Hyposensitization therapy with alum-precipitated pyridine extracts in animal dander sensitive patients

Radiological changes that may occur in the depenent lung when surgery is performed in the lateral position are generally of a transient nature; they disappear when the position of the patient is changed after the operation, but may, in some cases, be demonstrable post-operatively as atelectatic areas. From the second post-operative day onwards, and reaching a peak on the 5th post-operative day, there is an increased incidence of ventilatory disturbances and infiltrations. The course and distribution of these pulmonary disturbances point to post-operative immobilization in the recumbent position as the main causal factor.     

Occupational allergy caused by cow dander: detection and identification of the allergenic fractions

We describe two cases involving cow farmers, both males, one aged 28 and the other 45, who attended our center because his presented symptoms of rhinoconjunctivitis and asthma with 18 months and 4 year of evolution respectively, related to this laboral environment. The study included the following tests: skin tests (prick tests) to inhalant allergens (mites, pollens, moulds, dog and cat epithelium), foods, cow epithelium-dander, cow serum, beef and milk proteins. We determined the total seric IgE, specific IgE (RAST-CAP System) to cow meat and cow dander. Nasal provocation test with freeze-dried biological standardized extract of cow epithelium-dander were carried out. We observed the symptoms and realized control with a previous active computerized rhinomanometry. Cow dander proteins used for the provocation test were separated by means of SDS-PAGE or isoelectric focusing (IEF). The allergenic component were identified by immunoblotting with the patients' serum. The skin tests were positive to cow dander, and negative to the other allergens tested, including cow serum, cow milk and beef. The seric IgE were 383 and 477 kU/L, and the RAST was positive to cow dander, 20.10 and 36.4 kU/L (class 4). The provocation test were positive with a concentration of 500 SBU. We observed that the IgE of the two patients reacted with the same allergens: 3 major bands were identified with MW of 11, 15, 62.3 kDa. All these bands correspond to protein with acid pl.     

New diagnostic criteria in Marfan syndrome

Marfan's syndrome is a relatively frequent autosomal dominant condition which is due to structural or quantitative changes in a connective tissue protein, fibrillin. The syndrome is associated with life-threatening changes in the aorta and serious manifestations in many different organ systems. Unclear diagnostic criteria and lack of use of the criteria in clinical practice may have led to overdiagnosing this syndrome in individuals with a long and slender habitus. This in turn can lead to negative consequences for both the individual and his or her family. Failure of diagnosis may cause even more harm, in particular because of the risk of sudden cardiac events. In 1996 an international group of experts proposed a set of revised criteria for Marfan's syndrome which takes into account molecular findings and family history (the Gent criteria). It is important that all practising physicians are aware of these criteria in order to prevent over- and underdiagnosing. A correct diagnosis is of major importance for medical follow-up, genetic counselling, habilitation, and counselling with regard to education and occupation.     

Taxometrics and the revision of diagnostic criteria.

Comments on P. E. Meehl's (see record 1995-29291-001) article describing taxometric (mathematical) procedures used to classify psychiatric patients. Garb claims that Meehl did not cite studies that do not support the use of taxometric procedures, nor discuss how taxometric methods can be used to revise diagnostic criteria. To use taxometric methods, one needs to be correct in conjecturing the existence of a latent taxon, only it is very hard to know for sure when a single taxon exists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pollution and allergy: the contributions of animal and in vitro experimentation

The respiratory pathological symptoms induced by atmospheric pollutants are closely dependent on the action of the aerocontaminants on the cells of the respiratory tract that are exposed to their effects. Two methods of experimental investigation are used to specify the effects of pollutants on the respiratory system: Study of the morphological and functional alterations of animal respiratory systems after exposure to different pollution constituents. Exposure of bronchitic or pulmonary cells to microquantities of pollutants, using different techniques that create direct contact between the pollutant and target cells. In animals gaseous pollutants alter the means of defence (muco-ciliary purification and antibacterial defence), inducing development of a neutrophil inflammatory reaction and, for ozone and NO2 favouring sensitisation by allergen-dependent IgE; diesel particles are responsible for restrictive ventilation problems, an inflammatory reaction, a sensitisation develops to pneumoallergens and in some cases of the development of pulmonary tumours. In vitro studies specify the cellular mechanisms and the molecules that are responsible for the observed phenomena: increase in the synthesis and expression of messenger DNA the codes for the pro-inflammatory cytokines, adherance molecules and chimiokines.     

New classification and diagnostic criteria for diabetes mellitus

The new Classification and Diagnostic Criteria for Diabetes Mellitus (DM), prepared by a group of experts from the American Diabetes Association is presented and analyzed. On an etiopathogenic basis, it designates Insulin Dependent and Non Insulin Dependent as Type 1 and Type 2 respectively. It specifies DM having specific known causes. It maintains Gestational Diabetes and Glucose Intolerance and adds the Impaired Fasting Glucose Condition. It recommends fasting plasma glucose for search and diagnosis, and lowers the level to > or = 126 mg/dl instead of > or = 140 mg/dl, due to its association with chronical complications of DM. It maintains the diagnostic criteria of random and post charge glycemia > or 200 mg/dl. It does not alter the glucose intolerance figure (140-200 mg/dl in OGTT) and introduces fasting abnormality > or = 110 and < 126 mg/dl. It encourages the search with fasting glucose every 3 years in individuals aged over 45, and at more frequent intervals in younger individuals with high risk factors. Analysis of the report allows to conclude that, although the classification does not introduce any significant change in daily clinical use, its pathogenic orientation makes future innovations possible. The preferential use of fasting glucose > or = 126 mg/dl for diagnosis of DM has theoretical basis and practical advantages. Identification of individuals with impaired fasting glucose allows to detect, in a simple manner, a high risk group in which to start preventive measures. However, there is a percentage of cases which are not diagnosed by fasting glycemia, but are diagnosed by OGTT, therefore the latter should not be discarded.     

A multifactorial study of patients with asthma. Part 2: air pollution, animal dander and asthma symptoms

As part of a multifactorial computer-assisted study of patients with asthma, the relationship between air pollution, animal dander and asthma symptoms was evaluated. No association was found between four major air pollutants (carbon monoxide, ozone, nitrogen oxides and sulfur dioxide) and asthma symptoms. Patients who owned cats and dogs reported more severe asthma symptoms (p less than .01) than patients who did not own cats and dogs. The evaluations completed to date indicate that daily exposure to cats and dogs accounts for more of the asthma symptoms differences between patients than daily exposure to air pollutants.     

Juvenile psoriatic arthritis: followup and evaluation of diagnostic criteria

Platelet counts in newborns are similar to those of adults and children. However, newborn infants admitted to intensive care nurseries have a high prevalence of thrombocytopenia. The mechanisms responsible for the increased susceptibility to thrombocytopenia are not known. In addition, some studies have documented functional abnormalities in newborn platelets. In an effort to understand differences between platelets in newborns and in adults, we examined megakaryocyte ploidy in bone marrow from fetuses and compared it with bone marrow from adults, using a modified Feulgen stain to measure DNA of individual megakaryocytes. Faced with small fixed tissue samples, we developed a technique for use on bone marrow biopsies to estimate megakaryocyte ploidy and compared the results obtained with this method to those obtained from bone marrow aspirates. This study demonstrated that the overall mean ploidy of fetal megakaryocytes is decreased compared with adults. Additionally, fetal megakaryocyte ploidy increases as megakaryocyte maturation increases, but not to the same extent that adult megakaryocyte ploidy increases with megakaryocyte maturation. Over the gestational period studied, there was no relationship between gestational age and mean ploidy. The small size, shift to a less mature population, and decreased ploidy of fetal megakaryocytes indicate that there are differences in the post mitotic phase of megakaryocyte development in the fetus. Such differences may be related to quantitative and qualitative platelet abnormalities in the newborn. Understanding the physiology and regulation of megakaryocytopoiesis in the fetus and newborn will be valuable in determining the pathophysiologic basis of platelet dysfunction in the newborn.     

Cultural factors considered in selected diagnostic criteria and interview schedules.

Researchers have argued that diagnostic criteria and interview schedules inadequately reflect cultural influences in the definition and expression of psychopathology. In this study, 11 widely used diagnostic criteria and interview schedules for schizophrenia, affective disorders, and personality disorders were examined to assess the extent to which they refer to cultural factors. The results indicated that 8 of 11 instruments referred to cultural influences in psychopathology at least once. The consideration of cultural factors, however, was primarily limited to the identification of delusions and hallucinations in schizophrenia. Very few cultural references were made in the diagnostic instruments of affective and personality disorders. The clinical implications of these findings are discussed with respect to the evaluation of cultural minority group members residing in the United States. Specific recommendations are offered to increase the attention given to culture in diagnostic instruments and to increase our understanding of how culture influences psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective epidemiologic evaluation of laboratory animal allergy among university employees

OBJECTIVES: Evaluation of incidence and risk factors for development of laboratory animal allergy (LAA) among new hires previously unexposed to lab animals. METHODS: Baseline, 6-month and yearly follow-up, questionnaires, pulmonary functions, and methacholine challenges were collected from 98 never-before occupationally exposed and 90 control laboratory researchers. The two groups were followed between 6 and 36 months. RESULTS: At baseline, there were no differences in atopy, pulmonary functions, or methacholine reactivity between the two groups. The incidence of work-related asthma was comparable in the two groups, approximately 2.5% at 6 months and 4.5% at 24 months. The rate of decline in FEV1 was statistically significantly greater in the animal-exposed than nonanimal-exposed workers, and animal-exposed smokers' FEV1 declined significantly more rapidly than any other groups'. CONCLUSION: Despite the low incidence of laboratory-animal allergy and work-related asthma in this group, this study corroborates previously described interaction between smoking and animal exposure.     

Frequency of occurrence and the criteria for automatic processing.

Three experiments were conducted to assess the automaticity of event frequency processing. Using a modified concept-learning task, Experiment 1 showed that intentional frequency processing led to more accurate frequency judgments than incidental processing. Experiment 2 demonstrated that nonspecific (general memory) instructions in incidental processing conditions can actually lead to subjects' intentional processing of frequency information, which undermines the effectiveness of an intentionality manipulation. And, in Experiment 3, frequency processing accuracy was found to be interfered with by concurrent cover task capacity requirements, even though frequency processing occurred incidentally. The findings that frequency judgment is influenced by intentionality and by concurrent task factors clearly violate two of Hasher and Zacks' (1979, 1984) empirical criteria used to define automatic processing; they also challenge the assumption that automatic processing is always optimal. In light of our and others' data, either event frequency, the prototypical automatic process, is not automatic, or the assumption that a process must be optimal if it is to be considered automatic must be dropped. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of diagnostic tests for contact allergy to mydriatic eyedrops

AIM: To perform a clinical trial of selegiline in 25 patients with chronic fatigue syndrome (CFS) where patients were told they would receive placebo or active agent at different times during the 6-week trial. We chose selegiline, a specific monoamine oxidase (MAO) B receptor inhibitor, because a prior trial of lowdose phenelzine, a nonspecific MAO inhibitor, showed a small but significant therapeutic effect. METHODS: Questionnaires comprised of 19 tests of mood, fatigue, functional status and symptom severity were collected at the start and end of the trial as well as 2 weeks after its start. The trial was done in three 2-week blocks: in the first, 2 placebo pills were given per day; in the next, one 5-mg tablet of agent and one placebo were given per day, and in the last, a 5-mg tablet of agent was given twice a day. The plan was to compare the changes in the 19 tests during the placebo phase to those found in the active treatment phase in 19 patients completing the trial. FINDINGS: Significant improvement in 3 variables-tension/anxiety, vigor and sexual relations-was found. A significant pattern of improvement compared to worsening was found for the 19 self-report vehicles during active treatment as compared with placebo treatment. Evidence for an antidepressant effect of the drug was not found. CONCLUSIONS: Selegiline has a small but significant therapeutic effect in CFS which appears independent of an antidepressant effect.     

Psychosomatic syndromes in clinical practice. A proposal of diagnostic criteria

The following is a translation of the proposed diagnostic criteria established by a European group for twelve common psychosomatic syndromes found in general clinical practice. Many of them have the potential to occur during different stages of a large variety of diseases and their detection could lead to better holistic provision of health care.     

Creating and field-testing diagnostic criteria for partner and child maltreatment.

An integrated set of diagnostic criteria for partner abuse and child abuse and neglect were developed and tested in 4 studies conducted with a branch of America's largest family maltreatment protection agency (i.e., the U.S. military's Family Advocacy Program). Maltreatment criteria then in force were found to have adequate levels of content validity, but experts' and users' feedback indicated ambiguities and poorly specified criteria that undermined reliable application. Criteria incorporating elements of the best existing civilian and military operationalizations were developed and evaluated in two field trials. The final definitions were found to support very high levels of agreement (92%) between base adjudicating committees and master reviewers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retrospective study of the diagnostic criteria in a lead-poisoning survey of waterfowl

A review of childhood injuries at the Wesley Guild Hospital, a component of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, showed that 1,471 patients seen in the children's emergency room during a period of 4 years (1992-1995) were there as a result of trauma, representing 9% of all patients seen. The case notes and accident and emergency cards of 1,224 were available for review. Ages ranged from 2 months to 15 years, with a mean of 6.9 years, and 40% of the patients were between 5 and 10 years of age. More males were affected than females, with a ratio of 1.5:1. Road traffic crashes were the most common causal factor, responsible for 324 injuries (26.5%). About 90% of these were pedestrians knocked down by automobiles and motorcycles. Passengers accounted for about 10% of the cases. Falls occurred in 305 patients (25%); 229 patients fell while on level ground either playing or running, accounting for 75%. There were 122 patients (10%) with misplaced foreign bodies; about 60% of these were recovered from the ears, and 26.3% from the nostrils. Edible seeds were the most common foreign bodies, followed by beads. Injuries from bites occurred in 108 patients, with dog and snake bites taking the lead. Burns, mainly from scalding, occurred in 89 patients. Other rare injuries were knife wounds, gunshot wounds, and injuries resulting from assaults. The home was the most common site of injury (570 patients, 46.7%) followed by streets or roadways (363 patients, 29.7%); 19.5% of injuries occurred at school. The most common anatomic region affected was the head and neck, followed by the limbs. One hundred ninety-seven patients (16%) had bony fractures, femurs being the most affected bone. Head injury was seen in 104 patients, representing 8.5%, although only 17 of these injuries were severe. There were 10 cases of abdominal injury and 9 cases of chest injury, representing 0.8 and 0.7%, respectively. Wound infection occurred in 6.4% of the patients. Death occurred in 19 patients, accounting for 1.6%; 10 of these patients had severe head injuries. Road traffic injuries and burns accounted for the greatest number of complications. The findings of this study suggest that trauma is an important factor in childhood morbidity and mortality in our environment, with road traffic injuries taking the lead. Preschool pedestrian children were most commonly affected, the majority of them on errands for their parents. We believe that the majority of these injuries are preventable.     

Differences in diagnostic criteria for acute myocardial ischemia at Norwegian hospitals

In the present study medical departments at 57 (83%) of all hospitals in Norway answered a questionnaire about the criteria used to diagnose acute myocardial infarction. One hospital specified a period of chest pain lasting over 30 minutes; 14 hospitals worked on 30 minutes and 36 hospitals based their diagnosis on a period of less than 30 minutes. Six hospitals did not use any particular duration of pain in order to make a positive diagnosis. There were no important differences over the electrocardiogram criteria. Information on the type of enzymes used for diagnosis, enzyme combinations, and threshold values of the different enzymes, did reveal inequalities between the hospitals. In the 46 hospitals using creatine kinase (CK) the threshold for a positive diagnosis varied between 170 and 500 IE/1 for men and 150 and 400 IE/I for women. For aspartate dehydrogenase (ASAT) the variation was between 40 and 100 and 35 and 75 IE/I for men and women respectively. Unequal criteria for the diagnosis of acute myocardial infarction may lead to differences in treatment, variations in the assessment made by the health insurance scheme and could complicate follow-up studies of this disease.