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PubMed2001

Risk of Lyme disease: perceptions of residents of a Lone Star tick-infested community.

BACKGROUND: Lone Star ticks (Amblyomma americanum) have been suggested as a vector of the agent of Lyme disease (Borrelia burgdorferi sensu lato) in the USA, based on associations with an infection manifesting mainly as erythema migrans. In laboratory experiments, however, they failed to transmit B. burgdorferi sensu stricto. METHODS: In this study, carried out from 1994 to 1996, we determined the seroprevalences of B. burgdorferi (1.2%), Ehrlichia chaffeensis (7%), E. phagocytophila (0%), Rickettsia rickettsii (0%), R. typhi (0%), Coxiella burneti (0%), Francisella tularensis (0%), and Babesia microti (0%) by standard serological methods for 325 residents (97% of the total population) of Gibson Island, coastal Maryland, USA, where 15% of the residents reported having had Lyme disease within a recent 5-year span. FINDINGS: Of the 167 seronegative individuals who were followed up prospectively for 235 person-years of observation, only 2 (0.85%) seroconverted for B. burgdorferi. Of 1556 ticks submitted from residents, 95% were identified as Lone Star ticks; only 3% were deer ticks (Ixodes dammini), the main American vector of Lyme disease. B. burgdorferi s.s. infected 20% of host-seeking immature deer ticks, and borreliae ("B. lonestari") were detected in 1-2% of Lone Star ticks. Erythema migrans was noted in 65% of self-reports of Lyme disease, but many such reports indicated that the rash was present while the tick was still attached, suggesting a reaction to the bite itself rather than true Lyme disease. Sera from individuals reporting Lyme disease generally failed to react to B. burgdorferi or any other pathogen antigens. CONCLUSION: The residents of Gibson Island had an exaggerated perception of the risk of Lyme disease because they were intensely infested with an aggressively human-biting and irritating nonvector tick. In addition, a Lyme disease mimic of undescribed etiology (named Masters' disease) seems to be associated with Lone Star ticks, and may confound Lyme disease surveillance. The epidemiological and entomological approach used in this study might fruitfully be applied wherever newly emergent tickborne zoonoses have been discovered.

Adult↗

PubMed2006

Trisomy 20 mosaicism and nonmosaic trisomy 20: a report of 2 cases.

BACKGROUND: Together with chromosome 19, chromosome 20 belongs to group F, the group of small metacentric chromosomes. Trisomy 20 mosaicism is one of the most frequent chromosomal mosaicisms, representing approximately 16% of prenatally diagnosed cases. In nonmosaic trisomy 20, the usual findings are severe and manifold. Only 3 cases in the literature involved fetuses surviving past the first trimester. CASES: In case 1, a 42-year-old woman presented in her sixth pregnancy; she had had 4 vaginal deliveries of term infants and a miscarriage. Both her familial and personal genetic histories were unremarkable. Genetic amniocentesis was performed in the 18th gestational week for advanced maternal age. Sample analysis revealed a normal, male karyotype in 27 mitoses, while 4 were trisomy 20 (46,XY [27]/47,XY, +20 [4]). In the 37th gestational week a live, immature, male infant weighing 1,730 g was delivered. Chromosomal investigation of the newborn's blood sample did not reveal trisomy 20 but a normal male karyotype. In case 2, a healthy 37-year-old nullipara underwent amniocentesis at the 18th week of pregnancy for advanced maternal age. Amniotic fluid cell karyotype revealed trisomy 20 (47,XX, +20). Ultrasonography performed simultaneously with genetic amniocentesis showed slightly shortened fetal long bones, detectable narrowing of the cranium in the region of the frontal bone, lateral ventricles of 10 mm in width bilaterally, echogenic bowel and polyhydramnios. Abortion was induced in the 23rd week of pregnancy, and a 490-g female fetus was delivered. CONCLUSION: Based on these 2 well-documented, prenatally diagnosed cases, as far as genetic counseling is concerned, nonmosaic trisomy 20 is much less challenging than its mosaic form since the prognosis is uniformly poor in the former.

Abnormalities, Multiple↗

PubMed1994

Evaluation of stated motives for legal abortion.

In a study of 404 women (simple random sample), 20-29 years of age, 201 (group A) applying for abortion and 203 (group B) continuing their pregnancies, the women were given a questionnaire and in addition were interviewed. The aim of the study was to evaluate the spontaneous personal motives of women for abortion at a time when age is not supposed to be a common reason. The results showed that more than half of the women expressed that a bad relationship with the partner in one way or another was a motive for the abortion. Other important motives included characteristics of the women and their partners, mainly immaturity, work/studies and unsuitable life situation for having a child. Less common motives seemed to be economy, dwelling and medical and health factors. It is obvious that women in this study wanted to have a stable relationship to the child's father before they dared or wanted to have a child. Social networks in modern society seem to be too weak. The women do not want to face social and emotional problems as lonely mothers. Political decisions in the society, for example with parental benefit according to your income discourage women from continuing their pregnancies during their studies. It also seems important for the woman to feel mature enough to have a child. The provision and encouragement of methods for safer sex may be a possible way by which to reduce the number of abortions.

Abortion, Legal↗

PubMedDate not supplied

Activated umbilical cord blood cells from pre-term and term neonates express CD69 and synthesize IL-2 but are unable to produce IFN-gamma.

BACKGROUND: The immune response exhibits quantitative and qualitative differences throughout human development. Both phenotypical and functional immaturity of newborn immune cellular components have been reported. We aimed to analyze possible differences in cellular activation assessed by expression of surface CD69 and cytokine production in mononuclear peripheral blood cells from premature (<37) and term (>37 weeks of gestation) neonates compared to adult donors. METHODS: Ten persons from each group were selected; none was infected, immunodepressed, under medical treatment, or had any congenital abnormalities. Blood was obtained from umbilical cord of term and pre-term donors and vein punction of adults. All samples were collected in heparin and subsequently activated with PHA-L or PMA plus ionomycin at 37 degrees C for 4 h. After incubation, cells were labeled to determine CD69 expression on CD3+CD4+, CD3+CD8+, CD19+, and CD16+56+ subpopulations. Intracellular staining was performed to analyze IFN-gamma, IL-2, and CD69 in CD3+ cells. After staining, cells were analyzed by flow cytometry. RESULTS: We first found a substantially higher number of CD3+CD4+CD69+ cells in premature and term neonates than in adults. Secondly, percentage of CD3+CD8+, CD56+, and CD19+ cells expressing CD69 was similar among the three groups. Thirdly, expression of CD69 was higher in CD19+ cells than in CD16+56+ cells of all three groups. Regarding cytokine production, IFN-gamma was detected only in cells from adults and was consistent in all individuals analyzed. In sharp contrast, IL-2 and intracellular CD69 (iCD69) were detected in all three groups, with no significant differences among them. Induction of IL-2 and iCD69 showed that lack of response with IFN-gamma was restricted to pre-term and newborn populations. CONCLUSIONS: In summary, our results showed that a) CD69 is an early activation marker of both mononuclear umbilical cord and peripheral blood cells activated by a mitogenic stimulus, and b) newborn CD3+ cells probably lack conditions required to progress through the activation process that leads to IFN-gamma production. These conditions are still unknown but certainly constitute an interesting issue for further studies.

Antigens, CD↗

PubMed1993

The Defense Style Questionnaire.

The Defense Style Questionnaire has proven of interest as the first questionnaire to reliably describe defense styles. The 72-item DSM-III-R-labeled Defense Style Questionnaire was administered to 388 controls and 324 patients. Eight statistical and two a priori criteria were used in choosing two items to represent each of the 20 defenses. A new 40-item Defense Style Questionnaire is published together with normative and reliability data on a normal population, patients with anxiety disorders, and child-abusing parents. The scores are unaffected by the sex of the respondent, but the endorsement of immature defense styles decreases with age.

Adolescent↗

PubMed2001

[Coping with conflict as pathogenetic link between psychosocial adversities in childhood and psychic disorders in adulthood].

OBJECTIVES: The present study explores the connection between neurotic or immature strategies for coping with conflict in the presence of specific psychosocial adversities during childhood and their cumulative effect. Here we test the hypothesis as to whether certain coping strategies can be viewed as a pathogenetic link between psychic illness in adulthood and adversities during childhood. METHODS: 407 consecutive patients referred to the outpatient unit of a psychosomatic university hospital were included in the study. The strategies for coping with conflict were assessed by means of two psychometric methods (FKBS, Hentschel et al., 1996; SBAK, Ehlers u. Peter, 1989), and the childhood adversities were assessed using the Mainz Structured Biographic Interview (Egle, 1993). RESULTS: Patients with sexual abuse and/or physical maltreatment during the first 14 years of life showed significantly higher values for immature coping mechanisms than patients without such traumatisation. Childhood adversities correlated negatively with mature coping strategies and positively with immature strategies. Significant differences also arise when patients with low risk are compared to those with a higher amount of childhood adversities. The latter group exhibits significantly higher scores for immature neurotic coping strategies, while the former exhibits mature ones. By means of a multivariate logistic regression analysis, 7 and 10% respectively of the variance of the predominant coping strategies within each group occurring in adulthood could be accounted for. CONCLUSIONS: The results suggest that in patients exposed to psychosocial stress during childhood an increased vulnerability for psychic disorders in adulthood is, in part, caused by the use of immature strategies for coping with conflict.

Adaptation, Psychological↗

PubMed1994

[Extremely premature infants: what is their future? Lausanne experience 1982-1992].

This study describes neonatal mortality and morbidity as well as the neuropsychological outcome of extremely-low-birth-weight infants (less than 1000 grams) born between 1/1/1982 and 12/31/1992. The number of preterm infants admitted to the neonatal unit has increased over the last ten years. If neonatal mortality remains high, the prognosis of these immature children is favourable and depends on close collaboration between obstetricians and neonatologists and on the quality of perinatal care.

Brain Damage, Chronic↗

PubMed1996

Gastrointestinal stromal tumors.

Stromal tumors of the gastrointestinal tract represent relatively rare lesions that are thought to arise from connective tissue elements located along the entire length of the gut. For many years these tumors have been the subject of much controversy and debate in the literature regarding their histogenesis, criteria for diagnosis, prognostic features, and nomenclature. Only a minority of these lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma of the conventional type. The majority of stromal tumors of the gastrointestinal tract correspond to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layer and showing partial or incomplete myoid, neural, ganglionic, or mixed features of differentiation. This review will attempt to summarize our current knowledge and understanding of these lesions based on review of the literature and the author's personal experience, with an analysis of the criteria for distinguishing between benign and malignant tumors, and a proposal for a working classification for these lesions.

Gastrointestinal Neoplasms↗

PubMed1992

The function of humor in a four-year-old.

A child's attempt at humor in the midst of a psychoanalytic session is examined. A joke is told that began as a dream which the 4-year-old analysand attempted to modify. The joke is not entirely successful from a formal standpoint. This "failure" is examined from the point of view of the anxiety that may have derailed the joke and the developmental immaturity that may have compromised it. A developmental line of the symbolic process is suggested, double meanings and multiple meanings becoming more complex as development proceeds.

Child, Preschool↗

PubMed2000

Temperament and character during the course of unipolar depression among inpatients.

Cloninger has developed a novel approach concerning relationships between psychopathological syndromes and personality by his biosocial theory. Increased levels of harm avoidance (HA) were consistently found in unipolar disorders. The present study was conducted to cross-validate, in part, previous findings that high harm avoidance (HA) persisted in the course of disorder and to explore the distinct role of character dimensions. One hundred and twenty-six inpatients with an unipolar depressive disorder and 126 healthy controls, strictly matched for age and gender have been included in the study. Our findings underline that higher harm avoidance among unipolar depressives compared to healthy controls persisted after treatment even if a significant reduction could be observed. Recurrent disorders and comorbidity with anxiety disorders seem to be related to a relatively immature character in terms of consistently lower scores for the character dimensions (e.g. self-directedness and cooperativeness) of the patients classified into these groups both at admission and at discharge compared with their healthy counterparts.

Adult↗

PubMed2003

Evaluation of irregular menses in perimenarcheal girls: a pilot study.

Acyclic vaginal bleeding in girls within three years of menarche is most commonly attributed to an immature hypothalamic-pituitary-ovarian axis. Assuming this diagnosis may preclude the practitioner from performing more definitive studies and thereby diagnosing other, treatable causes of menstrual irregularities. A retrospective chart review of 178 girls presenting to an inner-city hospital-based adolescent clinic within three years of menarche was performed. Personal and family medical and menarcheal history was assessed, and findings on physical and laboratory examination performed were evaluated. Of the 178 girls still perimenarcheal at presentation, 47 were the focus of this study. Of these, 39 had no significant findings on physical examination, while 3 had signs of functional ovarian hyperandrogenism (FOH) including obesity, hirsutism, and moderate acne with corresponding LH/FSH ratios>3, although pelvic ultrasound examination revealed normal ovaries. Four of the 39 patients with normal physical exams had LH/FSH testing done, and 1 of the 4 had an abnormal LH/FSH ratio, indicating possible FOH. Two of the 47 patients were pregnant. Other laboratory abnormalities included microcytic, hypochromic anemia in patients, and an elevated Erythrocyte Sedimentation Rate in a patient later diagnosed with a rheumatologic disorder. Those perimenarcheal girls presenting with irregular menses and findings including obesity, acne, or pallor, were likely to have treatable causes of menstrual irregularities. In one of the four girls with a normal physical examination, hormonal testing indicated possible FOH, thus suggesting that hormonal evaluation of perimenarcheal girls with menstrual irregularities may be justified, as it may reveal previously unsuspected pathology.

Acne Vulgaris↗

PubMed1993

Dynamic life table model for Aedes aegypti (Diptera: Culicidae): analysis of the literature and model development.

The container-inhabiting mosquito simulation model (CIMSiM) is a weather-driven, dynamic life table simulation model of Aedes aegypti (L.). It is designed to provide a framework for related models of similar mosquitoes which inhibit artificial and natural containers. CIMSiM is an attempt to provide a mechanistic, comprehensive, and dynamic accounting of the multitude of relationships known to play a role in the life history of these mosquitoes. Development rates of eggs, larvae, pupae, and the gonotrophic cycle are based on temperature using an enzyme kinetics approach. Larval weight gain and food depletion are based on the differential equations of Gilpin & McClelland compensated for temperature. Survivals are a function of weather, habitat, and other factors. The heterogeneity of the larval habitat is depicted by modeling the immature cohorts within up to nine different containers, each of which represents an important type of mosquito-producing container in the field. The model provides estimates of the age-specific density of each life stage within a representative 1-ha area. CIMSiM is interactive and runs on IBM-compatible personal computers. The user specifies a region of the world of interest; the model responds with lists of countries and associated cities where historical data on weather, larval habitat, and human densities are available. Each location is tied to an environmental file containing a description of the significant mosquito-producing containers in the area and their characteristics. In addition to weather and environmental information, CIMSiM uses biological files that include species-specific values for each of the parameters used in the model. Within CIMSiM, it is possible to create new environmental and biological files or modify existing ones to allow simulations to be tailored to particular locations or to parameter sensitivity studies. The model also may be used to evaluate any number and combination of standard and novel control methods.

Aedes↗

PubMedDate not supplied

Expression of the stem cell factor receptor C-KIT (CD117) in acute leukemias.

BACKGROUND AND OBJECTIVE: The receptor for stem cell factor (CD117) is the gene product of the c-kit proto-ontogene. Together with its ligand, the stem cell factor (SCF), it plays an important role in hematopoiesis. In this study, we review the cellular distribution of CD117 in normal hematopoiesis and in hematopoietic malignancies focusing on the differential expression in subtypes of acute leukemias. EVIDENCE AND INFORMATION SOURCES: This review is based on a literature search in the Medline database, personal publications and results obtained as a reference laboratory of the German AML-BFM, AMLCG and ALL multi-center therapy studies. STATE OF THE ART AND PERSPECTIVES: Membrane expression of CD117 can be found on leukemic blasts from approximately 60% of adult and childhood AML patients, often associated with an immature immunophenotype (CD34). Moreover, AML with t(8;21) are frequently CD117 positive. Despite earlier reports, most recent studies have not been able to demonstrate any significant prognostic impact of CD117 expression in either childhood or adult AML. A small proportion of T-lineage ALL (9%), mainly consisting of immature pro-T/pre-T-ALL, is CD117 positive. CD117 expression is rare in B-cell-precursor-ALL and occurs in less than 3% of cases. CD117 in combination with other antigens might facilitate the immunologic characterization of acute leukemias, especially those of myeloid and early T-cell origin.

Acute Disease↗

PubMed1996

Intuitive theories of human immunodeficiency virus transmission: their development and implications.

Explored the use of cluster analysis to characterize the development of intuitive theories of HIV transmission and examined relationships between children's theories and their attitudes regarding AIDS. In Study 1, analyses of interviews with 188 children and adolescents led to the identification of three relatively immature theories (undifferentiated thinking in which anything can cause AIDS, uncertainty about its causes, and a hybrid theory emphasizing germs as well as any form of drug use) and two relatively mature ones (both emphasizing true AIDS risk factors but differing in their understanding of blood exchange as a cause). Unwillingness to interact with persons with AIDS and worry about AIDS decreased with age and the former in particular was most closely associated with the belief that AIDS is spread through casual contact. In Study 2, analyses of data from a largely Mexican American sample of 306 third, fifth, and seventh graders yielded largely similar findings despite use of different risk factor subscales. Overall, the intuitive theories approach and the use of cluster analysis in its service appear to be promising ways of assessing children's knowledge of disease so that appropriate interventions for different subgroups of children can be designed.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Atypical cortical responses underlie poor speech perception in children using cochlear implants.

Variability in speech perception abilities after years of cochlear implant use could reflect differences in central auditory processing of the electrical input provided. Cortical responses were measured in 23 experienced pediatric cochlear implant users who were 12.3+/-3.1 years of age at testing and had used their implants for 6.0+/-2.9 years. All had prelingual onset of deafness. An observer identified blind three types of cortical waveforms ranging from those similar to previous reports to more atypical responses. Children displaying atypical types of responses were implanted at a wide range of ages and had significantly poorer behavioral speech perception scores (P<0.05) than their peers with expected waveforms. Results suggest a persistent immaturity and/or abnormal organization in the auditory cortex in some children.

Age Factors↗

PubMed1989

[Polycythemia vera with an inhibitor against factor XII].

A case of polycythemia vera with an inhibitor against factor XII was reported. A 60-year-old female was admitted to Hokkaido University School Hospital because of erythrocytosis and hepatosplenomegaly. The hemoglobin was 22.5 g/dl and white cell count was 9,500/microliters without immature cells. The platelet count was 484,000/microliters. Bone marrow specimens showed marked hypercellularity. Philadelphia chromosome was not found on chromosome analysis. She was diagnosed as polycythemia vera according to the criteria of polycythemia Vera Study Group. Activity of factor XII was found to be decreased on the initial examination, but she had no personal and familial history of bleeding. In order to clarify the cause of decreased activity of factor XII, her plasma was mixed with normal plasma, and then examined PTT using factor XII deficient plasma. Her plasma mixed with equivalent normal plasma did not show the correction of prolonged PTT. It was suggested that an inhibitor of her plasma was included in the IgG fraction using gel chromatography. The patient was treated with phlebotomy and administration of N4-palmitoyl (1- -D-arabinofurasyl) cytosine (derivative of cytosine arabinoside; PLAC) 200 mg/day and Busulfan (1 mg/day). Factor XII was not corrected by phlebotomy, but corrected gradually by administration of PLAC and Busulfan.

Factor XII↗

PubMed1998

Scoliosis in total-body-involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction.

STUDY DESIGN: A nonrandomized descriptive case series. OBJECTIVES: To analyze the results of spinal fusion in patients with total-body-involvement cerebral palsy to determine early and late outcomes, including caregiver satisfaction. METHODS: Data from 79 to 100 patients with total-body-involvement spastic cerebral palsy who underwent posterior Luque instrumentation, or anterior spinal fusion, or both, were adequate to be included in the study. Functional status was evaluated by physical examination, and a personal interview was conducted with the patient, parents, and primary caregiver. RESULTS: Median follow-up was 4 years (range, 2-14 years). Late progression of scoliosis (> 10 degrees), pelvic obliquity (> 5 degrees), and decompensation (> 4cm ) were noted in more than 30% of the patients. More than 75% of patients with late progression were skeletally immature at the time of surgery and underwent a posterior procedure only. Twenty-one percent of the patients required a revision procedure because of disease progression. Progression was not noted in any patient who underwent anterior fusion (with or without anterior instrumentation) plus posterior instrumentation from the upper thoracic spine to the pelvis. Eighty-five percent of parents or caregivers were very satisfied with the results of surgery and noted a beneficial impact of the patient's sitting ability, physical appearance, ease of care, and comfort. CONCLUSIONS: To avoid late progression of trunk deformity in skeletally immature patients, anterior spinal release and fusion combined with posterior segmental spinal instrumentation and fusion from the upper thoracic spine to the pelvis are recommended. Skeletally mature patients with good curve flexibility can be treated with posterior instrumentation and fusion only. Skeletally mature patients with large fixed curves benefit from an anterior-posterior procedure for better correction of the scoliosis and pelvis obliquity. Despite the surgical complexity and expected complications, the overall good surgical results and high patient and caregiver satisfaction confirm that corrective spinal surgery is indicated and is beneficial for most patients with total-body-involvement cerebral palsy and scoliosis.

Adolescent↗

PubMed1992

Are children who steal different from those who are aggressive?

Data on 2181 children referred to a child psychiatry service were analyzed to determine if there were specific correlates for aggressive behavior and for stealing behavior. Compared with stealers, aggressive children tended to be younger and more immature males, and to come from stressed families with a history of mental illness. These findings support the notion that there are biological and reactive components to aggression.

Adolescent↗