Acute-stage para- and tetraplegia

A quarter of a century ago, in October 1964, the first spinal cord injury center in Switzerland was opened at Geneva University Hospital. At that time all para- and tetraplegics were classified as "high-risk" patients. Early mortality, covering the initial four weeks following trauma, was still around 15%. The available resources for diagnostic assessment were limited to clinical examination and neuroradiological assessment (subsequently improved by the introduction of tomography and gas myelography). A great many patients suffered a deteriorated neurological level due to inadequate, multiple transfers between hospitals. Most patients who are paralyzed following a road-traffic accident show severe polytrauma. Their chances of survival and functional recovery have greatly improved in recent years due to efficient emergency transport by helicopter, admission to an intensive care unit (respiratory therapy, prophylactic anticoagulation, gastrointestinal cytoprotection, prevention of pressure sores, etc.) and a comprehensive medico-surgical team approach (orthopedic surgeons, neurosurgeons, ICU specialists, internists, etc.). Evaluation of the spine and spinal cord by NMR and CT scan allows precise assessment of the extent of CNS damage and provides additional guide-lines regarding efficient surgical reposition and spinal fusion. Ongoing experimental research in neurophysiology and neurobiochemistry of the brain and spinal cord is presently yielding some interesting results which hold out new hopes for functional recovery in some specific types of incomplete spinal cord trauma.     

Sensitivity analysis in bayesian classification models: multiplicative deviations

The sensitivity of Bayesian pattern recognition models to multiplicative deviations in the prior and conditional probabilities is investigated for the two-class case. Explicit formulas are obtained for the factor K by which the computed posterior probabilities should be divided in order to eliminate the deviation effect. Numerical results for the case of binary features indicate that the Bayesian model tolerates large deviations in the prior and conditional probabilities. In fact, the a priori ratio and the likelihood ratio may deviate within a range of 65-135 percent and still produce posterior probabilities in accurate proximity of at most ±0.10. The main implication is that Bayesian systems which are based on limited data or subjective probabilities are expected to have a high percentage of correct classification despite the fact that the prior and conditional probabilities they use may deviate rather significantly from the true values.     

Evaluating Multimembership Classifiers: A Methodology and Application to the MEDAS Diagnostic System

Performance evaluation measures for multimembership classifiers are presented and applied in a retrospective study on the diagnostic performance of the MEDAS (Medical Emergency Decision Assistance System) system. Admission and discharge diagnoses for 122 patients with one or more of 26 distinct disorders in five major disorder categories were gathered. The average number of disorders per patient was 2 with 36 (29.5 percent) patients having 3 or more disorders simultaneously. The features (symptoms, signs, and laboratory data) available at admission were entered into a multimembership Bayesian pattern recognition algorithm which permits for diagnosis of multiple disorders. When the top five computer-ranked diagnoses were considered, all of the correct diagnoses for 86.1 percent of the patients were displayed by the fifth position. In 71.6 percent of these cases, no false diagnosis preceded any correct diagnosis. In ten cases a discharge diagnosis which was suggested by the available findings was omitted by the admitting physician. In six of these ten cases, the overlooked diagnoses appeared at the computer ranked list above all false diagnoses. Considering the urgency of diagnosis in the Emergency Department, the high uncertainty involved due to the limited availability of data, and the high frequency with which multiple disorders coexist, this limited study encourages our confidence in the MEDAS knowledge base and algorithm as a useful diagnostic support tool.     

Double contrast examination of the stomach. Definition, technic and indications

Double contrast examination constitutes an important element in radiological gastric examination. The author examines the history of the term "double contrast" and defines the designation of "double contrast examination". The exclusive use of the double contrast method reduces the diagnostic value of gastric X-ray examinations. Thus a method is suggested that will avoid the disadvantages of exclusive double contrast examination while adequately including double contrast in the gastric examination. This is done by using various methods - according to the problem posed - in order to achieve the double contrast.     

Syncillin in bacterial skin diseases

A multicentric open clinical trial was carried out by 8 practising specialists in dermatology or paediatrics in patients with bacterial skin diseases who were subjected to a systemic therapy with Syncillin (=Azidocillin). The Syncillin presentation for adults and schoolchildren was tablets of 750 mg each, and sachets of 125 mg or 250 mg for infants. The duration of treatment was 10 days. The parameters analyzed were bacteriological findings and the clinical course of disease. 71 (=74%) of the 96 patients included in this study were considered as cured, 21 (=22%) as improved and 4 patients (=4%) as unchanged. Bacterial identification was still positive in 10 cases after the termination of treatment. However, this did not preclude the assessments of "cured' (3 cases) or "improved' (7 cases). The tolerance of the preparation was considered as "very good' or "good' in 91 and as "poor' in 5 patients. The most common side effects were nausea and diarrhoea. Exanthema was observed in 2 cases. None of these side effects, however, made a discontinuation of medication necessary. The era of rational and well-directed chemotherapy enables good therapeutic approach also to bacterial skin diseases.     

Molecular cloning, sequencing, and expression of the 36 kDa protein present in pars planitis. Sequence homology with yeast nucleopore complex protein

PURPOSE: Patients with active pars planitis have increased levels of a 36 kDa protein (p-36) in their circulation. The current studies were undertaken to determine the primary structure of this protein. METHODS: A degenerate oligonucleotide probe based on the amino terminal sequence of p-36 was used to identify a clone from a human spleen cDNA library. The cDNA insert was subcloned into the EcoR1 site of pUC-19, and both strands were sequenced. Southern blot analysis was used to study the genomic hybridization pattern. p-36 cDNA was subcloned in a pSG5 expression vector, and the construct was used to transfect COS-7 cells. RESULTS: The cDNA sequence contained an open reading frame of 966 base pairs encoding a protein of 322 amino acids, an untranslated region of 322 base pairs, and 2693 base pairs at the 5' and 3' ends, respectively. The deduced amino acid sequence showed 96.8% identity with the carboxy-terminal region of a yeast nucleopore complex protein, nup 100. Southern blot analysis of human genomic DNA revealed a simple hybridization pattern. Transfection of p-36 cDNA in COS-7 cells resulted in the presence of p-36 mRNA and expression of protein. CONCLUSIONS: The 36 kDa protein (p-36) detected at increased levels in the blood of patients with active pars planitis was cloned from a human spleen cDNA library. Its deduced amino acid sequence is homologous with the carboxy-terminal region of a nucleopore complex protein. Thus, we refer to this protein as nup36.     

Differential effect of steady versus oscillating flow on bone cells

Loading induced fluid flow has recently been proposed as an important biophysical signal in bone mechanotransduction. Fluid flow resulting from activities which load the skeleton such as standing, locomotion, or postural muscle activity are predicted to be dynamic in nature and include a relatively small static component. However, in vitro fluid flow experiments with bone cells to date have been conducted using steady or pulsing flow profiles only. In this study we exposed osteoblast-like hFOB 1.19 cells (immortalized human fetal osteoblasts) to precisely controlled dynamic fluid flow profiles of saline supplemented with 2% fetal bovine serum while monitoring intracellular calcium concentration with the fluorescent dye fura-2. Applied flows included steady flow resulting in a wall shear stress of 2 N m(-2), oscillating flow (+/-2 Nm(-2)), and pulsing flow (0 to 2 N m(-2)). The dynamic flows were applied with sinusoidal profiles of 0.5, 1.0, and 2.0 Hz. We found that oscillating flow was a much less potent stimulator of bone cells than either steady or pulsing flow. Furthermore, a decrease in responsiveness with increasing frequency was observed for the dynamic flows. In both cases a reduction in responsiveness coincides with a reduction in the net fluid transport of the flow profile. Thus. these findings support the hypothesis that the response of bone cells to fluid flow is dependent on chemotransport effects.     

Long-term outcome after marrow transplantation for severe aplastic anemia

We reviewed the records and reevaluated 212 patients with aplastic anemia transplanted at the Fred Hutchinson Cancer Research Center (FHCRC) between 1970 and 1993 who survived >/=2 years and who have been followed for up to 26 years. Parameters analyzed included hematopoietic function, chronic graft-versus-host disease (GVHD), skin disease, cataracts, lung disease, skeletal problems, posttransplant malignancy, depression, pregnancy/fatherhood, and the return to work or school, as well as patient self-assessment of physical and psychosocial health, social interactions, memory and concentration, and overall severity of symptoms. Survival probabilities at 20 years were 89% for patients without (n = 125) and 69% for patients with chronic GVHD (n = 86) (the status was uncertain in 1 surviving patient). All patients had normal hematopoietic parameters. Skin problems occurred in 14%, cataracts in 12%, lung disease in 24%, and bone and joint problems in 18% of patients. Eleven patients (12%) developed a solid tumor malignancy and 19% of patients experienced depression. Chronic GVHD was the dominant risk factor for late complications. Seventeen patients died at 2.5 to 20.4 years posttransplant; 13 of these had chronic GVHD and related complications. At 2 years, 83% of patients had returned to school or work; the proportion increased to 90% by 20 years. At least half of the patients preserved or regained the ability to become pregnant or father children. Patients rated their quality of life as excellent and symptoms as minimal or mild. In conclusion, marrow transplantation in patients with aplastic anemia established long-term normal hematopoiesis. No new hematologic disorders occurred. The major cause of morbidity and mortality was chronic GVHD. However, the majority of patients who survived beyond 2 years returned to a fully functional life.