To treat or not to treat: the case of tuberculosis

Incomplete treatment of patients with infectious tuberculosis (TB) may not only lead to relapse but also to the development of antibiotic resistant TB-one of the most serious health problems facing society today. In this article, we formulate one-strain and two-strain TB models to determine possible mechanisms that may allow for the survival and spread of naturally resistant strains of TB as well as antibiotic-generated resistant strains of TB. Analysis of our models shows that non-antibiotic co-existence is possible but rare for naturally resistant strains while co-existence is almost the rule for strains that result from the lack of compliance with antibiotic treatment by TB infected individuals.     

Use of pulmonary rehabilitation strategies to wean a difficult-to-wean patient: case study

The primary purpose of this article is to describe the effectiveness of an interdisciplinary team and innovative interventions by a pulmonary rehabilitation specialist in addressing one patient's failure to wean from mechanical ventilation. This case study shows the importance of considering both physical and psychological factors that may hinder weaning. An interdisciplinary approach was used to address the patient's anxiety, sleep deprivation, lack of appetite, decreased communication, decreased activity, dyspnea, knowledge deficit about dyspnea and weaning, lack of self-confidence, and decreased verbalization. The pulmonary rehabilitation RCP effectively implemented the following strategies: biofeedback by using a flow-volume display, positive reinforcement, teaching about dyspnea and weaning, and use of the modified Borg scale. The patient's family participated in providing some of these interventions. With a concerted effort by all involved, the patient was successfully weaned from mechanical ventilation.     

Use of laser energy to treat central pulmonary emboli: a preliminary report

We evaluated the ability and safety of a laser fiber placed percutaneously into a pig's lobar pulmonary artery to lyse pulmonary artery blood clots that were created in situ. We developed a model to create blood clots in situ that could be placed in any desired location with a radio-opaque marker at the clot position. An excimer laser delivered energy to a flexible 600 microns fiber in three experiments and a coaxial 1.6 mm multifiber catheter in the last experiment. Pre- and postprocedure angiograms obtained from each experiment demonstrated that partial laser dissolution of central pulmonary emboli in four pigs was accomplished successfully. To avoid perforation, it is imperative that the laser fiber remain coaxial during the entire lasing process. These results suggest that laser dissolution may become an adjunctive procedure for the treatment of central pulmonary emboli in those patients who cannot be treated medically.     

Social-comparison jealousy: A developmental and motivational study.

72 6–11 yr olds were read 12 stories in which the protagonists failed to excel or attain something in each of 6 areas: possessions, sports, art, appearance, mathematics, and reading. In 6 stories, one child failed, whereas another excelled; in 6 stories no other child was involved. Ss rated the importance of the 6 areas to themselves and completed the PPVT-R and the Piers-Harris Self-Concept Scale. Measures from the responses to the stories were grouped into 3 components of social-comparison jealousy—spontaneous comparisons, affect, and thoughts about jealous behavior. Jealousy was a common response to comparison failure situations. Older Ss revealed more social-comparison jealousy in areas of greater importance to themselves, whereas younger Ss did not show this differentiation as clearly. No sex differences in the experience of social-comparison jealousy were found. Results are discussed in terms of social-comparison theory, and a stage model of jealousy development is proposed. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptive control: a strategy to treat autoimmunity

A possible mechanism of resistance to hydrogen peroxide (H2O2) in Vibrio rumoiensis, isolated from the H2O2-rich drain pool of a fish processing plant, was examined. When V. rumoiensis cells were inoculated into medium containing either 5 mM or no H2O2, they grew in similar manners. A spontaneous mutant strain, S-4, derived from V. rumoiensis and lacking catalase activity did not grow at all in the presence of 5 mM H2O2. These results suggest that catalase is inevitably involved in the resistance and survival of V. rumoiensis in the presence of H2O2. Catalase activity was constitutively present in V. rumoiensis cells grown in the absence of H2O2, and its occurrence was dependent on the age of the cells, a characteristic which is observed for the HP II-type catalase of Escherichia coli. The presence of the HP II-type catalase in V. rumoiensis cells was evidenced by partial sequencing of the gene encoding the HP II-type catalase from this organism. A notable difference between V. rumoiensis and E. coli is that catalase is accumulated at very high levels ( approximately 2% of the total soluble proteins) in V. rumoiensis, in contrast to the case for E. coli. When V. rumoiensis cells which had been exposed to 5 mM H2O2 were centrifuged, most intracellular proteins, including catalase, were recovered in the medium. On the other hand, when V. rumoiensis cells were grown on plates containing various concentrations of H2O2, individual cells had a colony-forming ability inferior to those of E. coli, Bacillus subtilis, and Vibrio parahaemolyticus. Thus, it is suggested that when V. rumoiensis cells are exposed to high concentrations of H2O2, most cells will immediately be broken by H2O2. In addition, the cells which have had little or no damage will start to grow in a medium where almost all H2O2 has been decomposed by the catalase released from broken cells.     

Use of an internal fixator device to treat comminuted fractures of the distal radius: report of a technique

An internal fixator technique for stabilizing comminuted Colles fractures has been developed in the anatomy laboratory and used in 35 clinical cases. The Colles Fracture Plate (Biomet, Inc, Warsaw, Indiana) can be used to treat any comminuted Colles fracture for which an external fixator is considered proper management. We have determined, based on our surgical experience with both the internal and external fixator techniques, that internal fixation using the Colles Fracture Plate is technically just as simple as external fixation. In addition to requiring a significantly less expensive device, internal fixation using this technique offers the advantages of better patient acceptance and fewer complications. This report will be followed by a more comprehensive analysis of the technical outcome of this procedure to further substantiate the initial results presented here. The process of compiling and analyzing these data is under way.     

Epirubicin and etoposide combination chemotherapy to treat hepatocellular carcinoma patients: a phase II study

Approximately half the patients affected with hepatocellular carcinoma (HCC) present with unresectable disease, so that efficacious systemic chemotherapy protocols are badly needed. We report the results of a phase-II study aimed at testing the efficacy and toxicity of a combination of epirubicin and VP-16. Thirty six patients (80 men and 6 women) received epirubicin (40 mg/m2, on day 1) and VP-16 (120 mg/m2, on days 1, 3 and 5) every 28th day. Chemotherapy was stopped in case of disease progression, while the patients who achieved an objective response or who had stable disease continued treatment for a maximum of 10 cycles. One patient (3%) achieved a complete response, while 13 patients (36%) achieved partial response, i.e. 14 objective responses in all (39%, 95% CI: 23-55%). 11 patients (31%) exhibited stable disease, while in the other 11 patients (31%) the disease progressed. Median overall survival time was 10 months and 13.5 months in the subgroup of patients responding to treatment. Significant, especially haematological, toxicity was documented, but in no case was it so severe as to require discontinuation of treatment or reduction of the dosage. In conclusion, this combination appears to be an active and tolerable therapeutic option for HCC patients who are not candidates for surgical or locoregional procedures, and in our opinion it deserves further exploration within a randomised controlled trial versus best supportive therapy.     

Use of ketolides in combination with other drugs to treat experimental toxoplasmosis

Because combination therapy is required to treat human toxoplasmosis, we examined combinations of the ketolides HMR 3004 and HMR 3647 with atovaquone, clindamycin or sulphadiazine in a murine model of toxoplasmosis. An oral dose of 50 mg/kg/day of HMR 3004 protected 30% of mice lethally infected with Toxoplasma gondii. The same dose protected 100% of infected mice when administered in combination with non-protective doses of atovaquone, clindamycin or sulphadiazine. Similar results were noted with 25 mg/kg/day of HMR 3647. These results demonstrate that these drug combinations are highly effective for treating toxoplasmosis in mice.     

Angioimmunoblastic lymphadenopathy: a case study

The case of a 57-year-old man with lymphadenopathy fever, splenomegaly, and polyclonal gammopathy is described. The difficult clinical course, the short lived response to cytotoxic treatment, the frequent infections, the immunologic abnormality, and the histologic findings in lymph node biopsy and postmortem material justified our diagnosis of angioimmunoblastic lymphadenopathy with dysproteinemia, a new entity described recently.     

Hypoglycemic hemiplegia: a case study

We report on a 59 year old patient with repetitive shoulder trauma due to numerous grand mal convulsions and consequent severe osteoarthritis of the shoulder joint with formation of multiple loose bodies. We discuss the aetiology of the loose bodies as being different to those found in synovial chondromatosis, as well as the radiological, histological, clinical and therapeutical features of this entity.     

Transmyocardial revascularization: a case study

Transmyocardial revascularization (TMR) is an investigational cardiovascular surgical procedure for patients with severe advanced coronary artery disease refractory to conventional treatment. The following case study traces one particular patient undergoing TMR from preoperative evaluation through a 6-month follow-up visit based on TMR research protocol.     

Transmyocardial revascularization: a case study

We evaluated the anatomic distribution and pattern of skin involvement in 155 pediatric patients with Henoch-Sch?nlein purpura treated in our center over the last 20 years. Of these, 120 (77.4%) presented with cutaneous signs; only 10% of them had no leg involvement. Seven patients (4.5%) had edema of the hands, feet, or face. The mean age of this subgroup was 9.2+/-2.2 months, compared to 6.8+/-2.3 years for the entire group (p < 0.05). Skin biopsies were performed in 18 of these patients, including the 7 with edema, to confirm the clinical diagnosis. All biopsy specimens showed leukocytoclastic vasculitis, with IgA deposits in two and C3 deposits in one. It is important that clinicians keep in mind that an atypical presentation of Henoch-Sch?nlein purpura is not unusual.     

Controlled study of treatment of PTSD using EMDR in an HMO setting.

67 individuals (aged 18–73 yrs) diagnosed with posttraumatic stress disorder (PTSD) were randomly assigned to either Eye Movement Desensitization and Reprocessing (EMDR) treatment or Standard Care (SC) treatment. Participants were assessed pretreatment, after 3 sessions, and at the completion of treatment using the SCL-90, Beck Depression Inventory, Impact of Event Scale (M. Horowitz et al, 1979), modified PTSD Symptom Scale (S. A. Falsetti et al, 1993), State Trait Anxiety Inventory, and other measures. In addition, an independent evaluator assessed participants using Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for PTSD including Global Assessment of Functioning at the 3 data points. Ss in the EMDR treatment group showed significantly greater improvement with greater rapidity than those in the SC treatment group on measures of PTSD, depression, anxiety, and general symptoms. Ss who received EMDR treatment used fewer medication appointments for their psychological symptoms and needed fewer psychotherapy appointments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)