Preliminary results from a psychoeducational program to rehabilitate chronic patients

Twenty-two chronic psychiatric patients enrolled in a psychoeducational rehabilitation program were assessed before and after the program to determine whether participation decreased severity of psychopathology and improved community functioning and quality of life. The program consisted of five 14-week modules that provided training in five skill areas: medication and symptom self-management, coping with anxiety and depression, social skills, living skills, and leisure skills. Most patients experienced significantly reduced psychopathology and negative symptoms and improved quality of life and community functioning. The program appears helpful to clients, and a controlled trial to further evaluate its effects is underway.

Retinoblastoma in association with the chromosome breakage syndromes Fanconi's anaemia and Bloom's syndrome: clinical and cytogenetic findings

Two children presenting with sporadic unilateral retinoblastoma and exhibiting a high degree of chromosome breakage were noted to have unusual facies, microcephaly and abnormal skin pigmentation. In the first child the pattern of both spontaneous and mitomycin-C-induced chromosome breakage was characteristic of Fanconi's anaemia although the degree of breakage was extreme. She also exhibited a striking increase in X-ray-induced chromosomal damage in G0 lymphocytes as measured by dicentric formation and increase in chromatid-type aberrations. She had a number of typical clinical features, including cafe-au-lait patches and abnormalities involving the kidney; however, she demonstrated neither the hypoplasia of radius and thumb nor the typical aplastic phase of this disorder. At age 22 months the child became anaemic with trilineage myelodysplasia, which was rapidly followed by the development of acute myeloblastic leukaemia. The early onset (at age 4 months) of retinoblastoma may have been associated with the underlying genomic instability. The second child exhibited a pattern of chromosome breakage characteristic of Bloom's syndrome, in addition to a moderate increase in damage induced by mytomycin-C. She had the typical stunted growth and malar hypoplasia of Bloom's syndrome although she did not demonstrate the frequently described erythematous 'butterfly rash' Although patients with Fanconi's anaemia and Bloom's syndrome are recognised to be at an increased risk of cancer, retinoblastoma has not previously been described in patients with either condition. We suggest that underlying recessive chromosome breakage syndromes may be underdiagnosed in paediatric cancer patients, with important implications for prognosis and genetic counselling.

Strecker stents in the femoropopliteal arteries: value of duplex ultrasonography in restenosis assessment

PURPOSE

Experience with Strecker stent implantation in the femoropopliteal arteries has been described; however, few of the reports were prospective studies, and none routinely used site-specific assessment methods for follow-up evaluation of stent patency. The purpose of this study was to evaluate 1-year Strecker stent patency using duplex ultrasound imaging to obtain a more precise delineation of stent restenosis than is possible with other noninvasive assessment modalities.

METHODS

A prospective study involved 52 patients with 57 sites treated by angioplasty and Strecker stent deployment in the femoropopliteal arteries. Assessment included clinical evaluation; ankle-brachial index (ABI) measurements at rest and after exercise; and duplex ultrasound imaging preprocedurally and at 3 and 12 months after the intervention.

RESULTS

All 74 stents were deployed successfully in the 35 occluded arteries and 22 stenotic lesions. Acute reocclusion occurred in 6 (10%). At 3 months, primary patency was 81% and secondary patency 84%. Mean ( +/- SD) ABIs increased from 0.64 +/- 0.15 at rest and 0.32 +/- 0.17 after exercise to 0.89 +/- 0.14 and 0.68 +/- 0.23, respectively (p < 0.0001). At 12 months, primary patency was 79%, and secondary patency was 82%. Mean ABIs were 0.82 +/- 0.15 at rest and 0.52 +/- 0.22 after exercise at 12 months (p < 0.0002 compared with preprocedural ABIs). Analysis of the length of lesion treated showed betted results with shorter diseased segments, but this was not statistically significant (p > 0.05). Better outcomes were also obtained when one stent was used rather than two stents at 12 months (p = 0.15), but there was no difference at 3 months (p = 0.3). Thirty-four percent of the stented segments progressed from < 20% stenosis at 3 months to > 50% stenosis at 12 months. Overall, 19 (43%) of 44 segments progressed from < 50% stenosis at 3 months to a > 50% stenosis at 12 months. Restenosis seen at 3 months generally was in the native artery just proximal or distal to the stent, but at 12 months, restenosis was mainly inside the stent.

CONCLUSIONS

Strecker stents at 1-year demonstrated satisfactory patency in the femoropopliteal arteries when deployed for angioplasty salvage or recurrent disease. The 3- and 12-month evaluations obtained with duplex ultrasound provided site-specific hemodynamic data for stent assessment. Resting ankle pressures were a poor index of restenosis.

Recognition and classification of clinically dysplastic nevi from photographs: a study of interobserver variation

The recognition of dysplastic nevi from photographs can aid in population surveys of nevi and in epidemiological studies of melanoma risk. The reproducibility of techniques for recognizing nevi as dysplastic or for scoring them according to the degree of dysplasia has not been measured. Using photographs of 300 nevi taken in the course of a case-control study of melanoma, we assessed the agreement among six clinicians in independently categorizing nevi as dysplastic and in grading the degree of dysplasia. On average, reviewers agreed with each other 77% of the time in classifying a nevus as dysplastic or normal. Pairwise agreement within one point on a six-point scale occurred 87% of the time on average. These results suggest that criteria for recognizing nevi as clinically dysplastic from photographs can be applied reproducibility.

Reporting of cases of non-accidental injury: a survey of parents' responses

Parental responses to the process of referral to statutory bodies because of their child's suspected non-accidental injury were obtained using the questionnaire method. The results were analysed in terms of their demographic details, subsequent social and emotional adjustment together with an evaluation of parental perception of the service they received. Parents' reported some positive outcomes as a result of the referral, but the majority of responses highlighted the need to develop a model of investigation that offers more emotional support to parents, giving them more and better information and allowing their point of view to be heard and respected.

Heterogeneity analysis in 40 X-linked retinitis pigmentosa families

Analysis of genetic heterogeneity in 40 kindreds with X-linked retinitis pigmentosa (XLRP), with 20 polymorphic markers, showed that significant heterogeneity is present (P = .001) and that 56% of kindreds are of RP3 type and that 26% are of RP2 type. The location of the RP3 locus was found to be 0.4 cM distal to OTC in the Xp21.1 region, and that of the RP2 locus was 6.5 cM proximal to DXS7 in Xp11.2-p11.3. Bayesian probabilities of linkage to RP2, RP3, or to neither locus were calculated. This showed that 20 of 40 kindreds could be assigned to one or the other locus, with a probability > .70 (14 kindreds with RP3 and 6 kindreds with RP2 disease). A further three kindreds were found to be unlinked to either locus, with a probability > .8. The remaining 17 kindreds could not be classified unambiguously. This highlights the difficulty of classifying families in the presence of genetic heterogeneity, where the two loci are separated by an estimated 16 cM.

Identification of an abundant disulfide-linked complex of glycoproteins in the envelope of guinea pig cytomegalovirus

Murine monoclonal antibodies were used to identify an immunogenic envelope glycoprotein complex of guinea pig cytomegalovirus (GPCMV). The glycoprotein complex consisted of two virion components of estimated masses 60,000 and 90,000 Da. Murine monoclonal antibodies specific for the gp60-90 complex neutralized infectious virus in the presence of complement and detected expression of the envelope complex on the surface of infected cells. Pulse-chase and immunoblot analyses suggested that these virion forms were proteolytic products of an intracellular polyprotein precursor of an estimated molecular weight of 150,000 Da (gp150). In addition, the intracellular forms of this envelope glycoprotein complex existed as a disulfide-linked oligomer. The intracellular polyprotein was synthesized as a 100,000-Da precursor which was likely cotranslationally glycosylated using N-linked linkages to the major intracellular form, gp150. Because of the similarities in size, expression, and processing pathway, these results suggested that the GPCMV gp60-90 complex may represent the HCMV gB homolog of GPCMV.

Endotracheal tube and tracheobronchial obstruction as causes of hypoventilation with high inspiratory pressures

Two cases of difficult ventilation are presented, the first caused by endotracheal tube obstruction with nasal turbinate, and the second caused by tracheobronchial obstruction with blood clots. The clinical presentation in each case was characterized by extreme difficulty in ventilating and severe hypercapnia despite vigorous ventilatory efforts with either a mechanical ventilator or resuscitator bag. A simple manipulation of the endotracheal tube cuff helped to differentiate between increased impedance caused by endotracheal tube obstruction as opposed to increased respiratory system impedance beyond the tip of tube. In the second patient, in whom even a short interruption of ventilation was poorly tolerated, simultaneous rigid bronchoscopy (for removal of intratracheal masses) and ventilation via endotracheal tube were successfully performed.

An outbreak of gastro-intestinal illness caused by eggs containing Salmonella enteritidis phage type 4

Seven of nine people developed gastro-intestinal symptoms between 18 and 27 h after eating a trifle with a topping containing raw eggs. Salmonella enteritidis Phage Type (PT) 4 was isolated both from the faeces of affected persons and from eggs remaining in the same box as those used to prepare the topping. The findings show that eggs being produced and sold in the U.K. still contain S. enteritidis PT4 and that this is continuing to cause human infection.

Perioperative nursing on the Amazon River. An experience that made a difference

We held a conference at the end of the team's visit. We concluded that there was a continuum of learning in both directions from both countries. Some of the problems and frustrations in medicine are the same worldwide. Leaving the US medical system to work in a remote area is a fascinating and exciting experience. Clean water, electricity, transportation, and food are not taken for granted in this area of the world. The next decade in an area like this holds many different plans, hopes, and projects. Nothing can be taken for granted. All that has been developed could be lost tomorrow. What we do makes a difference, whether it is in the jungles of Brazil or an OR in the United States. To see the health of the general population so markedly improved from our previous visit emphasized that point. Your skills as an OR nurse can be translated to other countries. An instrument may have a different name, but the use is the same. Operating room nursing on the Amazon River is the same, and it is different. You can and do make a difference to your patients each day. We found that the difference is less subtle in an area that has so little.

Extracellular organelles (prostasomes) are immunosuppressive components of human semen

Numerous reports have ascribed immunosuppressive activity to human seminal plasma and there is growing agreement that much of this activity can be accounted for by the very high levels of E series prostaglandins present (up to 300 microM 19-hydroxy prostaglandin E). However not all suppressive activity is due to prostaglandin since several reports have appeared of high molecular weight active substances and we have found that stripped seminal plasma is still effective in inhibiting the mitogen-induced proliferation of lymphocytes. In this study such immunosuppressive activity has been separated by molecular size fractionation and the activity has been found to be particulate and corresponded to the previously reported prostasomes. These are trilaminar to multilaminar vesicles (150 nm diameter) which are secreted by the prostate. Pure preparations of prostasomes inhibited mitogen-induced lymphoproliferation in a dose-dependent manner with a concentration of prostasomes equivalent to 40% of that seen in seminal fluid giving 69% suppression of thymidine incorporation. The suppressive activity survived boiling and therefore was unlikely to be due to enzymatic action associated with these organelles. Interaction with the accessory cells, involved in full development of the lymphoproliferation induced by mitogen, was indicated and this possibility was supported by the demonstration of a direct effect of prostasomes on macrophage function using a mouse macrophage cell line. The prostasomes in semen may play a complementary role to the prostaglandins in neutralizing the immune defences of the female reproductive tract. This combination would allow the alloantigenic spermatozoa the best chance of achieving fertilization, but at the same time leave the recipient open to any infection present in the semen.