A case is described in which massive development of pseudopolyps resulted in left colonic obstruction in a patient with a history of ulcerative colitis. Problems of diagnosis and management are discussed, with emphasis on the need for close radiographic and endoscopic follow-up of such patients.

Colitis, Ulcerative↗

PubMedDate not supplied

Two alternative program models for serving speech-disordered preschoolers: a second year follow-up.

This study investigates the appropriate roles of parents and speech-language pathologists in early intervention by longitudinally comparing the costs and effects of two programs for speech-disordered preschoolers: a home parent training program and a clinic-based, low parent involvement program. Results from follow-up testing one year after the intervention ended corroborated the results immediately following intervention. Specifically, the home parent training group performed at least as well as the clinic-based group on measures of speech and language functioning as well as on a measure of general development. On one variable measuring personal/social skills and one measuring adaptive behavior, the home parent training group performed significantly better than the other group. Results of the cost analysis indicated that, excluding the value of parent time, there was no meaningful difference in program costs. The implications of this study are that parents can be given significant responsibilities in early intervention and that program administrators have the viable option of training parents to provide the primary early intervention services. Findings support the need for therapists to be trained to work with parents as well as with the child.

Adaptation, Psychological↗

PubMedDate not supplied

[Narcissism inventory-90 (NI-90). Empirically-based reduction and identification of items sensitive for change--a questionnaire particularly suited for measuring self-regulatory parameters].

By analysing Narcissism Inventories [1] gathered by the admission from 639 consecutive in-patients, as well as a related sample of inventories gathered from 397 consecutive patients (7/93-7/96) by admission and discharge, we examined the possibility of reducing the number of items of the Narcissism Inventory without losing significant information. This examination shows that reducing the inventory to a total of 5 items per scale is reasonable, without a relevant loss of metric quality in the item-reduced scales. In addition, items particularly sensitive to change could be identified and pointedly kept in the new, reduced scales. Through the deliberate selection of these items, it was possible to produce an empirically-guided short-version of the Narcissism Inventory, suited particularly for the examination of clinical process and regulatory parameters. With persistence of the original 18 scales proposed by the authors of the original test, a reduction to a total of 90 items results. The name "Narcissism Inventory-90 (NI-90)" is, therefore, suggested for this new version.

Adult↗

PubMedDate not supplied

Development of cationically modified cellulose adsorbents for the removal of endotoxins.

The removal of endotoxins by extracorporeal adsorption processes seems the most promising therapeutic approach to Gram-negative sepsis and endotoxin shock. However, thus far adsorbents have failed to bind endotoxins efficiently or have shown adverse biocompatibility characteristics. To overcome these disadvantages, small particles of regenerated cellulose in the range of 1-8 microns in diameter were produced. Before use, the microspheres were cationically modified by substitution with polyethyleneimine (PEI) or diethylaminoethyl (DEAE) groups. A third kind of adsorbent was manufactured by (physically) coating the cellulose matrix with PEI. All three types of adsorbents exhibited a high adsorption capacity for endotoxins in human plasma, whereas activated charcoal and various anion exchange resins removed only small amounts of endotoxins under the same conditions. In addition, because the outer surface area is very large, adsorption takes place rapidly and diffusion becomes almost irrelevant. The adsorption process is primarily based on electrostatic interactions, which could be demonstrated by a significantly higher adsorption rate and binding capacity for lipid A-diphosphoryl, compared with lipid A-monophosphoryl. Use of these adsorbents in a newly developed plasma sorption system could be of great clinical interest because of the low production costs, the high adsorption efficiency, and the excellent biocompatibility data.

Animals↗

PubMedDate not supplied

Extracorporeal removal of proinflammatory cytokines by specific absorption onto microspheres.

Elevated plasma concentrations of interleukin 1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF alpha) derived from cellular stimulation have been found to correlate well with the systemic inflammatory response syndrome and clinical outcome of sepsis. Consequently, biologic inactivation and extracorporeal removal of these potent mediators gain increasing attractiveness as adjunctive therapeutic options. In realization of the latter strategy the authors developed specific adsorbents by covalently linking polyclonal antibodies against IL-1 beta and TNF alpha onto microspheres. The attachment process was characterized by high retention of antigen neutralizing activity. Batch testing of the adsorbents revealed specificity, biocompatibility, and high binding capacity (20.2 and 36.9 ng/mg of particles for IL-1 beta and TNF alpha, respectively). Employment of the particles in the Microspheres Based Detoxification System (MDS) resulted in efficient purification: human plasma spiked with recombinant IL-1 beta and TNF alpha (500 pg/ml) could be cleared at 42 ml/min (IL-1 beta) and 55 ml/min (TNF alpha) at a flow rate of 200 ml/min. These clearance rates are considerably higher than the values obtained with ultrafiltration. In conclusion, the microsphere technology allows efficient extracorporeal removal of cytokines from plasma. In addition, by combined application of IL-1 beta and TNF alpha binding particles and endotoxin adsorbents, such as cationically modified cellulose, it should be feasible to interfere with the complex pathobiochemical sequelae of sepsis.

Antibodies↗

PubMedDate not supplied

Intracoronary infusion of autologous bone marrow cells and left ventricular function after acute myocardial infarction: a meta-analysis.

Recent clinical studies have demonstrated that intracoronary infusion of autologous bone marrow cells (BMC) in conjunction with standard treatment may improve left ventricular function after an acute myocardial infarction (AMI). However, the results of these studies remain controversial, as the studies were relatively small in size and partially differed in design. We reviewed primary controlled randomized clinical studies comparing intracoronary transfer of autologous non-mobilized BMC combined with standard therapy versus standard therapy alone in patients with AMI. We identified five randomized controlled clinical trials, three of which were also placebo- and bone marrow aspiration-controlled. Non-mobilized BMC were infused into the revascularized coronary target artery 6.6 +/- 6.1 days after AMI. The mean follow- up period of 5.2 +/- 1.1 months was completed by 482 patients, 241 of which received infusion of BMC. The effect of BMC on left ventricular ejection fraction (LVEF) as a major functional parameter was evaluated. Analyzing the overall effect on the change in LVEF between baseline and follow-up value revealed a significant improvement in the BMCtreated group as compared to the control group (P = 0.04). Thus, considering the increase in LVEF during follow-up, transplantation of BMC may be a safe and beneficial procedure to support treatment of AMI. However, the functional improvement observed with this form of therapy was altogether relatively moderate and the studies were heterogeneous in design. Hence, further efforts aiming at large-scale, double-blind, randomized and placebo-controlled multi-center trials in conjunction with better definition of patients, which benefit from BMC infusion, appear to be warranted.

Acute Disease↗

PubMedDate not supplied

[Polyclonal activated circulating B-lymphocytes in patients with rheumatoid arthritis].

Peripheral B lymphocytes were studied to investigate the role of polyclonal B-cell activation in the pathogenesis of rheumatoid arthritis (RA). Proliferative responses to anti-mu antibodies coupled to sepharose used as a B-cell-specific mitogen were reduced as compared to healthy controls. When cell surface antigens were studied by flow cytometry employing monoclonal antibodies, B cells from patients with RA showed enhanced expression of Interleukin-2 (IL-2) receptor. In-vivo-activated, in-vitro spontaneously proliferating Epstein-Barr virus transformed B cells positive for immunoglobulin M, G, and A were obtained from patients with RA. In summary, our findings suggest the presence of polyclonal activated B cells in the peripheral blood of patients with RA, and a close relationship of polyclonal activated B cells and the activity of the disease process.

Adult↗

PubMedDate not supplied

Cost-effective practice as a focus for nursing grand rounds.

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Cost Control↗

PubMedDate not supplied

Reaching out as a parish nurse.

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Catholicism↗

PubMedDate not supplied

[The ocular manifestations of AIDS in children].

The exam of 33 children with AIDS revealed in 10 cases manifestations of the anterior pole and of ocular anexes specific to this infection. In 8 cases we noticed seborrheic dermatitis, exudative dermatitis. Molluscum contagiosum, staphilococies, papoulous eruptions . In 3 cases there were herpetic infections, one of them was corneal localized. In one case was Burkitt lymphoma with palpebral exteriorization. The fundus exam revealed retinal microvasculopathies with aneurysmal dilatations in cases and retinal hemorrhages in 3 cases. The discrete found in 8 cases, in 2 cases was bilateral papillary and papilloretinal edema was papillary stasis. In 8 cases was partial optical atrophia and in one case we noticed tapetoretinal degenerescente. The aid of the ophthalmologist in the thorough examination of children having AIDS was important, in spite of the unspecific nature of the noticed lesions.

AIDS-Related Opportunistic Infections↗