Cytomegalovirus-infected cells in routinely prepared peripheral blood films of immunosuppressed patients

We describe 4 patients identified over 5 years with large atypical cells on the feathered edge of routinely prepared peripheral blood films. Films were reviewed either as part of a blood film consultation or a bone marrow examination. The cells were 50 to 60 microns in diameter, with granular eosinophilic cytoplasmic inclusions and eccentric enlarged nuclei. Additional studies including buffy coat preparations and immunohistochemistry revealed that these were circulating cytomegalovirus (CMV)-infected cells, most likely of endothelial origin. All patients were immunocompromised (3 had HIV infection, and 1 was an organ transplant recipient) and had clinical evidence of CMV infection. The unique appearance of these cells at Wright-Giemsa staining, and their possible misidentification as malignant cells or other cells, highlights the need for pathologists to be aware of their morphologic features and possible clinical implication.

Prevention of childhood injury: clinical and public policy challenges

Injuries are the leading killer of children in the United States, at a rate significantly higher than in other industrialized countries. In this article, we outline how a behaviorally and developmentally based model of prevention may assist in determining effective interventions for various injury risks. Two conclusions emerge: (a) the strength of perceived costs and consequences for taking effective safety actions greatly influences the probability that they will be implemented; and (b) intervening at the most developmentally appropriate time is likely to result in more effective outcomes. Further, clinical psychologists are uniquely suited to assess contingencies that maintain unsafe practices, but we need to enlist the participation of citizens and other professionals to mount persuasive intervention campaigns. Despite strong demonstration projects, childhood injury reduction has lagged behind other public health endeavors. Obstacles to injury prevention include (a) the diffusion of injury threats, complicating the identification of effective targets for intervention; (b) the tendency of parents and even some health professionals to regard injuries as products of fate, which fosters complacency; (c) the failure of U.S. social service policy to support preventive strategies; and (d) an American cultural tradition of opposing regulation. Suggestions for improved public policy and intervention procedures are advanced.

Risk factors for anabolic steroid use in college students and the role of expectancy

Anabolic steroids are now recognized as a widespread addictive and dangerous substance, no longer exclusively used as an aid to muscle size and strength in world-class athletes. Psychologists have neglected prevention programs for steroid abuse, in part because of a lack of knowledge of the precipitants of abuse. This study examined demographics, personality factors, and steroid expectancies as risk factors for future steroid use. Older subjects, extraversion, global-positive expectancies for steroid use, and identification with peers who advocated health-risk behaviors predicted higher steroid use, whereas specific social-behavioral negative expectancies for steroid use significantly predicted lowered risk of steroid use. These findings are discussed in the context of past research, and implications for preventive intervention are described.

Does long-term finasteride therapy affect the histologic features of benign prostatic tissue and prostate cancer on needle biopsy? PLESS Study Group. Proscar Long-Term Efficacy and Safety Study

OBJECTIVES

Finasteride, a common agent used to treat benign prostatic hyperplasia (BPH), inhibits 5-alpha-reductase. Testosterone is converted by 5-alpha-reductase to the more potent dihydrotestosterone, which is the primary androgen in the prostate. Leuprolide is a stronger antiandrogen that is used to downstage prostate cancer before radical prostatectomy. Leuprolide induces marked atrophy of prostate carcinoma cells, which sometimes makes pathologic diagnosis of cancer difficult, although evaluation at radical prostatectomy is easier than at biopsy. It is unknown whether finasteride produces similar changes, which would result in greater diagnostic difficulty because such changes would be seen on biopsy to rule out cancer in men with suspicious clinical findings treated for BPH. The current study investigated the histologic effects of finasteride therapy on human prostate cancer and benign prostatic tissue on needle biopsy.

METHODS

In blinded manner, we reviewed 53 needle biopsy specimens showing prostate carcinoma (35 treated with finasteride, 18 with placebo). Also reviewed in blinded manner were 50 benign needle biopsy specimens (25 treated with finasteride, 25 with placebo). The Gleason score, number of cores involved, percentage cancer involvement in a core, percentage of atrophic changes in cancer cells, presence of mitoses, blue-tinged mucinous secretions, prominent nucleoli, and high-grade prostatic intraepithelial neoplasia were documented for each case in the cancer group. The percentage of atrophy, basal cell hyperplasia, transitional metaplasia, chronic inflammation, and stromal proliferation was documented for each case in the benign group.

RESULTS

No significant histologic differences were present in either the benign or cancer group between cases treated with finasteride and placebo.

CONCLUSIONS

We conclude that finasteride treatment for BPH does not cause difficulty in the diagnosis of cancer in prostate needle specimens. It is possible that there are severely atrophic areas resulting from finasteride treatment that are undersampled. However, the conclusion that cancer seen on needle biopsy in men treated with finasteride is unaltered and readily identified as cancer remains valid.

Of needles and skinned knees: children's coping with medical procedures and minor injuries for self and other

Children participated in four role-plays designed to assess what the children themselves would do and what they would suggest a friend should do when encountering a medical procedure and a minor injury. Open-ended responses were coded into an empirically derived continuum suggested by past research. Similar responses were given to cope with medical procedures and injuries. However, children suggested more reactive coping strategies (e.g., cry, pull away) for themselves and more proactive responses (e.g., think of something fun, take deep breaths) for friends. This finding questions the assumption that children choose the most effective coping strategy in their repertoire when they themselves confront an aversive stimulus, suggesting that preparation for invasive procedures should include motivational components.

Advanced techniques in autologous chondrocyte transplantation

Autologous chondrocyte transplantation (ACT) provides durable hyaline repair tissue in correctly selected patients; it is indicated for full thickness, weightbearing condyle injuries, and injuries to the trochlea of the femur. ACT results in reproducibly satisfactory results, with return to high level activities, including sports, in over 90% of these patients. Second look arthroscopies demonstrate macroscopic integrity of the grafts; and biopsies demonstrate hyaline cartilage repair, which is critical, as shown clinically, to giving durable results at two to nine years follow-up. Also discussed in this article is surgical technique which is especially important for complex reconstructions. As technical refinements and rehabilitation protocols improve, results for treating patellar and tibial injuries may improve; at this time, the response to treating bipolar focal chondral injuries is unknown and not recommended.

The MHC class I binding proteins LIR-1 and LIR-2 inhibit Fc receptor-mediated signaling in monocytes

The MHC class I binding proteins leukocyte immunoglobulin-like receptor (LIR)-1 and -2 recognize a similar broad spectrum of HLA-A, -B and -C alleles but are differentially expressed in lymphocytes, monocytes, and dendritic cells. In monocytes, phosphorylation of LIR-1 and LIR-2 results in the binding of the tyrosine phosphatase SHP-1. Coligation of either LIR with Fcgamma receptor I (CD64) inhibits tyrosine phosphorylation of the associated Fc receptor gamma chain and Syk molecules, as well as intracellular calcium mobilization. These findings suggest that LIR-1 and LIR-2 function as unique MHC class I receptors involved in the inhibition or down-modulation of monocyte activation signals, particularly those mediated through the receptors for IgG, IgE and IgA.

School-age children's attributions about their own naturally occurring minor injuries: a process analysis

OBJECTIVE

To analyze children's attribution of cause regarding their naturally occurring minor injuries in light of the pre-injury parental acceptability of children's behavior and the emotions children experienced immediately after the event.

METHOD

Sixty-one 8-year-old children were interviewed biweekly for one year about their naturally occurring minor injuries. Participants monitored environmental and psychosocial elements of the injuries and later answered questions about the cause of the event.

RESULTS

For a total sample of 1,037 minor injuries, children most frequently designated fate as the primary cause. Further analysis revealed that attributions varied by children's pre-injury behavior and post-injury feelings. Children were equally likely to accept primary responsibility or to assign cause to fate when they were engaged in unacceptable behavior before the event. Similarly, children assumed primary responsibility for the injury when they experienced post-injury guilt. No differences in injury attributions were revealed by gender or by the child's frequency of injuries during the year.

CONCLUSIONS

Results highlight the significance of adult caregiver safety rule creation, endorsement, and ongoing communication for the socialization of children's safe behaviors.

Improved gene transfer into baboon marrow repopulating cells using recombinant human fibronectin fragment CH-296 in combination with interleukin-6, stem cell factor, FLT-3 ligand, and megakaryocyte growth and development factor

We have used a competitive repopulation assay in baboons to develop improved methods for hematopoietic stem cell transduction and have previously shown increased gene transfer into baboon marrow repopulating cells using a gibbon ape leukemia virus (GALV)-pseudotype retroviral vector (Kiem et al, Blood 90:4638, 1997). In this study using GALV-pseudotype vectors, we examined additional variables that have been reported to increase gene transfer into hematopoietic progenitor cells in culture for their ability to increase gene transfer into baboon hematopoietic repopulating cells. Baboon marrow was harvested after in vivo administration (priming) of stem cell factor (SCF) and granulocyte colony-stimulating factor (G-CSF). CD34-enriched marrow cells were divided into two equal fractions to directly compare transduction efficiencies under different gene transfer conditions. Transduction by either incubation with retroviral vectors on CH-296-coated flasks or by cocultivation on vector-producing cells was studied in five animals; in one animal, transduction on CH-296 was compared with transduction on bovine serum albumin (BSA)-coated flasks. The highest level of gene transfer was obtained after 24 hours of prestimulation followed by 48 hours of incubation on CH-296 in vector-containing medium in the presence of multiple hematopoietic growth factors (interleukin-6, stem cell factor, FLT-3 ligand, and megakaryocyte growth and development factor). Using these conditions, up to 20% of peripheral blood and marrow cells contained vector sequences for more than 20 weeks, as determined by both polymerase chain reaction and Southern blot analysis. Gene transfer rates were higher for cells transduced on CH-296 as compared with BSA or cocultivation. In one animal, we have used a vector expressing a cell surface protein (human placental alkaline phosphatase) and have detected 10% and 5% of peripheral blood cells expressing the transduced gene 2 and 4 weeks after transplantation as measured by flow cytometry. In conclusion, the conditions described here have resulted in gene transfer rates that will allow detection of transduced cells by flow cytometry to facilitate the evaluation of gene expression. The levels of gene transfer obtained with these conditions suggest the potential for therapeutic efficacy in diseases affecting the hematopoietic system.

Resource allocation in general practice care

OBJECTIVE

Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia.

METHOD

Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice.

RESULTS

There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested.

CONCLUSIONS

Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Survey of pediatric hospitals' preparation programs: evidence of the impact of health psychology research

A survey of all 123 nonchronic-care pediatric hospitals in the United States revealed that 75% of hospitals responding had greatly increased the use of effective medical procedure preparation technologies, such as filmed modeling and coping skills instruction, in comparison to the last survey. Respondent characteristics such as position (e.g., nurse, child life worker, physician), degree (e.g., RN, MA, PhD), and length of time in the position failed to predict the type of techniques selected, but higher respondent knowledge and more psychological sources of preparation information did predict the use of preparation techniques used for drawing blood that experts rated as more effective. Challenges for more effective dissemination of research in the future are considered, as is the need for increased study of research-implementation links.

A novel immunoglobulin superfamily receptor for cellular and viral MHC class I molecules

The human cytomegalovirus UL18 gene product is a homolog of cellular major histocompatibility (MHC) class I antigens. UL18 has been proposed to protect virus-infected cells against natural killer (NK) cell cytotoxicity by engaging NK cell killer inhibitory receptors (KIR) for MHC class I. UL18 binds to a novel immunoglobulin superfamily glycoprotein, designated Leukocyte Immunoglobulin-like Receptor (LIR-1). This protein is distinct from, but related to, known KIRs and binds cellular MHC class I antigens. The cytoplasmic domain of LIR-1 contains four putative immunoreceptor tyrosine-based inhibitory motifs. Upon tyrosine phosphorylation, LIR-1 associates with the tyrosine phosphatase SHP-1. In contrast to KIRs, LIR-1 is expressed predominantly on monocytic and B lymphoid cell types, suggesting a distinct biological function.

Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development

Investigated problem-solving ability and reported regimen adherence among children, early adolescents, and middle adolescents with IDDM in response to hypothetical social situations where a choice between diabetes regimen adherence and peer desires must be made. Sixty-seven 8- to 17-year-olds with IDDM from two distinct U.S. geographical areas participated. Results indicated that compared to children with IDDM, adolescents with IDDM had better problem-solving abilities in response to social pressure situations, possibly reflecting their greater cognitive maturity. However, adolescents were also more likely to choose behaviors that are less regimen adherent. Differences in levels of problem-solving ability and adherence between the two regional subsamples were also found. Similar developmental patterns were found in both groups, showing the robust nature of the observed age-related trend of decreasing adherence in social situations despite increasing problem-solving abilities. Findings were interpreted in the context of normal adolescent development. Results are conceptually important for those interested in the transaction between peer and social influences and adherence for children and adolescents with IDDM, as well as other health behaviors.

The role of childhood stressors in the intergenerational transmission of alcohol use disorders

OBJECTIVE

This study examined relations between childhood stressors (e.g., disrupted family rituals, embarrassment, neglect, abuse), family history of paternal alcoholism, and alcohol use disorders in late adolescence and early adulthood. Of particular interest was the extent to which stressor exposure mediated the association between paternal and offspring alcohol use disorders.

METHOD

A mixed-gender sample of 457 (238 female) participants, approximately half (N = 234) with a family history of paternal alcoholism, were assessed for alcohol use disorders and childhood stressors via clinical interviews.

RESULTS

Family history of paternal alcoholism was associated with every childhood stressor examined, often strongly. In addition, a number of childhood stressors (e.g., verbal, emotional, physical and sexual abuse) were related to an alcohol use disorder in late adolescence/early adulthood. However, only a portion of the effect of family history on a subsequent alcohol use disorder was accounted for by the childhood stressors we examined.

CONCLUSIONS

Findings indicate that self-reported childhood stressors are strongly related to a family history of alcoholism, but are only moderately and inconsistently related to the development of an alcohol use disorder. Moreover, they appear to, at best, only partially mediate the relation between family history of alcoholism and an alcohol use disorder.

Recurring structural chromosome abnormalities in peripheral blood lymphocytes of patients with mycosis fungoides/Sézary syndrome

Cytogenetic analysis was performed on peripheral blood lymphocyte cultures from 19 patients with mycosis fungoides (MF)/Sézary syndrome (SS) stimulated with either phytohemagglutinin, a conventional mitogen, or a combination of interleukin-2 (IL-2) plus IL-7. The use of both PHA-stimulated and IL-2 plus IL-7-stimulated cultures enhanced the ability to identify clonal abnormalities. Clonal abnormalities were observed in 11 patients (53%) including one with monosomy for the sex chromosome as the sole abnormality. Five of the 11 patients with clonal abnormalities had normal peripheral white blood cell counts, indicating detectability of clones in the absence of frankly leukemic disease. The presence of clonal abnormalities correlated with advanced stage disease and a significantly reduced survival duration from the time of cytogenetic studies. Clonal abnormalities involving chromosomes 1 and 8 were observed in six cases. In five cases with aberrations of chromosome 1, loss of material involved the region between 1p22 and 1p36. In an additional case, a reciprocal translocation involving 1p33 was observed. Clonal abnormalities involving chromosomes 10 and 17 were observed in 5 cases, clonal abnormalities involving chromosome 2 in 4 cases, and clonal abnormalities involving chromosomes 4, 5, 6, 9, 13, 15, 19, and 20 in 3 cases. In 2 cases a der(8)t(8;17)(p11;q11) was observed. Regions of the genome that encode T-cell receptors were not involved in abnormalities. The region between 1p22 and 1p36 is identified as a region of the genome that requires detailed analysis toward the identification of potential gene(s) involved in the process of malignant transformation and/or progression in MF/SS.

Transactional patterns of child, mother, and father adjustment in insulin-dependent diabetes mellitus: a prospective study

Utilized both interview and self-report methods to examine transactional patterns of child, mother, and father adjustment in a sample of children and adolescents with insulin-dependent diabetes mellitus (IDDM). Overall, levels of child and parental adjustment were relatively stable over the 1-year study period. Regression analyses revealed that increases in fathers', but not mothers', distress over time contributed significant incremental variance to poorer subsequent children's adjustment, after controlling for demographic (age, gender, and SES) and disease parameters (illness duration and metabolic control). Decline in fathers' adjustment was a significant predictor of better mothers' adjustment at follow-up; child adjustment was not significantly associated with mothers' adjustment. Variations in both children's and mothers' adjustment made significant, independent contributions to predicting subsequent fathers' adjustment. Findings illustrate the transactional nature of relationships that exist in families of children with IDDM and underscore the importance of family systems or biobehavioral family treatment approaches in the clinical management of children with chronic illnesses.

Survey of pediatric hospitals' preparation programs: evidence of the impact of health psychology research

A survey of all 123 nonchronic-care pediatric hospitals in the United States revealed that 75% of hospitals responding had greatly increased the use of effective medical procedure preparation technologies, such as filmed modeling and coping skills instruction, in comparison to the last survey. Respondent characteristics such as position (e.g., nurse, child life worker, physician), degree (e.g., RN, MA, PhD), and length of time in the position failed to predict the type of techniques selected, but higher respondent knowledge and more psychological sources of preparation information did predict the use of preparation techniques used for drawing blood that experts rated as more effective. Challenges for more effective dissemination of research in the future are considered, as is the need for increased study of research-implementation links.