[Multiple osteonecrosis in a patient with chronic alcoholism]

The osteonecrosis is usually due to various precipitating circumstances or predisposing factors that quite often appear mixed, although it can also appear with no evident cause. In this report, we provide a case of multiple osteonecrosis caused by chronic alcoholism, we review the literature and go over the general characteristics of the aseptic necrosis.

[Agranulocytosis after application of silver sulfadiazine in a 2-month old infant]

BACKGROUND

A granulocytosis associated with the use of silver sulfadiazine has been described in burn patients. This agranulocytosis may be due to either an allergic reaction or a bone marrow toxicity by silver sulfadiazine.

CASE REPORT

A 1-month old baby was hospitalized in pediatric intensive care unit after a stage one repair of a tracheoesophegeal fistula. Gastroesophageal reflux and tracheomalacia appeared in the post operative period. When she was 2-months old, she developed a perineal erythema. A topical therapy was begun, with daily applications of silver sulfadiazine and ketoconazole. Five days later, agranulocytosis (granulocytes = 0.21 x 10(9).L-1) occurred. Silver sulfadiazine therapy was immediately stopped. Granulocyte count returned to normal over a few days. No other etiology than silver sulfadiazine could be found to explain agranulocytosis. The small surface of administration, the chronology of the events and the rapid correction of the disorders after silver sulfadiazine interruption argued for an immuno-allergic reaction to this drug. Medical problems were easily controlled and the patient recovered well.

CONCLUSION

This event occurred when sulfadiazine was applied in a small cutaneous area in a young baby. This may be an argument for an allergic reaction; alternatively, it could be explained by an increased cutaneous absorption of a cytotoxic drug in younger people.

Suppression, accessibility of death-related thoughts, and cultural worldview defense: exploring the psychodynamics of terror management

Previous research has shown that after a mortality-salience (MS) treatment, death thought accessibility and worldview defense are initially low and then increase after a delay, suggesting that a person's initial response to conscious thoughts of mortality is to actively suppress death thoughts. If so, then high cognitive load, by disrupting suppression efforts, should lead to immediate increases in death thought accessibility and cultural worldview defense. Studies 1 and 2 supported this reasoning. Specifically, Study 1 replicated the delayed increase in death accessibility after MS among low cognitive load participants but showed a reversed pattern among participants under high cognitive load. Study 2 showed that, unlike low cognitive load participants, high cognitive load participants exhibited immediate increase in pro-American bias after MS. Study 3 demonstrated that worldview defense in response to MS reduces the delayed increase in death accessibility. Implications of these findings for understanding both terror management processes and psychological defense in general are discussed.

Management of acute delirium in hospitalized elderly: a process improvement project

This article will describe a systematic practical approach that was developed to evaluate and manage one of the most dangerous and costly geriatric emergencies in our nation-delirium in hospitalized frail elders. The article is about nurses and physicians who worked together in a continuous quality improvement process to find a collaborative method to reduce the occurrence, severity, duration, and devastating outcomes of acute delirium.

Suppression, accessibility of death-related thoughts, and cultural worldview defense: exploring the psychodynamics of terror management

Previous research has shown that after a mortality-salience (MS) treatment, death thought accessibility and worldview defense are initially low and then increase after a delay, suggesting that a person's initial response to conscious thoughts of mortality is to actively suppress death thoughts. If so, then high cognitive load, by disrupting suppression efforts, should lead to immediate increases in death thought accessibility and cultural worldview defense. Studies 1 and 2 supported this reasoning. Specifically, Study 1 replicated the delayed increase in death accessibility after MS among low cognitive load participants but showed a reversed pattern among participants under high cognitive load. Study 2 showed that, unlike low cognitive load participants, high cognitive load participants exhibited immediate increase in pro-American bias after MS. Study 3 demonstrated that worldview defense in response to MS reduces the delayed increase in death accessibility. Implications of these findings for understanding both terror management processes and psychological defense in general are discussed.

Effect of solid and liquid diet on uptake of large particulates across intestinal epithelium in rats

The effect of diet composition on the uptake of particulates across the gastrointestinal epithelium has been examined in fasted male weanling Sprague-Dawley rats by estimating the systemic uptake of orally administered 2-microns latex polystyrene microspheres. Using a tissue solubilization assay, particle transfer in animals maintained on a fluid diet was determined. A larger number of particles was transferred from the gut lumen to the internal organs, including the mesenteric lymph node, spleen, bone marrow, liver, kidney, and heart of animals fed solid pelleted diet than those maintained on a fluid-diet 4 hr after oral administration of particles. The increase in particle number in rats fed the solid diet was only statistically significant (P < 0.05) for brain tissue in the analysis for trend. However, the number of particles retained in the proximal region of the gut at the end of this period was greater in animals fed the fluid diet. This work demonstrates that diet composition is important in gastrointestinal transepithelial translocation of microspheres.

Pre-anaesthetic assessment of coagulation abnormalities in obstetric patients: usefulness, timing and clinical implications

The usefulness and optimal timing of laboratory coagulation tests before obstetric extradural analgesia are controversial. Moreover, the significance of mild coagulation abnormalities during pregnancy remains unclear. We have assessed the reliability of coagulation tests performed several weeks before delivery as predictors of coagulation abnormalities during labour. Platelet count, plasma fibrinogen concentration, prothrombin time (PT) and activated partial thromboplastin time (aPTT) were sampled in 797 women during the ninth month of pregnancy and checked during labour. Platelet count was less than 100 x 10(9) litre-1 for 11 women during labour. Only three had been detected by the first sample. Platelet count less than 100 x 10(9) litre-1 or fibrinogen concentration less than 2.9 g litre-1 during labour were associated with an increase in the incidence of postpartum haemorrhage (odds ratio = 19.7). We conclude that a platelet count several weeks before delivery was not reliable in predicting thrombocytopenia during labour and that women with mild coagulation abnormalities in early labour may need special attention regarding the risk of postpartum haemorrhage.

Pathogen-induced programmed cell death in tobacco

Sacrificing an infected cell or cells in order to prevent systemic spread of a pathogen appears to be a conserved strategy in both plants and animals. We studied some of the morphological and biochemical events that accompany programmed cell death during the hypersensitive response of tobacco plants infected with tobacco mosaic virus. Certain aspects of this cell death process appeared to be similar to those that take place during apoptosis in animal cells. These included condensation and vacuolization of the cytoplasm and cleavage of nuclear DNA to 50 kb fragments. In contrast, internucleosomal fragmentation, condensation of chromatin at the nuclear periphery and apoptotic bodies were not observed in tobacco plants during tobacco mosaic virus-induced hypersensitive response. A unique aspect of programmed cell death during the hypersensitive response of tobacco to tobacco mosaic virus involved an increase in the amount of monomeric chloroplast DNA. Morphological changes to the chloroplast and cytosol of tobacco cells and increase in monomeric chloroplast DNA occurred prior to gross changes in nuclear morphology and significant chromatin cleavage. Our findings suggest that certain aspects of programmed cell death may have been conserved during the evolution of plants and animals.

Terror management and cognitive-experiential self-theory: evidence that terror management occurs in the experiential system

The authors hypothesized, on the basis of terror management theory and cognitive-experiential self-theory, that participants in an experiential mode of thinking would respond to mortality salience with increased worldview defense and increased accessibility of death-related thoughts, whereas participants in a rational mode would not. Results from 3 studies provided convergent evidence that when participants were in an experiential mode, mortality salience produced the typical worldview defense effect, but when participants were in a rational mode it did not. Study 4 revealed that mortality salience also led to a delayed increase in the accessibility of death-related thoughts only when participants were in an experiential mode. These results supported the notion that worldwide defense is intensified only if individuals are in an experiential mode when considering their mortality. Discussion focuses on implications for understanding terror management processes.

Ebrotidine versus ranitidine in the healing and prevention of relapse of duodenal ulcer. A multicentre, double-blind, parallel, randomized, controlled study

Two hundred and fifty patients were included in a double-blind, parallel, randomized, controlled clinical trial. Duodenal ulcer treatment lasted up to 8 weeks. Forty-nine patients were followed up for prevention of ulcer relapse for up to one year. All patients received either ranitidine (300 mg/day in the healing phase and 150 mg/day in the follow-up phase) or ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4 -thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide , CAS 100981-43-9, FI-3542) (400 mg/day in both phases) as a single dose at bedtime. Both groups were matched in all demographic parameters, except for a significantly higher percentage of smokers in the ranitidine group. The percentage of total healing was almost the same with both products. Healing occurred in a higher percentage with ebrotidine at weeks 4 (75% versus 66.7%) and 6 (87% versus 79.7%). A higher effect of ebrotidine on the incidence of duodenitis was identified during the whole study, but only reached statistical significance at week 6. The relapse rate during the follow-up phase showed no differences between the two study treatments, relapse percentage figures being 25% for ebrotidine and 24% for ranitidine. There were no differences in the number of unscheduled visits between the two groups, although 57% of patients in the ranitidine group had to make a second follow-up visit, as compared with 33% in the ebrotidine group. Both drugs caused hardly any side effects, affecting only one patient from each group: one patient with ebrotidine suffered from diarrhoea and one patient with ranitidine developed a skin rash on the limbs. Administration of ebrotidine in a single dose (400 mg/d) was at least as effective and safe as ranitidine both for healing and relapse prevention in patients with duodenal ulcer.

Terror management theory and self-esteem: evidence that increased self-esteem reduces mortality salience effects

On the basis of the terror management theory proposition that self-esteem provides protection against concerns about mortality, it was hypothesized that self-esteem would reduce the worldview defense produced by mortality salience (MS). The results of Experiments 1 and 2 confirmed this hypothesis by showing that individuals with high self-esteem (manipulated in Experiment 1; dispositional in Experiment 2) did not respond to MS with increased worldview defense, whereas individuals with moderate self-esteem did. The results of Experiment 3 suggested that the effects of the first 2 experiments may have occurred because high self-esteem facilitates the suppression of death constructs following MS.

Progression into the first meiotic division is sensitive to histone H2A-H2B dimer concentration in Saccharomyces cerevisiae

The yeast Saccharomyces cerevisiae contains two genes for histone H2A and two for histone H2B located in two divergently transcribed gene pairs: HTA1-HTB1 and HTA2-HTB2. Diploid strains lacking HTA1-HTB1 (hta1-htb1 delta/hta1-htb1 delta, HTA2-HTB2/HTA2-HTB2) grow vegetatively, but will not sporulate. This sporulation phenotype results from a partial depletion of H2A-H2B dimers. Since the expression patterns of HTA1-HTB1 and HTA2-HTB2 are similar in mitosis and meiosis, the sporulation pathway is therefore more sensitive than the mitotic cycle to depletion of H2A-H2B dimers. After completing premeiotic DNA replication, commitment to meiotic recombination, and chiasma resolution, the hta1-htb1 delta/hta1-htb1 delta, HTA2-HTB2/HTA2-HTB2 mutant arrests before the first meiotic division. The arrest is not due to any obvious disruptions in spindle pole bodies or microtubules. The meiotic block is not bypassed in backgrounds homozygous for spo13, rad50 delta, or rad9 delta mutations, but is bypassed in the presence of hydroxyurea, a drug known to inhibit DNA chain elongation. We hypothesize that the deposition of H2A-H2B dimers in the mutant is unable to keep pace with the replication fork, thereby leading to a disruption in chromosome structure that interferes with the meiotic divisions.

Incidence of childhood-onset IDDM in black African-heritage populations in the Caribbean. The Caribbean African Heritage IDDM Study (CAHIS) Group

OBJECTIVE

To compare incidence rates of childhood-onset IDDM among black African-heritage populations age 0-19 years in the Caribbean region.

RESEARCH DESIGN AND METHODS

Population-based registries for IDDM were established on the eastern Caribbean islands of Antigua, Barbados, Dominica, St. Croix, St. Kitts, St. Thomas, and Tortola using standardized criteria from the World Health Organization (WHO) Multinational Project for Childhood Diabetes (DiaMond). Average annual incidence rates (IR) with 95% CI for 0-19 years olds were computed using the DiaMond Registry program for the 5-year period from 1989 to 1993. Poisson regression analysis was used to determine differences in incidence rates.

RESULTS

The highest incidence rate for 0-19 year olds was for the black African-heritage population of St. Croix (IR 10.09 per 100,000; 95% CI 4.35-19.89), one of the U.S. Caribbean islands. A significant (P < 0.05) 3.9 variation in IDDM incidence across the registries was found when the IR for St. Croix was compared to the IR for Barbados (IR 2.57 per 100,000; 95% CI 0.90-4.64).

CONCLUSIONS

The variation in childhood-onset IDDM incidence rates among the black populations of the eastern Caribbean islands is consistent with the geographic variation in IDDM incidence seen among African Americans in the U.S. Variation in incidence rates of childhood diabetes in black populations may reflect differences in level of white genetic admixture or exposure to environmental diabetogenic agents.

Preclinical studies for cell transplantation: isolation of primate fetal hepatocytes, their cryopreservation, and efficient retroviral transduction

Fetal hepatocytes are an attractive target for in utero cellular transplantation. Their use could provide a very efficient way for implanting normal or transduced cells into the livers of affected fetuses. Marking cells with recombinant retroviruses is a powerful tool for evaluating the chimerism of grafted animals. The technique relies on the ex vivo transduction efficiency of the engrafted cells. We have isolated fetal primary hepatocytes from nonhuman primates. The cells were cultured and transduced with a retroviral vector carrying the Escherichia coli beta-galactosidase gene. Optimal gene transfer efficiency was obtained 48-60 hr after plating and was as high as 90%. Cryopreservation had little effect on cell viability and infectivity: The viability of thawed hepatocytes remained high (75-85%) and the infection efficiency was identical to that of freshly isolated cells. Efficient ex vivo retroviral gene transfer into fetal hepatocytes provides an appropriate system for testing allogenic grafting and for modifying immunogenicity of engrafted cells. These results open up new perspectives for cell transplantation through cell banking.

Terror management theory and self-esteem: evidence that increased self-esteem reduces mortality salience effects

On the basis of the terror management theory proposition that self-esteem provides protection against concerns about mortality, it was hypothesized that self-esteem would reduce the worldview defense produced by mortality salience (MS). The results of Experiments 1 and 2 confirmed this hypothesis by showing that individuals with high self-esteem (manipulated in Experiment 1; dispositional in Experiment 2) did not respond to MS with increased worldview defense, whereas individuals with moderate self-esteem did. The results of Experiment 3 suggested that the effects of the first 2 experiments may have occurred because high self-esteem facilitates the suppression of death constructs following MS.

Anatomical basis of a common embryological origin for epispadias and bladder or cloacal exstrophies

Epispadias, bladder exstrophy and its variants are in the first place usually considered as urological anomalies. Embryological theses and therapeutic approaches are mainly based upon this aspect. We challenge this point of view, in order to bring out a new axis of research about this still misknown pathologic field. A review of 16 cases of bladder exstrophy, 6 epispadias cases, and one cloacal exstrophy case, which had never been described before, revealed that the almost constant bony defect of the pelvic ring was linked with the severity of the visceral features, and with the continence status in epispadias cases. The commonly admitted theories about exstrophy development are based on a primary defect of the cloacal membrane. We suggest that the first anomaly could lie in a lack of rotation in the pelvic ring primordia.

Impact of Medicaid managed care on child and adolescent emergency mental health screening in Massachusetts

OBJECTIVE

The study evaluated the impact of Medicaid managed care on decision making during emergency mental health screening and the outcomes of such screening for children and adolescents.

METHODS

Data on client attributes and on system characteristics (payer, referral source, and disposition) were available for 297 Medicaid and non-Medicaid episodes of emergency mental health screening that occurred one year before the implementation of a statewide managed Medicaid program in Massachusetts and 393 episodes that occurred one year after implementation. Outcomes included changes in the volume of service provided and in the pattern of dispositions, particularly inpatient admissions.

RESULTS

Although the total volume of child and adolescent emergency screening episodes significantly increased after implementation of Medicaid managed care, inpatient admissions decreased significantly. Among episodes not covered by Medicaid, no significant changes were noted after implementation on any variables. In the Medicaid group, significant differences were found in client attributes and system characteristics. After implementation the volume of emergency screening episodes for Medicaid clients increased significantly, and inpatient admissions decreased significantly. The pattern of dispositions changed significantly, with increased use of newly available crisis stabilization services.

CONCLUSIONS

Although implementation of Medicaid managed care achieved the short-term goal of a decrease in hospitalizations, and probably concomitant savings, issues of quality of care for children and adolescents, and savings over the longer term, remain to be addressed.