Methylprednisolone therapy for acute asthma in infants and toddlers: a controlled clinical trial

A controlled double-blind trial was carried out to assess the effect of the early introduction of combined corticosteroid and beta-adrenergic drugs for the treatment of acute asthma in infants and toddlers. Seventy-four emergency room patients (aged 7 to 54 months) who were treated for acute asthma were studied. Treatment included, in addition to salbutamol inhalations, a single dose of intramuscular methylprednisolone (4 mg/kg) or normal saline as placebo. The patients were reevaluated 3 hours after initiation of treatment. At that time, patients were either admitted or discharged based on a clinical decision. Only 8 (20%) of 39 patients treated with steroids were admitted, compared with 15 (43%) of 35 in the placebo group (P less than .05). Sequential analysis of 33 pairs, matched by age and severity of symptoms, revealed statistically significant reduced admission rates in patients treated with steroids. In the younger patients (6 to 24 months), admission rate was significantly lower for those treated with steroids (18%) as compared with those treated without steroids (50%) (P less than .05). In the older group (24 to 54 months), the trend was similar but not statistically significant: 23% vs 31% in the steroid and placebo groups, respectively. These data indicate that corticosteroid treatment combined with an adrenergic agent, given early during an acute asthmatic episode, significantly reduces the hospital admission rate of infants and toddlers.

Overt gastrointestinal bleeding in the course of chronic low-dose aspirin administration for secondary prevention of arterial occlusive disease

We describe 13 patients who developed erosive gastritis with overt gastrointestinal bleeding while receiving 75-250 mg nonbuffered aspirin per day for the secondary prevention of cardiac or cerebrovascular events. The bleeding occurred despite good initial tolerance to aspirin for several months or years. All patients were elderly and had severe atherosclerotic cardiovascular disease. Our data suggest that, contrary to common belief, very low doses of nonbuffered aspirin are attendant with clinically apparent gastrointestinal complications.

Feline leukemia virus infection as a potentiating cofactor for the primary and secondary stages of experimentally induced feline immunodeficiency virus infection

Preexistent feline leukemia virus (FeLV) infection greatly potentiated the severity of the transient primary and chronic secondary stages of feline immunodeficiency virus (FIV) infection. Of 10 FeLV-FIV carrier cats, 5 died of experimentally induced FIV infection, compared with 2 deaths in 10 cats infected only with FeLV and 1 death in 7 cats infected only with FIV. FIV-infected cats with preexistent FeLV infections developed severe depression, anorexia, fever, diarrhea, dehydration, weight loss, and leukopenia 4 to 6 weeks after infection and were moribund within 2 weeks of the onset of signs, whereas cats infected only with FIV developed much milder self-limiting gross and hematologic abnormalities. Pathologic findings in dually infected cats that died were similar to those observed previously in cats dying from uncomplicated primary FIV infection but were much more widespread and severe. Coinfection of asymptomatic FeLV carrier cats with FIV did not increase the levels of FeLV p27 antigen present in their blood over that seen in cats infected with FeLV alone. The amount of proviral FIV DNA was much higher, however, in dually infected cats than in cats infected only with FIV; there was a greater expression of FIV DNA in lymphoid tissues, where the genome was normally detected, and in nonlymphoid tissues, where FIV DNA was not usually found. Dually infedted cats that recovered from the primary stage of FIV infection remained more leukopenic than cats infected with FIV or FeLV alone, and their CD4+/CD8+ T-lymphocyte ratios were inverted. One of these cats developed what was considered to be an opportunistic infection. It was concluded, therefore, that a preexistent FeLV infection in some way enhanced the expression and spread of FIV in the body and increased the severity of both the resulting transient primary and chronic secondary stages of FIV infection. This study also demonstrated the usefulness of the FIV model in studying the role of incidental infectious diseases as cofactors for immunodeficiency-causing lentiviruses.

Does a detailed explanation prior to gastroscopy reduce the patient's anxiety?

The object of this study was to investigate the assumption that a detailed explanation and description of gastroscopy to a patient reduces his fears of the procedure. In order to check this assumption, 243 consecutive patients who underwent elective gastroscopy were randomly distributed to 4 groups: Group A received a standard brief description of upper G-I endoscopy by the treating physician; Group B patients were given a detailed description by the endoscopist himself; Group C was given a comprehensive explanation and was shown an album of pictures illustrating each stage of the procedure; Group D saw a specially prepared video film of the procedure. A fifth group, E, consisted of patients who had previously undergone upper gastrointestinal endoscopy. Patient anxiety was measured using the "Spielberger State and Trait Anxiety Scales". According to the scoring on these scales there was no significant difference between the groups, thus showing that increasingly detailed description of the procedure did not diminish patients' fear. Neither did ethnic background or age have any significant influence on these results. Higher education had marginal influence on patients' apprehension about the procedure. However, female patients had significantly higher anxiety state and trait anxiety scoring than men. If endoscopy can be taken as typically representative of all invasive procedures, these results may have a much more general application.

Testing of gloves for permeability to UV-curable acrylate coatings

The handling of UV-curable acrylate formulations used in the coating of optical fiber requires protective measures to prevent contact dermatitis and/or allergic dermatitis. To characterize the permeability of various glove materials to a UV-curable acrylate coating, a study was undertaken using a modification of a standard ASTM permeability test, which demonstrated that nitrile rubber gloves provided the best protection of those glove materials tested.

Collagenase activity in colonic mucosa during inflammatory bowel disease

A simple test for collagenase activity was performed on colonic mucosa specimens of 35 patients with inflammatory bowel disease, 7 patients with carcinoma of the colon, 3 with benign polyps, and 34 normal subjects. Increased collagenase activity was present in 94.2% of the specimens taken from the inflamed mucosa and 71.4% of those obtained from colonic carcinoma, as compared to 8.8% of the control group.

Immunohistologic identification of phenotypic antigens associated with Hodgkin and Reed-Sternberg cells. A paraffin section study

A combination of two monoclonal antibodies, designated LN-1 and LN-2, were used in an attempt to identify the corresponding antigens in Hodgkin and Reed-Sternberg cells. The LN-1 antibody has been shown in previous studies in our laboratories to identify follicular center cells, whereas LN-2 marks certain B-cell subpopulations as well as interfollicular histiocytes. Utilizing the peroxidase-antiperoxidase (PAP) technique, paraffin-embedded sections were examined representing 39 cases of various histologic subgroups of Hodgkin's lymphoma following immunostaining with LN-1, LN-2, and the antibody to S-100. Of these 39 cases, the LN-2 antibody was found to consistently mark the majority of Hodgkin and Reed-Sternberg cells. LN-1 was found to identify Hodgkin and Reed-Sternberg cells in a smaller number of cases. In no instance were Hodgkin or Reed-Sternberg cells found to mark for the S-100 protein. The use of LN-1 and LN-2 antibodies facilitated the identification of Hodgkin and Reed-Sternberg cells and produced additional information regarding the phenotypic nature of these cells.