Three Case Reports

“Steakhouse Syndrome” occurs in patients who swallow meat without proper mastication or who have intrinsic esophageal disease. A history of excessive use of alcohol is frequently obtained and apparently contributes to a tendency for such patients to “bolt” their food and swallow a large bolus, which leads to the obstruction.

The enzymatic relief of “Steakhouse Syndrome” appears to be a safe and effective method of therapy, with few adverse effects. This method has been proven successful in many instances and offers an alternative to the reliable but lengthy and difficult procedure of endoscopic removal of the meat bolus.

Organic breakdown products resulting from hydrothermal carbonization of brewer's spent grain

Hydrothermal carbonization of brewer's spent grain resulted in a solid hydrochar and an aqueous phase rich in macromolecular dissolved organic matter. Both phases were analyzed with regard to low molecular weight organic compounds (MW<500 Da) in lyophilized form by exhaustive solvent extraction followed by pre-chromatographic derivatization and GC/MS-analysis. Low molecular weight acids, O-functionalized phenols, cyclopentenone derivatives, and benzenediols accounted for the majority of organic analytes in both hydrothermal carbonization product streams while being absent in solvent extracts of the pristine biomass. The pattern of short chain functionalized acids in the pristine biomass and in the hydrothermally produced matrices turned out very different. Acylglycerines as the most abundant lipids in pristine brewer's spent grain were quantitatively hydrolyzed under hydrothermal conditions. The recovery of total fatty acids present in the pristine biomass amounted to 19%. The major fraction of hydrophobic breakdown products including fatty acids, fatty alcohols, and sterols was sorbed onto the hydrochar.

Characterization of biochars and dissolved organic matter phases obtained upon hydrothermal carbonization of Elodea nuttallii

The invasive aquatic plant Elodea nuttallii was subjected to hydrothermal carbonization at 200 °C and 240 °C to produce biochar. About 58% w/w of the organic carbon of the pristine plant was translocated into the solid biochar irrespectively of the operating temperature. The process water rich in dissolved organic matter proved a good substrate for biogas production. The E. nuttallii plants showed a high capability of incorporating metals into the biomass. This large inorganic fraction which was mainly transferred into the biochar (except sodium and potassium) may hamper the prospective application of biochar as soil amendment. The high ash content in biochar (∼ 40% w/w) along with its relatively low content of organic carbon (∼ 36% w/w) is associated with low higher heating values. Fatty acids were completely hydrolyzed from lipids due to hydrothermal treatment. Low molecular-weight carboxylic acids (acetic and lactic acid), phenols and phenolic acids turned out major organic breakdown products.

Hydrothermal carbonization of poly(vinyl chloride)

Poly(vinyl chloride) (PVC) was subjected to hydrothermal carbonization in subcritical water at 180-260 °C. Dehydrochlorination increased with increasing reaction temperature. The release of chlorine was almost quantitative above ∼235 °C. The fraction of organic carbon (OC) recovered in the hydrochar decreased with increasing operating temperature from 93% at 180 °C to 75% at 250 °C. A wide array of polycyclic aromatic hydrocarbons (PAHs) could be detected in the aqueous phase, but their combined concentration amounted to only ∼140 μg g(-1) PVC-substrate at 240 °C. A pathway for the formation of cyclic hydrocarbons and O-functionalized organics was proposed. Chlorinated hydrocarbons including chlorophenols could only be identified at trace levels (low ppb). Polychlorinated dibenzodioxins (PCDDs) and dibenzofurans (PCDFs) could not be detected. The sorption potential of the hydrochar turned out to be very low, in particular for polar organic pollutants. Our results provide strong evidence that hydrothermal carbonization of household organic wastes which can be tied to co-discarded PVC-plastic residues is environmentally sound regarding the formation of toxic organic products. Following these findings, hydrothermal treatment of PVC-waste beyond operating temperatures of ∼235 °C to allow complete release of organic chlorine should be further pursued.

Characterization of biocoals and dissolved organic matter phases obtained upon hydrothermal carbonization of brewer's spent grain

The wet biomass brewer's spent grain was subjected to hydrothermal carbonization to produce biocoal. Mass balance considerations indicate for about two thirds of the organic carbon of the input biomass to be transferred into the biocoal. The van Krevelen plot refers to a high degree of defunctionalization with decarboxylation prevailing over dehydration. Calorific data revealed a significant energy densification of biocoals as compared to the input substrate. Sorption coefficients of organic analytes covering a wide range of hydrophobicities and polarities on biocoal were similar to those for dissolved humic acids. Data from GC/MS analysis indicated that phenols and benzenediols along with fatty acids released from bound lipids during the hydrothermal process constituted abundant products. Our findings demonstrate that the brewer's spent grain by-product is a good feedstock for hydrothermal carbonization to produce biocoal, the latter offering good prospects for energetic and soil-improving application fields.

Organic compounds in olive mill wastewater and in solutions resulting from hydrothermal carbonization of the wastewater

Organic components in olive mill wastewater (OMW) were analyzed by exhaustive solvent extraction of the lyophilisate followed by pre-chromatographic derivatization techniques and GC/MS-analysis of the extracts. Simple biophenols including tyrosol (Tyr), hydroxytyrosol (OH-Tyr) and homovanillic alcohol as well as complex biophenols including decarbomethoxy ligostride aglycon and decarbomethoxy oleuropein aglycon proved most abundant analytes. Hydroxylated benzoic and cinnamic acids are less abundant, which may indicate a humification process to have occurred. The pattern of organic components obtained from native OMW was compared with that obtained from hydrothermal carbonization (HTC) of the waste product. Former results provided strong evidence that HTC of OMW at 220°C for 14h results in an almost complete hydrolysis of complex aglycons. However, simple biophenols were not decomposed on hydrothermal treatment any further. Phenol and benzenediols as well as low molecular weight organic acids proved most abundant analytes which were generated due to HTC. Similarly to aglycons, lipids including most abundant acylglycerines and less abundant wax esters were subjected almost quantitatively to hydrolysis under hydrothermal conditions. Fatty acids (FAs) released from lipids were further decomposed. The pathways of volatile analytes in both native OMW and aqueous HTC solutions were studied by solventless headspace-Solid Phase Micro Extraction. Basically, a wide array low molecular alcohols and ketones occurring in native OMW survived the HTC process.

Hydrothermal carbonization of olive mill wastewater

Hydrothermal carbonization (HTC) is an emerging technology to treat wet biomasses aimed at producing a biochar material. Herein, olive mill wastewater (OMW) was subjected to HTC. Mass balance considerations provide evidence that the yield of biochar is low (~30%, w/w), which is associated with a low fraction of carbohydrates in OMW. The combination of different preparation schemes, pre-chromatographic derivatization reactions and GC/MS analysis for the analysis of organic compounds in aqueous HTC-solutions allowed to identify and quantify a wide array of analytes which belong either to intrinsic constituents of OMW or to characteristic HTC-breakdown products. Biophenols, such as hydroxyl-tyrosol (OH-Tyr), tyrosol (Tyr) account for the most abundant members of the first group. Most abundant breakdown products include phenol and benzenediols as well as short-chain organic acids. Secoiridoids, such as decarbomethoxy ligostride aglycon and decarbomethoxy oleuropein aglycon, all of them being typical components of OMW, are less abundant in HTC-solutions.

Nanosphere dispersed liquid crystals for tunable negative-zero-positive index of refraction in the optical and terahertz regimes

An analysis of aligned nematic liquid crystal cells containing core-shell nanospheres shows that it is possible to devise a new type of metamaterial whose index of refraction is tunable from negative, through zero, to positive values. The design parameters for the constituents can be scaled for application in the optical as well as very long wavelength (e.g., terahertz and microwave) regions.

The shaping of individual meanings assigned to assistive technology: a review of personal factors

PURPOSE

This review article examines the development of individualized meanings assigned to assistive technology and how these personal meanings influence the integration of assistive technology into daily activities.

METHODS

A review of the published literature regarding assistive technology use and abandonment was conducted by performing two independent searches using 26 search terms and three databases. Publications were reviewed for whether they addressed device use, device abandonment, coping, adjustment, adaptation, values, outcomes and/or cultural issues; 81 publications met these criteria.

RESULTS

The evidence suggests that psychosocial and cultural issues influence the shaping of individualized meanings assigned to assistive technology. Theoretical arguments suggest that the process of adapting to disability is another influential factor.

CONCLUSIONS

The synthesis of evidence and theories suggests that successful integration of assistive technology into daily lives requires potential device users to explore: (1) the meanings they assign to devices; (2) their expectations of assistive technology; (3) the anticipated social costs; and (4) ways to understand that disability is one, but not the defining, feature of one's identity.

[About Charles-Louis Cadet de Gassicourt and Dominique Larrey's correspondence]

From September 1805 to December 1809 , Charles-Louis Cadet de Gassicourt, pharmacien ordinaire of the Emperor, sent six letters to Dominique Larrey chirurgien de la Garde Imperiale. These papers show for the first time his personal and sentimental life, his health worries, his state of anxiety in front of the political and military events.

A meta-analytic review of coping with illness: do causal attributions matter?

OBJECTIVE

The present meta-analytic review assessed the relations between causal attributions, coping, and psychological adjustment in individuals with physical illnesses or undergoing medical procedures. A theoretical model predicting psychological adjustment was proposed. It was hypothesized that causal attributions would be both directly related to psychological adjustment and indirectly related to psychology adjustment via coping strategies.

METHODS

Relevant methodological and statistical information was extracted from 27 target studies. Weighted correlations from 27 studies were used as the unit of analysis to test the theoretical model.

RESULTS

Overall, internal, unstable, and controllable attributions were indirectly associated with positive psychological adjustment through the use of Approach and Emotion-Focused coping (P<.01). In addition, stable and uncontrollable attributions were indirectly associated with negative psychological adjustment through the use of Avoidance coping (P<.01).

CONCLUSION

These results suggest that attributions guide some motivated cognitions and behaviors within the context of illness, and are related to specific coping strategies. The discussion focuses on the predictive validity of these findings using the proposed theoretical model.

Observers' Reactions to Genetic Testing: The Role of Hindsight Bias and Judgments of Responsibility1

In 3 studies, we examined the effect of birth outcome on observers' reactions to genetic testing. Participants read a scenario in which a woman declined to take a genetic screening test and subsequently gave birth to a child with a genetic disorder (negative outcome) or a healthy child (positive outcome). Retrospective judgments of the likelihood that the child would have a genetic disorder were higher given negative than positive outcome knowledge under conditions of high genetic risk. Moreover, the more likely a negative outcome was perceived to be, the more responsible the mother was held for not taking the genetic screening test. Consistent with Weiner's (1993) theory, responsibility judgments were linked to displeasure and sympathy, with sympathy in turn being related to help judgments.

Review of immediate angioplasty after fibrinolytic therapy for acute myocardial infarction: insights from the RESCUE I, RESCUE II, and other contemporary clinical experiences

BACKGROUND

Prompt restoration of Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow improves survival in patients with acute ST-segment elevation myocardial infarction (MI). Fibrinolytic therapy fails to restore TIMI 3 flow within 90 minutes in 40% to 50% of patients. Because the results of percutaneous coronary intervention (PCI) for MI seem to be improving, a reevaluation of the role of PCI after fibrinolytic therapy for MI appears to be warranted.

METHODS AND RESULTS

Data from all 9 randomized controlled trials (including new data from 4 trials) of rescue percutaneous transluminal coronary angioplasty (PTCA) versus conservative therapy after fibrinolytic therapy (1456 patients), 4 contemporary registries of PCI in this setting (977 patients), and other germane studies are reviewed. PTCA after failed fibrinolysis (TIMI 0 to 1 flow) appears to reduce early severe heart failure (3. 8% vs 11.7%, P =.04) and improve survival over 1 year in patients with moderate to large MI (92% vs 87%, P =.001) and possibly reduces early repeat MI (4.3% vs 11.3%, P =.08). Assessment of the possible benefit of PTCA for TIMI 2 flow is hampered by the small number of patients randomly assigned. Repeat MI may be decreased and left ventricular functional recovery enhanced. PTCA early after successful fibrinolysis is nearly always technically successful and may reduce repeat MI and hospital length of stay. However, it must be recalled that randomized trials from the 1980s suggested increased mortality rates with PTCA after restoration of TIMI 2 to 3 flow with fibrinolysis. Data from contemporary randomized studies of stents and glycoprotein IIb/IIIa inhibitors suggest that PCI as performed today may yield better results than those reviewed.

CONCLUSIONS

These data suggest a probable benefit of rescue PTCA in several distinct scenarios and that the pivotal mid-1980s studies suggesting no benefit or harm for PTCA after fibrinolytic therapy may no longer be relevant. The role of mechanical intervention in the treatment of patients treated in these settings should be reassessed.

Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention

OBJECTIVES

The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention.

BACKGROUND

The ideal dose and duration of heparin infusion after successful coronary intervention is unknown.

METHODS

Patients were randomized to one of three heparin strategies after coronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patients) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any further heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome.

RESULTS

After successful coronary intervention, 414 patients were randomized. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overall incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all three groups.

CONCLUSIONS

Heparin infusion after successful coronary intervention is associated with more minor bleeding and vascular injury, prolonged length of stay and increased cost. In-hospital and one-month ischemic events rarely occur after successful intervention, irrespective of heparin use. Routine postprocedure heparin is not recommended, even in patients who present with unstable ischemic syndromes.

The influence of perceived responsibility and personality characteristics on the emotional and behavioral reactions to people with AIDS

The present study examined the effect of a target's personality and responsibility for a misdeed on a perceiver's emotions and behavior by determining the variables' impact on the perceiver's emotional reactions and willingness to help the target. A total of 134 Germans and 171 Americans were given information about the level of responsibility (low, medium, or high) for a person's infection with HIV, 2 variations of information about the target's personality (positive vs. negative), and the transmission mode of the virus (needle vs. unsafe sex). Although B. Weiner's (1995) model of responsibility partially explained the findings, the results showed that the target's personality also contributed to the perceiver's emotional and behavioral reactions.

Thrombolytic therapy for acute myocardial infarction

Numerous factors must be considered when determining the formulary status of thrombolytic agents for the treatment of acute myocardial infarction. Defined treatment options, predicted outcomes, and the economic consequences of this disorder continue to evolve from clinical trials. Pharmacists have a major role in delivering patient care, with responsibility for evaluating, procuring, and monitoring thrombolytic agents and drug therapy in general. By participating in the development and implementation of treatment guidelines, evaluating economic and therapeutic outcomes, providing timely optimal drug therapy, and educating health care providers and the public, they contribute significantly to the health care team.

Pharmacologic prophylaxis of supraventricular tachyarrhythmias after coronary artery bypass

Coronary artery bypass surgery is an accepted treatment for patients with coronary artery disease. Perioperative morbidity includes development of supraventricular arrhythmias. To prevent this, prophylactic administration of drugs such as calcium channel blockers, digoxin, and beta-blockers have been advised.

Efficacy and safety of pravastatin in the treatment of patients with type I or type II diabetes mellitus and hypercholesterolemia

PURPOSE

Patients with type I and type II diabetes mellitus have an increased risk of coronary heart disease. In many diabetics, hypercholesterolemia is present and further exacerbates this risk. We investigated the efficacy and safety of pravastatin in the treatment of patients with type I or type II diabetes mellitus and hypercholesterolemia.

PATIENTS AND METHODS

In this 24-week, multi-center, double-blind, placebo-controlled study, 94 patients (45 men, 49 women), 18 to 70 years of age, with type I or type II diabetes mellitus and hypercholesterolemia (fasting plasma low-density lipoprotein cholesterol [LDL-C] levels > 150 mg/dL and above the 75th percentile for the US population by age and gender) were randomized to receive pravastatin 20 mg hs or matching placebo. Two patients were randomized to treatment with drug for every 1 randomized to placebo. The dose could be doubled after 10 weeks, and cholestyramine or colestipol could be added after 18 weeks, as needed, to attempt to lower the LDL-C levels to below the 50th percentile for the US population.

RESULTS

Significant reductions in LDL-C (-27.6%), total cholesterol (-22.1%), very-low-density lipoprotein cholesterol (-22.6%), and triglycerides (-12.8%) (P < or = 0.001 versus placebo for all reductions), and significant increases in high-density lipoprotein cholesterol (4.4%) (P < or = 0.05 versus placebo) were noted in the pravastatin treatment group (average dose 29.5 mg) at 16 weeks. The beneficial lipid-lowering effects of pravastatin were maintained throughout the 24 weeks of the study. Pravastatin was well tolerated, and the frequency of side effects was similar in the pravastatin and placebo groups. No clinically significant changes in the control of diabetes, as assessed by fasting blood glucose levels and glycosylated hemoglobin measurements, were seen during this study.

CONCLUSION

The results of this study demonstrate that pravastatin is well tolerated and effective in lowering total cholesterol and LDL-C in patients with type I or type II diabetes mellitus and hypercholesterolemia.

On sin versus sickness. A theory of perceived responsibility and social motivation

Lack of effort as a cause of achievement failure evokes more punishment than does lack of ability. Perceptions of the controllability of these causes, inferences about personal responsibility, and affective reactions of sympathy and anger mediate between the causal perceptions of ability and effort and punishment responses. This general theory of social motivation explains some reactions to stigmatized persons as well as observations related to help giving, peer rejection, and aggression. The proposed conceptual system distinguishes the reactions to sin versus sickness.

Thrombolytic agents in critical care

Thrombolytic therapy, when instituted early in optimum dosage, has had an important role in improving the survival of critically ill patients. Thrombolysis is but one component of the processes associated with hemostasis, the mechanism by which humans are protected from death by hemorrhage following injury to a blood vessel. The natural process of thrombolysis is mediated by plasmin, the primary protein responsible for clot lysis. Recent studies have established the efficacy of the intravenous administration of thrombolytic agents in decreasing mortality and improving patient outcome.

A new method to assess contact lens care compliance

Failure to comply with contact lens care instructions is a conspicuous finding among both symptomatic and asymptomatic patients. We used a new methodology to quantify the extent of noncompliance and its clinical significance among 170 soft lens wearers. All patients were interviewed and asked to demonstrate their lens care practices. The significance of deviations from package insert instructions was assessed by 22 ophthalmologists and optometrists with regard to potential impact on safety and comfort. Virtually all patients were noncompliant with at least one required procedure. Noncompliant behavior that could significantly affect safety was more common and judged by practitioners to be of more concern than deviations that could affect comfort. Fifty-seven percent of the patients used disinfection procedures that could seriously affect safety. Overall, the study methodology was found to be very effective both for quantifying noncompliance and for evaluating its clinical significance.

Color Doppler mapping of aortic regurgitation in aortic stenosis: comparison with angiography

Color flow Doppler mapping has become the principal noninvasive method used for the qualitative grading of aortic regurgitation (AR). However, the performance of the color Doppler method in patients with AR accompanying aortic stenosis (AS) has not been studied. We therefore compared results of color Doppler and semiquantitative angiographic grading of AR in 32 patients with AS (mean valve area = 0.7 cm2) undergoing supravalvular aortography in the course of cardiac catheterization. Color Doppler demonstrated AR in all 27 patients who had AR by aortography. As expected, neither the maximal jet area nor the jet length discriminated patients by angiographic grade. The best correlation between color Doppler and aortography occurred when the ratio of maximal jet height (JH) to left ventricular outflow tract (LVOT) height was used to grade AR on a scale of 0-4. Four of 5 patients without AR by aortography had either absent or grade 1 AR by color Doppler. Although there was considerable overlap of color Doppler grades in patients with 1+ AR by aortography, grade 3 or 4 AR by color Doppler was always associated with III+ or IV+ AR by aortography. Thus, color Doppler sensitively depicts AR in patients with AS, and the ratio of JH to LVOT height by color Doppler correctly identifies patients with III+ or IV+ AR by aortography. Methods for distinguishing among milder grades require further evaluation.

Hemodynamic effects of antidysrhythmic drugs

Antidysrhythmic medications, when administered in the clinical setting, demonstrate a variety of effects on cardiac electrophysiology, inotropy, and peripheral vascular smooth muscle. The resultant hemodynamic effects may be of profound importance to the clinical well-being of the patient being treated for dysrhythmias. The following review will discuss the hemodynamic effects of the Class I agent moricizine; Class IA agents: quinidine, procainamide hydrochloride, and tocainide hydrochloride; Class IC agents: flecainide acetate, encainide hydrochloride, and propafenone; Class II agents: propranolol hydrochloride, esmolol hydrochloride, and acebutolol; Class III agents: bretylium tosylate and amiodarone hydrochloride; as well as the Class IV agent verapamil. Adenosine, an unclassified antidysrhythmic indicated in the treatment of supraventricular tachycardia will also be discussed. Specific attention will be directed toward the use of these agents in patients with left ventricular dysfunction or history of congestive heart failure.

Coronary artery bypass surgery: outcome assessment

Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life. Subsets of patients have also been shown to have improved survival. With new surgical techniques aimed at improvement in flow to the areas of ischemic myocardium, even better results can be expected. Future studies will determine the extent of this improvement in quality of life over time and will serve to predict for which patients early surgical intervention will be most beneficial.

Distinguishing elation, gladness, and joy

On the basis of a structural analysis of the emotions, descriptive items were created that were postulated to discriminate between elation, gladness, and joy. The items described the situation of each emotion, the different ways in which the body was transformed, the propensity to behave in particular ways, and the different manner in which the emotions functioned to improve the person's life. In the first study, the items were given to subjects who had been asked to recall an instance of elation, gladness, or joy. Ss noted the extent to which each of the items pertained to their particular experience. Analyses of the data establish clear distinctions between elation and gladness and suggest that there may also be a distinct structure for joy. In the second study, the situations for elation and gladness were experimentally created, and objective measures of bodily transformation and behavioral propensity were taken while subjects were in the different emotional states. The results confirmed the structural differences suggested by the retrospective accounts.

Second generation antidysrhythmic agents

Several new antidysrhythmic agents have been or are about to be approved for the prevention and/or treatment of life-threatening or symptomatic ventricular arrhythmias. Prior to use in clinical practice, however, their relative risk/benefit ratio must be assessed. Whereas relief of bothersome symptoms of ventricular dysrhythmias may improve the patient's return to a more active role in society, one must be aware, at the same time, that these antidysrhythmics have adverse effects of their own that may significantly limit their effectiveness. None of these new antidysrhythmic agents has been shown to prevent suddent cardiac death in controlled trials. At the present time, studies are being conducted to assess the efficacy of these agents in preventing sudden cardiac death. The new antidysrhythmic agents are highly effective in treating a wide variety of ventricular, and in some cases, supraventricular dysrhythmias. These agents are orally effective and, because of their unique pharmacokinetic profile, can often be prescribed less often per day than first generation antidysrhythmics. Side effects, for the most part, are predictable and involve the gastrointestinal and central nervous systems. In most cases, such side effects are reversible with dosage reduction. Upon treating a patient for a potentially lethal dysrhythmia, a Class IC agent such as encainide, flecainide, or propafenone, may be considered as the first-line therapy. Class IB agents, although less effective when used alone, show augmented antidysrhythmic efficacy with a reduction in side effects when administered concomitantly with a Class IA agent, such as quinidine or procainamide.(ABSTRACT TRUNCATED AT 250 WORDS)