The nutritional status of patients with an alcohol problem

73 patients with an alcohol problem seen in a hospital medical unit over a two year period were examined specifically for signs suggestive of nutritional deficiency and of organ or system damage due to alcohol. A seven day dietary recall was carried out on most of them. Clinical signs of nutritional deficiency were relatively uncommon but nine patients had Wernicke-Korsakoff syndrome and ten had peripheral neuropathy. Thiamine was present in less than recommended amounts in 81.5% of the diets. Vitamin D and vitamin C were the next most common dietary deficiencies. 66.1% were deficient in energy intake and about a third of patients derived more than 40% of their energy from alcohol.     

Prevalence of perioperative complications after anterior spinal fusion for patients with idiopathic scoliosis

BACKGROUND: The most common primary brain tumors in children and adults are of astrocytic origin. Classic histologic grading schemes for astrocytomas have included evaluating the presence or absence of nuclear abnormalities, mitoses, vascular endothelial proliferation, and tumor necrosis. MATERIALS AND METHODS: We evaluated the vascular pattern of 17 astrocytoma surgical specimens (seven from children and 10 from adults), and four normal brains obtained at autopsy, utilizing antibody to glial fibrillary acidic protein (GFAP) and von Willebrand factor (vWF) utilizing confocal microscopy. A modified WHO classification was used. RESULTS: All tumor cases showed cells positive for GFAP. Control tissues showed a few, widely separated vessels. Pilocytic astrocytomas (four cases) showed lacy clusters of small-to-medium sized vessels, with intact vessel wall integrity. Diffuse, low grade astrocytoma (three cases) showed a staining pattern similar to control tissue; intermediate grade (one case), anaplastic astrocytoma (three cases) and gliobastoma multiforme (six cases) showed an increased vessel density with multiple small vessels (glomeruloid clusters), some with prominent intimal hyperplasia, loss of vessel wall integrity, and with numerous vWF-positive single cells/microvessels within the tumor substance. CONCLUSIONS: Evaluation of astrocytomas utilizing antibody to vWF and confocal microscopy aids in the grading of these neoplasms.     

Feeding and nutritional characteristics in children with moderate or severe cerebral palsy

This study was undertaken to characterize the current feeding situation and nutritional status of moderately or severely disabled children with cerebral palsy (CP). Thirty-five children with CP (17 with diplegia, 11 with dystonia, 6 with tetraplegia and one child with ataxia) were investigated at a median age of 8 years. Information was obtained from parental interviews, medical records and clinical and anthropometric examinations. Twenty-one of the 35 children (60%), most of whom were severely disabled, were reported by the parents to have current feeding problems. Anthropometric indicators of undernutrition were found in 15 children (43%) and of overnutrition in 3 children (9%), compared with reference values of healthy children. Severely disabled children in the youngest age group were most at risk for poor nutritional status. Early identification of children at nutritional risk requires regular assessments of feeding skills and nutritional status.     

The relationship between status variables and criminal thinking in an offender population.

The authors examined the relationship between criminal thinking factors of control, cognitive immaturity, and egocentrism, and offender characteristics (i.e., age, education, sentence length, time served, reception of mental health services) in 435 adult male offenders. Results of a canonical correlation analysis identified 1 significant and meaningful relationship between a criminal thinking set containing all 3 factors and an offender characteristic set containing all characteristics except for age. Higher levels of criminal thinking on all 3 factors were associated with more education, longer sentence length, more time served, and lack of reception of mental health services. Implications for providing treatment with offenders that targets reducing criminal recidivism and future directions for investigation into the relationship between dynamic recidivism risk factors and offender characteristics are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

2-Chlorodeoxyadenosine treatment after splenectomy in patients who have myelofibrosis with myeloid metaplasia

2-Chlorodeoxyadenosine (2-CdA) is a purine nucleoside analogue with therapeutic activity in low-grade lymphoproliferative disorders. In addition, 2-CdA has a potent myelosuppressive effect, and it has been shown to be toxic to malignant myeloid cells both in vitro and in vivo. In this pilot study we treated nine patients who had advanced myelofibrosis with myeloid metaplasia (MMM) and progressive hepatomegaly or symptomatic thrombocytosis after therapeutic splenectomy. 2-CdA was administered at 0.05-0.1 mg/kg/d for 7 d for one to five treatment cycles. A reduction in liver size associated with marked improvement in fatigue and control of thrombocytosis and leucocytosis was achieved in seven of the nine patients (78% response rate). In four of the seven responding patients the reduction in liver size was durable (4-28 months) and was associated with a decrease in serum alkaline phosphatase levels. However, no patient had improvement in anaemia, and two of the seven initially responding patients have since died of acute leukaemia or progressive disease. Improvement in bone marrow fibrosis was noted in two of five available post-treatment marrow examinations. Toxicity was mainly myelosuppression, which was severe in two patients. 2-CdA may be considered a palliative therapeutic agent after splenectomy in noncytopenic patients with MMM who have progressive hepatomegaly or extreme thrombocytosis.     

Mammographic changes after hormone replacement therapy in patients who have undergone breast irradiation

OBJECTIVE: We examined three patients who began hormone replacement therapy after lumpectomy and breast irradiation. In these women increased tissue density appeared on mammography only or disproportionately in the nonirradiated breast. To our knowledge, this observation has not been reported. CONCLUSION: Breast irradiation may induce tissue changes that prevent or diminish the proliferative response that can be induced in breast tissue by postmenopausal hormone replacement therapy. Because this treatment is now recommended for some women after breast conservation therapy, mammographers may recognize this finding with increasing frequency.     

Evidence for an independent role of metabolic acidosis on nutritional status in haemodialysis patients

BACKGROUND: Malnutrition in haemodialysis (HD) patients has been referred to underdialysis with low protein intake, and to acidosis. However, the separate effects of underdialysis and acidosis on nutrition have not been clearly demonstrated. To evaluate the role of the dialysis dose and of metabolic acidosis on nutrition, we measured the predialysis serum HCO3, pH, serum albumin, PCRn, Kt/V, and BMI in 81 uraemic patients on maintenance bicarbonate HD for 93+/-80 months. Patients with chronic liver diseases, malignancies, and cachexia were excluded. RESULTS: Mean age was 59+/-17 years, Kt/V was 1.29+/-0.21, PCRn 1.06+/-0.22 g/kg/day, serum albumin 4.07+/-0.28 g/dl, BMI 23+/-4 kg/m2, HCO3 21.1+/-1.9 mmol/l, pH 7.36+/-0.04. Serum albumin showed a significant direct correlation with: PCRn (P=0.001), HCO3 (P=0.001), pH (P=0.002), but no correlation with Kt/V and BMI. Serum HCO3 correlated inversely with PCRn (P=0.027). Multiple regression analysis confirmed the significant role of serum bicarbonate and age, but not of Kt/V, on serum albumin concentrations. The role of PCRn appeared to be marginal compared to serum bicarbonate in determining serum albumin levels. Dividing patients into two groups, serum albumin was 3.96+/-0.22 g/dl with HCO3 < or = 20 mmol/l and 4.18+/-0.31 g/dl in those with serum HCO3 > or = 23 mmol/l (P=0.002). PCRn in the same groups was respectively 1.14+/-0.24 g/kg/day and 1.01+/-0.23 g/kg/day (P=0.03). Most importantly, serum albumin levels did not appear to be affected by the dialysis dose, with Kt/V ranging from 0.90 to 1.88. CONCLUSIONS: In HD patients with adequate Kt/V, metabolic acidosis exerts a detrimental effect on serum albumin concentrations partially independently of the protein intake, as evaluated by PCRn. In the presence of moderate to severe metabolic acidosis, PCRn does not reflect the real dietary protein intake of the patients, probably as a result of increased catabolism of endogenous proteins. For this reason PCRn should be considered with caution as an estimate of the dietary protein intake in HD patients in the presence of metabolic acidosis.     

The assessment of the nutritional status of patients in the terminal stage of liver disease who are candidates for orthotopic liver transplantation

We evaluated the intravenous infusion of a cocktail of I-131 anti-CEA and anti-CA19-9 monoclonal antibody F(ab')2 (IMACIS-1) in patients with gastrointestinal neoplasm and liver metastases in order to assess its efficacy in detecting the presence of cancer. Seven patients with primary or recurrent gastrointestinal cancer in whom liver metastases were also detected were studied. Accumulation of radioactivity in the primary tumor was seen in only one patient. Visualization of the liver metastases was achieved in all patients. Thus detection of liver metastasis was better than in primary or recurrent tumors. While tumor visualization was most often seen in the 3 day image, optimal visualization of the tumor was seen at 5-7 days. There was no correlation between the serum concentration of CEA or CA19-9 and the visualization of tumors. Serum kinetics of I-131 IMACIS-1 showed biexponential components with a 1st phase T1/2 of 5.0 hours and 2nd phase T1/2 of 34.7 hours. The mean whole body (I-131) half-life determined from the whole-body scans was 1.95 days. The mean urinary excretion of I-131 in 7 days was 85%. This value agreed closely with total radioactivity retention detected by scanning. This series of studies demonstrated the potential utility of a cocktail of antibodies consisting of an anti-CEA and an anti-CA19-9 monoclonal F(ab')2.     

颈动脉粥样硬化与脑梗死关系探讨

目的 研究颈动脉粥样硬化病变特点和颈动脉内膜中层厚度(IMT)与脑梗死的关系.方法 对观察组100例急性脑梗死患者和对照组100例同期体检的健康者进行颈动脉彩色多普勒超声检查,检测双侧颈总动脉、颈动脉分叉和颈内动脉IMT和颈动脉粥样硬化斑块情况.结果 观察组颈动脉粥样硬化检出率为76.1%,以软斑、溃疡斑和混合斑为主;对照组颈动脉粥样硬化检出率为37.8%,以硬斑和扁平斑为主,两组差异有统计学意义(P<0.05).观察组颈总动脉、颈动脉分叉和颈内动脉IMT均显著大于对照组(P<0.05).结论 颈动脉粥样硬化斑块的形成是造成脑梗死的主要原因,颈动脉超声检查能准确显示斑块的形态、大小、位置及管腔狭窄程度,对脑梗死的早期预防和治疗具有重要的临床价值.     

Improved results in patients who have congenital diaphragmatic hernia using preoperative stabilization, extracorporeal membrane oxygenation, and delayed surgery

Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia. The pulmonary vascular bed may be extremely reactive to various stimuli, and in the treatment it is important to avoid pulmonary vasospasm. The strategy in our institution since 1990 has involved a prolonged preoperative stabilization with gentle mechanical ventilation. Pressures have been kept as low as possible, and slight hypercarbia has been accepted. Peak inspiratory pressures exceeding 35 cm H2O have been avoided. Extracorporeal membrane oxygenation (ECMO) has been used according to standard inclusion criteria. Nitric oxide and high-frequency oscillation have been added to the therapeutic modalities during the study period. When the patient was considered stabilized, surgical repair was undertaken after a delay of 24 to 96 hours. In patients on ECMO who could not be decannulated, surgical repair was undertaken while on ECMO. From 1990 through 1995, 52 patients were admitted with a diagnosis of CDH. Forty-three of these were risk group patients presenting with respiratory distress within 6 hours after birth. A total of 48 patients survived (survival rate 92%), and 39 of the risk group patients (survival rate 91%). There were only four hospital deaths, all with contraindications to ECMO. It is suggested that the adopted protocol is beneficial in the treatment of CDH and that the fraction of patients who have pulmonary hypoplasia incompatible with life is smaller than previously believed.     

Current status of 21 patients who have survived more than 20 years since undergoing surgery for biliary atresia

Between 1952 and 1993, 289 patients with biliary atresia underwent surgery at the authors' institution. Twenty-two of them survived more than 20 years; one has since died of hepatic failure (at age 28 years). Of the 21 current survivors (age range, 20 to 39 years), 13 underwent hepatic portoenterostomy; the others had hepaticoenterostomy. None of these patients has undergone liver transplantation. Sixteen patients have led near-normal lives. This includes three married women, one of whom has given birth to a healthy baby boy. Of the six patients who had portal hypertension, three underwent both splenectomy and proximal splenorenal shunting in or before 1985. None of these patients has required additional treatment for portal hypertension. The quality of life of one patient has been severely affected by an unrelated condition (Turner's syndrome). A 22-year-old man was diagnosed as having intrahepatic stones 3 years ago. In another 22-year-old man, hepatic dysfunction developed after frequent episodes of cholangitis. He is now being considered for liver transplantation. The majority of the long-term survivors have good quality of life. However, a few continue to suffer from complications including recurrent cholangitis. Close long-term postoperative follow-up is required for patients with biliary atresia.     

The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease

We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.     

The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema

In a subgroup of patients with atopic eczema (AE), eczematous skin lesions can be induced by epicutaneous testing with aeroallergens (the atopy patch test: APT). An increased frequency of positive APT has been found in AE patients showing a predictive lesional pattern affecting air-exposed skin areas. This study investigates the dose-response of the APT in two different patient groups with AE. Petrolatum preparations of house dust mite, cat dander and grass pollen allergens in four concentrations (500-10,000 protein nitrogen units) were tested epicutaneously in 57 patients with AE, who were prospectively divided in two groups according to whether their AE pattern was with (group I) or without (group II) a predictive distribution. Sixty-nine per cent of patients in group I, and 39% in group II, had positive APT reactions (P = 0.02). The reactions in group I were elicitable with lower allergen concentrations (P = 0.03). A clinically recognizable subgroup of patients with AE showed increased cutaneous sensitivity to aeroallergens.     

Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy

Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia's Children's Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.     

The relationship between bronchial histamine reactivity and atopic status

It has been proposed that increased production of IgE, a feature of atopy, is a cause of the non-specific bronchial hyper-reactivity that is characterisitc of asthma. This hypothesis was examined by selecting groups of subjects with asthma or rhinitis and a group of healthy control subjects and studying the relationship between their bronchial histamine reactivity and their atopic status. In none of the groups tested was there a significant association between the degree of bronchial histamine reactivity and either the serum level of total IgE or the number of extracts of aeroallergens giving positive prick test reactions.     

The assessment and treatment of patients who have sensory loss following cortical lesions

The assessment of tactile and proprioceptive sensory function in patients with severe sensory deficits resulting from cortical lesions is reviewed. The importance of using age-appropriate normative data to interpret the scores on these tests is discussed in the context of the frequency of ipsilateral disturbances in somesthetic sensation following unilateral cerebral lesions. Tactile and proprioceptive sensory deficits not only affect the processing of sensory information but also result in impairments in manual control. Fine-motor skills, such as those required for grasping and manipulating small objects, must therefore be evaluated in these patients. The treatment of patients with severe sensory deficits focuses on improving the perception of sensory information arising from receptors in the hand and on retraining motor function. The procedures used for sensory re-education and retraining are described.     

The relationship between brain atrophy and asymptomatic cerebral lesions]

Serratia marcescens has emerged in the last few years as an important nosocomial pathogen. Many methods for typing this organism have been described. In this study the random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) was shown to be a convenient typing method for S. marcescens. Different combinations of primers previously used for typing other gram-negative bacilli were assessed. The combination of primer HLWL-74 and 1254 gave distinguishable patterns for different serotypes and proved to be the most satisfactory. By applying this combination to 175 isolates of S. marcescens, which could be classified into 38 groups on the basis of serotyping and phage typing, 73 different RAPD patterns with good reproducibility were obtained. This is, to our knowledge, the first application of the method to a large collection of S. marcescens representing a wide range of serotypes.     

Carotid artery stenosis in patients who have undergone radiation therapy for head and neck malignancy

Although it is established that small and medium sized arteries undergo extensive radiation damage, the effect on large vessels such as the carotid arteries is less well understood. We sought to determine if an increased severity of carotid artery stenosis is present in patients who have undergone radiotherapy for head and neck tumours. 45 patients aged 43-90 years (average 67) with head and neck malignancies treated with radiotherapy underwent colour Doppler ultrasonographic scanning of the carotid arteries. These patients were compared with a population of asymptomatic historical controls. 60% of patients demonstrated stenosis ranging from 21 to 86%. 38% of patients demonstrated a stenosis greater than or equal to 50%. Carotid artery stenosis appears to be increased in patients who have previously undergone treatment with radiotherapy to the head and neck regions compared with controls (p < 0.001). These findings suggest that radiation has an adverse effect on large vessels. Colour Doppler follow-up may be indicated for patients receiving head and neck radiation therapy.     

The reflex sympathetic dystrophy syndrome in patients who have had a spinal cord injury

Patients suffering from a spinal cord injury often present with a pain syndrome. Although the reflex sympathetic syndrome is a common diagnosis in some forms of neurological disease such as patients with a stroke, it is less frequent in those with a spinal lesion. The authors report eight patients with reflex sympathetic dystrophy who had a spinal cord injury. The diagnosis and treatment are discussed along with a review of literature.