Reliability and validity of the Diabetes Family Behavior Scale (DFBS)

The Diabetes Family Behavior Scale (DFBS) was designed to measure diabetes-specific family support. The purposes of this study were to refine the scale and to assess reliability and criterion validity in terms of relationship to metabolic control. The DFBS was administered to 321 children and adolescents with insulin-dependent diabetes mellitus (IDDM). Blood was drawn for determination of glycosylated hemoglobin (HbA1c). Based on an item-analysis procedure, the DFBS was revised to include 47 items with two subscales, one to reflect guidance-control and one to reflect warmth-caring. Acceptable internal consistency was found for the DFBS total score (.86), and for the guidance-control (.81) and warmth-caring (.79) subscales. There was a statistically significant relationship in the expected direction between DFBS total score and HbA1c (r = -.12, P < .03), and between the guidance-control subscale and HbA1c (r = -.17, P < .002).

Teaching assertive communication skills to adolescents with diabetes: evaluation of a camp curriculum

Diabetes management requires consistently implementing adherence behaviors in a variety of settings. For some adolescents, consistency may be difficult due to problems in communication and assertiveness. The purpose of the present study was to evaluate the impact of a camp curriculum to teach assertive communication skills to adolescents with diabetes. The curriculum included didactic information, sharing of personal experiences, and role playing. Results showed a significant increase in adolescents' perceptions of their assertiveness from before to after the camp experience, an increase that was still apparent at a 3-month follow-up. No changes were reported in parental perceptions of their adolescents' degree of openness in communicating or in communication problems. In contrast, adolescents reported a significant decrease in their degree of openness in communicating with fathers, with a similar trend for mothers. These results suggest that the curriculum was successful in meeting the primary goal of enhancing the adolescents' assertive communication skills but had a questionable impact on their general communications with parents.

The status of nursing administrators in Hungary

The College for Health Workers was established in 1973 in Hungary with the aim to educate and train highly qualified healthcare workers to meet all the demands of special health care. Although matrons (nursing administrators) who have graduated from the College are capable of performing special tasks to ensure quality care, they do not have the corresponding authority and recognition. Below, how nurse researchers in Hungary proved this hypothesis.

[Ogilvie syndrome as a complication following extensive total abdominal hysterectomy]

Acute pseudoobstruction of the colon (Ogilvie syndrome) is a rare entity observed postoperatively or in association with various medical conditions. Appropriate therapy avoids the life-threatening complication of cecal perforation with its attendant high mortality rate of over 40%. Today colonoscopic decompression is the treatment of choice.

[Thrombolytic therapy and balloon dilatation. The effect on infarct time, reperfusion and reocclusion]

127 patients, admitted within six hours of onset of symptoms of acute transmural myocardial infarction, received at first 250 000 U streptokinase intravenously over 20 min, followed by an intracoronary infusion of 250 000 U after coronary angiographic demonstration of the infarct vessel. Those in whom the infarct vessel was closed were randomized into two groups. An attempt at recanalization was made either by thrombolysis alone, through a specially developed 3F catheter (group I, 64 patients), or by thrombolysis and dilatation with 4F Grüntzig balloon catheter (group II, 63 patients). There was no significant difference between the two groups with regard to sex, age, infarct site, creatine-kinase level and interval between onset of symptoms and treatment. Re-perfusion rate for group I was 92% (59 patients), for group II 89% (56 patients). Re-occlusion during the hospital stay occurred in 10 of 59 patients in group I, in 9 of 55 in group II. Re-occlusion occurred in only 8% (3 patients) after successful dilatation, but in 35% (6 patients) after failed dilatation. In the subsequent six months further occlusions were observed in seven group I and two group II patients. Combined drug-mechanical recanalization thus increased the re-perfusion rate, shortened the infarction time and made possible full revascularization by subsequent dilatation which led to a reduction in the re-occlusion rate.

Coexisting idiopathic hypertrophic subaortic stenosis and coronary artery disease. Clinical implication and operative management

Patients with either coronary artery disease (CAD) or idiopathic hypertrophic subaortic stenosis (IHSS) may have angina as a dominant symptom. It is also possible that these two diseases may coexist in the same patient. Such an association has been reported in 25% of patients with IHSS who are over 45 years of age. It is important that both entities be looked for in the evaluation of the patient with angina, particularly when operative management is contemplated. Treatment of one and not the other may leave the patient symptomatic. We have encountered three patients with both CAD and severe IHSS and have managed each with septal myectomy and coronary artery revascularization. Each has obtained significant symptomatic improvement.

Vasography in rats

Vasovasostomy was performed in 20 rats. Vasography then was used to determine the patency of the vas. The scrotum was entered through a longitudinal incision and the scrotal contents were extruded extravaginally. The vas was divided near the epididymis and a 0.4/0.7-mm cannula was inserted into the abdominal end of the vas and contrast medium was injected under fluoroscopic control. The results were documented by radiography. It is concluded that vasography is a reliable method for assessing the success of vasovasostomy in rats.

Intramuscular urography in rats

In addition to macroscopic studies, microscopic studies, and biologic tests, urography is a valuable method for investigating renal function in rats. Intravenous urography is complicated, however, by the difficulty of puncturing a tail vein or the femoral vein. Intramuscular urography, on the other hand, is a simple and reliable method for radiographic examination of the kidneys and ureters, and gives information on morphology as well as physiology. In this study in 40 rats, intramuscular urography was performed under general anesthesia, and the contrast medium was injected into the gluteal muscles. Dense nephrograms and optimum films of the calices and the ureters were obtained approximately 40 minutes after injection.

Iron excretion from the goblet cells of the small intestine in man. An additional regulatory mechanism in iron homeostasis?

Iron-excreting goblet cells were observed by chance in a patient with myelogenic leukaemia. Duodenal and jejunal biopsies from patients with a wide spectrum of disorders have therefore been examined retrospectively after staining with Perl's iron method. Thirty-seven of the patients had iron-excreting goblet cells. The presence of iron has been confirmed by X-ray microanalysis and by electron microscopic histochemistry. In addition to iron-excreting goblet cells, most of these patients had iron-containing macrophages in lamina propria. This may indicate that the two types of cells co-operate in the excretion process. It is suggested that iron excretion may be part of the common iron balance mechanism.

Influence of cholesterol/fat feeding on cholesterol esterification and morphological structures in intestinal mucosa from guinea pigs

Guinea pigs were fed a semisynthetic diet containing 10% (by weight) cottonseed oil and 1% cholesterol. In response to cholesterol/fat feeding there was an increase in both the unesterified cholesterol (UC) and cholesteryl ester (CE) of the intestinal mucosal cell. Along with the increased cholesterol levels there was a 4-fold increase in the microsomal acylCoA:cholesterol acyltransferase (ACAT) activity after only two days of cholesterol/fat feeding. After 6 days on the experimental diet the ACAT activity was up to 8-fold the activity of the control, and then remained at this level for up to 20 days. The increased ACAT activity was probably not due to increased substrate concentration alone, since the fractional esterification of cholesterol also increased when the cholesterol/fat containing diet was given. There was also an increase in the triglyceride content of the intestinal mucosal cells from guinea pigs on the experimental diet. The mucosal cells of the cholesterol/fat fed animals accumulated varying amounts of lipid droplets, which were without an enveloping membrane, suggesting that the uptake of lipids from the intestinal lumen was higher than the capacity to synthesize and/or secrete lipoproteins. Simultaneously the size and amount of secondary lysosomes increased. A considerable increase in lipid droplets, lipolysosomes, and residual bodies was observed in the lamina propria macrophages while no crystalline clefts were seen.

[Experiences with the condition of resection of the hip joint following removal of the alloarthroplastic implantate (author's transl)]

30 patients whose total endoprosthesis of the hip joint had been removed without any replacement, thus creating a so-called state of secondary resection, were followed up 6 months to 6 years after the operation. It was found that in almost two-thirds of the cases a subjective feeling of improved mobility was reported. The objective findings consisted in restrictions of the total rotation, abduction and adduction of 1/3 rd of the normal extent of mobility. An average value of 74.7 degrees was recorded for flexion. 28 patients stated that their walking performance was satisfactory to very good when using a walking-stick as support. More than three-quarters of the patients questioned stated their pain had been positively influenced by the creation of the state of secondary resection. Another objective finding was a difference between the length of the legs amounting to 4.2 cm on the average. We could prove the existence of a relationship between the difference in leg length and the roentgenologically visualised supporting of the resection area of the coxal end of the femur at the lateral pelvis. Since all the patients with the exception of two could resume their customary daily routine activities, the state of secondary resection after unsuccessful total endoprosthesis of the hip joint must be considered a reasonably acceptable alternative.

Influence of 4-aminopyrazolopyrimidine on morphology, synthesis of triglyceride and protein and their secretion in rat hepatocytes

The influence of 4-aminopyrazolopyrimidine (4-APP) on morphology and on synthesis and secretion ability of isolated rat hepatocytes was investigated: 4-APP was found to inhibit both the synthesis and secretion of proteins. The synthesis of triglycerides was unaffected by 4-APP, while the secretion of triglycerides was markedly reduced. Transmission electron microscopy revealed that 4-APP induced morphological changes in the smooth membrane systems, the smooth endoplasmic reticulum and the Golgi apparatus. The possibility that 4-APP inhibits lipoprotein formation by inhibition of the apoprotein synthesis is discussed.

The effect of D-galactosamine on LCAT secretion and ultrastructure of isolated rat hepatocytes

The effect of D-galactosamine on secretory activity and morphology of isolated rat hepatocytes was investigated: Galactosamine was found to reduce the secretion of lipoproteins (as indicated by the release of free cholesterol and triacylglycerol) as well as the secretion of lecithin: cholesterol acyltransferase (LCAT) and [14C]-labelled proteins from the isolated cells. The secretion of LCAT was inhibited much more than that of the other secretory products studied. Transmission electron microscopy revealed that galactosamine induced morphological changes in RER, mitochondria and nucleoli. The most striking feature of galactosamine-treated hepatocytes, however, was the appearance of swollen lysosomes. Some of these organelles measured up to 3 mumicrometer in diameter. Uridine did not abolish the effect of galactoosamine upon the secretory activity of hepatocytes. The most conspicuous ultrastructural feature in cells that had been incubated with both uridine and galactosamine was the appearance of large amounts of glycogen. The possibility that galactosamine inhibits glycogenolysis is discussed. The rather selective effect of galactosamine on LCAT secretion suggests the use of this compound for the study of the interrelationship between LCAT and lipoprotein secretion.

Familial mitral valve prolapse and myotonic dystrophy

When a patient with mitral valve prolapse was found to have myotonic dystrophy, his family was studied to ascertain the occurrence of these abnormalities. Of 25 relatives screened, 8 had evidence of both myotonic dystrophy and mitral valve prolapse and 2 had evidence of myotonic dystrophy alone. Thirteen patients had evidence of neither condition and 1 had mitral valve prolapse alone. The association of these two conditions within a family has not previously been observed and valvular heart disease has not been recognized in myotonic dystrophy. This association should be looked for in other patients.

Complete correction of double-outlet right ventricle with situs inversus, 1-loop, and 1-malposition (I,L,L) with subaortic VSD and pulmonary stenosis

The repair a unique case of double-outlet right ventricle is reported. This case illustrates the increasingly difficult problem of developing an appropriate nomenclature in complex congenital heart disease. A classification of double-outlet right ventricle based upon Van Praagh's symbolic terminology is suggested.

Measurement of thickness within sections by quantitative electron microscopy

To apply the method of quantitative electron microscopy to the measurement of mass in thin sections, the thickness of the section at or very near the structure to be studied must be known. Dowex anion exchange resin AG 1 x 2, stained with phosphotungstic acid (PTA) at pH 6.4, was used as a thickness standard which could be embedded and sectioned. The sectioned PTA-Dowex appeared uniformly stained and exhibited suitable electron opacity. The stoichiometry of the reaction between PTA and the Dowex resin was measured by three independent methods based on gravimetric, colorimetric, and nitrogen determinations whose results showed close agreement. From the PTA uptake, the density of the stained spheres was calculated. Mass of a defined area of PTA-Dowex was measured by quantitative electron microscopy, and from this mass and density, the volume and then the thickness were calculated. The values for thickness were compared to those obtained by interference microscopy on the embedding medium alone in the same sections.