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Biopsy of the conjunctiva in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity.

PURPOSE: The aim of this work was to evaluate the different grades of squamous metaplasia of the conjunctiva during the clinical course of dry eye syndrome, detecting the most characteristic morphological and morphometric changes by biopsy in order to provide a diagnostic classification. METHODS: The conjunctiva was studied under light microscopy by conventional histological methods and by morphometric analysis in 165 patients and in 33 controls. Patients were classified according to the Schirmer 1 test, break-up time, rose Bengal staining, osmolarity and impression cytology. The epithelium and connective tissue, with their different cells and other structures, were studied. RESULTS: The conjunctiva in dry eye patients showed progressive stratification, hyperplasia, hypertrophy and cellular flattening, with loss of goblet cell density and mucous layer. We found five pathological grades of squamous metaplasia and one normal grade. Clear nuclear alterations (indentation and binucleation) were found in the early grades of dry eye syndrome, but pyknotic nuclei and anucleated cells were only seen in the most severe grades. The smallest epithelial cells were found in the control group and their size increased with the severity of the dry eye syndrome. From the earliest stages to the most severe cases, increases in cellular separation were observed. There was also an increase in the number of inflammatory cells. Blood and lymphatic vessels showed alterations only in the most severe cases. CONCLUSIONS: This is the first grading system proposed for biopsy evaluation of the ocular surface in dry eye patients. These morphological and morphometric studies alone were able, even in the earliest phases of dry eye, to detect the squamous metaplasia that progresses from the surface of the epithelium to the connective tissue. This degenerative or adaptative cellular process was characterized mainly by marked increases in the stratification, epithelial cellular size and a general loss of goblet cells.

Biopsy↗

Oxygen sensors in hypoxic pulmonary vasoconstriction.

Hypoxic pulmonary vasoconstriction (HPV) is an essential mechanism adapting lung perfusion to regional ventilation. Perturbations to HPV, such as those occurring in pneumonia, acute respiratory distress syndrome and liver failure, can result in arterial hypoxemia. Under conditions of general hypoxia, HPV increases pulmonary vascular resistance and thus causes acute pulmonary hypertension. Despite intensive research, the underlying mechanisms of HPV have not been fully elucidated. Deciphering signalling pathways that result in HPV could suggest novel approaches to address a failure of HPV, as well as for the treatment of pulmonary hypertension associated with HPV. Within this context, this review focuses on current concepts in the oxygen sensing mechanisms that underlie HPV.

Adenosine Triphosphate↗

Short-bowel syndrome. Medical aspects and prospects of intestinal transplantation.

Major intestinal resection may result in diarrhea and malabsorption, a clinical entity known as the short-bowel syndrome. Nutritional prognosis after a wide intestinal resection depends on the extent of resection, the nature of the intestinal segment removed (ileum or jejunum), the function and the adaptative capacity of the remaining intestine, and the preservation of the colon and the ileocecal valve. Adequate management of this dreadful syndrome requires a multidisciplinary effort between various medical specialties: general and pediatric surgery, intensive care unit, nutrition, psychology, pediatric and adult gastroenterology. Intestinal transplantation is the only chance for a real cure in patients who depend on total parenteral nutrition. Although results of small bowel transplantation have dramatically improved over the last few years, it remains a challenging surgical and immunologic enterprise. Severe rejection and infection are the major obstacles.

Adult↗

Molecular basis of intestinal adaptation: the role of the insulin-like growth factor system.

Ongoing and future approaches to the cellular and molecular actions of insulin-like growth factor I (IGF-I) and growth hormone (GH) in intestinal adaptation are reviewed. This is highly relevant to understanding the benefits and risks associated with increasing use of GH and IGF-I in patients with short bowel syndrome or other bowel diseases. As other growth factors share some of the properties of IGF-I including local expression in bowel, activation of signaling pathways common to other growth factors or cytokines, and modulation of action by growth factor-binding proteins or secreted receptor isoforms. The general issues and approaches outlined for IGF-I should, therefore, serve as a model for studies aimed at understanding the cellular and molecular mechanisms of action of other growth factors that are implicated in intestinal adaptation.

Adaptation, Physiological↗

Intestinal physiology relevant to short-bowel syndrome.

In summary, with resection of the small bowel, the remaining intestine mounts an adaptive response to increase its absorptive surface area. The malabsorption of nutrients is predicated on the importance of the bowel resected to the absorption of a given nutrient. Motor activity is little effected by small-bowel resection. In general, resection of the upper small intestine is better tolerated than resection of the lower small intestine, particularly if the ileocecal junction is affected.

Gastrointestinal Motility↗

No relationship between the size of the deletion and the level of developmental delay in cri-du-chat syndrome.

Molecular cytogenetic and developmental assessment was performed on 50 individuals with cri-du-chat syndrome. Fluorescent in situ hybridization analysis was used to confirm a terminal deletion karyotype and map more precisely the location of the deletion breakpoint. We identified terminal deletion breakpoints mapping from 5p15.2 to 5p13. Developmental assessment was performed using the Vineland Adaptive Behavior Scales test. Composite Vineland Scores ranged from 20-75. In general, the communication score was higher than the composite score. Comparison of the size of the deletion with the composite Vineland score, as well as the Vineland Communication score, demonstrated that there was no correlation between the size of the deletion and the level of developmental delay. These results demonstrate that patients with cri-du-chat syndrome show high variability in the level of developmental achievement.

Chromosome Deletion↗

Sick vessel syndrome: vascular changes in hypertension and atherosclerosis.

Hypertension and atherosclerosis are associated with structural and functional changes that may be collectively described as a 'sick vessel syndrome'. Structural changes in blood vessels (remodelling and hypertrophy) may be protective and adaptive. Functional changes in blood vessels include impairment of endothelium-dependent relaxation and impaired relaxation in response to activation of ATP-sensitive potassium channels. In general, vasorelaxation in response to direct activation of adenylate and guanylate cyclase is preserved in chronic hypertension and atherosclerosis. Vasoconstrictor responses to selected stimuli, such as serotonin, may be greatly potentiated. Impairment of endothelial function in combination with exaggeration of vasoconstrictor responses may predispose to vasospasm particularly during atherosclerosis.

Adaptation, Physiological↗

Are hard lenses superior to soft? The advantages of soft lenses.

Soft lenses now account for 85% of all lens sales in the United States and 74% of all sales worldwide. Several factors account for their popularity with patients, practitioners, and lens manufacturers. For patients, soft lenses offer easier adaptation, greater comfort, better appearance, less nighttime flare and spectacle blur, more flexibility in wearing schedule, and less chance of lens loss than polymethylmethacrylate (PMMA) or rigid gas-permeable lenses. Soft lenses also provide the options of disposability and of iris color change. Practitioners prefer soft lenses because they are less likely than hard lenses to cause epithelial staining, corneal molding, corneal edema, corneal desensitivity, or lens overwear syndrome. Furthermore, soft lenses present fewer fitting problems, satisfy therapeutic needs, are easier to stock for replacement purposes, and generally require no in-office modifications. Practitioners also welcome the benefits of disposable lenses: a simple lens care regimen, a decreased potential for deposit buildup, and adaptability to many different lifestyles. Manufacturers like the fact that hydrogels can be stock molded, and that their fitting is easier to teach.

Conjunctival Diseases↗

Behavioral phenotype of individuals with Down syndrome.

Evidence is reviewed for a developmentally-emerging behavioral phenotype in individuals with Down syndrome that includes significant delay in nonverbal cognitive development accompanied by additional, specific deficits in speech, language production, and auditory short-term memory in infancy and childhood, but fewer adaptive behavior problems than individuals with other cognitive disabilities. Evidence of dementia emerges for up to half the individuals studied after age 50. Research issues affecting control group selection in establishing phenotypic characteristics are discussed, as well as the possible genetic mechanisms underlying variation in general cognitive delay, specific language impairment, and adult dementia. MRDD Research Reviews 2000;6:84-95. Wiley-Liss, Inc.

Adaptation, Psychological↗

[Neuropsychiatric aspects of surgical indications of craniosynostosis and -stenosis].

In case of an indication for an operation on craniosynostosis not only an atrophy of the optical nerve, mental retardation and epileptic fits should be taken into consideration, but also the danger of faulty psychic developments, criminality of male patients, increased occurrence of psychoses and early cerebral blood flow disturbances as well as, especially in girls with scapho- or oxycephaly, cosmetic impairments with resulting psychosocial disturbances. Convulsions in craniosynostosis are not always an expression of a generally increased intracranial pressure, sometimes genetic couplings should be taken into consideration in case of an indication for craniotomy. Disturbances of social adaptation are related to a psychic fronto-cerebral syndrome due to frontal dysplasia of the base of the skull. For carrying out a craniotomy it is advisable to employ a combination of orbito-fronto-sphenoidal osteotomy for an extension of the anterior cranial fossa.

Brain Edema↗

[Transportation-related disease or motion sickness].

The manifestations of motion sickness result from neurovegetative effects linked to a change in the data used by the equilibration function in spatial integration. The syndrome is an adaptation to a physical environment that is different from that in which we live. Although each type of situation involves manifestations with a certain specificity, there is a general table of cinetoses. For the person who must face an environment at risk (usually for professional reasons), it is necessary to obtain active and voluntary adaptation by repeated exposure to the triggering conditions. The occasional traveler can use preventive or curative drugs which usually associate parasympatholytic agents and amphetamines. Despite the association of the latter, the risk of lowered attention level is large enough to preclude this type of treatment in anyone assuming responsibility in transportation.

Adaptation, Physiological↗

[Liver function in hormonal contraception].

Numerous interactions between hormonal contraceptives and liver function have been described. Changed laboratory results do not represent obligatory pathologic conditions or hepatotoxi effects. Some of these changed results are transient, suggesting that liver cells are capable of adaptation. The use of oral contraceptives is contraindicated in the following liver diseases: - recurrent intrahepatic cholestasis (recurrent jaundice of pregnancy, Dubin-Johnson syndrome, Rotor syndrome); - acute disturbances of liver function. In general it is recommended that hormonal contraceptives should not be used by patients with biliary cirrhosis although some authors have stated that chronic disturbances of liver function did not appear to be aggravated by these agents. Impairment of carbohydrate and lipid metabolism needs careful control of the laboratory tests concerned. Due to its low frequency the increased risk of gallstones does not necessitate the withdrawal of the medication. Up to now the interrelationship between the use of contraceptive steroids and the induction of hepatic tumours has not been proven.

5-Aminolevulinate Synthetase↗

Observations on the visual-perceptual abilities and adaptive behavior in adults with Down syndrome.

In this research, we consider some psychological, social, and clinical implications of premature aging in persons with Down syndrome (DS). Perceptual and adaptive tests contribute to a better knowledge of the characteristics of mental decline and self-government in DS adults. Visual-perceptual abilities (as measured by the Frosting Development Test of Visual Perception) and behavioral and social adaptation (measured by the Brown Adaptive Behavioral Inventory) were examined in 44 DS subjects aged 14 to 43 years. The results indicated a general decline in performance in the older groups (over 25 years), except in the visual-motor subtest, where a decline is less evident, as this ability continues to be exercised in craft work. Statistical analysis indicates a significant correlation between perceptual abilities, adaptive scales, and mental age. From the data collected, we draw some general conclusions about the trend of perceptual abilities and self-government in relation to aging in DS persons.

Adaptation, Psychological↗

[Gallstone duodenal obstruction or Bouveret's syndrome. Apropos of two cases].

Bouveret's syndrome is a rare form of Gallstone Ileus, characterized by its duodenal site after migration through a cholecysto-duodenal fistula in almost all cases. The two cases reported emphasize the interest of endoscopy in its early diagnosis. A therapeutic schema is proposed, based upon a systematic initial endoscopic extraction trial. The surgical treatment when needed is discussed in its modalities, and adapted to a reasonable evaluation of general and local conditions.

Aged↗

The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial.

OBJECTIVES: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. DESIGN: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. SETTING: Sixteen psychogeriatric wards in fourteen nursing homes in the Netherlands. PARTICIPANTS: One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer (DAT) type, mixed DAT and vascular dementia, and dementia syndrome (NAO) and 99 nursing assistants. INTERVENTIONS: Integrated emotion-oriented care and usual care. MESUREMENTS: Demented elderly: Behaviour and mood related to adaptation to the illness and the institutionalization. Nursing assistants: General health as measured by feelings of stress, stress reactions, feeling of competence and illness. RESULTS: Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks: maintaining an emotional balance (less anxiety) and preserving a positive self-image (less dissatisfaction). In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training. CONCLUSION: Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia. For the severely demented elderly we did not find this surplus value. This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes. With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them.

Absenteeism↗

Endocrine aspects of acute and prolonged critical illness.

Critical illness is characterized by striking alterations in the hypothalamic-anterior-pituitary-peripheral-hormone axes, the severity of which is associated with a high risk of morbidity and mortality. Most attempts to correct hormone balance have been shown ineffective or even harmful because of a lack of pathophysiologic insight. There is a biphasic (neuro)endocrine response to critical illness. The acute phase is characterized by an actively secreting pituitary, but the concentrations of most peripheral effector hormones are low, partly due to the development of target-organ resistance. In contrast, in prolonged critical illness, uniform (predominantly hypothalamic) suppression of the (neuro)endocrine axes contributes to the low serum levels of the respective target-organ hormones. The adaptations in the acute phase are considered to be beneficial for short-term survival. In the chronic phase, however, the observed (neuro)endocrine alterations appear to contribute to the general wasting syndrome. With the exception of intensive insulin therapy, and perhaps hydrocortisone administration for a subgroup of patients, no hormonal intervention has proven to beneficially affect outcome. The combined administration of hypothalamic releasing factors does, however, hold promise as a safe therapy to reverse the (neuro)endocrine and metabolic abnormalities of prolonged critical illness by concomitant reactivation of the different anterior-pituitary axes.

Acute Disease↗

[From today's foods to those of the future].

The prevention of cardiovascular diseases, and more generally of metabolic syndrome, goes with a well chosen diet. However, faced with a raft of often contradictory information, many patients can become disorientated. The role of the practitioner is to supply adapted, personaliZed and scientifically consensual advice. The consumption of certain types of foods naturally concentrated in protective elements should be favoured, such as those rich in folates, omega 3 fatty acids, and potassium, and low in sodium chloride. Furthermore, some new foodstuffs are appearing which have been subjected to modifications in their composition: enriched with certain nutrients or micronutrients, low in sugar and certain fats.... Thus, for example, margarines rich in phytosterols appear interesting despite limitations in their use; similarly, precautions of usage should accompany the consumption of products enriched with omega 3, sweeteners.... These attractive appearing and "gustatively correct" foods of the future will have more and more pronounced health claims. But alimentary innovation, relying on this basis in order to conquer new sections of the market, risks causing new nutritional imbalances. The practitioner must therefore remain sensible with nutritional advice and take account of economic and regional aspects by adapting it for each patient.

Cardiovascular Diseases↗

[Endocrinological aspects of acquired immunodeficiency syndrome (AIDS)].

The acquired immunodeficiency syndrome (AIDS) is a severe disease. Lung, brain and digestive complaints that result in opportunistic infections and neoplasms are the most documented. The endocrine disorders, the description of which is recent on the basis of post-mortem data, motivated some authors to undertake studies in order to evaluate endocrine function in patients infected with human immunodeficiency virus (HIV). An increase in serum cortisol level due to stress adaptation in the early stage of the disease is reported, whereas peripheral adrenal insufficiency, although unusual, appears in the late stage. Hypogonadism is common in men with HIV infection but its origin is discussed, central or peripheral. The thyroid function is generally preserved, but low T3 syndrome which correlates with bad prognosis may be observed. Anterior hypopituitarism, which is rare, hyponatremia more frequent because of its etiopathogenic factors in AIDS, constant and precocious hyperprolactinemia, are noticed. The episodes of asymptomatic or severe hypoglycemia may be explained by inanition and side effects of drugs. The non-specificity of the clinical manifestations of endocrine dysfunction masked by the classic signs of AIDS, shouldn't make forget the systematic search of glandular abnormalities as soon as an evocative symptomatology is conspicuous. The mechanisms of endocrine complications are badly known, but opportunistic infections, drugs, particularities related to the structure of HIV and interleukin 1 (IL1) surely play a role. The recognition of endocrine disorders is essential for optimal therapy because, unknown, their evolution is dramatic.

Acquired Immunodeficiency Syndrome↗