The Peabody Picture Vocabulary Test: What Does it Measure?

There has been some question as to what the Peabody Picture Vocabulary Test measures. Although research indicates it has inadequate validity as a test of intelligence, other studies indicate it is an adequate measure of language ability. The present study correlated and factor analyzed the results from the Peabody test with results from a measure of linguistic and intellectual functioning. The analysis indicates that the test is not an adequate measure of either linguistic or intellectual abilities.

A large multicenter study analysis of adverse events associated with single operator cholangiopancreatoscopy

AIM

Cholangiopancreatoscopy (CP) is an endoscopic technique that allows for direct visualization of the biliary and pancreatic ducts using a narrow caliber endoscope that passes through the working channel of a duodenoscope directly into the bile and/or pancreatic ducts. Little data is available on the safety of CP. We performed a multicenter retrospective study to evaluate the frequency and severity of adverse events with single operator CP.

METHODS

A multicenter retrospective study was conducted.

RESULTS

A total of 282 single operator peroral CP procedures were performed in 224 patients (128 M, 96 F). Most procedures involved the performance of therapeutic maneuvers, with most cases including multiple therapeutic maneuvers. Cholangioscopic or pancreatoscopic-assisted tissue sampling was performed in 222 procedures. Thirty-seven patients underwent electrohydraulic lithotripsy (EHL) for the treatment of common bile duct stones. Adverse events in patients undergoing single cholangioscopy and pancreatoscopy included post-ERCP pancreatitis (N.=11, 3.9%, all mild), post-ERCP cholangitis (N.=4, 1.4%), bleeding (N.=3, 1%), and perforation (N.=2, 0.7%).

CONCLUSION

Overall, our data shows that ERCP performed with single operator cholangioscopy or pancreatoscopy is safe with adverse events similar to that seen in large studies of ERCP performed without these additional techniques. Of note, vigorous irrigation of the bile ducts was not associated with increased rates of post-procedure cholangitis in our study.

Selective mechanisms for complex visual patterns revealed by adaptation

A great deal is known about the initial steps of visual processing. We know that humans have neural mechanisms selectively tuned to simple patterns of particular spatial frequencies and orientations. We also know that much later in the visual pathway, in inferotemporal cortex, cells respond to extremely complex visual patterns such as images of faces. Very little is known about intermediate levels of visual processing, where early visual signals are presumably combined to represent increasingly complex visual features. Here we show the existence of visual mechanisms in humans, tuned and selective to particular combinations of simple sinusoidal patterns, using a novel method of compound adaptation.

Are endometrial polyps from pre-menopausal women similar to post-menopausal women? An immunohistochemical comparison of endometrial polyps from pre- and post-menopausal women

OBJECTIVE

Do endometrial polyps from pre- and post-menopausal women have similar immunohistochemical expression of oestrogen and progesterone receptors (ER, PR) and markers of cellular proliferation/apoptosis (Ki67 and Bcl-2).

DESIGN

Prospective cohort study. Non-parametric statistical analysis was used.

SETTING

Polyps recruited from women attending an out-patient hysteroscopy clinic in a UK district general hospital.

PATIENTS

Fourteen pre-menopausal and 16 post-menopausal women who presented with abnormal bleeding with endometrial polyps.

INTERVENTIONS

Immunohistochemical staining was performed on endometrial polyps.

MAIN OUTCOME MEASURES

Significant differences or correlations between hormone receptor expression (oestrogen and progesterone) and cell growth indices (Ki67 and Bcl-2).

RESULTS

Endometrial polyps from pre- and post-menopausal women had significant differences in their expression of hormone receptors and Ki67. However, polyps from both groups of women had similarly increased levels of Bcl-2, an inhibitor of apoptosis.

CONCLUSIONS

Pre- and post-menopausal polyps exhibit differing hormone receptor and proliferation markers, presumably a result of their hormonal milieu. However, both groups appear to have lost the usual control mechanisms for apoptotic regulation, this appears to be responsible for their growth.

An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to HRT

OBJECTIVE

Our study set out to test the null hypothesis that oestrogen containing continuous combined hormone replacement therapy (HRT) would not affect the hormone receptor expression (oestrogen and progesterone receptors-ER, PR) or markers of cell proliferation/apoptosis (Ki67 and Bcl-2) in endometrial polyps from postmenopausal women exposed and not exposed to HRT.

DESIGN

Immunohistochemical staining for ER, PR, Ki67 and Bcl-2 was performed on polyps obtained from two groups of postmenopausal women.

SETTING

Polyps were obtained from postmenopausal women attending an outpatient hysteroscopy clinic in a district general hospital (Bradford Royal Infirmary, UK).

POPULATION

Twenty-five postmenopausal women presenting with abnormal bleeding subsequently diagnosed with endometrial polyps (16 from women not exposed to HRT, 9 from women exposed to HRT).

METHODS

Semiquantitative immunohistochemistry was performed.

MAIN OUTCOME MEASURES

Significant differences or correlations in either hormone receptor expression or markers of cell proliferation/apoptosis between the two groups of polyps.

RESULTS

There were no significant differences for hormone receptor expression (ER and PR) between endometrial polyps exposed and not exposed to HRT. Bcl-2 expression was higher than Ki67 in both groups, but polyps from HRT users had increased levels reflecting decreased apoptosis in these polyps.

CONCLUSIONS

HRT has no demonstrable effect on polyp ER and PR expression. However, HRT does appear to inhibit apoptosis and cell proliferation in endometrial polyps, which may affect polyp growth.

Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps? An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen

OBJECTIVE

This study set out to test the null hypothesis that tamoxifen therapy would not affect the hormone receptor expression (oestrogen and progesterone receptors-ER and PR) or markers of cell proliferation/apoptosis (Ki67 and Bcl-2) of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen.

METHODS

Endometrial polyps were prospectively obtained from women presenting with abnormal bleeding attending an out-patient hysteroscopy clinic who subsequently underwent endometrial polypectomy (16 from postmenopausal women not exposed to tamoxifen, 9 from women exposed to tamoxifen). Immunohistochemical staining for ER, PR, Ki67 and Bcl-2 was performed on polyps from both groups of women. Non-parametric statistical analysis was used (Mann-Whitney and Spearmans rank correlation).

RESULTS

Endometrial polyps from tamoxifen users had significantly lower oestrogen receptor but increased progesterone receptor and Bcl-2 expression. There were no significant differences for proliferation markers (Ki67) between postmenopausal endometrial polyps exposed and not exposed to tamoxifen.

CONCLUSIONS

Tamoxifen has a significant affect on hormone receptor expression and markers of apoptosis in endometrial polyps. The results support the hypothesis that tamoxifen promotes polyp growth by inhibiting apoptosis. The mechanism for this does not appear to be oestrogen receptor mediated.

Salmonella typhimurium translocates flagellin across intestinal epithelia, inducing a proinflammatory response

This study investigated whether soluble paracrine factors mediated Salmonella-induced IL-8 expression in polarized model intestinal epithelia. We found that the basolateral media of model epithelia that had been apically infected with Salmonella typhimurium for a short period (10 minutes) could activate IL-8 secretion in virgin model epithelia, demonstrating that a proinflammatory factor (PIF) was indeed present. Initial characterization found that PIF was a heat-stable protein with a molecular mass of about 50 kDa that acts on the basolateral, but not apical, surface of model intestinal epithelia to elicit IL-8 secretion. PIF was not present in the media of model epithelia stimulated with other inducers of IL-8 secretion (TNF-alpha or carbachol) but was present in S. typhimurium supernatants, indicating PIF is of bacterial origin. PIF was purified from bacterial culture supernatants by anion/cation exchange chromatography and SDS-PAGE and found by using microsequencing to be the protein flagellin. In support of this finding, flagellin-deficient S. typhimurium mutants did not secrete detectable levels of PIF (i.e., a bioactivity that induced IL-8 secretion when placed basolaterally on model epithelia). Furthermore, viable flagellin-deficient mutant organisms (fliC/fljB and flhD) failed to elicit IL-8 secretion when added apically to model intestinal epithelia. These findings indicate that translocation of flagellin across epithelia, subsequent to apical epithelial-S. typhimurium interaction, is likely a major means of activating a mucosal inflammatory response.

Structural requirements for the specific recognition of an m7G mRNA cap

7-Methylguanosine (m(7)G), also known as the mRNA "cap", is used as a molecular tag in eukaryotic cells to mark the 5' end of messenger RNAs. The mRNA cap is required for several key events in gene expression in which the m(7)G moiety is specifically recognized by cellular proteins. The configurations of the m(7)G-binding pockets of a cellular (eIF4E) and a viral (VP39) cap-binding protein have been determined by X-ray crystallography. The binding energy has been hypothesized to result from a pi-pi stacking interaction between aromatic residues sandwiching the m(7)G base in addition to hydrogen bonds between the base and acidic protein side chains. To further understand the structural requirements for the specific recognition of an m(7)G mRNA cap, we determined the effects of amino acid substitutions in eIF4E and VP39 cap-binding sites on their affinity for m(7)GDP. The requirements for residues suggested to pi-pi stack and hydrogen bond with the m(7)G base were examined in each protein by measuring their affinities for m(7)GDP by fluorimetry. The results suggest that both eIF4E and VP39 require a complicated pattern of both orientation and identity of the stacking aromatic residues to permit the selective binding of m(7)GDP.

Induction of the cellular E2F-1 promoter by the adenovirus E4-6/7 protein

The adenovirus type 5 (Ad5) E4-6/7 protein interacts directly with different members of the E2F family and mediates the cooperative and stable binding of E2F to a unique pair of binding sites in the Ad5 E2a promoter region. This induction of E2F DNA binding activity strongly correlates with increased E2a transcription when analyzed using virus infection and transient expression assays. Here we show that while different adenovirus isolates express an E4-6/7 protein that is capable of induction of E2F dimerization and stable DNA binding to the Ad5 E2a promoter region, not all of these viruses carry the inverted E2F binding site targets in their E2a promoter regions. The Ad12 and Ad40 E2a promoter regions bind E2F via a single binding site. However, these promoters bind adenovirus-induced (dimerized) E2F very weakly. The Ad3 E2a promoter region binds E2F very poorly, even via a single binding site. A possible explanation of these results is that the Ad E4-6/7 protein evolved to induce cellular gene expression. Consistent with this notion, we show that infection with different adenovirus isolates induces the binding of E2F to an inverted configuration of binding sites present in the cellular E2F-1 promoter. Transient expression of the E4-6/7 protein alone in uninfected cells is sufficient to induce transactivation of the E2F-1 promoter linked to chloramphenicol acetyltransferase or green fluorescent protein reporter genes. Further, expression of the E4-6/7 protein in the context of adenovirus infection induces E2F-1 protein accumulation. Thus, the induction of E2F binding to the E2F-1 promoter by the E4-6/7 protein observed in vitro correlates with transactivation of E2F-1 promoter activity in vivo. These results suggest that adenovirus has evolved two distinct mechanisms to induce the expression of the E2F-1 gene. The E1A proteins displace repressors of E2F activity (the Rb family members) and thus relieve E2F-1 promoter repression; the E4-6/7 protein complements this function by stably recruiting active E2F to the E2F-1 promoter to transactivate expression.

Nucleolar Arf sequesters Mdm2 and activates p53

The Ink4/Arf locus encodes two tumour-suppressor proteins, p16Ink4a and p19Arf, that govern the antiproliferative functions of the retinoblastoma and p53 proteins, respectively. Here we show that Arf binds to the product of the Mdm2 gene and sequesters it into the nucleolus, thereby preventing negative-feedback regulation of p53 by Mdm2 and leading to the activation of p53 in the nucleoplasm. Arf and Mdm2 co-localize in the nucleolus in response to activation of the oncoprotein Myc and as mouse fibroblasts undergo replicative senescence. These topological interactions of Arf and Mdm2 point towards a new mechanism for p53 activation.

Assessing the individual with asthma

Seven to 20 million Americans have asthma. Deaths related to asthma have increased 46% from 1980 to 1989. Individuals with asthma who are at risk for adverse outcomes are those who have low incomes and poor access to health care, have psychosocial problems, and do not understand or fail to follow treatment regimens. Additional risk factors include hospitalization within the past year, a previous near-fatal asthma attack, and a history of intubation for asthma. Assessment and appropriate treatment can prevent fatalities associated with asthma, especially in the home setting.

Interpretation of arterial blood gases by nurses

Many clinical nurses find the concept of acid/base balance confusing. This article presents a step-by-step approach to arterial blood gas (ABG) analysis. In addition, the components of ABGs (pH, PCO2 and HCO3) are presented; metabolic and respiratory abnormalities (acidosis and alkalosis) are discussed in relation to cause and signs and symptoms; the concept of compensation is reviewed; the degrees of compensation are explained; the five steps of ABG analysis are outlined; and practice problems are provided and explained. By using this approach, the nurse can analyze the ABG values confidently and make a wise choice about appropriate nursing actions.

Caring for the patient with a gastrostomy/jejunostomy tube

A gastrostomy or jejunostomy (G or J) tube is useful for feeding malnourished patients and is preferred to prolonged use of total parenteral nutrition. Because enteral feeding has become commonplace in both the hospital and home setting, it is vital that health care workers instruct caregivers on the treatment of individuals with G tubes and/or J tubes. Many problems can be prevented when caregivers know how to care for the patient and troubleshoot potential concerns.

Androgen regulation of ribosomal RNA synthesis in LNCaP cells and rat prostate

Androgen-dependent growth of prostate tissue has been well documented. An additional prerequisite for cellular growth is the accumulation of ribosomes. It is thus reasonable to hypothesize that ribosomal DNA (rDNA) transcription in prostate tissue must be stimulated by androgen either directly or indirectly. This hypothesis was tested using both LNCaP cells, an androgen-dependent tissue culture line and in a rat animal model. Nuclear run-on assays confirmed that the administration of DHT to LNCaP cells resulted in a two- to three-fold increase in the rate of rRNA synthesis when compared to cells maintained in the absence of androgen. Enzymatic analysis and Western blots were carried out to measure the amount (activity and mass) of RNA polymerase I in DHT treated LNCaP cells. These assays demonstrated that neither the catalytic activity of RNA polymerase I nor the amount of the enzyme varied in response to DHT. However, Western blots revealed that the amount of the auxiliary RNA polymerase I transcription factor UBF, was significantly increased (two- to three-fold) in cells grown in the presence of DHT. Similar experiments were carried out with prostatic tissue obtained from orchiectomized rats maintained on either placebo or testosterone pellets. In this model, both the catalytic activity as well as the amount of RNA polymerase I protein decreased. However, in agreement with the tissue culture model, UBF protein decreased in prostates from orchiectomized rats and was maintained in animals supplemented with testosterone. These lines of evidence are consistent with the hypothesis that androgens stimulate rRNA synthesis by increasing the quantities of the components of the rDNA transcription system.

Activity of RNA polymerase I transcription factor UBF blocked by Rb gene product

The protein encoded by the retinoblastoma susceptibility gene (Rb) functions as a tumour suppressor and negative growth regulator. As actively growing cells require the ongoing synthesis of ribosomal RNA, we considered that Rb might interact with the ribosomal DNA transcription apparatus. Here we report that (1) there is an accumulation of Rb protein in the nucleoli of differentiated U937 cells which correlates with inhibition of rDNA transcription; (2) addition of Rb to an in vitro transcription system inhibits transcription by RNA polymerase I; (3) this inhibition requires a functional Rb pocket; and (4) Rb specifically inhibits the activity of the RNA polymerase I transcription factor UBF (upstream binding factor) in vitro. This last observation was confirmed by affinity chromatography and immunoprecipitation, which demonstrated an interaction between Rb and UBF. These results indicate that there is an additional mechanism by which Rb suppresses cell growth, namely that Rb directly represses transcription of the rRNA genes.

Anterior lumbar fusion: results, assessment techniques and prognostic factors

One hundred and fifty-one patients underwent anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76%. The method of outcome assessment profoundly affected the results; whereas 68% of patients rated themselves as significantly improved by the procedure, only 40% achieved a good or excellent result on the more objective low-back outcome score. Patients who underwent a second procedure did not do well, and "salvage" surgery is not recommended. Posterior distraction instrumentation neither increased the rate of union nor improved the final results. The rate of fusion was influenced by the presence of a compensation claim. Compensation status and psychological disturbance at presentation were significant prognostic factors. Psychological disturbance at review had a profound effect on the outcome and patient satisfaction ratings. It is recommended that future studies employ a recognised outcome score and that the analysis specifically includes compensation status and psychological disturbance.

Anterior lumbar fusion. A comparison of noncompensation patients with compensation patients

One hundred fifty-one patients had an anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76% of the patients. Of patients unemployed before surgery, 50% had returned to work at review. Sixty-eight percent of patients rated themselves as significantly improved by the procedure. Posterior distraction instrumentation neither increased the rate of union nor improved the final results. Compensation status and psychological disturbance at presentation were significant prognostic factors. Psychological disturbance at review had a profound effect on the outcome and patient satisfaction ratings. It is recommended that in future studies compensation status and psychological disturbances are explicitly included in the outcome statistics.

Introduction of laboratory based ward liaison surveillance of hospital infection into six district general hospitals

A previous study demonstrated that laboratory based ward liaison surveillance (LBWLS) of hospital infection was an effective and efficient method. The method involved the follow-up of positive microbiology reports by the review of patient records and liaison with ward nursing staff to consider whether any patients had infection. Here we report the introduction of LBWLS into six district general hospitals to determine whether it is feasible to use this method on an everyday basis. The time required for data collection was assessed and the method was compared with a reference method in one hospital to check its ability to detect infections. To assess reproducibility two infection control nurses (ICNs) performed LBWLS independently, but concurrently, for 5 weeks. The method could be used in all hospitals studied; however, the time for data collection ranged from 3.0 to 6.8 h/100 beds per week. In comparison with the reference method, LBWLS detected 15/41 (37%) of community acquired infections and 30/43 (70%) of hospital acquired infections. In the reproducibility assessment 72 patients were identified by both ICNs. There was agreement about the infected/non-infected status of 65 of these patients. The mean pair agreement and Kappa statistic were 0.88 and 0.72. Laboratory based ward liaison was readily used in all hospitals and was reproducible.

Rheological basis of oral characteristics of fluid and semi-solid foods: a review

Oral viscosity plays an important role in the textural appreciation of fluid and semi-solid foods. Oral assessments of viscosity, thickness, stickiness and sliminess correlate with both small-deformation and large-deformation rheological measurements. Small-deformation measurements of viscosity at an oscillatory frequency of 50 rad.s-1 have the highest correlation with assessed thickness of texture but there is still much speculation as to what forces actually operate in the mouth.

A clinical trial of prostaglandin E2 in recurrent aphthous ulceration

Thirty-five patients suffering from minor recurrent aphthous ulceration (RAU) entered a single-phase double-blind clinical trial of treatment with topical prostaglandin E2 (PGE2). The PGE2 was applied as a gel at a dose of 0.3 mg twice daily for 10 days. The vehicle alone acted as control. Patients were examined on days 1, 3, 5, 7 and 10 and also maintained daily diary cards. Of the 33 patients (94%) who completed the study, 18 had been allocated the active PGE2 and 15 the placebo. The two volunteers who failed to complete were excluded on technical grounds related to the strict study design and did not withdraw on the basis of adverse reactions to the trial preparation. Patients using the active PGE2 gel experienced significantly fewer new lesions than those on placebo (P < 0.05) over the 10-day trial period. There were no significant differences between the PGE2 and placebo gels in terms of speed of healing or pain relief of established aphthous ulcers. Prostaglandin E2 may, therefore, have useful prophylactic activity in RAU.

An evaluation of surveillance methods for detecting infections in hospital inpatients

Eight selective surveillance methods were compared with a reference method for their ability to detect hospital infections in patients was also assessed. In the reference method, case records were reviewed three times a week, and during the 11-month period of study, 668 infections were identified amongst 3326 patients. Three hundred and thirty-eight were community acquired infections (CAI) and 330 were hospital acquired infections (HAI). The time for data collection was 18.1 h per 100 beds per week. Of the selective surveillance methods, those based on the review of treatment and temperature charts detected the highest proportion (70%) of CAI; and the review of microbiology reports with regular ward liaison identified the highest proportion (71%) of HAI. The time for data collection in the eight methods ranged from 1.2 h per 100 beds per week to 6.5 h per 100 beds per week. After considering the sensitivity for identifying patients with HAI and time for data collection, the review of microbiology reports with regular ward liaison was judged to be an effective and efficient method of surveillance.

An 11-month incidence study of infections in wards of a district general hospital

Between March 1988 and January 1989, an incidence study of infections in patients occupying 122 beds in a district general hospital was undertaken. Nursing notes, medical notes, temperature charts, drug prescription charts and laboratory information were reviewed three times a week to determine if patients had infection which met strict case definitions. In addition, the surveyor consulted with ward nursing and medical staff for clarification of symptoms and signs indicative of infection. During the study, 668 infections were identified amongst 3326 patients. Three hundred and thirty-eight (51%) were community-acquired infections (CAI) and 330 hospital-acquired infections (HAI). Excluding 24 HAI acquired in other hospitals, the incidence rates were 9.2 HAI per 100 discharges, and 1.1 HAI per 100 patient days. The common types of CAI were pneumonia, abdominal infection and urinary tract infection. The main types of HAI were urinary tract infection, surgical wound infection and pneumonia. The microorganisms most frequently associated with CAI and HAI were Gram-negative bacilli.

A double blind placebo controlled trial of recombinant tissue plasminogen activator in the treatment of digital ischemia in systemic sclerosis

The treatment of digital ischemia in systemic sclerosis remains inadequate. We report a double blind, placebo controlled trial of recombinant tissue plasminogen activator (rtPA), a potent thrombolytic agent. Ten patients received rtPA. A potent, acute fibrinolytic effect was observed. During the infusion of rtPA, improvements in skin blood flow were seen. These improvements were shortlived.

A survey of mentor relationships in academe

The purpose of this study was to assess the frequency, characteristics, and importance of the mentor-protege relationship among 477 female nurse academicians. This descriptive study consisted of a self-administered questionnaire packet of a demographic data sheet and a modified format of five mentor scales developed by Gilbert (1985) and Pierce (1983). Findings indicated that a majority (60 per cent) of respondents had one or more mentors. This study profiled the mentor by addressing the following: mentor behaviors, characteristics of the mentor-protege relationships, power and achievement characteristics of the mentor, personal qualities of the mentor, and proteges' achievements. Mentor behaviors reported as occurring most frequently were: discussion of strategies to handle professional situations (49.1 per cent), observing the mentor in professional situations (44.9 per cent), and providing opportunities for participation in professional activities (40.9 per cent). Concerning characteristics of the mentor-protege relationship, it was important for mentors to value proteges as people (72.1 per cent), provide professional advice when needed (66.4 per cent), and believe in the potential of the protege (62.3 per cent). Power and achievement characteristics reported by the protege to be very important included mastery of concepts and ideas (55.2 per cent) and capacity to work hard (52.1 per cent). The personal qualities of the mentor of greatest importance to the proteges were integrity (81.3 per cent), professional values (72 per cent), and trustworthiness (74 per cent). The elements rated as very important in relation to the protege's achievement were gaining confidence (49.3 per cent), enjoying work (42.7 per cent), and resolving conflicts (37.5 per cent).

Increased production of tumour necrosis factor by peripheral blood leukocytes in patients with recurrent oral aphthous ulceration

Much evidence suggests that recurrent oral aphthous ulceration (RAU) is an immunologically mediated disease. Tumour necrosis factor has multiple biologic properties, some of which may be relevant to the pathogenesis of RAU. This study has assessed its production by peripheral blood leukocytes from aphthous patients in active and remission phases of disease and from patients with nonaphthous ulceration (diseased controls). Each ulcer patient was studied in parallel with a matched healthy control volunteer. A bioassay against the standard mouse fibrosarcoma line, L929, was used to assess the levels of tumour necrosis factor-alpha (TNF). Significantly greater amounts of TNF were released from unstimulated monocyte-enriched and monocyte-depleted leukocyte fractions in active RAU compared with those from healthy control donors, suggesting that this cytokine may be associated with RAU.

Skin blood flow and limited joint mobility in insulin-dependent diabetes mellitus

Hand skin blood flow in 32 insulin-dependent (IDDM) diabetics was compared with 13 healthy controls at room temperature and after immersion of the hands in warm and cold water. Subjects were examined for limited joint mobility (LJM) to analyse the association between this and blood flow. Digital arteries remained patent in IDDM compared to controls after cold challenge (p = 0.0001), and the difference persisted to a lesser degree 15 min (p = 0.009) and 30 min (p = 0.03) after recovery. Capillary blood flow was reduced in IDDM at room temperature at the finger nailbeds (p less than 0.02) and the palms (p = 0.004) and remained so after warm water immersion in the palms (p = 0.002), where further vasoconstriction was observed immediately after cold water immersion (p less than 0.001) and 15 and 30 min into recovery (p = 0.07 and p = 0.009 respectively). Thermographic analysis confirmed a pattern of predominantly distal rewarming after cold challenge in IDDM with a greater mean index finger temperature than the controls. Together, these features suggested enhanced arteriovenous anastomotic blood flow. All IDDM and IDDM males with LJM had reduced palm capillary flow immediately after cold challenge (p less than 0.05). After warm water (p less than 0.03) and 30 min after cold challenge (p less than 0.05) IDDM males with LJM had reduced palm capillary flow compared to those IDDM without. A microvascular aetiology for LJM is proposed by virtue of reduced nutritional blood flow and evidence of enhanced arteriovenous shunting in the hands of insulin-dependent diabetics.

Altered hand skin blood flow in type 1 (insulin-dependent) diabetes mellitus

Disturbed upper limb skin blood flow has been described in insulin-dependent (Type 1) diabetes mellitus, but the pathophysiological mechanism remains unclear. Hand skin blood flow was therefore measured at room temperature and following immersion of hands in cold and warm water in 13 healthy control subjects, in 10 patients with Type 1 diabetes mellitus and cardiovascular autonomic neuropathy, and a further 10 Type 1 diabetic patients with normal cardiovascular autonomic tone. Following cold challenge there was failure of digital artery clampdown in all diabetic patients in comparison with healthy control subjects (p less than 0.005), and the index finger temperature fell less (p less than 0.05). Laser Doppler flow was reduced at the palms at room temperature or following the warm challenge (p less than 0.008), as well as on the dorsum at room temperature (p less than 0.05), in all diabetic patients. In addition laser Doppler flow in the diabetic patients was reduced at the palms and dorsum immediately following cold water challenge (p less than 0.004) and this reduction persisted 15 min (p less than 0.05) and 30 min (p less than 0.01) into the recovery phase. In comparison to those diabetic patients with normal cardiovascular tone, those with cardiovascular autonomic neuropathy had reduced laser Doppler flow at the pulp 15 min after cold water immersion (p less than 0.05), at the nailbed immediately after cold water immersion (p less than 0.01), and at the palms immediately after warm water challenge (p less than 0.01).

Irreducible dislocation of the subtalar joint: a report of two cases

Two patients with irreducible lateral dislocation of the subtalar joint are reported. In both patients the injury was closed and associated with a lateral calcaneal fracture. Open reduction confirmed the tendon of tibialis posterior was located around the lateral aspect of the neck of the talus and prevented reduction.

Stress and anxiety in the disabled patient

This article focuses on patients' feelings of anxiety and fear and the relationship of these feelings to stress. A model is described that identifies four steps in the perception of environmental stress and the emotional responses to it. A second model describes the stages of responses to stress. Both models are applied to the patient experience, and suggestions are offered for basic facilitative physical therapist behaviors. A strong request is made for physical therapists to observe the affective behavior of patients, perceive it in the context of stress, and respond effectively.

Undocumented Mexican immigrants and the earnings of other workers in the United States

This article examines the effects of undocumented Mexican immigrants on the earnings of other workers in geographical labor markets in the Southwest. The number of undocumented Mexicans included in the 1980 census in southwestern SMSAs is estimated. We then estimate the parameters of three specifications of a generalized Leontief production function with various demographic groups as substitutable factors. The statistically significant effects of undocumented Mexicans on the earnings of other groups are positive, but of slight magnitude. Legal immigrants' effects on native white earnings, however, are small and negative. The results are consistent with the possibility that undocumented Mexican immigrants' jobs complement those of other workers. The implications for public policy concerns about the effects of illegal Mexican immigration are discussed.

Musculoaponeurotic fibromatosis. A report of 28 cases and review of the literature

Although musculoaponeurotic fibromatosis (MAF) is a well-recognized entity, it still provides a histologic diagnostic enigma, particularly in its distinction from a well-differentiated fibrosarcoma. The lesion is histologically identical to a desmoid tumor. The lesion appears as a firm swelling in a limb or limb girdle, with a rare incidence of pain. Although it is more common in the second to fourth decades (premenopausal women predominantly), it does occur in children. The sex incidence in children is equal. A multicentric pattern of behavior may be evident. The mainstay of treatment has been surgical excision of varying extent. Local excision, even if radical, may be followed by up to a 65% recurrence rate. In this review, 40% of the cases had more than one recurrence. Recent evidence suggests radiotherapy, which has been reserved for inoperable lesions, may be of value as an adjunct to primary treatment. Limited local excision with adjunctive radiotherapy may decrease recurrence rate, minimize functional deficit, and improve cosmesis. Radical local resection (compartmental or amputation) may be avoidable. In children, amputation may not result in cure because of the multicentric behavior pattern and radiotherapy may lead to growth retardation. A shorter functional upper or lower limb is preferable to an amputation stump or a limb disfigured from radical excision.

Severe spondylolisthesis and scoliosis in association with Marfan's syndrome. Case report and review of the literature

Scoliosis in Marfan's syndrome may be painful, but severe spondylolisthesis with a cauda equina tension syndrome as the cause of pain has only recently been recognized. Scoliosis may be associated with spondylolisthesis. The scoliosis may be sciatic or structural. These may be true structural curves or secondary to the asymmetric slip of the spondylolithesis. Grade 4 spondylolithesis was treated with an in situ ala-transverse fusion combined with posterior decompression. The tension signs were rapidly dissipated. A plaster spica was applied for six months. Solid fusion was achieved without progression of spondylolisthesis or further rotation. Subsequently, the structural scoliosis was treated with a two-stage anterior release and posterior Harrington fusion. The progression of spondylolisthesis in Marfan syndrome may be related to the poor quality of the surrounding musculoligamentous structures. Sciatic scoliosis resolves after fusion of the spondylolithesis. The results of in situ fusion are satisfactory. Reduction of the spondylolithesis with combined anterior and posterior fusion offers the most satisfactory basis for subsequent treatment of a structural scoliosis but carries a significant risk of neurologic damage and recurrence of slip.

Antibiotic resistance monitoring, with particular reference to methicillin-resistant Staphylococcus aureus

Two surveys of antibiotic resistance in hospital pathogens are described. The first is a long-term, multi-center, laboratory based investigation in which antibiotic resistance data from laboratories with computerized reporting is collected. The difficulties of this type of investigation are discussed and some solutions suggested. In the second investigation reports of the isolation of methicillin-resistant Staphylococcus aureus (MRSA) were collected from microbiological laboratories on a nation-wide basis. The results were useful in monitoring the spread of the organism and in its control.

Acute effects of sublingual nifedipine in patients with Raynaud's phenomenon

Measurements of peripheral blood flow using bolometry, thermography, ultrasonic Doppler index, and laser light scattering were made in nine patients with primary Raynaud's phenomenon before and after administration of 20 mg sublingual nifedipine and matching placebo. Following nifedipine treatment, there was some evidence of protection against reduction in blood flow, suggesting that this way of taking nifedipine is helpful. Self-administration of sublingual nifedipine before cold exposure may be an effective way of preventing the development of attacks of Raynaud's phenomenon in contrast with the conventional form of regular oral administration.

Painful scoliosis: a need for further investigation

Images

Excision of the proximal end of the femur for hip stiffness in myelomeningocele

Operation on the hips of patients with myelomeningocele is often followed by stiffness or ankylosis. Excision of the upper end of the femur for this condition frequently fails because of extensive new bone formation. Twelve excisions in eight patients are reported. Six of these patients had recently had spinal fusion operations; the consequent loss of ability to compensate for hip stiffness by spinal flexion had made sitting difficult or impossible. Excision or even re-excision of the upper femur failed in most cases. Careful assessment of hip mobility before spinal operations in these patients is essential and osteotomy rather than excision of the upper femur is advised.