Adenosine deaminase in differential diagnosis of peripheral lymph node tuberculosis

Improved hemodynamics and blood flow have been reported in patients with IABPs who experience cardiopulmonary arrest and require CPR. The following research questions, however, remain unanswered: Is there a more effective method of using IABP to prevent cardiac arrest and the need for CPR? Is the timing of balloon inflation and deflation the same for patients undergoing CPR as it is for patients who do not require CPR? Would earlier or later inflation or deflation further enhance cerebral or systemic blood flow? What are the most effective ways for healthcare staff to maintain competency skills in CPR in patients with IABPs?     

Microchimerism and the pathogenesis of systemic sclerosis

OBJECTIVES: To ascertain the state of a mother's depression three months after childbirth and to what sort of or to whose social support it is related. METHOD: In October 1993, a questionnaire survey was conducted on the attributes, state of depression by Zung Self-rating Depression Scale, and social support of 300 mothers who received health examinations of their 3 to 4 months' old infants at five health centers in Tokyo. Relationship between depression and social support of 256 mothers (rate of valid answer 85.3%) was examined by one-way analysis of variance, Pearson's product moment correlation coefficient and multiple regression analysis. RESULTS: The depression score averaged 37.3 points, with 73 persons (28.5%) scoring 40 to 47 points (light) and 27 persons (10.5%) scoring 48 or more points (medium level or higher). The following were the variables which individually showed a significant relationship to the depression score after controlling for age, education, number of children, type of family, and whether or not the mother was working: The emotional support score from the husband and his parents, such as the frequency in which the husband "listened to the mother's worries and anxieties" "was attentive or considerate to the mother" and "helped in feeding the child", the frequency in which the husband's parents "could be consulted on worries the mother had about childbirth, child care and child development" and "nursed and played with the child". It was found that the better the state of such support, the less the state of depression. On the other hand, support from the mother's parents, neighbors, and friends had no bearing on depression. CONCLUSION: The level of depression of the surveyed group was the same as that of the general female public. Postpartum depression was related to emotional support from the husband and emotional and practical support from the husband's parents. Therefore, from the aspect of preventing depression, we believe it is important that, firstly, the mother and family should understand the importance of support and improve the support by the family, and, secondly, the mother herself should improve her ability to cope.     

The Ashkenazic Jewish Bloom syndrome mutation blmAsh is present in non-Jewish Americans of Spanish ancestry

Bloom syndrome (BS) is more frequent in the Ashkenazic Jewish population than in any other. There the predominant mutation, referred to as "blmAsh," is a 6-bp deletion and 7-bp insertion at nucleotide position 2281 in the BLM cDNA. Using a convenient PCR assay, we have identified blmAsh on 58 of 60 chromosomes transmitted by Ashkenazic parents to persons with BS. In contrast, in 91 unrelated non-Ashkenazic persons with BS whom we examined, blmAsh was identified only in 5, these coming from Spanish-speaking Christian families from the southwestern United States, Mexico, or El Salvador. These data, along with haplotype analyses, show that blmAsh was independently established through a founder effect in Ashkenazic Jews and in immigrants to formerly Spanish colonies. This striking observation underscores the complexity of Jewish history and demonstrates the importance of migration and genetic drift in the formation of human populations.     

Understanding the needs of children following large-scale disasters and the role of government

No one who experiences a disaster is untouched by it. Children and their families are often among the most affected. This article explains how mental health and medical professionals can assist families and communities in dealing with common disaster-related stress reactions in children. An overview of disaster research and examples of special concerns about children are given. In addition, an overview of the role of local, state, and federal governments, as well as other organizations, is provided.     

Immunologic bullous diseases: blisters without a precipitating event

Although the overall incidence of immunologic bullous diseases is comparatively low, they are nonetheless potentially lethal dermatologic disorders that occur most commonly in individuals age 55 and older. Thus familiarity with the signs, symptoms, and treatments will be valuable to the primary care physician. For bullous diseases in general, the challenge is to differentiate between those arising from immunologic rather than exogenous causes, such as drug-induced or drug-triggered pemphigus. Treatment goals include screening for associated malignancies, managing the lesions, and minimizing the morbidity and mortality associated with the disease. Collaboration with a dermatologist can aid in achieving these objectives.     

Therapeutic changes in extraction versus non-extraction orthodontic treatment

A family cancer database was constructed from the nationwide Swedish registries and includes approximately 6 million persons and >30,000 cancers in offspring diagnosed at ages 15-51 years and their parents. A particular advantage of the database is that the contribution of both parental lineages on cancer risk can be examined. Cancer risk in the offspring was increased approximately 1.1 times when the father had cancer, and no increase was noted when the mother had cancer. If both parents had cancer, the risk for sons was 1.4 and for daughters 1.3. The sites of increased cancer risk in the offspring were colorectum, breast, cervix, corpus uteri, ovary, testis, melanoma, eye, other endocrine glands, and multiple myeloma. The results among young and middle-age adults suggest that cancer in both parents increases the cancer risk in the offspring at many sites. The molecular genetic explanation may be that rare dominant single genes increase susceptibility at many sites, or that overlapping sets of genes control susceptibility at multiple sites.     

Iodine-131-labeled antitenascin monoclonal antibody 81C6 treatment of patients with recurrent malignant gliomas: phase I trial results

PURPOSE: To determine the maximum-tolerated dose (MTD) of iodine 131 (131I)-labeled 81C6 monoclonal antibody (mAb) in brain tumor patients with surgically created resection cavities (SCRCs) and to identify any objective responses to this treatment. METHODS: In this phase I trial, eligible patients were treated with a single injection of 131I-labeled 81C6. Cohorts of three to six patients were treated with escalating dosages of 131I (starting dose of 20 mCi with a 20-mCi escalation in subsequent cohorts) administered through an Ommaya reservoir in the SCRC. Patients were followed up for toxicity and response until death or for a minimum of 1 year after treatment. The SCRC patients, who were previously irradiated, were followed up without additional treatment unless progressive disease was identified. RESULTS: We administered 36 treatments of 131I doses up to 120 mCi to 34 previously irradiated patients with recurrent or metastatic brain tumors. Dose-limiting toxicity was reached at 120 mCi and was limited to neurologic or hematologic toxicity. None of the patients treated with less than 120 mCi developed significant neurologic toxicity; one patient developed major hematologic toxicity (MHT). The estimated median survival for patients with glioblastoma multiforme (GBM) and for all patients was 56 and 60 weeks, respectively. CONCLUSION: The MTD for administration of 131I-labeled 81C6 into the SCRCs of previously irradiated patients with recurrent primary or metastatic brain tumors was 100 mCi. The dose-limiting toxicity was neurologic toxicity. We are encouraged by the minimal toxicity and survival in this phase I trial. Radiolabeled mAbs may improve the current therapy for brain tumor patients.     

The Veterans Affairs Implantable Insulin Pump Study: effect on cardiovascular risk factors

OBJECTIVE: To determine whether implantable insulin pump (IIP) and multiple-dose insulin (MDI) therapy have different effects on cardiovascular risk factors in insulin-requiring patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A randomized clinical trial was conducted at seven Veterans Affairs medical centers in 121 male patients with type 2 diabetes between the ages of 40 and 69 years receiving at least one injection of insulin per day and with HbA1c, levels of > or =8% at baseline. Weights, blood pressures, insulin use, and glucose monitoring data were obtained at each visit. Lipid levels were obtained at 0, 4, 8, and 12 months, and free and total insulin levels were obtained at 0, 6, and 12 months. All medications being taken were recorded at each visit. RESULTS: No difference in absolute blood pressure, neither systolic nor diastolic, was seen between patients receiving MDI or IIP therapy, but significantly more MDI patients required anti-hypertensive medications. When blood pressure was modeled against weight and time, IIP therapy was significantly better than MDI therapy for systolic blood pressure in patients with BMI <33 and for diastolic blood pressure in patients with BMI >34 kg/m2. Total cholesterol levels decreased in the overall sample, but IIP patients exhibited significantly higher levels than MDI patients. Triglyceride levels increased over time for both groups, with IIP patients having significantly higher levels than patients in the MDI group. BMI was a significant predictor of, and inversely proportional to, HDL cholesterol level. No difference in lipid-lowering drug therapy was seen between the two groups. Free insulin and insulin antibodies tended to decrease in the IIP group as compared with the MDI group. C-peptide levels decreased in both groups. CONCLUSIONS: IIP therapy in insulin-requiring patients with type 2 diabetes has advantages over MDI therapy in decreasing the requirement for antihypertensive therapy and for decreasing total and free insulin and insulin antibodies. Both therapies reduce total cholesterol and C-peptide levels.     

Nerve growth factor in normal and psoriatic skin equivalent models

Our objective was to determine the pattern and time course of nerve growth factor expression in an established skin equivalent model that we have used in the past to study wound healing and psoriasis phenotypes. Skin equivalents were constructed in triplicate using normal neonatal foreskin keratinocytes plated on collagen gels containing fibroblast lines. These lines were derived from five specimens of psoriatic lesions, three specimens of normal skin from patients with psoriasis, and three specimens of eyelid skin from normal donors. Immunohistochemistry and a monoclonal nerve growth factor-b antibody were used to determine the pattern of protein staining over 2 weeks. We looked at the wound healing phenotype using the skin equivalent model for 7-14 days. When keratinocytes invaginate into the dermis of skin equivalents (beginning at around 7 days of growth), dark staining of nerve growth factor was seen under the basal membrane zone, suggesting that nerve growth factor serves in the development of the basal membrane zone and the epidermis, and may influence the migration of nerves through the basal membrane zone into the regenerated skin.     

Plasma lipoproteins and the incidence of abnormal excretion of albumin in diabetic American Indians: the Strong Heart Study

Animal studies suggest that lipids are risk factors for kidney diseases. Some prospective studies and clinical trials have reported predictive effects of lipoproteins on different stages of diabetic nephropathy in humans. We examined lipoprotein abnormalities to determine if they predict abnormal urinary excretion of albumin (> or = 30 mg albumin/g creatinine), using logistic regression. We followed 671 American Indians (211 men, 460 women) with Type II diabetes for a mean of 3.9 years (range 1.7-6.2). Participants were aged 45-74 years. They had normal excretion of albumin and normal serum creatinine at baseline. 67 men and 144 women developed abnormal excretion of albumin. In models controlled for age, treatment with oral hypoglycaemic agents or insulin, HbA1c, study site, degree of Indian heritage, mean arterial blood pressure, albumin excretion at baseline and duration of diabetes, a high HDL cholesterol was a protector for abnormal excretion of albumin in women [odds ratio (OR) comparing the 90th with the 10th percentile = 0.56, 95% confidence interval (CI) = 0.32-0.98], but not in men (OR = 1.5, 95% CI = 0.66-3.4). Further adjustment for obesity, insulin concentration, alcohol consumption or physical activity did not change the results. There was a tendency for high values of VLDL and total triglyceride and small LDL size to predict abnormal excretion of albumin in women only. We conclude that low HDL cholesterol was a risk factor for abnormal excretion of albumin in women, but not in men. Sex hormones may be responsible for sex differences in the association between HDL cholesterol and abnormal excretion of albumin.