Effect of hypoxia on the pressure developed by inspiratory muscles during airway occlusion

Patients with colitis and ileocolitis of unknown etiology from two previously reported series have been combined and the follow-up studies have been extended to compare the long term postoperative courses of ulcerative colitis (UC) and Crohn's disease of the colon (CDC). The combined and updated series of 176 patients, 99% of whom could be traced, provided a mean postoperative follow-up period for UC of 14 years (5 to 31) and CDC of 13.1 years (5 to 36). There were highly significant associations between generally accepted clinical and distributional features of UC and CDC and microscopic findings generally regarded as reliable for each. However, because of spectrum of features was found in each entity, neither clinical and distributional nor microscopic features alone are sufficient for diagnosis in every case. There were no differences in gross or disease-related mortality in UC and CDC whatever the method of diagnosis. After anastomotic procedures in CDC a recurrence rate of 73% was found. After proctocolectomy the ileostomy revision rate (considering all types of those which required further excision of ileum) was higher in CDC than UC whether the diagnoses were based on microscopic, clinical, or combined criteria, but the differences reached statistical significance only in the comparison of "clinical UC", with "clinical CDC". Moreover, after the first 2 postoperative years, the risk of having an ileostomy revision in UC and CDC (combined criteria) per patient year follow-up was virtually identical and there were no cases of short bowel syndrome. Differences in the clinical courses of UC and CDC after colectomy and ileostomy are of degree and do not reflect the ultimate course or potential for rehabilitation. Decisions regarding surgical therapy should be made independent of the diagnosis of UC or CDC.     

Observations on potential contributions of health planning

The passage of the National Health Planning and Resources Development Act in the United States in 1974 is used to set the context for a new assessment of health planning as a change agent. In reviewing the record of health planning the most striking conclusion is that even its friends have been unable to establish that it has had any quantifiable impact. The authors suggest, however, that comprehensive health planning may have stimulated the belief that changes in medical care organization are crucial to improving the health care system. The authors next consider the role of health planning inferred from three widely espoused "models" of the health care system: professional, central planning, and market. Although market advocates generally deemphasize health planning as contrasted to those supporting a centrally planned system, none of the models is sufficiently developed to indicate specific roles and functions fro health planning. Basing their argument on goals for health care reform generally espoused by students of medical care organization, the authors assert that health planning agenices will be most effective if they are organizationally linked to general-purpose governments, encourage the formation of Health Maintenance Organizations, consciously involve themselves in health system reorganization, and design their policies so they can be effectively evaluated.     

The asymmetrical brain--asymmetrical consciousness

To substantiate a term "asymmetry of consciousness", to throw light on it are compared disturbances of consciousness in dextral and sinistral persons with selective lesions in the right or left brain hemispheres. Is supposed a fundamental role of the spatial-temporal factors. By them are mediated relations "brain-consciousness", asymmetry of consciousness. The latter is expressed in dextral persons by an opposite spatial-temporal organization of psycho-sensory (which are realized in individual present and past) and psychomotor (which are displayed in external present and future) processes. This contrast is not observed in sinistrals or only in some of them. Is assumed a probability of evolution of space and time with appearance of their forms having been absent before the human level. They are presumably described by the authors as individual space and time, on the one hand being determined by the functioning brain of each dextral and sinistral person, on the other hand defining the limits and limitations of the mental abilities of each person. Individual space and time may be other in a sinistral person than in a dextral one.     

The psychophysiological criteria for assessing the excitable type of psychopathy

In the excitable psychopaths and persons with some psychopathic traits (Leonard's "accentuated personality") the study was made of a cognitive function of discriminating microintervals and event-related potentials to visual stimuli. A qualitative difference in the accomplishment of the cognitive task between the two groups was found. Disturbances of the cognitive function, learning deficiency and reduction of the P300 wave provide grounds for referring this "antisocial personality disorder" to pathology of the limbic system of the brain.     

A tuberculin screening and isoniazid preventive therapy program in an inner-city population

As tuberculosis transmission decreases, case rates decline and an increasing proportion of cases arises from the pool of persons with latent infection. Elimination of tuberculosis will require preventing disease from developing in infected persons. From 1994 to 1996 the Atlanta TB Prevention Coalition conducted a community-based tuberculin screening and isoniazid preventive therapy project among high-risk inner-city residents of Atlanta, Georgia. We established screening centers in outpatient waiting areas of the public hospital serving inner-city residents, the city jail, clinics serving the homeless, and with outreach teams in neighborhoods frequented by drug users. All services were provided free. A total of 7,246 persons participated in tuberculin testing; 4,701 (65%) adhered with skin test reading, 809 (17%) had a positive test, 409 (50%) fit current guidelines for isoniazid preventive therapy, 84 (20%) we intended to treat completed therapy. The major limitations of this community-based tuberculin screening and preventive therapy project were the low proportion of infected individuals who were eligible for isoniazid preventive therapy and the poor adherence with a complete regimen among those we intended to treat. For community-based programs to be efficacious, preventive therapy regimens that are of shorter duration and safe for older persons will need to be implemented.     

A bioluminescent method of determining antibiotic sensitivity of microbial cells in septic blood]

Previous studies have shown that adhesion molecules play a crucial role in leukocyte-endothelium interactions that occur during myocardial ischemia and reperfusion. We assessed the plasma levels of the soluble form of E-selectin (sE-selectin) and intercellular adhesion molecule-1 (sICAM-1) in 15 patients with acute myocardial infarction (AMI) and in 15 controls with chronic stable angina. In patients with AMI, the levels of sE-selectin and sICAM-1 increased significantly during the first 8 h after infarction and subsequently decreased. Soluble E-selectin levels were inversely related to the peak plasma levels of creatine kinase-MB (CK-MB), and the time course of their appearance in plasma correlated with that of neutrophil count and plasma D-dimer. In individual patients, peak and mean sICAM-1 levels correlated respectively with plasma D-dimer concentrations and monocyte count, but no correlation were found when their time courses were analyzed. Eight hours after symptom onset, the mean plasma sE-selectin levels were higher in patients with AMI than in those with stable angina, whereas no significant differences were found in mean plasma sICAM-1 levels between the two groups at every time analyzed. In the acute phase of MI (a) sE-selectin and sICAM-1 levels increase during the first 8 h and subsequently decrease; (b) the increase in sE-selectin probably reflects activation of endothelial cells, correlates with other inflammatory and coagulation parameters, and is inversely related to the degree of myocardial damage; and (c) sICAM-1 plasma levels do not represent a good marker of "cell activation" because they reflect activation of different cells and may be affected by different conditions.     

A decrease in the level of erythrocytes with micronuclei under the influence of pyrimidine and thiazolidine derivatives in the blood of persons who came under radiation exposure as a result of the accident at the Siberian Chemical Combine

Wild-type representatives of Francisella genus (F. tularensis, F. novicida, F. novicida-like, and F. philomiragia) produce S-type lipopolysaccharides (LPS) possessing different antigenic activity and common antigenic determinants in the core oligosaccharide. Electrophoretic analysis showed that F. philomiragia produced S-LPS containing two major molecular components with minor fractions between them, whereas S-LPS of F. tularensis, F. novicida, and F. novicida-like are characterized by the typical frequency distribution of molecules. A characteristic feature of Francisella LPS was the ability to form the dominant molecular components with similar electrophoretic mobility of major fractions of the original F. philomiragia LPS upon long storage in water solution. Natural virulent F. tularensis strains produce at least two types of S-LPS. Polysaccharide chains of type I S-LPS possess O-species-specific antigens, whereas the polysaccharide part of type II S-LPS has nonspecific antigenic epitopes. A decrease of F. tularensis virulence can be associated with impaired production of both S-LPS types or loss of S-LPS with O-species-specific antigenic activity.     

Syntagmatic and paradigmatic principles of organizing lexicon and functional asymmetry of the brain]

To evaluate the role of the amygdala in pain modulation and opioid-mediated antinociception, a recombinant, replication-defective herpes virus carrying the human preproenkephalin cDNA was injected bilaterally into the rat amygdala. Four days after gene delivery nociceptive behavior was assessed by the formalin test. Rats infected with the virus expressing preproenkephalin showed a selective, naloxone-reversible abolition of phase 2 flinching behavior compared to rats infected with a control virus. The results implicate the amygdala in the control of pain and in opioid analgesia and demonstrate the use of recombinant herpes viruses as tools for studying gene function in specific neural pathways of the central nervous system.     

MMPI profiles in PTSD as a function of comorbidity

A sample of 135 Vietnam veteran inpatients with combat-related PTSD was sorted into three groups, depending upon the presence of concurrent psychiatric disorders: Depression (n = 68), Psychosis (n = 31), and Other (n = 36). Pairwise comparisons were made on the MMPI with respect to the validity indicators, clinical scales, four relevant Harris-Lingoes subscales, the Psychoticism content scale, and the MMPI-PTSD subscale. Results indicate variations in scale elevations as a function of comorbid diagnosis. Various items and scales appear to differentiate the Psychosis group due to greater psychopathology. In general, the results spotlight the heterogeneous aspects that comorbidity brings to PTSD assessment.