Biomedical subjects
Publications and source records attributed to N Hansen.
A case history is presented of a child in puberty with multiple tics, concentration problems and conduct disorder. Contrary to expectations, the tics diminished after neuroleptics were discontinued and dexamphetamine given in an increasing dose. It is thus argued that multiple tics can hardly be regarded as a clearcut neuro-organic hyperdopaminergic disease.
This retrospective study examined the effects of type of payor (ie, catastrophic, Medicaid, and private) and extent of benefits and independent living (IL) resources received on functional and psychosocial outcomes after spinal cord injury (SCI). One hundred seventy SCI persons with dates of injury from 1985 to 1990 and who were on average 4 years after their initial discharge from rehabilitation participated in the study. Benefits and resources received from discharge to 2 years post-injury in housing, transportation, personal care assistance (PCA), and equipment were assessed. Outcome variables included measures of psychological distress, self-esteem, and participation in physical and work/school activities. Extent of benefits received after SCI was found to be both a function of source of payor and of subject's neurological classification. While an effect of total benefits received could not be detected on SCI subjects post-discharge physical activity, and benefits paid by self only were associated with physical activity. Transportation benefits received and type of payor were positively associated with work/school outcomes. Younger subjects, sponsored by private payors, and with incomplete injuries were more likely to be working or going to school after SCI. Benefits and payor were also associated with psychological distress. Privately sponsored subjects were less distressed, whereas those sponsored by Medicaid were most distressed. Extent of benefits received was found to be inversely associated with distress and self-esteem. Persons with lower self-esteem received more postdischarge benefits, whereas those who paid for their own benefits and those who received communication equipment benefits paid by insurance, reported higher self-esteem. Implications for possible policy changes based on these results are discussed.
Many of the acute inflammatory responses in critical illness are mediated by tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Furthermore, these cytokines are involved in mediating the characteristic changes of thyroid function during acute disease known as non-thyroidal illness. In the present studies we investigated in vitro whether TNF-alpha, IL-1 beta and IL-6 modify nuclear thyroid hormone receptor (TR) capacity and/or affinity. Regulation of TR synthesis was studied in the human hepatoma cell line Hep-G2. Subconfluent cells were incubated with recombinant cytokines in serum-free medium. Nuclear extracts were prepared by high-salt extraction of cell nuclei. Binding assays were performed with [125I]-triiodothyronine; bound and free hormone were separated by filtration. Interleukin 1 beta decreased TR capacity in a dose-dependent manner. Compared with unstimulated cells, the TR capacity was reduced to 87.9 +/- 3.9% (p < 0.05), 80.1 +/- 3.9% (p < 0.01) and 72.1 +/- 5.1% (p < 0.01) after incubation with 0.1, 1.0 and 100 micrograms/l IL-1 beta, respectively. Interleukin 6 and TNF-alpha significantly reduced receptor capacity only at concentrations of 10 micrograms/l or higher and the magnitude of the reduction was lower than with IL-1 beta. The TR capacity was reduced to 81.2 +/- 2.3% (p < 0.01) and 83.2 +/- 6.6% (p < 0.05) after stimulation with 10 micrograms/l IL-6 or TNF-alpha, respectively. TR affinity was not altered significantly after stimulation with any of the cytokines.(ABSTRACT TRUNCATED AT 250 WORDS)
This study examined differences between depressed and nondepressed individuals with a history of paralytic poliomyelitis in terms of demographics, health status and coping strategies. The prevalence of distress and depression in this group of 116 polio survivors was determined. Subjects completed the Brief Symptom Inventory, the Coping with Disability Inventory and a questionnaire concerning their polio histories and self-perceptions of health. Medical assessments were performed by physicians. Only 15.8% of the sample had scores indicating depression and elevated distress. Depressed/distressed polio survivors were more likely to: be living alone, be experiencing further health status deterioration, seek professional help, view their health as poor, report greater pain, be less satisfied with their occupational status and their lives in general and exhibit poorer coping outcome behaviors in relation to their disability. Three factors in coping with the late effects of polio were identified through a factor analysis of the Coping with Disability Inventory: positive self-acceptance, information seeking/sharing about the disability and social activism. Differences between depressed/distressed and other polio survivors were found across these three factors, with depressed/distressed subjects having significantly lower coping scores. These and other results are discussed.
We enrolled 1,353 subjects in a multicenter study to evaluate the spectrum of pulmonary complications associated with human immunodeficiency virus (HIV) infection and the feasibility of detecting pulmonary infections in asymptomatic members of this group. There were 1,171 who were HIV-seropositive; the remaining 182 were HIV-seronegative, but they belonged to high-risk transmission groups (homosexual/bisexual, or injection drug users). Single-breath carbon monoxide diffusing capacity (DLCO) was measured serially (at 3- to 12-month intervals) in a prospective fashion to determine whether a decline of > or = 20% predicted the presence of Pneumocystis carinii pneumonia or other pulmonary infections in the absence of new pulmonary symptoms and no new abnormalities on chest roentgenograms. In 64 subjects (6% of the group who had two or more measurements) DLCO declined > or = 20% from a prior value within 2 yr of entry, unassociated with fever, increased cough or dyspnea, or new chest roentgenogram abnormalities. Induced sputum was analyzed for the presence of P. carinii and mycobacteria in 44; fiberoptic bronchoscopy was performed with bronchoalveolar lavage in 14, six of whom also had transbronchial lung biopsy. All 64 subjects with the asymptomatic decline in DLCO were followed for an additional 3 to 12 months with additional clinical evaluations, chest roentgenograms, and DLCO determinations, or until death (one subject). In no case was the decline in DLCO due to P. carinii pneumonia or other pulmonary infection.(ABSTRACT TRUNCATED AT 250 WORDS)
A retrospective review of 24 patients treated at the University of Chicago for pyogenic liver abscess from 1979 to 1989 was performed to determine if there is a changing etiology in pyogenic liver abscess and if percutaneous drainage is a reliable treatment alternative to open drainage. Biliary tract disease was the most common cause and presented in 29 per cent of patients. Klebsiella and enterococcus were the most common bacterial organisms cultured in 33 and 29 per cent of patients, respectively. The overall mortality rate was 25 per cent, however, if open drainage, in addition to a definitive procedure such as cholecystectomy or bowel resection was performed, there were no deaths. We therefore recommend the use of percutaneous drainage alone only in selected patients.
Neonatal intensive care units are essential for the successful care of very immature and sick infants. The technology of NICUs has contributed significantly to the reduction of neonatal mortality and improvement of neonatal outcome. While the outcome for high-risk neonates has vastly improved over the past three decades, a number of infants sustain injuries and complications that result in long-term disabilities. It is now clear that some of the long-term problems of high-risk infants are a result of the environment and care practices and are not attributable to the original disease or condition that necessitated intensive care. There is accumulating evidence that environmental factors and care practices can interact with disease processes in ways that can increase morbidity, and possibly mortality. In addition to developmental and behavioral problems, there is growing evidence of effects on visual function and perhaps other sensory systems. Many of the environmental and care factors may cause delay in recovery and increase NICU time or unnecessary discomfort, yet not produce long-term disabilities or problems, as currently assessed. Many of the potential behavioral and developmental problems, as well as many of the potential problems with visual, auditory, and other modes of sensory discrimination, are not included in the usual follow-up assessments. The absence of data or the limitations of existing studies are not a cause for comfort or the assumption that the environment and care practices are safe or not harmful.(ABSTRACT TRUNCATED AT 250 WORDS)
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OBJECTIVE: To evaluate the efficacy and safety of zidovudine early in the treatment of human immunodeficiency virus type 1 (HIV) infection. DESIGN: A double-blind, randomized, placebo-controlled trial with subject stratification by pretreatment CD4 T lymphocyte counts. SETTING: Multicenter trial at AIDS Clinical Trial units. SUBJECTS: Seven hundred eleven subjects with mildly symptomatic HIV infection. INTERVENTION: Three hundred fifty-one subjects were assigned to placebo and 360 to zidovudine, 200 mg orally every 4 hours. The median duration of follow-up was 11 months. MEASUREMENTS AND MAIN RESULTS: Fifty-one subjects developed the acquired immunodeficiency syndrome (AIDS), advanced AIDS-related complex, or death as a first critical event. For the stratum of subjects with more than 200 but less than 500 CD4 T lymphocytes/mm3 before treatment, 34 events occurred in placebo recipients and 12 in zidovudine recipients (P = 0.0002; relative risk [RR] estimate, 3.23 [95% CI, 1.67 to 6.24]). For the stratum of subjects with 500 to 799 CD4 T lymphocytes/mm3 before treatment, 2 events occurred in placebo recipients and 3 in zidovudine recipients. Candidiasis at study entry independently increased the risk for having an event (P = 0.005; RR estimate, 2.3 [95% CI, 1.29 to 4.12]); HIV antigenemia at study entry also increased this risk (P = 0.01; RR estimate, 2.1 [95% CI, 1.2 to 3.8]). Significant differences between the treatment groups in CD4 T-lymphocyte counts occurred in subjects with more than 200 but less than 500 CD4 T lymphocytes/mm3 after 4 weeks of therapy (P = 0.002). Differences persisted through week 52. Less prominent changes occurred in subjects with 500 or more CD4 T lymphocytes/mm3. Serum levels of HIV antigen decreased significantly in zidovudine recipients. Serious anemia and neutropenia occurred in 5% and 4% of zidovudine recipients, respectively, and in 0% and 1% of placebo recipients, respectively. CONCLUSION: Zidovudine delayed progression of HIV disease and produced little toxicity in subjects with mildly symptomatic HIV disease and less than 500 CD4 T lymphocytes/mm3.
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During the years 1978-1981 both the European Economic Community (the EEC) and the Organization for Economic Cooperation and Development (the OECD) organized various interlaboratory comparison programs on standardized screening methods to study the biodegradability of chemicals in water. While the ring test results were generally rather heterogenous, one of the compounds studied, 4-nitrophenol, turned out to be particularly problematic as the compound was found either easily biodegradable or not biodegradable by various laboratories in various tests. This paper describes some more detailed studies on 4-nitrophenol degradation in two different tests, the modified OECD screening test (MOST test) and the Zahn-Wellens test, respectively. The test variables investigated include inoculum characteristics and pretreatment, test duration, and 4-nitrophenol concentration. The results are discussed in relation to toxicity and degradation pathways of 4-nitrophenol. It is concluded that in order to improve the comparability of results from standardized aquatic biodegradation tests, test strategies should allow the option of performing a test with a preadapted inoculum in the event of negative test results with freshly collected inocula. Increasing the inoculated concentration of microorganisms in some tests may also contribute to the attainment of more consistent test results.
Malassezia furfur, a lipophilic fungus commonly found on the skin of healthy adult, was isolated from Broviac catheter blood cultures in five sick infants who were receiving fat emulsions intravenously. The most common manifestations of sepsis included apnea and bradycardia, low-grade fever, interstitial pneumonia, elevated neutrophil band counts, and thrombocytopenia. All infants recovered without antifungal therapy after removal of the Broviac catheters. Early onset of fungemia after catheter placement in these five infants and the recovery of M. furfur from the skin of nearly 33% of hospitalized premature neonates indicate that contamination of the Broviac catheter at time of placement may be the most likely origin of infection.
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Impaired adrenal cortical responsiveness to ACTH has been reported in children with steroid responsive nephrotic syndrome. Plasma cortisol levels at 8 AM and 2 hours post ACTH stimulation were measured on 42 occasions in 33 children with steroid-responsive nephrotic syndrome. Twenty-two of 42 fasting 8 AM plasma cortisol and 39 of 42 post-ACTH plasma cortisol values were subnormal. Plasma cortisol values were similar in children evaluated prior to, immediately following or 2-24 moths after prednisone therapy. No relationship was observed between 8 AM or post-ACTH plasma cortisol values and serum albumin concentration or the presence of edema. Impaired adrenal responsiveness to ACTH was not helpful in predicting the length of clinical remission. Hydrocortisone replacement therapy given to five children with impaired ACTH-responsiveness did not alter the rate of relapses observed prior to this treatment.
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