A 1079 gram preterm neonate suffered complete avulsion of the common and external iliac arteries during aortic balloon valvotomy resulting in complete ischaemia of the lower limb. Salvage by microsurgical extra-anatomic vascular bypass was unsuccessful but additional thrombolytic therapy allowed restoration of blood supply. The limb was then seen to be dependent upon the microvascular bypass. In this case salvage depended upon combined medical and surgical treatment, and the case points to benefits from such a combined approach to therapy.

Aortic Valve Stenosis↗

PubMedDate not supplied

The Suicide and Aggression Survey: a semistructured instrument for the measurement of suicidality and aggression.

Despite the rising concern with the increasing rate of violent and suicidal behaviors in this country and others, we remain relatively limited in our ability to rigorously define, classify, and measure these behaviors. In addition to our previous work in developing self-rating scales assessing aspects of aggressive behaviors, we have developed the Suicide and Aggression Survey (SAS), a new, comprehensive, semistructured interview and research tool, for the purpose of comprehensively evaluating and understanding the multiple constituents of these behaviors, and for assisting in predicting which individuals might be at high risk for suicide or violence. The present report describes the need for such an instrument and the theoretical models that have guided us in constructing it; one of these is a sequential description of the major classes of variables related to aggression and the other is a two-stage model of countervailing forces. Preliminary reliability data and a description of the structure of the interview are included.

Adolescent↗

PubMedDate not supplied

Activation of the complement system as an indicator of pyrogenic reaction to lipopolysaccharide (LPS).

The generation of biologically active complement split products through the direct reaction of microorganisms with complement proteins is one of the earliest events of the defence reaction in humans. Complement activation develops within minutes, which highly corresponds with the onset of a febrile reaction after exposure to pyrogens. The possibility of the use of complement activation in human plasma as an indicator of pyrogen contamination has been tested. Additionally, the co-stimulatory effect of complement activation on tumor necrosis factor-alpha (TNF-alpha) production by blood-separated macrophages exposed to lipopolysaccharide (LPS) has been demonstrated. As an indicator of complement activation in test samples, the concentration of the iC3b fragment was measured by using an ELISA system based on neoantigen formation. The 3-h exposure time has been identified as optimal for the test. The variability between iC3b concentrations in untreated control samples obtained from seven unrelated healthy donors was less than 10%, while after activation by 100 ng/ml LPS, it increased to 13%. The lower detection limit has been identified as 10 pg/ml LPS. As the complement test is not affected by drug-cell interactions or cell viability, the test can be used in situations where tested formulations contain active substances, which interfere with a cell-based test. We conclude that a test based on the detection of complement activation in human plasma should be considered as a valuable element of an in vitro pyrogenicity testing battery along with a cell-based assay.

Animal Testing Alternatives↗

PubMedDate not supplied

Improving the application of quantitative methods in validation work.

The acceptance of quantitative methods in in vitro studies has seen a steady increase over the last 5 years. ECVAM's Biostatistics Task Force report in the mid-1990s (Holzhütter, H.-G., Archer, G., Dami, N., Lovall, D.P., Saltelli, A., Sjöström, M., 1996. Recommendations for the application of biostatistical methods during the development and validation of alternative toxicological methods. ECVAM Biostatistics Task Force Report 1. ATLA 24, 511-530) laid out clear guidelines for biologists in this field. Nevertheless, the application of more formal approaches to experimental design and statistics is still far from complete in many studies. Furthermore, the regulatory paradigm often does not encourage the use of standard statistical techniques; for example, lowest detectable concentration levels in assays are defined in international guidelines as a simple multiple of standard deviation, rather than tests which are accepted in the statistical field as more reliable and more powerful. ECVAM is currently defining a new approach to facilitate the improved acceptance of these methods into the development and validation process. This will cover a review of appropriate quantitative approaches that can be applied in the validation of alternative methods, as well as an educational element for the community as a whole. This paper will discuss some issues of concern, and outline the milestones planned to help facilitate the acceptance of quantitative methods.

Animal Testing Alternatives↗

PubMedDate not supplied

Both-bone midshaft forearm fractures in children.

To determine whether closed treatment of both-bone midshaft forearm fractures routinely results in acceptable clinical outcome for children less than 16 years of age, we retrospectively studied all such patients treated at our two hospitals between 1970 and 1982. All children less than 10 years of age at the time of fracture had excellent results. Of 14 patients between the ages of 10 and 16 years, closed treatment failed in nine. We conclude that the incidence of poor results from closed treatment of the fractures in children greater than 10 years of age is seriously underestimated.

Adolescent↗

PubMedDate not supplied

Pericardial hemangioma presenting as thoracic mass in utero.

Pericardial hemangiomas are rare lesions. We present the case of an infant who was referred to our fetal diagnosis and treatment group for the presence of a left thoracic mass, pleural effusion, and mediastinal shift on fetal ultrasound. The characteristics of the lesion suggested the presence of a pulmonary sequestration. A chest radiograph done at birth was normal. At 2 weeks of age, an enhancing lesion of the left pericardium was identified on chest CT. A cardiac MRI demonstrated enhancement of the mass on T2-weighted images. The patient underwent thoracoscopic assessment of the mass for diagnostic purposes. Multiple lesions were identified along the left pericardium and diaphragm. A frozen section biopsy revealed a hemangioma. The natural history for hemangiomas is gradual regression; however, they may increase acutely in size and cause symptoms prior to involution. Investigations should be performed to identify the involvement of other organs. This case illustrates the need to closely follow all patients with prenatally diagnosed thoracic masses with CT imaging, even when they are asymptomatic and have a normal chest radiograph at birth.

Adult↗

PubMedDate not supplied

Towards relevant medical information systems.

The successful development of computer information systems in medicine is fraught with problems. Structured methods of analysis and design are becoming increasingly popular and are seen as the means of overcoming many of the technical problems associated with these systems. Information systems, however, are notoriously complex and require socially oriented as well as technically oriented solutions. A fundamental problem, in which these two distinct perspectives are intertwined, is the effective communication of requirements between users and designers of medical information systems. In this paper, data modelling is proposed as a means of integrating these approaches by assisting in socio-technical design. One specific diagrammatic variant of this established technique is introduced by means of a case study in ambulatory care. The case study is also used to illustrate a unique participative approach intended to facilitate discussion of the user's requirements. This more active approach to modelling is discussed in relation to the softer perspective of problem setting rather than the traditional one of problem solving.

Information Systems↗

PubMedDate not supplied

Herpesvirus infection of the respiratory tract electronmicroscopic observation of the virus in cells obtained from a sputum cytology.

A case of herpesvirus infection of the respiratory tract in which the virus was seen ultrastructurally in cells obtained from a routine sputum collected for cytology studies, is presented. The method described would seem feasible for additonal studies at the ultrastructural level of cells obtained during collection of material for routine cytology of the respiratory tract. In the present case the virus particles were easily seen and characterized.

Cell Nucleus↗

PubMedDate not supplied

"Oh, no. Another suicide".

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Adult↗

PubMedDate not supplied

Immunosuppression as a high-risk factor in the development of condyloma acuminatum and squamous neoplasia of the cervix.

The iatrogenic immunosuppression in renal transplant recipients has been associated with an increased incidence of malignancy in these patients. Among 132 female transplant recipients at risk for the development of squamous lesions of the cervix, 11 (8.5%) developed cervical condylomas. Six (4.5%) of the 11 patients developed cervical neoplasia. The average age of the patients at the time of initial diagnosis was 32.2 years. The lag time from transplantation to the diagnosis of the condyloma was 22.4 months, and the lag time from transplantation to the diagnosis of cervical neoplasia was 38.0 months. The increased incidence of condylomas as well as of intraepithelial neoplasia of the cervix in this group of patients with an established higher risk of malignancy supports the hypothesis that condylomas may represent a precursor lesion of cervical cancer. Immunosuppression should be included among the high-risk factors in the development of cervical neoplasia.

Adult↗

PubMedDate not supplied

Mother Care: cost effective program in maternal-infant care.

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Female↗