Validation of the Functional Assessment Inventory against a multidisciplinary home care team

Systematic multidimensional assessment techniques such as the Functional Assessment Inventory (FAI) are increasingly used with the elderly for outcome measurement, prediction of service needs, and accurate description for comparative purposes. The FAI is a structured interview followed by a rating process which compares patient status against standard descriptive phrases. Patients are assessed in five areas: mental health, physical health, social resources, economic resources, and activities of daily living (ADL). The validity of the FAI was tested by comparing ratings of patient health obtained by a single investigator using only the instrument with ratings obtained by consensus from an interdisciplinary home care team providing long-term care for the patients studied. An excellent level of agreement (weighted kappas from .583 to .780) was found in all areas studied. A single significant difference in ADL rating with a high correlation coefficient (r = .85) was interpreted as due to a difference between the single rater and the team in the definition of ADL. The ease of obtaining summary ratings from clinical personnel suggests that further exploration of this rapid quantification of patient health is warranted.

Laboratory procedures in adenoviruses. XII. Comparison of five ELISA methods for demonstration of hexon antigen

To demonstrate adenovirus hexon, four different arrangements of a four-layer ELISA, to be performed with commercially available reagents, were compared with a three-layer ELISA. After evaluation of specific and control reagents and their dilutions, the guinea pig/rabbit or the rabbit/chicken method were equally practicable and sensitive as the three-layer method with rabbit serum and superior to two other methods. By testing about 100 stool samples and 74 throat swabs containing adenoviruses, it turned out that the sensitivity (1 ng/ml hexon) appears satisfactory for stool specimens in adenovirus enteritis of infants, but is much less sensitive than isolation in cell culture for adenoviruses in throat swabs. As confirmatory test, specimen were incubated with an adenovirus rabbit antiserum or normal serum and then tested.

[Total duodenal diversion by fundo-jejunostomy with Roux-Y-loop in the treatment of severe postoperative recurrent reflux esophagitis]

Fundo-jejunostomy with a 60 cm long Roux-en-Y loop removes almost all symptoms in severe postoperative recurrent reflux esophagitis. We analysed 12 own cases and compared them with those published in literature. 90% of most satisfactory results were obtained. Nevertheless indication for fundo-jejunostomy must be discussed and limited to those cases, which do not respond to medical treatment.

Imaging of optically active biological structures by use of circularly polarized light

If an optically active (chiral) sample is placed in a microscope and illuminated with circularly polarized light, an image can be formed that is related to the circular dichroism of each feature of the sample. A theoretical investigation has been done for the circular differential image obtained by subtracting the images formed under right- and left-circularly polarized light. Two types of differential images are possible: (i) dark-field images formed from light reflected or scattered by the sample and (ii) bright-field images formed from light transmitted through the sample. The sign and magnitude of each feature in a circular differential image strongly depend on the structure of the sample. The dark-field circular differential images are most sensitive to large features with dimensions similar to the wavelength of illumination whereas the bright-field images are most sensitive to the short-range molecular order. Applications of circular differential imaging may include clinical fingerprinting of normal and transformed cells and structural analysis of individual cellular components.

Danazol treatment increases serum enzyme levels

Six of seven women treated for endometriosis with daily administrations of 800 mg of danazol over 4.7 to 9 months developed one or more mildly abnormal serum enzyme levels. All seven patients had normal pretreatment enzyme levels and were evaluated after 2.5 to 5 months of drug therapy and again 1 to 2.5 months following completion of drug therapy. Danazol therapy was associated with statistically significant increases in the following serum enzyme levels: creatine phosphokinase, lactate dehydrogenase, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase. Mean serum enzyme increases ranged from 25% to 86% greater than the mean pre-drug-therapy level. Alkaline phosphatase levels were not altered by the danazol treatment. Following completion of danazol therapy, all enzyme levels were within the normal range except serum glutamic pyruvic transaminase, which was approaching normal. High-dose danazol treatment (800 mg daily) is associated with mild elevations of specific serum enzymes, and these changes appear to resolve spontaneously after cessation of treatment.

[Surgical treatment of acute necrotizing hemorrhagic pancreatitis. Analysis and prospective deductions on 58 cases]

Three degrees of severity could be recognized in 58 patients operated upon for severe acute hemorrhagic pancreatitis, based on results of intensive care, particularly anti-shock therapy, wide peritoneal lavage, and possible need for endoscopic relief of sphincter of Oddi obstruction due to a stone. The principal parameters evaluated were clinical and biological features and the course of the affection. As a result of these data, 44 pancreatic resections of variable extension and 14 excisions of necrotic tissues were performed. Results of these two types of operations, as well as the dominant causes of postoperative and secondary deaths, are analyzed in detail. The indications for surgery are discussed, together with the tactical methods to be applied as a function of the general condition and the detailed study of the pancreas and the state of the adjacent organs. Particular importance should be attached to the presence of respiratory insufficiency. The possible need for routine biliary external drainage is discussed, and the major role played by parenteral nutrition, which should be initiated as early as possible, is emphasized. These findings suggest that two fundamental principles should guide surgery of acute hemorrhagic pancreatitis: the need for surgery in selected cases, though over-aggressive operations should be avoided, and, more particularly, the concept, to be shared of the need for repeated operations, enabling avoidance of excessive procedures during initial surgery.

[New vagotomy technics]

Various new more extensive operative procedures have been proposed with the aim of increasing efficacy of vagotomy and ensuring maximum neurotomy. Though based on the principle of neurotomy as accomplished by highly selective vagotomy, it is completed or combined with a seromyotomy along one or both sides of the lesser curvature or with one in the cardiofundal region. Technical aspects of these different methods are discussed.

Analytical study and long-term results of 230 highly selective vagotomies for chronic duodenal ulcer

230 highly selective vagotomies (H.S.V.) for chronic duodenal ulcer are carefully studied. Per and postoperative complications are reviewed and compared with the most important reported statistics. A 10-year follow-up gives an indication of the late functional results and evaluation of the percentage of recurrences which lies at around 6%, on first estimation. A complete study of pre- and postoperative gastric secretion tests in duodenal ulcers which did not respond to treatment with Cimetidine and also in patients with very severe hyperacidity is reported, showing that, even in these cases, H.S.V. notably decreases acidity levels and gives satisfactory results. H.S.V. has practically no mortality, a very low morbidity and is followed by excellent functional results. The only factor which remains is the relatively high rate of recurrence which increases with time.

Immunological relationship among human adenoviruses of subgenus D

Antigenic relationships between adenoviruses of subgenus D were determined by neutralization tests in HeLa cell cultures by CPE inhibition. For cross-testing, several antisera of the same species were tested against the prototype viruses. 39 wild strains belonging to 12 different virus species were also studied. Marked variation in the degree of cross-neutralization between individual sera of the same species was often observed. However, virus strains within a species mostly showed identical serological reactions. Hence, antigenic specificity appears to be a fairly constant property of any one species. Strong cross-neutralizations between species are presumably due to a relationship of the hexon (hexon) antigen, whereas weak cross-neutralizations found between viruses related by hemagglutination-inhibition are due to the gamma (fiber) antigen. Viruses related to adenovirus 15 (Mastadenovirus h 15) showed a variety of cross-reactions in neutralization tests. In view of the new species definitions of adenoviruses and to facilitate identification, changes in the classification of Ad 15, 25, 29, and 15/H9 are proposed. The prototypes of Ad 13, 15, 25, 29, and 30 have been cloned by terminal dilution.

[Hartmann's operation. Results in 96 cases and present indications]

The results of 96 Hartmann's operations performed over a period of 10 years are analyzed. Surgery was indicated for cancer in 72 p. cent of cases, the objective being palliative treatment in one ouf of two patients, for perforating necrotizing lesions of the colon in 11 p. cent, and for complications of sigmoid diverticulitis in 7 p. cent. Emergency intervention was necessary in 41 p. cent of cases. Overall mortality was 19 p. cent, half of these being related to the original lesion and the other half to complications due to the primary peritonitis. Re-establishment of intestinal continuity was possible in 15 p. cent of patients, must of whom had been operated upon initially for benign lesions. Postoperative mortality was nil in this group. Hartmann's operation should be employed mainly when abdominoperineal and anterior rectal resections are contraindicated. It is principally indicated for palliative treatment of rectal or rectosigmoid cancers, and for benign or malignant tumors with colonic sceptical complications.

[Virological diagnosis of ocular adenovirus infection]

For laboratory diagnosis, virus isolation and identification from conjunctival swabs should be combined with serology (two blood specimens: early and 14 days or later after onset of disease). The group-specific complement fixation fails in almost one-half of the cases. Additional type-specific reactions (neutralization, hemagglutination inhibition, type-specific complement fixation) may be performed with adenovirus 8 and, in epidemic outbreaks, also with other types. Immunofluorescence procedures have proved to be of limited value; rapid diagnostic procedures are not yet available.

Adenovirus 37: identification and characterization of a medically important new adenovirus type of subgroup D

A new human adenovirus has been isolated from 62 eyes with (kerato)conjunctivitis and from nine genitourinary sites. The virus is closely related in haemagglutination inhibition tests to adenovirus type 19 (Ad 19) and Ad 10. Antiserum adsorption experiments demonstrated the presence of three haemagglutinin antigens in the virus: One unique, another common to Ad 19, and a third common to Ad 10 and 19. In neutralization tests, the virus is distantly related to Ad 13, 30, 19, and 10. Despite this relationship, it is proposed to call the virus adenovirus 37, in agreement with current species definitions. It belongs to subgroup D of human adenoviruses. Antisera to the new virus show virtually no neutralization of other human adenovirus types. Only bay use of this antiserum it is in practice possible to avoid wrong or indefinite typing, which has often occurred in the past.