Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

An African-American man in his 30s presented following seven weeks of symptoms including an initial febrile illness with a rash followed by onset of fatigue, facial weakness, daily headaches, neck pain, leg numbness, hyperacusis, and photosensitivity. Over the seven weeks, he had several evaluations and was treated for cellulitis and facial swelling before ultimately being diagnosed and treated for Lyme disease with seventh nerve palsy and meningitis. His symptoms failed to completely resolve after treatment, and he was diagnosed with post-treatment Lyme disease syndrome (PTLDS) due to ongoing symptoms which lasted for more than six months after treatment.

Delayed diagnosis increases the risk of PTLDS and other long-term complications from Lyme disease. Provider awareness of Lyme disease risk factors, common neurologic and other presentations, and racial differences in diagnostic findings such as the skin rash can improve care by achieving earlier, accurate diagnoses and reduce risk of PTLDS.

Burning the Midnight Oil: A Focus Group Study of Medical Student Night Call Preferences

BACKGROUND: Call is an integral component of clerkship, providing unique clinical and educational opportunities. Recently, traditional call has been the subject of scrutiny, resulting in changes to call requirements. Canadian Pediatric clerkships currently employ a variety of call modalities, including night float, evening call, and overnight call.

OBJECTIVES: To explore the impact that call modalities have on medical students, and elucidate preferences.

DESIGN/METHODS: We conducted focus groups of 5-7 medical students each. Participants were asked about their experiences with various call systems during clerkship. Verbatim transcripts were analyzed independently by 2 team members using grounded-theory. All codes were further reviewed by the Principal Investigator.

RESULTS: Thirty-eight students participated in 6 focus groups. Four over-arching themes were identified as influencing call preferences: (1) Educational value, including patient volume and variety, hands-on experience, and teaching; (2) Quality of life, including fatigue/burn-out, ability to maintain a healthy lifestyle, and free time; (3) Continuity and quality of patient care; (4) Contribution to professional identity and acquisition of CanMEDS roles. Overnight call was described as a “rite of passage”, contributing to improved time management skills, a sense of collegiality, and self-perception as future physicians. With traditional call, post-call days provide opportunity to maintain well-being, although some believe 24-hour shifts impair ability to learn. Moreover, this call modality results in the lowest patient continuity of care. With regard to night float, most students appreciate focused call duties, and enjoy consistency with residents, resulting in greater bonding and teaching. However, they have difficulty adjusting to a nocturnal schedule, and lament missing daytime educational activities during call week. Evening call has the fewest patient encounters, least teaching, and worst fatigue and burn-out. Nonetheless, this call modality has the best patient continuity of care with no loss of daytime work. Students designated overnight call and night float as their preferred modalities, with evening call being unanimously rated least favourite. Students believe that specific goal-setting, and feedback from residents and staff are lacking across all call modalities.

CONCLUSION: Students emphasize educational value and quality of life as important determinants of their call experience. Interestingly, acquisition of professional attributes and continuity of care play an important role in determining call preferences. We suggest that integrating the above elements and introducing a formal “call curriculum”, may make the clerkship call experience more standardized and beneficial to medical students, facilitating their growth as medical professionals.

The importance of identity and empowerment to teenagers with developmental co-ordination disorder

AIMS

The aim of the current study was to gain an understanding of the experiences and aspirations of young people living with Developmental Coordination Disorder (DCD) in their own words.

METHODS

Eleven young people aged 11-16 years with a prior diagnosis of DCD were identified from child health records of two participating NHS trusts. The sample included seven boys and four girls, from different socio-economic backgrounds living in different parts of one large urban area in England. In depth one-to-one semi-structured interviews and subsequent follow-up small group interviews were carried out with the young people. Interviews were enhanced using participatory arts-based techniques. All interviews were recorded verbatim and transcribed. Narrative data were analysed using Lindseth's interpretive phenomenology.

RESULTS

The central theme of 'We're all different' described how the young person saw themselves and encompassed the formation of identity. Subthemes illustrated the attitude of the young people to their day to day lives, their difficulties and strategies used by the young people to overcome these difficulties in school and at home. The attitude of the school to difference, the presence of bullying, the accepting nature of the class, teachers and peers were vitally important. Areas of life that encouraged a positive sense of identity and worth included being part of a social network that gave the young people a sense of belonging, potentially one that valued differences as well as similarities.

CONCLUSION

The current work highlights the need for services to adopt a model of DCD where the young person talks about what they can do and considers strategies of overcoming their difficulties. This has implications for education and future intervention strategies that focus on fostering psychological resilience and educational coping strategies rather than simply attempting to improve motor skills.

'Providing more scaffolding': parenting a child with developmental co-ordination disorder, a hidden disability

BACKGROUND

Few studies exist reporting the experiences of parents of children with developmental co-ordination disorder (DCD) a common disorder with a prevalence of 1.8-6%. DCD is characterized by poor motor co-ordination, not caused by a general medical condition, but significantly affecting daily living. This study explores the experiences of parents living with a child with DCD in obtaining a diagnosis; the impact of the diagnosis on parenting and the effect on parents as individuals.

METHODS

Semi-structured interviews with a purposive sample of 15 parents of children with DCD data were recorded and then transcribed. Data were analysed using a coding framework and themes identified similar to Attride-Stirling (2001, Qualitative Research, 1, 385-405).

FINDINGS

DCD was an all-encompassing condition that dominated all aspects of family life and was a 'hidden disability'. Parents were frustrated by the poor knowledge and expertise of health and education professionals working with children with DCD and the lack of good quality accessible information and support services. Parents became by default the 'expert' on DCD for schools and other services; they were advocates for DCD and their own children. They provided additional support for longer to their child with DCD and had concerns for their future. Parenting a child with DCD was frustrating, exhausting, guilt-ridden as well as rewarding. There was little available time to provide for the needs of other family members.

CONCLUSION

A better-trained, knowledgeable workforce would redress the balance for families with DCD by providing better information, support and advocacy freeing parents to parent their families.

The Effect of Dietary Protein Level and Total Sulfur Amino Acid:Lysine Ratio on Egg Production Parameters and Egg Yield in Hy-Line W-98 Hens

A 3 x 3 treatment arrangement varying in dietary protein and TSAA:Lys was used to evaluate the effect of low-protein diets fed to Hy-Line W-98 laying hens. Phase I was 20 to 43 wk of age with 18.9, 17.0, and 14.4 g of protein/hen per day and 0.97, 0.85, and 0.82 TSAA:Lys, whereas phase II was 44 to 63 wk of age with 16.3, 14.6, and 13.8 g of protein/hen per day and 0.92, 0.82, and 0.72 TSAA:Lys. Egg production and feed consumption decreased from 83.7 to 82.2% and 98.8 to 95.6 g, respectively. Feed efficiency improved from 1.680 to 1.645 g of feed/g of egg mass with decreasing dietary protein. Body weight gain was similar for hens fed high or medium protein diets. In phase II, hens consuming 13.8 g of protein/day had significantly reduced egg weight compared with hens consuming 14.6 or 16.3 g of protein/day. Wet and dry albumen percentage, albumen solids, and albumen and yolk protein percentages were significantly decreased with feeding low-protein diets. Yolk protein percentage was increased from 14.85 to 15.11% when decreasing the ratio from 0.97 to 0.82. Hens consuming a low-protein diet produced eggs with the lowest specific gravity. An interaction was observed for protein retention during phase I, feeding 14.4 g of protein/day or a ratio of 0.97 improved protein retention by 9 and 16%, respectively. Overall, hens consuming 16.3 or 14.6 g of protein/hen per day performed similar to hens consuming 18.9 and 17.0 g of protein/hen per day during P1 and P2, respectively. Also, hens consuming diets containing 0.97 and 0.92 TSAA:Lys produced eggs with improved shell quality as compared with other ratios during P1 and P2, respectively.

Broiler performance and intestinal alterations when fed drug-free diets

A study was carried out to investigate the effects of a drug-free feeding program on broiler performance and intestinal morphology. Chicks vaccinated against coccidia were randomly assigned to 4 dietary treatments: 1) negative control (NC), basal diet; 2) positive control (PC), diet 1 + Lincomycin; 3) program 1 (PG1); diet 1 + Bio-Mos, Vegpro, MTB-100, Acid Pak 4-Way, and All-Lac XCL; 4) and program 2 (PG2), diet 1 + Bio-Mos and All-Lac XCL, each of which were assigned to 13 pens (48 birds in each of 52 pens). Growth traits (BW, feed intake, yield, mortality, BW gain, and feed conversion rate) were obtained through 49 d. At d 14, 3 chicks per pen were challenged with coccidia. Segments of duodenum, ileum, and ceca were removed to measure intestinal morphology at d 14, 28, 35, and 49. Final BW gain of broilers on PC (2.736 kg) was numerically higher than those for NC (2.650 kg). Cumulative feed conversion rate at d 49 was improved (P < 0.05) in birds consuming PC and PG2 compared with NC. Overall, mortality was higher for birds consuming the NC (P < 0.05) than the PC, PG1, and PG2 diets. Interaction of dietary treatments with age and age alone were evident (P < 0.0001) for morphology of duodenum, ileum, and ceca. Lamina propria in ceca was thicker (P < 0.008) in broilers consuming the NC than PG1 and PG2 diets. The results of this study indicated that feeding birds without growth promoters resulted in higher mortality and decreased growth performance than did feeding a diet with an antibiotic, and the combination of Bio-Mos and All-Lac XCL helped to reduce negative effects.

Klinische Evaluation einer Software zur automatischen Lokalisation von Lungenrundherden in CT-Verlaufskontrollen

PURPOSE

To evaluate a software algorithm for automated localization of pulmonary nodules at follow-up CT examinations of the chest and to determine factors influencing the rate of correctly matched nodules.

MATERIALS AND METHODS

The "real-time automatic matching" (RAM) algorithm (Siemens LungCare trade mark software) was applied to 22 follow-up multirow-detector CT (MDCT) examinations in 11 patients (Siemens Somatom VolumeZoom, tube voltage 120 kVp; effective tube current 20 mAs (n = 18) or 100 mAs (n = 4); 4 x 1 mm detector configuration, 1.25 mm slice thickness; 0.8 mm reconstruction increment; standard lung kernel B50f) with a total of 190 lung nodules (mean diameter 6.7 +/- 3.5 mm, range 2 - 17 mm). The following nodule features were recorded: diameter, edge definition (well- or ill-defined), location (upper, middle or lower third; central or peripheral; right or left lung) and inspiration level (considered identical if the difference of diaphragm-apex distance between baseline and follow-up examination was < 5 %, otherwise it was considered different). A nodule was regarded as correctly localized if the marking box drawn by the software was visible on at least one slice together with the nodule and the center of the nodule was located inside the marking box. chi(2)-test was used to describe influence of nodule features on detection rate. Influence of nodule size was assessed using Mann-Whitney-U-Test.

RESULTS

RAM correctly located 164 of 190 of all lung nodules (86.3 %). Detection rate did not depend on nodule location (left vs. right lung: p = 0.48; upper vs. middle vs. lower third: p = 0.96; peripheral vs. central: p = 0.47) or diameter (p = 0.30). Influence of inspiration level was highly significant (p < 0.001): nodules were detected in 100 % (146/146) for identical inspiration levels and in 40.9 % (18/44) for different inspiration levels. The observation of a significant better localization of ill-defined nodules (p = 0.028) corresponds to a statistical artifact due to the inhomogeneous distributions of this specific feature in our data.

CONCLUSION

RAM is a valuable tool for follow-up of lung nodules at CT. Only very different inspiration levels influenced detection rate.

The Combined Effects of Dietary Lysine and Total Sulfur Amino Acid Level on Egg Production Parameters and Egg Components in Dekalb Delta Laying Hens

Dekalb Delta hens were randomly assigned to one of eight dietary treatment groups. Two intakes of lysine (860 and 959 mg/hen per day) and 4 intakes of TSAA (635, 689, 811, 877 mg/hen per day) were combined in a 2 x 4 factorial treatment arrangement and fed from 20 to 43 wks of age. A phase feeding regimen was implemented at 43 wk with lysine intake lowered to 715 or 816 mg/hen per day and TSAA to 578, 607, 699, or 779 mg/hen per day. Cage was the experimental unit (5 hens/cage), and dietary treatments were replicated 8 times. Egg production (EP) and feed consumption were not affected by dietary treatments. Feed efficiency improved linearly by increasing TSAA intake during phase I only. Hen weight gain was improved (P < or = 0.03) by increased dietary lysine (94.2 vs. 135.2 g weight gain/hen). During phase I, hen weight gain was affected quadratically (P < or = 0.02) by TSAA. Increasing TSAA intake up to 689 mg/hen per day increased hen weight gain, but gain decreased at the highest intake. Egg weights (EW) increased (P < or = 0.02) from 59.02 to 60.21 g with increased lysine intake. Increasing lysine intake increased wet and dry albumen percentage, whereas dry yolk percentage decreased with increasing lysine. Total sulfur amino acid intake affected wet yolk, dry yolk, and solids in a quadratic trend, with hens fed 811 and 699 mg/d producing eggs with the greatest yolk solids. Wet and dry shell percentages were not affected by lysine or TSAA, and specific gravity decreased linearly during phase II and overall, with increased dietary TSAA. In conclusion, the dietary lysine at 959 and 816 mg/hen per day for phases I and II, respectively, optimized EW and feed efficiency. Because EP was not affected by dietary lysine, the dietary level for optimizing EP is closer to 860 and 715 mg/hen per day for phases I and II, respectively. Dietary TSAA level for maximum EP and feed efficiency was near 811 and 699 mg/hen per day but for EW may be closer to 877 and 779 mg/hen per day for phases I and II, respectively.

Long-term effects of feeding flaxseed-based diets. 1. Egg production parameters, components, and eggshell quality in two strains of laying hens

We used a split-plot design of five diets: control (corn-soy) with 3.8% Ca, 10% flaxseed with 3.8% Ca, 10% flaxseed with 4.5% Ca, 10% flaxseed with 3.8% Ca and 22,000 IU vitamin D3/kg, and 10% flaxseed with 4.5% Ca and 22,000 IU vitamin D3/kg, and two strains of birds, DeKalb Delta (DD) and Hy-Line W-36 (HL), to evaluate long-term effects of flaxseed supplementation on egg production parameters. Each of the five treatments was randomly assigned and replicated six times with five hens per replicate pen from 21 to 57 wk of age. Phase I was from 21 to 39 wk, Phase II was from 40 to 48 wk, and Phase III was from 49 to 57 wk. Feed consumption was significantly (P < 0.04) greater for the hens fed 10% flaxseed diets (100.9 g) when compared to the corn-soy controls (99.3 g). Overall average egg production (P < 0.05) was 87.8, 87.1, 86.0, 87.1, 84.8, for diets 1, 2, 3, 4, and 5, respectively. Average hen weights during the study were significantly lower for the flaxseed-fed hens (1.559 kg) compared to the controls (1.616 kg). Egg weight was significantly affected by diet during Phase III with heavier eggs from flaxseed fed hens (62.6 g) compared to controls (61.44 g), but overall egg weight was not significantly affected. Average egg mass was not significantly affected by dietary treatments, but DD hens had a decrease in egg mass with Ca supplementation (Diet 2 vs. Diet 3), whereas HL egg mass increased with Ca supplementation. Percentage albumen had a significant strain effect and strain by diet interactions. Overall, significantly less albumen (P < 0.001) was produced by HL (59.4%) compared to DD (61.3%). Supplemental Ca increased albumen percentage in DD (interaction effect P < 0.03) and decreased albumen percentage in the HL strain. Flaxseed supplementation significantly increased albumen percentage (P < 0.02) when compared to the corn-soy control, 60.5 and 59.9%, respectively. An interaction effect (P < 0.01) was noted for percentage wet yolk, in which increasing Ca decreased wet yolk percentage in DD but increased yolk percentage in HL. Wet yolk percentage was also significantly (P < 0.001) less in DD (25.0%) when compared to HL (26.9%). Addition of flaxseed decreased yolk percent when compared to controls (P < 0.03) during Phase II. Ca supplementation significantly (P < 0.03) increased yolk solids in both strains. Grams of yolk solids per egg were affected by flaxseed supplementation (P < 0.06). Flaxseed eggs contained 7.18 g per egg yolk solids compared to 7.3 g in corn-soy control group. Wet shell percentage was significantly lower in the flaxseed diets (12.4%) when compared to the controls (12.6%). Addition of flaxseed to the diet of laying hens did not have any adverse effects on egg production parameters, but flaxseed supplementation can significantly alter weight of yolk solids and yolk and albumen percentages.

An engineered human antibody to TNF (CDP571) for active Crohn's disease: a randomized double-blind placebo-controlled trial

BACKGROUND & AIMS

We evaluated CDP571, a humanized antibody to tumor necrosis factor, for the treatment of active Crohn's disease.

METHODS

One hundred sixty-nine patients with moderate-to-severe Crohn's disease were enrolled in a 24-week placebo-controlled trial. Patients were initially randomized to a single dose of 10 or 20 mg/kg CDP571 or placebo to assess dose response. Patients were then retreated with 10 mg/kg CDP571 or placebo every 8 or 12 weeks to assess subsequent dosing intervals. The primary endpoint was clinical response at week 2, defined as a decrease in the Crohn's Disease Activity Index score > or = 70 points.

RESULTS

At week 2, clinical response occurred in 45% of CDP571-treated patients compared with 27% of patients in the placebo group (P = 0.023). Patients appeared to benefit from retreatment with CDP571 over 24 weeks, but not all of the results for secondary endpoints were statistically significant. The frequency of severe or serious adverse events was similar among all groups.

CONCLUSIONS

CDP571 at an initial dose of 10 or 20 mg/kg is safe and effective for treatment of patients with moderate-to-severe Crohn's disease. Preliminary evidence suggests that retreatment with 10 mg/kg CDP571 at dose intervals of 8 or 12 weeks may also be beneficial, but additional studies are needed.

Effect of exogenous thyroxine on the development of the Purkinje cell in fetal alcohol effects in the rat

The amelioration of fetal alcohol effects on the postnatal development of the Purkinje cell by exogenous L-thyroxine was investigated in the neonatal rat. Time-pregnant rats were divided into three groups. Group A (n = 6) received 35% liquid ethanol diet; Group B (n = 6) was fed a liquid diet in which maltose dextrins replaced alcohol isocalorically, constituting the pair-fed group; Group C (n = 6) received the 35% liquid ethanol diet and, in addition, received exogenous thyroxine (5 microg/kg/day) subcutaneously. After the pups were born, the mothers were removed and the pups of each were surrogate fostered by dams who were fed normal rat chow and water ad libitum. An average of six pups, one from each litter, were killed at days 7, 14, 21, and 28 for each of the above three groups. Light and electron microscopic observations of lobule II/III revealed a delayed alignment of Purkinje cells (Pc) in alcohol-exposed pups compared to pair-fed pups. The Pc of the pair-fed group showed a single-layer arrangement at 7 days which was seen only at day 14 in the alcohol group. However, in the alcohol + T(4)-exposed pups a single-layer arrangement was quite often seen at 7 days. Morphological observations showed impaired evidence of protein synthesis at all time sequences in the pups of Group A compared to Group B. A most interesting finding was the morphological evidence of greater protein synthesis in the Pc of the alcohol + T(4) group at all times as indicated by a hypertrophied nucleus, abundant ribosomal collection, and numerous Nissl bodies.

Low energy fluence CO2 laser treatment of lymphangiectasia

Lymphangiectasia is an uncommonly reported complication of lymphatic insufficiency. These dilatations of lymphatic vessels may be symptomatic, necessitating treatment. While CO2 laser ablation has been used with success in the treatment of lymphangiectasia, it is infrequently reported and previous laser protocols have relied on high irradiances. The successful use of low fluence CO2 laser in the treatment of multiple lymphangiectases on the lower limb of a middle-aged Caucasian woman with unilateral chronic lymphoedema is described.

Idiopathic multiple miliary osteomas of the face

A case of multiple miliary osteomas of the face arising in a 45-year-old Caucasian female with no history of skin disease is reported. Spontaneous development of numerous asymptomatic, skin-coloured facial papules had occurred over a 3 year period. Originally described in association with long-standing acne vulgaris, multiple miliary osteomas of the face has recently been reported in patients without prior skin disease. The pathogenesis, classification and treatment of this rare condition are discussed.

Effect of dietary vitamin E supplements on cholesteryl ester transfer activity in hamster adipose tissue

Increased concentration of cholesteryl ester transfer protein (CETP) in plasma favours a lipoprotein profile characterized by a reduced high density lipoprotein (HDL) cholesterol. Previous studies have demonstrated that a diet high in cholesterol and saturated fat (HCSF) is associated with elevated plasma CETP and increased release of cholesterol ester transfer activity (CETA) from hamster adipose tissue incubated in vitro. The present study investigated the effects of vitamin E (Vit.E) ingestion on plasma CETP activity and adipose tissue CETA in Syrian Golden hamsters. A regular diet supplemented by the addition of 1% cholesterol and 10% coconut oil (w/w) was associated with a time-dependent increase in plasma CETP activity and increased release of adipose CETA following incubation of fragments of perirenal adipose tissue. Vit.E ingestion (100 mg/kg body weight per day for 8 weeks) suppressed 85% of the increase of CETA released from cultured hamster adipose tissue and 70% of the increase of plasma CETP activity induced by the HCSF diet. Significant decreases in plasma total and LDL cholesterol and an increase in HDL cholesterol were found in hamsters receiving the HCSF diet plus Vit.E compared to the animals on the HCSF diet alone. In the hamsters on regular chow, Vit.E ingestion alone did not significantly alter adipose tissue CETA, plasma CETP activity or plasma lipoproteins. The results indicate that Vit.E prevents the HCSF diet-induced increase in plasma CETP activity, probably via a reduction of CETA secretion from hamster adipose tissue. This suggests that Vit.E supplementation may help to ameliorate the dyslipidemia caused by a HCSF diet through its inhibitory influence on CETP production in adipose tissue.

School-based aftercare for adolescents recovering from substance abuse: a secondary school needs assessment

Adolescent substance abuse is a critical problem facing an increasing number of families. Abuse and subsequent treatment and recovery often have negative effects on students' educational experience. The purpose of this study was to assess the need for school-based aftercare for recovering adolescents in a secondary school setting. A purposive sample of 37 secondary students responded to a Likert-type survey as well as two open-ended questions. The data indicated generally negative attitudes of where the students perceived themselves to be in their recovery process, but also revealed the respondents' desire for aftercare support at school.

Comprehensive pharmacokinetics of a humanized antibody and analysis of residual anti-idiotypic responses

A murine antibody to human tumour necrosis factor-alpha (TNF-alpha) (CB0010) was complementarity-determining region (CDR)-grafted using human IgG4 heavy and kappa light chain constant regions. In cynomolgus monkeys, the grafted antibody (CDP571) was eliminated with a half-life of 40-90 hr, two to three times longer than CB0010, and immunogenicity was reduced by > 90%. Responses to the constant regions were almost entirely eliminated and responses to the CDR loop (anti-idiotype) were lowered. CDP571 was given to 24 human volunteers in doses from 0.1 to 10.0 mg/kg. It was well tolerated, with a half-life of approximately 13 days. Anti-CDP571 antibodies were low or undetectable at higher doses. At lower doses, anti-CDP571 peaked at 2 weeks and then declined. The response was primarily IgM (in contrast to the cynomolgus monkey, where by 5 weeks IgG predominated) and was against a conformational epitope comprising heavy and light chain CDR loops. No antibodies were detected against the gamma 4/kappa domains or frameworks. The response had little or no effect on CDP571 binding to TNF-alpha or on plasma clearance.

Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers

A quality control (QC) program for bone mineral measurements at the proximal femur by dual-energy x-ray absorptiometry (DXA) was designed for the osteoporosis component of the Third National Health and Nutrition Examination Survey (NHANES III). Major elements of the QC program are (1) a QC center for review of all scans, (2) setup procedures for and continuous monitoring of daily QC procedures, (3) reference standards for cross-calibration, (4) longitudinal studies for assessment of instrument stability, (5) monitoring of technologist performance, and (6) training. This report describes the results of the QC program of the first half of this 6 year study, which began in 1988. Measurements were performed on 7376 subjects in three mobile examination centers, which traveled to a new location about every 3 months, a total of 44 locations. A small percentage (3.5%) of all scans were rejected, mostly because of patient motion during scanning, but 33% of the remaining scans required reanalysis at the QC center to refine the location of the regions of interest. Precision in spine and hip phantoms was below 1% at all ROIs. In 535 subjects with duplicate scans, age 20-91 of both sexes, examined in a blinded review, precision for BMD at the femur neck ROI was 3.2% (CV) and 5.1% for Ward's triangle BMD. The central review improved scan quality, increased the number of usable scans, and reduced significantly the range of the mean percentage difference in the duplicate scans. Minor alterations in machine function were observed and corrected. QC results on phantoms were similar to those obtained with stationary instruments in dedicated laboratories. Retrospective analysis of the regression slopes from QC records did not show a need for correction of the data base, indicating that the instruments were stable during the course of the study.

Fetal alcohol effects on the postnatal development of the rat myocardium: an ultrastructural and morphometric analysis

Heart disease is an entity frequently seen in the fetal alcohol syndrome. This paper describes the effect of in utero ethanol exposure on the postnatal ultrastructural development of rat cardiac muscle. To determine this time-pregnant Sprague-Dawley rats were fed either a nutritionally balanced protein- and vitamin-enriched liquid ethanol diet (with 36% of the calories derived from ethanol) or a liquid diet with maltose-dextrins isocalorically substituted for ethanol. The latter group was designated the pairfed control group. At birth, pups of both the groups were surrogate-fostered by normal dams. Body weights and crown-rump lengths were significantly less in the rat pups exposed to ethanol in utero at 21 days postnatal. Ultrastructural analysis of the cardiac muscle was performed at 7, 14, and 21 days postnatal in ethanol and pairfed groups. Several morphological features of myocyte damage were observed in ethanol-exposed pups, predominantly at 7 days postnatal, with nearly total absence of myocyte damage by 21 days postnatal. The most outstanding changes were observed in the myofibrils, which showed dysplastic changes at 7 days postnatal, a delay in M-band structural development at 14 days postnatal, and a significantly smaller myofibril volume density per tissue volume at 21 days postnatal in the ethanol rat pups compared to the pairfed controls.

Internal neurolysis fails to improve the results of primary carpal tunnel decompression

This prospective, randomized study compares two treatment methods in patients with primary carpal tunnel syndrome. Decompression of the transverse carpal ligament was done in thirty-two hands (thirty patients) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one hands (twenty-nine patients). Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis. Improvement in hand sensibility testing, in thenar muscle strength, and atrophy was noted in both treatment groups with no statistical difference between groups. The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome.

Phase I clinical trial of interleukin 2 and alpha-interferon: toxicity and immunologic effects

Because recombinant interleukin 2 (rIL-2) and recombinant alpha-interferon (rIFN-alpha) exhibit synergistic antitumor activity in C3HMT1820 T-cell lymphoma and B16 melanoma tumor systems, we have performed a Phase I study of this combination in 55 patients with advanced malignancies for whom no standard therapy exists. Successive groups of greater than or equal to 4 patients have been entered into 12 dose levels (1A-3D), with dose levels 1-3 referring to doses of rIL-2 of 0.1, 0.5, and 2.0 x 10(6) units/m2, respectively, and dose levels A-D referring to doses of recombinant human alpha 2a-interferon (rHuIFN-alpha 2a) of 0, 0.1, 1.0, and 10.0 x 10(6) units/m2. Both agents were given on Mondays, Wednesdays, and Fridays, with rIL-2 being given as i.v. bolus injections and rHuIFN-alpha 2a being given intramuscularly. Myelosuppression was dose-limiting and was related primarily to the dose of rHuIFN-alpha 2a. The maximum-tolerated dose level was reached at a dose of rIL-2 of 2.0 x 10(6) units/m2 and of rHuIFN-alpha 2a of 10.0 x 10(6) units/m2 (dose level 3D). At this dose level, 3/6 patients developed grade 3 neutropenia (absolute granulocyte count less than 1 x 10(9)/liter). Myelosuppression was transient, with no documented infections being associated with neutropenia. Hypotension was mild; a single patient was treated with a vasopressor, but all other cases of hypotension responded to fluid administration. No significant pulmonary toxicity was produced. Fever, chills, and malaise were universal but not dose-limiting. Three partial responses and one minor response were observed in patients with malignant melanoma, renal cell carcinoma, and breast cancer. Immunological studies suggested that natural killer activity was related to both the dose of rIL-2 and the dose of rHuIFN-alpha 2a, with natural killer activity being positively related to the dose of rIL-2 and maximal at the lowest dose of rHuIFN-alpha 2a of 0.1 x 10(6) units/m2.

Facial sensibility testing in the normal and posttraumatic population

A reliable, reproducible, simple examination of facial sensibility is described. Evaluation of 60 healthy subjects established normal values, trends, and variations of facial sensibility. Comparison of these normal values with 20 posttraumatic patients revealed that postfacial fracture sensibility testing was abnormal. Abnormalities in pressure threshold testing was most consistently associated with functional sensory complaints. Twelve of the 20 patients had significant sensory complaints at one year following the trauma.

A new tool for peptide separation

A family of reagents has been developed (Pep-Seps) which provide separations of peptides based upon the presence or absence of a single type of amino acid. This separation is achieved through a reversible, covalent attachment of the peptide to the Pep-Seps reagents. Pep-Seps provide a more specific separation than most forms of HPLC and may be used to complement HPLC in peptide separations and isolations. Several specific applications will be discussed.

Evaluation of the relative effectiveness of methylphenidate and cognitive behavior modification in the treatment of kindergarten-aged hyperactive children

This study of kindergarten-aged hyperactive children evaluated the effects of three modes of treatment in relation to an untreated control group. The treatments were administered over a 3-month period and included cognitive behavior modification, methylphenidate, and the two treatments combined. A follow-up assessment was done approximately 1 year later at the end of the first grade. Analyses of psychological, rating scale observational, and interview data showed that hyperactive children became less symptomatic over time; the data did not provide evidence indicating that any of the treatments studied was more effective than any other or than no treatment at all.