Dementia in cerebral amyloid angiopathy: a clinicopathological study.

Dementia is in addition to cerebral haemorrhage major symptom of cerebral amyloid angiopathy (CAa). In order to explore the pathological basis for dementia in CAa-related conditions, we made a clinicopathological analysis of CAa, with special attention to dementia. Among 150 patients (mean age 78.6 years) with autopsy-proven intracranial haemorrhage in Tokyo Metropolitan Geriatric Medical Center, CAa with cerebral haemorrhage accounted for 8.0% (12 cases), associated with hypertension and metastatic brain tumour. Among 38 patients with lobar haemorrhage, CAa represented the second most common cause (21.1%) of intracranial haemorrhage after hypertension. A total of 20 patients with CAa (mean age 82.5 years) were studies clinically and pathologically. Hypertension was present in 50%. Thirteen had a history of stroke and others had either ill-defined or no strokes. The average number of strokes 2.9. Fifteen patients (75%) had dementia. Based on the clinicopathological grounds for dementia, CAa-related conditions could be divided into three subtypes: "haemorrhagic", "dementia-haemorrhagic" and "dementia" type. Haemorrhagic type (30%, 6 cases) showed multiple recurrent lobar haemorrhages caused by CAa. Hypertension was present in only 1 patient. The incidence of senile plaques and neurofibrillary tangles was generally correlated with age. Only 1 patient had dementia. The dementia-haemorrhagic type (40%, 8 patients) had recurrent strokes with cerebral haemorrhage after preceding dementia. There were two different neuropathological subsets: CAa with atypical senile dementia of Alzheimer type (SDAT) and CAa with diffuse leucoencephalopathy. Patients with CAa with atypical SDAT had multiple cerebral haemorrhages caused by CAa combined with atypical Alzheimer-type pathology. Patients with CAa with diffuse leucoencephalopathy had cerebral haemorrhages in combination with diffuse white matter damage like Binswanger's subcortical vascular encephalopathy (BSVE). The incidence of senile changes correlated with age. Patients with the dementia type (30%, 6 patients) showed progressive dementia with or without haemorrhage. All had hypertension. They had a combined condition of Alzheimer-type pathology with conspicuous CAa with BSVE. Dementia in CAa-related conditions may be responsible for multiple factors including not Alzheimer-type degeneration, but also diffuse leucoencephalopathy like Binswanger's disease. We also found an asymptomatic type, an ischaemic type, a vasculitis type and an hereditary type in this condition.


A new way to use the Ishihara test.

The Ishihara plates are widely used as a test for colour vision. Originally designed for the purpose of detecting congenital red-green colour blindness, the test also has some value in demonstrating acquired colour vision defects. There are, however, several disadvantages in the present arrangement of the plates. A modification of the test, involving the rearrangement of the order of the plates, is presented which, together with a new recording chart, simplifies both the administration and the interpretation of the test.


Gadolinium-enhanced magnetic resonance imaging of the central nervous system in systemic lupus erythematosus.

Gadolinium (Gd)-DTPA enhanced magnetic resonance imaging (MRI) was performed in 15 systemic lupus erythematosus patients with past (12) or present (3) features suggesting central nervous system (CNS) involvement. Symptomatic Gd-DTPA enhancing lesions were seen in 2 patients, and immunosuppressive treatment was associated with a rapid reversal of enhancement. The pattern of enhancement was different from that usually seen in multiple sclerosis. Gd-DTPA enhanced MRI may sometimes be useful in demonstrating the activity of CNS lupus.


Ganglioside antibodies: a lack of diagnostic specificity and clinical utility?

Serum IgG and IgM antibodies to gangliosides GM1, GM2, GM3, AGM1, GD1a, GD1b and GT1b were determined in 210 patients with different degenerative and inflammatory disorders including motor neuron diseases, peripheral radiculopathies and neuropathies, multiple sclerosis and neuroborreliosis. No single disorder was associated specifically with ganglioside antibodies. No characteristic patterns of ganglioside antibodies were observed in any disease category. However, 32% of all patients had pathological antibody titres to at least one ganglioside. Four patients had pathological IgG and IgM titres for all gangliosides evaluated. They suffered from systemic lupus erythematosus [2], neuroborreliosis and schizophrenia, respectively. The results of this study indicate that the introduction of ganglioside antibody determination as a differential diagnostic test in clinical neurology is only helpful in a few patients with typical lower motor neuron syndromes.


Amplification and expression of the epidermal growth factor receptor gene during the progression of neuroepithelial tumours in vivo.

The epidermal growth factor receptor (EGFR) gene is homologous to the oncogene c-erbB. The occurrence of amplification and rearrangements at the EGFR gene locus is associated with malignancy in neuroepithelial tumours. Sixteen neuroepithelial tumours from eight patients with recurrence of their neoplasms were analysed for changes at the EGFR gene locus and for expression of EGFR. Ten tumours from five patients lacked changes at the EGFR gene locus. Three of eight individuals showed EGFR gene amplifications in both tumours with a higher grade of amplification in the second tumour. In addition to amplification, a rearrangement was found in both tumours of the first patient. In the second case an amplification of chromosome-7-specific c-met sequences was found in the regrown tumour, suggesting that a polysomy 7 was at least partly responsible for the higher copy number of the EGFR sequences. In both tumours of the third patient with EGFR gene amplification different alleles were amplified. In contrast to the findings at the DNA level the EGFR expression, analysed by immunohistochemical techniques, showed a more heterogeneous pattern after tumour progression.


Changing interpretations of angina pectoris associated with transient myocardial ischemia.

Silent ischemia associated with transient myocardial ischemia is currently recognized in the medical literature as a critical physiologic event that may occur in the absence of angina pectoris. A changing view of the clinical significance of angina pectoris as a reliable marker of myocardial ischemia is presented as a phenomenon of concern to nursing that carries implications for patient assessment, nursing interventions, and effectiveness of the nursing care.


Chronic arterial occlusive disease.

Cardiovascular disease continues to be a major cause of death in the United States. Although the number of deaths has decreased in the past several years, disability from the disease remains significant because of its systemic nature. As the population continues to age, peripheral vascular disease (PVD) will become increasingly prevalent in society as a result of the process of atherosclerosis. This article focuses on the care of patients with PVD. Risk factors, presenting signs and symptoms, and diagnostic and therapeutic modalities associated with chronic arterial occlusive disease, as well as nursing responsibilities and interventions, are discussed.


Coronary atherectomy: overview and implications for nursing.

Coronary atherectomy, a new invasive procedure for the treatment of atherosclerotic heart disease, consists of the excision and removal of atherosclerotic tissue from coronary artery walls. This article provides current information on atherectomy, including its potential advantages over percutaneous transluminal coronary angioplasty (PTCA). Indications, limitations, medical research, and implications for nursing research are described. A case study is presented.


Intracoronary stents: a new approach to coronary artery dilatation.

Percutaneous transluminal coronary angioplasty (PTCA) is a low-risk treatment for proximal and localized coronary artery disease. Two major complications associated with angioplasty are abrupt closure and restenosis of the treated vessel. Abrupt closure requiring intervention occurs in approximately 3.6% of patients; the average restenosis rate reported in the literature is 30%. These difficulties can produce profound hemodynamic compromise requiring additional intervention. PTCA research focuses on methods to treat or prevent abrupt closure and restenosis of the stenotic segment. One new approach to this goal is the use of intracoronary stents after balloon angioplasty to maintain the luminal diameter of the coronary artery. The effectiveness of intracoronary stents is currently being evaluated. This article describes the purpose and design of intracoronary stents and reviews clinical trial results and nursing management of patients with such stents.


A comparison of two techniques of care for indwelling arterial introducers after coronary angioplasty.

To determine whether indwelling arterial introducers can be maintained for 24 hours without risk of infection and/or hemorrhage in the post-coronary angioplasty patient, 96 patients were assigned to one of two groups. Introducers of the subjects in group I were flushed with 500 U of heparin, capped, and covered with a sterile occlusive dressing. Introducers of subjects in group II were connected to a heparinized (500 U in 500 mL normal saline) and pressurized (200 to 300 mm Hg) flush device. All introducers were removed 24 hours after coronary angioplasty. Results of t tests showed no significant difference between the two groups in incidence of infection or hemorrhage when hemoglobin, hematocrit, partial thromboplastin time, and white blood cell count were compared. Signs of inflammation at the introducer site (redness and swelling) and temperature elevation > or = 37.8 degrees C were not significantly different between the two groups. The incidence of hematoma formation at the introducer site was 40% in both groups. The two methods were found to be equally effective in maintaining a patent arterial introducer without risking infection and/or hemorrhage in the post-coronary angioplasty patient whose introducer remains indwelling for 24 hours.


Effect of concurrent chest pain assessment on retrospective reports by cardiac patients.

The purpose of this study was to examine the effect of a concurrent record of chest pain episodes on later completeness and accuracy of verbal recall. Patients included 23 men and eight women, ages 43 to 76 years from a private cardiology practice who were randomized into experimental (n = 16) and control (n = 15) groups. Following an initial interview, experimental patients were instructed in using a Chest Discomfort Diary in the home setting to record eight categories of information about each episode of chest pain experienced during the next 7 to 10 days. At the end of that time, both groups were interviewed about a specific typical episode of chest pain that had occurred; patients who did not have chest pain during the study period described an episode experienced prior to the initial interview. Experimental patients recalled their chest pain more completely than controls (P = 0.007), whether it had occurred during or prior to the study period. Experimental patients who had pain (n = 11), and thus actually used the diary, accurately recalled the duration, intensity, description, and treatment of the typical episode but were often inaccurate regarding their mood and the total number of episodes they had experienced. The findings suggest that a concurrent diary offers one method of teaching patients how to report their chest pain symptoms and may improve the completeness and accuracy of those reports.


Coronary artery fistulas: a review and case study.

Coronary artery fistula is a congenital abnormality that can present with a variety of cardiovascular complications. This article presents a patient with a coronary artery fistula outlining the pathophysiology and course of hospitalization, with particular emphasis on nursing management of a patient with coronary artery fistula.


Preparation for cardiac catheterization.

Cardiac catheterization is an invasive procedure often included in the medical evaluation of patients with ischemic heart disease. This article reviews one well-designed study that examines various approaches for preparing adults for a cardiac catheterization.


A report on a workshop on the National Institute for Occupational Safety and Health B reader certification program.

In September 1990, a 2-day workshop was held in Chicago to discuss the current status of the NIOSH B reader certification program and to suggest modifications and improvements. This is a summary report of the proceedings of that conference.


The NIOSH B reader certification program. An update report.

Physicians trained in the use of the International Labour Office system for classification of radiographs of pneumoconioses who pass a competence test administered by the National Institute for Occupational Safety and Health are designated as B readers. The current certification and recertification examinations for qualification under the NIOSH B reader program are described. Details of the rationale and format of each examination are given, and information on candidates' scores provided for the years 1987-1990.


Work-related electrocutions involving portable power tools and appliances.

Portable power tools and appliances can be identified as the source of injury in approximately 9% of occupational electrocutions. A search of fatality records for 1984 through 1986 in National Institute for Occupational Safety and Health (NIOSH) and Occupational Safety and Health Administration (OSHA) data bases identified 102 electrocutions involving portable appliances and tools that used 110-volt AC and 33 deaths involving welding equipment, which usually operates on 220-volt AC or higher. Of these 102 deaths, 51 occurred in the construction industry, 13 in services, 13 in manufacturing, and 25 in other industries. Plumbing contractors (Standard Industrial Classification [SIC] 1711) had the largest number of deaths (15) in construction. Powered hand-tools were involved in 58 deaths, with electric drills (23) and saws (13) the two largest classes. Proper provision of ground-fault circuit interrupter protection, particularly at temporary work sites, could have prevented most of the deaths from 110-volt AC. Engineering controls for preventing electrocution from portable arc-welding equipment should be evaluated.


Workers' attitude toward the occupational physician.

This article presents research findings concerning workers' perception and opinion of the occupational health service (OHS) in three different Dutch companies. Beside comparing the effect of company characteristics, we were able to relate a worker's evaluation of the OHS to employee variables such as health status. We conclude that workers see clear differences in the tasks and functions of the occupational physician compared with those of the curative physician. Relations with and dependence on management is considered to be self-evident. A negative evaluation of the OHS is mainly because of unclarity and uncertainty as to how the occupational physician combines his/her responsibility toward individual workers with his/her responsibility toward the company. Suggestions are made for improvement of the reputation and credibility of the OHS.


Hydrofluoric acid dermal burns. An assessment of treatment efficacy using an experimental pig model.

There currently exist various opinions concerning the best therapy for managing hydrogen fluoride (HF) dermal burns. Previously reported animal studies designed to evaluate the efficacy of certain therapies are not completely convincing. Studies initially were conducted to develop a reliable animal model for assessing efficacy of treatment. Evaluation of several animal species, dosing regimens (HF concentrations, exposure periods), and application techniques showed that the most consistent and reproducible dermal lesions were produced with 38% HF applied to the skin of anesthetized pigs for exposures of 9, 12, or 15 minutes using Hill Top Chamber patches. Using this model, the efficacy of six clinically applicable treatments was assessed by subjectively scoring and statistically analyzing photographic and histopathological data obtained from treated and untreated control lesions. Photographic data analysis ranked treatments with respect to effectiveness as follows: iced Zephiran and 10% calcium acetate soaks--highly effective; 2.5% calcium gluconate gel, 5.0% calcium gluconate injection and iced Hyamine soaks--effective; 10% calcium gluconate injection--ineffective. Histopathological data analysis showed the topical treatments (2.5% calcium gluconate gel, iced Hyamine, or iced Zephiran soaks) to be most effective in reducing superficial epidermal damage, and the 5% calcium gluconate injection or 10% calcium acetate soaks to be beneficial to deeper tissues of the dermis and subdermis. Injection of 10% calcium gluconate was ineffective. This study suggests that the anesthetized pig model has good applicability for assessing efficacy of HF dermal burn therapies. In addition, it indicates that further experimentation with 10% calcium acetate soaks is warranted.


Confined space fatalities in Virginia.

To better understand the frequency and characteristics of occupational confined space fatalities in Virginia, we reviewed death certificates, workers' compensation files, a Virginia Occupational Safety and Health Administration listing, and medical examiner records for all 50 fatalities (41 accidents) reported during 1979 to 1986. All fatalities were identified in medical examiner records (50), more than in any other source. The majority of decedents were male craftsmen, operators, or laborers less than 50 years old (mean 38). Drug screens of the 43 decedents tested were negative, with the exception of 2 cases where blood alcohol was detected (greater than or equal to 0.06%). Approximately 5% of "at work" civilian deaths (excluding plane, train, and motor vehicle fatalities) were confined space related. Virginia resident death rates per million employees were highest for shipbuilding and repair facilities (23.2), local government (8.9), and manufacturing other than shipbuilding (5.4%). Multiple fatalities occurred in 4 (10%) of the accidents, with 3 involving 2 fatalities each, and 1 accident involving 7 fatalities. Three fatalities (6%) were rescuers. Fifty nonfatal injuries of rescuers were known to have occurred in these accidents, 15 of co-workers and 35 of community rescue personnel (firefighters and rescue squad members). Approximately half the accidents occurred during the fourth quarter of the year and on a Thursday or Friday, and about one third occurred at night. The leading accident type was atmospheric condition, most commonly oxygen deficiency (33%) or the presence of carbon monoxide (20%). In 6 (40%) of the 15 accidents involving atmospheric condition, the toxic gas or oxygen deficiency was absent in the confined space at the time of entry.(ABSTRACT TRUNCATED AT 250 WORDS)


The Milan Automated Neurobehavioral System. Age, sex, and education differences.

The Milan Automated Neurobehavioral System (MANS) has been used in field studies to measure effects of toxicants on the central nervous system. The battery has not been deemed appropriate in clinical settings because of the paucity of available norms. In this study, 236 (151 men, 85 women) healthy 39- to 94-year-olds were given the MANS as part of a comprehensive neurobehavioral evaluation. The subtests were simple visual reaction time, digit symbol substitution, serial digit learning, and Benton visual retention. Age and years of education accounted for a significant proportion of the variance in all four subtests. In two of the subtests (simple visual reaction time and Benton visual retention) sex also accounted for a significant proportion of the variance. Age-, sex-, and years of education-specific normative values are presented for healthy persons aged 50 to 79 years.


Respiratory effects from the inhalation of hydrogen chloride in young adult asthmatics.

Almost no human data exist from controlled studies using low levels of hydrogen chloride (HCl), and, with no existing HCl ambient standards in the United States, the need for human health effects research is evident. In this study, five female and five male 18 to 25-year-old asthmatic subjects were exposed to filtered air, 0.8 ppm and 1.8 ppm HCl while wearing half-face masks, during three separate 45-minute experimental sessions involving 15 minutes exercise (treadmill walking), 15 minutes rest, followed again by exercise. Baseline and postexposure pulmonary function measurements were taken including forced expiratory volume in 1 second (FEV1), forced expiratory volume (FVC), maximal flow at 50% of expired vital capacity (Vmax50), maximal flow at 75% of expired vital capacity (Vmax75), and total respiratory resistance as well as peak flow. Nasal work of breathing and oral ammonia levels also were measured preexposure and postexposure. No significant pulmonary effects were found at these HCl concentrations and exposure duration. Nasal power showed no significant differences between test atmospheres; however, in isolation a significant decrease (P less than .01) was found in measurements of inspiration with exposure to 0.80 ppm. Ammonia levels showed a significant rise postexposure after both concentrations of HCl (paired t test, (P less than .01)), not seen after air exposure. In summary, the asthmatic subjects in this study showed no adverse respiratory health effects of inhalation of low concentrations of HCl.


Cholylglycine measured in serum by RIA and interleukin-1 beta determined by ELISA in differentiating viral hepatitis from chemical liver injury.

Serum bile acids have been shown to serve as useful indicators of liver disease. We have confirmed these findings and added an analysis of interleukin-1 beta (IL-1 beta) profiles to further differentiate viral hepatitis from toxic liver damage associated with exposure to vinyl chloride (VC) or trinitrotoluene (TNT). The frequency of elevated cholylglycine (CG) was 100%, 75%, and 37.5% in viral hepatitis, VC- and TNT-linked liver injury patients, respectively. The mean levels, expressed in micrograms/dL, were 578, 507, 142, and 65 in hepatitis B, hepatitis non-A non-B, VC and TNT liver injury patients, respectively. Thus, the CG test could detect viral hepatitis and, VC liver injury, and (less frequently) liver injury associated with exposure to TNT. The mean level of IL-1 beta in patients with hepatitis type B was 424 pg/mL and hepatitis non A non B was 384 pg/mL compared with a mean of 33-40 pg/mL in those with VC or TNT-linked liver disease. The IL-1 beta detection test proved further to be an important distinguishing parameter as it was 100% positive in patients with viral hepatitis but only 12.5% to 25% positive in patients with VC/TNT-induced liver damage.


Influences on cigarette smoking quantity. Selection, stress, or culture?

The selection, job stress, and job culture models of the association between occupation and smoking quantity were empirically evaluated in a random sample of 556 employed smoking adults in Orange County, California. Almost three quarters of the sample were heavy smokers (20 or more cigarettes per day). The largest percent of heavy smokers were blue-collar workers (77%). Age, sex, ethnicity, and the industry in which one works were all associated with heavy smoking, implying that selection and culture models contribute to smoking behavior. For example, men had twice the odds of being heavy smokers than did women, and Anglos had almost two and a half times the odds of being a heavy smoker than did non-Anglos. Smokers employed in the service, financial, insurance, and retail industries were one fourth as likely to be heavy smokers as those employed in the public administration sector. Smokers employed in the public administration sector had the highest percent of heavy smokers (88.9%). Job stress was not associated with heavy smoking compared with light smoking. Smoking cessation and prevention programs should address the social and job cultures in which the behavior occurs. Job-culture models of intervention should include elements that focus on individual coping mechanisms involving susceptibility to social pressure; social environment models imply that change in organizational culture is necessary.


The validity of study group assignments based on occupational histories obtained from questionnaires.

This study examined the validity of self-reported work histories for use in epidemiological studies of toxic exposures. Two uses that were examined were the assignment of subjects to exposure groups and the estimation of exposure duration. Questionnaire responses and data extracted from employment files were compared for 161 retired automobile workers. The questionnaire method assigned subjects to two extreme groups with 99% accuracy but rejected 30% of the subjects because of ambiguous data. Self-reports of exposure duration correlated moderately with the file estimates (r = .63, P = .01). The discrepancy between subjects' estimates and actual exposure duration correlated with subjects' job mobility. The findings indicate that the validity of self-report data declines with the precision required of the data, but that self-reports may have sufficient validity for studies that use extreme-group designs.


The primary treatment of frontobasal and midfacial fractures in patients with head injuries.

The timing of operation can be especially difficult when frontobasal fractures are combined with other head injuries and midfacial injuries. In these cases, the head injury represents a considerable hazard to the patient and therefore it is mandatory to avoid any additional strain that might be caused by treating the midfacial injury first. On the other hand, because of poorer results with the secondary treatment, the surgical therapy for midfacial injuries should be achieved as early as possible. This report describes the results obtained in 68 patients managed over a period of 5 years and discusses their definite primary treatment. It emphasizes the need for close cooperation between the various surgical specialties involved.


Cross-sectional tomography in evaluation of patients undergoing sagittal split osteotomy.

A study was performed to evaluate the possibility of locating the mandibular canal before sagittal split osteotomy by cross-sectional spiral tomography in 55 patients. Visibility of the whole canal wall circumference was excellent or good in 65.5% fair in 18.2%, and poor in 12.7% of cases. Only four canals (3.6%) were invisible. The canal was located lingually in 61 cases, buccally in 9 cases, and centrally in 34 cases. In patients with mandibular protrusion, the mean (+/- SD) buccolingual width was significantly smaller (9.5 +/- 1.51 mm vs 10.4 +/- 1.46 mm, P < .01) and the mandibular canal was more often buccally located than in patients with retrognathia.


Marsupialization for treatment of oral ranula: a second look at the procedure.

Simple marsupialization to manage oral ranula has fallen into disfavor because of excessive failures and the high incidence of iatrogenically caused cervical ranula that may follow this procedure. With the simple addition of packing the entire pseudocystic cavity with gauze after its unroofing, the rate of recurrence is minimized. It is recommended that oral ranula be treated initially by marsupialization with packing and, if recurrence occurs, then the offending sublingual gland should be excised.


Pediatric facial injuries associated with all-terrain vehicles.

All-terrain vehicles (ATVs) are becoming increasingly popular recreational devices. Multiple injuries have been associated with ATV accidents. This report reviews pediatric injuries treated at a regional pediatric trauma center, with special attention to facial trauma, as well as the ATV injury data for the United States.


A preliminary study of maximum voluntary bite force and jaw muscle efficiency in pre-orthognathic surgery patients.

The functional state of dentofacial deformity patients before orthognathic surgery has received relatively little study. In this study, the ability to generate occlusal force was compared between 84 patients before treatment for various dentofacial deformities and 57 controls. Maximal and submaximal bite forces were measured at the incisor and right and left first molar bite positions. Electromyographic activity (EMG) was recorded bilaterally from the anterior temporalis, posterior temporalis, and masseter muscles during each bite. An efficiency ratio was calculated for the jaw muscles by dividing the level of EMG by the occlusal force. There was a reduced ability to generate occlusal forces in the patients before surgery, especially among female patients. The reductions in maximal occlusal force were correlated with reduced efficiency of the jaw muscles.


The response of midfacial bone in sheep to loaded osteosynthesis screws in pretapped and nontapped implant sites.

This study compared the functional retention of pretapped and self-tapping 2-mm AO miniscrews (Stratec Medical, Waldenburg, Switzerland) in an animal experimental model. Histologic evaluation of the bone surrounding the loaded screws showed significantly more remodeling when pretapped screws were used than when self-tapping screws were used. Although the experimental situation may not be directly comparable with the clinical situation, this study does lend credibility to the assumption that pretapping is not advisable in the thin bone of the midface.


In vitro strength analysis of sagittal split osteotomy fixation: noncompression monocortical plates versus bicortical position screws.

An in vitro study using bovine ribs was performed to compare the strength of monocortical plates with bicortical position screws. An osteotomy was created to simulate a sagittal split and a 5-mm bone gap was produced. Four study groups were created: screw nongap, screw with gap, plate nongap, and plate with gap. Parameters of strength were analyzed by elastic deformation, stiffness ratio, permanent deformation, and breaking load. The results showed that monocortical plate fixation in bovine ribs provides less rigidity and is more susceptible to deformation than is bicortical position screw fixation.


Bone induction by composites of bioresorbable carriers and demineralized bone in rats: a comparative study of fibrin-collagen paste, fibrin sealant, and polyorthoester with gentamicin.

Host tissue response and heterotopic osteoinduction by composites of demineralized bone matrix and three different substances used as bioresorbable carriers implanted in the abdominal muscles were evaluated by strontium 85 uptake and histology 4 weeks postoperatively in 60 male Wistar rats. Both fibrin-collagen paste and fibrin sealant inhibited bone induction and produced a chronic inflammation; part of the fibrin-collagen paste was still present at 4 weeks. Polyorthoester with gentamicin was almost completely absorbed, induced minimal tissue reaction, and did not inhibit osteoinduction.


Healing of bony defects in the irradiated and unirradiated rat mandible.

A model system of the irradiated rat mandible has been developed and used in conjunction with a non-spontaneously healing mandibular defect. The contribution of the tissue components in the healing of bony defects was studied using demineralized bone powder (DBP) prepared from unirradiated or in vivo irradiated rat long bones. Better bony fill of the defects occurred in the irradiated beds filled with unirradiated DBP than in the unirradiated beds containing irradiated DBP. This suggests that, at least in the early postirradiation period, the bed is not the limiting factor in healing of bony defects and the osteogenic components of bone in the DBP may be most affected by irradiation. In the irradiated bed, the defects grafted 2 weeks after irradiation healed better than those grafted at 4 weeks. Thus, the timing of surgery after irradiation also plays a role in the healing process, with early surgery producing better results.


Ketorolac tromethamine: an oral/injectable nonsteroidal anti-inflammatory for postoperative pain control.

Ketorolac tromethamine is a new injectable/oral nonsteroidal anti-inflammatory analgesic with no apparent opiate receptor activity that has been administered alone and in combination with other opiate analgesics for the treatment of postoperative pain. The drug has shown promise in analgesic comparisons with morphine sulfate; it lacks the effects of respiratory depression and nausea and vomiting usually associated with narcotic agents. Intramuscular ketorolac may be particularly useful with those patients who have respiratory disease and patients being dismissed following short ambulatory or private-office anesthetic procedures.


Outcome assessment in oral and maxillofacial surgery advanced education programs.

Outcome assessments are becoming a standard by which predoctoral and postdoctoral advanced dental educational programs are being evaluated internally and externally. This article presents an overview of the process of development of an outcome assessment document for oral and maxillofacial surgery residency programs and provides an example of its value in the evaluation of two different types of oral and maxillofacial surgery programs.


Heterotopic gastrointestinal cyst of the oral cavity.

A case of an oral heterotopic gastrointestinal cyst of the tongue is described and a review of the literature is presented. The oral gastrointestinal cyst is a developmental lesion found more commonly in males, with a wide age range, but mostly occurring in the young. It presents as an asymptomatic swelling and most likely arises from misplaced embryonal tissue. Conservative surgical excision is the treatment of choice and no recurrence is expected.


Current status of digestive intolerance to food protein.

Digestive intolerance to food proteins may occur in childhood as a result of a wide range of etiologic and pathophysiologic mechanisms. Cow milk protein intolerance is the most common form of food intolerance in children. Food allergy and food intolerance may be confused because both produce similar symptoms, especially in young children with clinical manifestations of food allergy localized to the gastrointestinal tract. On the other hand, food-sensitive enteropathy may be defined as the clinical food-related syndromes associated with an abnormal small intestinal mucosa. Although several foods have been reported to damage the small intestinal mucosa in infancy (soy, rice, fish, chicken meat, egg), cow milk-sensitive enteropathy is the most common cause. Whatever the mechanisms, digestive intolerance to food proteins with or without enteropathy is primarily a temporary condition of infancy, in contrast to most forms of food allergy. In children with these disorders, symptoms usually resolve by 1 to 3 years of age. The variation in prevalence rates of this disorder in different countries can be explained by different diagnostic criteria. The classic food-sensitive enteropathy syndromes with chronic diarrhea and failure to thrive in infancy have become rarer in some European countries, including Spain. Some risk factors for the development of these conditions appear to be early exposure to cow milk feedings, acute infectious diarrhea, and malnutrition. Breast-feeding appears to be at least partially protective.


Cow milk-sensitive enteropathy: predisposing factors and treatment.

Cow milk-sensitive enteropathy is a temporary disorder of infancy characterized by a variably abnormal small intestinal mucosa while milk is in the diet. This abnormality is reversed by a cow milk-free diet, only to recur on challenge. Important predisposing factors are age (< 3 years), transient IgA immunodeficiency, atopy, and early bottle feeding. The disorder is diagnosed histologically by evidence of mild-to-moderate partial villous atrophy with thin, often patchy mucosa. For an accurate clinical diagnosis, challenge with the offending food after a demonstrated response to cow milk elimination is critical. When available, serial small intestinal bowel biopsies related to elimination and challenge are also important. Treatment is elimination of cow milk and all foods based on cow milk, and substitution of cow milk feedings with commercially available formulas free of cow milk protein. Five types of cow milk substitutes are described; only nutritionally complete formulas are recommended. Later, a milk challenge will determine the timing of safe reintroduction of cow milk to the diet, at a time when the child is gaining weight, thriving, and symptom free. This dietary treatment is always temporary; reintroduction of a normal diet is nearly always possible between 1 and 2 years of age.


Cow milk allergy in infancy and hypoallergenic formulas.

Substitute feedings have been used to treat infants with cow milk protein allergy for most of this century. For the past 50 years, several infant formulas based on animal proteins, both intact and chemically modified, or on vegetable protein have been labeled "hypoallergenic." Because of the risk of anaphylaxis and other serious adverse reactions, formulas that are claimed to be hypoallergenic should be subjected to rigorous preclinical and clinical testing. At a minimum, such formulas should not provoke any allergic signs or symptoms in 90% of infants with documented cow milk protein allergy when tested in double-blind, placebo-controlled trials. A standardized definition of "hypoallergenic" will allow clinicians and parents to understand the true risks to a cow milk-allergic infant fed such hypoallergenic formulas.


Allergenicity of cow milk proteins.

The allergenicity and antigenicity of cow milk proteins are age dependent. Because the nonspecific and specific factors inhibiting the passage of cow milk proteins through the epithelial layer of the intestine are deficient at birth, although developing during early infancy, allergy to cow milk may be acquired during the first year of life. Allergic reactivity to cow milk is lost during childhood in the vast majority of cases. This change may depend at least partly on the development of the local immune system of the gut producing antigen-specific IgA antibodies. Circulating IgG antibodies to cow milk proteins are always produced when an infant has cow milk in the diet but are not associated with allergy; their titer is reduced with age. Clinical challenge tests show that most cow milk-allergic patients react to several protein fractions of cow milk. A patient may have IgE antibodies to several fractions of cow milk, measured either by skin testing or by radioallergosorbent test. Likewise, various tests for cell-mediated immunity may show positive reactions to several fractions. No single major allergen is apparent in cow milk, according to either the challenge tests or laboratory procedures: casein, alpha-lactalbumin, and beta-lactoglobulin all show a high proportion of positive reactions.


Allergenicity and nutritional adequacy of soy protein formulas.

Soy protein formulas are used for different conditions, including cow milk protein allergy, lactose and galactose intolerance, and severe gastroenteritis. Feeding soy protein formulas to normal term infants is associated with normal growth, normal protein nutritional status, and normal bone mineralization. Recent studies of infants fed soy protein formulas exclusively during the first months of life revealed no immunologic abnormality; however, the use of such formulas for management of cow milk protein allergy and for prevention of atopy is controversial. Although in the past decade many studies have stressed soy allergenicity, soy allergenicity has been confirmed by the challenge test in only a few studies. In this article we review the studies dealing with the allergenicity of soy protein formulas. We also present our own data on their use in the prevention and management of cow milk protein allergy.


Fish allergy: evaluation of the importance of cross-reactivity.

Fish constitute one of the most important groups of allergens in the induction of immediate (type I) food hypersensitivity. In our environment, fish allergy is present in 22% of all patients with a diagnosis of food hypersensitivity. We studied the allergenic significance of the fish species considered most representative because of their greater consumption in our environment (flatfishes: Pleuronectiformes such as sole, whiff, and witch; Gadiformes such as hake; and Scombriformes such as albacore) or because of the results of previous studies of Gadiformes such as cod. Through the use of isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting, we have observed that several allergens common to all these species are able to bind specific IgE from the sera of sensitized patients. This allergenic community has been confirmed by radioallergosorbent inhibition. Another group of species-specific allergens focuses in the regions at about pH 5 and with molecular weights less than 14 kilodaltons; these allergens correspond to sarcoplasmic parvoalbumins. From the results observed, which have been confirmed by various procedures and techniques, we conclude that hake is the fish with the capability to induce the strongest IgE response, followed by whiff; the witch seems to be the least allergenic of all flatfishes. Among all species studied, albacore was the least allergenic. These results may be considered when one introduces supplementary feeding with fish in infants, most particularly in infants at high risk for atopy.


Nonclinical testing of formulas containing hydrolyzed milk protein.

The allergenic potential of cow milk-based infant formula can be reduced by protein hydrolysis. Controlled clinical studies are necessary to demonstrate conclusively the biologic efficacy of these formulations in human beings. Nonclinical testing programs provide manufacturers with the opportunity to characterize various molecular and immunologic properties of these hydrolysates and their corresponding final product forms. Physicochemical analyses provide data relating to the extent of protein hydrolysis and peptide molecular weight distribution. Immunochemical analyses can semiquantitatively estimate hydrolysate reactivity with preformed antibody. The ability of hydrolysate-based products to induce an immune response can be evaluated by using animal models. It is the responsibility of the manufacturer to choose the appropriate combination of nonclinical tests and use them to document product consistency, thus helping to ensure consistent clinical performance.


Food-processing approaches to altering allergenic potential of milk-based formula.

All the major cow milk proteins in their native states are potential allergens in infants with milk allergy. Heat treatment can reduce the antigenicity of whey proteins considerably, but it has virtually no effect on the antigenicity of casein. Infants allergic to milk still react to heat-denatured whey proteins. Therefore heat denaturation alone cannot produce a formula with low allergenicity. Enzyme hydrolysis reduces the antigenicity and allergenicity of protein. Partial hydrolysis produces hydrolysate consisting mainly of large peptides, whereas extensive hydrolysis produces hydrolysate containing a mixture of large and small peptides and free amino acids. Enzyme hydrolysis often produces bitter peptides and destroys the physical functionality of protein. When hydrolysate formula is made, casein or whey protein hydrolysate is ultrafiltered to remove large residual peptides. Certain amino acids are fortified to provide a balanced amino acid profile. The final formulation must comply with the recommendations of the Codex Alimentarius Commission (FAO/WHO) and the U.S. Infant Formula Act to provide adequate infant nutrition. Protein hydrolysate-based formula can be improved by further reducing the residual allergenicity, increasing the small peptide content, and improving the taste.


Prediction and detection of allergy development: influence of genetic and environmental factors.

The prevalence of atopic diseases is increasing in northwestern Europe and probably also in the rest of the Western world. Detecting cord blood IgE, in combination with obtaining a family history of atopic disease, seems to be the most valuable method of predicting all forms of atopic disease; however, this will identify only a small proportion of children with subsequent development of atopic disease. Determination of cord blood IgE cannot, without modifications, be recommended as a single test for identifying infants for allergy prevention programs. Skin prick reaction to egg white during the first year of life seems to identify a majority of children in whom allergic disease is going to develop during infancy. Other methods, such as genetic markers of an atopic constitution, eventually may facilitate early identification of infants at risk of atopic disease.


Definitions and diagnosis of food intolerance and food allergy: consensus and controversy.

This article describes the terms used for the various syndromes and diseases associated with reactions to foods; it outlines the principal types of food intolerance encountered in children, with particular emphasis on those caused by immune-mediated reactions of immediate hypersensitivity. Terms defined include food intolerance or food sensitivity; food allergy or food hypersensitivity; psychologically based food reactions (food aversions); and psychosocial and neurologic dysfunction. The spectrum of food sensitivity is considerable, and diagnosis is generally based on the monitoring of effects of exclusion diets and provocation tests, after appropriate objective measures are first selected. In children, manifestations of IgE-mediated food allergy (often in association with other immune mechanisms) include self-limiting and immediate reactions (e.g., urticaria, wheeze) and chronic diseases (food-sensitive enteropathies, eczema). Controversial and unresolved issues exist with some other conditions, including eosinophilic gastroenteritis, occult gastrointestinal bleeding, protein-losing enteropathy, and attention deficit disorder with hyperactivity. New methods for clinical investigation of gastrointestinal tract function and intestinal immune reactions are required to assess the relevance of foods in these conditions.


Dietary manipulation and induction of tolerance.

Clinical observations have suggested that the development of atopic diseases in childhood may be influenced by breast-feeding and the timing of first exposure to foreign protein, but the controversy is far from being resolved. Early weaning and introduction of foreign proteins (i.e., cow milk) have been associated with an increased prevalence of atopic symptoms in infants with a family history of atopy. Opposite results have been reported, and the effects of early protein introduction in infants not at risk of having atopic symptoms are poorly documented. Research in rodents suggests that perinatal antigen exposure is more likely to prime the immune system than to induce tolerance. Continuous feeding beyond the critical neonatal period leads to induction of tolerance. The immunologic response is dependent on the antigen dose. Protein transfer by breast-feeding can induce tolerance, though in a dose range otherwise associated with priming. The protective effect of antigen avoidance in infancy on the development of cow milk allergy and also on subsequent atopic symptoms is well documented. Protective effects have been observed in infants at risk who either were breast fed or received a hydrolyzed infant formula. Several clinical studies suggest a causative role of neonatal milk exposure in the development of cow milk allergy. Prospective, population-based studies are required to assess the true incidence of food-allergic diseases in childhood.


Comparison of the residual allergenic activity of six different hydrolyzed protein formulas.

The residual allergenic activity of protein hydrolysates contained in marketed "hypoallergenic" infant formulas can be determined both by in vivo methods (skin prick tests, provocation tests) and by in vitro methods (radioallergosorbent test, radioallergosorbent inhibition, crossed radioimmunoelectrophoresis, basophil histamine release). In general, whey hydrolysates containing a high percentage of larger peptides have the highest capacity to induce positive skin test and provocation test results, and to bind to human serum IgE antibodies of cow milk-sensitive children. Casein hydrolysates appear to have very little residual allergenic activity. Before hypoallergenic formulas are prescribed for cow milk-sensitive children, individual testing (e.g., skin test, challenge tests) is recommended.


Effects of brief early exposure to partially hydrolyzed and whole cow milk proteins.

Clinical experience ("the dangerous bottle") and experimental evidence indicate that the early life of an infant is particularly important for the development of the immune responses to food antigens. However, the clinical and immunologic consequences of a brief exposure to, or avoidance of, food antigens during the neonatal period in human infants are poorly understood and documented. We present the preliminary results of a prospective controlled study of 256 normal breast-fed infants randomly assigned to receive (blind) either an adapted formula (Nidina) or a partially hydrolyzed formula (Nidal HA) as a supplement to breast-feeding for a few days when necessary, and to be examined at days 5, 90, 150, and 365. The results indicated that (1) the prevalence of clinical symptoms and of total and specific IgE responses was not statistically different in the two groups of infants and (2) infants fed a hydrolyzed formula had median titers of specific IgG lower than those fed an adapted formula; the difference was significant for alpha-lactalbumin at day 90 (p < 0.005) and for alpha-lactalbumin (p < 0.05), casein (p < 0.05), and hydrolyzed formula (p < 0.01) at day 150. Humoral immune responses of breast-fed infants to food antigens thus appear to be modulated by early, short-term exposure to them.


Effects of prolonged exposure to partially hydrolyzed milk protein.

Formulas containing proteins with reduced potential to sensitize might be effective in reducing the risk of atopic disease, but such products should be nutritionally adequate. We designed a randomized, double-blind study to evaluate nutritional adequacy and sensitization potential of a formula containing partially hydrolyzed whey-predominant milk proteins. Subjects were term infants enrolled at birth. Infants in group A were fed human milk, and group B received the partially hydrolyzed formula; group C, fed a formula containing intact whey-predominant milk proteins, served as control subjects. We recorded anthropometric measurements and symptoms of formula intolerance at monthly intervals for 4 months in 205 infants. Milk IgE and IgG antibodies were measured until 8 months of age in 63 infants. Daily weight gain was not significantly different among the groups. Gastrointestinal symptoms attributed to feeding intolerance were also comparable. Increases in serum IgG antibodies were significantly greater in group C throughout the study. There were no significant differences in IgE antibodies. Thus a formula containing partially hydrolyzed whey-predominant milk protein promoted adequate growth and induced a lesser priming effect for IgG antibody response than did an intact whey-predominant formula.


Long-term prevention of allergic diseases by using protein hydrolysate formula in at-risk infants.

This prospective, long-term study assessed the effects of a protein hydrolysate formula on allergy prevention in infants with a family history of allergy. Infants were randomly assigned to receive either the hydrolysate formula (n = 92) or an adapted cow milk formula (n = 85) alone or with breast-feeding for 4 months. The groups did not differ in family allergy history scores or cord blood IgE levels. After 4 months, total IgE levels and allergic reactions did not differ significantly between groups, although the hydrolysate group had a lower prevalence of eczema. At 12 months of age, neither IgE levels nor allergic reactions were significantly different. At 2 years of age, however, 18 allergic reactions had occurred in the hydrolysate group and 31 had occurred in the control group; the differences were significant for eczema (p < 0.001) but not for asthma. At 4 years of age, allergic signs were found in 11 children in the hydrolysate group and in 17 children in the control group; the difference was significant only for eczema (p < 0.01). These results suggest that early feeding of a protein hydrolysate formula to infants at risk for allergies had a long-term preventive effect on the prevalence of eczema but not of asthma.


Relationship of cross-brain oxygen content difference, cerebral blood flow, and metabolic rate to neurologic outcome after near-drowning.

We evaluated the relationship of global cerebral blood flow, cross-brain oxygen content difference, cerebral metabolic rate for oxygen, intracranial pressure, and cerebral perfusion pressure to functional neurologic outcome in 12 comatose children on 2 consecutive days after near-drowning. Five children survived with functional neurologic outcome; five died and two survived with severe neurologic damage. Children who survived with functional neurologic outcome had a significantly higher cross-brain oxygen content difference (7.89 +/- 2.62 vs 3.91 +/- 1.59 ml/dl; p = 0.028) at 24 hours and a higher cerebral metabolic rate for oxygen 48 hours after admission (3.19 +/- 2.86 vs 0.96 +/- 0.45 ml/100 gm per minute; p = 0.030) compared with those who died or survived in a damaged state. There were no significant differences in global cerebral blood flow, intracranial pressure, and cerebral perfusion pressure between groups at either 24 or 48 hours. Our preliminary data suggest that a higher cross-brain content difference value is an important early variable associated with functional neurologic recovery after near-drowning. However, a single cross-brain oxygen content difference value must be interpreted with caution because considerable variability may occur among patient groups.


Coma associated with intense bursts of abnormal movements and long-lasting cognitive disturbances: an acute encephalopathy of obscure origin.

We report six previously healthy children who several days after a prodromal illness had an acute encephalopathy that ran a biphasic course. It appears to constitute a recognizable syndrome with a good prognosis that can be differentiated from other encephalopathies of obscure origin as previously defined by Lyon et al. The active phase was dominated by coma or confusion and by abnormal movements, including disordered gesticulation and attacks of orofacial dyskinesia or limb dystonia associated with permanent rigidity and culminating in opisthotonic posturing. Repeated seizures were observed in only two patients. Permanent slow waves were recorded on the electroencephalogram in all patients, even during bursts of abnormal movements. Cerebrospinal fluid and results of serologic studies were normal throughout the course of the disease, and attempts at viral isolation and antiviral antibody detection yielded negative results. Brain imaging either showed no abnormalities or suggested a moderate degree of brain edema. The recovery phase, which extended for several weeks, was characterized by a rapid return of motor function and persistent behavioral and cognitive disturbances. Nonverbal reasoning recovered long before verbal expression returned to normal. Four patients eventually recovered fully, whereas two had mild sequelae.


Concentration of milk secretory immunoglobulin A against Shigella virulence plasmid-associated antigens as a predictor of symptom status in Shigella-infected breast-fed infants.

We conducted a prospective, community-based study of healthy breast-fed Mexican infants to determine the protective effects of anti-Shigella secretory IgA antibodies in milk. Milk samples were collected monthly, and stool culture specimens were obtained weekly and at the time of episodes of diarrhea. Nineteen breast-fed infants were found to have Shigella flexneri, Shigella boydii, or Shigella sonnei in stool samples. Ages of the 10 infants with symptomatic infection and the nine with asymptomatic infection did not differ significantly. Milk samples collected up to 12 weeks before infection were evaluated by enzyme-linked immunosorbent assay for secretory IgA antibodies against lipopolysaccharides of S. flexneri, S. boydii serotype 2, S. sonnei, and virulence plasmid-associated antigens. The geometric mean titers of anti-Shigella antibodies to virulence plasmid-associated antigens in milk received before infection were eightfold higher in infants who remained well than in those in whom diarrhea developed. The significance of milk secretory IgA directed against lipopolysaccharide was less clear. We conclude that human milk protects infants against symptomatic shigella infection when it contains high concentrations of secretory IgA against virulence plasmid-associated antigens.


Comparison of acellular (B type) and whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines as the first booster immunization in 15- to 24-month-old children.

We compared an acellular (B type) pertussis-component diphtheria-tetanus-pertussis (DTP-Ac) vaccine containing equal amounts of filamentous hemagglutinin and lymphocytosis-promoting factor with a conventional whole-cell vaccine as the first booster immunization in 162 healthy children 15 to 24 months of age. Fewer local reactions (e.g., erythema, swelling, and tenderness at the injection site) were seen in DTP-Ac vaccine recipients during the first 48 hours of observation. This group also had fewer episodes of fever (> or = 38 degrees C) and other systemic reactions (e.g., irritability, drowsiness, and anorexia). Overall, 57% of the DTP-Ac vaccine recipients had no obvious adverse reactions, in contrast to 5% in the comparison group. At 4 to 8 weeks after vaccination, serum antibody responses to filamentous hemagglutinin and lymphocytosis-promoting factor were greater in recipients of the acellular vaccine as determined by an enzyme-linked immunosorbent assay. We conclude that this B-type acellular vaccine is both immunogenic and much less likely to cause an adverse reaction than a currently licensed whole-cell vaccine, and is suitable for routine booster immunizing doses to protect against pertussis.


Risk factors for asthma in inner city children.

Inner city children have the highest prevalence and the highest mortality rates for asthma in the United States. The purpose of this study was to evaluate sensitization and exposure to common indoor allergens among children aged 3 years to 15 years seen for treatment of asthma at Grady Memorial Hospital, Atlanta, Ga. Eighty children in this study were enrolled in the emergency department and 64 in hospital clinics. Dust from 57 homes, assayed for three indoor allergens (dust mite, cat, and cockroach), revealed similar exposure for asthma and control groups. Sixty-nine percent of the children with asthma had IgE antibodies to dust mite, cockroach, or cat; only 27% of the control subjects were similarly sensitized (p < 0.001). Of 35 children with asthma 21 had both sensitization and significant exposure to the relevant allergen; this was true for only 3 of 22 control subjects (odds ratio, 9.5; p < 0.001). Neither sensitization nor exposure to cat allergen was common in this population. The results show that black children in inner city Atlanta are exposed to high levels of mite and cockroach allergens and that a high proportion of the children with asthma are sensitized to these allergens; the combination of sensitization and exposure is a major risk factor for asthma in this population.


Clinical spectrum of chronic interstitial lung disease in children.

To describe the clinical spectrum of interstitial lung disease in children, we reviewed our experience with 48 patients during a 12-year period. Most patients initially had typical findings of restrictive lung disease and hypoxemia. Growth failure or pulmonary hypertension or both were found in more than one third. Specific diagnosis, made in 35 patients (70%), most often required invasive studies, particularly open lung biopsy. Although the diagnostic yield from open lung biopsy was high, the diagnosis of many patients remained uncertain. Many different disorders were encountered. The response to corticosteroids, bronchodilators, and chloroquine was inconsistent. Six patients died, five within 1 year after the initial evaluation. The spectrum of pediatric interstitial lung disease includes a large, heterogeneous group of rare disorders associated with high morbidity and mortality rates.


Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency.

We describe an unusual example of cellular immunodeficiency associated with interleukin-2 deficiency in an otherwise healthy 15-year-old boy who had isolated cryptococcal osteomyelitis of the scapula at 10 years of age. His previous medical history was remarkable only for prolonged, severe varicella infection at 6 years of age. He had persistent moderate lymphopenia, anergy, and absent lymphocyte blastogenic responses to mitogens, antigens, or monoclonal T cell antibodies. Subnormal blastogenic responses were seen after exposure to high concentrations of phorbol esters. Immunoglobulin levels and specific antibodies were normal. The patient has been in good health since treatment of his osteomyelitis. However, his lymphocyte blastogenic responses to mitogens have remained absent during 4 years of observation; investigation of the cause revealed a specific interleukin-2 deficiency resulting from defective generation of interleukin-2 messenger ribonucleic acid. Secretion of interleukin-1 by monocytes was normal, suggesting that the abnormal blastogenic response and interleukin-2 production were due to a problem intrinsic to T lymphocytes. The generation of messenger ribonucleic acid for interleukin-4 was not affected. Interferon-gamma was produced at subnormal levels. The addition of recombinant interleukin-2 restored lymphocyte blastogenic responses and increased the expression of interleukin-2 receptors. The clinical findings and immunologic abnormalities present in this patient differ from other primary and secondary immunodeficiencies associated with interleukin-2 deficiency. Thus our observations in this patient extend the spectrum of immunodeficiencies associated with abnormalities in the production of this important cytokine.


Preservation of ovarian function by ovarian transposition performed before pelvic irradiation during childhood.

Ovarian transposition in adults has been shown to protect ovarian function in about 60% of cases by reducing ovarian exposure to less than 4 to 7 Gy. We therefore evaluated the effect of ovarian transposition during childhood or adolescence. Eighteen girls had ovarian transposition performed at a mean (+/- SEM) age of 9.4 +/- 1.2 years (range, 1.2 to 16 years). Twelve were prepubertal and six had menstruated at the time of ovarian transposition. The initial abnormalities were Hodgkin disease (5 cases), iliac Ewing sarcoma (3), medulloblastoma (2), ovarian seminoma (1), and vaginal or uterine tumor (7). The irradiation was external in 11 cases and local by vaginal curietherapy in 7 cases. Fifteen girls received chemotherapy. The ovarian transposition was bilateral in 15 patients and unilateral in 3 cases; in the latter the other ovary had been destroyed by the tumor or by abdominal irradiation. Ovaries were placed just below the iliac crest (15 cases) or posterolateral to the uterus (3); thus, the calculated ovarian radiation dose was up to 9.5 Gy. At the time of evaluation (8.6 +/- 0.9 years after ovarian transposition), 16 girls had menstruated and 2 remained amenorrheic because of major lesions of the vagina and uterus caused by the vaginal curietherapy. Basal plasma gonadotropin values were normal. Ovulation was documented in seven cases. Two pregnancies occurred. Complications of ovarian transposition were present in four patients: intestinal occlusion, dyspareunia, functional ovarian cysts, and pelvic adhesions with tubal obstruction. We conclude that ovarian transposition, performed before abdominopelvic irradiation during childhood, can preserve ovarian function. Longer follow-up is required to assess the risk of ovarian dystrophy because of vascular lesions or chemotherapy.


Chemotherapy for acute lymphocytic leukemia: cognitive and academic sequelae.

Iatrogenic cognitive impairments have been reported for survivors of childhood leukemia after prophylactic central nervous system therapy with craniospinal radiation. To determine whether chemotherapy alone might be a source of central nervous system damage, we assessed in a cross-sectional design the cognitive and academic functioning of 48 children with acute lymphocytic leukemia who were at various stages in their treatment or who had completed treatment. The off-therapy patients who had completed a 3-year course of chemotherapy were more impaired in tasks of higher-order cognitive functioning than were those children whose leukemia had been newly diagnosed and those children whose diagnoses had been 1 year earlier. Off-therapy patients also had concomitant diagnosable learning disabilities in mathematics. We recommend appropriate liaison and special education placements, as well as continued evaluation of cognitive and leaning functioning of children treated for moderate-risk acute lymphocytic leukemia who receive chemotherapy alone.


Clinical response of alopecia, trichorrhexis nodosa, and dry, scaly skin to zinc supplementation.

Two unrelated patients had dry brittle hair, alopecia, trichorrhexis nodosa, dry scaly skin, pigment dyschromia, short stature, and neurosecretory growth hormone deficiency. By means of the zinc tolerance test, patient 1 was shown to have zinc deficiency, whereas no clear zinc deficiency could be demonstrated in patient 2. In both patients, hair and the skin abnormalities responded to oral zinc therapy.


Fatal infantile liver failure associated with mitochondrial DNA depletion.

A 3-month-old girl was admitted to the hospital because of hypotonia and frequent vomiting. She had severe metabolic acidosis and her liver function was abnormal. Hepatomegaly and rapidly progressive liver failure developed, and she died at 4 months of age. Two half-siblings from a different mother had died in infancy of an undiagnosed myopathy. The liver was fatty and hepatocytes were filled with large and small lipid droplets. Other tissues were morphologically normal. The respiratory chain enzymes containing subunits encoded by mitochondrial DNA were markedly decreased in liver, partially decreased in muscle, but normal in other tissues. Southern blot analysis showed 90% depletion of mitochondrial DNA in liver, 53% depletion in muscle, and normal amounts in other tissues. This is the second case of fatal infantile liver failure associated with mitochondrial DNA depletion. This pathogenetic mechanism should be considered in infants with multiple respiratory chain defects and variable tissue expression.


Olfactory performance during childhood. I. Development of an odorant identification test for children.

Because there has been no suitable diagnostic instrument for evaluation of olfaction in children, we designed an odorant identification test for that purpose. We screened 40 microencapsulated odorants ("scratch 'n' sniff" cards) by randomly grouping them into 40 overlapping sets of five odorants each. Forty-one children, 4 and 5 years of age, tried to identify each test odorant, selecting their responses from among five photographs depicting the substances in the set of odorants. We used the results to select a subset of five odorants (baby powder, bubble gum, candy cane, fish, and orange). To determine how well these odorants could be identified by normal children, we tested another 134 subjects, 3 1/2 to 13 years of age. For children 3 1/2 years to 5 years 4 months of age, the mean (+/- SEM) percentage of correct responses increased from 66% +/- 8% to 92% +/- 2%. Thereafter the mean percentage of correct responses remained at a plateau of about 90%. The 10th percentile for the percentage of correct responses tended to be higher for girls than for boys throughout childhood. We concluded that this set of five odorants can be correctly identified by most normal children 5 years of age or older. The performances of three older subjects with Kallmann syndrome were all subnormal, but the overall efficacy of the test for evaluating children with olfactory deficits needs to be determined.


Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants.

To determine whether thickening of infant formula feedings with rice cereal increases coughing, we studied 25 infants from birth to 6 months of age, referred for evaluation of gastroesophageal reflux. Coughing was blindly quantified after each of a pair of isocaloric meals (one thickened and one unthickened). Coughing was more frequent after thickened feedings than after unthickened feedings.


Pseudomembranous colitis in sickle cell disease responding to exchange transfusion.

We report a case of ischemic colitis with pseudomembrane formation in a 6 1/2-year-old boy with sickle cell disease that responded to medical management including exchange transfusion. This case was not associated with Clostridium difficile infection but with an elevation of serum levels of tumor necrosis factor alpha. This rare complication of sickle cell disease has been reported only in adults.


Symptomatic hyperammonemia caused by a congenital portosystemic shunt.

A child with trisomy 21 had altered mental status and hyperammonemia at presentation and was found to have a congenital portosystemic shunt as a result of a congenital abnormality of the portal venous system. Anomalies of the portal venous system leading to portosystemic shunting, although they are infrequent, should be considered in the differential diagnosis of hyperammonemia.


Congenital idiopathic growth hormone deficiency associated with prenatal and early postnatal growth failure. The International Board of the Kabi Pharmacia International Growth Study.

To assess the role of growth hormone in fetal and infant growth, we analyzed the pretreatment data on 52 patients with a diagnosis of congenital growth hormone deficiency before 2 years of age, obtained from the Kabi Pharmacia International Growth Study. These infants had reduced birth-length standard deviation scores, an excess of birth weight relative to length, and progressive growth failure. We conclude that congenital growth hormone deficiency may cause impaired growth in utero and early infancy, and that growth hormone plays an important role in perinatal and infantile growth.


Serial changes of serum interleukin-6, interleukin-8, and tumor necrosis factor alpha among patients with Kawasaki disease.

To determine the role of cytokines in Kawasaki disease, serial measurements of serum cytokine levels were done in 60 patients treated solely with aspirin. Coronary artery aneurysms later developed in 12 of them. The results suggest that elevated serum interleukin-6 and interleukin-8 levels during the first week of illness may be associated with a higher risk of coronary aneurysm formation.


Cerebral artery aneurysms in children infected with human immunodeficiency virus.

More than 250 children treated at our institution on antiretroviral treatment protocols have been monitored with brain imaging studies. We documented the occurrence and progression of aneurysms of major cerebral arteries in two children with advanced human immunodeficiency virus infection. In both cases these lesions remained clinically silent initially, despite progression to marked dilation.


Idiopathic arterial calcification of infancy: prenatal and postnatal effects of therapy in an infant.

In an infant with idiopathic arterial calcification of infancy, prenatal diagnosis of arterial calcification was made by ultrasonography and allowed initiation of therapy in utero. Etidronate therapy produced apparent radiographic and ultrasonographic improvement in the degree of vascular calcification but did not prevent the lethal progression of intimal vascular occlusive disease.


Arterial thrombosis and protein S deficiency.

A previously healthy boy had progressive painful discoloration of the lower extremities and was treated with exchange transfusion and anticoagulation, which were unsuccessful in arresting pedal ischemia; amputation of all of the child's toes was required. Studies of the patient and his parents resulted in a diagnosis of inherited protein S deficiency.


Sarcoidosis associated with nephrocalcinosis in young children.

Three patients with nonpulmonary sarcoidosis had chronic erythema nodosum within the first 2 years of life. Each subsequently had renal sarcoidosis and nephrocalcinosis; hypercalcemia was documented in each patient and hypercalciuria in two patients. Treatment with prednisone was not uniformly successful in normalizing creatinine clearance. Nephrocalcinosis may be more common than previously reported in patients with sarcoidosis.


3-Methylglutaconic aciduria associated with Pearson syndrome and respiratory chain defects.

3-Methylglutaconic aciduria was detected in four patients with Pearson syndrome, a multitissue disorder with hematologic abnormalities, lactic acidosis resulting from defective oxidative phosphorylation, and deletions in the mitochondrial genome. 3-Methylglutaconic acid may be an additional useful marker for Pearson syndrome and may be a more specific marker than other organic acids identified in this disorder.


Obstructive, mixed, and central apnea in the neonate: physiologic correlates.

In an attempt to determine physiologic responses to neonatal apnea, we evaluated changes in heart rate and oxygen saturation as measured by pulse oximetry during 2082 episodes of apnea lasting 15 seconds or more in 47 infants less than 34 weeks of gestational age with idiopathic apnea of prematurity. Of these episodes, 832 (39.9%) were central, 1032 (49.6%) were mixed, and 218 (10.5%) were obstructive. Oxygen saturation decreased with increasing duration of apnea regardless of type or treatment, and the decrease in saturation was correlated with preapnea saturation. The baseline heart rate was similar for all apnea types. Infants receiving doxapram had a lower baseline heart rate (137.8 +/- 10.5 beats/min) than did infants receiving no therapy (142.8 +/- 16.6 beats/min) and infants receiving theophylline (149.7 +/- 15.0 beats/min) (p = < 0.001). A heart rate fall to less than 100 beats/min was seen more frequently with central apnea than with mixed or obstructive events, and in infants who were not receiving therapy. Falls in heart rate were significantly less in infants receiving doxapram (27.8% +/- 18.0%) than in infants receiving theophylline (44.5% +/- 19.0%) or no therapy (48.4% +/- 18.3%) (p = < 0.001). The most common heart rate pattern overall was a gradual decrease interrupted by accelerations, whereas an initial heart rate acceleration was the most common pattern in obstructive apnea. We conclude that heart rate response to neonatal apnea is a complex and is dependent on therapy and on type and duration of apnea.


Early metabolic effects of sepsis in the preterm infant: lactic acidosis and increased glucose requirement.

The effects of sepsis on carbohydrate metabolism were studied in preterm newborn infants (weight > 1.2 kg, appropriate for gestational age) without maternal endocrine problems who were being examined for infection. Plasma glucose, lactate, and insulin concentrations were measured at initial evaluation and then every 8 hours for a total of 48 hours. Blood, urine, and spinal fluid were obtained for culture and counterimmunoelectrophoresis. Dextrose was administered to each patient to maintain glucose levels in the normal range. Dextrose infusion rates were calculated in milligrams per kilogram per minute. Of the 29 infants, 6 had sepsis (positive culture and counterimmunoelectrophoresis results). Infants with sepsis had significant elevations of plasma lactate concentration (p < 0.003) but normal pH. The dextrose infusion rate was also significantly elevated in the infected infants (p < 0.01). No hypoglycemia or hyperglycemia was observed in either group. No significant difference in plasma insulin concentration was observed. We conclude that significant elevations in plasma lactate concentrations and dextrose infusion rate may be early clinical markers of neonatal sepsis in the first 48 hours of life.


Increased nosocomial infection in neutropenic low birth weight (2000 grams or less) infants of hypertensive mothers.

The neutropenia often seen in infants of hypertensive mothers (IHMs) at < 12 hours of age has been associated with nosocomial infection in the first 18 days of life. To assess maternal hypertension as an independent factor for nosocomial infection, we compared 101 low birth weight (< or = 2.00 kg) IHMs to a concurrent birth weight-matched group of infants of normotensive mothers (INMs). Infants without differential leukocyte counts at < 12 hours of age were excluded, leaving 93 IHMs and 98 INMs. The incidence of neutropenia at < 12 hours among IHMs was not significantly different from that among INMs (42/92 (45%) vs 37/98 (38%)). Nosocomial infection was more frequent in neutropenic IHMs than in neutropenic INMs (12/42 vs 2/37; p = 0.007). Infection in IHMs included omphalitis (2 infants), pneumonia (4), and sepsis with or without meningitis (6); INMs had cellulitis (1) and sepsis (1). The underlying mechanism(s) for this predisposition remains to be elucidated, although limited data suggest that neutropenia may be more severe and prolonged among IHMs.


Response of preterm infants to hepatitis B vaccine.

Ninety-nine preterm infants with birth weights < 1750 gm had three doses of hepatitis B vaccine. Fifty-seven received the first dose when they weighed > or = 1000 gm (group 1) and 42 when they weighed > or = 2000 gm (group 2). The final seropositive rates and geometric mean titers of group 1 infants (79%, 61 mIU/ml) and group 2 infants (91%, 262 mIU/ml) were less than that of 43 normal term infants (100%, 679 mIU/ml).


A fatal neonatal case of medium-chain acyl-coenzyme A dehydrogenase deficiency with homozygous A-->G985 transition.

A term neonate became lethargic and hypotonic at 46 hours of age and died 10 hours later despite supportive therapy. Urinary organic acids indicated medium-chain acyl-coenzyme A dehydrogenase deficiency, and DNA studies confirmed this disorder. Neonatal symptoms in this enzyme deficiency have rarely been reported, and recent reviews have ignored or discounted this presentation.


Effect of age on ibuprofen pharmacokinetics and antipyretic response.

The effect of age on ibuprofen pharmacokinetics and antipyretic effect was studied in 49 infants and children aged 3 months to 10.4 years. The relationship of plasma concentration to antipyretic effect was examined in 38 of the children by using an iterative least squares technique that allows estimation of drug concentration with time in a theoretical effect compartment and rate constant for elimination of drug from the effect compartment. There was a delay of 1 to 3 hours between peak ibuprofen plasma concentration and peak temperature decrement. The mean elimination rate constant from the effect compartment was 0.6 hour-1, corresponding to a half-life of drug in the effect compartment of 1.1 hours. The mean slope of the effect compartment concentration versus temperature regression line was -0.242 degrees C/mg per liter. Age did not significantly influence the rate of absorption of ibuprofen, its plasma concentration, its rate of elimination, or the time course of ibuprofen concentration in the effect compartment. However, in younger children the onset of antipyresis was earlier, maximum antipyretic effect was greater, and the area under the curve of the percentage of change in temperature from baseline versus time was greater than in older children. We conclude that the greater relative body surface area in younger children may allow more efficient dissipation of heat in response to antipyretic-induced lowering of the temperature "set point" in the hypothalamus.


Pharmacokinetics and pharmacodynamics of bumetanide in neonates treated with extracorporeal membrane oxygenation.

Eleven term neonates treated with extracorporeal membrane oxygenation received bumetanide to treat volume overload. All patients had stable renal function, no history of prior diuretic therapy, and no overt evidence of hepatobiliary disease or hypoalbuminemia. Pretreatment creatinine clearance was 35.2 +/- 4.5 ml/min per 1.73 m2 (range, 20.3 to 57.5). Bumetanide, 0.095 +/- 0.003 mg/kg, was administered for 2 minutes into the postmembrane side of the extracorporeal membrane oxygenation circuit. Serial plasma and urine samples were collected for measurement of bumetanide and electrolyte concentrations. Total plasma and renal clearances for bumetanide were 0.63 +/- 0.11 and 0.16 +/- 0.04 ml/min per kilogram, respectively. The steady-state volume of distribution (0.44 +/- 0.03 L/kg) and the elimination half-life (13.2 +/- 3.8 hours) were greater than similar values reported in previous studies of bumetanide disposition in premature and term neonates who were not treated with extracorporeal membrane oxygenation. At observed rates of bumetanide excretion, the diuretic, natriuretic, and kaliuretic responses were linear. Significant diuresis, natriuresis, and kaliuresis were observed, although the duration of these effects was less than expected given the prolonged renal elimination of bumetanide. Nonrenal elimination of bumetanide was variable (47.2% to 96.9%) but higher than expected; this may explain the relatively brief diuretic and kaliuretic response.


Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates.

Four neonates had resolution of peripheral tissue ischemia after the application of 2% nitroglycerin ointment. A dosage of 4 mm nitroglycerin ointment per kilogram of body weight was applied to two patients with ischemia caused by vasospasm from indwelling radial artery catheterization and to two patients with ischemia resulting from dopamine extravasation. No adverse effects were noted except mild episodes of decreased blood pressure in two of the patients.


Tardive dyskinesia associated with use of metoclopramide in a child.

Tardive dyskinesia is a chronic, often permanent, movement disorder that has been reported in elderly patients receiving metoclopramide. We describe an 8-year-old boy with tardive dyskinesia that developed when he received metoclopramide as part of therapy for gastroesophageal reflux and erosive esophagitis.


Neurotoxicity of panipenem/betamipron, a new carbapenem, in rabbits: correlation to concentration in central nervous system.

The neurotoxic potential of panipenem/betamipron (PAPM/BP), a new carbapenem antibiotic, was compared with that of imipenem/cilastatin (IPM/CS). The drug concentration in cerebrospinal fluid (CSF) at the onset of epileptogenic electroencephalographic (EEG)-activity and the drug distribution into the central nervous system (CNS) were evaluated. Epileptogenic reactions correlated well with drug levels in CSF, but not with drug levels in circulating plasma. The concentration of PAPM in CSF at the onset of epileptogenic EEG-activity was almost twice that of IPM, suggesting that neurotoxic activity of PAPM is about half that of IPM. In addition, in terms of incidence percent for the epileptogenic EEG-activity, PAPM/BP was found to be less toxic than IPM/CS within the dose of 1.0-1.2 g/kg. Concentrations of PAPM in CSF and brain extracellular fluid after PAPM/BP i.v. infusion were comparable with those of IPM after IPM/CS infusion, indicating the similar characteristics of distribution into the CNS for the two antibiotics. From these results of pharmacologic effects and drug distributions, it is suggested that the neurotoxicity of PAPM/BP is less than half that of IPM/CS.


Are free radicals involved in Ca(2+)-induced membrane damage of mitochondria?

Ca(2+)-Induced membrane damage of energized mitochondria has been proposed to be due to lipid peroxidation induced by Ca2+. To examine this possibility, we studied the effects of the radical scavenger, 3,5-di-tert-butyl-4-hydroxytoluene (BHT), and its derivative, 3,5-di-tert-butyl-4-methoxytoluene (MeO-BHT), on membrane damage of respiring mitochondria induced by Ca2+ in the presence of inorganic phosphate. Both compounds inhibited Ca(2+)-induced damage almost completely at 20 microM, and their effects were identical, although MeO-BHT had no radical scavenging ability. These results indicate that the protective effects of BHT and MeO-BHT are not due to their radical scavenging ability. Thus, free radicals are concluded not to be involved in Ca(2+)-induced membrane damage of mitochondria.


Importance of hydrolysis of amino acid moiety in water-soluble prodrugs of disodium cromoglycate for increased oral bioavailability.

The relationship between physicochemical properties and oral absorption was investigated in prodrugs for the oral delivery of disodium cromoglycate (DSCG). To improve the lipophilicity of DSCG, various lipophilic moieties were introduced into the twin carboxyl groups. However, this did not lead to improved oral absorption in rabbits because of loss of water solubility, in spite of improved lipophilicity. Water-soluble prodrugs, in which an amino acid was introduced into a hydroxy group by ester linkage in addition to ethyl residues at twin carboxyl groups of DSCG, were synthesized and examined for oral absorption in rabbits and rats. The oral absorption of these prodrugs was affected by the species of amino acids introduced as a water-soluble moiety. Therefore, we examined the relation between the oral absorption of water-soluble prodrugs and the hydrolysis rate of the amino acid moiety. A good linear correlation was obtained between the oral absorption and the hydrolysis rate constant catalyzed by digestive enzymes, trypsin or alpha-chymotrypsin. It was thus concluded that the amino acid moiety of water-soluble prodrugs must be rapidly hydrolyzed to a permeable lipophilic prodrug still possessing the ethyl moiety at twin carboxyl groups in the small intestinal tract for good oral absorption.


Percutaneous absorption of pindolol and pharmacokinetic analysis of the plasma concentration.

The percutaneous (p.c.) absorption of pindolol, a beta-blocker, through rabbit skin was examined by in vitro and in vivo studies. Additionally, for practical use of the transdermal system (TTS), a trial for sustaining a suitable plasma concentration of pindolol by using a rate-controlling membrane and for describing plasma drug levels after p.c. application by using a simple pharmacokinetic model was tested. As a result, the drug penetrated through rabbit skin in vitro at a zero-order rate. In vivo, the drug was also absorbed through the skin from a gel base with or without enhancers. The gel preparation with Azone (Rp. 2) gave high plasma levels of pindolol. The transdermal system produced with Rp. 2 and a rate-controlling membrane (Hipore 4050) provided relatively constant plasma levels for 48 h. The model presented could describe the time course of plasma pindolol concentrations following p.c. application of the systems.


Generation of senescent antigen on erythrocytes by partial blocking of SH groups of the membrane proteins.

Human erythrocytes treated with diamide (0.2 mM) or N-ethylmaleimide (0.1 mM) at 37 degrees C for 1 h were susceptible to binding of anti-band 3 immunoglobulin G autoantibody and hemoglobin. A definite degree of cell modification appeared to be required for the effective bindings since the cells treated with the reagents above these concentrations were less susceptible. The enhanced binding activities of the cells treated with diamide were abolished on treatment with dithiothreitol. Partial blocking of SH groups of the membrane proteins but not disulfide-mediated protein cross-linking may be essential for the formation of band 3 senescent antigen, which may not be a neo-antigen formed by chemical modification of band 3 but an antigen formed by topological alterations of the molecules in the membrane.


Cognitive-experiential self-theory and subjective probability: further evidence for two conceptual systems.

Three experiments (N = 1,331) demonstrated that research findings on suspiciousness about coincidences (Miller, Turnbull, & McFarland, 1989) can be accounted for in terms of subjective probability, as predicted by cognitive-experiential self-theory (CEST) but in contrast with the norm theory (NT) account offered by Miller et al. (1989). Ss participated in a hypothetical (Experiments 1 and 2) or real (Experiment 3) lottery game in which they chose between 2 bowls offering equivalent probabilities of winning or losing but differing with respect to absolute numbers (e.g., 1 in 10 vs. 10 in 100). Responses across 4 conditions (2 probability levels x 2 outcome types) and across the 3 experiments supported predictions derived from CEST but not those derived from NT. Results are discussed in terms of 2 conceptual systems, rational and experiential, that operate by different rules of inference.


Stimulus recognition and the mere exposure effect.

A meta-analysis of research on Zajonc's (1968) mere exposure effect indicated that stimuli perceived without awareness produce substantially larger exposure effects than do stimuli that are consciously perceived (Bornstein, 1989a). However, this finding has not been tested directly in the laboratory. Two experiments were conducted comparing the magnitude of the exposure effect produced by 5-ms (i.e., subliminal) stimuli and stimuli presented for longer durations (i.e., 500 ms). In both experiments, 5-ms stimuli produced significantly larger mere exposure effects than did 500-ms stimuli. These results were obtained for polygon (Experiment 1), Welsh figure (Experiment 2), and photograph stimuli (Experiments 1 and 2). Implications of these findings for theoretical models of the mere exposure effect are discussed.


Role of meaningful subgroups in explaining differences in perceived variability for in-groups and out-groups.

Five aspects of the complexity of the knowledge representation of business and engineering majors were examined to see whether these differed by group membership and whether these differences were related to differences in perceived variability. Significantly more subgroups were generated when describing the in-group than the out-group; this difference predicted the relative tendency to see the in-group as more variable, and when controlled for statistically, out-group homogeneity effects were eliminated. Familiarity, redundancy, number of attributes used to describe the group, and the deviance of the subgroups from the larger group generally showed differences for in-group and out-group but did not show consistent evidence of mediation. In a 2nd study, Ss who were asked to sort group members into meaningful subgroups perceived greater variability relative to those who did not perform the sorting task.


Mood effects on attitude judgments: independent effects of mood before and after message elaboration.

This study investigated the independent effects of induced mood on the encoding of persuasive messages and on the assessment of attitude judgments. In Experiment 1, positive or negative mood was induced either before the encoding of a counterattitudinal message or before the assessment of attitude judgments. When mood was induced before message presentation, Ss in a bad mood were more persuaded by strong than by weak arguments, whereas Ss in a good mood were equally persuaded by strong and by weak arguments. When Ss encoded the message in a neutral mood, however, the advantage of strong over weak arguments was more pronounced when Ss were in a good rather than in a bad mood at the time of attitude assessment. In Experiment 2, Ss exposed to a counterattitudinal message composed of either strong or weak arguments formed either a global evaluation or a detailed representation of the message. Positive, negative, or neutral mood was then induced. Ss in a good mood were most likely and Ss in a negative mood least likely to base their reported attitudes on global evaluations.


Attributions and behavior in marital interaction.

To examine whether spouses' attributions for events in their marriage are related to their behavior in interaction, spouses were asked to report their marital quality, to make attributions for marital difficulties, and to engage in problem-solving discussions. Study 1 demonstrated that spouses' maladaptive attributions were related to less effective problem-solving behaviors, particularly among wives. Study 2 showed that spouses' maladaptive attributions were related to higher rates of negative behavior and, for wives, to increased tendencies to reciprocate negative partner behavior. In both studies attributions and behavior tended to be more strongly related for distressed than nondistressed wives. These results support social-psychological models that posit that attributions are related to behavior and models of marriage and close relationships that assume that maladaptive attributions contribute to conflict behavior and relationship dysfunction.


Moderators of the relation between perceived control and adjustment to chronic illness.

It was predicted that the relation between perceived control and adjustment to chronic illness would be stronger when (a) perceptions of control were based in reality and (b) the threat was severe. Perceived control was assessed during the hospitalization of 80 first cardiac event patients, and adjustment was assessed during hospitalization and 3-month follow-up. Results indicated that perceptions of vicarious control (perception that other people and things have control) were related to better adjustment only for patients who had undergone invasive procedures by physicians. The relation between control and adjustment was stronger under more severe threat conditions (poor prognosis and rehospitalization).


Vulnerability to depressive symptomatology: a prospective test of the diathesis-stress and causal mediation components of the hopelessness theory of depression.

The diathesis-stress and causal mediation components of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) were tested using a prospective methodology. Measures of the 3 vulnerability factors posited by the theory (cognitive diatheses about cause, consequences, and self) were completed by 152 Ss at Time (T) 1. Ss completed measures of depressive symptoms, anxious symptoms, and hopelessness at T1 and again at T2, 5 weeks later. Naturally occurring stressors were assessed at T2 (covering the T1-T2 interval). Consistent with the diathesis-stress component, each Cognitive Diathesis x Stress (CD x S) interaction predicted onset of depressive symptoms from T1 to T2. In contrast, the CD x S interactions predicted neither state nor trait anxiety. In addition, 2 of the 3 CD x S interactions (those involving cause and self, but not consequences) were partially mediated by hopelessness. Implications for future work on the hopelessness theory of depression are discussed.


Future-event schemas and certainty about the future: automaticity in depressives' future-event predictions.

The proposition was tested that depressives make predictions about the future based on a pessimistic future-event schema. Participants varying in depression predicted whether positive and negative events would happen to them (or to an average person) in the future by pressing yes or no at a computer terminal as quickly as possible, either under a concurrent attentional load or under no such load. As hypothesized, depressives predicted more negative events and fewer positive events than did mild depressives or nondepressives and showed greater automaticity in their predictions. That is, the attentional load did not increase depressives' response latencies for either negative or positive events, even though it did so reliably for both mildly depressed and nondepressed individuals. Depressives may thus possess a highly developed future-event schema that operates efficiently in enabling future-event predictions.


Natural sample spaces and uncertain belief.

This article proposes a novel framework for understanding judgments of probability. Both accurate and inaccurate judgments are conceptualized in terms of the sets of information, or sample spaces, on which they are based. When appropriate sample spaces are easily accessed from memory (e.g., when they correspond to natural cognitive categories), people will make relatively accurate judgments; otherwise, people may substitute more accessible but inappropriate sample spaces and make judgment errors. In 3 experiments, the sample space framework was applied to account for the base rate fallacy. Results showed that (a) people spontaneously access sample spaces that correspond to natural categories, (b) reliance on inappropriate sample spaces produces the base rate fallacy, and (c) highlighting appropriate sample spaces improves the sensitivity of people's judgments to base rates. Discussion extends the framework to explain accuracy and error in other judgment domains.