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8040784
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Carnitine-dependent changes of metabolic fuel consumption during long-term treatment with valproic acid.
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Energy metabolism was measured in children receiving long-term treatment with valproic acid. In 8 of 10 randomly selected subjects, the resting respiratory quotient was higher than in age- and sex-matched control subjects (0.91 +/- 0.01 vs 0.87 +/- 0.01; p < 0.05). A shift was observed in fuel consumption, and a significant reduction was found in the amount of fats oxidized (0.68 +/- 0.23 vs 1.18 +/- 0.18 gm.kg-1.day-1), which was accompanied by increased utilization of carbohydrates (5.31 +/- 0.79 vs 3.81 +/- 0.39 gm.kg-1.day-1) in comparison with the control subjects. The resting total energy expenditure was not affected by the treatment. The children with an altered energy consumption pattern (n = 8) received carnitine supplementation for a month; the respiratory quotient then decreased (0.87 +/- 0.02), the oxidation of fats increased (1.42 +/- 0.25), and the consumption of carbohydrates decreased (3.87 +/- 0.79), but no changes in resting energy expenditure were observed. We conclude that carnitine depletion, a known adverse effect of valproic acid administration, may result in inhibited fatty acid oxidation, leading to a shift of substrates utilized from fats to carbohydrates.
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8040785
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Prednisone dose limitation of growth hormone treatment of steroid-induced growth failure.
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Seven children with prednisone-induced growth failure were treated with recombinant growth hormone to improve linear growth. Six of seven patients had an increase in linear growth during therapy with recombinant growth hormone. The response to recombinant growth hormone was found to be related to the prednisone dose. When the prednisone dose was greater than 0.35 mg/kg per day, recombinant growth hormone did not increase the linear growth rate. At lower doses the response was inversely related to the amount of prednisone taken.
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8040783
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Pharmacokinetics of meso-2,3-dimercaptosuccinic acid in patients with lead poisoning and in healthy adults.
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We compared the pharmacokinetics of meso-2,3-dimercaptosuccinic acid (DMSA) in three children with lead poisoning, three adults with lead poisoning, and five healthy adult volunteers. All subjects received DMSA orally. Maximum blood concentration and time to maximum blood concentration of total DMSA concentration were not statistically different among the groups. Unaltered DMSA was detected in the blood of all poisoned patients but in only one of five healthy volunteers. Elimination half-life of total DMSA (parent drug plus oxidized metabolites) was longer in children with lead poisoning (3.0 +/- 0.2 hours) than in adults with lead poisoning (1.9 +/- 0.4 hours) and healthy adults (2.0 +/- 0.2 hours). Renal clearance of total DMSA was greater in healthy adults (77.0 +/- 13.2 ml/min per square meter) than in either adults (24.7 +/- 3.3 ml/min per square meter) or children with lead poisoning (16.6 ml/min per square meter); renal clearance of the metabolites of DMSA was also greater in healthy adults (64.6 +/- 10.1 ml/min per square meter) than in either adults (35.4 +/- 8.4 ml/min per square meter) or children with lead poisoning (19.5 ml/min per square meter). The DMSA appeared to enter the erythrocytes of patients with lead poisoning to a greater extent than in healthy adults. We conclude that renal clearance of DMSA and its metabolites may be impaired and that the distribution of DMSA in children with lead poisoning may be different from that in adults.
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8040782
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Intracranial abnormalities and neurodevelopmental status after venovenous extracorporeal membrane oxygenation.
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Computed tomography scans of the head and early neurodevelopmental assessment (Bayley Scales of Infant development) were recorded for 24 surviving infants who received venovenous extracorporeal membrane oxygenation and were compared with those of infants treated with venoarterial bypass matched by diagnosis and oxygenation index before extracorporeal membrane oxygenation. A comparable neuroradiographic and early neurodevelopmental outcome was documented for survivors of venoarterial and venovenous extracorporeal membrane oxygenation.
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8040781
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Right common carotid artery reconstruction after extracorporeal membrane oxygenation: vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery.
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Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. SUMMARY RESULTS: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely.
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8040780
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Calciuria and aminoaciduria in very low birth weight infants fed a high-mineral premature formula with varying levels of protein.
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To assess the influence of protein intake on renal excretion of calcium and amino acids and on bone mineralization in preterm infants, we randomly selected within weight group strata 27 infants who weighed < 1500 gm at birth (nine per group) to be fed a high-mineral (calcium, 940 mg/L; phosphorus, 470 mg/L) premature formula with one of the following protein contents: formula A, 3.0 gm/100 kcal; formula B, 2.7 gm/100 kcal; and formula C, 2.2 gm/100 kcal. Mean (+/- SD) daily weight gain was greater in infants receiving the higher protein intakes for the first 30 days (formula A, 24.8 +/- 5.1 gm; formula B, 20.5 +/- 3.8 gm; formula C, 16.2 +/- 5.9 gm (analysis of variance: p < 0.01; C < A, p < 0.05)). Bone mineral content did not differ at any time point, and all groups had a high prevalence of generalized aminoaciduria (4 weeks: formula A, 56%; formula B, 71%; formula C, 75%). Urinary calcium corrected for creatinine (in milligrams per milligram) increased as protein content decreased (2 weeks: formula A, 0.16 +/- 0.10; formula B, 0.20 +/- 013; formula C, 0.44 +/- 0.33 (C > A, C > B, p < 0.05); 4 weeks: formula A, 0.23 +/- 0.15; formula B,0.34 +/- 0.47; formula C, 0.49 +/- 0.22 (C > A, p < 0.01). We conclude that the high mineral content and other components of premature formulas result in a higher growth rate and may increase protein requirements. Failure to meet protein requirements may result in underutilization of absorbed calcium and increased renal excretion of calcium. In preterm infants, higher protein intake probably supports rather than jeopardizes bone mineral accretion, and reduces rather then increases calciuria.
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8040779
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Glucose metabolism in the infant weighing less than 1100 grams.
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We studied the rate of endogenous glucose production and disappearance in a group of 10 clinically stable < 1100 gm infants in the first week of life, using stable-isotope (6,6-2H-glucose) dilution analysis for a 2-hour study period. Plasma glucose and insulin concentrations at 2 hours were 5.4 +/- 2.5 mmol/L (97 +/- 15 mg/dl) and 71.4 +/- 2.9 pmol/L, respectively, and did not change during the study period. The rate of glucose disappearance was 37 +/- 10 mumol/kg (6.77 +/- 0.55 mg/kg) per minute. The rate of endogenous glucose production was 12.3 +/- 11 mumol/kg (2.22 +/- 0.61 mg/kg) per minute. The exogenous glucose infusion rate was 25.2 +/- 8.4 mumol/kg (4.54 +/- 0.47 mg/kg) per minute. Endogenous glucose production was correlated with plasma glucose concentration (r = 0.76; p < 0.05) and the rate of glucose disappearance (r = 0.75; p < 0.05); plasma glucose concentration was correlated with the rate of disappearance (r = 0.87; p = < 0.01) and insulin concentrations (p < 0.05). We conclude that infants who weight < 1100 gm utilize three to four times more glucose per kilogram of body weight than adults, reflecting their higher ratio of brain to body weight. Endogenous glucose production provided only approximately one third of the glucose needed--a mandate for the exogenous infusion of glucose to prevent the development of hypoglycemia.
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8040778
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Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity.
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We determined the effects of anemia of prematurity on myocardial, metabolic, and erythropoietic functions. Twelve anemic (hemoglobin range, 65 to 78 gm/L) infants without symptoms (gestational age, (mean +/- SD) 28 +/- 2 weeks; birth weight, 1178 +/- 326 gm) were studied at a postconceptional age of 35 +/- 1.6 weeks. All measurements were done before and 36 to 48 hours after a transfusion of packed erythrocytes. Cardiac output, heart rate, and myocardial function were assessed. Oxygen consumption, carbon dioxide production, resting energy expenditure, arterial oxygen pressure for 50% hemoglobin saturation, and the concentrations of erythropoietin and 2,3-diphosphoglycerate were also determined. After transfusion, increased hemoglobin level (75 +/- 4 to 150 +/- 16 gm/L) and decreased oxyhemoglobin affinity (20.8 +/- 1.7 to 23.6 +/- 2.1 gm/L; p < 0.05) caused a decrease in plasma erythropoietin concentration (from 21.1 +/- 6.2 to 5.8 +/- 1.5 mU/ml; p < 0.01). There was a decrease in heart rate (from 155 +/- 10 beats/min to 146 +/- 7 beats/min) and cardiac output (from 281 +/- 73 ml/kg per minute to 199 +/- 62 ml/kg per minute; p < 0.05). Myocardial function indexes, weight gain, and metabolic demands were normal before and after transfusion. These results suggest that oxygenation is adequately maintained in symptom-free infants with anemia of prematurity.
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8040777
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Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant.
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Thirty preterm infants (birth weight < 1500 gm) treated with Surfactant TA for the respiratory distress syndrome, who had no complicating clinical problems other than ductal patency, were studied by serial Doppler flow examinations to determine the effects of early left-to-right shunt through the patent ductus arteriosus on the left ventricular output and organ blood flows. Doppler flow variables in 15 infants with a hemodynamically significant patent ductus arteriosus (hsPDA) were compared with those in 15 subjects without hsPDA matched for age, body weight, and gestational age. Infants with hsPDA had significantly higher left ventricular output and significantly lower blood flow volume in the abdominal aorta, and lower temporal mean blood flow velocities, with concomitant increases in the relative vascular resistance in the celiac artery, superior mesenteric artery, and renal artery. Pulsatility indexes of these vessels and the anterior cerebral artery were significantly higher in the hsPDA group, but the temporal mean blood flow velocities in the anterior cerebral artery and its vascular resistance were not significantly different between the two groups. After closure of the patent ductus arterious was achieved with mefenamic acid therapy, alterations in Doppler flow variables in the hsPDA group reverted to the levels seen in the group without hsPDA. These results suggest that despite large left-to-right ductal shunting, the heart of the preterm infant is capable of mounting a compensatory increase of cardiac output sufficient to maintain unchanged cerebral blood flow, but is unable to maintain postductal organ blood flows because of decreased perfusion pressure (ductal steal) and localized increase in vascular resistance.
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8040776
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Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates.
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A randomized, double-blind, controlled trial was conducted to determine whether vancomycin added to parenteral alimentation solution given via a central venous catheter would decrease the incidence of catheter-related coagulase-negative staphylococcal sepsis. Seventy infants with a central venous catheter (CVC) in place were randomly selected to receive total parenteral nutrition--either the standard solution or a solution containing 25 micrograms of vancomycin per milliliter. Catheter-related sepsis was defined as the isolation of the same bacterial species from specimens of both peripheral and CVC blood with the concentration of bacteria at least tenfold greater in the specimen obtained from the CVC. Specimens from the CVCs were cultured on removal of the catheters to determine colonization. The colonization of catheters by coagulase-negative staphylococci was reduced from 40% to 22% (p = 0.03) in the vancomycin group; catheter-related sepsis was reduced from 15% to no cases (p = 0.004). Fewer infants required CVC reinsertion in the vancomycin-treated group (p = 0.02), who also regained birth weight earlier (13.4 vs 17.1 days (p = 0.014)). Adverse effects of vancomycin infusion were not observed. We conclude that vancomycin added to the solution used for total parenteral nutrition effectively reduces catheter-related sepsis in the neonatal intensive care unit and offers other potential benefits such as the need for fewer catheters and earlier weight gain. However, we do not recommend widespread implementation of this technique until there are data regarding the emergence of vancomycin-resistant organisms.
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8040775
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Prevention of gram-positive sepsis in neonates weighing less than 1500 grams.
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A prospective, randomized study to evaluate the effectiveness of a continuous low-dose vancomycin infusion to prevent nosocomial gram-positive bacteremia was initiated within the first 2 weeks of life in neonates weighing < 1500 gm. Seventy-one infants received constant infusion of vancomycin (25 micrograms/ml) mixed with their total parenteral nutrition solution; 70 infants served as control subjects. The groups were clinically similar in birth weight, estimated gestational age, and severity of illness. Administration of vancomycin was begun at a mean age of 5.4 +/- 2.9 days. Infants had mean serum vancomycin concentrations of 2.4 micrograms/ml, and received vancomycin for a mean of 11 +/- 7 days. No vancomycin-resistant organisms were detected in surveillance cultures during the 2-year study period. Twenty-four of seventy control infants, in comparison with 1 of 71 infants receiving vancomycin, had gram-positive bacteremia (p < 0.001). The addition of a low dose of vancomycin to alimentation fluids virtually eliminated the incidence of gram-positive bacteremia in an at-risk population of very low birth weight infants. However, the widespread use of vancomycin in total parenteral nutrition solution is not recommended until better data on the emergence of vancomycin-resistant organisms are available.
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8040774
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Recurrent episodes of bizarre behavior in a boy with ornithine transcarbamylase deficiency: diagnostic failure of protein loading and allopurinol challenge tests.
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Recurrent episodes of bizarre behavior were the only clinical symptoms that finally led to the diagnosis of ornithine transcarbamylase deficiency in an 8-year-old boy. The suspected diagnosis could not be confirmed with the use of current challenge tests. The response to a high-protein diet for 24 hours appeared to be a helpful diagnostic aid.
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8040773
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Nephrocalcinosis in pseudohypoaldosteronism and the effect of indomethacin therapy.
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We report four patients with pseudohypoaldosteronism, aged 5 months to 5 years. All patients had hypercalciuria and three had nephrocalcinosis. Two patients with nephrocalcinosis were treated with indomethacin. Polydipsia decreased and appetite and weight gain improved within 14 days of therapy. Hypercalciuria, polyuria, and creatinine clearance decreased 30% to 50% and urinary prostaglandin E2 levels decreased fourfold to eightfold.
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8040772
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Increases in hemoglobin concentration and iron needs in response to growth hormone treatment.
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We studied 36 children with short stature during the initial 6 months of recombinant human growth hormone treatment and found an elevation in the mean concentration of hemoglobin (p < 0.001). The elevation was highest in the eight patients with bone dysplasia (p < 0.001). The mean concentration of serum ferritin decreased (p < 0.01) and that of serum transferrin increased (p < 0.001). The prevalence of iron deficiency increased from 6 patients (17%) with initial deficiency to 20 (56%) patients after therapy, indicating that iron supplementation should be considered in children treated with recombinant human growth hormone.
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8040771
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Persistent hyperaminotransferasemia resolving after weight reduction in obese children.
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Nine obese children were referred to our liver disease unit because of asymptomatic, long-standing (range, 4 to 49 months) hyperaminotransferasemia of unknown origin. Ultrasonography showed a "bright" liver in most patients. A hypocaloric diet was prescribed, and the hepatic abnormalities of the complaint patients showed a prompt and persistent improvement that paralleled the loss of excess weight.
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8040770
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Clinical usefulness of cerebrospinal fluid bacterial antigen studies.
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A retrospective chart review was performed to evaluate the effect that positive results of cerebrospinal fluid bacterial antigen tests had on the care of patients with presumed bacterial meningitis. Of 901 tests ordered, costing $26,000 per year, 29 showed positive results--and only four of these affected patient care. By using cerebrospinal fluid bacterial antigen testing only when another test does not identify an organism, or in an attempt to determine central nervous system infection late in therapy for presumed sepsis, one can greatly reduce costs with no detrimental effect on patients.
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8040766
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Correlation of cognitive, neurologic, and ovarian outcome with the Q188R mutation of the galactose-1-phosphate uridyltransferase gene.
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This study was conducted to determine whether there is a genotype/phenotype correlation between aspects of cognitive, neurologic, and ovarian outcome in patients with galactosemia and the Q188R mutation of the galactose-1-phosphate uridyltransferase gene. The results showed that the Q188R mutation was found in 72% of alleles: 38 patients were homozygous and 21 were heterozygous for Q188R; eight patients did not have the mutation. The mean Broad Cognitive score for the group homozygous for Q188R was 75 (SD = 16), which was not statistically different from the outcome for the heterozygous group (mean score, 67; SD = 25) or the negative group (mean score, 88; SD = 21). Tremor, ataxia, and dysmetria were found in 12 subjects, and there was no association with Q188R status. Similarly, there was no association of this mutation with the development of primary amenorrhea (8 subjects) versus secondary amenorrhea (found in 14 women). Our findings suggests that the variability of outcome for patients with classic galactosemia cannot be explained by Q188R status alone, at least with regard to cognitive functioning, presence of neurologic symptoms, and timing of the onset of ovarian failure.
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8040765
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Polysomnographic characteristics of patients with Rett syndrome.
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During wakefulness, patients with Rett syndrome have disordered breathing. To understand further this ventilatory control disorder, we performed polysomnography in 30 patients with Rett syndrome and 30 control subjects (female subjects with primary snoring). The median age was 7 years (range, 1 to 32 years) for Rett syndrome and 6 years (range, 1 to 17 years) for control subjects. During periods of wakefulness, 67% of patients with Rett syndrome had the characteristic pattern of disordered breathing (i.e., episodes of hyperventilation followed by central apnea and desaturation). No such events occurred during sleep. Sleep efficiency and sleep architecture were similar for both groups. During sleep, there was no difference in duration of periodic breathing, number of episodes of central apnea with desaturation, or number of episodes of obstructive apnea or end-tidal carbon dioxide tension between the two groups. Although arterial oxygen saturation during rapid eye movement (REM) sleep was slightly lower in patients with Rett syndrome (nadir, 94% +/- 2% vs 96% +/- 2%), it remained within the normal range. Parental history reflected the awake respiratory findings in most cases. We conclude that patients with Rett syndrome have normal breathing during non-rapid eye movement (NREM) sleep. We speculate that patients with Rett syndrome have normal brain-stem control of ventilation, and that the disordered breathing seen during wakefulness is due to an abnormality of the cortical influence on ventilation.
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8040764
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Technetium-99m hexamethylpropyleneamine-oxime-labeled leukocyte scintigraphy in inflammatory bowel disease in children.
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Technetium Tc 99m-labeled hexamethylpropyleneamine-oxime (Tc-HMPAO) scintigraphy has been evaluated in adults with inflammatory bowel diseases and has shown promising ability to define intensity and extent of disease. To evaluate the method's utility in children, we studied 27 pediatric patients-23 with inflammatory bowel diseases and 4 control subjects without abdominal inflammation. Autologous leukocytes labeled with Tc-HMPAO were reinjected into each patient and serial scans were obtained up to 4 hours later. None of the control subjects had any uptake of Tc-HMPAO by the bowel. Disease localization as defined by the scan correlated well with that visualized in surgical specimens from five patients, at endoscopy in three patients, with barium studies of two patients, and with computed tomography scanning of the abdomen in one patient. A "scan score" was calculated by comparing uptake of tracer in five bowel segments with iliac crest bone marrow activity. Scan score correlated much better with clinical disease activity (correlation coefficient = 0.62) than did the erythrocyte sedimentation rate (correlation coefficient = 0.24). Scintigraphy with Tc-HMPAO appears to be useful in evaluation of disease localization and intensity in children with inflammatory bowel disease.
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8040763
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Kyphosis and fractures in children and young adults with cystic fibrosis.
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The purpose of this study was to examine children and adolescents with cystic fibrosis for an increased frequency of fracture and excessive thoracic kyphosis, which may result from inadequate skeletal mineralization. In a survey of 143 patients (ages 4.7 to 21.9 years; mean, 11.3 years), the fracture rate for male patients from birth to 5 years of age was higher than for female patients and both rates were comparable with those for normal children. In contrast, female patients 6 to 16 years of age with cystic fibrosis had a higher-than-normal fracture rate and a higher rate than their male counterparts. Review of the chest radiographs showed that thoracic kyphosis correlated with age and with disease severity as judged by Brasfield scoring. In the > 15-year-old age group, kyphosis exceeding 40 degrees, the upper limit of normal, was found in 77% of the female patients and 36% of the male patients. The cause of these findings is uncertain and perhaps multifactorial, but osteopenia is likely a contributing factor. As the life expectancy of patients with cystic fibrosis continues to increase, the skeletal consequences, particularly in female patients, may become increasingly significant.
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8040762
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Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity.
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To establish rates of skeletal mineralization in children and adolescents, and to identify factors that influence these rates. Three-year observational study. University hospital. Ninety white children, aged 6 to 14 years. Bone mineral density of the radius, spine, and hip was measured at baseline and 3 years later. Physical activity was assessed by questionnaires at 6-month intervals and dietary calcium intake by diet diary 1 day per month for 36 months. Sexual maturation (Tanner stage) was determined by an endocrinologist at 6-month intervals, as necessary to classify children as prepubertal, peripubertal, or postpubertal. Skeletal mineralization accelerated markedly at puberty in the spine (0.077 vs 0.027 gm/cm2 per year, peripubertal vs prepubertal) and greater trochanter (0.050 vs 0.027 gm/cm2 per year), less markedly in the femoral neck (0.047 vs 0.030 gm/cm2 per year), and only slightly in the radius. Nearly one third (15 gm) of the total skeletal mineral in the lumbar spine of adult women (approximately 52 gm) was accumulated in the 3 years around the onset of puberty. Increases in height and weight were the strongest correlates of skeletal mineralization: weight changes were more strongly correlated with trabecular bone sites and changes in height with cortical bone sites. Increases in calf muscle area were strongly associated with mineralization, particularly in peripubertal children, and physical activity was associated with more rapid mineralization in prepubertal children. Puberty has varying effects on skeletal mineralization depending on skeletal site; trabecular bone is apparently more sensitive to changing hormone concentrations. Physical activity and normal growth are also positively associated with skeletal mineralization, also depending on skeletal site and sexual maturation.
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8040761
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Final height after growth hormone therapy in non-growth-hormone-deficient children with short stature.
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We report the effect of growth hormone (GH) treatment for 4 to 10 years in 15 prepubertal non-GH-deficient short children (10 boys, 5 girls, aged 7.4 to 13.2 years). In 7 patients, GH was administered at a dosage of 0.5 U/kg per week (group 1: 4 boys, 3 girls) and in 8 patients (group 2: 6 boys, 2 girls) at a dosage of 1.0 U/kg per week. After the first year, mean linear growth velocity had significantly increased in both groups. The increase in growth velocity was sustained during the first 4 years and then declined to pretreatment values in the majority of subjects. Treatment with GH did not induce an earlier onset of puberty, but there was a tendency toward faster skeletal maturation. The mean final height standard deviation score (SDS) was similar in the two groups and was significantly higher than the height SDS for chronologic age before treatment, but it did not differ from mean pretreatment predicted adult height SDS nor from mean target height SDS in both groups. Final height was significantly correlated with target height in both groups. These preliminary observations indicate that GH treatment does not generally increase final height over target height in short non-GH-deficient children.
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8040760
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Effect of long-term growth hormone therapy on bone age and pubertal maturation in boys with and without classic growth hormone deficiency.
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We evaluated the effect of growth hormone (GH) therapy on bone age, pubertal maturation and predicted adult height in two groups of boys treated for 4 years: 40 growth hormone-deficient boys who had growth hormone response to provocative stimulation < 10 micrograms/L (GHD group) and 43 boys whose stimulated growth hormone > or = 10 micrograms/L (group with neurosecretory dysfunction (NSD)). All patients had a subnormal integrated concentration of growth hormone < or = 3.2 micrograms/L, height < -2 SD, growth velocity < 4.5 cm/yr, and bone age < or = -2 SD for chronologic age. Patients were treated with recombinant growth hormone, 0.1 mg/kg per dose given three times a week. The pretreatment height SD of the GHD group (-3.6 +/- 1.0) was less than that of the NSD group (-2.7 +/- 0.7; p < 0.001). After 4 years of therapy, both groups had catch-up growth (GHD group to -2.0 +/- 1.3 height SD (n = 35), and NSD group to -1.4 +/- 0.7 height SD (n = 32)); the rate of height SD gain was better in patients with GHD (p < 0.01). The response to growth hormone was inversely related to pretreatment chronologic age (p < 0.001). The Tanner-Whitehouse II predicted adult height improved for both groups: +9.3 +/- 7.7 cm in the GHD group, giving an adult height SD of -0.9 +/- 1.0, and +5.4 +/- 5.5 cm in patients with NSD, for an adult height SD if -0.8 +/- 0.7. Testosterone levels became higher in the NSD group after 2 years and remained higher at year 4. We conclude that patients respond favorably to growth hormone therapy and in a manner similar to patients with GHD. Initiation of therapy at a younger age gives a greater improvement in gained height and predicted adult height.
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8040759
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Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group.
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The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 years of age. We examined whether the effects of such treatment also occurred in the subset of young diabetic subjects (13 to 17 years of age at entry) in the Diabetes Control and Complications Trial. One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline (primary prevention cohort) and 70 adolescent subjects with mild retinopathy (secondary intervention cohort) were randomly assigned to receive either (1) intensive therapy with an external insulin pump or at least three daily insulin injections, together with frequent daily blood-glucose monitoring, or (2) conventional therapy with one or two daily insulin injections and once-daily monitoring. Subjects were followed for a mean of 7.4 years (4 to 9 years). In the primary prevention cohort, intensive therapy decreased the risk of having retinopathy by 53% (95% confidence interval: 1% to 78%; p = 0.048) in comparison with conventional therapy. In the secondary intervention cohort, intensive therapy decreased the risk of retinopathy progression by 70% (95% confidence interval: 25% to 88%; p = 0.010) and the occurrence of microalbuminuria by 55% (95% confidence interval: 3% to 79%; p = 0.042). Motor and sensory nerve conduction velocities were faster in intensively treated subjects. The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia. We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropathy when initiated in adolescent subjects; the benefits outweigh the increased risk of hypoglycemia that accompanies such treatment.
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8040757
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Potential photosensitizers for photodynamic therapy. IV. Photophysical and photochemical properties of azaporphyrin and azachlorin derivatives.
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The photophysical and photochemical properties of a 5-azaprotoporphyrin derivative ([5]AZPP), a zinc-15-azaporphyrin derivative (Zn-[15]AZIDP) and an E-Z isomeric mixture of a 5-azachlorin derivative ([5]AZCH) were studied in various solvents. The quantum yields of fluorescence phi F0, S1-T1 intersystem crossing phi T0 and singlet oxygen (1 delta g) formation phi delta were measured and the Stern-Volmer constants for the quenching of the S1 states by oxygen and the rate constants of quenching of O2(1 delta g) by the different azaporphyrinoid compounds were obtained. The fluorescence quantum yield (phi F0 = 0.23), the strong absorption in the red (lambda max = 674 nm, epsilon max = 66,000 M-1 cm-1) and the high value of the quantum yield for singlet oxygen (1 delta g) formation (phi delta = 0.65) observed for [5]AZCH recommend azachlorin derivatives as potential markers and photosensitizers for tumour therapy.
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8040756
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Intermediates in the oxidation of a dihydropyridine derivative of AZT related to AIDS dementia, studied by nanosecond laser photolysis.
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Radicals of the AZT derivative 5'-(1,4-dihydro-1-methyl-3-pyridinylcarbonyl)-3'-azido-2',3'-dideo xythymidine) were obtained on exposure of this compound in alkaline aqueous solution to pulsed laser emission of lambda = 355 nm and pulsewidth 2 ns FWHM. The radical formation was shown to be due to photoelectron ejection from the pyridine group following two-step excitation of the compound. The radicals were found to deprotonate rapidly. Electrochemical analysis showed that the photoionization does not affect the azido group.
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8040755
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Detection of a reduced-flavin triplet state in free flavins and DNA photolyase.
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A transient species was observed upon laser excitation (lambda exc = 355 nm) of reduced flavins (cFIH2) under anaerobic conditions. The transient decayed with a lifetime of about 1 microseconds, was quenched by iodide ions and was assigned as the reduced flavin triplet state 3cFIH2. The triplet-state absorption spectrum assumed three forms, depending on the pH of the solution, corresponding to 3cFIH2 and its monoprotonated and monodeprotonated forms. The triplet-state lifetime was not sensitive to the presence of pyrimidine cyclobutane dimers, apparently ruling out its involvement in the dimer splitting reaction observed with model systems of reduced flavins. An analogous species is apparently formed in the reduced form of Escherichia coli DNA photolyase.
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8040754
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Interaction between zinc(II)-phthalocyanine-containing liposomes and human low density lipoprotein.
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The interaction of human low density lipoprotein (LDL) and small unilamellar liposomes containing the photosensitiser zinc(II)-phthalocyanine (Zn-Pc) was studied in vitro to determine if Zn-Pc could be directly incorporated into the lipoprotein in the absence of other serum components. Incubation of LDL with increasing concentrations of liposomes resulted in a progressive increase in the net negative charge of LDL as determined by agarose gel electrophoresis and both Zn-Pc and liposomal phospholipid were incorporated into the modified LDL particles. Gel chromatography experiments indicated an increase in the molecular mass of modified LDL and immunoaffinity chromatography provided evidence that apoprotein B epitopes on modified LDL were unable to bind to antibody. The study indicated that the liposomal components could be selectively incorporated into LDL by a process that did not appear to involve either aggregation or fusion of particles.
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8040753
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Molecular mechanism of drug photosensitization. 5. Photohemolysis sensitized by Suprofen.
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Red blood cell lysis photosensitized by Suprofen (SPF) and the photolysis of the drug were investigated. The photohemolysis process occurs at a higher rate in anaerobic than aerobic conditions. The effect of additives demonstrates the involvement of free radicals and, to a lesser extent, singlet oxygen and hydroxyl radicals in the process. Photolysis of the drug at 310-390 nm in deaerated buffered solutions (pH 7.4) leads to a decarboxylation process with the formation of p-ethylphenyl 2-thienyl ketone (I), whereas in aerated solutions formation of photoproduct I and of the photoproducts p-acetylphenyl 2-thienyl ketone (II) and p-(1-hydroxyethyl)phenyl-2-thienyl ketone (III) occurs. The photodegradation products, which were separated and characterized, show a moderate lytic and photolytic activity. The rate of SPF photodegradation decreases in the presence of oxygen and increases in the presence of hydrogen donors. The overall results lead us to propose a mechanism of SPF photodegradation and a hemolysis scheme in which cell damage is provoked principally by the direct attack of drug radicals and secondarily by singlet oxygen and hydroxyl radicals.
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8040752
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UVA-induced peroxidation of lipid in the dried film state.
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Exposure of a dried lipid thin film to UVA produced a dose-dependent linear increase in the three peroxidation products, conjugated diene, lipid hydroperoxide and malondialdehyde (MDA). All three lipid peroxidation products exhibited an inverse dose rate effect. Identical amounts of malondialdehyde were produced when the lipid film was exposed to UVA either directly or through the thickness of the Corning glass on which the film was cast. Antioxidants, alpha-tocopherol, butylated hydroxytoluene (BHT) and the singlet oxygen quencher beta-carotene significantly inhibited the UVA-induced peroxidation of the lipid film. The biological implications of the UVA-induced peroxidation of the dried lipid film are discussed.
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8040751
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Cell membrane, a target for PUVA therapy.
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The photochemical reactions occurring in the cell membranes, sensitized photo-oxidation and psoralen photoaddition to lipids, are briefly reviewed. Phospholipid dynamics in the membrane structure, based on erythrocyte lipid organization, are described. Evidence for alterations of cell membrane functions under psoralen plus UVA radiation (PUVA) treatment in a variety of mammalian cells is presented. Cell receptor dysfunctions under PUVA treatment are demonstrated in a number of biological investigations. The purpose of this survey is to illustrate the feasibility of studying psoralen photobiology with phospholipids. The reaction of psoralens with phospholipids is considered to be one of the triggering mechanisms of the subsequent physiological responses, which may be relevant to PUVA photochemotherapy.
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8040741
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Flow cytometric analysis of primary and metastatic squamous cell carcinomas of the oral and maxillofacial region.
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To elucidate characteristic changes in nuclear DNA content and cell kinetics in primary lesions and metastatic lymph nodes of squamous cell carcinomas of the oral and maxillofacial region. Materials used were paraffin-embedded tissue specimens obtained from 96 primary lesions of 96 patients and 85 metastatic lymph nodes of 41 patients with squamous cell carcinoma of the oral and maxillofacial region. Single cell suspensions for flow cytometry analysis were prepared, and cell cycle analysis was performed. The incidence of aneuploidy in 41 carcinomas with metastasis was 39%, which was significantly higher than the 16% incidence in 55 carcinomas without metastasis. In terms of T classification and mode of invasion, the incidence of aneuploidy and metastasis increased with the increase in gradings. Forty-four of 46 metastatic lymph nodes associated with 25 diploid primary tumors remained diploid, whereas a shift down to diploidy was observed in 25 of 39 metastatic lymph nodes associated with 16 aneuploid primary tumors. The incidence of aneuploidy and S-phase fractions of 85 metastatic lymph nodes in 41 patients were 19% and 9.6%, respectively. The values were significantly lower than the 39% and 14.3% of the corresponding primary lesions. The chance of evolution of metastatic cell lines is higher in aneuploid carcinomas than diploid carcinomas, possibly because the former are more heterogenous; however, most cell lines responsible for causing lymph node metastasis are diploid.
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8040740
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Effect of multiple ligations of the external carotid artery and its branches on blood flow in the internal maxillary artery in dogs.
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The effect of occlusion of the external carotid system on blood flow of the internal maxillary artery was investigated in 16 dogs. The external carotid system was occluded by ligation or clamping at different levels separately or simultaneously and the blood flow of the internal maxillary artery was measured with an electromagnetic flowmeter before and after each occlusion. The ligation of the external carotid artery below (low ligation) and above (high ligation) the origin of the occipital, lingual, and facial arteries reduced the blood flow by 61.1% and 71.5%, respectively. Low ligation together with ligation of the lingual artery reduced the blood flow by 73.5%. Multiple ligations (high and low ligations combined with ligations of the occipital, lingual, and facial arteries) reduced the blood flow by 81.8%. The internal maxillary artery was sectioned after the multiple ligations, and retrograde flow from the distal segment was studied. The flow was only a trace and could not be measured with the flowmeter. Total blood loss from both ends almost equaled the blood flow of the proximal segment, 18.2% of normal. Multiple occlusion appears to be the most effective treatment for hemorrhage from the initial part of the internal maxillary artery.
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8040739
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Oral opening and other selected facial dimensions of children 6 weeks to 36 months of age.
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Four hundred twenty-two children (Caucasians, Asians, and blacks) aged 6 weeks to 36 months were recruited. Five measurements (incisal edge distance, alveolar crest distance, closed mouth breadth, open mouth breadth, and nose-lip distance) were made by two calibrated examiners and an average was recorded. Because there were no statistically significant differences among races or genders the data were combined. The normative data for seven age groups (6 weeks to 36 months) and five oral-facial parameters are presented.
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8040738
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Comparison between intranasal and intravenous midazolam sedation (with or without patient control) in a dental phobia clinic.
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Two new modes of sedation; patient-controlled sedation (PCS) and intranasal sedation (INS) were compared with the traditional bolus intravenous sedation (BIVS) while delivering dental care to apprehensive patients in a specialized dental fear clinic. Effective sedation was evaluated in a randomized, prospective study in 42 ASA 1 and 2 patients, in a factorial design. Eighteen patients were sedated with .5% midazolam INS. Ten patients received intravenous PCS via a patient-controlled analgesia pump containing midazolam, and 14 patients received intermittent intravenous boluses of 1 mg midazolam given as needed (BIVS). Appropriate local anesthetic nerve blocks with 2% lidocaine with 1:100,000 epinephrine, and supplementary inhalation of nitrous oxide and oxygen via a nasal mask, were also given to all patients in the study. The dosage requirement with PCS was higher than that found with INS or BIVS. However, PCS produced some anxiety reduction when compared with INS and BIVS. It also reduced interfering movements during treatment more effectively than the other sedation modes. No complications were detected in any of the patients and they were able to leave the clinic within 1 hour after completion of treatment.
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8040737
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Fibrous union of the mandible: a review of 27 patients.
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To identify personal data, social traits, fracture characteristics, and treatment modalities that result in the development of mandibular fibrous union. Hospital charts and radiographs for 714 patients with mandibular fractures treated between March 1984 and August 1993 were retrospectively reviewed for the presence of fibrous union. The charts were evaluated for age, sex, race, fracture etiology, fracture location, personal habits, medical compromise, compliance, type and timing of treatment, type and timing of antibiotics, the presence of infection, type of fibrous union, and definitive care. The data were recorded and analyzed. A 3.2% incidence of fibrous union was identified. The body of the mandible was the most frequent site of fibrous union (66%). Twenty-one of the 24 patients surgically treated had a tooth in the line of fracture. Only five had teeth removed at the time of the initial procedure. Thirteen developed a post-operative infection. Ninety-four percent of the patients with fibrous union had at least one medical or social risk factor, which included alcohol abuse (63%), intravenous drug abuse (26%), noncompliance (37%), pulmonary problems (37%), smoking (41%), and others (37%). Age, race, sex, mechanism of injury, and failure to use antibiotics were not factors in the development of fibrous union. Medical and social risk factors (especially self-abusive habits), inadequate immobilization, anatomic location, teeth in the line of fracture, and the occurrence of late postsurgical infections were factors that contributed to the development of fibrous union.
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8040736
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Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy.
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Intraoperative maxillary blood flow was measured using laser Doppler flowmetry (LDF) in two groups of patients undergoing orthognathic surgery. Group 1 (n = 14) consisted of patients undergoing Le Fort I osteotomy and group 2 (n = 8) consisted of patients undergoing isolated mandibular osteotomies. In group 1, the mean gingival blood flow (GBF) decreased significantly over time during the course of the operation from 29.5 mL/min/100 g of tissue to 13.2 mL/min/100 g of tissue (P = .0001). The mean GBF did not change significantly over time in group 2 (P = .39). The results of this study demonstrate that 1) LDF may be used to measure intraoperative GBF during Le Fort I osteotomy with an acceptable level of variability, and 2) maxillary GBF decreased significantly over time during Le Fort I osteotomy procedures.
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8040735
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Radiographic evaluation of bone invasion of adenoid cystic carcinoma in the oral and maxillofacial region.
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To investigate the relationship between clinicopathologic features and bone invasion in adenoid cystic carcinoma. Thirty-two patients with adenoid cystic carcinoma were included. Of 17 patients with suspected bone invasion based on clinical and/or radiographic findings, 13 also underwent histologic evaluation. Bone invasion was detected in nine patients. Bone involvement was radiographically classified as erosive, diffuse invasive, or minimal change. No tumor infiltration into the surrounding bone marrow spaces was observed in the erosive-type tumors. However, tumor invasion through the resorbed cortex was observed with the diffuse invasive tumors and through the bone defects in the minimal change tumors. Histologically, diffuse invasive radiographic change was observed with solid lesions. However, minimal bone resorption was observed on radiographs of the glandular lesions, even when the tumor cells had infiltrated extensively into the bone marrow spaces. In the tumors of the tubular type, all three radiographic types were observed.
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8040734
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Management of severe facial injuries by local tissue traction.
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To evaluate the technique of tissue traction for the management of severe facial injuries. Twenty patients, 15 adults and five children, with severe soft tissue facial disfigurement resulting from war injuries were treated by the tissue traction technique. This procedure provides a cosmetically acceptable appearance when used as an immediate measure. A few complications were encountered in delayed cases such as areas of skin breakdown and some stiffness. The described technique proved to have several advantages over other more commonly used methods for closure of large wounds.
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8040733
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Procurement of dermal graft from the suprapubic or inguinal fold region with primary linear closure.
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To report on two cosmetically advantageous sites for the harvesting of dermal grafts. The traditional method of dermal graft harvest using a dermatome may leave an unsightly defect. Thirty-eight dermal grafts were harvested from either the inguinal fold or the suprapubic region. A freehand harvesting technique was used. The patients were all female and were having concurrent temporomandibular joint procedures. The donor sites were monitored for cosmetic result, patient satisfaction, and complications. All donor site wounds were determined to be cosmetically acceptable. The scars were well placed in anatomic skin folds. One complication, a seroma, was reported. Freehand graft harvest with primary closure provides an acceptable defect. The use of this technique in anatomically advantageous areas successfully conceals the resultant scar for heightened cosmesis.
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8040732
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An accurate method for open reduction and internal fixation of high and low condylar process fractures.
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This study was undertaken to evaluate a protocol for open reduction of both high and low condylar fractures that consistently produces accurate reductions, uses rigid internal fixation, and allows immediate function. This protocol was retrospectively evaluated in 22 consecutive patients (23 fractures). All patients functioned immediately. There were no inaccurate reductions, malocclusions, wound infections, neurosensory deficits, or reports of chronic pain. No patients required reoperation. The results of this study indicate that this protocol consistently produces accurate reduction of condylar process fractures and allows immediate function with a minimum of morbidity.
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8040731
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Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discoplasty and abrasion arthroplasty: preliminary results.
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This article describes the arthroscopic surgical treatment of disc perforations by discoplasty to mobilize the disc and reduce joint friction. Grade IV chondromalacia with exposed bone was treated by abrasion arthroplasty with the goal of resurfacing the bone with fibrocartilage. Preliminary data on the results of these procedures are presented.
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8040730
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Analysis of possible factors leading to problems after nonsurgical treatment of condylar fractures.
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An attempt was made to identify types of condylar fractures that, despite active nonsurgical treatment, lead to unsatisfactory clinical results. Ninety-two dentate adult patients with unilateral condylar fractures were studied clinically and radiologically. On the basis of the information collected, problematic cases were identified. These consisted of patients with persistent occlusal change and/or marked deviation of the mandible on mouth opening after removal of maxillomandibular fixation or during follow-up. Radiologic analyses were performed using panoramic and Towne's views, and the results of problematic and nonproblematic cases were compared. Using clinical parameters, two problem groups were found. In patients with persistent malocclusion, ramus height was significantly reduced, irrespective of degree or direction of angulation between the fragments. Deviation of the jaw on mouth opening, but no occlusal disturbances, occurred in those with dislocated condyles. Problematic condylar fractures can often be identified preoperatively by means of simple radiographic measurements and these cases should probably be treated surgically.
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8040729
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Tumor necrosis factor-alpha as a biochemical marker of pain and outcome in temporomandibular joints with internal derangements.
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Previous studies have demonstrated the presence of tumor necrosis factor-alpha (TNF) in human temporomandibular joint (TMJ) synovial fluid. The present study continues the investigation of the role of TNF in TMJs with internal derangements. Synovial fluid was obtained from 18 TMJs in 12 patients undergoing either arthroscopy (14 joints) or arthrotomy (four joints) for internal derangements. Standardized clinical data were collected preoperatively, intraoperatively, and postoperatively. When pain on palpation was absent, the mean preoperative TNF level was 14 +/- 6 ng/mL. When pain on palpation was present, the mean TNF level was 42 +/- 39 ng/mL (significant difference at P = .05). When the surgical outcome was poor, the mean preoperative TNF level was 26 +/- 9 ng/mL. When the outcome was within the stated guidelines for a favorable result, the mean TNF level was 12 +/- 7 ng/mL (significant difference at P = .05). In addition, a significant reduction (P = .05) in TNF following joint lavage (preoperative, 48 ng/mL to postoperative, 7 ng/mL) was found. The finding of a positive correlation between preoperative pain and TNF values suggests a biochemical basis for the origin of the pain associated with internal derangements. The relationship between preoperative TNF levels and surgical outcome suggests that the prognosis for surgery may be predicted by measuring biochemical markers of joint disease.
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8040724
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Denture labels affixed with light-cured versus self-cured resin.
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The use of a light-cured acrylic resin was compared to self-cured resin for sealing personal identification labels in existing removable dental prostheses. The light-cured material rated better consistently than the self-cured resin in lack of stain or yellowing, legibility of print, lack of porosity, marginal seal, and surface finish. Another valuable feature of this system was the reduced time required for completion of the procedure.
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8040723
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Dental professional liability issues.
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This article discusses the areas of practice and patient relations that contribute to dental malpractice claims. These areas include informed consent, third-molar extractions, failure to treat periodontal disease, prosthetics, and treatment of post-operative infections. Ways to avoid such claims are discussed. Emphasis is placed on the value of documentation and communication to help decrease the dentist's liability exposure.
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8040720
|
Direct posterior composites.
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Advances in materials science and a greater understanding of handling characteristics have come about with composite resin systems. This has led to more liberal use of these materials with greater confidence. In particular, greater success has been realized in posterior applications. The combined factors of material selection, case selection, and proper clinical techniques are reviewed in light of established findings.
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8040719
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Glass ionomer restoratives.
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This article gives an overview of the new hybrid (light-cured) glass ionomers, which are a combination of auto-cured glass ionomer and light-cured composite resin. The characteristics of these materials and the different brands available are discussed. A clinical technique for restoration of cervical lesions with these materials is presented.
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8040718
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A clinical perspective on dentin adhesives.
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The newer generation of dentin adhesives has changed the practice of restorative dentistry. Two features common to most of the bonding restorative materials are the ability to alter, through the use of acidic etching agents, the surface of the dentin and the ability to completely wet and re-infiltrate the altered dentin surface with a hydrophilic polymerizable monomer. The acidic etchants remove or break up the smear layer, partially demineralize and/or alter the mineral in the first few microns of the dentin surface, and expose the collagen fibril network. The hydrophilic adhesive monomers that contain both acidic and methacrylate groups on the same molecule are bifunctional in nature. These monomers are able to infiltrate the demineralized dentin due to their hydrophilic nature and polymerize to encapsulate the exposed collagen fibers. Available products can be divided into two broad categories: systems that contain a low concentration of adhesive monomer diluted in a volatile solvent and systems that use adhesive resins of moderate to high viscosity. Knowledge of the features and properties of dentin adhesives provides the needed rationale for the protocol of application and the proper choice of materials in restorative dentistry.
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8040717
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Repairing the ditched amalgam.
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Fractured or ditched margins are the most common problem associated with amalgam restorations. Unfortunately, continuously replacing dental amalgams takes its toll on a tooth. Good restorative practices demand that we limit the number of restorative procedures to which we subject a tooth. This paper looks at an effective technique for sealing the margins of ditched amalgam restorations. This technique allows the practitioner to repair the ditched area of the amalgam without replacing the amalgam restoration.
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8040716
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The indirect aesthetic inlay/onlay.
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Tooth-colored inlays and onlays for posterior restorations have gained in popularity, replacing time-honored amalgam or cast gold restorations in patients with high aesthetic concerns. This article discusses the available types of indirect inlay/onlay systems and compares them in relation to their marginal integrity, wear, and overall esthetics. A basic preparation outline is discussed.
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8040715
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The current status of etched porcelain veneer restorations.
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Since its introduction 10 years ago, the etched porcelain veneer restoration has performed exceedingly well. The union of etched porcelain, composite resin cement, and etched enamel has proven over this time to be an exceptionally durable and highly esthetic restoration. The author has placed more than 5,000 etched porcelain veneer restorations over the past 10 years, but has had to replace less than two percent of these restorations because of clinical failure. If properly constructed and placed, this restoration has the potential to survive the hostile oral environment at least as long as any other dental restoration, if not longer. This restoration should now be considered the modality of choice for many conditions that might previously have been treated with full coverage or direct composite bonding.
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8040707
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The effect of baking soda/hydrogen peroxide dentifrice (Mentadent) and a 0.12 percent chlorhexidine gluconate mouthrinse (Peridex) in reducing gingival bleeding.
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The purpose of this study was to determine the effectiveness of a baking soda/hydrogen peroxide dentifrice, Mentadent, and a 0.12 percent chlorhexidine gluconate mouthrinse, Peridex, in reducing gingival bleeding. Forty subjects were divided into three groups; the baking soda group, the chlorhexidine group and the control group. All groups received oral hygiene instruction and brushed and flossed three times per day. Bleeding point scores were evaluated at baseline and at five weeks. The baking soda/hydrogen peroxide group used the supplied dentifrice as their sole toothpaste. The 0.12 percent chlorhexidine group used the mouthrinse twice per day. The control group performed oral hygiene as instructed. At five weeks, the 0.12 percent chlorhexidine mouthrinse significantly reduced gingival bleeding. The dentifrice and control groups revealed no statistically significant reductions. The results indicate that the 0.12 percent chlorhexidine mouthrinse is useful in improving oral health, whereas the baking soda/hydrogen peroxide dentifrice offered no advantages to conventional oral hygiene.
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8040700
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Evaluation of the cariogenicity of sugar containing drinks by estimating changes in pH of human dental plaque and saliva.
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Cariogenicity of five commonly consumed carbonated beverage and sugar containing drinks (Frooti, sugarcane juice, Limca, Thumps up and Big Sipp) was evaluated by estimating changes in pH of human dental plaque and saliva in 2 groups of subjects (20 each) differing in caries experience (Group A DMFT zero; Group B DMFT 3-5). In group A subjects, pH of plaque did not fall to levels near critical pH (5.5) with any of the test drinks or control. However, in group B children the salivary pH did fall below critical levels in the case of Frooti while salivary pH fell below critical pH with Frooti and Thums up.
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8040699
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In vitro evaluation of micromarginal leakage of three filling systems--an autoradiographic analysis using radio isotope S35 as a tracer.
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An in vitro study was carried out on 60 human pre- molar teeth to study the sealing efficacy of Glass Ionomer, Silver amalgam, Composite resin and cavity varnish in Class V cavities. The filled specimens were thermocycled (4 degrees C +/- 2 degrees C and 60 degrees C +/- 2 degrees C) and subjected to Radio Isotope penetration tests. S35 was used as a tracer and autoradiography for detecting the microleakage. The extent of penetration of S35 in case of each material was assessed. No material was found to completely seal the cavity, however, Glass Ionomer could minimise the microleakage. Amalgam restorations exhibited gross microleakage which reduced to a great extent after application of cavity varnish. Composite resin was found to be superior to Silver amalgam in controlling microleakage.
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8040698
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Management of natal/neonatal/early infancy teeth.
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The natal, neonatal and early infancy teeth predominantly being of the normal series of primary dentition, the management should aim at preservation of these teeth for esthetics and maintenance of space for eruption of permanent successor. The treatment method should take into consideration (a) trauma to child's oral tissue or mother's breast (b) mobility and (c) danger of inhalation. Trauma was noted in 10 percent, mobility and danger of inhalation in 94 percent. Extraction carried out in 97 percent of 50 children with natal/neonatal/early infancy teeth showed that the neighbouring primary teeth tended to move into the extraction space. Eruption of the permanent successors to natal/neonatal teeth was not delayed, rather in some instances the eruption was found to be enhanced as compared to contralateral incisor as noted in unilaterally occurring natal/neonatal teeth. The mandibular anterior arch collapse was not permanent as the successors erupted uncrowded. The paper discusses the method and timing of extraction. From the immunological and hematological point of view the best time for extraction was calculated to be 7-25 days of birth.
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8040697
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Prevalence location and patency of accessory canals in primary molars using dye penetration under vacuum suction technique--an in vitro study.
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A study conducted on 120 primary molars (30 each of maxillary and mandibular 1st and 2nd molars) to find out the prevalence, location and patency of accessory canals and furcation formina using safranin red dye revealed the presence of accessory canals in 46 teeth (38.33 percent) with the major site being the furcation and furcation region.
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8040696
|
Prevalence of dental caries in handicapped children of Calcutta.
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A total of 1042, 3-14-year-old children with different types of handicapping conditions when recorded for dental caries using WHO 1987 caries recording index revealed that dental caries experience was higher in handicapped children than normal children. The prevalence of dental caries was highest in mentally retarded children followed by cerebral palsied, blind, epileptic, physically handicapped, children with Down's syndrome and deaf and dumb. Higher deft+DMFT was recorded in mandibular teeth compared to maxillary teeth.
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8040695
|
Langerhans' cell histiocytosis--a case report.
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A three and half year old boy with Langerhans' cell histiocytosis (LCH) formerly called as eosinophilic granuloma has been presented along with the desired treatment plan.
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8040693
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Role of trace elements Se and Li in drinking water on dental caries experience.
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An epidemiological survey of dental caries using modified Moller's index (1966) carried out in 483 children (aged 7-17 years) of rural areas--Talwandi Kalan, Dhanansu and Bhatian (District Ludhiana) of Punjab with almost similar F levels in their drinking water supply, similar socio-economic status, environmental factors/demographic parameters and dietary habits revealed wide variations in the prevalence and severity of dental caries. Further investigation extended to evaluate the concentrations of various trace elements Se, Li, Zn, Cu, Fe and Mn in drinking water to find out the disparity of dental caries status, revealed that the higher figures of prevalence and severity of dental caries observed in Dhanansu and Bhatian as compared to Talwandi Kalan could be attributed to the presence of Se in drinking water supply of these areas which was not detectable in the water supply of Talwandi Kalan. On the contrary, the concentration of Li in water supply of Talwandi Kalan with low caries was found to be higher compared to that of Dhanansu and Bhatian with higher dental caries in children population.
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8040692
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Placental transfer of fluoride in pregnant women consuming optimum fluoride in drinking water.
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The study was conducted on 25 healthy women residing in optimum fluoride areas, who were to deliver normally through vaginal route, to correlate the maternal and cord plasma fluoride levels and evaluate the placental transfer of fluoride. A wide variation was found in the maternal and cord plasma fluoride levels. In only 8 percent of the cases the fluoride levels in cord plasma were higher than maternal plasma. It was deduced that the placenta allows passive diffusion of fluoride from mother to foetus and does not act as a barrier.
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8040689
|
The effect of a career planning workshop on graduate dental hygienists.
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Purpose. The purpose of this study was to determine the effects of a career planning workshop on the career satisfaction, decisions, and plans of graduate dental hygienists. Method. A workshop was designed to teach graduate dental hygienists a systematic process for analyzing their needs and opportunities and making informed, realistic, and satisfying career decisions. This workshop incorporated vocational testing, interpretation by a professional counselor, lecture/discussion, small group interaction, and an accompanying manual of career planning resources and exercises. Sixty-nine dental hygienists attended a two-day workshop in fall 1990. Participants completed data collection instruments consisting of 42-item pre-assessment and 40-item follow-up questionnaires designed by the authors. Sixty-three completed the pre-workshop questionnaire. Fifty-four participants responded to the follow-up questionnaire mailed six months after the workshop. Data analyses included frequency distributions, percentages, means, and standard deviations. Paired t-tests and chi-square statistics were also calculated. Results. Findings from the pre-workshop questionnaire indicated that over 76% of participants had considered leaving their present position and 70% had considered leaving the profession. The six-month follow-up questionnaire revealed that four participants had changed dental hygiene employers and two had left the profession to pursue different careers. Forty-four percent reported that their feelings toward dental hygiene as a career had become more positive since attending the workshop. Pre-workshop to six-month follow-up responses indicated increased mean satisfaction in amount of challenge, compensation/rewards, and overall career satisfaction. Conclusions. The results of this study indicated that career planning workshops, in combination with other methods, are a useful strategy for helping dental hygienists maintain satisfaction, and have the potential to promote career longevity in the dental hygiene profession.
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8040688
|
ADHA Graduate Student/Faculty Research Project: health history.
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An American Dental Hygienists' Association (ADHA) study gathered demographic and practice data on dental hygienists in the United States. This paper describes the health history component of the survey. Specifically, this report focuses on who sees new patients first in the dental office, who collects health history information, who updates the health history and when, type of health history used, and how positive responses to health history items are investigated. A questionnaire jointly developed by ADHA and a research firm was sent in July 1986 to a stratified random sample of 10,507 ADHA member and nonmember dental hygienists licensed and practicing in the United States. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) to determine frequency distributions, cross-tabulations, and select profiles. Results. A response rate of 49.6% was obtained. Results revealed that new nonemergency patients were scheduled first with the dental hygienist. Health histories were recorded for almost all new patients but updated irregularly. A combination of a self-administered form and verbal interview was used. Recall patients' health histories were mainly updated by an oral interview. Follow-up on positive responses was most often accomplished by asking additional questions, followed by consultation with the dentist and/or physician. Dental hygienists felt least adequately informed to follow up on positive responses to homosexual status, and i.v. and recreational drug use. Conclusions. The dental hygienist plays a significant role in health history data collection both for new and recall patients. Educational programs for entry-level and practicing dental hygienists should emphasize effective interviewing to gather patient health history data.
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8040684
|
Quantitating familial cancer risk: a resource for clinical oncologists.
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Because a family history of cancer constitutes an important risk factor, estimation and communication of cancer risk can facilitate efforts toward early detection and prevention. This review provides a resource for health professionals called to draw upon a multidisciplinary literature to provide quantitative risk estimates to families with cancer. Descriptive population-derived, epidemiologic, genetic, genetic epidemiologic, and molecular studies are critically reviewed in the context of cancer genetic counseling. Data are presented that document the increased lifetime relative risk to relatives of individuals with cancers of the breast, ovary, colon, prostate, or other sites. In general, risk ratios are poorly suited for clinical counseling. Age-specific absolute risks are presented for first-degree relatives of individuals affected by cancers of the breast, ovary, and colon. The derivation of Mendelian and Bayesian risk estimates in the setting of well-defined cancer family syndromes, and the growing role of DNA testing in more accurately assessing these risks, are discussed. Such carrier testing requires careful psychologic and ethical considerations. Multidisciplinary cancer genetic counseling is an emerging resource available to physicians who care for families with common adult malignancies.
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8040683
|
The Community Clinical Oncology Program (CCOP) story: review of community oncologists' experiences with clinical research trials in cancer with an emphasis on the CCOP of the National Cancer Institute between 1982 and 1987.
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To review the growth of community physicians' involvement in National Cancer Institute (NCI) clinical research trials as a significant contribution to cancer control, and to show their impact, not yet fully realized, on cancer morbidity and mortality in the United States. Background information, based on the personal experience of participants, as well as a review of pertinent literature, portrays the evolution of the clinical research component of community oncology in the United States over the last 25 years. Data from Community Clinical Oncology Programs (CCOPs) I and II have been used to outline some of the results of this far-reaching program. The CCOP was introduced at an appropriate time to expand the clinical trial resources of the NCI, while at the same time helping community oncologists practice state-of-the-art cancer management found in the research protocols. This in turn provided improved resources to manage cancer patients, as most of them are treated in their own communities. CCOPs have also indirectly had a positive impact on the trial processes of the NCI cooperative groups and comprehensive cancer centers, and have helped to widen the scope and hasten progress in cancer-control research and practice.
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8040682
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Leukemia: management of relapse after allogeneic bone marrow transplantation.
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To review the current state of knowledge regarding the management of leukemic relapse after allogeneic bone marrow transplantation (BMT). The literature was analyzed using MEDLINE (National Library of Medicine, Bethesda, MD) and reports were identified through review of report bibliographies. Pertinent studies were selected and data synthesized into a review format. Leukemic relapse after allogeneic BMT is an important cause of treatment failure. The risk of leukemic relapse varies from 20% to 60% depending on the diagnosis and phase of disease. Reinduction chemotherapy (CT), second BMT, interferon (IFN) alfa, and donor leukocyte infusions are various options, but none of the approaches is clearly optimal. Approximately 50% of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients achieve remission after standard induction CT. However, most patients finally relapse and die of uncontrolled leukemia. Second BMT is successful in 20% to 25% patients and is a reasonable option in patients who relapse more than 6 months after the initial transplant. Young patients with a good performance status and those in remission from initial transplant relapse have a better outcome after second BMT. Venocclusive disease (VOD), interstitial pneumonitis (IP), and acute graft-versus-host disease (GVHD) are the main complications. Therapy with IFN alfa results in cytogenetic complete remission (CR) in 10% to 25% patients with chronic myeloid leukemia (CML). The initial results of leukocyte infusions from the original donor are promising. However, acute GVHD and bone marrow aplasia are associated complications. The correct dose and schedule of donor leukocyte infusions need to be determined in future studies to minimize GVHD while maintaining the graft-versus-leukemia (GVL) effect. Identification of patients at increased risk for relapse and use of biologic response modifiers post-transplant to augment the GVL effect in such patients are possible areas of improvement for future studies.
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8040681
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Transient acantholytic dermatosis in oncology patients.
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To evaluate the characteristics of patients with cancer who have a previous history, concurrent episode, or subsequent appearance of transient acantholytic dermatosis (TAD). We report four oncology patients who developed TAD and review the 22 reports that have previously been published of individuals in whom TAD appeared either before, concomitant with, or after the diagnosis of their malignancy. TAD was associated more frequently in patients with hematologic malignancies, especially acute and chronic myelogenous leukemia. It also appeared in patients with solid tumors, primarily those of the genitourinary organs. In almost all the cases, the onset of TAD was either concurrent or followed the discovery of malignancy. The TAD resolved completely, with or without treatment, in at least 20 patients in a median of 3 weeks. TAD is a benign and temporary condition that may occur in patients with an internal malignancy. When the diagnosis of TAD is being considered, a lesional skin biopsy readily establishes histologic confirmation in a febrile patient with cancer who develops a new rash. TAD has been observed most frequently in oncology patients who have either myelogenous leukemia or carcinoma of the genitourinary organs. The appearance of TAD coincided with either the detection or the recurrence of malignancy in three individuals (12%). In the other 23 oncology patients, TAD was most likely secondary to either antineoplastic agents, excessive perspiration, fever, occlusive immobility, and/or ionizing or UV radiation.
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8040680
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Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group.
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To evaluate incidence, time trends, geographic distribution, clinicopathologic presentation features, and prognostic factors for survival and relapse in gastrointestinal (GI) non-Hodgkin's lymphomas (NHLs). Over a 9-year period (1983 to 1991), 2,446 new NHL cases were recorded in a Danish population-based NHL registry (Danish Lymphoma Study Group [LYFO]). Of these, 306 (12.5%) were GI NHL (175 gastric, 109 intestinal, and 22 both sites). LYFO registry data were used for incidence rate (IR) assessment, and time-trend and geographic distribution analysis. Relative risk (RR) values for survival and relapse were identified by multivariate analysis. The mean annual, age-standardized IRs for gastric and intestinal NHL were 0.71/10(5) and 0.48/10(5) per year, respectively. Age-specific IRs for both localizations showed an exponential increase as a function of age. Time-trend analysis for the period 1983 to 1991 showed stable IRs for both localizations. Intestinal NHL was more frequent in males (male-to-female ratio, 2.0 v 1.3), and had a higher occurrence of disseminated disease, constitutional symptoms, high-grade histology, and T-cell phenotype (10% v 2%). Gastric NHL had more low-grade cases (38% v 19%), and almost all were of the mucosa-associated lymphoid tissue (MALT) type. The cause-specific 5-year survival rate was 63% for gastric NHL and 49% for intestinal NHL. The Musshoff staging system was an excellent discriminator between truly localized (stage I and II1) and disseminated cases (stage II2 to IV), particularly for gastric NHL, for which no survival difference was found between surgically and conservatively stage localized cases. (1) No increase in the incidence of GI NHL was found over a 9-year observation period; (2) nonrandom spatial distribution of new GI NHL cases was observed; (3) factors that significantly increased the risk of death in gastric cases were presence of B symptoms (RR = 3.3), clinical stage is more than II1 (RR = 3.0), age more than 72 years (RR = 2.4), and elevated serum lactate dehydrogenase (s-LDH) level (RR = 2.0); and factors that increased the risk of death in intestinal cases were presence of B symptoms (RR = 3.2), age more than 58 years (RR = 2.8), and clinical stage more than I (RR = 2.1); (4) factors that significantly increased the risk of relapse in gastric cases were male sex and no radiotherapy in primary treatment; and in intestinal cases were T-cell phenotype and no surgery in primary treatment; (5) surgical staging, as opposed to thorough noninvasive staging, did not improve staging accuracy and final outcome in localized gastric NHL.
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8040679
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Patient characteristics associated with high-risk methotrexate concentrations and toxicity.
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Following high-dose methotrexate (HD-MTX) treatment, delayed MTX elimination is an important problem because it necessitates increased leucovorin rescue and additional hospitalization for hydration and urinary alkalinization. Our purpose was to identify factors associated with high-risk MTX plasma concentrations (defined by plasma concentration > or = 1.0 mumol/L at 42 hours from the start of MTX) and with toxicity. Variables associated with MTX concentrations and toxicity were assessed in 134 children treated with one to five courses of HD-MTX (900 to 3,700 mg/m2 intravenously [i.v.] over 24 hours for a total of 481 courses) for acute lymphoblastic leukemia (ALL). High-risk MTX concentrations, toxicity (usually mild mucositis), and delay in resuming continuation chemotherapy occurred in 106 (22%), 123 (26%), and 66 (14%) of 481 courses, respectively. Using a mixed effects model for repeated measures, high-risk MTX concentrations were significantly associated with a higher MTX area-under-the-concentration-time curve (AUC), low urine pH, emesis, low MTX clearance, low urine output relative to intake, use of antiemetics during the MTX infusion, and concurrent intrathecal therapy (all p values < .01). Clinical toxicities and delay in resumption of continuation chemotherapy due to myelosuppression were more common in those with high 42-hour MTX concentrations, despite increased leucovorin rescue for all patients with high-risk MTX concentrations. However, with individualized rescue, no patient developed life-threatening toxicity. A more aggressive hydration and alkalinization regimen for subsequent courses reduced the frequency of high-risk MTX concentrations to 7% of courses (13 of 183) (P = .0001), and the frequency of toxicity decreased to 11% of courses (P = .0074). This study identified several clinical variables that influence MTX disposition that, when modified, can reduce the frequency of high-risk MTX concentrations and toxicity.
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8040678
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Comparative study of the pharmacokinetics and toxicity of high-dose epirubicin with or without dexrazoxane in patients with advanced malignancy.
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We evaluated the toxicity and pharmacokinetics of the combination of dexrazoxane with epirubicin at dexrazoxane/epirubicin dose ratios of 5 to 9:1 in a controlled, crossover phase I study in patients with advanced malignancy. Thirty-eight patients with a variety of malignancies were enrolled. Assessable patients received two cycles of chemotherapy consisting of epirubicin alone and in combination with dexrazoxane. Comparisons were made between the toxicity and pharmacokinetics of epirubicin in the two treatment arms, using each patient as his or her own control. Dexrazoxane and epirubicin were delivered at dose levels of 600/120 mg/m2, 900/120 mg/m2, 900/135 mg/m2, 900/150 mg/m2, and 1,200/135 mg/m2, respectively. Twenty-six patients completed two cycles of chemotherapy and were therefore assessable. The maximum-tolerated doses (MTDs) of dexrazoxane/epirubicin were 1,200/135 mg/m2, with the dose-limiting toxicities being neutropenia, infection, and stomatitis. There was no difference in the nadir neutrophil or platelet counts between single-agent and combination treatment at any of the dose levels. Severe vomiting and stomatitis occurred less frequently following administration of epirubicin and dexrazoxane when compared with epirubicin alone (P = .01 and .02, respectively). Prior administration of higher doses (900 mg/m2 and 1,200 mg/m2) of dexrazoxane increased the systemic clearance of epirubicin, resulting in a decrease in the area under the curve (AUC). Elimination half-life, maximum plasma concentration (Cmax), and apparent volume of distribution of epirubicin were not significantly affected by dexrazoxane. Left ventricular ejection fraction (LVEF) decreased by greater than 10% in two patients, but neither developed clinical or radiologic evidence of cardiac failure. This study demonstrates that dexrazoxane can be safely combined with escalating doses of epirubicin at dose ratios of 5 to 9:1 without having an adverse impact on toxicity. Studies are need to determine the optimal dose ratio for cardioprotection and to explore further the pharmacokinetic interactions of the two drugs at increasing doses of epirubicin supported by hematopoietic growth factors.
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8040677
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Plasminogen activator inhibitor-1 and prognosis in primary breast cancer.
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Evaluation of the relationship between plasminogen activator inhibitor-1 (PAI-1) and the metastatic potential of primary breast cancer, and to compare the prognostic impact of PAI-1 in multivariate analysis with those of conventional prognostic factors, including steroid-hormone receptors, and those of urokinase plasminogen activator (uPA), pS2-protein (PS2), and cathepsin D. Cell biologic prognostic factors were analyzed in 657 cytosols routinely prepared from frozen-tissue biopsies that were submitted to our laboratory for the assessment of steroid-hormone receptor status. The median duration of follow-up in patients still alive at the time of analysis was 48 months. Estrogen receptor (ER) and progesterone receptor (PgR) status were assessed by radioligand binding assay, PS2, and cathepsin D by radiometric immunoassay, and uPA and PAI-1 by enzyme-linked immunosorbent assay (ELISA). PAI-1 levels were found to be strongly positively correlated with the rates of relapse (P < .0001) and death (P < .001). Relating the levels of PAI-1 with those of other cytosolic prognostic factors, we found a positive association with the metastasis-related proteases uPA (P < .0001) and cathepsin D (P < .0001). On the other hand, PAI-1 levels were found to be negatively correlated with ER (P < .005) and PgR (P < .001), and the estrogen-regulated pS2-protein (P < .001), which are proteins associated with a favorable prognosis. In multivariate regression analysis for 5-year relapse-free survival, and using an optimized cutoff point for discrimination between PAI-1-positive and -negative, independent predictors of the rate of relapse were found to be PAI-1 (P < .0001) and uPA (P = .01) of the cytosolic parameters, and tumor size, lymph node status, and premenopausal age of the clinical parameters. In multivariate analysis in patients with node-negative disease, only PAI-1 (P < .001) and tumor size (P = .03) were positively and premenopausal age negatively (P < .001) associated with the rate of relapse. In patients with node-positive disease, PAI-1 (P < .001), uPA (P = .02), tumor size (P < .001), and the number of positive lymph nodes (P < .001) were all positively associated with the rate of relapse. We conclude that the PAI-1 level measured in routinely prepared cytosols is an important parameter to predict the metastatic potential in both node-negative and node-positive human primary breast cancer.
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8040675
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Tamoxifen versus high-dose oral medroxyprogesterone acetate as initial endocrine therapy for patients with metastatic breast cancer: a Piedmont Oncology Association study.
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To determine in a prospective randomized trial whether high-dose orally administered medroxy-progesterone acetate (MPA) was superior to tamoxifen in patients with recurrent or metastatic breast cancer who had received no prior endocrine therapy in either the adjuvant or advanced setting. Patients initially received either tamoxifen 20 mg/d orally or MPA 1 g/d orally. At the time of disease progression, patients were crossed over to the other regimen. Eligibility required patients to be age > or = 18 years, performance status 0 to 3, and estrogen receptor (ER)- or progesterone receptor (PR)-positive or unknown. One hundred eighty-two eligible patients were entered and 166 were assessable for response. Complete plus partial response rates for tamoxifen and MPA were 17% and 34%, respectively (P = .01). Patients with bone metastases had a significantly higher partial response rate with MPA compared with tamoxifen (33% v 13%). Median time to treatment failure was 5.5 months for tamoxifen and 6.3 months for MPA (P = .48). The median survival duration was 24 months for tamoxifen and 33 months for MPA (P = .09). Multivariate analysis showed that treatment significantly influenced response rate, but not time to treatment failure or survival. After treatment failure following MPA, six of 42 patients (14%) treated with tamoxifen responded, compared with six of 49 (12%) treated with MPA following tamoxifen. Both agents were associated with minimal toxicity, but 35% of patients on MPA gained more than 20 lb as opposed to only 2% on tamoxifen. In this trial, initial treatment with MPA of endocrine-naive metastatic breast cancer patients was associated with a significantly higher response rate but not with improvement in time to treatment failure or survival, when compared with initial treatment with tamoxifen. Further randomized trials in patients with bone metastases are warranted to determine if high-dose progestin therapy is superior to tamoxifen in these patients.
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8040676
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Salvage therapies in women who fail to respond to first-line treatment with fluorouracil, epirubicin, and cyclophosphamide for advanced breast cancer.
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We studied all salvage therapies given until death or the end of follow-up evaluation in women who failed to respond to the same first-line cytotoxic therapy for metastatic breast cancer. The study cohort consisted of 140 women who had received the fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen for metastatic breast cancer. Eight patients were excluded. No exclusions with respect to disease site, performance status, or biochemical abnormalities were made. The median follow-up time was 29 months for surviving patients. Most patients (88%) died during the follow-up period. Patients received a median of three salvage therapies (range, zero to eight) during the course of disease. Most courses (52%) were not assessable for response. Fifty-percent of courses consisted of chemotherapy: 35% of hormonal and 15% of combination of cytotoxic and hormonal therapies. The median duration of therapy (DT) ranged from 4 to 1 months, and decreased with advancing stages of therapy. Similarly, median time to treatment failure (TTF) ranged from 3 to 0.5 months. For unknown causes, patients who received second-line hormonal therapy fared better than those who received other forms of therapy. Of 366 analyzed courses, only one complete response (CR) and 18 partial responses (PRs) were observed (response rate, 11% for assessable and 5% for all courses). Stable disease for at least 3 months was found in 20% to 25% of courses. Most responses (n = 10) occurred during first salvage therapy, and no responses were observed after third salvage therapy. Response rates for salvage therapies were low, and median treatment times short. The value of offering more than two salvage chemotherapy regimens to an unselected group of patients is questionable.
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8040674
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Phase II investigational window using carboplatin, iproplatin, ifosfamide, and epirubicin in children with untreated disseminated neuroblastoma: a Pediatric Oncology Group study.
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Children less than 1 year of age with metastatic neuroblastoma NB are at high risk of death. The need to identify new and effective chemotherapy agents is clear. A study was conducted by the Pediatric Oncology Group (POG) to determine the efficacy and safety of administering two courses of a single phase II agent before conventional treatment as a means to evaluate new agents in this setting. One hundred seventy-three eligible patients more than 1 year of age with disseminated neuroblastoma received two courses of one of the following: ifosfamide (IFOS) 2 g/m2/d for 4 days intravenously (IV) plus mesna; carboplatin (CARB) 560 mg/m2 i.v. over 1 hour; iproplatin (CHIP) 325 mg/m2 IV over 2 hours; or epirubicin (EPIR) 90 mg/m2 i.v. push. Following evaluation for response and toxicity, eligible patients were randomized to receive either cisplatin 90 mg/m2 i.v. on day 1, etoposide 200 mg/m2 i.v. on day 3, cyclophosphamide 150 mg/m2/d orally on days 7 to 13, doxorubicin 35 mg/m2 i.v. on day 14 (CECA), or cisplatin 40 mg/m2 IV on days 1 to 5 and etoposide 200 mg/m2 i.v. on days 2 to 4 alternating at 3-week intervals with cyclophosphamide 150 mg/m2/d orally on days 1 to 7 and doxorubicin 35 mg/m2 IV on day 8 (HDP/VP/CA). An additional 86 patients were randomized to receive either CECA or HDP/VP/CA without initial phase II therapy. After phase II therapy, only 20% of patients experienced grade 3/4 hematopoietic toxicity. No toxic deaths occurred. Objective response rates (partial responses [PRs] plus minor responses [MRs]) following IFOS, CARB, CHIP, and EPIR were 70%, 77%, 67%, and 26%, respectively. Following phase III treatment, there was no statistically significant difference in rates of complete response (CR)/PR or progressive disease (PD), or in time to PD of patients who participated in the phase II window versus those who received only CECA or HDP/VP/CA. IFOS, CARB, and CHIP are efficacious in neuroblastoma, are well tolerated, and should be incorporated into primary treatment regimens. Combination regimens using these agents may be possible, since most repeat courses were given within 2 weeks. Administering phase II therapy to untreated patients with high-risk tumors provides a unique and sensitive method to assess new agents without compromising patient outcome.
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8040673
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Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the Childrens Cancer Group.
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Very young children with CNS primitive neuroectodermal tumors (PNETs) and ependymomas have a poor prognosis and commonly have impairment of growth and cognitive abilities, in part resulting from radiotherapy. Thus, an intensive chemotherapeutic regimen was used to treat children less than 18 months of age at diagnosis. Children were treated on a Childrens Cancer Group (CCG) protocol with an eight-drug chemotherapeutic regimen (vincristine, carmustine, procarbazine, hydroxyurea, cisplatin, cytarabine, prednisone, and cyclophosphamide) following surgery and postoperative staging. Delayed or reduced-volume radiotherapy was to be administered to all patients, but, in fact, was omitted in most cases. On central review of pathology, 82 children had diagnosis concordant with study entry criteria. Of these, 46 (56%) had posterior fossa (PF) PNET, eight (10%) had pineal PNET, 11 (12%) had nonpineal supratentorial PNET, 15 (18%) had ependymoma, and two had rhabdoid tumors. Fifty percent of tumor resections were complete, as verified by postoperative computed tomographic (CT) scan, and 23% of patients had metastatic disease at the time of diagnosis. Objective tumor response was documented following two cycles of chemotherapy in 28% of assessable patients. Toxicity of chemotherapy was primarily hematopoietic. Five children died of chemotherapy-related complications. Radiotherapy was administered to only nine patients before tumor progression. The 3-year progression-free survival (PFS) rates for PF PNET, pineal PNET, supratentorial nonpineal PNET, and ependymoma are 22% (SE = 6%), 0%, 55% (16%), and 26% (11%), respectively. The 3-year PFS rate for those children without metastatic disease was 29% (6%), as compared with 11% (6%) for those with metastatic disease. The only independent predictors of PFS were metastasis stage and location of the tumor within the pineal region. The median time to progression was 6 months. Twenty-four children completed the chemotherapeutic regimen without tumor progression; 19 are event-free survivors more than 2 years from diagnosis, only three of whom received radiation therapy. While overall survival in this group of very young patients is poor, a subset of children who have received only chemotherapy as adjuvant treatment remain free from tumor recurrence.
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8040672
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Correlation of DNA content of laryngeal epithelial lesions to degree of malignancy.
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The aim of the present study was to determine the role of DNA content in laryngeal epithelial lesions of different degrees of malignancy. A total of 53 lesions were studied, which included five benign tumors, 18 dysplasias, and 30 carcinomas of different degrees of differentiation and clinical stage. In all cases, the DNA content was determined by microspectrophotometry of paraffin-embedded Feulgen-stained biopsies. We found significant differences between the DNA-content histograms corresponding to each lesion group studied. Of special interest was the transition from moderate to severe dysplasia (characterized by a striking increase in the G2M-phase cells) and the transition from severe dysplasia to carcinoma (characterized by a brusque change in the modal ploidy of the lesion). The determination of DNA content, and study of DNA histogram, will help to assess degree of malignancy in epithelial lesions of the larynx.
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8040671
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Tumor response, toxicity, and survival after neoadjuvant organ-preserving chemotherapy for advanced laryngeal carcinoma. The Department of Veterans Affairs Cooperative Laryngeal Cancer Study Group.
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In 1984, the Department of Veterans Affairs Cooperative Studies Program began a trial in which patients with resectable squamous cell carcinoma of the larynx were randomized to receive standard surgery followed by radiation therapy or to receive neoadjuvant therapy with cisplatin and fluorouracil (5-FU) followed by radiation therapy for those achieving a greater than 50% tumor response to chemotherapy. This analysis reviews the tumor responses, toxicity, compliance, and long-term survival for those patients randomized to the chemotherapy arm. One hundred sixty-six patients were randomized to the chemotherapy arm. Standard tumor response data, chemotherapy toxicity, and survival have been examined using standard statistical methods. The high response rates and acceptable toxicity to cisplatin and 5-FU of previously untreated patients were confirmed. Long-term disease-free survival was more likely to occur in patients who achieved a complete response to chemotherapy, particularly in those who had a confirmed histologic response to chemotherapy. Pretreatment histologic growth patterns were highly predictive of responses to chemotherapy. Neoadjuvant chemotherapy was well tolerated and did not negatively affect the definitive treatment that followed. The survival of nonresponding patients who underwent prompt salvage surgery was also not impaired. The role of organ preservation should be explored in other head and neck sites.
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8040670
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Incidence of multiple myeloma in Olmsted County, Minnesota: 1978 through 1990, with a review of the trend since 1945.
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Incidence rates of multiple myeloma appear to have increased in recent decades, but it is difficult to compare the incidence rates over time because of changes in laboratory procedures, differences in diagnostic criteria, and variations in indexing of medical records. However, Olmsted County, Minnesota, provides a rare opportunity to minimize these limitations, because the medical care has been provided mainly by the Mayo Clinic. Records of Olmsted County residents with a diagnosis of multiple myeloma from January 1, 1978 through December 31, 1990 were reviewed. Criteria for diagnosis and residency were the same as in previous Olmsted County studies. The incidence rate per 100,000 age-adjusted to the 1950 United States white population was 5.4 for males and 2.8 for females; the overall rate was 4.1. The rates were age-adjusted to the 1950 United States population for comparison with earlier data from this population. The rates increased with age for both sexes. There was no significant change in incidence rates from 1945 through 1990. A comparison of the median age for Olmsted County patients with the age of those referred to the Mayo Clinic from elsewhere indicated that the local patients were appreciably older (74 v. 62 years, respectively). Thirty-two of 55 patients (58%) with multiple myeloma from 1978 through 1990 had a monoclonal plasma-cell proliferative process before the diagnosis of multiple myeloma. The incidence rate of multiple myeloma in Olmsted County, Minnesota, has not changed significantly during the past 46 years. We believe that reports of increasing rates over time are mainly due to improved case ascertainment.
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8040669
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Randomized comparison of high-dose and low-dose intravenous interleukin-2 for the therapy of metastatic renal cell carcinoma: an interim report.
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A randomized prospective study was performed to compare the efficacy and toxicity of high-dose intravenous bolus interleukin-2 (IL-2) and a lower-dose intravenous bolus regimen for the treatment of metastatic renal cell carcinoma (RCC). Between March 1991 and April 1993, 125 patients with metastatic RCC were randomized to receive IL-2 by intravenous bolus every 8 hours at either 720,000 IU/kg (high-dose) or 72,000 IU/kg (low-dose) to the maximum-tolerated number of doses (or a maximum of 15 doses). After approximately 7 to 10 days, both treatment groups were re-treated with a second identical cycle of therapy. Those patients who were stable or responding to treatment 5 to 6 weeks later went on to receive re-treatment with another course (two cycles) of therapy. Response rates and toxicity were determined for the two treatment arms. One hundred twenty-five patients received a total of 208 courses of therapy. Sixty patients were randomized to receive low-dose, and 65 to receive high-dose IL-2. There were no treatment-related deaths in either arm. There was a greater incidence of grade III or IV thrombocytopenia, malaise, and hypotension in patients who received high-dose IL-2, while patients who received low-dose IL-2 had significantly more infections. Three percent of treatment courses with low-dose IL-2 required vasopressor support, compared with 52% of courses with high-dose IL-2. Patients who received low-dose IL-2 had a 7% complete response (CR) and an 8% partial response (PR) rate, and patients who received high-dose IL-2 had a 3% CR and a 17% PR rate. Low-dose intravenous bolus IL-2 represents an effective regimen for the treatment of metastatic RCC, with preliminary results comparable to those observed with high-dose IL-2. Low-dose IL-2 can be administered with significantly fewer complications, reduced use of vasopressor support, and fewer admissions to an intensive care unit (ICU).
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8040668
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Phase I/II study of iodine 131-labeled monoclonal antibody A33 in patients with advanced colon cancer.
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A phase I/II study was designed to determine the maximum-tolerated dose (MTD) of iodine 131-labeled monoclonal antibody (mAb) A33 (131I-mAb A33) administered intravenously, its limiting organ toxicity, and its radioisotope retention in tumors, and to develop preliminary evidence of antitumor activity. Patients (N = 23) with colorectal cancer who had failed to respond to conventional chemotherapy but had not received prior radiotherapy were treated with escalating doses of 131I-mAb A33. Three or more patients were entered at each dose level, starting at 30 mCi/m2, with increments of 15 mCi/m2 to a maximal dose of 90 mCi/m2. Radiolabeling was performed to maintain a specific activity of 30 mCi/m2/4 mg mAb A33 (projected maximum, 15 mCi/mg). Patients were under strict isolation precautions until whole-body radiation levels decreased to less than 5 mrem/h at 1 m. Serial radioimmunoscintigrams were performed in some cases for up to 3 weeks after 131I-mAb A33 administration. All 20 patients with radiologic evidence of disease showed localization of radioisotope to sites of disease. Two patients with elevated carcinoembryonic antigen (CEA) levels and negative radiologic tests did not have positive antibody scans. One patient with a small-bowel cancer also had a negative antibody scan. The major toxicity was hematologic and was more pronounced in patients with compromised bone marrow due to prior chemotherapy. Of five patients who received 78 to 84 mCi/m2 131I-mAb A33, one had grade 3 and one grade 4 toxicity; of six patients treated with 86 to 94 mCi/m2 131I-mAb A33, two had grade 4 and one grade 1 toxicity. The MTD was determined to be 75 mCi/m2 in these heavily pretreated patients. Although the isotope showed variable uptake in the normal bowel, gastrointestinal symptoms were mild (n = 8) or absent. No major responses were observed; however, three patients had evidence of mixed responses, and CEA levels decreased in two patients without clinical or radiologic measurable disease. Immunoreactivity of radiolabeled mAb A33 decreased at the highest dose levels in preparations in which specific activity exceeded 18 mCi/mg. The A33 antigen appears to be a promising target for radioimmunotherapy of colon cancer. The modest antitumor activity of 131I-mAb A33 in heavily pretreated patients is encouraging because of its lack of toxicity in the bowel, the only antigen-positive normal tissue.
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8040667
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Multiinstitutional phase II trial of intensive combination chemoimmunotherapy for metastatic melanoma.
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To evaluate the activity and toxicity of combined high-dose cisplatin, dacarbazine (DTIC), and tamoxifen chemotherapy and high-dose bolus interleukin-2 (IL-2) in patients with metastatic melanoma. Patients with metastatic melanoma, Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and normal organ function were enrolled onto this multiinstitutional Cytokine Working Group trial. Patients received intensive chemoimmunotherapy consisting of cisplatin (50 mg/m2) and DTIC (350 mg/m2) intravenously (IV) on days 1 to 3 and 43 to 45, IL-2 600,000 IU/kg IV every 8 hours on days 12 to 16 and 26 to 30 (maximum, 28 doses), and tamoxifen 20 mg orally each day. Patients were evaluated for response at day 63 of each cycle, and responding patients were given a second cycle of therapy beginning on day 71 to 85. Thirty-eight patients were entered onto this study. Toxicities were as expected for the chemotherapy and immunotherapy components of this regimen. Overlapping toxicity consisted primarily of thrombocytopenia (76% of patients required platelet transfusions), neutropenia, anemia, fatigue, and weight loss. Despite these cytopenias, bleeding and infectious complications were rare. There were no treatment-related deaths. Three patients achieved a complete response (CR; 8%), and 13 achieved a partial response (PR). The overall objective response rate was 42% (95% confidence interval [CI], 26% to 58%). Six additional patients had greater than 50% tumor reduction at day 63, which did not persist until a subsequent evaluation. The median duration of response was 5 months (range, 2 to 20+), and the median survival duration was 11 months. This intensive treatment regimen appears to possess activity in metastatic melanoma comparable, but not superior, to that of other less intensive cisplatin- and IL-2-based chemoimmunotherapy regimens. Although the toxicity and complexity of this regimen make it unsuitable for phase III testing and impractical for more widespread use, the results of this study support a potential favorable interaction between IL-2 and chemotherapy in this disease and highlight the need for appropriately designed phase III trials.
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8040666
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Role of radiotherapy in combined modality treatment of locally advanced non-small-cell lung cancer.
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For patients with locally advanced (stage III) non-small-cell lung cancer (NSCLC), radiotherapy (RT) has been used conventionally for many years. Few prospective trials have determined the role of RT. Recently, chemotherapy (CT) has been shown to produce excellent responses in regionally advanced disease. We therefore conducted a randomized trial using cisplatin (P)-based CT regimens with or without thoracic irradiation. We randomly assigned 92 patients with locally advanced NSCLC to receive one of three arms of P-based combination chemotherapy: vindesine (V) plus P, mitomycin (M) plus V plus P, or etoposide (E) plus P alternating with V plus M. After two cycles of CT, patients were reevaluated and those with stage III were again randomized to receive RT or not. RT consisted of 50 to 60 Gy in 5 to 6 weeks; 2 Gy was delivered once daily in conventional fractions. Sixty-three patients were included in the second randomization. The patients in the CT/RT group (n = 32) and CT-alone group (n = 31) were comparable in terms of age, sex, performance status, histologic features, stage of disease, and induction CT regimen. The median durations of survival were similar for the two groups (461 days in CT/RT group and 447 days in CT-alone group). The survival rate in the CT/RT group was 58% at 1 year, 36% at 2 years, and 29% at 3 years, as compared with 66%, 9%, and 3% at 1, 2, and 3 years, respectively, in the CT-alone group. One patient in the CT/RT group died of pneumonitis, but there were no CT-related deaths. In locally advanced NSCLC, P-based combination CT followed by chest irradiation significantly increases the number of long-term survivors as compared with CT alone. RT to bulky disease in the thorax is thus an important part of combined modality therapy, and a necessary part of further studies in locally advanced disease.
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8040665
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Clinical significance of t(14; 18)-positive cells in the circulation of patients with stage III or IV follicular non-Hodgkin's lymphoma during first remission.
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To evaluate polymerase chain reaction (PCR) analysis as a method for the detection of circulating lymphoma cells in patients with stage III and IV t(14; 18)-positive follicular Non-Hodgkin's lymphoma (NHL) in first remission in a longitudinal prospective study. Peripheral blood or bone marrow from eight patients with stage III and IV t(14; 18)-positive NHL was studied using PCR to detect the presence of t(14; 18)-positive cells in the circulation at different times during first remission. In four of six patients with no clinical evidence of disease (NCED), t(14; 18)-positive cells were detectable in the circulation. In one of two patients with clinical evidence of disease (CED), no t(14; 18)-positive cells were found at the four different occasions tested during first remission. First-remission duration ranged from 17 to 81+ months. The duration from the first PCR determination in remission until first relapse or the end of the observation period ranged from 10 to 37+ months. In patients with t(14; 18)-positive follicular NHL stage III and IV, treated with conventional remission induction therapy, the presence or absence of t(14; 18)-positive cells in the circulation shows no obvious correlation with the clinical remission status and the remission duration.
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8040664
|
Efficacy and safety profile of gemcitabine in non-small-cell lung cancer: a phase II study.
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The aim of this study was to evaluate the efficacy and toxicity of gemcitabine at higher doses than had been used previously in patients with non-small-cell lung cancer (NSCLC). Eighty-four patients (65 men, 19 women; age range, 35 to 75 years; mean age, 59 years) with locally advanced or metastatic pathologically documented NSCLC were enrolled. Patients had bidimensionally measurable disease, as defined by computed tomographic (CT) scan or chest x-ray. A total of 28.6% had previously been surgically treated, while 9.5% had received radiotherapy. Fifty-three patients commenced at a dose of 1,000 mg/m2, and 31 at a dose of 1,250 mg/m2. Patients were to receive two dose escalations of 25%, provided that overall toxicity was no worse than World Health Organization (WHO) grade 1 or WHO grade 0 for platelets. Responding patients were reviewed and validated by a blinded oncology review board (ORB) of experts not involved with the study. Of the original 84 patients enrolled, 76 were assessable. The overall response rate was 20% (95% confidence interval [CI], 11.6% to 30.8%). There were two complete responses (3%) and 13 partial responses (17%). Hematologic toxicity was negligible. WHO grade 3 WBC toxicity occurred in 0.9% of doses and WHO grade 4 in 0.1%. WHO grade 3 and 4 thrombocytopenia occurred in 0.1% and 0.1% of all doses, respectively. Nonhematologic toxicity was minor and easily controlled. Common side effects included peripheral edema, asthenia, and transient malaise. The single-agent efficacy of gemcitabine is equivalent to other agents commonly used to treat NSCLC. Gemcitabine has an unusually mild side effect profile for such an active agent. The nausea and vomiting experienced with gemcitabine are mild and generally well controlled with standard antiemetics; 5-HT3 receptor antagonists are typically not required. The use of gemcitabine does not cause significant alopecia, and hematologic toxicity is modest and unlikely to require hospitalization. Gemcitabine may have a role as monotherapy in patients with inoperable NSCLC.
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8040659
|
Gender differences in how medical students learn to rate psychopathology.
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The aim of this study was to examine factors influencing medical students' learning of psychopathology assessments during the psychiatric clerkship. The subjects included 122 third-year medical students participating in a 6-week psychiatric clerkship. They completed Brief Psychiatric Rating Scale ratings on short, focused interviews in a balanced design before and at the end of the clerkship. Deviation of their ratings from standard ratings by experienced psychiatrists constituted the dependent variables. Female medical students showed a clear significant improvement during the clerkship, whereas male students tended to experience a significant reduction in their accuracy. We conclude that there may be gender-related differences in these medical students' ability to assimilate and cope with the clinical experience of the psychiatric clerkship. The implications of these findings for psychiatry training are discussed.
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8040658
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Risk perception by patients with anxiety disorders.
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Studies by social psychologists have recently shown that normal people have systematically distorted perceptions of risk. We extend these studies to patients with anxiety disorders to see how they differ from normal subjects, and, more specifically, to test the hypothesis that anxiety disorders might result from excessively objective risk assessments. Fifty patients with anxiety disorders and 50 matched controls estimated the likelihood that 22 events would happen to the average person or to the self. On both measures, and on accuracy, the groups were essentially identical. In confirmation of previously reported patterns of risk distortion, both groups overestimated rare risks, underestimated common risks, and consistently underestimated the relative risks to self. These results suggest that cognitive estimates of specific risks are normal in patients with anxiety disorders.
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8040657
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Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified.
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The diagnostic validity of multiple personality disorder (MPD) and its association to trauma have been questioned because corroboration of child abuse in studies of patients with MPD is scant. The purpose of this study was to determine on a retrospective basis whether external corroboration of child abuse could be found in a group of patients with MPD and dissociative disorder not otherwise specified. A group of child and adolescent psychiatric inpatients and outpatients was chosen because of the extensive number of collateral records collected on them in a tertiary care setting. This group was also chosen because of the intense interest paid by child protective services and courts to child abuse during the past 15 years. This retrospective chart review confirmed child abuse in eight of nine patients with MPD and in all 12 cases of dissociative disorder not otherwise specified. This study provides further evidence of the association of severe dissociative disorders with trauma, particularly child abuse. Future studies should be prospective and blinded to avoid the possibility of investigator bias, and should include a control group for comparison of base rate of child abuse.
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8040655
|
Depressive symptoms and the deficit syndrome of schizophrenia.
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One of the most influential ideas in schizophrenia research is that schizophrenia may be a syndrome with significant pathophysiological heterogeneity, rather than a single disease. Among patients with schizophrenia, presence or absence of the deficit syndrome has been suggested as a method for defining relatively homogeneous groups. The criteria for the deficit syndrome require the presence of negative symptoms that are judged primary to the illness, rather than to factors, such as depressive mood, that may resemble the negative symptoms of schizophrenia. To test one aspect of the validity of the primary/secondary judgment, we tested the relationship of depressive symptoms to the deficit/nondeficit categorization. Using independent clinician ratings, the depressive mood of deficit and nondeficit patients was compared at the time the categorization was made, and at an average follow-up of 2 1/2 years. Using patients' self ratings, deficit and nondeficit patients were compared at an average follow-up of 1 1/2 years. Deficit patients had significantly less severe depressive symptoms by clinicians' ratings both cross-sectionally and at follow-up, and less severe self-rated symptoms at follow-up. These differences were not due to confounding by age, race, sex, socioeconomic status, or chronicity. These results support the validity of the deficit/nondeficit categorization.
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8040656
|
Proneness to dissociation and traumatic childhood events.
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Several researchers have proposed that proneness to dissociation in adulthood is linked developmentally with experiences of traumatic events in childhood. Past investigation of this hypothesis, however, typically has focused on very narrow samples of childhood trauma. In this study, dissociative experiences in adulthood were analyzed in relation to a broad measure of childhood trauma. Standard regression analysis revealed three predictors of dissociation, namely familial loss in childhood, intrafamilial sexual abuse, and extrafamilial sexual abuse. The data call for greater cognizance of childhood loss in the investigation of the origins of dissociative defenses.
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8040654
|
Cognitive characteristics of the parents of schizophrenic patients.
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This article reviews the empirical literature on cognition and communication in the parents of schizophrenic patients to address the questions of whether these parents as a group show evidence of any distinguishing cognitive characteristics and, if so, what those characteristics might be. Included in the review are studies of thought and communication disorder, and psychometric studies of cognitive functioning. We included only those that used reliable measures and included control groups in their designs. Taken together, the findings provide substantial evidence that nonschizophrenic parents of schizophrenic patients as a group demonstrate subtle cognitive difficulties in the area of concept formation and maintenance. There are also indications of other cognitive anomalies that will require further study. We discuss the importance of clarifying the etiological relevance of these findings and of pursuing further research in this area.
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8040653
|
Mood regulation expectancies, coping responses, depression, and sense of burden in female caregivers of Alzheimer's patients.
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This study focused on the role of generalized expectancies for negative mood regulation in coping among caregivers to Alzheimer's disease patients. Self-report measures were used to obtain information on expectancies, hassles, coping strategies, depressive symptoms, and sense of burden from 73 female primary caregivers in support groups. Stronger expectancies for negative mood regulation were associated with less severe depressive symptoms, even with stress levels and coping responses controlled. These expectancies were also associated with less avoidant coping, but were unrelated to active coping. Burden and depressive symptoms were strongly related, but correlated differently with other variables.
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8040652
|
Cross-Cultural Cognitive Examination performance in patients with Parkinson's disease and Alzheimer's disease.
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Performance profiles of patients with different dementia syndromes (Alzheimer's disease and Parkinson's disease) were compared with each other and with those of neurologically impaired and healthy individuals without dementia on a new instrument for screening dementia, the Cross-Cultural Cognitive Examination (CCCE). The CCCE measures discriminated reliably between nondemented and demented patients, regardless of etiology. Comparisons between dementia groups found that dementia patients with Parkinson's disease (PD) showed more severe psychomotor slowing and depression, compared with patients with Alzheimer's disease, who showed more impaired recall of recently learned verbal information and verbal abstract reasoning. The CCCE also distinguished between the motor and affective symptoms that are common to all PD patients and the dementia symptoms that occur in some PD patients. These results provide further support for the clinical utility of the CCCE for discriminating dementia from normal cognitive functioning and for initial identification of different dementia syndromes.
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8040651
|
Longitudinal assessment of depression and cognitive impairment following stroke.
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Previous studies have demonstrated that patients with major depression following stroke have a greater degree of cognitive impairment than nondepressed patients with comparable lesions. The present study examined the longitudinal course of cognitive impairment related to depression. Patients were prospectively evaluated following an acute stroke (N = 309), using a structured psychiatric interview and the Mini-Mental State Examination. Longitudinal evaluations were obtained at 3, 6, 12, and 24 months follow-up in a subset of these patients. During the initial in-hospital evaluation, the frequency and severity of cognitive impairment was significantly greater in patients with major depression compared with nondepressed patients. This effect occurred predominantly in patients with major depression following left hemisphere stroke. The association of depression and cognitive function was strongest during the initial evaluation, but was present for up to 1 year. The year-long effect, however, was evident only in patients with left hemisphere stroke. Patients with both depression and cognitive impairment had a greater duration of depression than depressed patients without cognitive impairment. Depression with cognitive impairment appears to be a phenomenon produced by left hemisphere lesions. This suggests that left hemisphere stroke may produce depression through a different mechanism than lesions in other locations. In addition, the fact that the strongest influence of depression on cognitive function was seen during the initial evaluation suggests that this phenomenon may be mediated by acute or subacute physiological effects of the lesion.
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8040636
|
Getting caught in misconduct: conceptions of adolescents with and without learning disabilities.
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This study examined adolescents' conceptions about how to respond after being caught in misconduct, in order to determine whether students with learning disabilities differ from nondisabled students in their beliefs regarding apprehension. A total of 88 students with learning disabilities (62 male, 26 female) and 84 nondisabled students (45 male, 39 female) were interviewed about 10 scenarios in which a teenager was caught by authorities after participating in misconduct, either alone or with a peer. The mean age of the students was 16 years (SD = 1.4). The results indicated that the students with learning disabilities were significantly more likely than other students to suggest escaping and less likely to suggest accepting the consequences, although the differences were not great. The implications of these findings are discussed.
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8040635
|
Mother-child teaching strategies and learning disabilities.
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The teaching strategies used by mothers of sons with learning disabilities (LD) (n = 30) and normally achieving sons (NLD) (n = 30) were examined. The children were matched for age (8- to 11-year-olds) and for parents' socioeconomic status. The behavior of mother-child pairs was videotaped in a teaching task that was constructed to resemble a homework assignment. The results showed that the mothers of children with LD used fewer high-level strategies, and their total time used in teaching was less than that of the mothers of NLD children. The mothers of children with LD exhibited more dominance and less emotionality and cooperation than did the mothers of NLD children; however, the mothers did not differ in task motivation. The children with LD seemed to have more inactive learning strategies, evident in their weaker initiative and greater dependence on their mothers. Analyses concerning the variation of maternal strategies within the LD group revealed that the mothers' motivation, combined with their emotionality and proportion of high-level strategies, had a strong positive association with their children's success in learning.
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8040634
|
Lesson talk as the work of reading groups: the effectiveness of two interventions.
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This study compares the effectiveness of two interventions that differed in the nature of dialogic interactions among teachers and students in the reading group. One hundred nine children with mild disabilities were instructed by 35 teacher-interns in special education resource rooms. Sixty-three and 46 students, respectively, participated in the two instruction interventions. The analyses indicated that the intervention that produced the greatest effects was the one in which dialogue, social interactions, and scaffolded instruction figured prominently. Limitations and implications of the study are discussed.
|
8040633
|
Is it true that the differences in reading performance between students with and without LD cannot be explained by IQ?
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This study was designed to demonstrate whether the differences in reading between students with learning disabilities (LD) and non-learning disabled students (NLD) can be explained by IQ. A sample of 133 Spanish children (85 male, 48 female) ranging in age from 8 to 13 years were classified into four groups according to IQ as measured by the Wechsler Intelligence Scale for Children-Revised (< 80; 81-90; 91-109: 110-140) and into two groups based on reading level (LD and NLD). A lexical decision task was used and we manipulated different word parameters (length, positional syllabic frequency, and familiarity) and pseudoword parameters (length and positional syllabic frequency) to study the routes used by both groups. Our findings indicate that IQ does not explain the differences between children with LD and NLD children in lexical processing. We found that the lexical and sublexical parameters have a greater influence on students with LD than NLD students, independent of IQ. In synthesis, the LD group has more difficulty in lexical processing, which is influenced by poor phonological skills.
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8040632
|
Principal identifying features of the syndrome of nonverbal learning disabilities in children.
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The identifying features of the syndrome of nonverbal learning disabilities (NLD) were examined with a view to determining their relative discriminant validity. A stepwise linear discriminant function analysis of children with NLD (n = 29), children with reading and spelling disabilities (Group R-S; n = 27), and a group of nonclinical children (NC; n = 27) on 15 neuropsychological variables yielded a subset of scores on four tests (Target Test; Trail Making Test, Part B; Tactual Performance Test; and Grooved Pegboard Test) that accurately (> 95%) discriminated the NLD group from the R-S and NC subjects. Of the neuropsychological features of NLD described by Rourke (1987, 1988b, 1989), deficits in visual-perceptual-organizational psychomotor coordination and complex tactile-perceptual skills appeared to be most representative (in the sense of most discriminative) of the NDL syndrome in the children examined. These are also the dimensions that are considered to be "primary" in the NLD model (Rourke, 1989). Replication of these results, employing children with other clinical disorders, is necessary.
|
8040630
|
An Italian perspective on learning disabilities.
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The authors' experience derives from over 10 years of study of the neuropsychological characteristics of children with learning disabilities (LD) who were referred to a public children's hospital. Some sociocultural and linguistic aspects of children with learning disabilities in Italy, and in particular in the northeastern Friuli-Venetia-Julia region, are described. The role of bilingualism and the type of grapheme-phoneme correspondence in "standard" Italian are discussed in relation to learning disabilities. Legislative aspects, the roles of the school, hospitals, public field services, and private institutes, as well as the concern of parents of children with LD, are alos taken into account. According to the authors, Italy's major deficiencies with respect to the question of learning disabilities are (a) lack of a systematic study of the problem in order to increase general knowledge, (b) insufficient training of teachers and rehabilitators, and (c) inadequate legislation.
|
8040625
|
[Potentiation of cisplatin sensitivity of cisplatin-resistant human ovarian cancer cell lines by L-buthionine-S,R-sulfoximine].
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We established two human ovarian cancer cell lines (KK and MH) from the ascites of patients who did not respond to cisplatin (CDDP)-based combination chemotherapy. These cell lines showed higher resistance to CDDP in vitro than HRA cells which were established previously in our laboratory, and also have cross resistance with its analogues. The amount of intracellular glutathione (GSH) in these cells correlated with the degree of resistance to CDDP and was high, but the intracellular platinum (Pt) uptake was unchanged. Preincubation with L-buthionine-S,R-sulfoximine (BSO) reduced cellular GSH in these cells to 9-25%, while the Pt uptake remained unchanged. When the CDDP-resistant KK and MH cells were incubated in the presence of 10 microM BSO, they were sensitized to CDDP and its analogues showing a decrease to 79-38% in the IC50 values. On the basis of these results, we conclude that GSH may be involved in the mechanisms of resistance to CDDP and its analogues in the KK and MH cells.
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