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Children's pain predictions and memories.

A cross-sectional descriptive design was utilized to explore expected, experienced and recalled pain, and anxiety. Subjects were 138 children (5-17 yr) who were attending an outpatient laboratory for venipuncture. They reported state anxiety and expected visual analogue scale pain prior to having venipuncture. Following venipuncture, they reported sensory and affective pain. Two months afterward, subjects were contacted and asked to recall sensory and affective pain from the venipuncture. Analysis of data determined that children's recall of pain was quite good although better for affective pain than sensory pain. Prediction accuracy for pain was not good. From analysis it was determined that overestimation of pain was related to anxiety but not to greater experienced pain. Four patterns of responses were identified when prediction and recall accuracy were further examined. These patterns were designated as realism, irrelevance, over-reaction and denial. It was suggested that these patterns of response may provide clues about avoidance and coping behavior for children's pain. In general, the results of this study did not support previous research. It was demonstrated that various statistical techniques which have been employed in research on this topic have influenced the interpretation of pain prediction and recall data.

Adolescent↗

The effect of phlebotomy as a treatment of Fabry disease.

Senescent erythrocytes are considered a major source of the ceramide trihexoside which accumulates in Fabry disease patients. We have evaluated weekly phlebotomy as a method to reduce the catabolic load imposed by the senescence of erythrocytes and thereby ceramide trihexoside in one Fabry patient; no change was observed in either plasma or urinary level of ceramide trihexoside. The implications of this observation are discussed with regard to glycolipid metabolism in man.

Bloodletting↗

Distal and very distal digital replantations.

Ninety-five patients with 98 complete or incomplete amputations of digits are reviewed. Three levels are considered according to the bony lesion, zone III being distal to the nail matrix. In this area, artery, nerve and vein repair need special techniques. The use of leeches in the absence of vein repair does not preclude an acceptable survival rate (68%), compared to the overall series (65.5%); however, smoking is detrimental (52%). Distal replantation is a fast and worthwhile procedure providing acceptable sensibility, no PIP limitation and good appearance at the price of a mean 74 days off work.

Amputation, Traumatic↗

Leeches: controlled trial in venous compromised rat epigastric flaps.

Leeches were studied for their efficacy to improve survival of venous compromised rat skin flaps. In 22 rats, bilateral epigastric island flaps were created and subjected to 6 h of venous occlusion. One flap in each animal was randomised to leech treatment, while the contralateral flap served as its own control. Flap survival, leech feeding time, weight gained by the leech and bleeding time from leech bites were measured. The area of flap survival was significantly increased in leech treated flaps compared to contralateral controls (n = 22 pairs, p = 0.03; Wilcoxon signed rank test). Weight gained in the feeding leech averaged 1.3 +/- 0.2 g (n = 18). Leech feeding time was 107 +/- 13 min (n = 18). Bleeding time from each leech bite averaged 79 +/- 12 min (n = 18). Hence, the extent of flap necrosis resulting from venous impairment can be partly diminished by leech treatment until definitive surgical venous revascularisation.

Animals↗

Primary hepatocellular carcinoma in idiopathic hemochromatosis after reversal of cirrhosis.

Previous reports have emphasized the association of primary hepatocellular carcinoma in patients with idiopathic hemochromatosis with cirrhosis. In contrast, patients with idiopathic hemochromatosis without cirrhosis have no increased risk of hepatocellular carcinoma. Phlebotomy therapy, by preventing the accumulation of parenchymal iron and subsequent cirrhosis, is believed to prevent hepatocellular carcinoma in the precirrhotic stage of the disease. We report the case of a 67-yr-old man with a 32-yr history of idiopathic hemochromatosis complicated by cirrhosis, who had reversal of cirrhosis with phlebotomy therapy, yet developed hepatocellular carcinoma. There was no serologic or tissue evidence of hepatitis B infection.

Aged↗

Long-term survival analysis in hereditary hemochromatosis.

This study investigated the long-term survival rates of 85 patients with hereditary hemochromatosis. Eighty-five patients with documented hereditary hemochromatosis diagnosed between 1958 and 1989 and followed up at the University Hospital (University of Western Ontario) medical center were retrospectively reviewed for this analysis. The current status of the patient was assessed by interview or written questionnaire completed by the patient or the family physician. Estimates of differences in survival rates were obtained using Kaplan-Meier life-table and Cox regression analysis. Liver histology, clinical features of the disease, and number of venesections were analyzed to determine their relationship to survival. In the course of a mean follow-up interval of 8.1 +/- 6.8 years (range, 0-31 years), there were 17 deaths among the 85 hemochromatosis patients. Patients with cirrhosis at the time of diagnosis were 5.5 times more likely to die than noncirrhotic patients. Patients who were noncirrhotic at the time of diagnosis had an estimated survival that was not significantly different from age- and sex-matched members of the normal population. Diabetes did not increase the risk of death after data were controlled for the presence of cirrhosis. Early diagnosis and treatment of hemochromatosis in the precirrhotic stage can lead to long-term survival similar to that in the general population. The presence of cirrhosis significantly increases mortality and is the major clinical factor affecting survival.

Aged↗

Studies on ferritin in rat liver and spleen during repeated phlebotomy.

1. The ferritin content of liver and spleen in normal and iron-loaded rats decreased during repeated phlebotomy. 2. During increased iron demand, ferritin is degraded in toto. 3. With the ESI and EELS technique the iron distribution was followed in different cell types and cellular compartments. 4. We have demonstrated two methods of iron mobilisation: (a) catabolism of lysosomal ferritin in toto and (b) delivery of ferritin from parenchymal cell into the bile and degradation of ferritin in toto.

Animals↗