Direct visualisation of B1 inhomogeneity by flip angle dependency

Inhomogeneities in the spatial distribution of the excitatory Radio Frequency (RF) field, are still a dominant source of artifacts and loss of signal to noise ratio in MR imaging experiments. A number of strategies have been proposed to quantify this distribution. However, in this technical note we present a relatively simple MR imaging procedure which can be used to visualise RF inhomogeneities directly either by means of the magnitude or the phase of an image. To visualise the RF field distribution in both the inner and outer volumes of the coil, we have performed experiments in which the entire coil is submerged in a non-conducting fluid. To the best of our knowledge this strategy has not been used previously in order to evaluate coil performance. Finally, we demonstrate that the method is sensitive enough to reveal the effects of the sample properties on the effective RF wavelength of the transmitted field.

A pituitary mass and hypopituitarism: improvement after corticosteroid therapy

Lymphocytic hypophysitis of the anterior pituitary is a rare autoimmune disease, invariably diagnosed either by surgical biopsy of the adenohypophysis or at autopsy. The current report describes the rapid development of hypopituitarism in a 42-year-old nulliparous woman with a large sellar mass, who did not undergo pituitary surgery. Transient regression of the sellar mass and partial improvement of the hypopituitarism was induced by treatment with corticoids. We suggest that the diagnosis of lymphocytic hypophysitis can be established clinically and that conservative treatment with corticoids should be considered prior to surgical intervention.

[Clinical study of the effectiveness of a dexpanthenol containing artificial tears solution (Siccaprotect) in treatment of dry eyes]

PURPOSE

In this controlled, randomized, double-masked study the effect of dexpanthenol-containing artificial tears (Siccaprotect) on patients with dry eyes was examined.

PATIENTS AND METHODS

50 patients applied either dexpanthenol-containing artificial tears (Siccaprotect) or the identical, but free of dexpanthenol, eye drops five times daily into the conjunctival sac. No other ophthalmics were administered. The corneal epithelial permeability was measured by fluorophotometry and Schirmer-Test, Rose Bengal staining, tear film break-up time and the patients' subjective complaints were determined before and after 6 weeks of treatment.

RESULTS

The dexpanthenol-containing artificial tears (Siccaprotect) improved disturbances of the corneal epithelial permeability significantly in comparison to the dexpanthenol-free eyes drops. The other parameters didn't show relevant differences.

CONCLUSION

These data suggest that, in dry eyes, treatment with dexpanthenol-containing eye drops leads to a favorable and comparing with dexpanthenol-free eye drops superior improvement in disturbances of corneal epithelium permeability.

Influence of repeated oral doses of ethinyloestradiol on the metabolic disposition of [13C2]-ethinyloestradiol in young women

OBJECTIVE

To examine the influence of daily oral administration of ethinyloestradiol on the total clearance of 13C-labeled ethinyloestradiol in women.

METHODS

19, healthy, young women received a single IV dose of 0.06 mg 13C-ethinyloestradiol. Subsequently, they were treated with daily oral doses of 0.06 mg ethinyloestradiol for 8 days. On the last day of oral treatment, they received a further IV dose of 0.06 mg 13C-ethinyloestradiol. The pharmacokinetic parameters clearance, area under the serum level-time curve, terminal half-life, steady-state volume of distribution and mean residence time of 13C-ethinyloestradiol in each volunteer were evaluated after both IV doses, and the corresponding pairs of parameters were examined statistically for the significance of intraindividual differences.

RESULTS

Following the first (second) intravenous administration, the mean area under the curve was 2.54 (2.67) ng.h.ml-1. The terminal half-life and mean residence time were 9.7 (9.6) h and 10.5 (10.1) h, respectively. The steady-state volume of distribution was 4.3 (3.9) 1.kg-1 and the clearance was 7.0 (6.6) ml.min-1.kg-1. No significant difference was observed in any of these parameters between the first and the second IV doses of 13C-EE2.

CONCLUSIONS

Since the clearance in particular remained unchanged after repeated oral administration of ethinyloetradiol, the hypothesis that ethinyloestradiol can inhibit its own metabolism in vivo can be rejected.

[Exclusion of wound physicians from health care in Germany 1871/72]

At the beginning of the 1870s, non-academic surgeons were finally banished from officially accepted medical practice in Württemberg - the last German Land in which they had still been recognized. As contemporary reports by barber-surgeons make clear, they had agreed to the elimination of their handiwork - in the hope of winning thereby generous "terms of transition" for the remaining practitioners of their trade. The fact is that in this point, too, barber-surgeons - at least for the most part - had but little success, clearly put them on the losing side in political conflict of professional interests.

Prenatal power--education for life

OBJECTIVE

To expand community service opportunities in health promotion and disease prevention for approximately 20% of the female students at Boston High School, who are pregnant or parenting.

METHODS

Students at Tufts University School of Medicine created, organized, and taught an interactive curriculum encompassing pre- and postnatal health at Boston High School. Evaluation of program effectiveness is provided by questionnaires completed by participating high school students, medical students, and the high school Health Services Advisor.

RESULTS

Short-term outcomes will examine self-esteem, prenatal care knowledge and decision making behavior. Long-term followup will assess outcomes such as birth weight complications, educational status of parents, additional pregnancies, and child health.

[Demise of the wound physician vocation exemplified by the political representative Arnold Schlegel (1850-1924)]

The name of Arnold Schlegel stands for a dazzling and complex personality. After being apprenticed to a barber surgeon in Württemberg, he spent about four decades in Switzerland working as an innkeeper. Yet, Schlegel distinguished himself as one of the leading representatives of the last non-academic surgeons in Württemberg. In contrast to most of his surgical colleagues, most of Schlegel's vocational activities are documented. This study is based on unpublished documents of different archives of Württemberg and Switzerland. The aim of the study is to illuminate the life of Arnold Schlegel and, in view of his policy, to illustrate the trying circumstances of contemporary barber surgery.

The efficacy of parent training for promoting positive parent-toddler relationships

The effectiveness of a parent training program for promoting positive parent-child relationships was examined among families of 2-year-olds. Forty-six mothers and fathers and their toddlers were assigned to either an intervention or comparison group. Intervention group parents participated in a 10-week program that focused on principles for effectively interacting with their toddlers. Parents completed measures of parenting self-efficacy, depression, stress, and perceptions of their toddler's behaviors and were videotaped playing with their toddlers preintervention, postintervention, and 3 months following the intervention. Repeated measures ANOVAs showed that the parent training program led to significant increases in maternal self-efficacy, decreases in maternal stress, and improvements in the quality of mother-toddler interactions. No significant effects were found among fathers. Explanations for obtaining different outcomes for mothers and fathers are discussed and directions for future research are recommended.

Carboxyhemoglobin levels in neonatal immune hemolytic jaundice treated with intravenous gammaglobulin

In order to examine the effect of intravenous immunoglobulin (IVIG) on the rate of hemolysis in immune hemolytic hyperbilirubinemia, we measured the carboxyhemoglobin levels of 5 newborn infants who were subjected to IVIG treatment. The pretreatment rate of hemolysis, in the 5 patients with isoimmune hemolytic jaundice (3 patients with Rh hemolytic disease of the newborn and 2 patients with ABO hemolytic disease of the newborn), as reflected by carboxyhemoglobin levels was higher than the rate of hemolysis in normal newborn infants. In 4 out of the 5 patients treated with IVIG, there was a rapid decline ( > 30%) of carboxyhemoglobin levels, a pattern which was different from that observed in normal newborn infants with no hemolytic jaundice and in 3 untreated patients with ABO hemolytic disease of the newborn. None of the treated patients required an exchange transfusion. Our preliminary results support the theory that the attenuation of jaundice observed following IVIG treatment in patients with immune hemolytic hyperbilirubinemia is caused, at least in part, by the reduction in hemolysis.

Insulin secretion in obese and non-obese NIDDM

Both the insulin response to glucose and the sensitivity to insulin show large variation in the normal population. Many subjects have either a markedly low insulin response or low sensitivity to insulin, with nevertheless normal glucose tolerance. For such subjects to become diabetic, insulin secretion or insulin action must further deteriorate with time, or other factors are added which tip the balance towards diabetes. Most evidence to date indicates that reduced beta-cell responsiveness and reduced insulin sensitivity co-exist in subjects prior to developing NIDDM. Both insulin secretion and insulin action are genetically controlled and influenced by intrauterine and neonatal factors. Insulin secretion and insulin action vary inversely in a closely linked manner; inability to fully compensate for changes in one variable may generate a functional deficit in glucose homeostasis. Subjects combining low functions would run a proportionately larger risk of decompensating the glucose tolerance and be more vulnerable, in terms of diabetes susceptibility, to factors that further reduce insulin output or insulin action. Careful analysis of existing data prompts us to ascribe a dominating role to the impairment of insulin secretion in the pathogenesis of IGT and NIDDM. Patients with NIDDM also exhibit increased proportions of proinsulin and proinsulin conversion intermediates. We used hyperinsulinaemic diabetic and non-diabetic Psammomys obesus to study the possible relationship between steady-state pancreatic insulin stores and the proportion of proinsulin-related peptides in the plasma and the pancreas. A marked increase in these peptides was associated with 90% reduction in insulin stores of the pancreas. After food deprivation, the depletion of pancreatic insulin in the diabetic animals was partially corrected, and the proinsulin/insulin ratio normalized. In contrast, non-diabetic psammomys showed only 50% reduction in pancreatic insulin stores under non-fasting conditions, with no change in proinsulin/insulin ratio. These findings suggest that in the diabetic Psammomys obesus, pancreatic capacity for storage/production of insulin is limited; the metabolic consequences of this limitation are amplified by increased secretory demand secondary to insulin resistance, thus facilitating the establishment of hyperglycaemia, which may in itself further exacerbate the pancreatic dysfunction.

Temperament in toddlerhood

The purpose of this article is to describe how toddler temperament can affect parent-child relations using a goodness-of-fit framework. Nursing considerations for assessing toddler temperament with families and providing parental guidance for managing toddlers with difficult temperament styles are discussed. Emphasis is placed on helping parents to understand their toddler's temperament-based behavior and to devise strategies that maximize compatibility between the toddler's temperament and parental expectations.

Child bereavement after paternal suicide

BACKGROUND

Studies of child suicide survivors are rare and often these studies have not included direct interviews with children.

OBJECTIVES

To describe the bereavement process in a sample of prepubertal children whose fathers died by suicide within the previous three years.

METHODS

Sixteen prepubertal children, their mothers, and a relative or caretaker were interviewed to examine grief, trauma, and behavior within 25 months of paternal suicide.

RESULTS

Reminiscing was the most frequently endorsed grief behavior. Males were more likely than females to score above the standard means for CBCL scores. PTSD scores were significantly related to parental threats of divorce and exposure to death by discovery of the body.

CONCLUSIONS

The concept of grief and trauma as separate and overlapping phenomena is supported by the study findings.

Phenotyping of CYP2C19 with enantiospecific HPLC-quantification of R- and S-mephenytoin and comparison with the intron4/exon5 G-->A-splice site mutation

S-Mephenytoin 4'-hydroxylase (CYP2C19) is a genetically polymorphic cytochrome P450. A modified method for CYP2C19 phenotyping was evaluated in 174 healthy German volunteers and the results were compared with genotyping for the intron4/exon5 G-->A splice site mutation (m1) of CYP2C19, associated with the poor metabolizer (PM) phenotype. A smaller than usual test-dose of 50 mg (R,S)-mephenytoin was used and urine samples were collected from 0 to 5 h and from 5 to 8 h after administration. Trait measurements included the mephenytoin S/R enantiomeric ratio and the hydroxylation index (i.e. the molar ratio of 4'-hydroxy-mephenytoin urinary recovery to the administered S-mephenytoin dose). S- and R-mephenytoin were quantified by isocratic HPLC with a Chiraspher column and 80% n-hexane and 20% dioxane as the mobile phase. All individuals from whom DNA was available (n = 140, including six phenotypically identified PMs) were analysed for the m1 mutation. The population frequency of this CYP2C19 mutation was 0.15. Four individuals were homozygous for m1 having S/R ratios of 0.9 or greater in both intervals of urine collection. Thus, individuals with an S/R ratio > or = 0.9 were classified as PMs and seven of all 174 phenotyped individuals were PMs (4%; 95% confidence limits: 1.6-8.1%). Heterozygous carriers of m1 (n = 34) had a median S/R ratio (5-8 h urine) of 0.06 compared to 0.01 in individuals without this mutation (n = 102; p = 0.0005, Mann-Whitney U-test). No such gene-dose relation was apparent with the hydroxylation index.(ABSTRACT TRUNCATED AT 250 WORDS)

1H-NMR microscopy of tablets

A 1H-nuclear magnetic resonance (NMR) microscopy method was utilized for the first time to determine the porosity distribution of physically intact tablets. The main advantage of this newly developed method was that porosity cross sections through whole tablets or specific locations could be obtained without mechanically destroying the tested tablet. This was achieved by filling tablet cavities with silicone oil under vacuum. The amount of silicone oil locally within the tablet was then determined by 1H-NMR microscopy, revealing the inverse inner structure. To reduce the measuring time, a paramagnetic gadolinium complex was added to the silicone oil. The cross sectional signals produced by 1H-NMR microscopy through the tablet were transformed into a color image by a specially designed computer graphic program. To improve the signal-noise ratio an algorithm of 3D-filtering was introduced. The maximal spatial resolution achieved with this method was about 95 microns for a cube's edge length corresponding to some 380,000 positions in a 9-mm-diameter compression-coated tablet. Uneven porosity distributions within tablets, cracks, or cavities could be visualized with this newly developed method. Different compaction mechanisms were observed with plastic- or brittle-type tablets. The different states of densification during compaction of powders could be detected. The integrity of compression coatings was determined to be dependent on the pressure load and the location of the core within the coat.

A longitudinal study of maternal depression and preschool children's mental health

The purpose of this longitudinal study was to examine the relationship between maternal depression and preschool children's mental health in a community sample. Cohort 1 (n = 97) consisted of mothers and children followed from 2 to 3 years of age. Cohort 2 (n = 97) consisted of mothers and children followed from 3 to 4 years of age. Mothers completed a self-report measure of depression twice during 1 year. The children's day care providers/nursery school teachers completed two instruments measuring the children's social competence and behavior problems at the end of the year. Maternal depression was significantly related to lower social competence and more behavior problems in the children. Although there were no significant mean differences in children's mental health scores by gender, boys of more depressed mothers were more likely to have poorer social competence and more behavior problems than girls. Item analyses suggest that the boys' behaviors may be particularly aversive for depressed mothers, increasing the likelihood that these mothers will respond to and reinforce their sons' difficult behaviors.

Parenting confidence during toddlerhood. A comparison of mothers and fathers

Previous research has shown the Toddler Care Questionnaire (TCQ) to be a valid measure of parenting confidence among mothers of toddlers. However, there is no evidence demonstrating the validity of the TCQ among fathers of toddlers. The purposes of this study were to 1) examine the reliability and validity of the TCQ among fathers of 12- to 36-month old children and 2) compare the childrearing topics mothers and fathers identify as those for which they would like information. Forty-six married mothers and fathers (n = 92) completed the TCQ, three measures of child behavior, and a measure of parental depression. Maternal confidence was related to depression and all measures of child behavior. Paternal confidence was related only to the intensity of the child's behavior. Mothers requested more than twice the amount of childrearing information than did fathers although there were similarities in the types of information requested. The data support the validity of the TCQ and its clinical utility among fathers of toddlers although different factors appear to affect parenting confidence among mothers and fathers.

Lipoprotein levels in newborns and adolescents

Previous studies established that cardiovascular disease can be predicted early in life. Active modification of risk factors in the general population should include screening as the first step. For this reason, lipoproteins and apolipoproteins were measured in newborns and adolescents. Almost all lipids and apolipoproteins were much lower at birth than at adolescence. Based on these results, reference ranges were calculated.

A longitudinal model of maternal self-efficacy, depression, and difficult temperament during toddlerhood

The purpose of this study was to test a model of maternal self-efficacy during toddlerhood using a longitudinal sequential design. Participants were 126 mothers of 1-year olds (Cohort 1) and 126 mothers of 2-year olds (Cohort 2) who completed questionnaires measuring maternal self-efficacy, depression, and perceived difficult toddler temperament three times over 1 year. Data were analyzed using structural equation modeling and maximum likelihood estimation. Findings support a model whereby (a) the more depressed the mother feels, the more likely she is to rate her toddler's temperament as difficult, (b) the more difficult the child's temperament is perceived to be, the lower the mother's estimates of her parenting self-efficacy, (c) the lower the mother's self-efficacy, the greater her depression, and (d) the more depressed the mother feels at one point in time, the more likely she is to remain depressed 6 months later. Implications of the findings are discussed as they relate to self-efficacy theory and nursing intervention with parents of difficult toddlers.

The effect of heat load and dehydration on hypertonic saline solution treatment of controlled hemorrhagic shock

Small volume hypertonic saline solution has been suggested for initial effective resuscitation of hemorrhagic shock. The effect of hypertonic saline solution in controlled hemorrhagic shock was studied in rats subjected to dehydration or heat, or both. The rats were randomly divided into four groups--group 1 (n = 19), normal rats; group 2 (n = 21), water deprivation for 12 hours; group 3 (n = 20), heating at 37 degrees C. for five hours, and group 4 (n = 19), water deprivation for 12 hours and heating at 37 degrees C. for five hours. Controlled hemorrhagic shock was induced in all rats by arterial bleeding of 15 milliliters per kilogram and the rats were divided into three treatment subgroups--group a was untreated, group b was treated with 5 milliliters per kilogram 0.9 percent NaCl and group c was treated with 5 milliliters per kilogram 7.5 percent NaCl. Arterial bleeding of 15 milliliters per kilogram in group 1 resulted in decrease in mean arterial pressure (MAP) to 44 +/- 2 millimeters of mercury (p < 0.001) and pulse rate to 280 +/- 13 per minute (p < 0.01). A similar decrease in MAP and pulse rate was observed in all four groups. Infusion of hypertonic solution (HTS) in group 1c was followed by an increase in MAP to 89.0 +/- 9.7 milliliters of mercury (p < 0.01) in 15 minutes. This was significantly higher than infusion of normal saline solution in group 1b (p < 0.01) or untreated group 1a (p < 0.01). This difference remained significant also after 45 minutes from infusion (p < 0.05 and p < 0.05, respectively). The increase in MAP in response to HTS in group 1c after 15 minutes was significantly higher than the rise in groups 2c (p < 0.05), 3c (p < 0.05) and 4c (p < 0.05). This difference in response to HTS remained significant 45 minutes from infusion in groups 3c (p < 0.05) and 4c (p < 0.05), but not in dehydrated rats in group 2c. Arterial bleeding did not alter serum sodium significantly in all four groups. Infusion of HTS in group 1c was followed by an increase in serum sodium from 149.1 +/- 1.4 to 161.1 +/- 2.4 milliequivalent per liter (p < 0.001), while infusion of HTS in group 4c, where serum sodium was initially elevated to 157.1 +/- 3.0 milliequivalent per liter, did not further elevate the serum sodium level.(ABSTRACT TRUNCATED AT 400 WORDS)