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PubMed2003

Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients.

We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV) infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone). Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Forty-eight patients (78.7%) developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8%) presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P<0.005) in the number of CD3+, CD4+, CD8+ and CD3+HLA-DR+ cells. No significant changes were observed in natural killer cells or B lymphocytes during the disease. We conclude, as observed in all viremic patients recovering from infection, that recovery is associated with an increase in the number of T cell subsets. The monitoring of different lymphocyte subsets along with antigenemia can be extremely useful in the detection of patients at high risk of developing CMV symptoms, allowing the early introduction of antiviral therapy or the reduction of immunosuppression therapy.

Adolescent↗

PubMed1977

Melanin distribution and sensitivity to group therapy.

Student participants in group therapy were hypothesized to improve on three dimensions of behavior as a result of therapy. It was further hypothesized that improvement would be related to participant eye color, with dark-eyed persons demonstrating greatest improvement and lighter-eyed individuals demonstrating lesser improvement. Differences were also expected from Ss by program. Ss were 35 male and female master's level students in clinical, counseling, and educational psychology programs, ranging in age from 23 to 39 years. Dependent measures were collected before and after therapy with the Vriend and Dyer Scale, an instrument yielding three factors: Self Defeating Behaviors, Fully Functioning Behaviors, and Personal Mastery Index. The design utilized a 3 (eye color) X 2 (program) two-way ANOVA, fixed effects model. Significant main effects were found for Fully Functioning Behaviors: by eye color (p less than .002) and by program (p less than .03). No interactions or other main effects were found.

Adult↗

PubMed1996

[Doppler and color Doppler ultrasound diagnosis in differentiation of focal liver lesions].

The frequent detection of benign liver lesions during ultrasound routine examination and a possible curative therapy of early detected malignant tumors require a reliable method of differentiation. Conventional gray-scale ultrasound, according to this problem, has been extended by the Duplex technique and color Doppler ultrasound. Measurement of blood flow velocity by Doppler in the center and at the periphery of liver lesions is not reliable enough to distinguish between benign and malignant lesions. Color Doppler ultrasound possesses some reliable criteria for differentiation. A central spot could be detected in 2 out of 12 hemangiomas, a giant spot in 1 out of 3 giant cavernous hemangiomas. The halo sign without detectable blood flow is considered to be specific for malignancy. We found this sign in 26 out of 81 malignant liver lesions and only in one benign lesion (sensitivity 32%, specificity 97%). The vascularization of focal liver lesions is excellently demonstrated with color Doppler ultrasound. This is very helpful for the diagnosis (e.g. "chaotic blood vessel architecture' in malignant tumors) and for the therapy of focal liver lesions (e.g. follow-up examinations after chemotherapy or chemoembolization). Therefore, application of Duplex and color Doppler ultrasound is highly recommended as a noninvasive diagnostic method of first choice for unknown liver lesions.

Blood Flow Velocity↗

PubMed2003

Photodynamic therapy using verteporfin for choroidal neovascularization in angioid streaks.

PURPOSE: To evaluate the efficacy of photodynamic therapy with verteporfin in the management of choroidal neovascularization (CNV) associated with angioid streaks. DESIGN: Retrospective case series. METHODS: Eleven eyes of nine patients with subfoveal or juxtafoveal CNV due to angioid streaks underwent visual acuity testing, ophthalmic examination, color photography, and fluorescein angiography to evaluate the results of photodynamic therapy with verteporfin. Retreatment of persistent CNV was based on criteria from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Investigation (TAP) except in one case. Follow-up ranged from 5 to 28 months (mean, 17 months). RESULTS: Nine of 11 eyes had subfoveal lesions while two eyes had juxtafoveal lesions on initial examination. Conversion from a choroidal neovascular membrane (CNVM) to a fibrous disciform lesion following photodynamic therapy was observed in nine eyes. Enlargement of the CNVM was noted in seven of these eyes by fluorescein angiography at final follow-up. Initial best-corrected visual acuity (BCVA) ranged from 20/25 to counting fingers (CF) (mean, 20/400; median, 20/200). Final BCVA ranged from 20/20 to CF (mean, 20/600; median, 20/400). Seven eyes with subfoveal CNVM had an initial BCVA of at least 20/200 while only three eyes maintained this level or better at last follow-up. In one patient with a juxtafoveal CNVM in one eye, vision decreased from 20/25 to 20/400 with enlargement and fibrosis of the CNVM and subfoveal extension. In the fellow eye a juxtafoveal CNVM was initially treated and then retreated earlier than TAP criteria at 6 weeks. Vision improved to 20/20 and has remained stable 5 months after the initial treatment. CONCLUSIONS: Verteporfin for choroidal neovascularization-associated with angioid streaks does not appear to significantly alter the course of this disease with most eyes undergoing enlargement and disciform transformation of the neovascular process. However, aggressive management of these patients with biomicroscopic and fluorescein angiographic examination and timely photodynamic therapy with early retreatment when indicated may be beneficial in certain cases.

Adult↗

PubMed2006

Is quality control of Cochrane reviews in controversial areas sufficient?

OBJECTIVES: Some conclusions from the Cochrane Database of Systematic Reviews (CDSR) seem volatile in areas of controversy and have recently changed conclusions. With this perspective in mind we decided to test the validity and sensitivity of negative conclusions in a systematic review of low-level laser therapy (LLLT) for osteoarthritis (OA) from the Cochrane Library was valid and robust. SETTINGS/LOCATION: None as this was a systematic review of literature. DESIGN: Validity was tested against a 9-item checklist for systematic reviews. Review selections were analyzed for possible discrepancies between trial and review reports and omissions of relevant trials and data. Data from discrepancies and omissions were then entered into sensitivity and subgroup analyses. OUTCOME MEASURES: Continuous and dichotomous data for pain SUBJECTS: Patients with osteoarthritis. INTERVENTIONS: LLLT. RESULTS: Only clinicians who had performed LLLT trials, and had negative results were invited into the review group. The review was oblivious to findings published after 1993 about physiologic mechanisms and dose response patterns for LLLT. We found 18 questionable selections that favored a negative review conclusion in 17 of 18 cases. These were largely omissions of relevant positive data and selective inclusion of negative data from trials with small, ineffective doses. When existing and omitted data from relevant trials were combined, results changed from negative to significantly positive for continuous and categorical data. Subgrouping trials by location and recommended doses taken from current guidelines, revealed a highly significant effect of LLLT for treating knee OA. CONCLUSIONS: The results of this CDSR was not robust and seems to be colored by questionable selections or omissions. For alternative pain therapies, it should be considered if lack of expertise on therapy mechanisms, or conflicts of interests with competing pain drug manufacturers, may bias conclusions. Review groups should recruit a balanced mix of current views and expertise and expand the use of sensitivity analyses to improve quality of CDSRs in areas of controversy.

Advisory Committees↗

PubMed1979

Continuous wave argon laser iridectomy in angle-closure glaucoma.

Utilizing a continuous wave argon laser in a multiburn fashion, successful iridectomies were achieved in 42 of 45 phakic eyes with either acute or chronic angle-closure glaucoma. Five of the successful procedures required multiple sittings on different days or abandonment of the primary treatment site in favor of an alternate site to attain patency. Within the immediate postoperative period, ten eyes needed further treatment to eliminate moderate pigment proliferation at the perforation site. The procedure was performed on an outpatient basis under topical anesthesia, usually required less than one-half hour for completion, and resulted in only minimal complications. Therefore, CWAL iridectomy appears to present an alternative to surgical iridectomy for the definitive treatment of angle-closure glaucoma, although long-term evaluation of this modality of therapy is presently unavailable.

Adult↗

PubMed2002

Effect of tumor-infiltrating lymphocyte subsets on prognosis and susceptibility to interferon therapy in patients with renal cell carcinoma.

INTRODUCTION: Immunotherapy effectively treats advanced renal cell carcinoma in only a limited number of patients. However, the predicted prognosis for each patient in relation to immune status and response to immunotherapy remains problematic. We analyzed tumor-infiltrating lymphocyte (TIL) subsets to determine whether these correlated with the prognoses for the patients and the response to alpha-interferon therapy. MATERIALS AND METHODS: TIL subsets from resected specimens of 79 patients were analyzed by two-color flow cytometry and then compared with the patients' long-term clinical courses and responses to interferon therapy. RESULTS: In patients with stages III and IV, an increased infiltration of CD4+ cells and decreased CD8+ cells constituted a fair prognostic factor. In 17 patients with metastatic lesions, 8 of 10 patients who had disease progression after interferon therapy showed an increase in CD8+ cells above 25%, whereas 2 responders and 5 patients who had stable disease showed infiltration of CD8+ cells below 25%. CONCLUSIONS: The TIL subset is a prognostic factor for advanced renal cell carcinoma, and its analysis provides a method to predict the susceptibility to interferon therapy.

Adult↗

PubMed2006

Impact of enzyme replacement therapy on cardiac morphology and function and late enhancement in Fabry's cardiomyopathy.

The present study evaluated the evolution of cardiac morphology, function, and late enhancement as a noninvasive marker of myocardial fibrosis, and their inter-relation during enzyme replacement therapy in patients with Fabry's disease using magnetic resonance imaging and color Doppler myocardial imaging. Late enhancement, which was present in up to 50% of patients, was associated with increased left ventricular mass, the failure of a significant regression of hypertrophy during enzyme replacement therapy, and worse segmental myocardial function. Late enhancement may predict the effect of enzyme replacement therapy on left ventricular mass and cardiac function.

Adult↗

PubMed2002

[Sonographically guided vascular sclerosation: new method of myoma treatment].

AIM: Authors present new method of myoma therapy: sonographically guided vascular sclerosation. MATERIAL AND METHOD: Sclerosation was performed under color doppler sonographic visualisation. Sclerosation was performed with 96% alcohol. Study comprised of 40 patients. Group A consisted of 20 patients with sclerosation, while there were 20 patients in group B with operative therapy. RESULTS: There was no difference in age, size, location, vascularisation and degeneration of uterine tumors. Indication for treatment (bleeding, pain, pressure) showed no difference. Sclerosation was intravascular in 15% and perivascular in 85% of patients. During procedure, pain was present in 20%, burning in 85% and bleeding in 15%. Procedure had to be repeated in 30%, and it was done three times in 15% of patients. There was decrease in vascularisation (in 85%), and in size (in 95% of patients) after vascular sclerosation. After sclerosation, decrease in bleeding had 75% of patients, 65% had less pain, and 80% decreased pelvic pressure. In group with operative treatment, 50% of patients had myomectomy, while 50% had hysterectomy. Higher complication rate was found in group with operative treatment (15%), comparing with sclerosation group (0). Hospitalisation was significantly shorter 1,5 days and 6,3 days, as well as ICU treatment 0 and 1,5 days, and time to return to work 3 days and 33 days, in groups A and B, respectively. CONCLUSIONS: Sonographically guided vascular sclerosation is safe and effective myoma treatment. It has less complications and shorter recovery time. To the best of our knowledge, this is the first report of sonographically guided vascular sclerosation.

Adult↗

PubMed2002

[Intervention therapy for secondary hyperparathyroidism].

We reported that selective PEIT in parathyroid glands guided by color doppler flow mapping is effective for severe secondary hyperparathyroidism (2HPT) in chronic dialysis patients. According to the recent Survey by the Japanese Working Group on PEIT of Parathyroid, more than 600 patients have been treated by PEIT in Japan by September, 1998. Based on the results of this survey and based on pathophysiological consideration, Working Group proposed a guideline of selective PEIT of parathyroid. I give a brief summary here. But PEIT has a risk of side effects such as recurrent nerve palsy. Recently another way of percutaneous injection therapy (PIT) using Calcitriol, maxacalcitol and acetic acid has been developed and used. These data suggest that parathyroid intervention (IVR) is an effective adjunct to medical therapy for the management of hyperparathyroidism in uremia.

English Abstract↗

PubMed2003

Racial disparities in receipt of secondary stroke prevention agents among US nursing home residents.

BACKGROUND AND PURPOSE: Although medications can significantly reduce the risk of recurrent stroke, little is known about the extent to which such therapies are given to nursing home residents. We sought to evaluate the extent to which people of color were less likely to receive pharmacological agents in the treatment of recurrent stroke while living in US nursing homes. METHODS: We identified 19 051 residents with a recent hospitalization and primary discharge diagnosis of 434 or 436 in 5 states from 1992 to 1996; of these, 7053 had concomitant conditions indicating anticoagulant therapy. We considered aspirin, dipyridamole, ticlopidine, or warfarin alone or in combination as secondary drug prevention. Generalized linear models provided estimates of the absolute difference in prevalence estimates of the receipt of agents used for the prevention of recurrent stroke between each race-ethnicity group adjusted for potential confounders. RESULTS: Variability in use of any treatment was observed by race-ethnicity ranging from 58% of American Indians receiving therapy to only 39% of Asian/Pacific Islanders. Among residents with an indication for anticoagulant therapy, the absolute estimated crude differences indicated that residents of color were less likely than non-Hispanic whites to receive warfarin. After controlling for confounding, Asian/Pacific Islanders, blacks, and Hispanics eligible for anticoagulant therapy received warfarin less often than non-Hispanic white residents. CONCLUSIONS: Overall, only half of our elderly population received any pharmacological agent for secondary prevention of stroke. Interventions designed to improve the pharmacological management of recurrent stroke regardless of race are needed in the nursing home setting.

Aged↗

PubMed1995

Suppurative pylephlebitis and pylethrombosis: the role of anticoagulation.

Suppurative thrombophlebitis of the portal vein resulting from inflammatory intra-abdominal conditions is a rare complication that may result in pylethrombosis and portal hypertension. A case is presented with documented pylethrombosis caused by diverticulitis. Color flow Doppler scanning was used to establish the diagnosis. Systemic anticoagulation therapy was added to the antibiotic regimen because of postoperative propagation of the clot. Anticoagulation therapy prompted resolution of the episode. Long-term follow-up studies demonstrated recanalization of the portal vein. Anticoagulation should be instituted with documented acute pylethrombosis caused by inflammatory disease of the abdomen.

Acute Disease↗

PubMed2006

A gale force wind: meaning making by male survivors of childhood sexual abuse.

This in-depth qualitative study explores how 16 resilient male survivors of serious childhood sexual abuse, representing a range of racial, ethnic, and socioeconomic backgrounds, made meaning from their abuse experiences. Three main types of meaning making styles were identified in the narratives: meaning making through action, using cognitive strategies, and engaging spirituality. Meaning making through action included helping others and using creative expression to describe and process the abuse. Reasoning systems that helped survivors to understand why the abuse happened included developing a psychological framework for understanding the abuser or the role of the self in the abuse, using a sociocultural explanation, or developing a philosophical view. A few men made meaning through their spirituality. Meaning making styles seem to be related to experiences with therapy; the more experience these men had had with specialized trauma therapy, the more likely they were to make meaning by attempting to understand their perpetrators. In this study, men of color, regardless of socioeconomic class, were less likely than Caucasian men to have received specialized trauma therapy.

Adaptation, Psychological↗

PubMed1991

Imipramine hyperpigmentation: a slate-gray discoloration caused by long-term imipramine administration.

A 48-year-old white woman, skin type III, had a slate-gray discoloration of the face and dorsa of both hands after ingesting imipramine, 150 mg/day for 5 years. Her iris color was also darkened. One year after cessation of the therapy, the discoloration became lighter. Sun-protected skin showed no discoloration. Light microscopy revealed an accumulation of doubly refractile golden yellow granules in the papillary dermis, mostly scattered, with some concentration around the blood vessels but not in the endothelial cells. Electron micrographs showed numerous amorphous electron-dense inclusion bodies in histiocytes, phagocytes, fibroblasts, and dermal dendrocytes. Melanosomes were phagocytosed in the same cells but in separated locations. Imipramine is structurally related to chlorpromazine and can cause slate-gray discoloration. However, the color of the granules deposited in the papillary dermis is golden-yellow and they are not deposited in endothelial cells.

Adult↗

PubMed2005

Color vision and contrast sensitivity in epilepsy patients treated with initial tiagabine monotherapy.

The purpose of the study was to determine whether the use of a GABAergic antiepileptic drug (AED), tiagabine, affects color vision and contrast sensitivity. Twenty newly diagnosed patients with partial epilepsy (aged 19-72 years), receiving tiagabine as their initial monotherapy for 5-41 months were examined. Color vision was examined with the Standard Pseudoisochromatic Plates 2 (SPP2), with the Farnsworth-Munsell 100 Hue Test (FM100) and with the Color Vision Meter 712 (CVM) anomaloscope. Contrast sensitivity was measured with the Pelli-Robson letter chart. Three patients excluded from the color vision evaluation for congenital red-green color vision defects. Seven out of 17 patients (41%) had acquired color vision deficit examined with the FM100. The CVM anomaloscope revealed minor defects in two patients. Contrast sensitivity function was within normal ranges. The present study suggests that AED therapy with tiagabine, like with other established and newer AEDs may interfere with color perception.

Adult↗

PubMed2002

[Comparison of methods for quantifying contrast enhancement exemplified by dynamic MRI mammography].

AIM: Aim of this study was to demonstrate and compare different quantification techniques to assess contrast enhancement in dynamic MRI studies. The diagnostic potential of dynamic MRI studies is increasingly appreciated and already used in different organ systems. METHOD: A patient population of 314 histologically verified breast lesions (138 malignant, 176 benign) were evaluated using a high temporal resolved dynamic sequence. Different quantification techniques such as the use of a cutoff line, time dependent and pharmacokinetic assessment were comparatively evaluated. RESULTS: Time dependent quantification methods revealed higher diagnostic potential which was further improved by in vivo normalization of the contrast availability in the vascular system. Significant differences in the enhancement characteristics were determined between malignant and benign as well within the different histological entities. CONCLUSION: Time dependent quantification methods enable an angiogenic characterization of lesions to improve diagnostic interpretation as well as monitoring during therapy. They are also the basis for automated, color-coded visualization of dynamic studies.

Breast↗

PubMed2004

Acute appendicitis-like symptoms as initial presentation of ovarian vein thrombosis.

Postpartum ovarian vein thrombosis is a rare condition, with an incidence rate being 1/600 deliveries. It most often arises in the right ovarian vein. A 33-year-old patient who had had normal vaginal delivery presented with fever, pain in the right iliac fossa, and leukocytosis on the sixth day after delivery. An antibiotic course was instituted but 3 days later symptoms reappeared. Diagnosis of acute appendicitis was made. At surgery through a McBurney incision, a woody tumoration consistent with ovarian vein thrombosis was found. Anticoagulation therapy with heparin and antibiotics were instituted. Phlebography and color Doppler sonography confirmed the presence of thrombosis of both the common femoral iliac and inferior vena cava. Fribrolysis with urokinase was performed. The patient has remained stable and symptom-free over a 4-year follow-up. Ovarian vein thrombosis typically presents with symptoms suggestive of acute appendicitis, as was the case in our patient. Color Doppler sonography is the favored diagnostic procedure, with CT being a supplementary tool. Surgery is not necessary and treatment consists of anticoagulants and antibiotics. Even though postpartum ovarian vein thrombosis is rare, early recognition of the condition is of paramount importance to institute the adequate treatment and avoid potential serious sequelae.

Adult↗

PubMed1979

Continuous wave argon laser iridectomy in angle-closure glaucoma.

By using a continuous wave argon laser in a multiburn fashion, successful iridectomies were achieved in 42 out of 45 phakic eyes with either acute or chronic angle-closure glaucoma. Five of the successful procedures required multiple sittings on different days or abandonment of the primary treatment site in favor of an alternate site, or both, to attain patency. Within the immediate postoperative period, ten eyes needed retreatment to eliminate moderate pigment proliferation at the perforation site. The procedure was performed on an outpatient basis under topical anesthesia, usually required less than one-half hour for completion, and resulted in only minimal complications. Therefore, continuous wave argon laser iridectomy appears to present a viable alternative to surgical iridectomy for the definitive treatment of angle-closure glaucoma, although long-term evaluation of this modality of therapy is presently unavailable.

Adult↗