Failure-to-thrive with no organic etiology: A critical review of the literature

This article is a critical review of the literature pertaining to the syndrome of failure-to-thrive w'rth no organic etiology (FTNOE). Following a review of definitions, incidence, criteria for diagnosis, clinical forms, signs and symptoms, five perspectives on the etiology of FTNOE are critiqued. They include: environmental deprivation, maternal deprivation, sensory deprivation, psychosomatic and nutritional. The role of the family with respect to FTNOE is examined next. The main family foci discussed are the functioning of each parent, the relationship between them, mother-child interaction, and characteristics of the entire family. Where possible, the incidence of key family variables is determined across studies and presented. Treatment approaches are reviewed with particular emphasis on attempts to ameliorate the depriving environment. Follow-up studies conducted in the hospital and long term follow-up studies are examined; the latter with particular respect to the effects of FTNOE on cognitive development. Finally, the methodological problems inherent in most of the FTNOE research are discussed and suggestions made for future research.     

Cross-sectional echocardiographic recognition of submitral left ventricular aneurysm

Three cases of annular submitral left ventricular aneurysm precisely diagnosed by cross-sectional echocardiography are reported from the Indian subcontinent. The cineangiographic findings are available in all and morphologic findings in two cases. The apical four-chamber view demonstrated a characteristically large aneurysm arising below the mural leaflet of the mitral valve extending anterolaterally and posteriorly and communicating with the left ventricular cavity in all the cases. Contrast echocardiography performed during cardiac catheterisation promises to be a good technique for the qualitative assessment of the associated mitral regurgitation. Cross-sectional echocardiography is invaluable in diagnosis and assessment of results of surgery in this entity.     

Lifestyle and testicular dysfunction: A brief update

The incidence of testicular cancer, cryptorchidism and defective spermatogenesis is increasing probably due to environmental and lifestyle-related factors. The aim of this review is to briefly describe and comment on the principal lifestyle factors. The recent findings that the electromagnetic waves following the use of the cell phone and the prolonged exposure to the noise stress cause relevant testicular dysfunction in man or animals reinforce the hypothesis of the importance of lifestyle-related factors.     

A laboratory model for testing agents for hygienic hand disinfection: handwashing and chlorhexidine for the removal of klebsiella

A model for the laboratory assessment of hygienic hand disinfection is described which closely reproduces handwashing in a ward setting. The model uses a clinically relevant test organism and takes into account the natural antibacterial action of the skin. It also provides a means of measuring any residual antibacterial action after hand disinfection. Using an epidemic multiply-resistant strain of Klebsiella aerogenes K21, 0.5% chlorhexidine in iso-propyl alcohol yielded sterile post-disinfection finger washings more often than 4% chlorhexidine digluconate. Both preparations were more effective than soap and water, and with each residual action was demonstrable. The model is applicable to the laboratory evaluation of hygienic hand procedures and for agents of potential use in defined clinical settings.     

Intradialytic hypotension and vascular access thrombosis

Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up. There were 2005 total episodes of vascular access thrombosis during a median 3.1 years of follow-up. The relative rate of thrombosis of native arteriovenous fistulas for the highest quartile of intradialytic hypotension was approximately twice that of the lowest quartile, independent of predialysis systolic BP and other covariates. There was no significant association of intradialytic hypotension with prosthetic arteriovenous graft thrombosis after multivariable adjustment. Higher predialysis systolic BP was associated with a lower rate of fistula and graft thrombosis, independent of intradialytic hypotension and other covariates. In conclusion, more frequent episodes of intradialytic hypotension and lower predialysis systolic BP associate with increased rates of vascular access thrombosis. These results underscore the importance of including vascular access patency in future studies of BP management in hemodialysis.     

Modulation of metastasis phenotypes of non-small cell lung cancer cells by 17-allylamino 17-demethoxy geldanamycin

Background. Cancer cells that overexpress c-erbB oncogenes exhibit resistance to chemotherapy, enhanced tumorigenicity, as well as increased propensity for metastasis. The aim of this study was to investigate if depletion of erbB-1/EGFR and erbB-2/HER2neu oncogene products by 17-allylamino 17-demethoxy Geldanamycin (17AAGA) could diminish the metastatic potential of non-small cell lung cancer (NSCLC) cells that express varying levels of the erbB1/erbB2 oncogenes.

Methods. NSCLC cell lines (H460, H358, H322, or H661) were assayed for expression of erbB1 and erbB2, the cell adhesion molecule E-cadherin, secretion of the matrix metalloproteinase 9 (MMP-9), and vascular endothelial cell growth factor (VEGF), as well as their ability to invade Matrigel after 48-hour exposure to 17AAGA.

Results. 17AAGA significantly depleted erbB1 or erbB2 levels in NSCLC cells expressing high levels of these proteins, and effectively inhibited their growth with IC₅₀ values ranging from 50 to 90 nmol/L. Moreover, drug treatment enhanced E-cadherin expression in H322 and H358 cells, and inhibited secretion of MMP-9 and VEGF secretion by tumor cells. 17AAGA diminished hypoxia-induced upregulation of VEGF expression as well as growth factor-mediated augmentation of MMP-9 secretion, and profoundly inhibited the ability of H322 and H358 cells to migrate through Matrigel in response to chemoattractants.

Conclusions. In addition to its known antiproliferative and chemosensitization effects, 17AAGA inhibits the metastatic phenotype of lung cancer cells. 17AAGA may be a novel pharmacologic agent for specific molecular intervention in lung cancer patients.     

SYSTEMATIC TRAINING OF BUS,SHOPPING, AND CAFETERIA SKILLS

Four mentally handicapped adults from an ATC were systematically trained (using role-play and other techniques) to travel by bus, go shopping, and use cafés at a local shopping complex. It was hypothesised that their general social interaction skills would improve as a consequence of teaching them these three specific self-help or “community living” skills (Marholin et al., 1979). Pre- and post-measurements on the AAMD Adaptive Behavior Scales, and on an observational scale (TAF) devised by the author, showed that this prediction was fulfilled. There were also clear improvements in the three taught skills although these were not always statistically significant. The trainees' level of confidence (as measured by the TAS) also showed improvement, with increasing independence in using these public facilities. Since this study, three more groups at the ATC have started using the same assessment and training methods.