BACKGROUND: Endothelial cell dysfunction is an early feature of vascular disease and oxidative stress may be involved in its pathogenesis. METHODS: Fifty-one children, adolescents and young people with Type 1 diabetes with no clinical diabetic angiopathy, mean age+/-SD of 16+/-4 years, diabetes duration of 8+/-5 years, and HbA(1c) of 8.5+/-1.6%, and 29 age, sex matched normal controls had blood samples assayed for E-selectin, intercellular cell adhesion molecule-1, von Willebrand Factor, red cell superoxide dismutase, plasma thiol and red cell glutathione. RESULTS: E-selectin and ICAM-1 levels were significantly higher in the diabetic patients at 72+/-24 ng/ml and 287+/-57 ng/ml, respectively vs 43+/-16 ng/ml and 248+/-71 ng/ml in the normal controls (p<0.0002 and p<0.013). Von Willebrand Factor levels were not different between the two groups. Superoxide dismutase activity was significantly higher in the diabetic group at 220+/-58 micro/ml vs 175+/-24 micro/ml in the normal controls p<0.001, and those of plasma thiol and red cell glutathione were significantly lower in the diabetic group, at 1267+/-202 micromol/l and 458+/-38 micromol/l, respectively vs 1403+/-278 micromol/l and 487+/-70 micromol/l in the controls p<0.02 and p<0.03. Levels of superoxide dismutase correlated negatively with plasma thiol, age and diabetes duration r=-0.318, p<0.02; r=-0. 328, p<0.02; and r=-0.286, p<0.05, respectively. CONCLUSION: These results confirm evidence of endothelial perturbation in young people with diabetes mellitus, and they also suggest that free radical generation may contribute to this dysfunction. This supports the hypothesis that vascular disease starts early in the course of childhood diabetes, akin to the situation in adults with diabetes.

Adolescent↗

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Pathophysiological responses following phosgene exposure in the anaesthetized pig.

This study aimed to develop a reproducible model of phosgene-induced lung injury in the pig to facilitate the future development of therapeutic strategies. Ten female young adult large white pigs were used. Following induction of anaesthesia using a halothane/oxygen/nitrous oxide mixture, arterial and venous catheters were inserted together with a pulmonary artery thermodilution catheter, and a suprapubic urinary catheter by laparotomy. Anaesthesia was maintained throughout the experiment by intravenous infusion of ketamine, midazolam and alfentanil. On completion of surgery the animals were allowed to equilibrate for 1 h and then were divided into two groups. Group 1 (n = 5) was exposed to phosgene for 10 min (mean Ct = 2443 +/- 35 mg min m(-3)) while spontaneously breathing, whereas control animals (Group 2 n = 5) were exposed to air. At 30 min post-exposure, anaesthesia was deepened in order to allow the initiation of intermittent positive pressure ventilation and the animals were monitored for up to 24 h. Cardiovascular and respiratory parameters were monitored every 30 min and blood samples were taken for arterial and mixed venous blood gas analysis and clinical chemistry. A detailed post-mortem and histopathology was carried out on all animals following death or euthanasia at the end of the 24-h monitoring period. Control animals (Group 2) all survived until the end of the 24-h monitoring period with normal pathophysiological parameters. Histopathology showed only minimal passive congestion of the lung. Following exposure to phosgene (Group 1) there was one survivor to 24 h, with the remainder dying between 16.5 and 23 h (mean = 20 h). Histopathology from these animals showed areas of widespread pulmonary oedema, petechial haemorrhage and bronchial epithelial necrosis. There was also a significant increase in lung wet weight/body weight ratio (P < 0.001). During and immediately following exposure, a transient decrease in oxygen saturation and stroke volume index was observed. From 6 h there were significant decreases in arterial pH (P < 0.01), P(a)O(2) (P < 0.01) and lung compliance (P < 0.01), whereas oxygen delivery and consumption was reduced from 15 h onwards in phosgene-exposed animals. Mean pulmonary artery pressure of phosgene-exposed animals was increased from 15 h post-exposure, with periods of increased pulmonary vascular resistance index being recorded from 9 h onwards. We have developed a reproducible model of phosgene-induced lung injury in the anaesthetized pig. We have followed changes in cardiovascular and pulmonary dynamics for up to 24 h after exposure in order to demonstrate evidence of primary acute lung injury from 16 h post-exposure. Histopathology showed evidence of widespread damage to the lung and there was also a significant increase in lung wet weight/body weight ratio (P < 0.001).

Administration, Inhalation↗

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Immune competence and survival in patients with advanced cervical cancer: peripheral lymphocyte counts.

Explore the source record for details and available documents.

Adult↗

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Hazards associated with the use of benzodiazepines in alcohol detoxification.

While benzodiazepines possess many positive attributes for the treatment of alcohol withdrawal, they are not ideal drugs. The occurrence of toxic effects is not infrequent, and unless recognized promptly, toxicity may significantly impact treatment and length of stay. Use of shorter acting benzodiazepines may result in seizure activity under certain conditions of withdrawal.

Adult↗

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Cortical visual impairment following birth asphyxia.

Visual defects are often poorly recognized in children with multiple neurologic problems due to perinatal hypoxic-ischemic encephalopathy. We report the clinical, radiologic, and electrodiagnostic characteristics of 20 children with cortical visual impairment secondary to birth asphyxia. Clinical diagnosis often was delayed. Ten patients recovered vision during the first two years of life. Four infants had coexisting damage to the pregeniculate visual pathway. Useful investigations included cranial computed tomography and visual evoked potential mapping. Electroencephalographic abnormalities were nonspecific. The classical definition of cortical blindness must be modified for children.

Adolescent↗

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Current concepts of hypoxic-ischemic cerebral injury in the term newborn.

Acute perinatal hypoxic-ischemic cerebral injury in the term newborn is a major cause of long-term neurologic abnormalities in childhood. Earlier diagnosis and more precise localization of hypoxic-ischemic cerebral injury has been made possible by optimal timing and the use of new imaging modalities (e.g., magnetic resonance imaging, spectroscopy, computed tomography, cerebral perfusion techniques). Recent concepts on pathogenesis of such injury involves metabolic factors, regional distribution of excitatory (glutamate) synapses, and factors related to active myelination in specific areas at the time of insult. Consideration of these aspects of pathogenesis permit a rational approach to the management of this major neurologic problem in the newborn.

Brain↗

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Clinical features for prediction of survival in neonatal muscle disease.

Review of 17 newborns with muscle disease demonstrated that clinical features associated with survival beyond 1 year of age included gestational age of at least 35 weeks and requirement of mechanical ventilation for less than 21 days. In contrast, poor outcome was associated with Apgar scores below 5 at 5 min, pulmonary complications, arthrogryposis, or other congenital anomalies. The incidence of decreased fetal movements, polyhydramnios, hypotonia, and assisted delivery was not statistically different between infants who died early and those who survived beyond 1 year of age. Clinical features of newborns with muscle disease may be useful for prediction of outcome, especially when muscle biopsy abnormalities are nonspecific.

Biopsy↗

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Physicians' low detection rates of alcohol dependence or abuse: a matter of methodological shortcomings?

Previous research may have underestimated physicians' detection rates of alcohol dependence or abuse because case findings have been based on screening questionnaires instead of using in-depth diagnostic criteria and detection rates have been assessed by analyzing patient records instead of directly interviewing the physician. To test this hypothesis, consecutive patients of a general hospital (N=436) and of 12 randomly selected general practices (N=929) were examined. A two-step diagnostic procedure included screening questionnaires and a diagnostic interview (SCAN). The analysis compares detection rates based on methods used in previous studies to data using more precise methods. Physicians' detection rates ranged from 37.0% to 88.9% in the general hospital and from 11.1% to 74.7% in general practices depending on methods used. The physicians' detection rates could be improved by 10% (general hospital) and 20% (general practice) through the additional use of a screening questionnaire. Of those patients assessed by the physicians as problem drinkers in the general hospital, 13.9% were referred to an addiction consultation-liaison service. Data reveal that physicians' abilities to detect problem drinkers have been underestimated. Routine screening procedures could play a major role in improving detection rates and reminding the physician to intervene.

Adolescent↗

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Early results of punch trabeculectomy.

PURPOSE: To evaluate the effectiveness of punch trabeculectomy in controlling intraocular pressure (IOP) in patients with uncontrolled chronic open-angle glaucoma (COAG) undergoing medical treatment. METHODS: This prospective study included 22 patients (27 eyes) with uncontrolled COAC on medical treatment undergoing punch trabeculectomy through a scleral tunnel. The tunnel was created with a 3.5 mm keratome, the tunnel mouth was not sutured but the conjunctival flap was sutured by 8/0 vicryl. The mean surgical time from opening the conjunctiva to closing the conjunctiva was 8 m 59 s. IOP and other parameters were checked on day 1 and subsequently at intervals appropriate to the individual. RESULTS: After a mean period of 22.2 months follow-up the mean IOP was 13.3 mmHg (SD 5.2). There were few transient early post-operative complications; two eyes had a shallow anterior chamber (AC) due to excess drainage, five had IOP above 21 mmHg, which responded to ocular massage, ten eyes had hyphaema less than 1.5 mm and two eyes had no filtration bleb. CONCLUSIONS: Punch trabeculectomy is a rapid and effective method of controlling IOP. The complication rate is moderate and mainly transient.

Aged↗

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The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders.

We studied the associations between comorbid anxiety and depressive disorders in treated alcoholics, the course of current anxiety and depression during the early and late post-detoxification periods, and drinking behaviours after discharge. Lifetime psychiatric comorbidity was assessed in 100 alcoholics using the Composite International Diagnostic Interview (CIDI). Three subgroups defined as group DA (comorbid depressive and anxiety disorders, n = 15), group A (anxiety disorder only, n = 23), and group NO (no comorbid disorder, n = 62) were studied. Beginning 21 +/- 13 days after cessation of drinking, state anxiety (STAI-X1), trait anxiety (STAI-X2) and depression (BDI) were assessed once per week (t1 to t4) and once more 6 months after discharge (t5, n = 68). The severity of psychopathology decreased during the first 4 weeks after detoxification in all subgroups. However, trait anxiety remained at higher levels in both the comorbid subgroups from t1 to t4. In the follow-up sample, 60.5% of the non-comorbid subjects remained abstinent, but only 26.7% of all comorbid patients and only 12.5% of those with comorbid depressive disorder plus severe current trait anxiety or depression at t1. Independent of their comorbidity status, relapsers at t5 had already reported more trait anxiety than abstainers at t1. We conclude that severe trait anxiety persisting after 3 weeks of abstinence, comorbid depressive and/or anxiety disorders, and combinations of these with moderate or severe current anxiety and depressive states represent the greatest risks of relapse and therefore may indicate a treatment need.

Adult↗

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A new implantable burst generator for skeletal muscle powered aortic counterpulsation.

Skeletal muscle (SM) can be used for long-term circulatory assist. To generate contractions of appropriate duration and strength, SM requires bursts of electrical pulse trains. Presently, the implantable pulse train stimulator for SM assist is unable, at different heart rates, to adjust pulse burst duration or delay time, adversely affecting timing of counterpulsation. A prototype implantable microprocessor based stimulator (Medtronic Prometheus) has been developed to address this issue. The purpose of this study was to test this generator in an acute dog model. A dual chambered counterpulsation device was connected to the aorta in six dogs, using the latissimus dorsi to power the pump. The generator was connected by sensing/stimulating leads to the heart/left thoracodorsal nerve, programmed to give bursts of 2 V, 30 Hz, and pulse widths of 180 microsecs. Burst delay and duration was set as a fixed percent of the R-R interval of the EKG. The baseline aortic pressures ranged from 75/33 to 118/87 mmHg. During counterpulsation, diastolic pressure increased from 17 to 50 mmHg (30-111% increase). With changing heart rates, the pulse generator spontaneously readjusted its burst delay and duration, maintaining optimal diastolic counterpulsation without systolic interference. We conclude that this new pulse generator can stimulate SM for counterpulsation at varying heart rates, and is suitable for implantation in chronic studies.

Animals↗

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Small intestinal permeability in pediatric clinical practice.

Passive permeability of small intestine to lactulose and mannitol was studied in children suspected of having intestinal disease, using a hypertonic differential sugar absorption test. Children with coeliac disease and cows' milk intolerance were shown to have an elevated urinary lactulose/mannitol recovery ratio when compared with controls, children with normal jejunal biopsy, or children in whom alternative explanations for failure to thrive had been demonstrated. The abnormality in permeability ratio principally reflects a reduced urinary recovery of mannitol following oral administration. This study demonstrates that a hypertonic sugar absorption test is well tolerated even by young children, is practicable in routine clinical pediatric practice, and is capable of demonstrating abnormal intestinal function in children with small intestinal disease.

Adolescent↗

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Stability and interpersonal agreement of the interview-based diagnosis of autism.

Interpersonal agreement and stability of the Autism Diagnostic Interview-Revised (ADI-R) was examined in this study. Four raters judging 55 subjects agreed moderately to excellently on the items of the diagnostic algorithm, operationalizing the main autistic symptoms according to the classification guidelines of ICD-10 and DSM-IV. When retesting 33 individuals, some items revealed only weak stability. On the level of domains of autistic behavior and diagnosis, the interrater reliability and retest reliability were consistently convincing.

Adolescent↗

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Pott's puffy tumor, frontal sinusitis, frontal bone osteomyelitis, and epidural abscess secondary to a wrestling injury.

A blow sustained to the head while wrestling may produce frontal osteomyelitis and its complications, Pott's puffy tumor and epidural abscess. The symptoms may be minimal and may be manifested only by a mild headache and occasional stuffy nose. A 16-year-old boy was studied one month after a head injury sustained while wrestling, complaining only of recurrent headaches and fever. A fluctuant mass was found in the midfrontal area. Frontal sinusitis, subperiosteal abscesss epidural abscess, and frontal osteomyelitis were found at surgery. The frontal bone involved by the osteomyelitis was debrided, and the epidural abscess was evacuated.

Adolescent↗