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7785658
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Acute intermittent porphyria in a native North American family. Biochemical and molecular analysis.
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A native North American family with acute intermittent porphyria was investigated by molecular methods to locate the causative mutation and identify carriers of the mutant allele. All 15 exons of the porphobilinogen deaminase gene were screened by single-strand conformation polymorphism analysis, and a unique banding pattern was observed in exon 14. Sequencing revealed a one base-pair insertion in this exon that shifts the reading frame of the mRNA, and generates a premature stop codon. Family members were tested for the mutation by amplification of exon 14 followed by digestion with the restriction enzyme NlaIII. The activity of erythrocyte porphobilinogen deaminase was measured in 36 family members. The results agreed with mutational analysis in 32 cases. However, four individuals who were not gene carriers had low enzyme activity, and in the absence of molecular genetic data would have been incorrectly diagnosed. This is the first study to identify the molecular basis of acute intermittent porphyria in native North Americans.
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7785657
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Is myoglobin useful in the diagnosis of acute myocardial infarction in the emergency department setting?
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The authors evaluated the usefulness of a rapid fluorometric enzyme immunoassay for myoglobin (Myo) for early diagnosis of acute myocardial infarction (AMI) in patients in the emergency department. The rapid fluorometric enzyme immunoassay for myoglobin was performed on timed blood samples collected previously for serial CK and CKMB determinations from 41 patients who initially presented to the ED with chest pain and were subsequently admitted to patient care units. Twenty-two patients were AMI positive and 19 were AMI negative. In 12 patients who were AMI positive, Myo increased rapidly and significantly peaking at 6.53 +/- 5.45 hours, whereas in the other 10 patients who were AMI positive, only the declining slopes of Myo were observed due to late AMI presentation. In the AMI negative group, Myo values were within reference range in 8 and persistently elevated in 11. Using the initial rate of Myo release of 20 ng/mL per hour as criteria of discrimination, this assay has a sensitivity of 90.1% and a specificity of 74%. Available samples for the two patients who were false negative were past the window of Myo release for AMI detection. All five patients who were false positive were associated with various degrees of muscular trauma or renal disorder. The authors conclude that the initial rate of Myo release demonstrates good utility both at early detection and early exclusion of AMI. However, its tissue nonspecificity may not permit AMI recognition in the presence of muscular injury.
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7785656
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A strategy to promote rational clinical chemistry test utilization.
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There is abundant evidence that clinical chemistry laboratory tests are over-ordered in North America, but there does not seem to be an effective corrective strategy that has a prolonged effect. The goal of this study was to design one that had a prolonged effect. Using a pre- and post-intervention survey study design, the authors observed the effect of physician education followed by a ban on test-panel ordering of common clinical chemistry tests, reinforced by written reminders to physicians not heeding the ban, on ordering patterns (tests per specimen), and total numbers of these tests ordered. Panels of > 16 common biochemistry tests per specimen were reduced from 15% to 6% of orders for inpatients and from 44% to 11% for outpatients 1 year after the implementation of the ban on test-panel ordering. However, the ban had little effect on the ordering rates for panels of 7 common tests. Educational exercises (newsletters and lectures) had no effect. The authors conclude that a ban on test-panel (profile) ordering reinforced by continuing reminders to nonconforming physicians is an effective means of reducing clinical chemistry test usage over the long term. A 38% reduction of common biochemistry tests ordered was achieved. However, overall costs savings were modest. Nevertheless, the authors conclude that the cost-effective use of the clinical pathology laboratory by careful selection of tests in an essential part of a medical trainee's education.
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7785655
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Identification of patients for pharmacologic review by computer analysis of clinical laboratory drug concentration data.
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Clinical pharmacokinetics evaluation and consultation can improve drug therapy and decrease the incidence of adverse reactions in selected patients. However, identification of patients appropriate for review is difficult. The authors developed a microcomputer-based expert system that scans clinical laboratory drug concentration data to identify patients for follow-up. Rules were developed from a review of data for digoxin, phenytoin, and theophylline. These were implemented in software that provides for simple rule creation and modification, on-screen graphic review of data, and printing of chart reports. This program is readily adapted for use with most laboratory information systems. In a retrospective study of 868 patients monitored for digoxin, phenytoin, and theophylline, 29% were flagged as having drug level profiles of possible concern. The majority (62%) of these patients had multiple specimens flagged, suggesting persistent problems. These data suggest that patients can be identified for follow-up by scanning serial drug concentrations, allowing consultative resources to be focused on patients most likely to benefit from them.
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7785654
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Protoplasmic astrocytoma. A clinicopathologic study of 16 tumors.
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Protoplasmic astrocytomas, composed of process-poor astrocytic cells and a microcystic background, are rare variants of low grade astrocytoma. Three hundred eight low grade astrocytomas over a 23-year period were reviewed. Sixteen (5.2%) were classified as pure protoplasmic astrocytoma. Patients (12 males, 4 females) ranged in age from 2.5 to 41 years (mean, 20.7 years). All patients presented with seizures and three had headaches. Duration of symptoms ranged from 7 months to 28 years (mean, 6.6 years). Nine tumors (56%) were left-sided and seven right-sided (44%). Seven (44%) occurred in the temporal lobe, six (37%) in the frontal lobe, two (13%) in the parietal lobe, and one (6%) in the thalamus. Surgery consisted of partial lobectomy with total tumor resection in nine and biopsy alone in seven. Five patients received adjuvant therapy with no apparent effect on survival. At frozen section, protoplasmic astrocytoma was most confused with fibrillary low grade astrocytoma (n = 6). Follow-up revealed 10 patients with no evidence of disease 2 to 108 months postoperatively (mean, 41 months), 5 patients were alive with disease 10 to 84 months postoperatively (mean, 56 months) and 1 patient died with disease at 36 months. Of patients with total tumor resection, eight had no evidence of disease and one died with disease. (1) protoplasmic astrocytomas in this study were more frequently observed in males at a younger mean age than fibrillary low grade astrocytomas as reported in literature; (2) temporal and frontal lobes were the most likely site of origin; and (3) complete excision may be beneficial, whereas adjuvant therapy appeared to have no effect on outcome.
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7785653
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Intraneural perineurioma. A clonal neoplasm associated with abnormalities of chromosome 22.
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The nature of perineurioma, variably termed "localized hypertrophic neuropathy," "intraneural neurofibroma," and "hypertrophic interstitial neuritis" has long been an issue of contention. Most authors consider it a neoplasm, but some a reactive process. Eight clinically and morphologically typical perineuriomas were studied by histologic, immunohistochemical and ultrastructural methods. One perineurioma was subject to tissue culture and cytogenetic study and another to fluorescence in situ hybridization (FISH) analysis. The patients, 3 males and 5 females, ranged in age from 11 to 38 years. All tumors were intraneural, and involved extremities (2 sciatic, 1 median, 1 femoral, 1 peroneal, 1 brachial plexus, 1 ulnar, and 1 radial). Neurologic symptoms, motor in all cases and sensory in 4, were present from 1 month to 7 years (mean 1.2 years). Fusiform, segmental nerve enlargement was clinically apparent in only two patients, but was evident on MRI in five of eight patients. Lesion length ranged from 3.5 to 30 cm, the largest involving the sciatic nerve from the obturator foramen to the knee. One lesion involved two nerve roots, but no association with a phakomatosis was noted. Treatment consisted of biopsy in six cases and resection in two cases. Histologically, pseudo-onion bulbs composed of epithelial membrane antigen-reactive, S-100 protein-negative perineurial cells surrounded myelinated or nonmyelinated nerve fibers. Many were accompanied by their S-100 protein-positive Schwann sheaths. Some whorls lacked a central axon. A single mitosis was noted in one case. The MIB-1 antigen labelling index ranged from 4% to 17%. Staining for p53 antigen in six cases showed no (2 of 6), rare (2 of 6), or scattered (2 of 6) immunoreactive nuclei. Cytogenetic analysis in one case demonstrated a chromosomally abnormal clone. Each of 16 metaphases was abnormal; the tumor cells appeared to be homozygously deficient for the region 22q11.2qter. In another case, 53% of interphase nuclei showed three FISH signals with a chromosome 14/22 probe, thus suggesting either monosomy for the centromere of chromosome 14 or that of chromosome 22.(ABSTRACT TRUNCATED AT 400 WORDS)
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7785652
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Assessment of histopathologic changes in the colonic biopsy in acute graft-versus-host disease.
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The authors reviewed 78 colonic biopsies from 63 patients undergoing bone marrow transplantation (BMT), 56 allogeneic and 7 autologous, to assess different morphologic changes related with intestinal acute graft-versus-host disease (A-GVHD). Only five biopsies were done before the 20th day after BMT. The authors studied the presence of ulcers and atrophy in the mucosa, the nuclear atypia, and inflammatory infiltrate in the surface epithelium, and the architectural abnormalities, as well as dilation of the glands, and the presence of crypt abscesses. The authors explored the glandular epithelium for apoptosis and intraepithelial lymphocytes. They examined the lamina propria for inflammatory infiltrate, especially for so-called "focal periglandular infiltrate (FPGI)," edema fibrosis, increase of capillary vessels and presence of muciphages and clusters of enterochromaffin cells. Cases were grouped according to clinical symptoms and histologic diagnosis of A-GVHD in skin or liver. Group A had 15 asymptomatic cases (control). Group B had 20 cases from asymptomatic patients with a histologically proven A-GVHD. Group C had 43 cases with gastrointestinal symptoms and histologically proven A-GVHD. Then, the relative frequency of every histologic feature previously described were compared in the different groups by means of an univariate analysis. Apoptosis of the glandular epithelium was found in 48 cases, two of them in patients carrying an auto-BMT. Focal periglandular infiltrate was found in 11 cases that was associated with apoptosis (P < .03, Fisher's exact test). In this series, the presence of FPGI was linked with finding apoptosis in a given specimen with a probability of 91%. Glandular architectural changes and dilation were also more frequent in group C than in groups A and B when compared in the univariate analysis.
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7785651
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Hamartoma of the breast, an underrecognized breast lesion. A clinicopathologic and radiographic study of 25 cases.
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This study investigated the clinical, radiographic, and pathologic features of breast hamartoma. The patients ranged in age from 18 to 89 years, with a mean age of 45 years, and a median age of 43 years. Seventy-five percent of the patients were asymptomatic, other than reporting a breast lump. In two patients, the lesions recurred at 7 and 18 months after the initial resection. The clinical diagnoses were fibroadenoma in 10 cases, carcinoma in 5 cases, hamartoma in 4 cases, and phyllodes tumor and lipoma in 2 other cases. Mammograms were available in 12 cases, the majority of which showed a well-defined mass of homogeneous density. Grossly, these lesions were oval to round, well-circumscribed masses, ranging in size from 1 to 7 cm in maximum dimension (mean, 3.9 cm). The microscopic appearance of these tumors corresponded to their gross appearance. Lesions that were grossly firm, rubbery, and white consisted largely of dense fibroconnective tissue with variable amounts of glandular elements with little adipose tissue. Softer, pale, yellow lesions contained more adipose tissue. A consistent and important diagnostic feature was the presence of both lobules and ducts, in contrast to fibroadenoma in which lobules are often absent or rare. The current trend of mammographic breast screening has made us aware that mammary hamartomas are not uncommon. These lesions may go unrecognized by the pathologists because they show all the constituents of normal breast tissue and may be reported as "no pathological diagnosis" or "normal breast tissue," which are inappropriate diagnoses for a lesion that presents as a palpable and a well-circumscribed mass.
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7785650
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Vernix caseosa peritonitis. An infrequent complication of cesarean section with distinctive histopathologic features.
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The authors report two cases of vernix caseosa peritonitis, an infrequent complication of cesarean section with distinctive histopathologic findings. Both patients underwent exploratory laparotomy for unexplained abdominal pain after cesarean section. Histopathologic evaluation of surgically removed tissue revealed an organizing peritonitis, which included prominent collections of anucleate squamous cells in association with a foreign body-type granulomatous response. In both cases, the surgical pathologist suggested that the abdominal pain was likely a result of peritoneal reaction to spillage of keratinous material (vernix caseosa) derived from amniotic fluid contents during cesarean section. Surgical pathologists should be aware of this entity and include it in the differential diagnosis of acute abdominal pain.
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7785643
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Percutaneous balloon catheter dilatation of benign ureteral strictures: effect of multiple dilatation procedures on long-term patency.
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The purpose of this study was to evaluate the long-term efficacy of multiple percutaneous balloon dilatations of benign ureteral strictures. Percutaneous dilatation of ureteral strictures with a balloon catheter was done as an alternative to open surgical repair. Twenty-eight benign ureteral strictures (in 23 patients) were dilated. These included 21 postoperative strictures, 18 of which were at ureteroenteric anastomosis, three postradiation strictures, and four strictures of unknown origin. If the stenosis persisted, dilatation was repeated (maximum of four dilatations at 1-month intervals). Patients were reevaluated with sonography at 1-month intervals after stent removal. The procedure was considered a technical success if there was no radiographic evidence of a stricture or if hydronephrosis improved on the sonographic examination. Clinical success was determined by stable or improved renal function. All dilatations were technically successful. Fifteen (54%) of the 28 ureters remained patent 1 month after the final dilatation and removal of the stent. Of these 15, 12 were patent 2 months after stent removal, and only five were free of stenosis at the 9-month follow-up, making overall success 18%. All five of these ureters were in the subgroup of patients with ureteroenteric strictures. Balloon dilatation of ureteral strictures is technically successful; however, long-term results are poor. Multiple dilatations are of no benefit in maintaining ureteral patency.
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7785644
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Fatal post-cesarean endometritis: report of two Alabama cases.
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Postpartum endometritis remains a major cause of morbidity in the puerperium with a fatal outcome on occasion. We present two cases of fatal, post-cesarean endometritis which occurred within a fifteen month period in Alabama. We discuss the features of endometritis including pathophysiology, causative organisms, risk factors and complications.
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7785645
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A case of lumbar hernia occurring through surgical defect of iliac crest.
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Hernias occurring in the lumbar area are rare. The lumbar area is a broad anatomic area bordered superiorly by the 12th rib, interiorly by iliac crest, medially by the erector spinae muscle and laterally by the external oblique muscle. Acquired hernias occurring in the lumbar area are often diffuse and grotesque appearing and most of them are post operative incisional hernias occurring in nephrectomy incisions. Rarely hernias occur through bicortical surgical defect of iliac crest. We would like to present such a case and review the literature briefly.
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7785642
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Characterization of adrenal masses (< 5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures.
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The purposes of this study were to evaluate the ability of chemical shift MR imaging to differentiate 1- to 5-cm adrenal adenomas from metastases and to compare subjective interpretation with several different quantitative measures. Forty-three patients with 46 proved adrenal lesions (28 adenomas and 18 metastases) had MR imaging with a gradient-echo breath-hold technique and echo time varied to obtain in-phase and out-of-phase images. Qualitative analysis of the MR images was done by three experienced observers, who reported their confidence in diagnosing the benignity versus the malignancy of the adrenal masses on the basis of signal loss on out-of-phase images. Quantitative analysis was performed by calculating the difference in signal intensity between in-phase and out-of-phase images by use of regions of interest (signal intensity index) and by use of adrenal-liver, adrenal-spleen, and adrenal-muscle signal intensity ratios. Results between quantitative and qualitative measures were compared by use of receiver operating characteristic (ROC) analysis. The mean signal intensity was significantly different between adenomas and metastases on out-of-phase images (64 versus 98) (p < .0005) but not in-phase images (130 versus 122) (p = .47). The adrenal-spleen ratio discriminated between adenomas and metastases better than did the adrenal-liver ratio, the adrenal-muscle ratio, or the signal intensity index. No significant difference in interpretation among the three observers was evident (areas under the ROC curves, 0.93, 0.95, and 0.96). The performance of the observers was comparable to the results obtained with the adrenal-spleen ratio measurement (area under the ROC curve, 0.97). Experienced observers were able to differentiate adrenal adenomas from metastases just as well as quantitative measures. The adrenal-spleen ratio is the best quantitative means of distinguishing benign from malignant adrenal masses. Chemical shift MR imaging is a good but imperfect discriminator of adrenal adenomas.
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7785641
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Diagnosis and management of ascites in the age of TIPS.
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In the mid 1990s, radiologists are asked to provide advice on managing patients with cirrhosis and refractory ascites. Liver disease is the most common cause of ascites. However, appropriate management of these patients is based on the ability to exclude other causes as well as knowledge of the physiological abnormalities that result in ascites. The goal of this review is to summarize advances in these areas as well as to discuss therapeutic options.
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7785640
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Acute cholecystitis in an animal model: findings on color Doppler sonography.
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The purpose of our study was to evaluate the color Doppler findings of acute cholecystitis in a controlled canine model. Fourteen animals had a laparotomy: cystic duct ligation was done in eight, and incision with closure was performed in six control subjects. Animals were scanned in a blinded fashion preoperatively, immediately postoperatively, and on postoperative days 1-5. On postoperative day 5, a hepatobiliary scan was done with 2 mCi (74 MBq) 99mTc-mebrofenin. Blinded histopathology was performed and correlated with imaging. Flow was seen in the wall of each gallbladder at some point during the postoperative course, demonstrating vascular patency. Hepatobiliary scintigraphy confirmed cystic duct status in 12 cases; two animals died before radionuclide imaging was complete. Color Doppler signal decreased in the gallbladder wall in ligated dogs from postoperative day 1 to postoperative day 3 (p = .03 versus controls at postoperative day 2) and increasingly returned by postoperative day 5. Hyperemia was seen in only two cases (both with severe necrotizing cholecystitis) and only at postoperative day 5. Although not statistically significant, a weak trend of increasing flow with more severe pathologic grades of cholecystitis was observed (p = .20). In this animal model, loss of vascular signal (not hyperemia) at postoperative day 2 was the finding to diagnose early acute cholecystitis, although lack of flow can also be seen in some normal subjects. Flow tended to return by postoperative day 5, and it increased in some of the more severe cases of cholecystitis. Hyperemia was a somewhat useful sign of acute necrotizing cholecystitis.
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7785638
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High-dose localized radiation therapy for treatment of hepatic malignant tumors: CT findings and their relation to radiation hepatitis.
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High-dose radiation therapy of the liver performed using overlapping portals defined by a three-dimensional treatment-planning system (conformal radiation therapy) is a new method of treating hepatic tumors. This study was performed to delineate the differences in the CT appearances of the liver after therapy compared with other methods of radiotherapy and to correlate imaging findings to clinical findings of radiation hepatitis. Contrast-enhanced CT scans were obtained at 8- to 12-week intervals on 31 consecutive patients with primary or metastatic hepatic malignant tumors. All had undergone high-dose conformal radiation therapy and injection of fluorodeoxyuridine into the hepatic artery as part of the treatment for unresectable hepatic neoplasms. Tumor size, location, presence of changes within the target volume after therapy, presence of atrophy of the treated segments or hypertrophy of the untreated segments, ascites, and any changes in adjacent organs seen on serial CT scans obtained before and after treatment were recorded. Clinical records were reviewed for evidence of radiation hepatitis (nonmalignant ascites evident on physical examination and a twofold elevation of alkaline phosphatase in the anicteric patient). In 23 (74%) of the 31 patients, follow-up CT studies after treatment showed a low-attenuation area adjacent to the hepatic tumor in the target volume. In two patients with fatty infiltration of the liver, CT showed relative increased density in the treatment portal. A sharp, straight interface was rarely seen at the treatment margin. Maximal effect was seen 2-3 months after completion of therapy and persisted for up to 3 months. Atrophy in the treated segment or lobe was seen in four patients, hypertrophy of the untreated liver was seen in four patients, and both effects were seen in seven patients. Extrahepatic effects included segmental right renal atrophy in three patients and duodenal wall thickening in two patients. Only two patients (6%) in this series had clinical evidence of radiation hepatitis. High-dose localized radiotherapy of the liver results in reversible hypodense regions in the liver parenchyma within the target volume that do not have a sharp interface delineating the radiation portal. This appearance should not be confused with tumor progression or irreversible liver injury. The changes evident on CT scans after therapy are not predictive of radiation hepatitis.
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7785637
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Helical CT of the liver: clinical application of an automated computer technique, SmartPrep, for obtaining images with optimal contrast enhancement.
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The purpose of this study was to evaluate an automated computer technique (SmartPrep) for achieving a consistently high level of contrast enhancement in the liver with helical CT. The technique compensates for variability between patients by indicating graphically the time at which scanning should be initiated to reach a desired level of hepatic enhancement. One hundred nine consecutive patients undergoing helical CT of the abdomen were randomly evaluated, using either a standard 70-sec delay from the start of the injection of contrast material to scanning or a newly developed, commercially available automated technique, SmartPrep. A series of multiple low-dose scans was performed until an arbitrary threshold of hepatic enhancement (50 H) over baseline was achieved. Three regions of interest (ROIs) were imaged on a baseline scan and on contrast-enhanced scans at the upper, mid, and lower liver. Average hepatic enhancement and the standard deviation over baseline was calculated for each group at all anatomic levels. For the SmartPrep group, the range of time between scan initiation and onset of scanning was calculated. The mean hepatic enhancement for the control group (n = 56) was 59.8 +/- 20.1 H, which differed significantly (p = .0002) from that for the SmartPrep group (n = 53), which was 71.6 +/- 15.2 H. Comparison of the variability between the two groups' enhancement levels was also significant (p = .02). The range of delay times for the SmartPrep group was 48-86 sec. In two additional cases, abnormal graphically displayed enhancement curves were the first indication of an improper injection. Use of SmartPrep yields a greater and more consistent level of hepatic enhancement from patient to patient than does use of a conventional fixed delay time. The ability to scan more efficiently to achieve greater hepatic enhancement using SmartPrep has significant implications for potential contrast cost savings.
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7785636
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Cytomegalovirus colitis in AIDS: CT features.
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The purpose of this study was to determine the CT features of cytomegalovirus colitis in patients with AIDS. Abdominal CT scans of 24 patients with biopsy-proved cytomegalovirus colitis (colonoscopy, n = 14; sigmoidoscopy, n = 8; surgery, n = 2) were jointly reviewed by two observers. Patients were men 26-68 years old (mean age, 39 years; SD, 9 years) with CD4 counts of 3-129 mm3 (mean, 32 mm3; SD, 34 mm3). The mean interval between CT and biopsy was 6 days (range, 0-20 days; SD, 6 days). Scans were assessed for colonic wall thickening (> or = 4 mm), ulceration, mural edema, pericolonic stranding, ascites, lymphadenopathy, and thickening of the small-bowel wall. Mural involvement was recorded as asymmetric or circumferential. Disease location was recorded as ascending colon, transverse colon, descending colon, rectosigmoid colon, or pancolonic. Colonic wall thickening of 8 to 33 mm (mean, 15 mm; SD, 6 mm) was seen in 22 patients. One patient had pancolonic involvement. The ascending colon was involved in 13, the transverse colon in five, the descending colon in 10, and the rectosigmoid colon in 16. Circumferential colonic thickening was seen in 17 patients. Deep mural ulceration was seen in 15 patients, mural edema in 15, pericolonic stranding in 23, ascites in 10, lymphadenopathy in four, and small-bowel involvement in 10. Two patients had appendicitis. Three patients had perforations (two rectal, one cecal). One patient had a giant rectal ulcer. Although many of the CT features of cytomegalovirus colitis are nonspecific, the diagnosis should be suggested when CT shows colonic wall thickening, particularly if the thickening is associated with mural ulceration in patients with AIDS and CD4 counts of less than 200 mm3.
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7785633
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Mammography immediately after stereotaxic breast biopsy: is it necessary?
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The purpose of this study was to determine whether mammography immediately after stereotaxic core breast biopsy should be performed routinely to diagnose hematoma, to confirm the sampling site, and to establish a new baseline for future mammograms. Stereotaxic core biopsies of 113 mammographically indeterminate or suspicious lesions were performed by use of a dedicated stereotaxic table with digital imaging, a 14-gauge needle, and an automated gun. The indication for biopsy was a mass with or without calcifications in 59 cases (52%) and calcifications without a mass in 54 cases (48%). The number of core biopsies per case ranged from one to 16 (mean = six). Craniocaudal and mediolateral oblique mammograms of the sampled breast were obtained immediately after the biopsies and were compared with prebiopsy mammograms. In cases with microcalcifications, the mammograms also were compared with specimen radiographs. Mammograms obtained immediately after the procedure showed changes related to the biopsy in 86 cases (76%). These findings included decreased lesion size in 11 (10%), air at the biopsy site in 47 (42%), and hematoma, manifested as poorly defined increased density at the biopsy site, in 58 (51%). One hematoma was clinically significant, but the remaining 57 were clinically occult. When core biopsies were performed for calcifications, the postprocedural mammograms showed a decrease in the number of calcifications in 26 (48%) of 54 cases, but specimen radiographs showed calcium in 50 (93%) of 54 cases. Four lesions (three masses and one cluster of microcalcifications) disappeared after biopsy. In three cases, hematomas obscured residual calcifications at the biopsy site. Mammography immediately after core biopsy is not necessary for the diagnosis of procedure-related hematoma and is inferior to specimen radiography for verifying that calcifications have been sampled. Postprocedural mammograms also may be suboptimal for the establishment of a new baseline because of the frequent finding of hematoma.
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7785631
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CT-guided automated needle biopsy of the chest.
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The purpose of this study was to determine the diagnostic accuracy and frequency of complications of CT-guided transthoracic needle biopsy done with an automated biopsy system. Thirty-three consecutive biopsies were performed on 32 patients between February 1992 and July 1994 (mean age, 55 +/- 15 years; 18 men and 14 women). An 18-gauge (n = 28) or 20-gauge (n = 5) needle was used. Core specimens were submitted for pathologic examination in 10% formalin. No cytopathologist or frozen section analysis was available at the time of biopsy. All biopsies but one were performed by one chest radiologist. Thirty-one lung biopsies and two mediastinal biopsies yielded a mean lesion size of 4.0 cm (range, 1.2-13.0 cm). Postbiopsy pneumothorax occurred in three (9%) of 33 biopsies; none of the pneumothoraces required placement of a chest tube. The mean number of needle passes was 1.3 (+/- 0.6). Thirty biopsies (91%) yielded sufficient tissue for pathologic evaluation. The diagnoses included carcinoma in 14 cases, acute or chronic pneumonia in 4 cases, non-Hodgkin's lymphoma in two cases, and Kaposi's sarcoma, plasma cell granuloma, hypersensitivity pneumonitis, Pneumocystis carinii pneumonia, and fibrosis in one case each. One patient with a 1.5-cm nodule stable for 1 year on CT had fibrosis and chronic inflammation found on needle biopsy, and the nodule was considered benign. Overall, biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic. In three patients, the tissue obtained was not representative of the underlying abnormality. The biopsy specimen showed only inflammatory changes in two patients who ultimately had proved carcinoma. One patient with multiple pulmonary infarcts due to tumor emboli showed evidence of only pulmonary infarct on biopsy. Three patients had insufficient tissue for analysis; none of the three had malignant tumor on follow-up. The sensitivity of CT-guided automated needle biopsy of the chest was 84%. CT-guided transthoracic needle biopsy of the chest done with an automated biopsy system is safe, with a pneumothorax rate comparable to that of skinny needle aspiration. An overall accurate tissue diagnosis was made in 26 (81%) of 32 patients. Biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic, which compares favorably with the reported accuracy of skinny needle aspiration.
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7785630
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Pulmonary lymphangitic carcinomatosis: chronicity of radiographic findings in long-term survivors.
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Long-term survival after development of pulmonary lymphangitic carcinomatosis is considered unusual. However, modern chemotherapy can result in surprising stability or only gradual progression of lymphangitic carcinomatosis. We evaluated the course of radiographic findings in 10 patients with chronic lymphangitic carcinomatosis. Ten patients met our criterion of having lymphangitic carcinomatosis for at least 6 months. The primary tumor was a carcinoma of the breast in six cases, the ovary in two, the pancreas in one, and the skin in one. Serial radiographs (all cases) and CT scans (eight cases) were analyzed retrospectively. Survival with lymphangitic carcinomatosis ranged from 11 to 30 months (median, 13 months). With chemotherapy, the radiographic abnormalities and pulmonary symptoms initially regressed in six patients, progressed in two, and remained unchanged in two; the radiographic findings of lymphangitic carcinomatosis were progressing at the time of death in four patients. All patients had periods of at least 4 months of relative stability or slow progression of pulmonary radiographic abnormalities. Serial transbronchial biopsies in one case confirmed persistent lymphangitic carcinomatosis despite therapy, and autopsy disclosed persistent lymphangitic tumor in two others. Stability or slow progression of radiographic findings can occur in some patients with lymphangitic carcinomatosis. Therefore, chronicity of radiographic findings should not be taken as evidence against lymphangitic carcinomatosis as the cause of an interstitial abnormality in a patient with cancer.
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7785629
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Detection of pneumoperitoneum on chest radiographs: comparison of upright lateral and posteroanterior projections.
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This study was done to determine whether upright lateral chest radiographs were more sensitive than upright posteroanterior chest radiographs in detecting pneumoperitoneum. We prospectively evaluated the ability of upright posteroanterior and lateral chest radiographs to show subdiaphragmatic air in 100 consecutive patients with known pneumoperitoneum from a variety of causes. The difference in sensitivity between the two was evaluated by means of McNemar's test. The upright lateral chest radiograph showed pneumoperitoneum in 98% of the cases; the upright posteroanterior chest radiograph showed pneumoperitoneum in only 80%. The upright lateral chest radiograph was significantly better at showing pneumoperitoneum than was the upright posteroanterior chest radiograph (p < .01). The upright lateral chest radiograph is more sensitive than the upright posteroanterior chest radiograph in detecting small amounts of pneumoperitoneum. When there is a strong clinical suspicion of a perforated hollow viscus, it may be of benefit to include an erect lateral chest radiograph as part of the acute abdominal series.
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7785627
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Radiology in Lithuania: impressions of a visiting professor.
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In the fall of 1993, I had the privilege of spending 3 months as a Radiological Society of North America (RSNA) International Visiting Professor at the Kaunas Medical Academy in Lithuania. This visiting professor program was started in 1986 and is funded by the RSNA Research and Education Fund [1]. It is designed for a visiting professor who can spend 3 months or longer at a radiology residency training program in an evolving country. Lithuania, with a population of about 4 million, is located on the eastern shore of the Baltic Sea, just north of Poland. The land area is approximately equal to that of Switzerland. An independent country until World War II, when it was forcibly occupied and integrated into the Soviet Union, it regained independence in 1990. As a result of 50 years of communist rule, two generations grew up having little knowledge about Western medicine in general and radiology in particular. A communist legacy is still evident not only in education but also in the thought process of the people, although there is a clear desire to integrate into western Europe. Currently Western and Asian consumer goods are readily available, but the country has undergone steep inflation and it is the perception of many that the standard of living continues to decline.
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7785625
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Triage of patients to angiography for detection of aortic rupture after blunt chest trauma: cost-effectiveness analysis of using CT.
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The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest trauma. The use of CT was evaluated in relation to the prior probability of aortic rupture. A cost-effectiveness analysis comparing six diagnostic strategies combining chest radiography, CT, and angiography in various sequences was performed. Effectiveness was expressed as survival to hospital discharge, and costs were those incurred to society. Estimates for the variables in the analysis were derived from published reports. The model was evaluated for two cohorts of patients: those undergoing and those not undergoing CT for the evaluation of other injuries. Sensitivity analysis was performed for all variables in the model with emphasis on the prior probability of aortic rupture. Selecting patients for triage to angiography based on the CT findings yielded higher effectiveness at a lower cost-effectiveness ratio than doing so based on the chest radiograph, and the incremental cost-effectiveness ratio was less than $500,000 per life saved. For the cohort undergoing CT for the evaluation of other injuries, triage to angiography based on the CT findings yielded equivalent survival chances compared with immediate angiography and cost less ($1468 per patient evaluated compared with $2508). For the cohort not undergoing CT for other injuries, immediate angiography yielded the highest survival chances but was expensive, with an incremental cost-effectiveness ratio of $2 million per life saved compared with triage based on CT. In the latter cohort, immediate angiography yielded higher survival chances and had a cost-effectiveness ratio of less than $500,000 compared with the triage by CT if the prior probability of aortic rupture was 5% or more. Selecting hemodynamically stable patients after blunt chest trauma with suspected aortic rupture for angiography on the basis of CT findings is more effective than doing so based on the findings on chest radiography and is cost-effective compared with other accepted health care programs. Immediate angiography has a high incremental cost-effectiveness ratio compared with triage by CT and is warranted only in patients not undergoing CT for the evaluation of other injuries who have a prior probability of aortic rupture of 5% or more.
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7785586
|
The mammography audit: a primer for the mammography quality standards act (MQSA).
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The medical audit of a mammography practice is a recognized method for evaluating mammography and the accuracy of mammographic interpretation [1-4]. As such, portions of the audit will become integral to the quality assurance activities of every mammography practice under the Mammography Quality Standards Act (MQSA) of 1992, administered by the Food and Drug Administration (FDA). The FDA Interim Rules, which became effective October 1, 1994, state that "each facility shall establish a system for reviewing outcome data from all mammography performed, including follow-up on the disposition of positive mammograms and correlation of surgical biopsy results with mammogram reports" [5]. It is expected that the proposed final rules, due to be released for public comment in 1995, will require collection of additional data for medical audits (public meeting of the National Mammography Advisory Committee, May 3, 1994). Although most mammography practices are now collecting clinical outcomes data on abnormal mammographic examinations, very few have established an organized and deliberate system of data collection necessary for a more complete mammography audit [6]. A detailed discussion of and recommendations for such an audit were recently published as part of the Quality Determinants of Mammography Guideline by the Agency for Healthcare Policy and Research (AHCPR) [7]. As members and consultants on the multidisciplinary panel that produced the guideline, we offer the following review of the various elements, definitions, and processes of the mammography audit. This is intended as a primer for all radiologists who will be performing some of the same audit activities for the MQSA.
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7785581
|
Accuracy of a voice-to-text personal dictation system in the generation of radiology reports.
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Systems that convert spoken words directly into text have recently become available. The purpose of this study was to test the accuracy, on a word-for-word basis, of one such system for generating radiology reports. The IBM Personal Dictation System (IPDS), with the optional add-on radiology vocabulary, was assessed (the system is now known as VoiceType Dictation). The system requires one to use discrete speech (i.e., with a momentary pause between words). Two hundred current radiology reports, including 100 consecutive chest radiographs, 50 consecutive thoracic CT scans, and 50 random sonography and angiography reports, were read to the system. Before testing, the IPDS had been used in the dictation of material related to chest radiology. All errors were noted on a word-for-word basis and categorized as follows: incorrect, partially incorrect (no effect on meaning), not in dictionary (word was then added), homophone, or formatting. Medical words (those thought to be relevant to the meaning of the report) were considered separately. Specific assessments of numbers and dates were made. Words added to the dictionary were reread after the 200 reports had been assessed. When all mistakes were considered, the accuracy was 0.99 for chest radiology and 0.96 for material not concerning chest radiology. When only relevant mistakes on medical words were considered, the accuracies were 0.98 and 0.96, respectively. Accuracy for numbers was 0.95 and for dates 0.97. Redictation of the 22 words previously not in the dictionary was 100% accurate. The IPDS is an accurate system for direct voice-to-text dictation of radiology reports that improves with continued use. The most important future enhancement of such systems will be to allow the more natural continuous or conversational speech style.
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7785579
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The value of portal vein pulsatility on duplex sonograms as a sign of portal hypertension in children with liver disease.
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The purpose of this study was to determine the significance of portal vein pulsatility on duplex Doppler waveforms in children with end-stage hepatic failure undergoing liver transplantation. Thirty-eight children with end-stage hepatic decompensation were examined with color-assisted spectral Doppler waveform analysis of the hepatic artery and the portal vein. Correlation was made with age, duration of illness, clinical and pathologic diagnosis, and presence of portal hypertension. Findings were compared with those for six patients with acute viral hepatitis and 12 healthy control subjects. Portal vein pulsatility was noted in all 36 patients in whom portal vein flow was detected by Doppler imaging. The majority of these (34) had clinical or sonographic evidence of portal hypertension. In two patients, no portal vein flow was identified in the liver hilum; both had a large portosystemic shunt through collaterals or surgical graft. Significantly increased pulsatility of the hepatic artery waveform (resistive index [RI] = 0.89 +/- 0.15, p < .0001) was seen in patients with end-stage liver disease. In contrast, no portal vein pulsatility and normal hepatic artery pulsatility (RI = 0.60 +/- 0.11) was noted in all patients with acute hepatitis and control subjects. Portal vein waveform pulsatility is 94% sensitive and 90% specific for portal hypertension in end-stage liver disease.
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7785578
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Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty.
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We reviewed the early results of percutaneous portal venoplasty as a method of treating portal vein stenosis in 11 children with reduced-size liver transplants. Percutaneous transhepatic portal venoplasty was attempted in 11 children with portal vein stenoses over a period of 9 months. The venoplasty was performed by direct puncture of an intrahepatic portal vein followed by balloon angioplasty of the stenotic segment. Patients presented with symptoms of portal venous hypertension or were identified by routine surveillance with posttransplant Doppler sonography. All stenoses were verified with angiography before portal venoplasty was attempted. In patients with suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. In eight of 11 patients, initial clinical and technical success was achieved. Intravascular stents were placed in two of these patients. In the three unsuccessful procedures, complete occlusion of the portal vein precluded vascular access. Two procedure-related complications and one nonprocedure-related complication developed. In one patient, the portal vein restenosed after 6 months, and a metallic intravascular stent was placed to alleviate the stenosis. Portal vein patency in all other successful procedures has been maintained for 3-9 months (mean, 6.1 months) without further intervention. Percutaneous transhepatic portal venoplasty of portal vein stenosis in children with living, related liver transplant donors has excellent early results. In patients with this complication, the procedure has become the initial choice in our hospital, eliminating the need for surgical revision, portacaval shunting, or retransplantation.
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7785575
|
Lateral ventricular effacement as an isolated sonographic finding in premature infants: prevalence and significance.
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The sonographic finding of effaced lateral ventricles in premature infants, defined as the absence of visible CSF within the lateral ventricles on both coronal and sagittal sonograms, may be cause to suspect diffuse cerebral edema, especially as published reference standards do not address this phenomenon. This investigation was undertaken to determine the prevalence and significance of effaced lateral ventricles without associated parenchymal abnormality (isolated lateral ventricular effacement, or ILVE) in premature infants. Sonographic records of 398 consecutive newborns examined from January 1 to December 31, 1993, were reviewed retrospectively to identify those premature infants (< 36 weeks of gestational age) whose initial sonograms showed no evidence of intracranial hemorrhage, ventriculomegaly, structural abnormality, or abnormal parenchymal echogenicity. We identified 142 neonates who met these criteria. Patients were separated into two groups on the basis of whether they had at least one sonographic study in which CSF was not visible within both lateral ventricles on coronal and sagittal images. Medical records were reviewed to assess neurologic outcome. Forty patients (28%) had at least one sonogram demonstrating ILVE, with neurologic follow-up in 33 (representing group A). One hundred two patients (72%) never demonstrated ILVE, with neurologic follow-up established in 86 (representing group B). A comparison of the two groups showed no significant difference in the development of ischemic injury (one patient in each group). ILVE was first detected on the initial sonogram obtained (mean, 4 days) in 30 of the 33 neonates in group A. ILVE was demonstrated beyond the seventh day of life in 30%. Of the 89 patients whose initial sonograms showed CSF in the lateral ventricles (86 in group B and three in group A), three (3%) subsequently had sonograms that showed ILVE; all three were normal at follow-up. ILVE in premature infants is common and not associated with neurologic deficits indicative of hypoxic-ischemic encephalopathy. By itself, ILVE is not a significant finding.
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7785576
|
The role of imaging in patients with ascites.
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Imaging plays a significant role in patients with ascites for assessing the size and the causes of ascitic fluid, for assisting sampling or draining of ascitic fluid, for selecting candidates for TIPS placement, and for surveilling and detecting complications after TIPS placement. Sonography and CT are primary imaging tools, and MR imaging is used in selected cases such as demonstration of peritoneal or ascitic fluid enhancement, particularly in patients with compromised renal function. Interventional procedures combined with CT and sonography play a major role in the assessment of patients considered for TIPS placement because of refractory esophageal bleeding or ascites. Before the TIPS procedure, these procedures are used to exclude contraindications such as polycystic liver disease, hypervascular hepatic tumors, and portal vein thrombosis. After the TIPS procedure, sonography combined with interventional procedures is used to detect immediate complications such as hemorrhage or intractable shunt-induced encephalopathy due to excessive portosystemic diversion and to detect and treat mid- to long-term complications such as shunt stenosis and occlusion through a routine surveillance program.
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7785574
|
Estimation of total lung capacity from chest radiography and chest CT in children: comparison with body plethysmography.
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The purpose of this study was to evaluate two methods of estimating lung volume using chest radiographs and one using chest CT in children. Estimates made with these techniques were compared with total lung capacity calculated with body plethysmography. CT scans and posteroanterior and lateral radiographs of the chest were obtained in 21 children (14 girls and seven boys) for follow-up evaluation after lung transplantation. Lung volume was measured by CT using a previously validated technique of tracing the margins of the lungs on each axial CT scan. Two methods were used to estimate lung volume on chest radiographs: a technique previously described in adults and children that requires 21 measurements on posteroanterior and lateral radiographs, and a modification of a simplified technique previously reported in adults that uses only two measurements on a posteroanterior radiograph alone. Estimated lung volumes from CT and from both methods using chest radiographs were compared with total lung capacity determined from body plethysmography using regression analysis, and 95% prediction intervals were generated. All three methods of estimating lung volumes from radiographs correlated well with total lung capacity from plethysmography (r = .89-.92). However, we found no statistically significant or clinically meaningful difference among the methods of estimating lung volume. Lung volumes in children can be accurately estimated from specific measurements made on chest radiographs and on CT scans. Of the two methods tested with chest radiographs, the technique that required only two measurements from a posteroanterior chest radiograph was as accurate as the more complicated technique that required 21 measurements.
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7785573
|
Renal osteodystrophy: imaging findings that mimic those of other diseases.
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Musculoskeletal complications in patients with chronic renal failure are common and may be related to the disease itself or to treatment. The altered metabolism in patients with chronic renal failure leads to renal osteodystrophy, which consists of osteomalacia and secondary hyperparathyroidism [1]. Erosive changes attributable to secondary hyperparathyroidism may be easily confused with rheumatoid arthritis, seronegative spondyloarthropathies, infection, or even malignancy. Brown tumors and amyloid deposition can easily be mistaken for a neoplastic process. The purpose of this article is to illustrate radiographic findings that are caused by renal failure and that often mimic other diseases by use of plain radiographs, CT scans, and MR images. Particular emphasis is placed on periarticular findings.
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7785572
|
Primary bone tumors: value of MR angiography for preoperative planning and monitoring response to chemotherapy.
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The purposes of our study were to investigate the use of MR angiography with two- (2D) and three-dimensional (3D) displays in evaluating vascular morphology of musculoskeletal neoplasms for preoperative planning of limb-salvage surgery and to assess the use of MR angiography for monitoring changes in neovascularity and evaluating response to chemotherapy. We used MR angiography (2D time-of-flight) to study 13 patients with primary bone tumors (nine osteogenic sarcomas, two Ewing's sarcomas, and two primary lymphomas of bone) at the time of initial presentation. Eight patients (all of whom had osteogenic sarcoma) also underwent MR angiography following chemotherapy before limb-salvage surgery. Two-dimensional maximum intensity projections were obtained. Three-dimensional reconstructions of vascular structures were created from the angiographic source images and were displayed simultaneously with 3D reconstructions of tumor and normal bone generated from conventional MR images. Two-dimensional maximum intensity projections were useful for evaluating small vessel neovascularity; 3D displays demonstrated spatial relationships of tumor, feeder vessels, and normal vascular structures. Tumor encroachment onto or encasement of normal vascular structures was shown in four patients on 2D maximum intensity projections and on 3D displays. The eight patients with osteogenic sarcoma who had follow-up imaging showed marked neovascularity prior to chemotherapy. Five patients responded to chemotherapy (> or = 90% tumor necrosis at histology); MR angiography showed marked reduction in tumor neovascularity in these patients. Three patients did not respond to chemotherapy; MR angiography showed unchanged neovascularity in one and increased neovascularity in two of these patients. MR angiography provides good visualization of peripheral vascular branches and tumor neovascularity in patients with primary bone tumors. MR angiography demonstrates encroachment onto and encasement of major vessels by the tumor mass and appears to be useful for assessing response to chemotherapy in osteogenic sarcoma and possibly other primary bone tumors by detecting treatment-induced changes in tumor neovascularity.
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7785571
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Treatment of high-grade bone sarcomas with neoadjuvant chemotherapy: the utility of sequential color Doppler sonography in predicting histopathologic response.
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The purpose of this study was to use color Doppler flow imaging to predict the response to preoperative chemotherapy in patients with Ewing's sarcoma or high-grade osteosarcomas early in treatment. Color Doppler flow imaging was done in 31 patients before, during, and after chemotherapy. In each phase of treatment, semiquantitative changes in intratumoral blood flow, changes in maximum intratumoral Doppler shifts, and changes in resistive indexes of arteries feeding limbs that contained tumors relative to contralateral normal arteries were compared with the histopathologic response, as evaluated on the resected specimens. Before chemotherapy, pathologic flow was found in the extraosseous component of all but two patients. Resistive indexes in arteries that fed tumors were significantly lower (p < .001) than the resistive indexes in the contralateral normal arteries. Histopathologic response could not be predicted on the basis of the initial measurements of Doppler shifts and resistive indexes taken before or after the first cycle of chemotherapy. Histopathologic response could be predicted after the second cycle of chemotherapy. After the second cycle of chemotherapy, the resistive index in the arteries that fed tumors increased in eight of nine good respondents but did not change or decreased in eight of nine poor respondents (p = .03). Lower intratumoral Doppler shifts were measured in six of 10 good respondents but also in five of 13 poor respondents (p = .07). After the full course of chemotherapy, persistent lower resistive indexes were measured in the arteries that fed tumors in all poor respondents but one. Intratumoral flow and Doppler shifts further decreased in all good respondents but one. Changes in Doppler shifts (p = .001) and resistive indexes (p < .001) were statistically significant between good and poor respondents, irrespective of the tumor type studied. Decreased or unaltered resistive index in the arteries that feed tumors in addition to persistent intratumoral flow and high-frequency Doppler shifts after two cycles of chemotherapy suggest poor histologic response to chemotherapy in osteosarcoma and Ewing's sarcoma. An increased resistive index after two cycles is indicative of good response.
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7785570
|
Abnormalities of the foot and ankle: MR imaging findings.
|
Although plain film radiography remains the appropriate imaging technique used in the initial evaluation of ankle and foot disorders, MR imaging has rapidly become important because it provides high soft-tissue contrast and multiplanar capability, and because it can detect subtle marrow abnormalities. MR imaging is most useful for evaluating pathologic processes that involve soft-tissue structures and for evaluating patients whose clinical findings remain unexplained despite normal findings with other imaging techniques. This pictorial essay illustrates various applications for MR imaging of the foot and ankle.
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7785569
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Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis.
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Jumper's knee, or chronic patellar tendinitis, can be a source of considerable pain in athletes. The changes that occur with shearing of the tendinous fibers from repeated microtrauma can progress to significant degeneration and increase the risk of tendon rupture. In order to better understand this phenomenon, a correlative study relating the MR imaging and pathologic findings was performed. Nine high-performance athletes 18-22 years old (mean age, 20 years) underwent operation of 11 knees for long-standing jumper's knee. The average period of symptoms was 3 years (range, 2 to 6 years). MR knee examinations were performed before surgery in all athletes. The symptoms, MR findings, and pathological findings were correlated. There was focal thickening in the proximal one third of the patellar tendon (range, 9-16 mm; mean, 12 mm) in all 11 knees, involving the medial portion of the tendon in 10 and the center in one. On proton-density-weighted MR images, all knees demonstrated a focus of abnormal signal intensity in the proximal one third of the patellar tendon. On T2-weighted MR images, 10 knees demonstrated abnormal signal intensity; eight were isointense to that seen on proton-density-weighted images, and two were relatively hyperintense. Ten tendons demonstrated a poorly defined posterior margin. Pathologically, the areas of abnormal signal intensity corresponded to tissue containing tenocyte hyperplasia, prominent angiogenesis with endothelial hyperplasia, loss of longitudinal collagenous architecture, and microtears with collagen fiber separation. Hyaline degeneration was present in specimens from every patient. In athletes with chronic patellar tendinitis, areas of abnormal signal intensity on MR imaging corresponded to degenerative pathologic changes consistent with angiofibroblastic tendinosis. In nearly all patients, the tendon thickening occurred eccentrically. Disproportionate medial tendon thickening may be related to unequal tensile forces across the knee joint, resulting in greater stress on the medial portion of the extensor mechanism of the knee.
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7785568
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Increased signal in the normal supraspinatus tendon on MR imaging: diagnostic pitfall caused by the magic-angle effect.
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Increased signal intensity within the distal portion of the supraspinatus tendon during MR imaging is a frequent observation even in healthy subjects. This finding has been variously attributed to the presence of fat, muscle, connective tissue, abnormal vascularity, or degenerative changes. More recently, the effect of tendon orientation in the static magnetic field (Bo) has been implicated. It has been shown that tendons at the magic angle of 55 degrees to Bo show markedly increased signal. This study was designed to determine the contribution of the magic-angle effect to the MR signal in the distal portion of the supraspinatus tendon. Five healthy volunteers were imaged in a 1.5-T unit using short TR/TE sequences in standard supine position; they were then reimaged laterally flexed at the waist to reorient the plane of the distal portion of the supraspinatus tendon by approximately 20 degrees relative to Bo. In the second part of the study, three cadaveric shoulders were similarly imaged, first in standard position and then reoriented approximately 35 degrees by simple rotation of the specimen. The supraspinatus tendon was evaluated in each subject by noting the length of the segment with increased signal and the position of this segment relative to the insertion of the tendon on the greater tuberosity. Comparisons were made for each live and cadaveric subject between neutral and rotated positions. Segments of increased signal changed in length and position for each live and cadaveric subject from the neutral to the reoriented position. Our study suggests that tendon orientation contributes significantly to the presence of increased signal within the supraspinatus tendon, as caused by the magic-angle effect. Failure to recognize this effect may lead to diagnostic inaccuracy when evaluating the rotator cuff on short TR/TE sequences.
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7785566
|
Filmless musculoskeletal radiology: why is it taking so long?
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Digital images as an alternative to plain radiographs in musculoskeletal radiology have not been readily accepted to date. This article looks at the different aspects of filmless imaging and offers an opinion concerning this lack of acceptance. Although spatial resolution, image storage, and image transmission present potential problems, the greatest problem is image display. Commercially available workstations do not compete well with the speed and simplicity of the conventional film and view box.
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7785564
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Duplex sonography after transjugular intrahepatic portosystemic shunts (TIPS): normal hemodynamic findings and efficacy in predicting shunt patency and stenosis.
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Portal hemodynamics are altered by placement of a transjugular intrahepatic portosystemic shunt (TIPS). Normal duplex sonographic findings after TIPS placement and hemodynamic alterations indicating shunt failure have not yet been well described. The purposes of this study were to determine normal hemodynamic changes on duplex sonography after TIPS placement and to assess the efficacy of duplex sonography in detecting shunt dysfunction. Forty patients underwent TIPS placement and were entered into a study that included routine sonographic evaluation and portal venography at regular intervals. Portal venography was also performed if shunt velocities on duplex sonography changed from the baseline, which raised the question of shunt stenosis or occlusion. The pre-TIPS duplex sonographic study included determination of patency, velocity, and flow direction in the main, right, and left portal veins and in the hepatic artery. Follow-up sonography included the pre-TIPS examination in addition to velocity determinations in three segments of the shunt. Correlation was made between 82 concurrent sonographic and portal venographic studies. High-velocity blood flow (mean peak velocity, 135-200 cm/sec) was consistently seen within patent, well-functioning shunts. Hepatic artery peak systolic velocities increased from 79 cm/sec before TIPS placement to 131 cm/sec after TIPS placement (p < .001). Main portal vein velocities increased from 21.8 cm/sec before TIPS placement to 41.5 cm/sec after TIPS placement (p < .001). When compared with portal venography, duplex sonography was 98% sensitive and 100% specific in predicting the presence of blood flow within the stent. Sonography was highly sensitive and specific for detecting stent stenosis. Final sonographic criteria for shunt stenosis in angiographically documented cases were low-velocity shunt flow (< or = 60 cm/sec) in the entire stent, or low-velocity shunt flow with an associated focal velocity elevation. Consistent changes in portal venous and hepatic arterial hemodynamics are normally seen on duplex sonography after placement of a TIPS. Duplex sonography accurately predicts shunt patency and dysfunction when compared with portal venography. Duplex sonography is an effective, noninvasive method of evaluating shunt function and should be considered for use as the primary imaging technique in routine follow-up after TIPS placement.
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7785563
|
[Clinical statistics at the urological clinic of Sanjukai Hospital--statistics on new outpatients during the last five years].
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We report the clinical statistics of new outpatients for five years since 1989 at our hospital. The average total number of new outpatients in a year was 8309.8 (8122-8691) and new outpatients tended to show little change. The male to female ratio was 1.57:1, and 24.3% of the outpatients were referred to us by others sources. The representative operations on outpatients were circumcision, vasectomy, resection of condyloma and resection of caruncle. A statistical study was made on new outpatients according to the international classification of disease. There were 140.6 (1.97%) malignant urogenital tumors per year. Sexually transmitted diseases showed a tendency to increase for the last five years. In males the major disease was upper urinary tract stone (21-24%), prostatistis (21-24%) and benign prostatic hypertrophy (17-20%) and in females they were cystitis (58-61%), upper urinary tract stone (15-17%) and pyelonephritis (3-4%). We conclude that our hospital plays a major role as a private urological hospital.
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7785561
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[Two cases of priapism cured by transcatheter embolization of internal pudendal arteries].
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We report here two cases of priapism. One of these cases was suspected to be drug induced and high and low flow mixed type. The patient had taken the drugs, alpha-blocker for hypertension and dysuria by BPH for a long time. He was treated by a caveno-glandular shunt. After surgery, detumescence was obtained for some time, but erection appeared again soon. Transcatheter embolization of the internal pudendal arteries was then performed, and detumescence became permanent. The other case was an idiopathic and high flow type. Detumescence was achieved soon by transcatheter embolization of the internal pudendal arteries only, then he experienced morning erection imperfectly on the 9th day after this treatment. The management of priapism as reported to date is also reviewed.
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7785562
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[A case of granulomatous orchitis].
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A 69-year-old man complained of a painless left scrotal swelling. The scrotal mass was enlarged to a hen's egg size with a smooth surface. The scrotal ultrasonogram showed diffuse hypoechogenicity. A testicular tumor was suspected and left high orchiectomy was performed. Histopathological diagnosis was granulomatous orchitis.
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7785560
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[Intra-arterial chemotherapy with cisplatin, vincristine, methotrexate and adriamycin for recurrent penile cancer: a case report].
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A 60-year-old man visited our hospital with a chief complaint of penile tumor on November 13, 1984. Circumcision of true phimosis was performed and biopsy of the 27 x 27 mm fixed tumor on the glans revealed well differentiated squamous cell carcinoma. Seventy Gy of electron irradiation to the penis revealed a complete response. On February 1, 1985 bilateral inguinal lymph node dissection was performed and revealed metastasis to a left inguinal node. In May 1990, erosive changes occurred on the irradiated region, and local recurrence was confirmed. Since 2 courses of MBD (methotrexate, bleomycin, cisplatin) chemotherapy was not effective, additional wedge dissection was performed. In January 1992, local recurrence was found. Four courses of intra-arterial chemotherapy (cisplatin, vincristine, methotrexate, adriamycin) was performed with a complete response. No evidence of disease has been recognized for more than two years after completion of the treatment.
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7785559
|
[A case of middle ureteral tumor treated by end-to-end anastomosis following resection of 6.7 cm segment].
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A 71-year-old male with a right ureteral tumor in the midportion and contracted kidney of the opposite side, due to complete vesicoureteral reflux, underwent end-to-end anastomosis after partial ureterectomy 6.7 cm in length. Our experience in this case led us to conclude that end-to-end anastomosis of the upper or mid-portion of the ureter was possible for the maximal 7.0 cm length of the ureteral loss, when the kidney could be fixed downward as much as possible.
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7785558
|
Evaluation of effects of chitosan in preventing hemorrhagic cystitis in rats induced by cyclophosphamide.
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Hemorrhagic cystitis is a common problem following cyclophosphamide or radiation therapy. Chitosan has been shown to be an effective hemostatic agent and promoter of wound healing in animal experiments. We evaluated the safety and efficacy of intravesical chitosan in an animal model of cyclophosphamide cystitis. Hemorrhagic cystitis was induced in female F344 rats by intraperitoneal cyclophosphamide, 100 mg/kg. Chitosan solution (0.3 ml) was instilled intravesically on day 1 (Group 1), on days 1, 3, and 5 (Group 2), or 1 hour after the administration of cyclophosphamide (Group 3). The rats in group 4 were treated with chitosan diluent on day 1 after cyclophosphamide, and the rats in group 5 received intravesical chitosan without cyclophosphamide. Sequential examination revealed decreased mortality and lower incidences of severe bladder bleeding, necrosis and inflammation in Group 3. Treatment delayed until after the appearance of the cystitis, especially repeated treatments, appeared to make the cyclophosphamide-induced changes worse. Used within 1 hour of cyclophosphamide administration, before the cystitis develops, chitosan seemed to have the possibility to inhibit the appearance of hemorrhagic cystitis. In addition to the changes in the bladder, severe changes occurred in the kidneys secondary to cyclophosphamide.
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7785557
|
[Consecutive annual changes in minimum inhibitory concentration in clinically isolated Neisseria gonorrhoeae strains].
|
Between 1983 and 1991, 465 gonococcal strains isolated in the urological department of Japanese Red Cross Medical Center. The minimum inhibitory concentration (MIC) of these isolates to 22 kinds of antibiotics including penicillins (PC), cephems, tetracyclins (TC) and new quinolons (NQ) were determined and the annual difference of MIC was studied. The annual incidence of penicillinase producing neisseria gonorrhoeae (PPNG) of these 9 years were distributed in 3 to 17% and increasing tendency was not observed. As for Penicillin G, the MIC 90 of PPNG was seven fold higher than that of non-PPNG. No remarked difference was observed between MIC 90 of Cephems, TC and NQ of PPNG and non-PPNG. No annual difference was observed in MIC of PC, Cephems and SPCM. However the rising tendency of MIC was observed in NQ.
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7785556
|
[Experimental studies on evaluation of rat testicular function by 31P magnetic resonance spectroscopy].
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To evaluate the efficacy of 31P magnetic resonance spectroscopy (31P MRS) as a diagnostic method for abnormal testicular function, we examined three conditions using rat testes, ischemia, irradiation, and hormone manipulation. 1) Ischemia: Immediately after clamping of the feeding vessels, ATP signals began to fall and disappeared within 60 minutes. With the release of blood supply after 3 hours of ischemia, ATP appeared within 2 hours. However, after more than 4 hours of ischemia, ATP did not recover within 2 hours and the testis became necrotic after 1 week. 2) Irradiation: 31P MRS of the testis 2 weeks after irradiation with 10 Gy., 9 MeV showed a significant decrease (P < 0.05) in the PME/beta-ATP ratio from 1.30 +/- 0.11 (control level) to 1.11 +/- 0.12 and a decrease in PME/PDE ratio from 1.43 +/- 0.17 to 1.13 +/- 0.20. However 3 weeks later, the PME/beta-ATP ratio recovered to a control level. 3) Hormone manipulation: In the testes 5 weeks after weekly intramuscular injections of estradiol benzoate and testosterone enanthate, PDE/beta-ATP ratio significantly increased (P < 0.01) from 0.83 +/- 0.09 (control level) to 1.03 +/- 0.19. 31P MRS is a non-invasive method for evaluation of various testicular abnormalities, and ATP signals may be useful to evaluate an acute ischemic change for example testicular torstion and the changes of PME, PDE signals may be useful parameters in the assessment of the status of spermatogenesis.
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7785555
|
[Morphological changes in major pelvic ganglion neurons and histological structure of bladder using rat model of partial urethral ligation].
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Ninety six rats were divided into 4 groups (normal control group (N = 4), ligation group (N = 20), ligation-removed group (N = 36), and sham surgery group (N = 36)). The neuronal size of the 4-week ligated rats returned to normal 6 weeks after removal of the ligation. Rats ligated for 7, 11 and 20 weeks also exhibited a significant increase in the mean area but they could not make a complete recovery after removal of ligation for 6 weeks. Only the rats in the 1- and 4-week ligation groups could recover their neuronal size. Area densities of smooth muscle: connective tissue (ADsc ratio) was calculated using Elastica van Gieson staining sections of bladder strips. When ligation was removed, the ratio dropped and became nearly equal to the value of the sham surgery group. Only the 7-week group showed a lower ADsc ratio than the sham surgery group after the ligation was removed. These findings suggest that the reversibility of neuronal hypertrophy might become irreversible when the period of partial urethral ligation persisted beyond 7 weeks. Irreversible hypertrophy of major pelvic ganglion (MPG) neurons might be greatly related with the irreversibly enlarged fibrous bladder which could not show the same ADsc ratio as was seen in the sham surgery groups.
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7785554
|
[Expression of PCNA/cyclin, p53, C-erbB-2 versus histological grade in transitional cell carcinoma of urinary bladder].
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It is important to know the proliferating ability and the malignant potential of tumor tissues. We have examined the expression of PCNA/cyclin, p53 and C-erbB-2 in transitional cell carcinoma of the human urinary bladder by an immunohistochemical method, and compared the results with the histological grade, stage and survival rate. Immunohistochemical studies, using monoclonal and polyclonal antibodies, on these proteins were performed with formaline fixed-paraffin sections of tumor tissue from 40 patients with bladder cancer. Generally, a higher grade and higher stage tumors expressed PCNA/cyclin, p53 and C-erbB-2 with a greater frequency than the tumors with a lower grade and lower stage and strongly stained cases had a lower survival rate than weakly stained cases. These findings suggest that the detection of each antigen is useful for estimating the malignant potential of transitional cell carcinoma as the adjuvant studies, because of its applicability to paraffin-embedded tissue sections and its simple, rapid technique.
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7785553
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[Clinical study on antimicrobial prophylaxis following extracorporeal shock wave lithotripsy].
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One hundred and sixty one patients with upper urinary stones were examined for antimicrobial prophylaxis following extracorporeal shock wave lithotripsy (ESWL). They were divided into two groups, the low-risk group (n = 133) and high-risk group (n = 28), according to the risk factors of urinary tract infection. The patients in the low-risk group were further randomized into two groups which were orally given ofloxacin for 7 days after ESWL (Group A, n = 66), no antimicrobial (Group B, n = 67). The patients in the high-risk group were randomly subdivided into three groups which were given flomoxef intravenously for 2 or 3 days and ofloxacin for 4 or 5 days thereafter (Group C, n = 10), flomoxef only for 2 or 3 days and no drugs later (Group D, n = 10), ofloxacin for 7 days (Group E, n = 8). In all of the patients in the low-risk group, during the 7 days after ESWL, fever elevation was observed in only 1.5% of patients, and bacteriuria in 10.0% on the 7th day. There was no difference in frequency of fever elevation and bacteriuria following ESWL between Group A and Group B. These findings indicate that prophylactic antimicrobial after ESWL treatment is not necessary for low risk patients with urinary tract infections. In the high-risk group, the over-all rates of fever elevation and bacteriuria were 21.4% and 24.0% respectively. The difference of effectiveness among the prophylactic regimens of the three groups (Group C, D, E) was not shown.(ABSTRACT TRUNCATED AT 250 WORDS)
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7785552
|
[Evaluation of surgical treatment for bone metastatic lesion in renal cell carcinoma].
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Ten renal cell carcinoma (RCC) patients with bone metastatic lesions were treated in the Kyoto Prefectural University of Medicine between January, 1977, and December, 1992. Surgical treatment for the metastatic lesion was performed on 4 patients, while conservative treatment was performed on the other 6 patients. Surgical treatment made the patients painless consecutively, resulting in higher activities of daily life. However, recurrence of RCC developed in all the cases between 2 and 7 years later. Surgical treatment for the metastatic lesion was considered to be only a palliative therapy for RCC with bone metastasis and the indication should be limited to patients expected to have a good prognosis.
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7785550
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Bladder function and non-neurogenic dysfunction in children: classification and terminology.
|
Urological function and dysfunction in children are different from function and dysfunction in adults. The dynamics of the urinary tract in children are more complex as development from simple reflex controlled infant bladder to mature bladder function takes place during the first five years of live. The most crucial event in this development is the maturation of the inhibition that takes place in the growing urinary tract. Apart from gaining neurological control over de lower urinary tract there is the physical growth of the bladder-sfincter unit. Otherwise in children there exist a large amount of structural organic congenital pathology of the lower urinary tract that can trouble the normal development. Finally there is the cognitive function that has no anatomical substrate in the lower urinary tract but which takes place in the central nervous system and which is influenced by training and which can play a major role in development of non structural functional dysfunction. In order to train a child adequately the anatomical structure needs to have undergone enough maturation. By training a child on a too early age one can help to develop non structural functional dysfunction. In a time where competition in dry-training is encouraged by commercial pressure and where parents have less time, so that they are urged to train their children dry, more and more non-structural functional dysfunction in children is seen. The most prominent symptom of maldevelopment of the urinary tract, be it structural or functional is urinary incontinence. It is the most common problem seen in the paediatric urology practice.(ABSTRACT TRUNCATED AT 250 WORDS)
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7785551
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Pitfalls in urodynamic investigations in children.
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For the evaluation of bladder (dys)function in young children with neuropathic bladder or other congenital malformations urodynamic investigations have become widely accepted. Although urodynamic studies can be conducted as early as the newborn period, there are some specific studies that can only be performed in somewhat older children, such as pressure-flow studies. Unlike adult patients, children most often do not understand why such an invasive study needs to be performed and are therefore less co-operative. In order to make the study as pleasant as possible some special measures have to be taken. This paper describes the different modalities available to perform urodynamic investigations in children, its drawbacks, pitfalls, indications, clinical implications and prerequisites.
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7785548
|
Laparoscopy: any indication in the work-up and treatment of undescended testis?
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About 10% of undescended testis are non palpable. Surgical exploration of the inguinal region was the standard treatment, mainly because reliable "localisation tests" were not available. Today, laparoscopy is becoming the first step for optimal management of this problem. This technique combines relevant diagnostic information with therapeutic facilitations.
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7785545
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[Examination of the non-palpable cryptorchid testis].
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Cryptorchidism affects approximately 1 in 150 boys. Non-palpable testes represent nearly 20% of all cases. If present, they are situated between the inferior renal pole and the external inguinal ring. Often at surgical exploration, however, a "nubbin" of testicular tissue is found at the end of blind ending spermatic vessels without demonstration of a recognizable testis; this finding is referred to as an absent testis. In other patients, no vascular or ductular (epididymis-vas deferens) or even testicular structure can be observed. This situation defines true testicular agenesis. Non-palpable testes have an increased risk of malignant transformation, infertility, associated inguinal hernia and congenital ductular abnormalities. Surgical treatment is often more complex and unsuccessful. Many imaging diagnostic methods to investigate patients with non-palpable testes (pneumoperitoneography, angiography, ultrasonography, CT scan and RMN) have been used so far but none of these has been uniformly accepted as the ideal investigative technique because they are unreliable and/or they involve a fair risk. Since Cortesi and associates first described in 1976 a case of abdominal testes identified by laparoscopy, this technique has gained increased acceptance by pediatric urologists and surgeons. Today, celioscopy plays a central role in the exploration of non-palpable cryptorchid testes. The authors try to establish an algorithm methodology for investigating non-palpable testes under the light of recently reported anatomical, pathological and surgical data.
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7785544
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[Laparoscopic treatment of recurrence and embolization failure of varicocele].
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Varicocele is a benign pathology, for which the less invasive treatment is percutaneous embolisation. Literature reports results from 70 to 85% (1,2). Laparoscopic treatment seems to be a good alternative for patients suffering from a recurrence, or patients who can not be embolised. We report our experience concerning the first 13 patients treated with laparoscopic technic. In all 13 cases it was possible to practice the technic, and patients were cured.
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7785543
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[Antegrade scrotal sclerotherapy in the treatment of varicocele].
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The antegrade scrotal sclerotherapy is a minimally invasive surgical technique in the treatment of the varicocele. Through a small scrotal incision a straight vein merging in the spermatic vein is isolated and cannulated. An antegrade phlebography is performed and ethoxysclerol is injected in the vein. We have performed this technique in 35 patients with a follow-up of at least 3 months. All patients except one (97%) show no more varicocele. This technique has a low morbidity, is cheap and as effective as the other treatment modalities. The antegrade sclerotherapy is competitive to the retrograde embolisation and has the advantage that the treatment can be performed in all cases, even in cases of recidive.
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7785540
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Colpopromontoriopexy.
|
This is a review article about the colposacropexy and the colpopromontoriopexy in the treatment of vaginal prolapse. We reviewed the literature through the eyes of a urologist dealing with genuine stress incontinence. The treatment of genuine stress incontinence without sphincterdeficiency consists in the correction of the anterior compartment prolapse. Preoperative it is important to examen the middle and the posterior compartment of the vagina in order to achieve good postoperative results. Most urologists cure genuine stress incontinence with an abdominal approach. The combination of a colposuspension and a colpopromontoriopexy is an operation that corrects anterior, middle and posterior compartment prolapse by the same approach without significant more complications or bloodloss.
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7785535
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Female incontinence: critical analysis of diagnostic procedures.
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Urodynamic procedures when required as part of the evaluation of female urinary incontinence should be tailored to the individual case. A wide range of tests are available which are reviewed with hints to which will add most information to previously obtained clinical data.
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7785534
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Female urinary incontinence: imaging by or for the urologist.
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The author reviews the imaging techniques useful in the evaluation of female urinary incontinence: voiding cystourethrography and videoradiourodynamics. Voiding cystourethrography allows to disclose two forms of bladder base suspension defects: anterior and posterior suspension defects. It will be performed before surgery. Videoradiourodynamics will be limited to patients with recurrent urinary incontinence following unsuccessful surgery.
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7785533
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Reducing uncertainty for vesico-urethral sonography in women.
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The author endeavours to detail the technical modalities which can be used to avoid uncertainty in urodynamic sonography, and to obtain easily reproducible quality imaging. The 5 major techniques (transparietal, transperineal, introital, endovaginal and endorectal) are compared. The artifacts generated are described. A choice between these different techniques is performed as a function of the methodological advantages specific to each of them and the clinical applications contemplated by the sonographer. The characteristics of the "ideal" equipment are defined to help the sonographer-to-be to choose his or her equipment with full awareness of the facts (characteristics of the probe, emission frequency, settings by the sonographer, automatic image freeze during coughing). The methodology is described in detail and widely illustrated: position of the patient, choice of the section plane, choice of the reference system, location of the urethra, and definition of the vesical neck, maintenance of the probe position during effort or free movement, degree of vesical fullness, choice of the parameters. Some difficulties can be linked to the patient's anatomical characteristics (vaginal scar, short or narrow vagina, twisted urethra,...); ways to avoid them are briefly described.
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7785531
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Commercial television bladder dysfunction.
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Bladderdysfunction seems to have an increasing frequency in infancy, and especially in children without obvious congenital organic or functional bladderdysfunction. The disorder seems is related with changes in our behaviour, that are stimulated by familial and social pseudo-reasons. Commercial interests and marketing play a major role. This leads to wrong dry-training, an exaggerated hygienic education, prudisheness, wrong toilet-posture, lack of time to void, post-poning, wrong drink- and void-pattern, wrong food-pattern and increasing constipation. Prevention is necessary by an adapted reeducation of parents ans society.
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7785527
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Inoculum size and severity of malaria induced with Plasmodium ovale.
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Although it might be expected that the size of the infecting inoculum would influence the severity of the consequent malaria, evidence that it does so is scarce. Using records from 80 non-immune neurosyphilis patients who received malaria therapy with a single strain of Plasmodium ovale by blood inoculation, the relationships between the number of trophozoites inoculated, the prepatent period, and measures of severity of the resulting malaria were examined. The number of trophozoites was not related to any of the outcome measures, but patients with shorter prepatent periods had higher and more peaks of fever and longer lasting infections.
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7785525
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Social aspects of malaria in Heping, Hainan.
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This paper presents findings from a study conducted in Heping Town, Qiongzhong County, Hainan Province, China. The study, conducted in 1992, used qualitative as well as quantitative methods to gather social, cultural and behavioural data associated with the acquisition, transmission and prevention of malaria, and the diagnosis and treatment of disease. These methods included focus groups, key informant and other in-depth interviews, and observations, a household survey and tests of school children of knowledge of malaria. The study is among the first to our knowledge that has utilized this broad mix of methods for tropical disease research in China.
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7785526
|
Anaemia and Plasmodium falciparum infections among young children in an holoendemic area, Bagamoyo, Tanzania.
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Although the aetiology of anaemia in tropical areas is multifactorial, Plasmodium falciparum malaria is commonly associated with anaemia in children living in holoendemic malaria areas. Such an association was examined in a population based study of 338 children 6 to 40 months of age living in the Bagamoyo area of Tanzania. Stepwise regression analysis showed that fever and parasitaemia were effective in predicting anaemia and that the anaemic condition was age dependent. The majority of the children were iron deficient, followed by normochromic macrocytic anaemias. There was strong evidence in this age group that the anaemia was associated with malaria and not geohelminth infection. The importance of malaria and anaemia as a cause of childhood morbidity in Africa is discussed. This condition has taken on new significance with the realization that blood transfusions commonly used to treat severe anaemia are a major vehicle for Human Immunodeficiency Virus (HIV) transmission.
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7785524
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Characterisation of taeniid cestode species by PCR-RFLP of ITS2 ribosomal DNA.
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Seven species of taeniid cestode (Echinococcus granulosus. E. multilocularis, Taenia hydatigena, T. ovis, T. pisiformis, T. multiceps and T. serialis) were characterised using a polymerase chain reaction-based restriction fragment length polymorphism technique (PCR-RFLP). The second internal transcribed spacer of ribosomal DNA (ITS2) was amplified from various geographical isolates of each of the seven species, digested separately with four restriction endonucleases and the fragments were separated by conventional agarose gel electrophoresis. PCR-RFLP produced characteristic patterns for each taeniid species examined. No variation in RFLP patterns was observed among different isolates of E. multilocularis and the species of Taenia, but distinct intraspecific variation was detected in E. granulosus. The present study indicates the usefulness of the PCR-RFLP of ITS2 for systematic, epidemiological and diagnostic purposes.
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7785523
|
Immunodiagnosis of schistosomiasis mansoni in a low endemic area in Surinam by determination of the circulating antigens CAA and CCA.
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We evaluated the applicability of circulating antigen detection in serum and urine for the diagnosis of Schistosoma infections in a low endemic area. In total 389 individuals from Saramacca (Surinam) participated in the survey. Stool samples were examined using the Kato method, while circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) were determined by highly specific monoclonal antibody-based ELISA's. Also schistosome specific IgM antibodies were measured by the indirect immunofluorescence assay, but the diagnostic performance of this test was found to be poor in this population. S. mansoni eggs were found in 29% of the examined cases, while CAA and CCA could be demonstrated in 23% and 17% of the serum samples and in 3% and 28% of the urine samples, respectively. Forty three percent of the study population was positive in at least one of these diagnostic assays, indicating that each individual test misses a substantial part of the subjects with an active infection. In most positive cases, intensities of infection were very low. As 204 individuals participated in all screening assays, diagnostic performance of each test was evaluated in this sub-population. The highest sensitivities were achieved with the urine-CCA assay and the parasitological examination, detecting 59 and 58 out of the 107 cases with an active infection, respectively. The serum-CAA assay detected 47 positive cases. Our results demonstrate that determination of circulating antigens, especially CCA in urine and CAA in serum, provides information additional to the parasitological examination, for the assessment of prevalence and intensity of Schistosoma infection in low endemic areas.
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7785522
|
Mapping the densities of malaria vectors within a single village.
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Small scale spatial variation and temporal heterogeneity in mosquito densities can have important consequences for disease transmission, but the extreme variation which is observed in populations of malaria vectors makes it difficult to obtain good predictions of densities for short time periods over limited areas. We have applied Bayesian techniques derived for use in cancer epidemiology in order to map densities of Anopheles gambiae s.l. and A. funestus in a Tanzanian village where there is intense transmission of Plasmodium falciparum malaria. Estimates derived in this way should prove useful in vector population biology and in improving estimates of exposure-response relationships of the human host to malaria. The same methods can be applied in other fields of animal ecology.
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7785521
|
[Horizontal gaze palsy due to lesion of the abducens nucleus detected with magnetic resonance imaging].
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A case of unilateral horizontal gaze palsy is reported. The lesion of the abducens nucleus was clearly detected with magnetic resonance imaging. In the early stage, the adduction of the right eye and abduction of the left eye were completely limited and the vestibulo-ocular reflex was also impaired. However, during the recovery stage, the improvement of limitation of abduction was delayed compared with that of adduction. We suggest that this phenomenon is useful as a differential diagnosis between lesions of the abducens nucleus and of the paramedian pontine reticular formation.
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7785520
|
[A case of multifocal choroiditis associated with progressive subretinal fibrosis].
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Multifocal choroiditis associated with progressive subretinal fibrosis, which was reported by Cantrill and Folk in 1986, is characterized by acute multifocal choroiditis resulting in progressive subretinal fibrosis. All cases were young, healthy females. Our case was a 17-year-old female who complained of visual disturbance in her left eye. Ophalmoscopy showed multiple, small, yellowish-white hypopigmented, choroidial lesions in the posterior fundus of her left eye. These lesions showed hyperfluorescence in fluorescein angiography and hypofluorescence in indocyanine green (ICG) angiography. One month later the yellowish-white hypopigmented, choroidal lesions increased in number and subretinal fibrosis appeared in the macular area. Two months later subretinal fibrosis was also found in the area except for the macula. In her right eye, ophthalmoscopy and fluorescein angiography showed no abnormal findings, but ICG angiography revealed choroidal hypofluorescence areas. Two years later the subretinal fibrosis was increased and the yellowish-white lesions showed pigmentation.
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7785519
|
[Functional magnetic resonance imaging of the human primary visual cortex during visual stimulation].
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Signal changes in the human primary visual cortex during visual stimulation were evaluated using non-invasive functional magnetic resonance imaging (fMRI). The experiments were performed on 10 normal human volunteers and 2 patients with homonymous hemianopsia, including one who was recovering from the exacerbation of multiple sclerosis. The visual stimuli were provided by a pattern generator using the checkerboard pattern for determining the visual evoked potential of full-field and hemifield stimulation. In normal volunteers, a signal increase was observed on the bilateral primary visual cortex during the full-field stimulation and on the contra-lateral cortex during hemifield stimulation. In the patient with homonymous hemianopsia after cerebral infarction, the signal change was clearly decreased on the affected side. In the other patient, the one recovering from multiple sclerosis with an almost normal visual field, the fMRI was within normal limits. These results suggest that it is possible to visualize the activation of the visual cortex during visual stimulation, and that there is a possibility of using this test as an objective method of visual field examination.
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7785518
|
[Static characteristics of accommodation on the relationship between accommodative resting position and viewing distance].
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The steady-state accommodation of subjects during a 15 min visual task was measured in real time by an infrared optometer to investigate the relationship between accommodative resting position and the effect of viewing distance. When the subjects were loaded at 50 cm (closer than their resting state), the steady-state accommodation showed an inward shift which was enhanced when computation was done. On the contrary, when they worked outside their resting position-2m viewing distance-, an outward shift of steady-state accommodation was seen in the control group who reacted only to the visual objects displayed. For the mental task group this was not evident. It appears that the steady-state accommodation is different between the cases of visual stimuli given inside and outside the resting position.
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7785517
|
[An apparatus using laser speckle phenomenon for noncontact two-dimensional analysis of microcirculation in optic nerve head or choroid in human eyes].
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The previously reported apparatus using the laser speckle phenomenon for noncontact two-dimensional analysis of the fundus peripheral circulation was improved so that peripheral circulation in the optic nerve head (ONH) or choroid in human eyes can be measured on a real-time basis. The fundus was illuminated by a diode laser spot and its image speckle was detected with an area sensor. The NB value, a quantitative index of blood velocity, was calculated by the logic board every 0.125 sec successively for 7 sec. Using this apparatus, the NB averaged over the measurement field located in the temporal site of ONH, free of visible surface vessels (NBONH), and that located in the posterior choroid (NBCh) were measured in normal human eyes. The coefficients of reproducibility of 5-minute interval measurements were 11.7% for the NBONH averaged over 5 pulses (mean NBONH) and 8.7% for the NBONH averaged over 5 pulses (mean NBCh), and those of 24-hour interval measurements were 13.0% for the former and 9.7% for the latter, respectively. The average of pulsatile component of NBONH was 38.4% of mean NBONH and that of NBCh was 26.6% of mean NBCh.
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7785516
|
[A new method to elicit pathological entoptic phenomenon from the retina--stenopeic flicker test].
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Patients with central serous chorioretinopathy noticed that a part of the visual field became light for a few seconds when half of the visual field was covered in front of the eye. We devised a stenopeic flicker test (s-f test) to elicit this phenomenon continuously, and evaluated the clinical usefulness. We examined 17 eyes with central serous chorioretinopathy using the s-f test and Amsler grid test. Retinal abnormality was detected in 17 of 17 eyes with the s-f test and 14 of 17 eyes with the Amsler grid test. In detecting the extent of the retinal detachment on fluorescein angiograms, the s-f test (p < 0.0001, r = 0.842) was more precise than the Amsler grid test (p < 0.0003, r = 0.506). These results suggest that the s-f test is useful to detect retinal abnormality and to grasp the extest of the retinal detachment in central serous chorioretinopathy.
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7785515
|
[Localization and response characteristics of thalamic corneal units in the cat].
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Units in the thalamus responsive to mechanical stimulation of the cornea (thalamic corneal units) were studied in urethane-chloralose anesthetized cats. Four different classes of corneal units were found in the nucleus ventralis posteromedialis (VPM) and intralaminar nuclei. They corresponded to 4 different classes of corneal units in the trigeminal subnucleus caudalis and adjacent bulbar lateral reticular formation reported by Nishida (1987). Low threshold corneal specific (LTCS) units, whose mechanical threshold was well below the pain threshold in patients with cataract, were located in the dorsolateral part of the VPM proper. High threshold corneal specific (HTCS) units and wide dynamic range (WDR) units, whose mechanical threshold was well above the pain threshold of the human cornea, were located in the shell region of caudal VPM. Each class of these three corneal units was incorporated in the somatotopic organization of low threshold mechanoreceptive, nociceptive specific, or WDR units having a cutaneous receptive field in the contralateral trigeminal nerve territory. Units having receptive fields in the head similar to those of subnucleus reticularis ventralis (SRV) units were found in the intralaminar nuclei. Their corneal mechanical thresholds were much the same as those of HTCS units and WDR units. These results supported the suggestion that both nonpainful sensation and pain can be evoked in the cornea.
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7785514
|
[Matrix metalloproteinase in the cynomolugus monkey optic nerve heads].
|
Gelationolytic and caseinolytic activity of matrix metalloproteinase in normal cynomolugus monkey optic nerve heads was investigated. Optic nerve heads of three eyes were incubated in the media for 20 hours. Each media was applied to the gelatin or casein containing gels, and zymography was performed. Major bands of 94 kDa and 62 kDa gelatinase activities were demonstrated in all three eyes. In one eye gelatinolytic activity of the 58 kDa band was also demonstrated. Caseinase activity was not detected in any of the three optic nerve heads.
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7785513
|
[An electrophysiological study on the effect of antioxidant drugs against retinal ischemia-reperfusion damage].
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The effects of antioxidant drugs on retinal ischemia-reperfusion damage were studied by electroretinograms (ERGs) from reperfused Dutch rabbit eyes. After inducing retinal ischemia by increasing the intraocular pressure (IOP) up to 140 mmHg for 60 minutes, the reperfusion was started by lowering the IOP to the normal level. Mannitol, polyethylene glycol superoxide dismutase (PEG-SOD), or ascorbic acid was administered by drip-infusion to the rabbits immediately after (early group) or 1 hr after (delayed group) the start of reperfusion. Saline, as a control, was administered by the same method as the early group. The a- and b-waves were recorded before the ischemia and during the reperfusion. In the early group treated by each drug, the recovery rates of the b-wave amplitudes at 4 hrs after the start of reperfusion were significantly greater than those in the controls. In the delayed group, the ERG recovery rate in rabbits treated with PEG-SOD was significantly better than in the controls. These results indicated that all these drugs were effective in protecting from the retina from the ischemia-reperfusion damage, and that some antioxidant drugs might be effective even when they were administered after the start of reperfusion.
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7785512
|
[Endothelin receptors in bovine retinal vessels--quantitative receptor autographic analysis with radioluminography].
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Endothelin (ET) receptors in bovine retinal macrovessels, microvessels, and nonvascular tissues were characterized using a quantitative receptor autoradiographic method with 125I-endothelin-1 (125I-ET-1), ET-1, ET-, ET-3, BQ123 (a selective antagonist for the ETA receptor) and sarafotoxin S6c (an agonist for the ETB receptor). A quantitation was made with a computerized radioluminographic system and imaging plates. The method we used revealed that there were specific binding sites for 125I-ET-1 in the bovine retinal macrovessels, microvessels, and nonvascular tissues. There was no difference in the dissociation constant (Kd) showing binding characteristics between the retinal macrovessels and the microvessels. The bindings to the retinal macrovessels and the microvessels were effectively displaced by BQ123, whereas the binding to the retinal nonvascular tissues was displaced by sarafotoxin S6c. Thus, we obtained evidence that macrovessels and microvessels of the bovine retina have ETA receptor, and that the nonvascular tissues have ETB receptors.
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7785511
|
[MHC and non-MHC gene effects on the development of experimental autoimmune uveoretinitis].
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Experimental autoimmune uveoretinitis (EAU) can be induced in rats by interphotoreceptor retinoid-binding protein (IRBP), and served as a model for human uveitis. Using IRBP-derived peptide R16, we investigated the MHC and non-MHC genes' effect on the regulation and susceptibility to EAU. EAU-high susceptible LEW (RT1l), EAU-low susceptible WKAH (RT1k), and WKAH.1L rats which carry RT1l and WKAH background were immunized with 2 nmol of R16. One hundred percent of LEW rats developed EAU and 92.9% of WKAH. 1L rats. Only, 18.8% of WKAH rats developed EAU. Among these strains tested, the severity of EAU was 2.06 in LEW, 1.23 in WKAH.1L, and 0.38 in WKAH. R16 evoked substantial proliferative responses in all these strains. The present data suggest that both MHC and non-MHC genes play distinct roles in development of EAU.
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7785509
|
[Permeability to horseradish peroxidase of the ciliary muscle vessels of squirrel monkeys].
|
The morphology and permeability to horseradish peroxidase (HRP) of the ciliary muscle capillaries of squirrel monkeys were studied. The endothelial cells of the capillaries were of the continuous type and the interendothelial clefts were closed by a zonula occludens. Many vesicles were present in the cytoplasm of the endothelial cells. In addition to these vesicles, large vacuole-like structures, 100-500 nm in diameter, were observed in the cytoplasm of capillary endothelium, especially in the circular and radial ciliary muscles. When HRP was perfused into the anterior chamber, the 3,3'-diaminobenzidine reaction product was observed in the lumen of the ciliary muscle vessels after 30 minutes. When HRP was administered intravenously, the reaction product was observed among the muscle fiber bundles after 15 minutes. In both cases, the reaction products were also present in the cytoplasmic vesicles and vacuole-like structures, suggesting that these structures are involved in the bidirectional transport of HRP between interstitium and blood.
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7785510
|
[In vitro topically applied fluoroquinolone penetration into the anterior chamber].
|
The penetration mode of five fluoroquinolone ophthalmic solutions (OFLX, NFLX, LVFX, LFLX and CPFX) through the rabbit cornea was examined with an in vitro experimental system. The system was an artificial anterior eye segment model made of acrylamide covered with a New Zealand albino rabbit cornea with a scleral flap. In vivo studies on the penetration of OFLX and NFLX ophthalmic solutions into the anterior chamber of albino rabbits were performed separately. Parameters gained from in vivo pharmacokinetic analysis and those from the model eye were compared. The permeability coefficients (K) (cm/s) through the cornea and partition coefficient were 6.95 x 10(-7) cm/s in LVFX, 6.78 x 10(-7) cm/s in OFLX, 3.58 x 10(-7) cm/s in LFLX, 2.46 x 10(-7) cm/s in CPFX and 0.06 x 10(-7) cm/s in NFLX, and 0.24, 0.23, 0.14, 0.06 and 0.07, respectively. High correlation was seen between the corneal permeability coefficients, and the partition coefficient Cmax of OFLX obtained from the in vivo study was higher than that of NFLX. The applied experimental system would be a useful tool for the estimation of the in vivo Cmax of the examined drug.
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7785507
|
[Induction of oral tolerance to experimental allergic conjunctivitis in rats].
|
Immunological tolerance can be induced by the oral administration of antigen. We induced oral tolerance rats to experimental allergic conjunctivitis by ovalbumin and investigated the suppression of inflammation. In groups which had started eating antigen both before and after the immunization, the serum anti-ovalbumin IgE level measured by passive cutaneous anaphylaxis reaction was significantly lower than in a group that had not been fed antigen. The intensity of experimental allergic conjunctivitis in the group which had started eating antigen before immunization, was significantly suppressed in regard to the leakage of Evans Blue from conjunctival vessels 30 minutes after the challenge and the neutrophil infiltration 6 hours after. The dye leakage of the group which had started feeding after immunization was also significantly suppressed. There was a positive correlation between the serum IgE level and the leakage of Evans Blue (r = 0.90, p < 0.001). These results suggest that the suppression of antigen-specific IgE antibody production caused by oral tolerance affected the decrease of local inflammation on the conjunctiva.
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7785508
|
[Distribution of free amino acids and related compounds in ocular fluids of rat--I. Aging and inherited cataracts].
|
The distribution of free amino acids and their related compounds has been determined in the aqueous humors of Wistar strain and Ihara cataract f-strain (ICR) aging rats. Taurine was the most abundant amino acid in aqueous humors except in ICR rats of 16 and 70 weeks. It was supposed that the increase of serine and glutamine, and the decrease of aspartate, proline and glycine in aqueous humors were related to aging. There were interesting changes in amino acids related to opacity of lens, concentration of taurine was lower than that of Wistar rats in ICR rats of 4, 16, and 70 weeks, alanine and citrulline increased in Wistar rats and decreased in ICR rats, and histidine increased in ICR rats with aging. The changes in free amino acids in aqueous humors were the greatest in ICR rats, and these data will provide useful clues for the formation of cataract and the transportation of amino acids.
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7785505
|
Protein kinase C in cell signaling: strategies for the development of selective inhibitors.
|
Protein kinase C plays a central role in the cellular signaling pathway for the lipophilic second messenger sn-1,2-diacylglycerol, which is involved in many biological responses, including tumor promotion and inflammation. A major effort has been directed at understanding diversity within this system in order to develop strategies for selective inhibition. Two classes of ligands for the regulatory domain of protein kinase C have been identified which, although they function in vitro as activators of the enzyme, paradoxically behave in vivo as partial antagonists. Identification of targets for the phorbol esters distinct from protein kinase C argues that antagonists acting on the regulatory and catalytic domains of protein kinase C will have different spectra of action.
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7785501
|
Immunoglobulin gene expression in rheumatoid arthritis.
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Rheumatoid arthritis (RA) is characterized by inflammation of synovium, in which immunoglobulin-secreting plasma cells are generally present. The forces driving immunoglobulin expression in RA synovium are unknown. Sequences of VH and VK transcripts from an RA synovial cDNA library demonstrate patterns of somatic mutation typical of an antigen-driven response. Moreover, 5% of the kappa repertoire appears to derive from the same B cell progenitor, suggesting an oligoclonal response. Immunoglobulin expression in this synovium thus appears to result from antigen stimulation. In addition, this patient's synovium is enriched for unusually long VK-JK joins (CDR3s), suggesting abnormal selection or regulation of the B cell response in RA.
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7785490
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Site-directed mutagenesis--molecular biology and rational drug design.
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Using site-directed mutagenesis, we have determined the location and composition of the binding sites in human IL-1 alpha and IL-1 beta for the Type I IL-1 receptor (IL-1R). The binding site in each ligand is a discontinuous epitope made up of at least seven amino acids whose side chains are exposed on a contiguous region of the protein surface. Although human IL-1 alpha and IL-1 beta have similar affinities and cross-compete for binding to the human Type I IL-1R, the binding site residues are not identical in the two ligands. In addition, the residues in the binding site of each ligand contribute differently to binding of the human versus the mouse IL-1R. The structure of the IL-1 binding site has implications for the rational design of IL-1 antagonists.
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7785489
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Regulation of alpha 6 beta 1 integrin-mediated migration in macrophages.
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Several integrin alpha subunits have structural variants that are identical in their extracellular and transmembrane domains but that differ in their cytoplasmic domains. In the present study, we examined the possibility that the A and B variants of the alpha 6 beta 1 integrin laminin receptor differ in function. P388D1 macrophages that had been transfected with the alpha A integrin subunit were 3-4 fold more migratory than P388D1 macrophages that had been transfected with the alpha 6 B integrin subunit. Deletion of the alpha 6 cytoplasmic domain markedly inhibited the ability of the alpha 6 beta 1 receptor to promote migration.
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7785487
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The pathogenesis of rheumatoid arthritis and the development of therapeutic strategies for the clinical investigation of biologics.
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This review discusses current concepts of the pathogenesis of rheumatoid arthritis. It is proposed that RA is a T cell mediated disease following which a large number of subsequent inflammatory events are unleashed. Many of the pathogenetic steps are targets for new therapies including biologics. Laboratory, clinical and radiological methods of assessing disease activity are sufficiently sensitive and reproducible to permit their use in multicentre studies capable of detecting a biologic with disease modifying activity. The clinical assessment of the efficacy and toxicity of biologics poses unique problems. These have been illustrated by the example of 3 monoclonal antibodies directed against ICAM-1, CD4 and TNF alpha. The main role of most biologics may be to pinpoint important therapeutic targets which can be attacked by more easily administered and less costly xenobiotic drugs.
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7785485
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Exercise enhances the maintenance of smoking cessation in women.
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We examined the effects of physical exercise on smoking relapse. Twenty previously sedentary female smokers were randomly assigned to smoking cessation plus exercise or smoking cessation with frequency contact control. The smoking cessation program included 12 professionally led sessions over 12 weeks. Exercise treatment included three supervised exercise sessions per week for 15 weeks. Contact control included three women's health/wellness lectures per week for 15 weeks. Smoking abstinence was validated by carbon monoxide and saliva cotinine. Mean exercise attendance for exercise subjects was 88% with an increase in estimated VO2 of 25%. The percentage of subjects who quit for 24 hours was 80% for the exercise and 90% for the contact group. One subject in the contact group remained abstinent at the end of the 12-week treatment and at 1-, 3-, and 12-month follow-ups, whereas three subjects in the exercise group were abstinent at these time points. These results suggest that exercise training improves short-term quit rates and may prove a useful strategy for long-term maintenance of smoking cessation.
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7785486
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Alcohol consumption: biochemical and personality correlates in a college student population.
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The frequency of alcohol use among a subject population of 28 male and 60 female college students was assessed using the Student Alcohol and Drug Use Survey (STADUS). Data were also collected on personality traits as measured by the Sensation Seeking Scale V (SSSV) and the Eysenck Personality Questionnaire (EPQ). Finally, three biochemical variables were assessed: monoamine oxidase (MAO) activity, dopamine beta hydroxylase (DBH) activity, and testosterone levels. Among males, high SSSV scores, high testosterone levels, and low MAO activity contributed to the variance in alcohol use, whereas among females, a significant proportion of the variability in alcohol use was accounted for by high SSSV scores, high DBH activity, and younger age.
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7785484
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Childhood and adulthood temperament and problem behaviors and adulthood substance use.
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A sample of 229 adult men and women were assessed to examine the relationships between childhood and adulthood temperament and problem behaviors. The influence of these variables on adult substance use was also assessed. Results indicated that individuals who had "difficult" temperament characteristics (e.g., hyperactivity) and who experienced problem behaviors (e.g., antisocial behaviors) as children were likely to exhibit them as adults. In addition, the continuation of temperament characteristics and problem behaviors from childhood into adulthood did not demonstrate a high degree of specificity. When the relationships between temperament and problem behaviors to substance use were examined, conduct disorder during childhood and antisocial behavior during adulthood were found to be the best predictors of adult substance abuse. Moreover, this relationship became increasingly stronger with more substance involvement. These results underscore the importance of examining substance use in finer detail by assessing the pattern of substance use, instead of overall substance use involvement.
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7785482
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Parent-child closeness affects the similarity of drinking levels between parents and their college-age children.
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College males reported drinking more frequently and in higher amounts than females. Correlations between quantity-frequency (QF) indices of drinking by parents and by their college-age children showed the greatest similarity between fathers and sons. Log linear analyses compared each parent's drinking level against each of three other factors that might affect the QF levels of college-age children: the relationship between parent and child, the effect of the parent's drinking on the parent, and how the parent's drinking affected their treatment of the child. The results supported models in which the relationship of each parent's drinking to the QF levels of both sons and daughters was affected by the closeness of the parent-child relationship. However, there was no support for models involving how each parent's drinking affected that parent or how each parent's drinking affected their treatment of the child.
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7785483
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Eating style and symptoms of eating disorders: further explorations.
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Based on earlier efforts to document relationships between eating styles involving hunger, deprivation, and restraint and symptoms of eating disorders, three scales--Eating Style, Feeling Deprived, and Dieting Style--were created and administered to 259 University females, 118 males, and 50 nonstudent females. Of interest were psychometric properties of the scales, their relationships to each other and with symptoms, beliefs about weight control, and body weight. One year later, findings based on Eating Style were replicated and extended in smaller groups of the original University subjects. Appreciable relationships occurred almost uniformly between Eating Style (addressing hunger, deprivation, and restraint) and proposed correlates. Feeling Deprived (a measure of avowed deprivation) correlated consistently with beliefs about weight control and weight variables, but not symptoms. Measurement of Dieting Style was hampered by small ns.
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7785481
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Vagal tone regulation during sustained attention in boys exposed to opiates in utero.
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Attention and learning problems among children exposed to opiates in utero have been previously reported but are difficult to interpret due to imprecise measurement and inadequate control of postnatal factors. In this study, we used a behavior-based measure of attention (continuous-performance tasks) and a physiological index of sustained attention (cardiac vagal tone) to measure more precisely the process of sustained attention. Boys, aged 7 to 12, exposed to opiates in utero, were compared to boys whose mothers began using illicit substances after the child's birth (environmental controls), and boys whose mothers were non-drug users. This three-group design was intended to isolate in utero effects from postnatal environmental influences. Vagal tone, a measure of heart-rate variability sensitive to vagal influences on the heart, was measured pre- and postbaseline and during the three tasks of the Gordon Diagnostic System (Delay, Vigilance, and Distractibility). Vagal tone has been found to be sensitive to changes in environmental demand for sustained attention in infants, school-age children, and adults. Results indicated that when distractors were added to the vigilance task (Distractibility task), opiate-exposed boys failed to suppress vagal tone compared to both control groups. However, both the opiate-exposed boys and the environmental controls made fewer correct responses than non-drug-exposed controls on this task. These results indicate that normal physiological responses to increased attentional demand may be impaired in boys exposed in utero to opiates in this age range. However, the poor Distractibility scores of both the opiate-exposed and environmental controls suggests an important role of environmental influences on attentional performance.
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7785480
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An empirical classification of drinking patterns among alcoholics: binge, episodic, sporadic, and steady.
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Steady (daily, continuous) versus nonsteady (binge, episodic, bout, intermittent) drinking pattern have been influential Jellinek's (1960) formulation of delta and gamma drinkers, and are used as variables in various typological systems and drinker profiles. However, definitions of drinking patterns vary widely across studies, and most studies rely on one self-report item to establish a subject's pattern. To systematize and empirically test drinking-pattern schemas, we developed detailed definitions of binge, episodic, sporadic, and steady drinking patterns. A computer algorithm was written in SAS to classify 94 male alcoholics participating in outpatient conjoint therapy, using 6-month pretreatment drinking data from the Timeline Followback Interview. The final classification was: 3 (3%) binge, 33 (35%) episodic, 12 (13%) sporadic, and 40 (43%) steady drinkers. Six (6%) were unclassifiable (due to too few drinking days or too many interruptions to the pattern) by the computer. Episodic, sporadic, and steady drinkers did not differ in demographics, alcohol-related consequences, global psychological distress, or marital satisfaction. Steady drinking was associated with later onset of drinking problems (> 25), while episodic and sporadic drinking were associated with earlier onset. These results are contrary to current use of "binge drinking" as a variable associated with Type 1 alcoholism. Predictive validity analyses indicated that steady drinkers continued to drink more frequently than episodic and sporadic drinkers during treatment and 6 months posttreatment. Also, preliminary data indicate that pretreatment drinking pattern may be predictive of similar within-treatment urge-to-drink patterns. Implications for research and treatment are discussed.
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7785479
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MMPI performance among women with bulimia: a cluster-analytic study.
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Forty-two women, meeting criteria for bulimia, completed the MMPI. Cluster analysis of their scores revealed two distinct profile types. The first cluster, comprising about 64% of subjects, produced a mean profile in which only the Pd scale exceeded a t score of 70. In contrast, about 36% of subjects yielded a cluster-derived mean profile that was significantly elevated on many scales, including Pd, D, Pt, and Sc. The existence of these two very different subgroups of women with bulimia replicates previous work in this area and has potentially important implications for the description, treatment, and general understanding of those with this condition.
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7785478
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Influence of family disharmony and parental alcohol use on adolescent social skills, self-efficacy, and alcohol use.
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Deficits in social skills have been found to be related to adolescent substance use. Little effort has been devoted to understanding how family factors influence the acquisition of these skills. This study examined the manner in which family disharmony and parental alcohol use affect adolescent alcohol use through their influence on the acquisition of social skills and self-efficacy regarding one's ability to utilize these skills. It was hypothesized that family disharmony and parental alcohol use directly influenced usage and affected usage indirectly through their influence on acquisition of social skills. Social skills were also hypothesized to affect usage directly and to affect usage indirectly by influencing beliefs regarding one's ability to implement these skills. Results indicated that family disharmony was directly related to adolescent alcohol use and social skills. Parental alcohol use was related only to adolescent usages, not to social skills. Social skills were related to self-efficacy, which was related to alcohol use but was not directly related to usage. Results are discussed in terms of the importance of family influences on adolescent alcohol use, the importance of including families in prevention efforts, and the importance of the acquisition of self-efficacy relative to social skills.
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7785477
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Participation in a parent training program for methadone clients.
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Programs for drug abusers are plagued by high rates of dropout. Because of the strong relationship between longer treatment and positive outcome, researchers have begun to study individual and program-specific factors that influence premature termination of treatment. For the most part, these studies have focused on dichotomous measures of dropout or number of sessions attended. In this article, we extend this line of research in two ways. First, we develop and measure a number of indicators of treatment participation based on therapist ratings. Second, we develop a model of treatment participation that employs both individual and program-specific factors. The data show that tremendous variation in participation occurred even among those who attended a majority of sessions, which highlights the importance of obtaining more elaborate measures of treatment participation. The model predicting treatment participation suggests that initiation of heroin use later in life, continued use of marijuana, and behavioral indicators of motivation are the strongest predictors of program participation. Research and practical implications of the findings are discussed.
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7785476
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Pretreatment dropout as a function of treatment delay and client variables.
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Utilizing a retrospective analysis we examined factors correlated with preintake dropout in patients phoning to make intake appointments for cocaine treatment. Inquiries of 235 individuals calling our outpatient cocaine treatment program over a 7-month period were analyzed for relationships between patient age and gender; residence in the city where the program is located; marital status; referral source; reported problems with alcohol, marijuana, and heroin; reported last use of cocaine or other illicit stimulants; assigned counselor gender; person who made the appointment; days to the intake appointment; and attending the scheduled intake session. Only days to appointment was significantly (Wald = 12.4587, df = 1, p < .05 and chi 2 = 17.7, df = 8, p < .05) correlated with attending the scheduled intake session. Appointments scheduled the same day differed significantly (chi 2 = 4.3, n = 235, df = 1, p < .05) from appointments scheduled later. This suggests that client and situational variables are not significantly related to initial attendance and enhances the significance of systemic variables that are under a clinic's control, such as appointment delay. The results indicate that the longer the delay between the initial phone contact and the scheduled appointment, the less likely a client is to attend an appointment. Further, they suggest that the greatest decrease in initial attendance occurs in the first 24 hours following the phone inquiry. Taking a "microscopic" look at the appointment delay variable is valuable in understanding and addressing preintake dropout.
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7785474
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Evaluating multiple outcomes and gender differences in alcoholism treatment.
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This study followed 592 alcoholics (180 women and 412 men) after discharge from inpatient treatment. Multiple measures of treatment outcome were used to broaden our understanding of the process of recovery from alcohol abuse, and how that process differs for men and women. Patients were interviewed by telephone between 3 and 15 months after discharge to gather information about post-treatment experiences including: relationship with family, role performance, psychological impairment, and effort toward recovery. Additionally, if any alcohol use took place after treatment, information was collected about the pattern of alcohol consumption. Results indicated being married is consistently related to less drinking for men, while for women, being married contributes to relapse in the short term. The determinants of each measure of outcome were different for women and men, indicating that the process of recovery is not the same for both genders. The study confirms that drinking is related to other adverse outcomes for men, but not necessarily for women. It is evidence that women and men have different post-treatment functioning, and that different characteristics are predictive of these outcomes.
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