Immediate and delayed type hypersensitivity to malathion

Between December 1989 and June 1990, 1,874 reports of alleged malathion application related illness from repeated spraying of a mixture of malathion corn syrup bait to eradicate a Mediterranean fruit fly infestation in Southern California were received by the Toxics Epidemiology Program of Los Angeles County. Among these complaints were 47 reports of urticaria, 38 reports of angioedema and 213 reports of a nonspecific skin rash. In order to determine whether these alleged skin reactions were the result of an immediate or delayed type of hypersensitivity reaction to malathion or to the corn syrup bait we studied ten subjects referred for testing by the local health department. All ten subjects had no reaction on patch testing. One child exhibited a positive reaction to the bait and one child had irritant reactions to malathion and to the bait. This study documented one case of a possible immediate IgE reaction to malathion bait. Due to the low participation rates in this study, no specific conclusions concerning the rate of sensitivity in the population can be drawn, although it appears that such reactions are uncommon.

Effect of terfenadine in asthmatic patients

The bronchodilator effect of terfenadine, 60-mg or 120-mg single dose, and 1 week twice daily dosing, was evaluated in 12 allergic asthmatic patients. When compared with baseline, FEV1 rose significantly for single dose 120 mg terfenadine at one, one and one-half, three, five and one-half, and six hours and for 60 mg terfenadine at three, five and one-half, six, and eight hours postdose. Variations in patient response were observed. At steady state, 120 mg terfenadine b.i.d. showed consistent improvement over placebo from three to 12 hours postdosing but no improvement in FEV1 was noted for terfenadine, 60 mg b.i.d. There no longer was a statistically significant difference in mean FEV1 or percent change from baseline. Thus, terfenadine proved to be a safe and a mild bronchodilator; however, tachyphylaxis might develop to the bronchodilator effect after 1 week of continuous b.i.d. dosing.

Response of negative symptoms of schizophrenia to neuroleptic treatment

BACKGROUND

In view of the inconclusive reports in the literature about the response to neuroleptics of chronic schizophrenics with negative symptoms, the authors further evaluated this issue.

METHOD

A sample of 30 ambulatory chronic schizophrenics meeting DSM-III-R criteria who had to a marked degree at least two negative symptoms of the five on the Scale for the Assessment of Negative Symptoms (SANS) received various therapeutic dosages of thiothixene for 3 months. The average dose was 26.75 mg/day. Subjects were periodically evaluated with the Brief Psychiatric Rating Scale, Negative Symptoms Rating Scale (a modified version of the SANS), and the Randt Memory Test. The time effect on treatment was calculated by repeated measures of analysis of variance. The relationship between the positive and negative symptoms was tested by an analysis of covariance.

RESULTS

Both negative and positive symptoms improved with treatment. The negative symptoms tended to respond to treatment predominantly independently of the positive ones. At the end of the study, 63% (N = 19) of patients had improved moderately, 16% (N = 5) had improved slightly, and 20% (N = 6) had not improved.

CONCLUSION

The data require further support from a long-term follow-up study that may show the extent to which these gains are maintained over time.

Ophthalmologic manifestations of genitourinary diseases

There are several urologic disorders which also involve the eye and orbit. We have compiled examples of these and reviewed the literature. Metastasis from genitourinary malignancy (including neuroblastoma), Wilms tumor, Reiter syndrome, tuberous sclerosis, von Hippel-Lindau disease, and oxalosis may all have ophthalmologic manifestations. Urologists need to be aware of these and obtain appropriate consultation in order to fully care for patients with these diseases.

The associative basis of contingent color aftereffects

According to a conditioning analysis of the orientation-contingent color aftereffect (McCollough effect, ME), orientation stimulus (grids) become associated with color. Contrary to this interpretation are reports that simple forms cannot be used to elicit illusory color and that the ME is not degraded by decreasing the grid-color correlation. The present results indicate: (a) Form stimuli can contingently elicit color aftereffects; (b) even a non-patterned stimulus--the lightness of a frame surrounding a colored area--can contingently elicit color aftereffects; (c) this frame lightness-contingent aftereffect, like the ME, persists for at least 24 hr; and (d) the frame lightness-contingent aftereffect can be used to demonstrate that correlational manipulations affect the ME, as they affect other types of conditional responses.

The role of surgery in abdominal non-Hodgkin's lymphoma: experience from the Childrens Cancer Study Group

To determine the appropriate role of surgical intervention in non-Hodgkin's lymphoma primary to the abdomen, we analyzed the effect of multiple prognostic determinants on event-free survival for patients entered into the CCG-551 study. Eighty-four patients were identified with abdominal lymphoma and of these adequate data for analysis was available on 68 (81%). Variables of interest included: extent of disease at diagnosis, completeness of resection, use of bowel resection, radiation to the primary site, and sex/age/race. The median age on study was 8 years; 79% of patients were white and 85% were male. Thirty-three patients (49%) presented with localized disease. Laparotomy was performed in 67 children (99%) with complete gross resection in 28 (42%). Of the 10 reported surgical complications, 8 occurred in those with extensive disease who were incompletely resected. Radiation to the primary site was given in 60% of patients with median dose of 2,000 cGy. Analysis was performed both for the overall group and for the subgroup receiving optimal chemotherapy for histopathology. Variables with significant predictive effect on event-free survival in univariate analysis included extent of disease (P less than or equal to .001), complete resection (P less than or equal to .002), and use of bowel resection (P less than or equal to .004). However, in multivariate analysis, only extent of disease was an independent predictor of outcome. The data support a role for complete operative excision of localized lymphomas especially when accomplished with bowel resection. Aggressive attempts at debulking extensive retroperitoneal or mesenteric lymphomas are contraindicated.

Left ventricular mural bacterial endocarditis: diagnosis by transesophageal echocardiography

An unusual case of staphylococcal endocarditis with a vegetation attached to the left ventricular myocardium is described. No valvular vegetations are present. The diagnosis was made by transesophageal echocardiography. The patient had no chronic debilitating disease, nor was she immunosuppressed.

The associative basis of contingent color aftereffects

According to a conditioning analysis of the orientation-contingent color aftereffect (McCollough effect, ME), orientation stimulus (grids) become associated with color. Contrary to this interpretation are reports that simple forms cannot be used to elicit illusory color and that the ME is not degraded by decreasing the grid-color correlation. The present results indicate: (a) Form stimuli can contingently elicit color aftereffects; (b) even a non-patterned stimulus--the lightness of a frame surrounding a colored area--can contingently elicit color aftereffects; (c) this frame lightness-contingent aftereffect, like the ME, persists for at least 24 hr; and (d) the frame lightness-contingent aftereffect can be used to demonstrate that correlational manipulations affect the ME, as they affect other types of conditional responses.

Emergency coronary artery bypass surgery following failed balloon angioplasty: role of the internal mammary artery graft

During a 4-year period (1986-1989), 3,502 patients had percutaneous transluminal coronary angioplasty (PTCA) in our institution. One hundred nineteen (3.4%) patients required emergency coronary artery bypass graft surgery (CABG) because of abrupt vessel closure following PTCA. Factors associated with vessel closure included lesion angulation greater than or equal to 90 degrees (p less than 0.007), the presence of thrombus (p less than 0.02), or a long (greater than or equal to 2 cm) lesion (p less than 0.03). Of these 119 emergency CABG patients, 108 (91%) arrived in the operating room in a stable condition (group I) and 11 (9%) were in cardiogenic shock (group II). Five (45%) of the group II patients were admitted to the hospital with an acute myocardial infarction and all 11 patients had a higher incidence of multivessel disease (p less than 0.05) and lower left ventricular ejection fraction (p less than 0.001) than group I patients. The overall surgical mortality was 10.1%; however, in group I the mortality was 5.6% and in group II it was 54.5% (p less than 0.001). The vessel that abruptly closed ("culprit vessel") was the left anterior descending (LAD) in 60%, the right coronary artery in 27%, and the left circumflex in 13%. The internal mammary artery was utilized to bypass the culprit artery in 51 (43%) patients, including 50% of the culprit LADs. With group I culprit LAD patients, when the left IMA was the bypass conduit, there were no hospital deaths nor strokes and there was a 6.3% incidence of perioperative infarction.

Characteristics of the indirect McCollough effect

Induction of contingent color aftereffects with a single chromatic grid sometimes results in an illusory color on a grid different from the one presented during induction. Such illusory color, contingently elicited by a noninduced grid, has been termed the indirect McCollough effect (indirect ME). We show that the indirect ME occurs only when the color complementary to the grid color is present during induction (either physically present or as a color afterimage), and that the indirect ME is seen only on gratings that are orthogonal to the induction orientation. These findings are in accord with the account of the indirect ME proposed by Humphrey, Dodwell, and Emerson (1989). We also show that characteristics of the indirect ME (seen following one-grid induction), both on induced and orthogonal orientations, are similar to those observed with the direct ME (seen following the usual two-grid induction procedure). Both procedures result in contingent aftereffects that display substantial retention and that do not display interocular transfer.

The role of EGF in testosterone-induced reproductive tract differentiation

EGF is known to modulate a variety of cellular functions including differentiation. The aim of this investigation was to determine the role of EGF in androgen-induced masculine differentiation. Accordingly, a series of experiments were designed and the results are summarized as described below. (1) We found that the specific deprivation of EGF using anti-EGF serum during the period of masculine differentiation in an organ culture bioassay system resulted in the disintegration of the Wolffian system in a dose-dependent manner. (2) Exogenous EGF supplemented in the above experiment corrected the anti-EGF effect, suggesting a specific role of EGF. (3) Anti-EGF serum was also found to disrupt the differentiation even in the presence of exogenous testosterone, suggesting an effect independent of testosterone synthesis. (4) EGF was found to have a direct masculinizing effect both in vivo and in vitro; however, it was not able to mimic all masculinizing effects of testosterone. The mesonephric segment of the Wolffian duct was retained by EGF in the female fetal tract under in vitro conditions, and under in vivo conditions EGF was able to increase anogenital distance and to induce epididymis in some female fetal mice. (5) We were able to detect an EGF-like material in the fetal genital tract during differentiation and found that the level of this material increased with advancement of differentiation. Thus, it appears from the above results that EGF plays a role in testosterone-induced reproductive tract differentiation.

Evidence for independent processing of subjective contour brightness and sharpness

Subjective contours have been of considerable interest because of their importance to theories and physiological models of form perception. In particular, they have recently been characterized as the result of magnocellular cortical processing. There is, however, a paucity of parametric data relating to basic psychophysical parameters in this field. Two experiments are reported in which the roles of subjective contour size, retinal eccentricity, and flicker rate in subjective contour salience were investigated. Eleven observers estimated subjective contour magnitude using an Ehrenstein configuration. Configurations ranging in size from 0.25 to 3 deg were presented to three retinal loci (fovea, 2 deg, and 4 deg) at flicker rates ranging from 5 to 15 Hz. Subjective contour brightness and distinctness were measured separately. Brightness was greatest at a subjective contour size of about 1.25 deg, at flicker rates of 5-7 Hz, and at 3 deg peripheral for all flicker rates and all but the smallest stimulus sizes. Distinctness decreased with eccentricity and flicker, but remained high at small diameters (thus implicating spatially sensitive mechanisms). Taken together, the results support a magnocellular processing of subjective contours with respect to brightness, but also suggest that there is a parvocellular contribution to subjective contour sharpness.

An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures

In previous research, a cognitive-behavioral therapy (CBT) package was found to be effective in reducing children's distress associated with the painful medical procedures of bone marrow aspirations (BMAs) and lumbar punctures (LPs). Orally administered Valium demonstrated less effectiveness but was helpful in reducing behavioral distress before the medical procedure. In the present study, we investigated whether the combination of oral Valium and CBT would result in increased efficacy of the CBT. Eighty-three subjects were randomly assigned to receive either CBT or CBT plus Valium while undergoing either a BMA or an LP. Dependent variables included observed behavioral distress, self-reported fear and pain, and pulse rate. Results failed to support the value of such a combination but did provide additional evidence in regard to the effectiveness of the CBT. The need for more potent medical interventions for some children is discussed.

Spatial contingency and the McCollough effect

On the basis of a conditioning analysis of the orientation-contingent color aftereffect (McCollough effect, ME), orientation stimuli become associated with simultaneously presented chromatic stimuli. This account suggests that decreasing the contingency between the grid orientation and color should decrease the strength of the aftereffect. Results of previous research indicate that decreasing the temporal contingency (by presenting homogeneous chromatic stimuli between presentations of chromatic grids) does not decrease the ME. However, it has been suggested that the appropriate contingency-degradation procedure would involve decreasing spatial (rather than temporal) contingency. That is, the illusion should be attenuated by extending the color beyond the confines of the grid. Contrary to this hypothesis, the results of the present experiments provide no evidence that decreasing the spatial contingency between grid and color decreases the ME; rather, the aftereffect is increased by such a manipulation.

Modified pericardial closure to protect cardiovascular structures during sternal reentry

A technique is described for covering the anterior surface of the heart and bypass grafts with autologous pericardium after myocardial revascularization. A trapezoidal flap is created that incorporates bilateral relaxing incisions to avoid distortion of grafts or increased risk of pericardial tamponade.

Cyclic adenosine monophosphate-mediated induction of F9 teratocarcinoma differentiation in the absence of retinoic acid

F9 teratocarcinoma stem cells differentiate into parietal endoderm-like cells when given retinoic acid (RA) and dibutyryl cyclic adenosine monophosphate (DB-cAMP). It is generally accepted that the stem cells are resistant to the action of cAMP alone and need to be primed by RA in order to respond to cAMP. In this report, we demonstrate that F9 stem cells differentiate into parietal endoderm-like cells in the absence of exogenous RA when treated with cholera toxin and 1-methyl,3-isobutyl xanthine (CT/MIX) or 8-bromo-cAMP/MIX (8B2-cAMP/MIX). Cells treated with CT/MIX or 8B2-cAMP/MIX were morphologically similar to parietal endoderm-like cells, produced high amounts of plasminogen activator, and synthesized both type IV collagen and laminin mRNA. Conversely, markers made in abundance by stem cells such as stage-specific embryonic antigen (SSEA-1) and an mRNA species of 6.8 kb (pST6-135) were markedly reduced in CT/MIX-treated cells. To prove that cAMP alone could induce differentiation Lipidex-1000, a hydrophobic gel, was used to remove 80-90% of the endogenous serum retinoids. F9 cells grown in this retinoid-depleted serum and treated with 8B2-cAMP/MIX differentiated to parietal endoderm-like cells as shown by both dramatic changes in morphology and induction of type IV collagen mRNA. Our results indicate that the differentiation of F9 to parietal endoderm-like cells can be induced by increased intracellular cAMP and is not strictly dependent on the addition of RA.

Computed tomography scans and negative symptoms in schizophrenia: chronic schizophrenics with negative symptoms and nonenlarged lateral ventricles

Computed tomography scans of 31 chronic schizophrenics with negative symptoms and 31 age-matched normal volunteers were assessed for ventricular size, cortical atrophies, third ventricle diameter, and cerebellar atrophies. No significant differences were found in the size of the lateral ventricles or third ventricles between the chronic schizophrenics and the controls. The frontal horns in patients did show a tendency toward increased size compared with controls. Sulci width showed significant differences between patients and controls. The clinical variables, except for the memory test, did not correlate with any brain morphology. A meta-analysis was performed on 17 studies that used the planimetric method in order to evaluate the relationships between the size of the lateral ventricles in patients and their respective controls. We found significant differences between the group of studies using normal controls and the group using medical controls.

Color aftereffect contingent on text

During adaptation, two different letter strings (each five or six letters) were presented to subjects alternately, one in green and the other in magenta. The extent to which these letter strings subsequently elicited a color aftereffect was assessed. In different experiments, the chromatic letter strings consisted of words and nonwords. The results indicated that letter strings that form English words can contingently elicit a color aftereffect. This was the case even when the words were anagrams. There was no evidence that nonword letter strings could contingently elicit such an aftereffect, even when the nonwords conformed to English orthography. The results are relevant to understanding other contingent color aftereffects (McCollough effects), illusory color noted by computer operators who work at monochrome (green or amber) displays, and the processing of text.

Detection of multiple cardiac papillary fibroelastomas using transesophageal echocardiography

Papillary fibroelastomas are rare, benign cardiac tumors that may be associated with embolization, angina, and sudden death. We report a case of multiple papillary fibroelastomas diagnosed during life by transesophageal echocardiography. Surgical resection during mitral valve replacement for rheumatic mitral stenosis prevented the development of any of the life-threatening complications sometimes associated with this tumor.