Role assignment and continuing education for college graduate nurses

The levels of alpha-granule membrane protein (GMP-140) on the surface of platelet and serum TXB2 were determined in 55 patients with coronary heart disease (CHD) and 20 healthy individuals before and after exercise test. Among the 55 CHD patients, 36 had positive and 19 had negative results. The number of GMP-140 molecules on the platelet surface and serum TXB2 level were significantly increased in the patients with positive exercise test, P < 0.05. The increase was transient and GMP-140 returned to the preexercise level 15 minutes after the exercise test. In contrast, GMP-140 and TXB2 levels were not elevated in CHD patients with negative exercise test and also in normal subjects after exercise. The result indicates that platelet activation may be related to the exercise-induced myocardial ischemia in CHD patients.     

Fructosamine in blood serum, binding and degradation of 125J-insulin by erythrocyte receptors in young persons with type I diabetes--effect of physical exercise

The aim of investigation was the determination of the effect of regular physical exercise of intensity 35% VO2max on glycolysation of proteins, expressed by fructosamine concentration in blood serum and on insulin sensitivity of erythrocyte receptors in children with diabetes mellitus type I. The investigations were performed with 10 young persons with diabetes mellitus type I, during their sanatorium treatment. During 21 days the children effected every day a 20-minutes ergometric exercise of intensity equivalent approximately to 35% VO2max. Before the 3-weeks therapy and after its termination the examined children have performed an ergometric test exercise, with collection of blood samples. Obtained results allow to ascertain, that regular aerobic exercise contributed to the growth of physical efficiency expressed by the VO2max value, reduction in fructosamine level in blood serum, increase in insulin sensitivity of erythrocyte receptor and improved effort tolerance related to glycemia.     

Propranolol and exercise as a screening test for growth hormone deficiency

There is a need for a safe, inexpensive, and reliable screening test for growth hormone (GH) reserve. Exercise has been utilized for this purpose but false-negative responses (inadequate GH release in non-GH-deficient patients) has limited the effectiveness of this stimulus as a screening test. Beta-adrenergic blockade (propranolol) was used to enhance the effect of exercise on GH release. Thirty-two non-GH-deficient children and five GH-deficient children were evaluated. All of the non-GH-deficient children responded to propranolol and exercise with serum GH levels exceeding 7 ng/ml. The peak serum GH levels in the five GH-deficient patients did not exceed 4 ng/ml. Propranolol and exercise appears to be an effective screening test for GH function.     

Onset of cell proliferation in the shortened gut: growth after subtotal colectomy

Serum IgE levels were studied in 2 groups of children with a family history of atopic disease, 30 in whom the mother only and 38 in whom both parents had atopic disease. IgE antibodies were determined with Phadebas RAST Test and serum IgE with Phadebas IgE Test and Phadebas PRIST at 0, 3, 9, 12 and 18 months of age. There was no correlation between the serum IgE levels in mothers and their newborns. RAST tests were frequently positive in maternal sera but no positive RAST test was found in the newborns. Obvious and probable atopic disease developed during the observation period in 42.1% of the children with a double family history of atopic disease. In 75% of these the serum IgE level was above the upper limit of normal on an average 6 months before the onset of atopic symptoms. An elevated IgE level without atopic symptoms during the observation period occurred in only one child. It is concluded that the serum IgE in newborns seems to be of foetal origin and that the determination of serum IgE in infants is of value in predicting atopic allergy.     

Fine needle aspiration of secretory breast carcinoma resembling lactational changes. A case report

The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.     

Endocrinological evaluation of sellar and suprasellar tumor cases (the eighth report)--on growth hormone secretion of acromegalic patients before treatment (author's transl)

Serum GH levels were measured in 14 acromegalic patients in ITT, TRH test, LH-RH test, arginine test, OGTT, exercise test, CPZ test and PEG. More than 50% increase of serum GH level was observed in 3 of 13 ITT, 8 of 14 TRH test, 6 of 14 LH-RH test, 2 of 12 arginine test, 2 of 9 OGTT and 2 of 7 PEG. Only 2 out of 7 cases showed more than 50% decrease of serum GH level in CPZ test. Striking GH responses were observed in TRH and LH-RH test. Five of 14 cases showed more than 100% increase of serum GH level in TRH test but they did not have a significant response to LH-RH. Four of 14 cases also had more than 100% increase in LH-RH test with no significant response to TRH. The rest of the cases (5 cases) did not have marked response to either TRH or LH-RH. According to these results, serum GH responses of acromegalic patients could be devided into 30 types, 1) TRH responding type, 2) LH-RH responding type, 3) no response type.     

Exercise ECG and case history in the diagnosis of latent coronary heart disease among presumably healthy middle-aged men

Previously undetected coronary heart disease (CHD) was suspected in 152 of 2014 presumably healthy males aged 40-59 yr. 63 had angina pectoris, 100 a positive exercise test and only 13 both angina and a positive exercise test. Coronary angiography was performed in 105 cases of whom 69 had a positive angiogram. A 2:1 proportion of true vs false positive diagnoses of CHD was found regardless of whether the diagnosis was suspected by the exercise test and/or the case history. Exercise test data show that CHD-suspect individuals differ only marginally from normal age counterparts irrespective of angiographic findings. However, of the 12 with a positive exercise ECG and maximal pulse greater than or equal to 2 SD below normal mean, 10 had pathologic angiograms. Of 58 with positive exercise ECGs and pathological angiograms, 43 had work performance below normal mean. By using a target pulse of 150 beats/minute 69% of the positive exercise ECGs had remained undisclosed.     

Heat treatment modifies the allergenicity of beef and bovine serum albumin

The effect of heat on the allergenicity of beef and bovine serum albumin was investigated among 10 toddlers skin prick test (SPT)-positive to raw and cooked beef. The meat-allergy diagnosis was confirmed during double-blind, placebo-controlled food challenge (DBPCFC) with 180 g of beef cooked for 5 min at 100 degrees C. SPT with homogenized and freeze-dried beef, and heated and unheated bovine serum albumin were performed. Both heated and unheated bovine serum albumin, homogenized beef, and freeze-dried beef were used in trial DBPCFC. All children were SPT-positive to unheated bovine serum albumin. Seven were positive to heated bovine serum albumin, one to freeze-dried beef, and none to homogenized beef. DBPCFCs were negative for homogenized beef and freeze-dried beef, positive for unheated bovine serum albumin in five patients, and positive for heated albumin in four children. We conclude that heating reduces sensitization to beef and bovine serum albumin but does not abolish reactivity to albumin under home conditions. However, industrially heat-treated and sterilized homogenized beef and freeze-dried beef may be suitable substitutes in beef-allergic children's diets.     

Phosphaturia in thalassemia

Thirteen phosphorus balances were performed in four thalassemic children aged 6 to 10 years. No correlation was found between phosphorus intake and serum level or between phosphorus intake and net absorption. There was a positive correlation among daily phosphorus intake, net absorption, and 24-hour urinary excretion. The 24-hour urinary excretion level was higher than net absorption, indicating that these children have normal phosphorus absorption but abnormally high renal phosphaturia, which leads to a deficiency of phosphorus. A strongly positive correlation was found between values for hemoglobin and serum alkaline phosphatase. In the thalassemic patients with hemoglobin levels larger than or equal to 7.5 gm/100 ml, the serum alkaline phosphatase values were larger than or equal to 15 King-Armstrong units, suggesting normal osteoblast function.     

Pneumolysin PCR-based diagnosis of invasive pneumococcal infection in children

Blood-based pneumolysin PCR was compared to blood culture and detection of pneumolysin immune complexes, as well as to detection of antibodies to pneumolysin and to C polysaccharide, in the diagnosis of pneumococcal infection in 75 febrile children. Invasive pneumococcal infection was suspected on clinical grounds in 67 of the febrile children, and viral infection was suspected on clinical grounds in 8 of the febrile children. In addition, 15 healthy persons were examined to test the specificity of the PCR assay. Plasma, serum, and leukocyte fractions were analyzed by PCR. The combination of all test results led to the diagnosis of pneumococcal infection in 25 patients. Pneumolysin PCR was positive in 44% of these children, an increase occurred in the pneumolysin antibodies in 39% and in the C polysaccharide antibodies in 30% of the patients; pneumolysin immune complexes were found in convalescent serum in 30%, pneumolysin immune complexes occurred in acute-phase serum samples in 16%, and a positive blood culture was found in 20% of the patients. None of the healthy controls had positive results by PCR. The results suggest that the diagnosis of Streptococcus pneumoniae infection from blood samples necessitates the use of several different assays. Pneumolysin PCR was the most sensitive assay, but its clinical value is reduced by the fact that three blood fractions are needed.     

Atopy and IgE in a pediatric allergy practice

In children under six years of age referred to a pediatric allergy practice the usefulness of serum IgE assay was evaluated in relation to age, symptoms, nasal eosinophilia, skin tests and family history. In more than 60% of the children the initial symptom, usually rhinorrhea, had occurred before one year of age. In infancy the diagnosis was more difficult, gastrointestinal complaints were more frequent and nasal eosinophilia less frequent than in the older children. Many infants had positive skin tests to foods and to environmental allergens. There was a significant correlation between elevated serum IgE level and age, nasaeosinophilia, the number of positive skin tests and the probability of immunotherapy being prescribed. Although no clear diagnostic level is seen, an IgE level above 100 micron/ml at any age and an IgE level above 20 micron/ml in infants strongly suggest the possibility of atopic disease. However, a low IgE level does not exclude atopic disease.     

Primary adenomatous tumor of the middle ear: a case report

This study was aimed at evaluating the level of metabolic control and cardiovascular risk factors in a population of Type 2 diabetic patients with coronary artery disease. We used myocardial thallium-201 scintigraphy as a measure of coronary perfusion integrity. One hundred and forty six diabetic patients presenting with chest pain, ischaemic ECG changes or a positive exercise test underwent myocardial thallium-201 imaging perfusion in conjunction with exercise stress. Scintigrams were assessed by a computer assisted image analysis. The cardiovascular risk factors considered were sex, age, BMI and waist-hip ratio, smoking, systolic and diastolic blood pressure, serum lipids (total cholesterol and triglycerides), glycated haemoglobin A1, urinary albumin excretion, white blood cell count, and diabetes duration. The proportion of male diabetic subjects with a positive scintigraphy was 63% while that of diabetic women was 45% (p < 0.05). Mean age, anthropometric measures and diabetes indices were similar when diabetic patients with positive or negative scintigraphy were compared. The prevalence of patients with microalbuminuria and retinopathy (both non-proliferative and proliferative) was higher in positive (26% and 27%, respectively) than in negative (10% and 11%, respectively, p = 0.01) diabetic patients. Total cholesterol and white blood cell counts were also higher in positive diabetics (p < 0.05-0.01). These findings suggest that a cluster of risk factors (cholesterol, white blood cells, microalbuminuria) may be implicated in the development of coronary artery disease in Type 2 diabetes mellitus.     

The 30-minute (1-24)ACTH test for evaluation of adrenocortical function in childhood

Twenty-eight children with normal adrenocortical function and two patients with adrenocortical insufficiency were enrolled in the present study. The ACTH test was performed in these 30 children, and the insulin hypoglycemia test was also performed for the same group, except for one with Addison's disease. Serum cortisol response after intravenous administration of (1-24)ACTH was below normal range in two patients with adrenocortical insufficiency. Neither significant correlation nor statistically significant difference was found between the serum cortisol level 30 minutes after (1-24)ACTH and the peak cortisol value during the insulin hypoglycemia test. None of these children had any adverse reaction to ACTH test. This study suggests that the 30-minute (1-24)ACTH test is a simple, safe and valuable screening procedure for evaluation of adrenocortical function in children.     

Effect of operationalized computer diagnosis on the therapeutic results of sumatriptan in general practice

Three representative cytokines interleukin (IL-8), RANTES and tumour necrosis factor alpha (TNF-alpha) have a concentration-dependent chemotactic effect on the unicellular Tetrahymena. Maximal effective concentrations of IL-8 (1 ng/ml) and RANTES (75 ng/ml) are in the same range as in mammals, which indicates an evolutionary background of physiological effects elicited. Progeny generations of cells selected for their affinity to cytokines (IL-8 and TNF-alpha) show an enhanced positive chemosensory reaction to the cytokines. The changed reaction of these cells to the chemoattraction of the culturing medium was also observed. The results call attention to the presence of cytokine-dependent processes at a low phylogenetic level.     

Cardiovascular effects of desipramine in children and adults during exercise testing

OBJECTIVE: In light of recent reports of sudden death in children being treated with desipramine (DMI), 3 of which were associated with physical exercise, the authors examined the effects of DMI on exercise in children and adults before and during DMI treatment. METHOD: Before treatment, 22 subjects (9 children, 13 adults) participated in a graded treadmill exercise test. Outcome measures included exercise tolerance, cardiovascular, and electrocardiographic parameters at progressive intensity levels and serum norepinephrine (NE) levels before and after exercise testing. Subjects were then treated with DMI, titrated to an average DMI dosage of 3 mg/kg, and underwent repeated exercise testing. RESULTS: DMI treatment was associated with a significant elevation of circulating NE levels in the pre-exercise assessment. Exercise tolerance was not affected by DMI, and blood pressure and heart rate effects were modest. The cardiovascular impact of DMI treatment was similar in children and adults. One 31-year-old subject exhibited a brief episode of ventricular tachycardia associated with exercise during DMI treatment. CONCLUSIONS: DMI has only minor effects on the cardiovascular response to exercise, and these effects do not appear age-related. However, DMI may increase the risk of exercise-associated arrhythmias in rare individuals.     

Effect of ambulatory sports therapy on bronchial asthma in children

Exercise-induced asthma (EIA) is very common in children with asthma. For this reason they avoid every strenuous exercise because they fear a new asthma attack. Working capacity and maturation of motor performance can be insufficient as a consequence. We investigated whether a special training programme in an asthma sports group has positive effects not only on asthma, but also on working capacity and motor performance. 11 children with extrinsic asthma (4 girls, 7 boys), 8 to 14 years old, were studied before and after a 6-month out-patient rehabilitative sports therapy (sports group) with regard to their degree of bronchial hyperreactivity (BHR), frequency of EIA, cardiopulmonary capacity for exercise; knowledge about their asthma, level of coordination and condition, and their movement-related anxiety. There were 9 children with extrinsic asthma (2 girls, 7 boys), 8 to 15 years old, in a control group. They did not take part in any special training programme. After the sports therapy we found in 3 children of the sports group a decrease in BHR, EIA was now present in only 2 of formerly 4 children. Physical working capacity (PWC) at the aerobic/anaerobic threshold improved in the sports group by about 1 W/kg body weight (p = 0.008), efficiency of work from 23.7% to 27.9% (p = 0.009). We also found a remarkable improvement of motor abilities. Movement-related anxiety decreased in the sports group both in Indoor sports (p = 0.0089) and aquatics (p = 0.026). In the control group there was no significant change. Physical training in children with asthma has many positive effects on lung function and motor performance. We believe that the limit for an EIA release is shifted to a higher PWC. The reduction of the anxiety over sports at a higher level of PWC contributes to an improved quality of life for children with asthma.     

Secular trends in menopause age

Serum and colostrum from 73 sows were collected. The serum samples were tested by Immuno. Peroxidase Monolayer Assay (IPMA) and the corresponding colostrum samples with the indirect Immuno fluorescent Antibody (IFA) technique. All serum positive sows were colostrum positive and all colostrum negative were serum negative. Eight sows only reacted positively in the colostral testing. Compared to the serum standard test the specificity was 82.6% and the sensitivity 100%. The observed agreement between both tests was 89.2%. In addition all serum samples were also tested with the IF test (IFT). Of the eight sows which were negative in the IPMA serum test and positive in the IFA colostrum test, three were found positive when the serum was tested with IFA. Consequently, the observed agreement was higher at 93.2%. After the suitability of colostrum for porcine reproductive and respiratory syndrome (PRRS) diagnosis was demonstrated, 1915 colostrum samples collected from 135 different farms were tested in a comparative study with the IPMA and IFA techniques. Of the 1915 colostrum samples 139 were positive with both IPMA and IFA. With IPMA only, 43 samples were positive compared with 192 samples found positive with the IFA technique. A total of 1541 samples were negative in both tests. The observed agreement between both tests was 87.5%. The quotient of the observed agreement minus chance agreement and the maximum possible agreement beyond chance level (Kappa Quotient) was 0.49. In 90% of the farms that tested IFA positive there was a seroconversion of more than 50% of all colostrum tested. By comparison only 29% of the IPMA positive farms were positive with more than 50%. Based on the epidemiological findings on PRRS it was concluded that the IFA technique indicates a higher sensitivity for the detection of PRRS virus antibodies in sow colostrum. Finally the possible advantages and disadvantages of sow colostrum testing and serum testing are discussed.     

The house-dust mite and childhood asthma in the Cape Peninsula

Sensitivity to house-dust and the mites Dermatophagoides pteronyssinus and D. farinae was the commonest cause of asthma in children living in the Cape Peninsula. Of 103 asthmatic children examined, 65,5% had positive skin tests to these allergens. Only a small number of the children were sensitive to pollens, feathers, moulds or food. The median serum IgE level was 496 U/ml, with a range of 18-15972 U/ml, and the median blood eosinophil count was 691/microliter (range 93-8 159) in 102 of the children.     

Vernal keratoconjunctivitis in the child. Clinical and complementary study apropos of 22 cases

PURPOSE: Vernal kératoconjunctivitis was studied in a population of 22 children aged 3 to 14 years and followed up in an allergy and ophthalmology outpatient clinic. The role of allergy and the severity of inflammation where assessed by a systematic exploration, which combined a detailed allergy evaluation and blood and lacrimal sampling. MATERIALS AND METHODS: Allergy criteria chosen and recorded in 9 cases are: an increase of total IgE over the higher limit for the age, a positive skin prick test to one allergen, a positive serum specific IgE dosage (> 0.35 IU/mL) of specific IgE. Conjunctival allergy was present in 6 of the 9 children with a positive allergenic provocation test, or with a high local production of total IgE and a lacrimal/serum eosinophilic cationic protein ratio greater than one. RESULTS: Criteria used for supporting the IgE mediated hypersensitivity diagnosis are discussed: they have to be very strict to eliminate false positive results. Allergen involvement can only be evidenced by a specific provocation test. When evidenced as described, limbic or palpebral conjunctivitis had the same frequency. Lacrimal ICAM 1 levels seemed to be higher (p < 0.05) in the severe limbal forms (24.7 +/- 3 pg/mL) than in the palpebral ones (8.1 +/- 6.5 pg/mL). Interpretation of biological parameters evidencing conjunctival inflammation is more difficult. CONCLUSION: Allergic involvement in child vernal keratoconjunctivitis can only be assessed through a detailed evaluation, leading to a specialised ophthalmic and allergic management. A specific treatment can then be established, based on allergen eviction and possibly on specific immunotherapy (5 cases). H1 antihistamin treatments are dedicated only to children with a positive allergic evaluation.     

Day-case adenoidectomy--is it safe?

In a prospective study we looked for the presence of both IgE plasma cells in small bowel mucosa and specific serum IgE antibodies to cow milk in children suspected of cow milk protein intolerance. Thirty-one children with complaints possibly due to cow milk intolerance were submitted to two consecutive cow milk elimination/challenge tests. The diagnosis of cow milk protein intolerance was confirmed in 16 of our 31 patients on the basis of two positive elimination/challenge tests. IgE plasma cells were found in nine of 16 patients with proven cow milk protein intolerance and in only one of the 15 patients without cow milk protein intolerance (p < .01). The RAST for cow milk was positive in six of 16 infants with cow milk protein intolerance and in two of the 15 other infants. Serum IgE level was of no value for the diagnosis of cow milk protein intolerance. Neither of these diagnostic procedures was sensitive enough to be used as a screening test for cow milk protein intolerance. Furthermore, the relationship between specific IgE antibodies for cow milk and the presence of mucosal IgE plasma cells was poor: five of nine infants with cow milk protein intolerance and the presence of mucosal IgE plasma cells had negative RASTs for cow milk.