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Repetitive ischemia-reperfusion injury: a plausible mechanism for documented clinical burn-depth progression after thermal injury.

Our previous studies confirmed the phenomenon of burn depth progression despite adequate Parkland formula resuscitation [Kim et al. J Burn Care Rehabil 2001;22960:406-6]. Repetitive ischemia-reperfusion injury (I-R) is a plausible explanation and is suggested by the concomitant swings we have observed in serum base deficit (BD) during resuscitation from burn shock. We chose to explore whether laser Doppler imaging (LDI) evidence of burn depth progression mirrored cycles of I-R (episodic swings in continuously measured BD). Positive findings would support the hypothesis that repetitive episodes of I-R is a factor in burn depth progression despite apparently adequate resuscitation. A total of 14 patients with severe life-threatening burns (median 51% TBSA) underwent continuous BD monitoring using a Paratrend 7 (Malvern PA) during 48 hours of resuscitation. Fluid needs were estimated using the Parkland formula, then were titrated to urine output. The slopes of BD changes were then analyzed. Worsening of BD greater than 0.2 mmol/l/min was noted, and a proportion derived relative to pooled data on 5-minute intervals. In four of the patients, LDI scans were performed on six representative areas sequentially every 4 hours. The analysis of median flux in these LDI images provided real-time determination of burn depth progression. Eight patients eventually died. Only four patients achieved a normal BD within 12 hours of monitoring despite exceeding the Parkland formula estimate and meeting urinary output parameters. Our analysis also showed cyclical peaks and valleys in the BD curve (P < .001), suggesting repetitive I-R insults. All increases in BD preceded changes that could be detected in vital signs or urine output. Finally, LDI confirmed that the burn depths continued to progress despite apparently adequate resuscitation, and also showed that there are similar peaks and valleys in the perfusion of the wounds (P < .0001), which mimic the changes in the BD curve. Responses to fluid resuscitation do not follow a linear pattern in the case of massive burns. These results in repetitive periods of tissue hypoperfusion evidenced by BD alterations and may contribute to progressive deepening of the burn wound.

Acid-Base Imbalance↗
PubMed2005

Assessment of progress tests.

BACKGROUND: Progress testing is a form of longitudinal examination which, in principle, samples at regular intervals from the complete domain of knowledge considered a requirement for medical students on completion of the undergraduate programme. Over the course of the programme students improve their scores on the test, enabling them, as well as staff, to monitor their progress. AIM: We aimed to review methods which have been used to assess the results of individual tests, and to make recommendations on best practice. DISCUSSION: In assessing progress tests, there are a variety of choices that must be made. These include whether the test is norm- or criterion-referenced; whether marking is negative or "number-right"; whether the grades are reported on a continuous or a discontinuous scale, and whether the grades are weighted towards the most recent observations, or the entire set of grades is used to determine the final grade. Grade boundary setting in the context of progress tests is also considered, using a mathematical model to predict the consequences of different approaches. The relationships between boundary setting, progression and remediation rules are considered. CONCLUSIONS: We concluded that norm referencing is preferable to criterion referencing, negative marking preferable to number-right marking, a discontinuous scale preferable to a continuous scale and that grades should be weighted to favour the most recent outcomes, although there should still be a degree of persistence (earlier grades should not disappear all together). Grade boundaries should be established with regard to rules on remediation and progression.

Clinical Competence↗
PubMed1998

Progression of the proportion of hepatitis B virus precore stop mutant following acute superinfection of hepatitis C.

To examine the progression of the proportion of hepatitis B virus (HBV) precore stop mutant (codon 28 of precore sequence; TGG to TAG) in the viral population of patients with dual hepatitis virus (B and C) infection, a series of serum samples obtained from six cases with chronic hepatitis B with acute hepatitis C superinfection were analysed by the method of amplification-created restriction site. At the time of superinfection, all patients included in the study were negative for hepatitis B e antigen and positive for its antibody. During the follow up of 30-90 months, in five of the six patients, three different patterns were observed: (i) the proportion of precore stop mutant increased in the first 20 months after acute hepatitis C virus superinfection and then decreased progressively thereafter (two cases); (ii) the proportion of precore stop mutant decreased progressively after superinfection (two cases); and (iii) no precore stop mutant was found during the course (one case). The remaining patient showed a progressive increase in the proportion of precore stop mutant over a period of 9 months after superinfection. Rather than the progressive increase in the proportion of precore stop mutants during the natural course of chronic HBV infection alone, the results of the present study showed a reverse course of progression following acute hepatitis C virus superinfection. This observation raised the possibility of a preferential or accumulative suppression on precore stop mutant by hepatitis C virus in the later stage of dual infection.

Adult↗
PubMed1994

P53 expression, ploidy and progression in pT1 transitional cell carcinoma of the bladder.

OBJECTIVE: To investigate a potential role for overexpression of the p53 protein in the identification of pT1 bladder tumours destined to progress. PATIENTS AND METHODS: The protein expression of the tumour suppressor gene p53, nuclear ploidy and tumour grade were studied in 25 patients with pT1 bladder tumours. Follow-up data was available for 21 tumours over a 10 year period. p53 expression was determined by immuno-histochemistry on paraffin embedded sections and flow cytometry was performed on cell suspensions derived from the same blocks. RESULTS: Ten of 21 (48%) tumours progressed to muscle invasive disease. Nuclear staining for the protein was seen in 16 (64%) tumours and of these nine (56%) progressed. All tumours with abnormal DNA content and all high grade tumours demonstrated overexpression of p53. Significantly more patients with high levels of p53 expression (> 10% nuclear staining) progressed compared with tumours with less than 10% of nuclei staining (P = 0.007). However, grade was the most specific predictor of progression (100%), with all grade 3 tumours progressing and grade was also the most significant prognostic indicator in terms of survival (P = 0.025). CONCLUSION: Tumour grade is likely to remain as the most useful aid to management decisions in pT1 bladder tumours.

Aged↗
PubMed2003

Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy.

GOAL: Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. OBJECTIVES: (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. DATA SOURCES: Official documents, secondary analyses, and interviews with policymakers. STUDY DESIGN: Qualitative, policy analysis. DATA COLLECTION: 2001-2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case-studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policymakers and documentary analysis. PRINCIPAL FINDINGS: (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. CONCLUSIONS: Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls.

Health Plan Implementation↗
PubMed1994

Diabetic control and progression of retinopathy in elderly patients: five-year follow-up study.

OBJECTIVE: To assess whether control of diabetes mellitus is as important in the elderly as in young and middle-aged diabetic patients in terms of progression of retinopathy. DESIGN: A 5-year longitudinal cohort study. SETTING: Outpatient diabetic clinic. PATIENTS: One hundred fourteen non-insulin-dependent diabetic patients (30 males, 84 females) > or = 60 years of age. MEASUREMENTS: Retinopathy was checked at the beginning and end of the follow-up period. During the 5-year follow-up period, demographic variables, body mass index, HbA1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non-proliferative retinopathy; grade 2, pre-proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5-year follow-up was defined as an increase in its grade. RESULTS: At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5-year follow-up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA1c during the follow-up were as follows: lower than 7%, 2%; 7-8%, 20%; 8-9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA1c was a significant risk factor for progression of retinopathy. CONCLUSIONS: Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.

Aged↗
PubMed1994

Progressive differentiation of human sebocytes in vitro is characterized by increasing cell size and altering antigen expression and is regulated by culture duration and retinoids.

Increasing cell size, lipid accumulation, and altered antigen expression are features of sebaceous differentiation in vivo. Enhanced lipid synthesis with progressive differentiation is also present in cultured human sebocytes. This study was conducted to investigate the evolution of cell size and antigen expression of human sebocytes with progressive differentiation in vitro. Subconfluent human sebocyte cultures were examined for sebocyte differentiation evaluated on cytocentrifuge preparations by light microscopy and classified in stages according to morphological criteria described for sebocytes in vivo. Rates of 5.1 +/- 2.2% undifferentiated sebocytes, 29.2 +/- 4.9% early differentiated, 20.7 +/- 4.1% advanced differentiated, 37.6 +/- 6.4% fully differentiated, and 5.9 +/- 1.9% mature sebocytes were calculated in secondary cultures. The size of cultured sebocytes measured by computer-assisted planimetry significantly increased with progressive differentiation up to 4-5.5 times. The low rates of mature sebocytes and the only moderate increase of their size with progressive differentiation indicate an incomplete terminal differentiation in vitro. Sebocytes were subsequently stained with a series of monoclonal antibodies (mAb) to determine antigen expression using the alkaline phosphatase anti-alkaline phosphatase technique. The number of sebocytes labeled with the anti-keratin mAb CK8.12 and KL1, and the mAb 34D11 (82 kD protein) increased with progressive differentiation; significant differences were found after comparing early and advanced differentiated sebocytes. Sebocytes were positively stained with the anti-keratin mAb 6B10 (K 4), RPN1162 (K 7), CK13 (K 13), RPN1165 (K 19), CK8.60, and the mAb 115F5 (MAM-6c), OM-1 (sebaceous gland antigen), and 24F10 (basic polypeptides) only at late-stage differentiation. The expression of keratins 4, 7, 13, and 19 was confirmed by gel electrophoresis and immunoblotting. The data obtained were used to study the effects of the duration of cultivation and of the retinoids isotretinoin and tretinoin on sebocyte differentiation in vitro. Subcultivation of sebocytes upregulated, and treatment with isotretinoin but not with tretinoin downregulated labeling with mAb which recognize indicating progressive and late-stage differentiation.

Antigens, Differentiation↗
PubMed2004

Pulmonary xenotransplantation: rapidly progressing into the unknown.

As one approach to circumventing the dire shortage of human lungs for transplantation, a handful of investigators have begun to probe the possibility of pulmonary xenotransplantation. The immunologic and perhaps physiologic barriers encountered by these investigators are considerable and progress in pulmonary xenotransplantation has lagged behind progress in cardiac and kidney xenotransplantation. However, during the last few years there have been substantial advances in the field of pulmonary xenotransplantation including, most noticeably, significant progress in attenuating hyperacute dysfunction. Progress has been made in understanding the barriers imposed by xenoreactive antibodies, complement, coagulation incompatibility and porcine pulmonary intravascular macrophages. Although our understanding of the barriers to pulmonary xenotransplantation is far from complete and the clinical application of pulmonary xenotransplantation is not yet in sight, current progress is fast paced. This progress provides a basis for future work and for a hope that the shortage of human lungs for transplantation will not always be a matter of life and death.

Animals↗
PubMed1985

Reversibility of progression of the transformed phenotype in Ad5-transformed rat embryo cells.

The carcinogenic process is extremely complex and is affected by diverse environmental and host factors. The mechanism for the gradual development of the transformed phenotype (a process termed "progression") was studied in type 5 adenovirus (Ad5)-transformed rat embryo cells. Progression was not correlated with major changes in the pattern of integration of viral DNA sequences. Instead, it was associated with an increased methylation of integrated viral sequences other than those corresponding to the E1 transforming genes of Ad5. A single exposure of progressed cells to the demethylating agent 5-azacytidine (Aza) resulted in a stable reversion to the unprogressed state of the original parental clone. A further selection of cells after growth in agar allowed the isolation of Aza-treated clones that had regained the progressed phenotype. These observations indicate that progression is a reversible process and suggest that progression may be associated with changes in the state of methylation of one or more specific genes.

Adenoviruses, Human↗
PubMed2004

mTOR controls cell cycle progression through its cell growth effectors S6K1 and 4E-BP1/eukaryotic translation initiation factor 4E.

The mammalian target of rapamycin (mTOR) integrates nutrient and mitogen signals to regulate cell growth (increased cell mass and cell size) and cell division. The immunosuppressive drug rapamycin inhibits cell cycle progression via inhibition of mTOR; however, the signaling pathways by which mTOR regulates cell cycle progression have remained poorly defined. Here we demonstrate that restoration of mTOR signaling (by using a rapamycin-resistant mutant of mTOR) rescues rapamycin-inhibited G(1)-phase progression, and restoration of signaling along the mTOR-dependent S6K1 or 4E-BP1/eukaryotic translation initiation factor 4E (eIF4E) pathways provides partial rescue. Furthermore, interfering RNA-mediated reduction of S6K1 expression or overexpression of mTOR-insensitive 4E-BP1 isoforms that block eIF4E activity inhibit G(1)-phase progression individually and additively. Thus, the activities of both the S6K1 and 4E-BP1/eIF4E pathways are required for and independently mediate mTOR-dependent G(1)-phase progression. In addition, overexpression of constitutively active mutants of S6K1 or wild-type eIF4E accelerates serum-stimulated G(1)-phase progression, and stable expression of wild-type S6K1 confers a proliferative advantage in low-serum-containing media, suggesting that the activity of each of these pathways is limiting for cell proliferation. These data demonstrate that, as for the regulation of cell growth and cell size, the S6K1 and 4E-BP1/eIF4E pathways each represent critical mediators of mTOR-dependent cell cycle control.

Animals↗
PubMed1984

Progression of radiological changes in rheumatoid arthritis.

A prospective study over one year of patients who had active rheumatoid arthritis discovered 64 who had received treatment for an adequate time with second-line drugs. In these patients there was evidence of continuing joint destruction as shown by radiological progression. During the year there were highly significant correlations between improvements in clinical and laboratory measurements, but neither group of tests was related to the degree of radiological change. However, in the second 6 months of treatment there was evidence that radiological progression was reduced. In a second prospective study of 88 patients with rheumatoid arthritis given prolonged, intensive therapy with second-line drugs and followed up for 10 years two-thirds showed radiological progression. However, the number of joints damaged per year fell significantly during the study period. There was a divergence between deterioration in radiological features and improvements in the ESR and functional capacity, though patients with a persistently low ESR had less radiological progression. These studies provide evidence that treatment may be associated with a reduced rate of radiological progression but suggest that changes in radiological progression and clinical and laboratory measurements may result from different mechanisms.

Adult↗
PubMed1986

Long term progression of joint damage in rheumatoid arthritis.

Joint damage in rheumatoid arthritis is assessed radiologically. Previous studies have not examined in detail its long term progression. We evaluated the overall changes of peripheral joint damage radiologically in 50 rheumatoid patients followed up at one rheumatology centre for 10 years. All peripheral joints were scored in 12 groups with Larsen's standard films at 0 and 10 years. In 48 cases the total scored deteriorated (mean increase 13% maximum damage). There was no different pattern of progression in any of the patients, though seropositive patients had more initial damage and a greater rate of progress. The wrist and small joints of the feet were most affected initially. During the 10 years most progression occurred in the wrist, knee, and metacarpophalangeal joints. Progression occurred in both initially normal and abnormal joints. By 10 years only 16.5% joint groups showed no damage. Complete destruction was most common in the wrist, knee, and small joints of the feet. Damage to the hands and wrists have a god indication of overall changes at 0 and 10 years and also the increase in damage (correlation coefficients were from r = 0.74 to r = 0.85). These results show that specific joints are involved in different stages of the disease. Some joints are frequently involved and some less often. The hands and the wrists give a reasonable picture of the overall progression of damage.

Arthritis, Rheumatoid↗
PubMed1989

Effect of spectacle use and accommodation on myopic progression: final results of a three-year randomised clinical trial among schoolchildren.

Two hundred and forty mildly myopic schoolchildren aged 9-11 years were randomly allocated to three treatment groups and the progression of myopia was followed-up for three years. The treatment groups were: (1) minus lenses with full correction for continuous use (the reference group), (2) minus lenses with full correction to be used for distant vision only, and (3) bifocal lenses with +1.75 D addition. Three-year refraction values were received from 237 children. The differences in the increases of the spherical equivalents were not statistically significant in the right eye, but in the left eye the change in the distant use group was significantly higher (-1.87 D) than in the continuous use group (-1.46 D) (p = 0.02, Student's t test). There were no differences between the groups in regard to school achievement, accidents, or satisfaction with glasses. In all three groups the more the daily close work done by the children the faster was the rate of myopic progression (right eye: r = 0.253, p = 0.0001, left eye: r = 0.267, p = 0.0001). Myopic progression did not correlate positively with accommodation, but the shorter the average reading distance of the follow-up time the faster was the myopic progression (right eye: r = 0.222, p = 0.0001, left eye: r = 0.255, p = 0.001). It seems that myopic progression is connected with much use of the eyes in reading and close work and with short reading distance but that progression cannot be reduced by diminishing accommodation with bifocals or by reading without spectacles.

Accommodation, Ocular↗
PubMed1984

Prevention of progression of coronary atherosclerosis by treatment of hyperlipidaemia: a seven year prospective angiographic study.

The progression of coronary atherosclerosis was assessed by repeat angiography in 28 patients and 20 controls with hyperlipidaemia (serum cholesterol concentration greater than 7.2 mmol/l (278 mg/100 ml) or serum triglyceride concentration greater than 2.0 mmol/l (177 mg/100 ml), or both) and symptomatic coronary artery disease of two or three vessels. Twenty eight patients (26 men and two women) were treated with diet and drugs (clofibrate or nicotinic acid, or both) to lower lipid concentrations. Twenty men taking part in a simultaneous study served as non-randomised controls. They received medical treatment for coronary artery disease but no treatment to reduce lipid concentrations. The initial levels of coronary risk factors and the angiographic state were comparable in the two groups. In the 28 patients total cholesterol, total triglyceride, and low density lipoprotein cholesterol concentrations were reduced by an average 18%, 38%, and 19% respectively by treatment for hyperlipidaemia and high density lipoprotein cholesterol concentration was increased on average by 10%. The treatment maintained these concentrations during a follow up of seven years. By all criteria coronary lesions progressed significantly less in the patients than the controls: the angiographic state remained completely unchanged in nine (32%) of the patients compared with only one (8%) of the surviving controls; of the arterial segments at risk, 46 (16.5%) progressed in the patients compared with 50 (38.2%) in the controls (p less than 0.001); and the coronary obstruction increased less in patients than in controls (p less than 0.05). Cardiac survival was 89% in seven years in the patients compared with 65% in five years in the controls (p less than 0.01). The anginal symptoms diminished or remained stable in 16 of the 24 patients who survived until the end of the study. The progression of coronary atheromatosis was significantly greater in those patients who during the seven years of treatment had an average total cholesterol concentration, VLDL plus LDL cholesterol concentration, or ratio of LDL to HDL cholesterol concentration above the respective median value than in those with the corresponding values below median. On the other hand, the patients with HDL cholesterol concentrations above the median during treatment showed less progression than those with lower HDL cholesterol concentrations. The increase in coronary obstruction was inversely related to the average HDL cholesterol concentration during treatment. The progression was not, however, related to LDL cholesterol concentration during treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Arteriosclerosis↗
PubMed1987

Radiological progression and lung function in silicosis: a ten year follow up study.

Chest radiographs and spirometric tests were performed on 81 patients who had silicosis from two granite quarries in 1975, 73 of whom were followed up for two to 10 (mean 7.2) years. Each patient's initial and most recent chest radiographs were assessed independently by three experienced readers, and the yearly declines in forced expiratory volume in one second and forced vital capacity were estimated from two to four (mean 3.45) serial spirometric readings. Estimates of individual dust exposure were based on extensive historical data on hygiene. All but 11 patients were no longer exposed to dust by the start of follow up, but 24 (45%) of 53 patients who had simple silicosis and 11 (55%) of 20 who had the complicated disease showed radiological evidence of disease progression. In patients who had simple silicosis and showed no radiological progression the yearly declines in forced expiratory volume in one second and forced vital capacity were modest (64 ml/year and 59 ml/year, respectively), whereas significantly greater declines in lung function were seen in those who showed radiological evidence of progression (97 ml/year and 95 ml/year, respectively). In addition to radiological progression the previous average dust concentration to which patients had been exposed also influenced declines in both forced expiratory volume in one second and forced vital capacity after allowing for the effects of age, smoking, duration of exposure, history of tuberculosis, initial state of disease, and baseline lung function. The probability of radiological progression was most strongly influenced by the average dust concentration previously exposed to. The progression of simple silicosis is thus accompanied by appreciable declines in lung function and is strongly affected by previous levels of exposure to dust.

Dust↗
PubMed1990

Progression of HIV infection in misusers of injected drugs who stop injecting or follow a programme of maintenance treatment with methadone.

OBJECTIVE: To see whether misusers of injected drugs who stop injecting or switch to a programme of maintenance treatment with methadone have a reduced risk of progression of HIV infection when compared with a group of persistent misusers. DESIGN: Observational cohort study in HIV seropositive subjects with a current or past history of misusing injected drugs. SETTING: HIV outpatient clinic at the University Hospital of Zurich, Switzerland. PATIENTS: 297 Current and former parenteral drug misusers (median age 27) with asymptomatic HIV infection. During the observation period 80 subjects adhered to a programme of maintenance treatment with methadone, 124 continued with parenteral drug misuse, and 93 former misusers remained free of illicit drugs. No antiretroviral treatment was given during the study. MAIN OUTCOME MEASURES: Probability of progression of HIV infection from asymptomatic to symptomatic (Centers for Disease Control stage IV) as calculated by life table analysis and compared in the three groups of patients by means of a log rank test, and predictors of disease progression as analysed with a Cox proportional hazards regression model. RESULTS: The 297 patients were followed up for a median of 16 months. The median duration of injecting drug misuse before enrollment was 7.1 years. There were no significant differences among the three groups with respect to CD4+ counts at the beginning of the study (median 0.44 x 10(9)/l). Life table analysis showed a significantly lower probability of progression of HIV disease in both the methadone treated group and former drug misusers than in persistent injecting drug misusers. Multivariate regression analysis showed a relative risk of progression of the disease of 1.78 (95% confidence interval 1.20 to 2.67; p less than 0.01) in persistent injecting drug misusers, 0.48 (0.29 to 0.77; p less than 0.01) in the methadone treated group, and 0.66 (0.41 to 1.06; p = 0.085) in former drug misusers. CONCLUSIONS: Stopping the misuse of injected drugs slows the progression of HIV disease in infected subjects. Drug treatment programmes are effective in secondary prevention of HIV associated morbidity.

Adult↗
PubMed1994

Progression of alcoholic acute to chronic pancreatitis.

Alcoholic chronic pancreatitis usually progresses from acute attacks to chronic pancreatitis within one to 19 years. The factors responsible for the appreciable variability in progression are unclear. In this study the relation between progression and the incidence and severity of acute episodes in a large cohort of patients with alcoholic chronic pancreatitis was analysed. All patients with at least one documented episode of acute pancreatitis have been studied prospectively over the past 30 years according to our protocol. Patients were classified according to their long term course into (a) calcific (n = 185), (b) non-calcific (n = 30), and (c) non-progressive (n = 39) chronic pancreatitis groups. The yearly incidence of acute attacks of pancreatitis was significantly higher in groups (a) and (b) than in group (c). Furthermore, the progression rate to advanced chronic pancreatitis (groups (a) and (b)) correlated with the incidence of severe pancreatitis (associated with pseudocysts in more than 55%). Pseudocysts were located primarily in the cephalic pancreas in groups (a) and (b) (58-71%) and in the pancreatic tail in group (c) (61%). In conclusion, these data suggest that the progression of acute to chronic pancreatitis is closely related to the incidence and severity of acute attacks. This finding and the primary location of pseudocysts in the cephalic pancreas (groups (a) plus (b)) are compatible with the 'necrosis-fibrosis' pathogenetic hypothesis.

Acute Disease↗
PubMed1995

Brain magnetic resonance imaging and multimodal evoked potentials in benign and secondary progressive multiple sclerosis.

Brain MRI and multimodal evoked potentials (EPs) were obtained for 13 patients with benign multiple sclerosis and 13 patients with secondary progressive multiple sclerosis, matched for age and duration of the disease, to investigate the nature of the disability in multiple sclerosis. Patients with secondary progressive multiple sclerosis had significantly greater lesion loads for five of seven periventricular regions and for three of nine regions separate from the ventricles. Patients with secondary progressive multiple sclerosis also had more severe infratentorial atrophy scores (p = 0.04), whereas there were no differences between the two groups in number and extent of enhancing lesions. The frequencies were significantly higher and severities greater for multimodal EP abnormalities of all the modalities in patients with secondary progressive multiple sclerosis. At least one EP component was absent in 12 (92%) patients with secondary progressive multiple sclerosis but in only one patient (8%) with benign multiple sclerosis (p < 0.001). There was neurophysiological evidence for cervical cord involvement in eight (61%) patients with secondary progressive multiple sclerosis and in one with benign multiple sclerosis (p < 0.01). These data indicate that the total amount of lesions, the distribution, and the nature of the pathological process might all account for the development of disability in multiple sclerosis.

Age of Onset↗