Two-neutrino double- beta decay measurement of 100Mo.
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Journal Article↗
Biomedical subjects
D Blum
Publications and source records attributed to D Blum.
Cancer pain management and the role of social work: barriers and interventions.
Quality of life has become increasingly important in the management of cancer, because patients with the disease are surviving longer. Although effective therapies exist, more than half of all cancer patients suffer unrelieved pain during illness and treatment. Undertreated and unnecessary pain represents a failure of the multidisciplinary team, including the social worker, to respond appropriately to the needs of cancer patients. This article increases social workers' awareness of the prevalence of cancer-related pain, identifies the barriers that undermine effective pain relief, and develops a model for social work intervention. Skills such as communication, assessment, problem solving, and psychological support are explored in detail.
Health Knowledge, Attitudes, Practice↗
Clobazam, oxcarbazepine, tiagabine, topiramate, and other new antiepileptic drugs.
Clinical investigators recently have studied at least 21 new antiepileptic drugs (AEDs) in people with epilepsy. This review briefly examines 15 of these new AEDs: clobazam (CLB), dezinamide, flunarizine (FNR), loreclezole, milacemide (MLM), MK-801, nafimidone, ORG-6370, oxcarbazepine (OCBZ), progabide (PGB), ralitoline, stiripentol, tiagabine (TGB), topiramate (TPM), and zonisamide (ZNS). CLB, PGB, and TGB represent agents that act on the GABA system, and MLM acts on the glycine system. MK-801 and ZNS (in part) are excitatory amino acid antagonists, and FNR is a calcium-channel antagonist. OCBZ is a keto analogue of carbamazepine, which is not metabolized to the epoxide and may have fewer side effects. The remaining agents are novel compounds with a variety of suspected mechanisms. TPM appears especially effective for intractable partial seizures but has a high incidence of cognitive side effects. None of these new AEDs is useful for all patients with inadequate seizure control or ongoing toxicity. The role of each will require further clinical study and experience.
Animals↗
Thyroid function in non-growth hormone-deficient short children during a placebo-controlled double blind trial of recombinant growth hormone therapy.
GH treatment in GH-deficient children has been reported to cause decreases in serum T4 and TSH and an increase in serum T3. We sought to determine whether GH treatment alters thyroid function in non-GH-deficient short children. Twenty children (18 boys) were followed for 12 months while receiving either GH (Humatrope, Eli Lilly; 0.074 mg/kg, sc, 3 times/week; n = 9) or placebo (n = 11). Total T4, free T4, T3, and TSH were measured every 6 months and in 12 children also at 1, 2, 3, and 9 months. A TRH test and measurement of nocturnal TSH surge were performed at baseline and after 6 months of treatment in 19 subjects. There were no significant differences at baseline in the clinical features between the placebo and GH groups. Total T4, free T4, T3, and TSH levels did not significantly differ between the placebo and GH groups at baseline and at 1, 2, 3, 6, 9, and 12 months. There were no significant differences between the two groups in TSH response to TRH or nocturnal TSH surge. Although an early transient effect of GH treatment could not be excluded, we conclude that GH treatment for 12 months does not produce sustained alterations in thyroid function in non-GH-deficient children.
Body Height↗
Differential response characteristics in nonepileptic and epileptic seizure patients on a test of verbal learning and memory.
Investigators have found it difficult to separate patients with nonepileptic seizures (NES) from those with true epileptic seizures (ES) using quantitative measures of neuropsychological test performance. We examined qualitative response characteristics on the California Verbal Learning Test of 41 patients undergoing continuous video/audio-EEG monitoring in an effort to distinguish these patient groups (12 patients with left temporal [LT] foci, 11 with right temporal [RT] foci, and 18 with NES). NES patients explicitly recognized fewer target words compared with ES patients. In addition, NES patients rarely made false-positive errors, which resulted in failure to endorse a significant number of items on the recognition list. This response tendency is called a negative response bias. In contrast, LT patients endorsed a high number of items on the recognition test, which resulted in a positive response bias. RT patients demonstrated no consistent response tendency. In our sample, a negative response bias index (ie, a cutoff score < 0) showed a sensitivity of 61% and a specificity of 91%. We propose that failure to explicitly recognize words following repeated exposure may reflect aspects of psychological denial in NES patients. Response bias indices may thus help identify patients with NES and may begin to explain the psychological mechanisms underlying this complex disorder.
Adult↗
Reduction in obstructive breathing events during body rocking: a controlled polygraphic study in preterm and full-term infants.
OBJECTIVE: To investigate the effect of body rocking on infant respiratory behavior during sleep. METHODS: Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. RESULTS: In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. CONCLUSION: In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.
Beds↗
An overview of the safety of isepamicin in adults.
The safety profile of isepamicin has been assessed from a series of phase II and III clinical trials. A total of 1243 patients were randomised to treatment with isepamicin, mainly administered once daily at a dose of 15 mg/kg or 8 mg/kg depending on the severity of infection. A small proportion of patients were randomised to isepamicin at a dosage of either 7.5 mg/kg twice daily or 4 mg/kg twice daily. In the majority of studies, isepamicin was compared with a standard twice-daily dosing regimen of 7.5 mg/kg amikacin = (n - 552). The clinical studies included patients with a variety of bacterial infections, including lower respiratory tract, urinary tract, intra-abdominal and skin and skin structure infections. The study aminoglycosides were co-administered with other antimicrobial agents in line with normal clinical practice depending on the site, nature and severity of infection. Most patients received isepamicin or amikacin as a 30-minute intravenous infusion and a small proportion of patients with less severe infections received intramuscular injections. The mean duration of treatment was nine days for both the isepamicin and amikacin treatment groups, and was similar for patients with both severe and less severe infections. Overall, the proportion of patients reporting any adverse event was comparable between the isepamicin (13%) and amikacin (11%) groups. No individual adverse event was reported in more than 2% of patients, the most commonly reported events being phlebitis, rash, headache and renal compromise. The frequency of adverse events was not influenced by treatment duration, age or gender. Treatment-related adverse events which were considered severe or life-threatening were reported in 1.8% of patients receiving isepamicin and 2.0% of patients receiving amikacin. Two per cent of patients in each treatment group discontinued the study because of adverse events and 2% of patients in each treatment group died during treating. Four per cent of patients in each treatment group died within 30 days after the end of treatment. Changes in laboratory tests were similar in both treatment groups; few changes were considered by the investigators to be treatment-related. Increases in serum creatinine indicative of possible renal compromise occurred in 4.6% of isepamicin and 5.1% of amikacin patients. The occurrence of ototoxicity as measured by standard frequency pure tone audiometry was low. In summary, isepamicin is a sell-tolerated aminoglycoside with a safety similar to that of amikacin.
Adult↗
Early MR detection of cortical and subcortical hypoxic-ischemic encephalopathy in full-term-infants.
Four observations illustrate the potential of MR imaging in the early depiction of multiple types of neuropathologic lesions which may coexist in the full-term newborn, upon severe hypoxic-ischemic encephalopathy (HIE). In particular, diffuse, postnatal involvement of cerebral cortex and subcortical white matter (WM) is demonstrated. Cortical hyperintensity on both proton-density- and T1-weighted images is probably related to cellular necrosis which is distributed diffusely or parasagittally. Hyperintense, frontal, subcortical WM edging on proton-density-weighted images results from the increase of water concentration, induced either by infarct or by edema. Diffuse WM areas of low intensity on T1-weighted images and of high intensity on T2-weighted images are presumably related to cytotoxic and/or vasogenic edema, proportional to the underlying damaged tissues. On follow-up MR examinations, several months later, the importance of cortical atrophy and of the myelination delay appeared related to the importance of the lesions detected during the postnatal period.
Brain Ischemia↗
Prevalence of bilateral partial seizure foci and implications for electroencephalographic telemetry monitoring and epilepsy surgery.
Most patients with partial seizures of temporolimbic onset have predominantly unilateral seizure foci, which partly accounts for the success of unilateral temporal lobectomy. The prevalence of bilateral foci is not known. "Discordant" seizures are those which arise from the contralateral side from the usual focus. "Concordance" is the fraction of seizures which arise from the majority side, ranging from 0.5 to 1.0. From observations of seizures recorded in an epilepsy monitoring unit, a model of the patient population can be determined by non-linear least squares methods. Six hundred and five seizures from 57 consecutive patients with non-lesional temporolimbic epilepsy were studied. In the model population, 15% of patients have concordance of less than 70%, and 80% have concordance > 90%. Using Bayes' theorem, the observation of 5 concordant seizures implies a 95% chance of the patient having a concordance of at least 90%. If one discordant seizure is recorded, then to reach the 95% confidence level of 90% concordance requires a total of 11 concordant seizures. For the smaller group of patients with strictly unilateral interictal spikes, only 4 concordant seizures need to be recorded to achieve the same level of confidence of unilaterality. Interpretation of telemetry studies requires knowledge of the patient population.
Brain↗
Advances in epilepsy.
Recent advances in clinical epilepsy have included improved systems for classifying seizures and epileptic syndromes, better definition of nontemporal seizures, improved methods for distinguishing syncope and pseudoseizures from epilepsy, and new approaches in the management of pregnant women with epilepsy. There has been continued development of the concept that epilepsy is a heterogeneous disorder with many imitators. Treatment is most successful when tailored to the particular seizure type, epileptic syndrome, and special needs of the individual patient.
Abnormalities, Drug-Induced↗
Markers of cerebral lateralization and alcoholism.
We assessed markers of anomalous cerebral dominance in 70 problem drinkers at risk for alcoholism, 43 alcoholics who had been sober for at least six months, and 311 healthy control subjects age-matched to the problem drinkers. Markers of anomalous cerebral dominance included left-handedness, learning disabilities, neuro-immune disorders, and special cognitive talents. We also administered a "drinking inventory" to assess frequency and severity of drinking patterns for self and family. Analysis showed elevated rates of left-handedness and learning disabilities in the alcoholic group and in the "at risk" problem drinkers. These same subjects rated themselves and their families as relatively poor at left-hemisphere-mediated cognitive talents. Alcoholic women evidenced significantly greater incidence of immune disorders than alcoholic men. Alcoholism appears to be related to biological factors which have been associated with anomalous cerebral dominance.
Adolescent↗
Haemolyzed samples: responsibility of short catheters.
The haemolysis of blood samples is a source of error in the electrolytic and enzymatic determination in clinical biochemistry. This circumstance seems dependent on the material used for the venepuncture. In this study we compared three kinds of material in 350 patients who were sampled in the emergency department. This randomized study compared the haemolysis of blood samples collected with stainless steel needles and short catheters, either Teflon FEP (Cathlon Critikon) or polyurethane Vialon (Insyte Becton-Dickinson). Quantification of hemolysis was performed by assay of the optical density of plasma haemoglobin. Results were analysed, after verification of the randomization, by one-way analysis of variance by ranks. This study demonstrated a highly significant relation between occurrence of haemolysis and the sampling material, used according to its technical obligations. Haemolysis occurred frequently when short catheters were used in 42% and 55% of cases with the Teflon and Vialon catheters, respectively. Haemolysis was much less frequent with stainless steel needles (12%). This difference was even more marked for haemoglobin levels above 1.5 milligrams of plasma, where the incidence was 4.2%, 9% and 30%, respectively, for the stainless steel needles, the Teflon catheter and the Vialon catheter. This study induced our emergency department to take more blood samples with a needle, even if an infusion was to be given subsequently, or to take them using a Teflon catheter.
Adolescent↗
In-utero carbon monoxide poisoning and multiple fetal abnormalities.
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Abnormalities, Multiple↗
Interferon sensitivity of expression of histone H5/H1(0)-vaccinia thymidine kinase fusion genes expressed by recombinant vaccinia viruses is enhanced by shortening the histone sequence.
To elucidate the structural basis responsible for the reduced IFN sensitivity of expression of the histone H1(0) and H5 gene, integrated into the vaccinia virus genome, vaccinia virus thymidine kinase (VV-TK)-histone H1(0)/H5 fusion genes were constructed and translocated into the TK locus of the VV genome. The chimeric genes, consisting of parts of either of the two histone genes and the 5' or 3' half of the TK gene, respectively, were expressed as histone-TK fusion proteins under the control of either the VV-TK promoter or the early sequences of the VV 7.5K promoter. IFN sensitivity of the expression of histone-TK fusion genes was shown to be influenced by the relative length of the histone sequence. Expression of fusion genes containing more than 45% cellular sequence either from the 5' or the 3' part of one of the two histone genes showed clearly reduced IFN sensitivity compared to the expression of VV-TK. On the other hand, by further reducing the relative amount of histone H5 or H1(0) sequence to 32%, the IFN sensitivity of expression of the corresponding fusion gene was drastically enhanced to levels indistinguishable from those of VV-TK.
Animals↗
Congenital absence of insulin cells in a neonate with diabetes mellitus and mutase-deficient methylmalonic acidaemia.
We report on a female neonate with diabetes mellitus and methylmalonic acidaemia, who died at age 16 days. Using immunocytochemistry, electron microscopy and in situ hybridisation, we were unable to demonstrate any insulin cells in the pancreatic islets. Methylmalonic acidaemia was caused by a methylmalonyl coenzyme A mutase apoenzyme defect. The metabolic crisis of the methylmalonic acidaemia aggravated the diabetes and may explain the failure of insulin therapy. Our results suggest that the infant suffered from a congenital absence of beta cells associated with a genetically transmitted mutase apoenzyme defect.
Autopsy↗
Patient advocacy in cancer pain relief: the Cancer Care model.
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Health Promotion↗
Elderly men with cancer: social work interventions in prostate cancer.
Prostate cancer requires the attention of social workers in health care for three reasons: the growing elderly population which will increase the number diagnosed, the recent introduction of new treatments and the lack of social acceptability for this condition. Interventions for prostate cancer are specific to the stage of the disease. These individual, family and group interventions are a model for social work services to elderly men with other forms of cancer. Social workers have opportunity to research quality of life and decision-making issues to enhance medical practise in prostate cancer.
Adaptation, Psychological↗
[Fetal cardiology: prenatal diagnosis of cardiac malformations].
Foetal cardiology is now a recognised chapter of both paediatric cardiology and foetal medicine. We describe here our experience with antenatal diagnosis of cardiac malformations and discuss both its genetic and epidemiological issues. Our experience confirms if need be that foetal medicine requires a well organised first-level foetal evaluation.
Abnormalities, Multiple↗