Foundations'' impact on policy making: results from a pilot study

Thirty-two consecutive patients with haematological disorders, in need of a permanent central venous catheter (CVC) were randomly allocated to have their CVC bandages (Tegaderm) changed once (OAW, n = 20) or twice (TAW, n = 19) a week. The two randomization arms were balanced in respect of age, sex, and underlying disease. The exit site of the CVC was inspected daily through the transparent bandage and erythema was noted. If severe erythema occurred, daily wet gauze dressings were applied. Samples for bacterial cultures were taken from the exit site of the CVC at every change of bandages. There was no difference in complications leading to removal of the CVC between the two groups (7/20 OAW vs. 7/19 TAW) or in CVC survival-time (P = 0.4). However, the OAW group had more positive CVC tip cultures (OAW 11/14 vs. TAW 2/9; P < 0.05) and a tendency to: (i) more extra dressings (P = 0.08); (ii) more cultures from the exit skin site showing high numbers of colony forming units (P = 0.07); (iii) shorter time to first exit site infection (P = 0.09); and (iv) more Gram-positive septicaemias (P = 0.08). Both clinical and bacteriological data in this study indicate that changing transparent polyurethane CVC bandages twice a week is superior to once a week.     

Occlusion of large atrial septal defects with a centering buttoned device: early clinical experience

A feasibility clinical study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects with the centering buttoned device. The centering buttoned device is a modification of the regular buttoned device in which a centering counter-occluder is sutured at the central 40% portion of the occluder. During centering it is stretched, forming a parachute-shaped structure and pulling the occluder over the center of the defect. During buttoning, the counter-occluder forms a double figure eight, opposing the right atrial side of the atrial septum. Occlusion was performed in 12 patients aged 6 to 56 years. All had been rejected for transcatheter occlusion by the regular buttoned device, because of either their defect size or the lack of adequate septal rim. The defect size varied between 23 and 31 mm, and the device size varied between 45 and 60 mm. Nine had immediate effective occlusions of their defects and three residual shunts. One patient with unbuttoning had hemolysis at 2 weeks and underwent surgery. Early results of the transcatheter occlusion of large atrial septal defects are promising, and larger clinical trials are justified.     

Selective monitoring of peptidase activities with synthetic polypeptide substrates and polyion-sensitive membrane electrode detection

A novel method to monitor specific peptidase activities in biological samples as complex as undiluted plasma/blood is described. The approach is based on the design of synthetic polypeptide substrates in which di- or triarginine sequences are linked to each other via one or more other amino acids recognized specifically by the peptidase to be determined. Detection of chymotrypsin and renin activities using synthetic substrates P4 (F-R-R-R-F-V-R-R-F-NH2) and P5 (R-R-R-L-L-R-R-L-L-R-R-R), respectively, serves to demonstrate the principles of this new assay system. A polyion-sensitive membrane electrode, prepared by doping polymer films with dinonylnaphthalene-sulfonate (DNNS), is shown to exhibit significant nonequilibrium electromotive force (EMF) responses toward these and other polycationic substrates at microgram/milliliter levels under physiological conditions. The same electrode, however, exhibits much smaller total EMF response toward the shorter fragments of the synthetic peptides generated by peptidase activity; hence, the addition of peptidase to a solution containing the synthetic substrate yields a change in electrode EMF response, the rate of which is proportional to the activity of peptidase present. Other synthetic polycationic peptides as well as natural polycationic peptides (e.g., protamine) that lack specific cleavage sites for chymotrypsin and renin, yet are detected by the DNNS-based membrane electrode, do not elicit any significant change in EMF response in the presence of the peptidases, confirming the feasibility and utility of the proposed bioanalytical method.     

Perceived equity and intimacy in marriage

The extent to which perceived inequity is related to perceived marital intimacy was examined. Sixty-six couples married five years or less were randomly selected from marriage license records in a western rural community. Equity/inequity was assessed using the Walster global measure of equity. Levels of overall intimacy, conflict resolution, affection, cohesion, sexuality, identity, compatibility, autonomy, and expressiveness were measured using the Waring Intimacy Questionnaire (WIQ). Inequity was associated with lower levels of overall intimacy, compatibility, identity, and expressiveness among the wives. Among the husbands, inequity was not associated with any types of intimacy. When comparing husbands in inequitable relationships to wives in inequitable relationships, the wives reported lower scores for only one kind of intimacy--identity. Explanations and implications for marriage therapy are discussed.     

Malignoma versus bacterial spondylodiscitis: value of spinal MRI for the differential diagnosis in an emergency situation. Description in an acute case with progressive paraplegia

BACKGROUND: For the radiation oncologist in an emergency situation with acute progressive paraplegia distinguishing between benign versus malignant vertebral compression fracture without known malignoma may cause a severe diagnostic problem, when a rapid therapeutic decision is required. PATIENT AND METHOD: A case of an elderly diabetic patient with acute onset of a progressive neurologic deficit is reported. No malignancy was known so far. The CT of the spine showed a destruction of the 7th and 8th thoracic vertebral body with compression of the spinal cord. The patient was referred to the radiotherapist for radiation of a presumed malignant spinal process. RESULT: For differential diagnosis a magnetic resonance imaging (MRI) of the spine was performed and could lead to the correct diagnosis of an infectious spondylodiscitis. CONCLUSION: The MRI of the spine has a potential role for correct differentiation between benign and malignant spinal lesions and may thereby assist the radiotherapist in the decision making in an emergency situation.