A behaviour management and life stress course for a group of mothers incorporating training for health visitors

Six mothers of preschool children presenting behaviour problems attended a 10-week course on behaviour management and life stress run jointly by a clinical psychologist and a family health visitor. Results indicated benefits to the family in terms of changes in childrens behaviour, the development of friendship networks, and increased knowledge of and willingness to apply behavioural principles to current and potential child management problems. Treatment in groups required fewer professional hours per family than an equivalent individual service and served a training function for the family health visitor.     

The Carpentier-Edwards Supra-Annular Porcine Bioprosthesis: New Generation Low Pressure Glutaraldehyde Fixed Prosthesis

The Carpentier-Edwards supra-annular porcine bioprosthesis was implanted in 1,576 operations (1,536 patients with 1,704 valves) between 1981 and 1987. The mean age of the patients was 61.9 years (range 13 to 87 years). During the years 1981 and 1987, approximately 90% of the total valvular surgery population received the prosthesis. The early mortality was 7.0% (included patients with concomitant procedures including coronary artery bypass and ascending aortic aneurysm resection). Late mortality was 4.0% per patient-year. The total cumulative follow-up was 4,237 years. Thromboembolism (TE) was 2.4% per patient-year (fatal 0.4% per patient-year) (minor 1.2%; major 1.3%); antithromboembolic therapy-related hemorrhage (ATH) 0.5% (fatal 0.07%); prosthetic valve endocarditis (PVE) 0.5% (fatal 0.2%); periprosthetic leak (PPL) 0.3% (fatal 0%); clinical valve dysfunction (CVD) 0.3% (fatal 0.02%); and structural valve deterioration/primary tissue failure (SVD) 0.2%/patient-year (fatal 0%). Thromboembolism and structural valve deterioration were the significant complications, SVD occurring primarily between the fourth and fifth year of evaluation. The overall patient survival was 77.1% +/- 1.4% at five years. The patients were classified as 89.6% NYHA functional Class III and IV preoperatively and 96.1% Class I and II postoperatively. The freedom at five years from TE was 90.6% +/- 1.0%; SVD 98.9% +/- 0.5%; and reoperation 95.9% +/- 0.9%. Freedom from all valve-related complications at five years was 84.1% +/- 1.3%; valve-related mortality 96.8% +/- 0.7%; mortality and reoperation (valve failure) 92.9% +/- 1.1%; mortality and residual morbidity (treatment failure) 93.7% +/- 0.9%; and mortality, residual morbidity, and reoperation (valve failure and dysfunction) 90.0% +/- 1.2%. There were 28 valve-related deaths of a total 280 deaths (early 4, late 24) (TE 17; ATH 3; CVD 1; PVE 7; PPL 0; and SVD 0). Valve-related reoperations were performed in 32 patients (TE 2; CVD 4; PVE 7; PPL 11; and SVD 8). The supra-annular Carpentier-Edwards porcine bioprosthesis has provided very satisfactory clinical performance and afforded patients an excellent quality of life. The long-term durability of this low pressure glutaraldehyde fixed prosthesis will be determined by observation over the next five to seven years.     

CEROID–LIPOFUSCINOSIS (BATTEN''S DISEASE): PATHOGENESIS AND SEQUENTIAL NEUROPATHOLOGICAL CHANGES IN THE OVINE MODEL

A sequential morphological study of ovine ceroid-lipofuscinosis showed that brains of affected lambs were normal at birth, grew until four months of age but then atrophied. Laminar necrosis of cerebral cortex was noted at 10 weeks, occurring first in the parietal area, then spreading to involve frontal and occipital areas while the temporal lobe was least and last affected. With progression of the disease, the laminar pattern was lost. Neuronal necrosis was accompanied by a severe astrocytosis. The granular and multilamellar storage cytosomes increased in size with age. Their structure was interpreted as paracrystalline in which repeating molecules of the dominantly stored lipid binding subunit of mitochondrial ATP synthase interact with neutral lipids and phospholipids. Abnormal cytosomes in neurons of lamb fetuses and a neonate were interpreted as early lesions which contained whorls or stacks of bilayered membrane as well as the more complex multilamellar material. The underlying anomaly leading to the storage of the lipid binding subunit of mitochondrial ATPsynthase remains to be defined. However, it is noted that this disease should be regarded as a lipid binding protein proteinosis or alternatively as a proteolipid proteinosis.     

Allergy to guinea pigs: II Identification of specific allergens in guinea pig dust by crossed radio-immunoelectrophoresis and investigation of the possible origin

An extract of dust from the air-vent filters of a room housing guinea pigs was analysed by quantitative immunoelectrophoretic procedures and compared with extracts of various materials derived from guinea pigs. Crossed radio-immunoelectrophoresis (CRIE) of the dust, performed with sera from twenty asthmatic patients who were positive by skin testing and RAST to guinea pig extracts, identified fourteen IgE-binding constituents. Although responses varied, most sera reacted with lour particular allergens, antigens 2. 3, 10 and SI. The numbers of allergens recognized by individual patients correlated with the RAST score, but not with total scrum IgE. All seventeen dust constituents detected by crossed immunoelectrophoresis (and all four major allergens), were also present in extracts of guinea pig dander, fur. saliva and urine; several of these components were absent in an epithelial extract, and there were even less in preparations of shaved pelt, serum or faeces. None of the dust extract antigens were detected in materials used in animal husbandry, dust samples from rooms without guinea pigs, or a D. pteronyssinus extract. These findings suggest that inhalant allergens may be derived predominantly from material shed from the guinea pig coat after contamination with saliva, and possibly to a lesser extent, urine.     

Antibodies mediating type I skin test reactions to polysaccharide and protein antigens of Candida albicans

Immediate, type I, prick test reactions in man to purified fractions of Candida albicans group A were mediated by different classes of antibody. The allergens were the cell-wall polysaccharide, mannan, and a ‘purified’ cytoplasmic protein fraction, free of mannan, prepared by passage through Sepharose-concanavalin-A. Passive transfer tests in the monkey gave immediate reactions, (1) to the purified, cytoplasmic, protein mediated by heat-labile long-term sensitizing antibody, and (2) to the polysaccharide, mannan, mediated by heat-stable short-term sensitizing antibody.     

IMMUNOLOGICAL FEATURES OF HLA-B27 ANTERIOR UVEITIS

Analysis ol the immunological features of anterior Uveitis (AU) revealed a dichotomy of abnormalities defined in terms of the HLA-B27 status of the patient. HLA-B27-positive AU was characterised by the occurrence of ins autoantibodies and an absolute T cell lymphopenia during active disease which returned to normal with recovery. This phenomenon was not observed in HLA-B27-negative AU or in controls and could not be attributed to antilymphocyte antibodies as these were not detected. Furthermore, there were no changes in T-cell subsets (helper and suppressor T lymphocytes). Compared with HLA-B27-positive AU patients, the HLA-B27-negative group demonstrated elevated lgE levels and increased prevalence of smooth muscle autoantibodies. Key words: anterior Uveitis, HLA-B27, immunological abnormalities, T lymphocytes, autoantibodies.     

On the Origin of Peritoneal Fluid Cells

Peritoneal fluid cells from mouse radiation chimeras were tested to determine their strain of origin by reaction with donor-specific and host-specificisoimmune sera. In all chimeras that retained donor hemopoietic grafts, peritoneal fluid cells were found to be of donor type. This was true regardless ofthe kind of hemopoietic tissue transplanted into the irradiated mouse. Donorhemopoietic transplant material included bone marrow, fetal liver, peripheralblood leukocytes, and peritoneal fluid cells from mice and bone marrow fromrats. Irritation of the peritoneal cavity shifted differential counts but did notchange the cytotoxicity results: all the free cells removed were of donor type.

Submitted on May 17, 1963 Accepted on August 20, 1963     

Research in human sexuality education

Since human sexuality courses are relatively recent additions to most U.S. medical school curricula, there are no established procedures for evaluating the courses. The purpose of this study was to test medical students' attitudes toward concepts in sexuality before and after a 5-day sexuality course using the semantic differential. The concepts students rated were 'my sexuality', 'masturbation', 'homosexuality' and 'my role in understanding sexual problems '. Post-test scores were subtracted from pre-test scores andan alysed by multivariate analysis of variance testing for significant difference from zero.
Ninety-six second-year medical students completed the pre- and post-semantic differential tests. The changes between the pre- and post-tests were significant at the 0.001 level for all four concepts with the concept, 'homosexuality' showing the greatest change. The study suggests the semantic differential may be an effective instrument in assessing attitude changes. It also suggests the teaching techniques used in human sexuality courses may be successfully applied to other areas of medical education.