Statistical models for evaluation of pleural effusions

Statistical models designed to aid in the identification of neoplastic effusions were formulated. A computer program utilizing n-chotomous, multivariate probit analysis was used for estimation of model parameters. These parameters were estimated for an illustrative sample of 88 patients with effusions of unknown etiology. The outstanding feature of the statistical approach is its potential as a diagnostic and research tool. Regarding its diagnostic potential, if carcino-embryonic antigen (CEA) levels of plasma (PLAS-CEA) and pleural fluid (PLFL-CEA) were used separately, PLAS-CEA values greater than 4.833 ng/ml and PLFL-CEA values greater than 4.193 ng/ml discriminated malignant from benign effusions. Elevated CEA levels in conjunction with cell block examination noticeably improved diagnostic efficacy. The thresholds are consistent with CEA levels found by other investigators. Furthermore, the method employed is specific in predicting the probability that a given effusion is malignant. Regarding its research potential, the efficacy of different sets of tests in predicting malignancy can be simultaneously and comparatively evaluated.

[Aphasia with epilepsy: a new syndrome?]

Three children are described who between 5 and 7 years of age developed behaviour disorders and comprehension deficit for acoustic language. All had associated spike-and-wave discharges in the EEG. Clinical seizures occurred after the onset of aphasia and were easily controlled by anticonvulsant treatment. The aphasia disappeared but without clear-cut correlation to the EEG or control of clinical seizures. The clinical picture resembled the "syndrome of acquired aphasia with convulsive disorder" described by Landau and Kleffner. Previous reports on aphasia in childhood show that this syndrome was already well-known then. The relationship to other acquired language disorders with psychiatric illnesses is discussed.

[Kinship help for the elderly. An exploratory study of patterns of help by female helpers]

The study is based on interviews made with women who care for an elderly relative. The activities which they perform can be classified to five basic forms of assistance: basic care and nursing, psycho-social care, obligatory attendance, house keeping, and supporting contacts to the social environment. The relationships between these women and the elderly contain a certain amount of reciprocity, which is reflected in material and emotional gratifications for the person rendering help. The burdens on the helper result from constant awareness of the decrepitude of a relative, from fear of the future, and from the necessity of constantly being in attendance of a dependent person. Women who feel burdened by their tasks perceive few rewards from the relationship, and have the impression that the person being cared for has no adequate idea of the efforts made. Because of the burdens on the relatives, the continuation of care of the elderly in their familiar social environment remains precarious. This finding is not an argument against care in familiar surroundings, but it does call attention to the importance of mobile social services for stabilizing primary assistance.

Interventricular septal configuration as a predictor of right ventricular systolic hypertension in children: a cross-sectional echocardiographic study

Abnormal interventricular septal position and motion have been noted in patients with right ventricular pressure overload. The quantitative relationship between this alteration in septal configuration and the severity of right ventricular systolic hypertension has not been previously reported. We used cross-sectional echocardiography to assess the radius of septal curvature at end-diastole, midsystole, and end-systole in 20 normal children and 29 children (ages 2 weeks to 20 years) undergoing cardiac catheterization for a variety of congenital cardiac disorders. The measured septal radius of curvature (r) was normalized by the ideal radius (ri) for the left ventricular cavity area and then expressed as normalized septal curvature [l/(r/ri)]. A slight leftward shift and flattening of the interventricular septum occurred in the course of normal systolic contraction (mean +/- SEM normalized curvature at end-diastole 0.92 +/- 0.03 and at end-systole 0.85 +/- 0.02; p less than .05). Marked exaggeration of this configurational change occurred in patients with right ventricular systolic hypertension (right ventricular systolic pressure greater than 50% systemic pressure), with progressive loss of curvature from end-diastole (0.45 +/- 0.05) to end-systole (0.19 +/- 0.06). Normalized septal curvature correlated well with relative right ventricular systolic pressure at all three sampling periods, with the best correlation at end-systole (r = .86). End-systolic flattening of the interventricular septum thus proved to be a sensitive marker for right ventricular systolic hypertension.

Ethanol-induced hyperlipoproteinemia. Crucial role of preceding ethanol intake in the removal of chylomicrons

Ethanol produces a number of effects in different steps of lipid metabolism which have been suggested to be responsible for the common phenomenon of ethanol-induced hyperlipoproteinemia in man. The occurrence of hyperchylomicronemia has been attributed to an ethanol-specific disturbance of the clearing mechanism of triglyceride-rich lipoproteins. However, the reports on lipolytic activities and the clearance of chylomicrons after ethanol ingestion are contradictory. In this investigation the short-term excess of serum lipoproteins and the lipolytic activities in healthy volunteers were studied after single and prolonged ethanol ingestion followed by an intravenous lipid load. One hour after a single oral dose of ethanol, the intravenous fat tolerance test was unchanged. After an ethanol load over a 5 hr period, the fat tolerance was reduced, although the same ethanol levels at the time of infusion were maintained. In addition, the lipolytic activities of the serum were significantly reduced after 5 hr of ethanol ingestion followed by intravenous fat load. Hence the time relations between ethanol and fat loads determine whether a defect in chylomicron catabolism can be observed or not. A striking difference in the situations when the fat infusions were performed was the development of endogenous hypertriglyceridemia after 5 hr of ethanol ingestion. Since ethanol-dependent differences in the absorption of fat are ruled out by our experimental design, we attribute our findings to a competitive inhibition of chylomicron degradation by VLDL and partial depletion of the lipolytic system by combined endogenous and exogenous hypertriglyceridemia.

[The cell number in spontaneous uncentrifuged urine]

The leucocytes and erythrocytes in spontaneous urines were determined in the counting chamber at native and experimentally reduced pH values after standing for various periods. The pH value remained constant for up 6 h, whereby the disintegration of cells increases with rising pH values. The investigations do not rule out a circadian rhythm of cell excretion referring to the quantity of cells/time. Depending on the absolute number of cells the methodic variation coefficient lies between 4 and 25%.

Lead encephalopathy treated by versenate (CA-EDTA)

A patient with generalised epileptic seizures, mental and psychotic signs was diagnosed as suffering from lead encephalopathy. He was a big consumer of home-made arrack, illicit alcohol prepared at home in secrecy, in tools containing copper and lead. Basophilic stippling increased the possibility of lead encephalopathy, which was soon proved. He was successfully treated with low doses of Versenate, a chelating factor, and totally recovered.

Does postural asymmetry indicate directionally of rotation in rats: role of sex and handling

Postural asymmetry of male and female Wistar rats was assessed during 4 tests: (a) tail suspension, (b) tail holding, (c) tail pinch and (d) walking on a narrow path. The tests were conducted prior to and after (+)-amphetamine (1 mg/kg, i.p.) administration. Rotational directionality was assessed in a rotometer. Only in female rats did postural adjustment during the tail-pinch predict with borderline significance the direction of circling prior to and after amphetamine. In both surgically castrated and conjugated estrogen-treated male rats, in sham-castrated and handled males, the tail-pinch test caused the same dominant directionality as rotation under amphetamine. The duplicity of postural tests suggests that there is a multitude of systems controlling and modulating postural response.

Postural asymmetry and directionality of rotation in rats

The hypothesis [12] that the direction of postural asymmetry can predict rotational side preferences caused by amphetamine, was tested. Postural asymmetry of male and female Wistar rats was assessed using four tests: (a) tail suspension, (b) tail holding, (c) tail pinch, and (d) walking on a narrow path. The tests were conducted prior to and after (+)-amphetamine (1 mg/kg, IP) administration. Rotational directionality was assessed in a rotometer. None of the tests predicted the direction of circling. The findings suggest that there is a multitude of systems contributing to asymmetric posture.

A 3 1/2-year experience with double-lumen implants in breast surgery

The use of the double-lumen implant, with 20 mg of Solu-Medrol or less, has improved the final results in patients having reconstruction after mastectomy. However, the results in patients having augmentation mammaplasties have been much more dramatic, with far superior results over those patients having a gel implant. During the first year the incidence of scar tissue problems is 17 times greater with the gel implants than with the double-lumen implants and 20 mg or less of Solu-Medrol. Scar capsules were also extremely amenable to closed capsulotomy after augmentation with the double-lumen implant, in marked contrast to the gel implant. There is no evidence to support the hypothesis that the double-lumen implant and Solu-Medrol merely delays the eventual appearance of the scar tissue problem. The recommended dosage of Solu-Medrol would appear to be 20 mg and not less.