[Results of a prognosis study of in vitro fertilization after brief psychotherapy]

During the last four years, our research has been focussed on prediction criteria for IVF after a Short Course of psychotherapy. Our study can be divided in two phases: In an earlier phase (up to 1990), prediction criteria were derived from "expert" rating, whereas in a later phase (from 1990 onwards) they were derived by self-rating of the patients. The predictions refer to changes in the patients' behaviour, affective state, mood and attitude (acronym: BAMA) towards their infertility. Our work is based on the hypothesis, that a perceivable change in BAMA and in how the patients relate to their wanting a child, represents the solution of the problem, which facilitates the consequential events of either pregnancy or acceptance of childlessness or else adoption. As a rule, the absence of such a change entails none of the consequential events. - We report on and discuss the results of the earlier, as well as the later phase and finally compare them as to how well they correlate with prediction and consequences. A marked correlation could be found between changes in BAMA and the occurrence of pregnancy or acceptance of childlessness in both phases of our study. Comparing the two phases (expert- vs. self-rating) on the accuracy of prediction, we could find almost identical results. Because of the easier and more economical application of self-rating we decided to continue with this method and to refine it for further research.

HOMEWARD BOUND: Broadening Student Experience With Home Visits

1. Because of patients are rapidly discharged after medication stabilization or crisis resolution, tertiary care in the home is emerging as an integral part of current psychiatric care. Students miss a valuable opportunity to participate in psychosocial rehabilitation if the clinical rotation is limited to an inpatient setting. 2. Guiding the client toward mental stabilization is the process of psychiatric care; outcomes are most apparent in the home. 3. Nursing is moving into psychiatric case management and continues to provide home care as a traditional role. Student home visits promote awareness of nursing responsibilities to families beyond the institution.

Cardiohemodynamic and serum catecholamine response to surgical removal of impacted mandibular third molars under local anesthesia: a randomized double-blind parallel group and crossover study

The aim of this study was to differentiate between the extent to which surgical stress and the epinephrine in local anesthetic solutions influence serum catecholamine, cAMP, and potassium levels, and contribute to changes in cardiohemodynamic parameters. One hundred sixty mg of articaine hydrochloride (4.0 mL of a 4% articaine hydrochloride solution) with two different epinephrine doses was injected into outpatients prior to removal of an impacted mandibular third molar in a randomized, double-blind parallel group and crossover design. The results showed that the amount of epinephrine absorbed from the intraoral injection site predominantly determined the serum epinephrine concentration. The anesthetic-induced increase in the serum epinephrine level did not correlate with changes in the cardiohemodynamic parameters under study at any time during the operative procedure. The serum cAMP changes correlated with those of epinephrine, whereas the serum potassium levels remained unchanged. The procedure of tooth extraction was a stressful event when the 1:200,000 epinephrine-containing anesthetic solution was used, showing that the risk of inducing a cardiovascular incident during oral surgery seems to be higher the greater the extent of operation and the lower the epinephrine dose in the anesthetic solution.

The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip

Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.

The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand

Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multicenter study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylarthropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the "classification tree" method were 92% sensitive and 98% specific. The "traditional format" classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.

New tetracyclic guanidine derivatives with H1-antihistaminic properties. Chemistry of epinastine

A series of new tetracyclic guanidines were synthesized by various methods. Specific binding of the described compounds to histamine-1 and histamine-2 receptors was determined. The compound 3-amino-9,13b-dihydro-1H-dibenz[c,flimidazo[1,5-a]azepine (epinastine, WAL 801, compound IIIa) combines high selectivity with high affinity for the H1 receptor and was selected from the compounds studied for further pharmacological and clinical investigations. Experimentally determined physicochemical parameters (pka-value, partition coefficient) and the hydrogen-bonding ability of epinastine are indications that this compound will not easily cross the blood-brain barrier. This explains the absence of CNS side-effects of epinastine in pharmacological and clinical studies.

Enteral feeding contamination: comparison of diluents and feeding bag usage

This quasi-experimental study compared bacterial growth in enteral feeding solution in six Kangaroo feeding bags filled with enteral formula diluted with sterile water vs six of the same diluted with tap water. Feeding bags, which were on continuous pumps in patient-occupied rooms, were rinsed and refilled every 8 hours, and formula cultures were obtained at 0, 24, and 48 hr. Acceptability of cultures was based on published recommended standards. Low levels of nonpathogenic staphylococci were found in sterile water bags; high levels of bacilli and Gram negative rods were found in tap water bags. No significant differences were found in the relationship between type of formula diluent and outcomes. Type of water diluent and acceptability were not related. There was a systematic relationship between length of use and outcome; with both diluents, bags used over 24 hr became unacceptably contaminated. Further study with a larger sample is needed to determine the effects of using tap water rather than sterile water as diluent.

[Effect of various combinations of DL-alpha-tocopherol and acetylsalicylic acid on adjuvant arthritis in the rat]

The influence of per os application of different combinations of DL-alpha-tocopherol (TOC) and acetylsalicylic acid (ASS) on adjuvant-induced arthritis was tested in male Wistar rats (body weight 227 +/- 18 g; 8 groups, n = 8). One group (control) was without adjuvans arthritis and received no treatment, another group was also not treated in spite of adjuvans arthritis. Further, six groups of adjuvans arthritis were treated with the following combinations: ASS/TOC (mg/kg BW/d each) 250/-, 250/250, 167/250, 83/250, 167/167 and 167/83. During the course of the experiment (21 d), body weights, food intake, and the swelling of injected and noninjected paws, and (at the end of the test period) relative weight of spleen and the albumin-globulin-ratio in plasma were recorded. With the ASS/TOC combination of 250 mg/kg BW each, the highest antiinflammatory effect could be reached, as compared with all treated groups. The reduction of acetylsalicylic acid does by one-third to 167 mg/kg BW in combination with 250 mg DL-alpha-tocopherol/kg BW seem to have the same antiphlogistic effect as acetylsalicylic acid alone at 250 mg/kg BW. This positive effect could be confirmed by the partially normalized relative spleen weight and albumin-globulin-ratio. The results allow the conclusion: --main antiphologistic effect of the combination is due to acetylsalicylic acid; --when combined with 250 mg DL-alpha-tocopherol/kg BW acetylsalicylic acid dosage can be reduced by one-third to 167 mg/kg BW and still have the same effect as ASS alone (250 mg/kg BW); --further reductions of ASS and/or DL-alpha-tocopherol dosage minimize the antiinflammatory effect.

Longitudinal study of electrometric sensitivity of young permanent incisors

Electrometric sensitivity of permanent maxillary central incisors was studied longitudinally in 34 children at 6-month intervals over 2 1/2 yr (mean age of the children at the beginning of the study: 94.6 months). Root development stages were determined from radiographs obtained at the beginning of the study, after 1 yr, and after 2 1/2 yr. An increase in sensitivity was found over the study period, but large variations were found from child to child and even within the same child. Especially at the first examinations a few children showed very low sensitivity. Statistical analysis showed that examination number, root development and side of the mouth (right or left central incisor) all were statistically significantly related to sensitivity. Statistically significant differences were also found between the individuals.

Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association

For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

Metabolic fate of [14C]-brotizolam in the rat, dog, monkey and man

The metabolism of brotizolam (2-bromo-4-(2-chlorophenyl)-9-methyl-6H-thieno [3,2-f]-1,2,4-triazolo[4,3-a]-1,4-diazepine, We 941, Lendormin) was studied in the bile of the rat and in the urine of the dog, rhesus monkey and man using 14C-labeled substance. Concentration, fractionation and purification of the metabolites were performed using thin layer chromatography, column chromatography or high pressure liquid chromatography. Metabolites were structurally characterized by thin layer chromatography, high pressure liquid chromatography, mass spectrometry and nuclear magnetic resonance spectrometry using reference compounds. Hydroxylation at different sites of the brotizolam molecule and subsequent conjugation were the metabolic pathways preferred by far in the species studied. Unchanged brotizolam was excreted in minute amounts only, if at all. In man and monkey We 964 (brotizolam hydroxylated in the methyl group) and We 1061 (brotizolam hydroxylated in the diazepine ring) represented the main metabolites. In the rat, the main metabolites were We 1061 and a brotizolam hydroxylated in the phenyl ring. The main metabolites found in the dog were We 964 and We 1064, an isomeric compound of We 1061. Since We 1061 is irreversibly transformed in an alkaline medium to We 1064, the latter could be formed due to the clean-up processes. Thus, in the dog also We 1061 was probably the metabolite which was actually excreted renally. The proposed structures of minor metabolites are presented.

Chromatographic and immunochemical characterization of neurotensin in cat adrenal gland and its release during splanchnic nerve stimulation

A subpopulation of norepinephrine-containing cells in the cat adrenal medulla contain neurotensin (NT) immunoreactive material. Using high performance liquid chromatography (HPLC) and radioimmunoassay with region-specific antisera we have demonstrated that electrical stimulation of the splanchnic nerve releases NT and its metabolites NT(1-8) and NT(1-12) from cat adrenal gland into the circulation. Blood samples from anesthetized cats were simultaneously collected from the adrenolumbar vein and femoral artery over a 10-min period prior to and during splanchnic nerve stimulation. Trains of stimuli (15 Hz/10V) were applied at 30-s intervals over 10 min. Plasma samples were extracted, run on HPLC and column fractions assayed with C- und N-terminal directed antisera. During splanchnic nerve stimulation unchanged. Concomitant with the increase in NT was a two- to threefold increase in the levels of NT(1-8) and NT(1-12). The chromatographic profiles of extracted adrenal glands showed a major peak of immunoreactive material with the same retention time as NT (18.6 +/- 3.0 pmol/g weight wet of tissue) as well as a small peaks on NT(1-8) (0.96 +/- 0.18 pmol/g) and NT(1-12) (2.05 +/- 0.1 pmol/g). HPLC analysis of a tryptic digest of the NT-like material gave 1.0 equivalent of NT(1-8) and NT(9-13). These results are consistent with the presence of NT in adrenal tissue and its release and metabolism during stimulation of the splanchnic nerve.

Antimicrobial therapy of febrile children with malignancies and possible sepsis

A prospective study of 100 pediatric patients (2 months to 17 years of age) who had malignancies and fever was conducted. Gentamicin or netilmicin and a beta-lactam antibiotic were administered as initial empiric treatment. Before therapy profound granulocytopenia (fewer than 500 polymorphonuclear leukocytes/microliter) was present in 66% of children and persisted to the end of therapy in 42% of children. Of the 40 children with microbiologically documented infections, 38 (95%) responded to therapy. The aminoglycoside dosing regimen of 2 mg/kg/dose intravenously over 60 minutes every 6 hours produced antibiotic concentrations in serum of 5.8 +/- 0.3 microgram/ml at the end of the infusion in the netilmicin group and 1.5 +/- 0.1 microgram/ml 6 hours after the infusion and of 6.2 +/- 0.2 and 0.9 +/- 0.1 microgram/ml for the two time periods in the gentamicin group. The serum half-lives, volumes of distribution and the total body clearance rates were comparable for netilmicin and gentamicin. No accumulation of netilmicin or gentamicin was noted. Seven patients had renal compromise, five before institution of antibiotic therapy and two while on therapy. Four episodes of ototoxicity were not related to antibiotic therapy. Superinfection occurred in five children. The combination of either gentamicin or netilmicin with a beta-lactam antibiotic produced excellent results for episodes of fever in neutropenic children with cancer. In children with severe underlying disease and/or granulocytopenia, antibiotic combinations have achieved an optimal efficacy. Future emphasis should be placed on prevention, immunoregulation and nonbacterial pathogens.

[Biotransformation of fentanyl. III. Effect of chronic drug exposure on the distribution, metabolism and excretion in the rat]

In male Wistar rats, tissue distribution and excretion of fentanyl and its metabolites were studied after intravenous of intramuscular injection. Oxidative desalkylation leading to phenylacetic acid and norfentanyl proved to be the main degradation pathway in-vivo, whereas other metabolites, including the pharmacologically still active p-hydroxy(phenethyl)fentanyl were formed only in minor quantities. All compounds could be detected in any tissue under study (brain, lung, liver, kidney, muscle and fat) as well as in the gastric contents, the amount of fentanyl in the latter cumulating to about 2% of the total dose 60 min after injection, compared with about 10% in the fat. In rats chronically treated with ethanol, nicotine, morphine, phenobarbital, promethazine or diazepam, major differences in in-vitro fentanyl metabolism by liver homogenates were observed including both inhibition and induction. Phenobarbital pretreatment also induced extrahepatic biotransformation in kidney, adrenals and intestinal mucosa. On the other hand, tissue concentrations of fentanyl and its metabolites did not clearly reflect the in-vitro changes in metabolic activity. Fentanyl brain levels were found to be lower in the treatment groups but seemed not to correlate with pharmacodynamics, less effects following injection being observed only after ethanol and morphine. The in-vitro metabolic drug interaction proved to be of less importance than changes in diuresis and/or urinary pH when excretion products were analysed. As a conclusion, it is suggested that altered sensitivity of brain tissue rather than changes in bioavailability must explain variations in dose-response relationship which are frequently believed to be seen when fentanyl is used in patients with chronic drug administration.

Effects of diphosphonates on glycosaminoglycan synthesis and proteoglycan aggregation in normal adult articular cartilage

The effects of disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP) and disodium dichloromethylene diphosphonate (Cl2MDP) on glycosaminoglycan synthesis and macromolecular organization of proteoglycans have been examined in normal adult canine cartilage. One to 500 micron of either compound produced reversible inhibition of glycosaminoglycan synthesis to about 70% of control levels, whereas lower concentrations had no effect. Based on Sephadex G-200 chromatography, the average hydrodynamic size of glycosaminoglycans in diphosphonate-treated cartilage was similar to that of those in control cartilage. In most cases proteoglycan aggregates from diphosphonate-treated cartilage were smaller in hydrodynamic size than those from control cartilage, as judged by Sepharose 2B elution profiles. The size of purified proteoglycan subunits, obtained after dissociation of the aggregates with 4 M guanidinium chloride or after incubation of the aggregates with hyaluronic acid beta1 leads to 3 hydrolase, was not affected by the diphosphonates. Furthermore, proteoglycans from diphosphonate-treated cartilage did not interact in vitro with hyaluronic acid, suggesting that diminished proteoglycan aggregation may have resulted from an abnormality in the hyaluronate-binding region of the proteoglycan core protein.

Effects of aspartame in young persons during weight reduction

Given the potential use of a low-calorie sweetener during weight reduction, a toxicity study of chronic aspartame ingestion was conducted. Particular attention was given to possible long-term effects of aspartame on the fuel hormonal alterations characteristically caused by weight reduction. As a group mean age was 19.3 yr, body weight was 164.6 lb, and mean height was 65.4 in. Subjects were an average of 33% in excess of ideal body weight. The aspartame dose was 2.7 g/day and was compared on a double-blind randomized basis with a lactose placebo. Both materials were given in gelatin capsules. An average of 6.9 +/- 1.5 lb was lost by the aspartame group during the 13-wk study on a calculated 1,000-calorie diet. The placebo group lost 4.5 +/- 1.2 lb (no significant difference between the two groups). After an overnight fast, reductions in glucose and immunoreactive insulin were seen in both groups, while rising trends in immunoreactive glucagon were observed. These changes are all characteristic of calorie restriction. In no instance was there a detectable effect of the ingested aspartame. No meaningful effect of weight reduction or aspartame was seen on plasma triglyceride and cholesterol, nor on any other parameter of hematologic, hepatic, or renal function that was measured. Similarly, side effects were equally distributed between asparatame and placebo.

The human leukocyte test system. IX. DNA synthesis and mitoses in PHA-stimulated 2-day cultures set up with Eagle's mimimal essential medium (MEM)

In human leukocyte cultures set up with Eagle's MEM and stimulated with Difco's PHA M, DNA synthesis and mitotic indices were analyzed by means of 3(H)-thymidine autoradiography and cell counting from 23 up to 52 h after culture initiation. Considerable amounts of DNA synthesis and mitoses were found in this time span. This resembles the results found with Ham's F-10 medium. However, the DNA synthesis pattern and the distribution of mitotic indices a higher yield of asynchrony in Eagle's MEM as compared with Ham's F-10 cultures. Proportions of first, second, and third mitoses at 72 h culture time were determined with different methods.

Hyaluronate-binding by proteoglycans. Comparison of mildly and severely osteoarthritic regions of human femoral cartilage

The ability of proteoglycans from hip cartilage of a patient with osteoarthritis to bind hyaluronic acid was examined. Proteoglycans from areas showing severe morphologic changes of the disease showed no interaction with hyaluronic acid in vitro. Moreover, fractions which normally contain aggregated proteoglycans were no larger in hydrodynamic size than disaggregated proteoglycans, suggesting that the proteoglycans from these regions were not aggregated in vivo. Proteoglycans from less extensively diseased areas, in contrast, underwent aggregation in vitro and appeared to have been aggregated by tissue hyaluronic acid in vivo. The results suggest that the progressive morphologic changes of osteorthritis are associated with progressive defects in proteoglycan aggregation due, at least in part, to impaired ability of the proteoglycans to interact with hyaluronic acid.

Specificity in verbal and physiological indicants of anxiety

Relationships between subjective self-reports of anxiety and objective recordings of comparable physiological indices were studied. A modification of the Taylor Manifest Anxiety scales for autonomic arousal (AA) and striated muscle tension (MT) provides self-reports of anxiety. Group 1 Ss' scores showed AA < MT and Group 2 MT > AA. Skin resistance, basal conductance, heart rate, eyeblinks, and number of EMGs showed consistent group differences. Heart rate indicated that differences between groups were related to the level of induced stress, the higher levels being associated with greater group differences. Most measures showed successive increases in activity across conditions, indicating that Ss were responsive to them. EMG showed a peak in the condiition of mild stress which might reflect inhibitory control.