Transjugular intrahepatic portosystemic shunts (TIPS) in children

The transjugular intrahepatic portosystemic shunt procedure is an accepted treatment for adults with complications of portal hypertension. We performed a retrospective review of all pediatric TIPS placements performed at the University of California, San Francisco between 1990 and 1996. Twelve procedures were attempted in nine children, with a mean age (+/- SD) of 9.4 +/- 3.9 years (range, 5 to 15 years) and a mean weight of 31 +/- 18 kg (range, 16 to 70 kg). The indications for TIPS placement were portal hypertension complicated by chronic variceal hemorrhage not controlled with sclerotherapy (n = 7) and hypersplenism with thrombocytopenia (n = 2). TIPS placement was successfully completed initially in seven of nine (78%) patients. Unfavorable vascular anatomy was the cause of failure in two cases. The seven patients who underwent successful TIPS placement were followed up for an average of 136 days (range, 1 to 800 days); two still have patent shunts, three underwent liver transplantation, one had a splenorenal shunt after stenosis, and one died of underlying liver disease. Variceal bleeding was controlled in four of five patients who successfully underwent TIPS placement. Shunt occlusion occurred in four patients; patency was restored by transjugular shunt revision in three, and a splenorenal shunt was performed in one.     

Expectations about counseling in Yucatán, Mexico: Toward a "Mexican psychology."

Conducted a study of client expectations of psychological services in Yucatán, Mexico, under the sponsorship of a grant from the Organization of American States. The Expectations about Counseling–Brief form (EAC-B) questionnaire was translated and administered to 488 subjects across age, sex, and experience with psychological services. Subsequent analyses supported the reliability and robustness of the Spanish EAC-B, with factor structure similar to the EAC-B in English. Some relation was found among age, sex, prior counseling experience, and expectations about counseling. Implications of these data for future research and comparison with U.S. subjects are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between urbanization and the oak resource of the Minneapolis/St. Paul Metropolitan area from 1991 to 1998

Urbanization was associated with loss and transformation of the oak forest in the Twin Cities (Minneapolis and St. Paul) metropolitan area (TCMA) over a recent 7-year interval. Between 1991 and 1998, urbanization increased based on several indicators: population density, area of developed land, and area of impervious surface—total impervious area and area within three classes of increasing degree of imperviousness (protected, affected, and degraded). We quantified relationships between changes in urbanization and changes in several parameters describing the oak forest at the scale of ecological subsection. Increased total and affected impervious area were strongly correlated with decreased area of oak forest when changes of the urbanization indicators and oak were expressed as percentages of the subsection area. Relationships were reversed when changes were expressed as percentages of the 1991 values. Increased population density was strongly correlated with increased loss in numbers and increased isolation of oak patches, but weakly correlated with loss of oak forest area. This is the first study to quantify relationships between changes in urbanization and changes in a specific forest cover type. Our results demonstrate complexities of urbanization impacts on a metropolitan forest resource, and highlight the importance of selected variables, spatial and temporal scales, and expressions of change when quantifying these relationships.     

Serum amyloid P component scintigraphy and turnover studies for diagnosis and quantitative monitoring of AA amyloidosis in juvenile rheumatoid arthritis

OBJECTIVE: To evaluate aspects of the natural history of AA amyloidosis complicating juvenile rheumatoid arthritis (JRA), and its response to therapy with chlorambucil. METHODS: Scintigraphy and 7-day turnover studies were performed in JRA patients with histologically proven (n = 35) or clinically suspected (n = 30) AA amyloidosis, following intravenous injection of 123I and 125I-labeled serum amyloid P component (SAP). Prospective monitoring studies were performed over 2-3 years in 20 patients with amyloidosis. All but 2 amyloidosis patients were treated with chlorambucil. RESULTS: Positive scanning results were obtained in all patients in whom imaging was performed within 12 years of positive biopsy findings of amyloid and in 5 patients with clinically suspected amyloidosis. Negative scanning results with normal SAP metabolism, indicating regression of amyloid, were obtained in 4 patients whose amyloidosis had been in full clinical remission for more than 12 years. Prospective monitoring studies in patients whose JRA-associated inflammatory activity was in remission demonstrated regression of amyloid in 8 patients and no substantial changes in 8 others; however, in 4 further patients with active inflammation, there was accumulation of amyloid. There was a very poor correlation between the amount of amyloid present at a particular site and the resultant organ dysfunction. CONCLUSION: Radiolabeled SAP scintigraphy and turnover studies are useful complementary tools in the diagnosis, screening, and quantitative monitoring of type AA amyloidosis in JRA. The amyloid deposits may progress and/or regress at different rates in different anatomic sites over short periods.     

Internal mammary vein to coronary artery anastomotic fistula

Two patients are presented where internal mammary artery grafting was performed for the relief of symptomatic coronary artery disease. At follow-up the internal mammary artery was occluded and a communication between the internal mammary vein and the native coronary artery was demonstrated. These patients were characterised by the early recurrence of angina or the appearance of a continuous murmur. Both patients were treated by re-operation with ligation of the arterio-venous fistula and saphenous vein grafting.     

Laser therapy of Barrett''s mucosa

Midden and Dahl, in a recent paper, have presented important data on the inactivation of bacteria by singlet oxygen. In analyzing the data, use was made of a theory published earlier by the present author. The purpose of this paper is to point out that theory and experiment can be brought into better agreement by assuming that the interaction of singlet oxygen with the bacteria takes place in an essentially lipid environment rather than aqueous.