menstrual cycle and pregnancy and is also produced by the endometrium and decidua, although these nonluteal sources may not contribute to circulating relaxin concentrations. The reports of luteal production of relaxin have failed to consider nonluteal ovarian sources. To look for sources of nonluteal ovarian relaxin, human ovaries were collected from patients who underwent removal of the ovary for a variety of reasons. Tissues were fixed in formalin and embedded in paraffin. Two monoclonal antibodies were used for immunocytochemical staining, one directed against human relaxin and the other against the C peptide of prorelaxin. In addition to the expected staining of corpora lutea, the luteinized theca interna but not granulosa of developing follicles from ovaries with an active corpus luteum of the cycle also stained positive for both relaxin and prorelaxin. Ovaries from term pregnant women with luteinized theca also demonstrated staining for relaxin and prorelaxin. In addition to luteal and thecal cell staining, small clusters of pseudodecidual cells in the periphery of the ovary stained positive for relaxin and prorelaxin. These data indicate that the ovary contains theca interna-derived structural elements in addition to the corpus luteum that produce relaxin when a corpus luteum is active, while granulosa-derived elements do not. This suggests that luteal production of relaxin is from theca-derived elements and may explain instances of independent relaxin and progesterone secretion. |
8040837 | Production of interleukin-6 and interleukin-8 by human mammary gland epithelial cells. | The production of transforming growth factor-beta 2 (TGF-beta 2), interleukin-1 beta (IL-1 beta), IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) by spontaneously immortalized human mammary gland epithelial cells of non-malignant origin and the effect of prolactin upon the production of those cytokines were investigated. Cells were cultured on plastic with epithelial growth factor, insulin, and hydrocortisone. Cytokines were quantified by enzyme-immunoassays. The cells produced IL-6 and IL-8, but no detectable TGF-beta 2, IL-1 beta, or TNF-alpha. Although prolactin enhanced the uptake of [3H]thymidine, it did not alter the production of cytokines/interleukins. Because of the marked production of IL-8 by mammary epithelium and a past report of TGF activity in human milk, those agents were quantified in human milk. The mean +/- S.D. concentrations of IL-8 and TGF-beta 2 in human milk obtained in the first 3 days of lactation were 3684 +/- 2910 and 130 +/- 108 pg/ml, respectively. Thus, IL-8 and TGF-beta 2 are normal constituents in human milk, and human mammary gland epithelium may be responsible for producing some of the IL-6 and IL-8 in human milk. |
8040836 | GM-CSF and CSF-1 stimulate DNA synthesis but not cell proliferation in short-term cultures of mid-gestation murine trophoblast. | Short-term cultures of purified murine trophoblast were used to investigate the potential trophic effects of a number of cytokines. Both granulocyte-macrophage colony stimulating factor (GM-CSF) and colony stimulating factor-1 (CSF-1) increased [3H]thymidine (TdR) uptake (3-8 times control values) by trophoblast harvested from placentae on day 12 or 14 of pregnancy. In contrast, interleukin-3 (IL-3) had only a mild stimulatory effect ([3H]TdR uptake 1.5 times control), and IL-2 did not alter the level of DNA synthesis in these cells. Immunocytochemical analysis confirmed that the cells engaged in DNA synthesis were cytokeratin-positive trophoblast cells and revealed that these cells predominantly bore markers (alkaline phosphatase, transferrin receptors) characteristic of trophoblast cells from the placental labyrinth. The increased DNA synthesis observed after exposure to GM-CSF or CSF-1 was not associated with a change in the proportion of nuclei involved in synthesis, nor did it result in significantly increased trophoblast cell numbers in the cultures. These findings suggest that DNA-synthesizing trophoblast cells were not proliferating, but were more likely engaged in endoreduplicative cycles leading to the formation of terminally differentiated trophoblast giant cells. These results caution against the presumption of proliferation when measuring [3H]thymidine incorporation by placental or trophoblast cells in standard in vitro cultures. In addition, taken together with the reports of high levels of CSF-1 in the pregnant uterus and the expression of the CSF-1 receptor on placental trophoblast cells, they suggest that the hemopoietic cytokines may play a role in the differentiation and/or function of trophoblast cells in the developing murine placenta. |
8040835 | The immunosuppressive contribution of prostaglandin components of human semen and their ability to elevate cyclic adenosine monophosphate levels in peripheral blood mononuclear cells. | We have compared the ability of fractions from seminal plasma to suppress lymphocyte proliferation and examined the effects of these fractions in raising intracellular cyclic adenosine monophosphate (cAMP) in the same preparations of peripheral blood mononuclear cells. Human seminal plasma is very effective at raising cAMP but seminal plasma stripped by C-18 reverse phase columns is inactive. Both prostaglandin E (PGE) and 19-hydroxy PGE contribute to the elevation of cAMP and a combination of these two prostaglandins is as effective as whole seminal plasma in raising cAMP but not as effective in inhibiting lymphoproliferation. These results suggest that human seminal plasma prostaglandins act through the EP2 receptor to inhibit T cell and NK cell function and thus attenuate both the cellular and humoral actions of the female's immune system. |
8040834 | Evaluation of the role of exogenous pathogens on the incidence of embryo loss during early pregnancy in mice. | The mating of CBA/j female mice (H2k) by DBA/2j male mice (H2d) typically results in an elevated incidence of spontaneous embryo loss thus providing an ideal genetically controlled laboratory model for the study of the factors causing early embryo loss during pregnancy. There is now considerable data on the cells and factors involved in fetal resorption but little is known about the events which activate this process. While the activation of the maternal response to the fetal implant could have endogenous or genetic origins, a role for exogenous factors including microbial pathogens could also be involved. In order to investigate these possibilities, the reproductive success of CBA/j female x DBA/2j male matings in a conventional animal care facility were compared with matings in a specific pathogen free (SPF) animal facility. All animals housed under these conditions were routinely screened by immunoassay and culture, for the presence of a number of viral and bacterial pathogens of mice. The incidence of spontaneous embryo loss in specific pathogen free CBA female mice mated by DBA and other male strains was found to be virtually identical to that of CBA female mice infected with multiple viral pathogens and housed under otherwise identical conditions (non-SPF). However, the numbers of implantation per pregnancy was significantly greater in an SPF facility. Therefore, exposure of mating mice to exogenous viral and bacterial pathogens did not appear to alter the overall incidence of spontaneous embryo resorption. It was concluded that the immunomodulatory effects of infection by common murine pathogens neither augmented nor reduced post-implantation embryo losses. |
8040833 | Granulated metrial gland cells--not part of the natural killer cell lineage? | The relationship of rodent granulated metrial gland (GMG) cells to the natural killer (NK) cell lineage is reviewed. The antigenic profile of GMG cells provides insufficient evidence to indicate that these cells form part of the NK cell lineage. No good evidence is found that GMG cells are cytotoxic to the NK cytotoxicity target, Yac-1. In Beige mice, which have a defect in the lytic pathway of NK cells, GMG cells were found to kill labyrinthine cytotrophoblast. It is concluded that GMG cells are not a type of NK cell but a novel member of the leucocyte population. |
8040831 | A quick method for boxing complete denture elastomeric impressions. | Rubber base impressions must be poured immediately for maximum accuracy. A method of boxing is presented that uses a previously formed thermoplastic box for pouring the complete denture rubber base impressions in a few minutes. |
8040830 | Restoration of inadequate occlusal face height by using resin bonded to etched metal removable prosthesis. | The resin bonded to etched metal casting of a removable partial denture was used anteriorly in combination with posterior acrylic resin teeth to restore patients with mandibular overclosure. The procedure is simple, esthetic, conservative, inexpensive, and not time-consuming. Patients maintained their new occlusal facial height with normal functional activity. The remaining natural teeth showed no signs of changes in 6 months in either opposing tooth structure or the periodontium. |
8040829 | A full-arch interocclusal impression tray to eliminate lack of coverage and tendency to distort. | This article discusses a metal full-arch interocclusal impression tray. It uses a separation insert that extends into a split handle. Portions of the tray may be used to record sections of an arch singly or in combination from quadrant to full arch. A combination of different materials may be used, selected for low-cost properties that work compatibly side-by-side and/or back-to-back. The tray can be modified by the addition of a mounting stud to the tray handle, which permits linking it to a face-bow to facilitate axis mounting. |
8040828 | The effects of sterilization on addition silicone impressions in custom and stock metal trays. | Five groups of addition silicone impressions (four made in custom autopolymerizing acrylic resin trays and one in stock metal rim-lock trays) were made of a stainless-steel master die. The first group (control group) was not sterilized. The second group was sterilized in an ethylene oxide gas autoclave, the third group in a steam autoclave, and the fourth and fifth groups by immersion for 12 hours in 2% glutaraldehyde. Casts made from each sterilization group were found to be significantly different from control impressions by multivariate analysis of variance and should not be used to fabricate prostheses. |
8040827 | Leaching and cytotoxicity of formaldehyde and methyl methacrylate from acrylic resin denture base materials. | Acrylic resin dentures have the potential to elicit irritation, inflammation, and an allergic response of the oral mucosa. Studies of substances leachable from acrylic resins, their cytotoxicity to cultured cells, and means of reducing their leaching were systematically conducted. Under in vivo and in vitro conditions, formaldehyde and methyl methacrylate were significantly leached into human saliva and saliva-substitute buffer, especially from autopolymerized resins. Both leachable substances showed cytotoxic potentials in the range of their leaching concentrations. Formaldehyde was cytotoxic at lower concentrations than methyl methacrylate. Preleaching in water reduced subsequent leaching of both formaldehyde and methyl methacrylate, and the amount of reduction depended on an increase in the preleaching temperatures. Immersion of acrylic resin dentures in hot water (50 degrees C) before insertion is recommended, especially for autopolymerized resins used either for rebasing or as denture base materials, to minimize the risk of adverse reactions in patients who wear acrylic resin dentures. |
8040826 | Acrylic resin-fiber composite--Part II: The effect of polymerization shrinkage of polymethyl methacrylate applied to fiber roving on transverse strength. | This study determined the effect of polymerization shrinkage of polymethyl methacrylate (PMMA) coating of fiber roving on the transverse strength of an acrylic resin-glass fiber composite. The test specimens were heat-cured acrylic resin reinforced with glass fibers. The glass fiber rovings were treated with four PMMA-MMA mixtures (30 specimens per group) of various ratios assumed to have different amounts of polymerization shrinkage. A transverse strength test was used to determine the fracture resistance of the test specimens and the polymerization shrinkage of the PMMA-MMA mixtures was measured. After the specimens were fractured, single glass fibers used to reinforce the test specimens were studied by SEM. The fracture resistance of the specimens was statistically different (p < 0.001) among treatments, and the polymerization shrinkage of the PMMA-MMA mixture also varied as the calculations predicted. The SEM micrographs showed differences in thickness of the acrylic resin layer on the surface of the fibers with PMMA-MMA mixtures of various ratios. According to the results, the ratio that caused only minor polymerization shrinkage of PMMA in the glass fiber roving improved the fracture resistance of the test specimens and seemed to increase the amount of PMMA inside the fiber roving. |
8040825 | Acrylic resin-fiber composite--Part I: The effect of fiber concentration on fracture resistance. | This study tested the effect on the fracture resistance of acrylic resin test specimens when different amounts of fibers were incorporated in the resin matrix. The fibers used included glass, carbon, and aramid fibers, with 30 test specimens of each concentration of fibers. Transverse sections of the specimens were studied by scanning electron microscope to establish how the fibers behave in the polymerization process. The results indicated that an increase in the amount of fibers enhanced the fracture resistance of the test specimens (p < 0.001). The SEM micrographs of transverse sections of test polymerized specimens revealed void spaces of different sizes inside the fiber roving. |
8040824 | Effectiveness of a professional formula disinfectant for irreversible hydrocolloid. | In this study, the effectiveness of Professional Lysol (PL) disinfectant in both its spray and solution forms was evaluated as a surface disinfectant for irreversible hydrocolloid (IH) impressions. Sixteen impressions of a typodont were made with IH, immersed in a microbial broth, and then rinsed in running tap water. The impressions were then treated as follows: four were immersed in PL for 2.5 minutes; four were sprayed by PL and stored for 10 minutes; four were immersed in 2% glutaraldehyde for 10 minutes; four were untreated. Pretest plates showed an average of 421 colonies per plate (c/p). The glutaraldehyde group showed 0.00 c/p. The PL spray group showed 1.75 c/p. The PL immersion group showed 19.00 c/p and showed evidence of surface deterioration in the IH. The untreated group showed 426.25 c/p. |
8040823 | Cone positioning device for oral radiation therapy. | This article describes the fabrication and modification of a peroral cone-positioning device. The modification provides added cone stability and prevents tongue intrusion into the radiation field. This device provides a repeatable accurate cone/lesion relationship and the fabrication technique is simplified, accurate, and minimizes patient discomfort. |
8040822 | Tightening characteristics for screwed joints in osseointegrated dental implants. | The significance of tightening abutment screws and gold cylinders to osseointegrated fixtures with the correct torque is demonstrated, and a simple relationship between applied torque and screw preload is derived by use of mechanical engineering principles. The principles of a number of tightening methods are outlined and assessments made of their accuracy. The difference between optimum and design torque is highlighted. The necessity and means of achieving optimum torque to ensure a reliable joint in clinical practice is discussed. |
8040821 | A modified impression technique for implant-supported restoration. | An impression technique is proposed for construction of implant-borne restorations that uses a modified autopolymerizing resin custom tray to allow splinting of the impression copings directly to the tray. This method eliminates the use of the dental floss-autopolymerizing resin complex, thus decreasing resin distortion and simplifying the clinical procedures. |
8040820 | A histologic comparison of the functional loading capacity of an occluded dense apatite implant and the natural dentition. | A histologic comparison of the functional loading capacity of an occluded dense apatite implant and the natural dentition at a ratio of one implant to three natural teeth was carried out on six monkeys. Single implants were placed in the maxillary left second molar and mandibular right second molar of each monkey. Four months later, the vertical dimension of occlusion was raised at the contacting areas between the implant and the connected first, second, and third opposing molar teeth by placing metal crowns on them. The three connected molars gradually intruded over time, whereas the supporting bone of the mandibular and maxillary implants showed no abnormalities and was able to bear the load because of thickening and remodeling of the surrounding bone. |
8040819 | Assessing shade differences in acrylic resin denture and natural teeth. | Four experiments in this study assess shade differences in acrylic resin denture and natural teeth. The first two examine the perceptual errors made by experienced dentists in their use of a manufacturer-provided shade guide for acrylic resin denture teeth. In the first of four experiments, dentists examine whether the numbering of a selected shade guide corresponds to the arrangement of the tabs from light to dark. In the second experiment, a visual discrimination task determines whether dentists can distinguish shade guide tabs from one another. The results from these two experiments revealed that the numbered progression of the shade tabs does not correspond to a light-to-dark order, that dentists have difficulty discriminating between several shade tabs, and that the shade tabs can be rearranged on an empirical basis. The third experiment demonstrated how the shade of natural teeth varies by age, gender, and complexion. The Biotone shade guide, rearranged in the manner suggested by the second experiment, was used to make these assessments. The fourth experiment examined whether the shades used for complete dentures were similar to shades found in natural teeth. The results from the last two experiments showed that shade selection can be facilitated by use of a rearranged set of shade guide tabs. The results also reveal that natural teeth significantly and clinically darken with age; however, selections made for denture teeth tend to be relatively constant in color, despite the age of the patient. Differences for gender and complexion do not appear to be clinically significant. |
8040818 | A diagnostic craniometric method for determining occlusal vertical dimension. | There is no precise scientific method for determining the correct edentulous occlusal vertical dimension. This study established the proportion between the ear-eye to chin-nose distance for determining reasonable occlusal vertical dimension. Two hundred white and 400 Asian men and women participated in this study. The ear-eye and chin-nose distances were measured with a modified craniometer. The results revealed that left ear-eye distance can be used to predict chin-nose distance with reasonable accuracy. However, the algorithm for making this prediction is not the same for combinations of sex and ethnic origin. |
8040817 | Biomechanical considerations in restoring endodontically treated teeth. | Various concepts for dental treatment have been established without appropriate documentation, such as restoration of endodontically treated teeth. Some researchers and dentists strongly recommend including a post with the restoration to strengthen the root. Other studies have indicated that posts may substantially weaken the roots and should be avoided. An additional approach suggested that the post did not improve the resistance to fracture during occlusion and did not support the restoration. Biomechanical problems are analyzed, and a recommended clinical approach is presented. |
8040816 | Effect of increasing cement space on cementation of artificial crowns. | In this study, the effect of cement space on cementation with an artificial crown and machined die was investigated. Spacing was varied in increments of 10 microns, and the dies were cemented in the crown by a force of 25 N with either zinc phosphate cement or a silicone fluid. Separation of the artificial crown and die was measured relative to complete seating without cement. A silicone fluid of 10.6 Pa seconds viscosity was used first with seating times from 168 seconds (SD 8.8 seconds) with no spacing to 2.1 seconds (SD 0.07 second) with 50 microns spacing. Unless 40 microns of spacing was used, the zinc phosphate cement did not allow the artificial crown to seat to less than 30 microns seating discrepancy, and it was suggested that particles in the cement caused this effect. The seating discrepancy ranged from 368 microns (SD 10 microns) without spacing to 29 microns (SD 1 micron) with 50 microns spacing. It was concluded that providing cement space substantially facilitated seating of crowns during cementation. |
8040815 | Effect of physical properties of direct bonding adhesives on bonding to etched enamel. | Five types of light-cured direct bonding adhesives with different volumes of microfiller were prepared for study of the relationships between bond strength to enamel, resinous tag length, and flexural strength, and between viscosity and resinous tag length. The resinous tag length was measured with the combination of 2,4,6-trichlorophenoxy methacrylate as a tracer and electron-probe microanalyzer. Correlating resinous tag length versus viscosity or bond strength after 1-day immersion, and flexural strength with bond strength after 1-day and 30-day immersion resulted in high correlation coefficients. However, the bond strength after thermocycling did not correlate with resinous tag length or flexural strength. |
8040813 | Posterior tibial tendinitis. A literature review with case reports. | Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity. The stress can cause microtrauma and rupture of some of the fibers of the tendon. This leads to an inflammatory process and the classical clinical signs and symptoms. Therapy is directed at reducing the inflammation, minimizing the fibrosis buildup, re-strengthening the weakened tissue, and controlling the pronatory force. The two case reports illustrate typical clinical signs, symptoms, and treatment for this injury. |
8040810 | Simple bone cyst of the calcaneus. A case report and literature review. | The authors presented a case report of a patient presenting with heel pain symptoms and physical findings similar to those associated with a heel spur syndrome. With a standard x-ray, the presence of a simple bone cyst was evident. Although mainly reported in tubular bones, steroid injection therapy has been successful and appears to be replacing surgical curettage and packing as the preferred choice of treatment in many cases. As more reports of the successful eradication of simple bone cysts of the calcaneus with steroid injections are reported, greater confidence for using it as a treatment choice for this particular lesion may be gained. The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient. The larger body weight and the resulting stress of the patient more likely to present with a calcaneal cyst may also be factors to consider. |
8040808 | Effect of hosiery on skin temperature in spastic quadriplegia. A preliminary study. | The effect of hosiery on 21 patients with spastic quadriplegia was studied by examining skin temperatures before and after wearing control socks (cotton or cotton/acrylic), compared with the test socks (21% stretch nylon and 80% synthetic hollow-core fiber). The latter are claimed by the manufacturers to provide superior warmth. Other investigations suggest that no material for a given thickness has superior insulation properties. The results of this preliminary study support these investigations, in that no significant difference in skin temperatures was found between the control and test socks when worn by this population. |
8040807 | Effects of surgical technique on bone. A preliminary study. | The authors compared the use of the power saw with bone-cutting forceps for excision of bone. A total of 44 digits were studied in 12 patients. The study was performed on patients requiring bilateral digital arthroplasties of the proximal and distal interphalangeal joints. The authors examined the differences in healing: pain, inflammation, and fibrosis. Digits on which the power cuts were made showed a slight advantage with regard to inflammation and pain, until 1 week after surgery. By week 12, neither technique demonstrated superiority. Overall results demonstrated no significant digit (p > 0.2) or treatment effect (p = 0.11). The authors believe that the study showed that the technique used for bone excision may have little effect on inflammation and healing in the long-term management of a surgical patient. |
8040806 | Comparative study of ankle support devices. | The purpose of this study was to compare the ability of four commonly used ankle support devices (Active Ankle, Aircast Sport Stirrup, DonJoy Ankle Ligament Protector and Malleoloc) to restrict active inversion range of motion before and after exercise. The subjects also compared the devices on subjective characteristics, including stability, comfort, and ease of application and removal. Eighteen subjects had both ankles tested for maximum inversion on a specially designed measuring apparatus during three sessions: 1) before application, 2) before exercise with the support device, and 3) after exercise with the support device. |
8040799 | Home care of the infant with gastroesophageal reflux and respiratory disease. | An increasing number of infant's with gastroesophageal reflux (GER) and respiratory disease and are being cared for at home. These infants have a chronic disease requiring long-term medical care. However, once the infant's condition stabilizes, home care is preferable to prolonged hospitalization. Nursing care of the infant with GER and respiratory disease is a challenging process that is complicated by the severity of GER and the degree of respiratory compromise. An understanding of disease process, family process, and skills of assessment are essential in planning care for these infants and their families. |
8040798 | Providing better access to health care: a pediatric nurse practitioner WIC-based clinic for one-stop health care. | The University of Texas Women, Infants, and Children (WIC) Well Child Clinic was established in January 1992 to provide high-quality "user-friendly" health care to children in Houston, Texas. As the name implies, the traditional services of the WIC nutritional program are coupled with primary care to offer more comprehensive and greater access to care. The services are provided by pediatric nurse practitioners and focus on health maintenance, with an emphasis on anticipatory guidance and immunizations. Acute care and management of chronic illness are also provided. The clinic serves as a teaching site for pediatric nurse practitioner and medical students. This article addresses the rationale for and planning of a WIC-based clinic and the implementation of the plan and addresses issues concerning reproducibility in other settings. |
8040797 | Update in pediatric dentistry. | The pediatric nurse practitioner advises families in proper oral hygiene, fluoride supplementation, prevention of damaging oral habits and tooth decay, and the need for children to see a pediatric dentist. This article presents the issues of oral health for children from infancy through adolescence. Common pathologic conditions, oral trauma, and the use of sealants in children are also described. |
8040796 | Lessons for prevention and intervention in adolescent pregnancy: a five-year comparison of outcomes of two programs for school-aged pregnant adolescents. | Adolescent fertility control has been linked with educational completion and long-term economic success. This study evaluated the effect of short-term prenatal intervention on selected maternal and child indexes with first-time pregnant adolescents. Birth patterns were examined over a 5-year period for three groups (N = 216) of adolescents who received varying amounts of prenatal intervention for the index birth. No significant differences between groups were found on number of subsequent births within 5 years, mean time between births, graduation from high school, gestational age, or mean birth weight of infants. Age at first birth was a predictor of the number of subsequent births and subsequent graduation from high school. Grade in school at first pregnancy and total number of births in 5-years were related to high school graduation. Findings support the need for continued intensive community-based collaborative intervention for adolescent mothers during the 5 years after the index birth, the peak childbearing years for these women. |
8040795 | The adolescent athlete. Part I: Preseason preparation and examination. | The benefits of athletics to adolescent self-image and physical and social growth are widely recognized, but participation in sports also presents inherent risks to this population. Nurse practitioners assist in developing a safe athletic environment for teenagers through preseason preparation and anticipatory guidance. The health maintenance examination and preseason screening merge to form an educational opportunity for the teenager, parents, and coaches. This article is the first in a three-part series addressing the nurse practitioner's role in the health maintenance of the adolescent athlete. |
8040786 | Serum sickness-like reactions associated with cefprozil therapy. | Four patients had serum sickness-like reactions during treatment with cefprozil, a new cephalosporin. Two patients had had previous mild reactions associated with cephalosporin therapy. It remains uncertain whether cefprozil-associated serum sickness-like reaction represents a unique or a class-related adverse drug reaction. |
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