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Clinical Observations (clinical + observation)
Selected AbstractsTiming of Thyroid Hormone Action in the Developing Brain: Clinical Observations and Experimental FindingsJOURNAL OF NEUROENDOCRINOLOGY, Issue 10 2004R. T. Zoeller Abstract The original concept of the critical period of thyroid hormone (TH) action on brain development was proposed to identify the postnatal period during which TH supplement must be provided to a child with congenital hypothyroidism to prevent mental retardation. As neuropsychological tools have become more sensitive, it has become apparent that even mild TH insufficiency in humans can produce measurable deficits in very specific neuropsychological functions, and that the specific consequences of TH deficiency depends on the precise developmental timing of the deficiency. Models of maternal hypothyroidism, hypothyroxinaemia and congential hyperthyroidism have provided these insights. If the TH deficiency occurs early in pregnancy, the offspring display problems in visual attention, visual processing (i.e. acuity and strabismus) and gross motor skills. If it occurs later in pregnancy, children are at additional risk of subnormal visual (i.e. contrast sensitivity) and visuospatial skills, as well as slower response speeds and fine motor deficits. Finally, if TH insufficiency occurs after birth, language and memory skills are most predominantly affected. Although the experimental literature lags behind clinical studies in providing a mechanistic explanation for each of these observations, recent studies confirm that the specific action of TH on brain development depends upon developmental timing, and studies informing us about molecular mechanisms of TH action are generating hypotheses concerning possible mechanisms to account for these pleiotropic actions. [source] Liver function test abnormalities in anorexia nervosa,Cause or effectINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2010Vignesh Narayanan MD Abstract Objective: Two females with severe anorexia nervosa (BMI of 10) were seen with marked abnormalities in their liver function tests before the initiation of refeeding. These paradoxically resolved with progressive refeeding and weight restoration. Method: Clinical observation during regimented medical stabilization and refeeding of two patients with severe anorexia nervosa with frequent monitoring of liver function tests. Results: Normalization of liver function tests ensued as caloric intake increased and weight gain progressed. Discussion: Although classically liver function test elevations occur during refeeding, as a manifestation of excessive calories and fat deposition in the liver, they may also be elevated due to severe malnutrition before refeeding has commenced and improved as refeeding occurs. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stressACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009C. EICH Background: Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. Methods: In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and ,-amylase, as well as a post-trial questionnaire. Results: Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled. Conclusions: Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels. [source] Alpha2 macroglobulin elevation without an acute phase response in depressed adults with Down's syndrome: implications,JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000J. A. Tsiouris Abstract Studies of immune function during depression in persons without intellectual disability (ID) have revealed elevated levels of ,2 macroglobulin (,2M) and an acute phase protein (APP) response. Clinical observation suggests that people with Down's syndrome (DS) may have associated genetic abnormalities in their immune systems. The APP response and ,2M changes in depressed versus non-depressed adults with DS was the subject of the present study. The serum pan-proteinase inhibitor ,2M, and the AP proteins c-reactive protein (CRP), ,1 antitrypsin (,1AT), ceruloplasmin (Cp), ,2 Macroglobulin (,2M), transthyretin (Trans), serum amyloid protein (SAP), and albumin (Alb) were measured in 38 adults with DS, 19 of whom were diagnosed with and 19 without depression using a sandwich enzyme-linked immunosorbent assay (ELISA). The DSM-IV criteria were used for diagnoses. Medical and neurological examinations excluded medical disorders associated with APP response. Only ,2M and CRP were significantly different in the depressed versus non-depressed groups. The ,2M was higher, a response similar to one observed in depressed people without ID, but the CRP was lower in the depressed group, especially in those subjects not on psychotropic medications, contrary to the expected APP response to depression. The results suggest that ,2M elevation in depressed adults with DS is independent of the APP response. An alternative explanation for its elevation is proposed linking the core symptom of depression with the mammalian dormancy/hibernation process. Further studies are needed to confirm that ,2M elevation is specific to depression and that it might provide a helpful marker for the diagnosis of depression in people with ID. [source] The role of loss of meaning in the pursuit of treatment for posttraumatic stress disorderJOURNAL OF TRAUMATIC STRESS, Issue 2 2005Alan Fontana Clinical observation and theory suggest that people who have difficulty coping with their exposure to traumatic events often experience a loss of meaning to their lives. This article examines the contribution of loss of meaning to seeking help from clergy and/or mental health providers. Results support the hypotheses that veterans who have suffered a greater loss of meaning are more likely to seek help from clergy and from VA mental health professionals. We suggest that veterans who seek help from clergy are particularly desirous of achieving a restoration of meaning that is specific to their loss, and that this quest sustains a continued pursuit of mental health treatment, especially among those who seek help from the VA. [source] Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skillsMEDICAL EDUCATION, Issue 3 2006Johanna Shapiro Introduction, Observation, including identification of key pieces of data, pattern recognition, and interpretation of significance and meaning, is a key element in medical decision making. Clinical observation is taught primarily through preceptor modelling during the all-important clinical years. No single method exists for communicating these skills, and medical educators have periodically experimented with using arts-based training to hone observational acuity. The purpose of this qualitative study was to better understand the similarities and differences between arts-based and clinical teaching approaches to convey observation and pattern recognition skills. Method, A total of 38 Year 3 students participated in either small group training with clinical photographs and paper cases (group 1), or small group training using art plus dance (group 2), both consisting of 3 2-hour sessions over a 6-month period. Findings, Students in both conditions found value in the training they received and, by both self- and instructor-report, appeared to hone observation skills and improve pattern recognition. The clinically based condition appeared to have been particularly successful in conveying pattern recognition concepts to students, probably because patterns presented in this condition had specific correspondence with actual clinical situations, whereas patterns in art could not be generalised so easily to patients. In the arts-based conditions, students also developed skills in emotional recognition, cultivation of empathy, identification of story and narrative, and awareness of multiple perspectives. Conclusion, The interventions studied were naturally complementary and, taken together, can bring greater texture to the process of teaching clinical medicine by helping us see a more complete ,picture' of the patient. [source] Fabricated bodies: A model for the somatic false selfTHE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 4 2004Peter Goldberg This paper draws attention to a particular use of the body, one in which basic psychical security is achieved through a radical detachment from body vitality, necessitating the creation of a coercive regime of psychosomatic control and autostimulation for purposes of artificial enlivenment of the self. When the personality is organized predominantly along the lines of a systematic dissociation (and then pseudo-integration) of the mental and the somatic realms of psychical life, the psyche-soma undergoes a far-reaching transmutation: the desiring body is eclipsed and replaced with a fabricated body. Clinical observation of this set-up is obscured by the fact that, in these cases, the body is deployed in a ,realistic' manner, rather than in a recognizably symptomatic way. It is, indeed, the hallmark of a successful somatic false-self organization that the colonization of the body is disguised as natural, ego-syntonic and compatible with social norms. The treatment approach requires a broadening of analytic attention to apprehend shifts in states of consciousness and psychophysical cues. [source] The Effect of CO2 and KTP laser on the cat saccule and utricleTHE LARYNGOSCOPE, Issue 8 2009Larry Lundy MD Abstract Objectives/Hypothesis: To assess the potential carbon dioxide (CO2) and potassium-titanyl-phosphate (KTP) laser-related trauma to the saccule and utricle in a cat model. Study Design: Basic science experiment utilizing cat model. Methods: Twelve adult male cats were divided into two groups,CO2 and KTP,to assess the potential saccule and/or utricle trauma with direct discharge of laser energy into the vestibule after the stapes was removed. Both groups were subdivided to assess the effects with acute sacrifice and three-month survival. Bone conduction auditory brain-stem response thresholds were used to monitor auditory function. Clinical observation was used to monitor vestibular function. The temporal bones were harvested, processed, and stained with hematoxylin and eosin (H&E) in all animals with the uninvolved side serving as the control. Results: None of the animals demonstrated changes in bone conduction auditory brain-stem responses. None of the animals in the survival group demonstrated clinical vestibular dysfunction. Saccular and utricular wall rupture was observed in all animals sacrificed acutely. None of the saccular and utricular wall ruptures were of a size and location that could be attributed to laser trauma, and none of the saccular and utricular wall ruptures were associated with neuroepithelial trauma. Conclusions: There is no evidence of a difference between the CO2 and KTP laser in potential laser-related trauma. Using bone-conducting auditory brain-stem response threshold and clinical monitoring of vestibular function, there was no evidence of clinical auditory or vestibular dysfunction. The histologic evidence of saccular and utricular wall rupture is more consistent with stapes extraction trauma than laser-related trauma. Laryngoscope, 2009 [source] Elevated Incidence of Posttransplant Erythrocytosis After Simultaneous Pancreas Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010G. Guerra Posttransplant erythrocytosis (PTE) poses a potential risk of thrombosis in kidney transplantation. Clinical observation of our systemically drained simultaneous kidney pancreas transplant (S-SPK) patients showed a higher incidence of PTE and need for phlebotomies. To evaluate the incidence of PTE we analyzed hematocrit (Hct) levels and frequency of phlebotomies in 94 SPK as compared to 174 living donor (LD) recipients and 53 type-I diabetic with kidney transplant only. For study purposes we defined PTE as Hct >50% or the necessity for phlebotomies. Kaplan,Meier plots and Cox proportional hazard models were used to examine the association between the transplant type and PTE. We found an increased incidence of PTE in SPK compared to LD (p < 0.001). In the multivariate model, SPK had a 5-fold risk for the development of PTE (AHR 5.3, 95% CI 1.8, 15.9). The incidence of therapeutic phlebotomy was 13% among SPK patients and 4% in LD kidney recipients; 19 patients altogether. A total of 64 units were phlebotomized (48-SPK and 16-LD). Type I diabetic patients with a kidney transplant showed a 0% incidence of PTE. We observed a greater incidence of PTE and phlebotomies in S-SPK compared to LD with kidney only transplant recipients. [source] Status 5 Years after Bilateral Hand TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2006S. Schneeberger Graft survival and function early after hand transplantation is good. It remains unknown, however, whether long-term survival is limited by chronic rejection. We here describe the clinical course and the status 5 years after bilateral hand transplantation with emphasis on immunosuppression (IS), function, morphology and graft vascular changes. Clinical observation, evaluation of hand function, skin biopsies, X-ray, ultrasound, angiography, CT angiography, electrophysiologic studies including compound motor and sensory action potentials (CMAP, CSAP) and somatosensory evoked potentials were performed and results recorded at regular intervals. Following reduction of IS one mild (grade II) rejection episode occurred at 4 years. Subsequently, skin histology remained normal and without signs of chronic rejection. Hand function continuously improved during the first 3 years and remained stable with minor improvement thereafter. CMAP and CSAP progressively increased during the observation period. Latencies of the cortical responses were prolonged but amplitudes were within normal range. Investigation of hand vessels revealed no signs of occlusion but showed revascularization of a primarily occluded right radialis artery. Motor and sensory function improved profoundly between years 1 and 5 after hand transplantation. No signs whatsoever of chronic rejection have been observed. [source] Microcephaly, lymphedema, chorioretinopathy and atrial septal defect: a case report and review of the literatureACTA PAEDIATRICA, Issue 4 2009Smadar Eventov-Friedman Abstract Background: The rare congenital combination of microcephaly, lymphedema and chorioretinopathy (MLCD) has been described. Recently, three cases with these clinical characteristics have been diagnosed as having, in addition, various congenital cardiac anomalies, which may be part of this genetic entity that presents with variable expression. Clinical observation: Here we present a new case of a one-year-old infant who was born with microcephaly and lymphedema and atrial septal defect (ASD) and developed chorioretinopathy at the age of 6 months. This infant had normal neurodevelopment at one year of age. Conclusion: We recommend that cardiac evaluation and long-term ophthalmologic follow-up should be part of the evaluation in each child born with microcephaly and lymphedema. Family counseling should include the fact that normal to near-normal development may be possible, despite the presence of microcephaly. [source] Regional variations in action potential alternans in isolated murine Scn5a+/, hearts during dynamic pacingACTA PHYSIOLOGICA, Issue 2 2010G. D. K. Matthews Abstract Aim:, Clinical observations suggest that alternans in action potential (AP) characteristics presages breakdown of normal ordered cardiac electrical activity culminating in ventricular arrhythmogenesis. We compared such temporal nonuniformities in monophasic action potential (MAP) waveforms in left (LV) and right ventricular (RV) epicardia and endocardia of Langendorff-perfused murine wild-type (WT), and Scn5a+/, hearts modelling Brugada syndrome (BrS) for the first time. Methods:, A dynamic pacing protocol imposed successively incremented steady pacing rates between 5.5 and 33 Hz. A signal analysis algorithm detected sequences of >10 beats showing alternans. Results were compared before and following the introduction of flecainide (10 ,m) and quinidine (5 ,m) known to exert pro- and anti-arrhythmic effects in BrS. Results:, Sustained and transient amplitude and duration alternans were both frequently followed by ventricular ectopic beats and ventricular tachycardia or fibrillation. Diastolic intervals (DIs) that coincided with onsets of transient (tr) or sustained (ss) alternans in MAP duration (DI*) and amplitude (DI,) were determined. Kruskal,Wallis tests followed by Bonferroni-corrected Mann,Whitney U -tests were applied to these DI results sorted by recording site, pharmacological conditions or experimental populations. WT hearts showed no significant heterogeneities in any DI. Untreated Scn5a+/, hearts showed earlier onsets of transient but not sustained duration alternans in LV endocardium compared with RV endocardium or LV epicardium. Flecainide administration caused earlier onsets of both transient and sustained duration alternans selectively in the RV epicardium in the Scn5a+/, hearts. Conclusion:, These findings in a genetic model thus implicate RV epicardial changes in the arrhythmogenicity produced by flecainide challenge in previously asymptomatic clinical BrS. [source] A Model of Ischemically Induced Ventricular Fibrillation for Comparison of Fixed-dose and Escalating-dose Defibrillation StrategiesACADEMIC EMERGENCY MEDICINE, Issue 6 2004James T. Niemann MD Abstract Objectives: Fixed- and escalating-dose defibrillation protocols are both in clinical use. Clinical observations suggest that the probability of successful defibrillation is not constant across a population of patients with ventricular fibrillation (VF). Common animal models of electrically induced VF do not represent a clinical VF etiology or reproduce clinical heterogeneity in defibrillation probability. The authors hypothesized that a model of ischemically induced VF would exhibit heterogeneous defibrillation shock strength requirements and that an escalating-dose strategy would more effectively achieve prompt defibrillation. Methods:Forty-six swine were randomized to fixed, lower-energy (150 J) transthoracic shocks (group 1) or escalating, higher-energy (200 J,300 J,360 J) shocks (group 2). VF was induced by balloon occlusion of a coronary artery. After 1 or 5 minutes of VF, countershocks with a biphasic waveform were administered. The primary endpoint was successful defibrillation (termination of VF for 5 seconds) with ,3 shocks. Results: VF was induced with occlusion or after reperfusion in 35 animals. Only five of 17 group 1 animals (29%, 95% CI = 10 to 56) could be defibrillated with ,3 shocks; 15 of 18 group 2 animals (83%, 95% CI = 59 to 96) were defibrillated with ,3 shocks (p < 0.002 vs. group 1). Nine of the group 1 animals (75%) that could not be defibrillated with 150-J shocks were rescued with ,3 shocks ranging from 200 to 360 J. Conclusions: In this ischemic VF animal model, defibrillation shock strength requirements varied among individuals, and when defibrillation was difficult, an escalating-dose strategy was more effective for prompt defibrillation than fixed, lower-energy shocks. [source] E6* oncoprotein expression of human papillomavirus type-16 determines different ultraviolet sensitivity related to glutathione and glutathione peroxidase antioxidant defenceEXPERIMENTAL DERMATOLOGY, Issue 6 2005Stéphane Mouret Abstract:, Clinical observations of non-melanoma skin cancer in immunocompromised patients, such as organ transplant recipients, suggest co-operative effects of human papillomavirus (HPV) and ultraviolet (UV) radiation. The aim of the present study is to evaluate UV sensitivity and DNA damage formation according to antioxidant status in HPV16-infected keratinocytes. We used SKv cell lines, infected with HPV16 and well characterized for their proliferative and tumorigenic capacities. We showed that SKv cell lines presented various E6* (a truncated form of E6) RNA levels. We demonstrated that the higher oncoprotein RNA expression level was associated with a higher resistance to solar-simulated radiation, more specifically to UVB radiation and to hydrogen peroxide. Moreover, this high resistance was associated with a low oxidative DNA damage formation after UV radiation and was related to high glutathione content and glutathione peroxidase activities. Therefore, the results of our study suggest that E6* levels could modulate the glutathione/glutathione peroxidase pathway providing a mechanism to protect HPV-infected keratinocytes against an environmental oxidative stress, such as UV radiation. [source] The relationship of some negative events and psychological factors to periodontal disease in an adult Swedish population 50 to 80 years of ageJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2002A. Hugoson Abstract Background: Clinical observations and epidemiological studies suggest that experiences of negative life events, especially those manifested as depression, may contribute to an increased susceptibility to periodontal disease. Objective: In the present study, the prevalence of some negative life events and psychological factors and their relation to periodontal disease were investigated. The sample consisted of individuals 50,80 years of age from an extensive cross-sectional epidemiological study performed in 1993 in the city of Jönköping, Sweden. Method: 298 dentate individuals from the Jönköping study were randomly selected. Clinical and radiographic examinations included registration of the number of existing teeth, plaque index, gingival index, pocket depth, and alveolar bone loss. In addition, a questionnaire about socioeconomic status, life events, and psychological and stress-related factors was used. Results: The results revealed that, in addition to the well-documented periodontal disease risk factors such as increased age, oral hygiene status, and smoking, the loss of a spouse (being a widow or widower) and the personality trait of exercising extreme external control were also associated with severe periodontal disease. Conclusion: The findings support recent studies suggesting that traumatic life events such as the loss of a spouse may increase the risk for periodontal disease. Above all, the present results indicate that an individual's ability to cope with stressful stimuli (coping behavior), as measured by the beliefs of locus of control of reinforcements may play a role in the progression of periodontal disease. Zusammenfassung Hintergrund: Klinische Beobachtungen und epidemiologische Studien legen den Schluss nahe, dass negative Ereignisse im Laufe des Lebens, insbesondere solche, die sich in Depression manifestieren, zu einer erhöhten Empfänglichkeit für Parodontitis beitragen. Zielsetzung: Untersuchung der Prävalenz von negativen Ereignissen im Lebenslauf sowie psychologischen Faktoren und deren Beziehung zu Parodontalerkrankungen in einer Population im Alter zwischen 50 und 80 Jahren, die im Rahmen einer extensiven epidemiologischen Querschnittsstudie im Jahre 1993 in der Stadt Jönköping in Schweden untersucht worden war. Material und Methoden: 298 bezahnte Personen wurden randomisiert aus der Jönköping-Studie ausgewählt. Die klinischen und röntgenologischen Untersuchungen umfassten die Erhebung der vorhandenen Zähne, der Plaque Index, Gingival Index, Sondierungstiefen und alveolärem Knochenabbau. Zusätzlich wurden durch Befragung sozioökonomischer Status, Lebensereignisse sowie psychologische und stressbezogene Faktoren erfasst. Ergebnisse: Die Resultate ergaben, dass zusätzlich zu den bekannten Parodontitisrisikofaktoren wit Alter, Mundhygienestatus und Rauchen der Verlust des Ehepartners, also eine Witwe oder ein Witwer zu sein, und das Persönlichkeitsmuster extreme externe Kontrolle auszuüben, mit schwerer Parodontitis assoziiert waren. Schlussfolgerungn: Diese Ergebnisse unterstützen neuere Studien, die Hinweise dafür gegeben haben, dass traumatische Lebensereignisse wie der Verlust eines Ehenpartners das Risiko an Parodontitis zu erkranken erhöhen. Darüber hinaus legen die Ergebnisse den Schluss nahe, dass die individuelle Fähigkeit mit Stress umzugehen (Coping), die in dieser Studie durch die Erfragung der Überzeugung über die Lokalisation der Kontrolle von Verstärkungen erfasst wurde, eine Rolle in der Progression der Parodontitis spielen. Résumé Origine: Des observations cliniques et des études épidémiologiques suggèrent que des évènements négatifs, particulièrement ceux manifestés par une dépression, puisse contribuer à une susceptibilité augmentée à la maladie parodontale. But: Dans cette étude, la prévalence de ces évènements négatifs et les facteurs psychologiques et leurs relations avec la maladie parodontale ont été recherchés. L'échantillon était composé de personnes âgées de 50 à 80 ans issues d'une étude épidémiologique extensive croisée réalisé en 1993 dans la ville de Jonkoping en Suède. Méthode: 298 individus dentés de cette étude furent sélectionnés au hasard. Les examens cliniques et radiographiques comprenaient l'enregistrement du nombre de dents présentes, l'indice de plaque, l'indice gingival, la profondeur de poche et la perte osseuse alvéolaire. De plus, un questionnaire sur le statut socio économique, les évènements de la vie et les facteurs psychologiques en relation avec le stress, fut utilisé. Résultats: Les résultats montrèrent qu'en plus des facteurs de risque bien documentés de maladie parodontale comme l'âge, l'hygiène orale et le tabagisme, la perte d'un époux (que l'on soit veuf ou veuve) et le trait de personnalité de pouvoir exercer un contrôle externe extrême étaient aussi associés avec une maladie parodontale sévère. Conclusion: Ces résultats soutiennent de récentes études qui suggèrent que des évènements traumatisant de la vie quotidienne comme la perte d'un époux puisse augmenter le risque pour la maladie parodontale. Par-dessus tout, ces résultats indiquent que la capacité d'un individu à gérer des stimuli stressants, (comportement gestionnel), mesurés par les convictions de contrôle des renforcements pourrait jouer un rôle dans la progression de la maladie parodontale. [source] Superficial mycoses and HIV infection in YaoundeJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2004J Lohoué Petmy ABSTRACT The incidence of superficial infections in patients with human immunodeficiency virus (HIV) is increasing in Yaounde. To determine the prevalence of superficial mycoses in HIV-positive subjects, a study was carried out in different hospital settings in Yaounde over a period of 18 months. Clinical observations were followed by the culture of samples on Sabouraud's glucose agar. Of the 148 HIVab-positive patients examined, 79 (44 males and 35 females) had at least one superficial mycosis (53%). The clinical presentations and the causative organisms did not differ from those found in immunocompetent individuals. The main lesions were oral candidiasis (77%), tinea corporis (21%), tinea versicolor (15%), tinea pedis (13%) and tinea inguium (12%). Trichophyton rubrum and Candida albicans were the organisms most commonly isolated. These results indicate the benefit of studying superficial mycoses for optimal management of HIV patients. [source] Low-dose cyclosporine A therapy increases the regulatory T cell population in patients with atopic dermatitisALLERGY, Issue 11 2009C. Brandt Background:, Atopic dermatitis (AD) is a T cell dependent chronic relapsing inflammatory skin disorder successfully treated with cyclosporine A (CsA). Clinical observations indicate that even low-dose CsA therapy is successful in severely affected AD patients. We studied the impact of low-dose CsA therapy on the ability of T helper cells to be activated, and examined whether regulatory T (Treg) cells are increased in these patients. Methods:, Peripheral T cells were activated in a whole blood sample and interleukin-2 producing cells were measured by intracellular cytokine staining. Regulatory T cells were analyzed by intracellular FoxP3 staining. Regulatory T cells (CD4+CD25+CD127low) and effector T cells (CD4+CD25,CD127+) were sorted by flow cytometry and used for suppression assays. Results:, A group of AD patients treated with low-dose CsA had a significantly larger Treg cell population than a healthy control subject group. In individual patients, onset of low-dose CsA therapy reduced the ability of T cells to be activated to 42 ± 18% (P < 0.005) and significantly increased Treg cells, both in absolute numbers (1.6-fold change) and frequencies (1.7-fold change). Treg cells from AD patients showed similar suppressive capacities as Treg cells from healthy donors. Furthermore, Treg cells from AD patients had skin homing properties. Conclusion:, Our results indicate that the therapeutic effect of low-dose CsA therapy in AD patients might be not only mediated by the inhibition of T cell hyperactivity but also by an increased population of Treg cells. [source] Allergy to goat and sheep milk without allergy to cow's milkALLERGY, Issue 11 2006S. Ah-Leung Background:, Cow's milk (CM) allergy is the most frequent cause of food allergy in infants. Most children who are allergic to CM are also sensitized to whey proteins and/or to the casein fraction and many of them cannot tolerate goat's or sheep's milk (GSM) either. Conversely, the GSM allergies that are not associated with allergic cross-reactivity to CM are rare. Methods:, Twenty-eight children who had severe allergic reactions, including anaphylaxis, after consumption of GSM products but tolerated CM products were recruited in a retrospective study. Whole casein and whey proteins were fractionated from CM and GSM. , -Lactoglobulin and the different caseins were isolated, purified and used to perform enzyme allergosorbent tests (EAST) and EAST inhibition studies with the sera of the allergic children. Results:, Clinical observations, skin prick testing and immunoglobulin (Ig)E-binding studies confirmed the diagnosis of GSM allergy without associated CM allergy. EAST determinations demonstrated that GSM allergy involves the casein fraction and not whey proteins. Cow's milk caseins were not at all or poorly recognized by the patient's IgE, while ,S1 -, ,S2 - and , -caseins from GSM were recognized with a high specificity and affinity. In all cases, increasing concentrations of CM caseins failed to inhibit the binding of patient's IgE to sheep or goat milk caseins, whereas this binding was completely inhibited by GSM caseins. Conclusions:, The characteristics of GSM allergy differ from those of the CM allergy because it affects older children and appears later. CM products do not elicit any clinical manifestation in GSM allergic patients, whereas CM allergic patients, usually cross-react to GSM. In all the GSM allergic children, the IgE antibodies recognized the caseins but not the whey proteins. Moreover, IgE specificity and affinity was high to GSM and lower to CM caseins despite their marked sequence homology. Doctors and allergic individuals should be aware that GSM allergy requires a strict avoidance of GSM and milk-derived products because reactions could be severe after ingestion of minimal doses of the offending food. [source] Bifocals and Down's syndrome: correction or treatment?OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2009Mohammad Al-Bagdady Abstract Purpose:, Accommodation is reduced in approximately 75% of children with Down's syndrome (DS). Bifocals have been shown to be beneficial and they are currently prescribed regularly. Clinical observations suggest the likelihood of improving accommodative ability after bifocal wear. The aim of the study is to evaluate the potential use of bifocals as a treatment for the reduced accommodation. Methods:, Clinical records of 40 children from the Cardiff Down's Syndrome Vision Research Unit, who were prescribed bifocals, were reviewed. Accommodation was noted before wearing the bifocals and during either their latest visit or when the children stopped using bifocals. Accommodation was reassessed during a follow up visit for the children who stopped wearing bifocals. Development of accommodation before bifocal commencement, age at bifocal prescription, gender, type of refractive error, visual acuity and the presence of strabismus were examined to evaluate their contribution to accommodation improvement. Results:, The accommodative ability of 65% (n = 26) of the children improved (through the distance part of the lens) after using the bifocals. More than half of those developed accurate accommodation without the use of bifocals (n = 14). Accommodative responses did not show any improvement with age before the children began wearing bifocals. Accurate accommodation was sustained after returning to single vision lenses in all examined children. The age distribution of the children on bifocal commencement was diverse. Presence of strabismus, refractive error type, visual acuity and gender did not have any effect on gaining improvement. Conclusions:, Bifocals are an effective correction for the reduced accommodation in children with DS and also act to improve accommodation with a success rate of 65%. Bifocal wear can therefore be temporary, i.e. a ,treatment' for the deficit, in at least one third of children. [source] Lung-function tests in neonates and infants with chronic lung disease: Tidal breathing and respiratory controlPEDIATRIC PULMONOLOGY, Issue 5 2006BMedSc, David N. Baldwin MBBS Abstract This paper is the fourth in a series of reviews that will summarize available data and critically discuss the potential role of lung-function testing in infants with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses information derived from tidal breathing measurements within the framework outlined in the introductory paper of this series, with particular reference to how these measurements inform on control of breathing. Infants with acute and chronic respiratory illness demonstrate differences in tidal breathing and its control that are of clinical consequence and can be measured objectively. The increased incidence of significant apnea in preterm infants and infants with chronic lung disease, together with the reportedly increased risk of sudden unexplained death within the latter group, suggests that control of breathing is affected by both maturation and disease. Clinical observations are supported by formal comparison of tidal breathing parameters and control of breathing indices in the research setting. Pediatr Pulmonol. 2006; 41:391,419. © 2006 Wiley-Liss, Inc. [source] The roots of empathy and aggression in analysisTHE JOURNAL OF ANALYTICAL PSYCHOLOGY, Issue 4 2005Richard Kradin Abstract:, Empathy and interpretation have complementary roles in analysis. Empathy diminishes psychological arousal, ego-defences, and promotes the therapeutic relationship. Interpretation, when adopted in the service of character analysis and the uncovering of unconscious conflict, represents one element of a larger set of interventions termed analytic aggression, whose primary goal is to promote insight. Psychoanalysis has been increasingly influenced by derivative theories that promote the therapeutic relationship. Clinical observations suggest that the application of analytic aggression has diminished and that many modern treatments may have become overly skewed towards empathic approaches. This paper explores ethical humanism, Jamesian typology, and feminine psychology, as factors that have contributed to the diminished emphasis on analytic aggression in practice. Eastern myth and Buddhist psychology are used to explicate the core features of narcissistic mental structuring and to support the continued importance of analytic aggression in its treatment. Case material is examined to elucidate the benefits and limits of analytic aggression. [source] Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic areaBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2006T. McPherson Summary Background, Lymphatic filariasis (LF) is a mosquito-borne nematode infection that causes permanent lymphatic dysfunction in virtually all infected individuals and clinical disease in a subset of these. One major sequel of infection is lymphoedema of the limbs. Lymphoedema of the leg affects an estimated 15 million persons in LF-endemic areas worldwide. Acute dermatolymphangioadenitis (ADLA) in people with filarial lymphoedema causes acute morbidity and increasingly severe lymphoedema. Episodes of ADLA are believed to be caused by bacteria, and it has been shown that entry lesions in the skin play a causative role. Clinical observations suggest that interdigital skin lesions of the feet, often assumed to be fungal, may be of particular importance. Objectives, To investigate the epidemiology and aetiology of interdigital lesions (IDL) of the feet in filarial lymphoedema. Methods, The frequency and mycological aetiology of IDL in 73 patients with filarial lymphoedema were compared with 74 individuals without lymphoedema in a region of Guyana highly endemic for Wuchereria bancrofti. Results, More than 50% of patients with lymphoedema had one or more IDL (odds ratio 2·69; 95% confidence interval 1·31,5·66; P < 0·005 compared with controls). The number of lesions was the strongest predictor of frequency of ADLA. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium). Conclusions, These findings highlight the importance of interdigital entry lesions as risk factors for episodes of ADLA and have implications for the control of morbidity from filarial lymphoedema. [source] Establishment of an ovarian metastasis model and possible involvement of E-cadherin down-regulation in the metastasisCANCER SCIENCE, Issue 10 2008Yoshiko Kuwabara Clinical observations of cases of ovarian metastasis suggest that there may be a unique mechanism underlying ovarian-specific metastasis. This study was undertaken to establish an in vivo model of metastasis to the ovary, and to investigate the mechanism of ovarian-specific metastasis. We examined the capacity for ovarian metastasis in eight different human carcinoma cell lines by implantation in female NOD/SCID mice transvenously and intraperitoneally. By transvenous inoculation, only RERF-LC-AI, a poorly differentiated carcinoma cell line, frequently demonstrated ovarian metastasis. By intraperitoneal inoculation, four of the eight cell lines (HGC27, MKN-45, KATO-III, and RERF-LC-AI) metastasized to the ovary. We compared E-cadherin expression among ovarian metastatic cell lines and others. All of these four ovarian metastatic cell lines and HSKTC, a Krukenberg tumor cell line, showed E-cadherin down-regulation and others did not. E-cadherin was then forcibly expressed in RERF-LC-AI, and inhibited ovarian metastasis completely. The capacity for metastasizing to the other organs was not affected by E-cadherin expression. We also performed histological investigation of clinical ovarian-metastatic tumor cases. About half of all ovarian-metastatic tumor cases showed loss or reduction of E-cadherin expression. These data suggest that E-cadherin down-regulation may be involved in ovarian-specific metastasis. (Cancer Sci 2008; 99: 1933,1939) [source] Mortality after uveal and conjunctival melanoma: which tumour is more deadly?ACTA OPHTHALMOLOGICA, Issue 2 2009Emma Kujala Abstract. Purpose:, We aimed to model and compare mortality rates for uveal melanoma (UM) and conjunctival melanoma (CM) by adjusting for differences in tumour size and local recurrence. Methods:, Population-based mortality data for 240 and 85 patients with primary UM and CM and 91 and 23 patients with disseminated UM and CM, respectively, were compared with cumulative incidence analysis. Cox proportional hazards multivariate regression with time-dependent variables was used to adjust for differences in tumour diameter, thickness and recurrence rates. Results:, The 10-year cumulative incidences of metastatic death from UM and CM were 39% (95% confidence interval [CI] 33,45) and 32% (95% CI 21,44), respectively. After adjusting for tumour size, risk of death from CM was higher than from UM (hazard ratio [HR] 1.9; p = 0.039). Additional adjustment for more frequent local recurrence of CM diminished the difference (HR 1.5; p = 0.25). Survival periods after systemic metastasis of UM and CM were comparable (median 8 months). Conclusions:, Clinical observations show longer survival after primary CM than after primary UM. This reflects the smaller average size of CM. However, a primary CM of a given size is more deadly than a UM of equivalent size because primary CM tends to recur after treatment and, possibly, because additional lymphatic dissemination occurs with CM. [source] The number of authors of scientific publicationsACTA PAEDIATRICA, Issue 5 2004Rolf Zetterström As in most other scientific journals, the number of authors per paper published in Acta Paediatrica is gradually increasing. In the 2003 volume, the number of authors was six or more in about one-third of the Regular papers and Clinical observations. The editorial board has handled several conflicts of interest due to disputes about authorship. Conclusion: Editors of scientific journals should promote a policy with the aim of creating a true balance between authorship and originality of papers. [source] Cutaneous melanoma: therapeutic lymph node and elective lymph node dissections, lymphatic mapping, and sentinel lymph node biopsyDERMATOLOGIC THERAPY, Issue 6 2005David B. Pharis ABSTRACT:, Early clinical observation in cancer patients suggested that tumors spread in a methodical, stepwise fashion from the primary site, to the regional lymphatics, and only then to distant locations. Based on these observations, the regional lymphatics were believed to be mechanical barriers, at least temporarily preventing the widespread dissemination of tumor. Despite evidence now available disputing its validity, this barrier theory has guided the surgical management of the regional lymphatics in cancer patients for more than a century, influencing the use of such surgical modalities as therapeutic lymph node dissection, elective lymph node dissection, and most recently lymphatic mapping and sentinel lymph node biopsy. No published randomized controlled trial exists that demonstrates improved overall patient survival for cancer of any type, including melanoma, after surgical excision of regional lymphatics. This article will review the biology of lymphatics as it relates to regional tumor metastasis, and based on available information, offer practical recommendations for the clinical dermatologist and their patients who have cutaneous melanoma. [source] Novel treatments for autistic spectrum disordersDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2005Susan E. Levy Abstract In no area of developmental pediatric practice is there more controversy regarding the choice of treatment than related to children with autistic spectrum disorders (ASD). Complementary and alternative medical therapies (CAM) are often elected because they are perceived as treating the cause of symptoms rather than the symptoms themselves. CAM used for autism can be divided by proposed mechanism: immune modulation, gastrointestinal, supplements that affect neurotransmitter function, and nonbiologic intervention. Secretin as a therapy for autism is discussed as an example of how a clinical observation rapidly grew to a widespread treatment before well-designed studies demonstrated absence of effect. The plausibility for behavioral effect was not substantiated by clinical studies. CAM used for treatment of autism is examined in terms of rationale, evidence of efficacy, side effects, and additional commentary. Families and clinicians need access to well-designed clinical evidence to assist them in choice of therapies. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:131,142. [source] Stimulant medication in 47,XYY syndrome: a report of two casesDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2005Anne Ruud MD In two males, 11 and 12 years of age, referred for attention-deficit-hyperactivity disorder (ADHD), 47,XYY syndrome was diagnosed. A team that included a neuropsychologist, a physiotherapist, and a physician examined them. Stature (patients were above 97.5% height for age), muscle consistency, and tremor indicated chromosome analysis. Psychological tests results did not fully fit the ADHD diagnosis. On the basis of our clinical observation we felt that stimulant medication was indicated. Administration of methylphenidate led to improved motor and cognitive functions as well as social adaptation in both patients. We suggest that this treatment might well be considered in clinically similar patients with XYY sex chromosomes; we further suggest that learning problems in such individuals may be related to ADHD. [source] Electroclinical Picture of Autosomal Dominant Nocturnal Frontal Lobe Epilepsy in a Japanese FamilyEPILEPSIA, Issue 1 2000Masatoshi Ito Summary: Purpose: Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is the first described partial epilepsy syndrome known to be due to a single gene mutation. We found a first Japanese ADNFLE family with a novel mutation of the neuronal nicotinic acetylcholine receptor (nAChR) ,4 subunit (CHRNA4) gene. The aim of this report is precisely to describe the electroclinical manifestations of ADNFLE in this family and to compare these findings with those of other families reported previously in the literature. Methods: Three affected family members were investigated electroclinically by close clinical observation, interictal EEG, video-EEG monitoring, magnetic resonance imaging, and single-photon-emission tomography. Information about other affected family members was obtained from either the spouse or the parents. Mutations within the CHRNA4 gene were examined in seven family members. Results: The clinical manifestations and diagnostic findings in the members of this family were consistent with ADNFLE. However, there were intrafamilial and interfamilial variations in clinical features. The seizures of the patients were brief tonic seizures, with hyperventilation in children and secondarily generalized tonic,clonic convulsions in adults. The onset of the children's seizures began in infancy and early childhood. The children's seizures were sometimes provoked by movement and sound stimulation, and did not respond to antiepileptic drugs. On the other hand, the adults' seizures disappeared spontaneously or were easily controlled with carbamazepine. Three children showed hyperactivity, and two children had mild mental retardation. All patients had impaired consciousness during their seizures and no auras. A novel missense mutation (c755C>T) in exon 5 of the CHRNA4 gene was found in four affected family members. Conclusions: The electroclinical pictures of a Japanese family with ADNFLE were basically the same as those of other families reported, but with slight differences. ADNFLE is probably not uncommon, and it is very likely that there are unidentified patients with this inherited disorder in Japan. [source] Theories of drug craving, ancient and modernADDICTION, Issue 1 2001D. Colin Drummond This paper reviews the principal theoretical models of drug craving and provides some directions for future research. The main models are classified broadly into three categories: (1) phenomenological models; based on clinical observation and description; these have been influential in classification systems of addictive disorders and in the development of pharmacological therapies; (2) conditioning models: based on conditioning theory; these have been influential in the development of cue exposure treatments; (3) cognitive theories; based on cognitive social learning theory: these have been influential in the development of cognitive therapies of addiction. It is concluded that no one specific theory provides a complete explanation of the phenomenon of craving. However, theories of craving grounded in general theories of human behaviour offer greatest promise, and generate more specific and testable research hypotheses. Theories that do not require craving to be present for relapse to occur have more empirical support than those that provide simplistic causal explanations. The cue-reactivity model shows promise in the exploration of the relationship between craving and relapse. However, further attention to the phenomenology of craving could help to advise the future measurement and study of drug craving, particularly in the context of research in which drugs are available to human subjects, with adequate ethical safeguards. There is a need for further study of the temporal dynamics of craving and consensus in the field on the most appropriate methods of measurement. Finally, new psychotherapies such as cue exposure and pharmacotherapies that aim to attenuate drinking behaviour, such as naltrexone and acamprosate, provide opportunities to improve understanding of the nature and significance of craving. However, the relatively uncritical assumption that craving is the underlying basis of addiction and represents the most appropriate target for treatment is challenged. [source] | |||||||||||||||||||||||||||||||||||||