Impact of HIV infection/AIDS on social service agencies serving children and youth in Toronto

There are few data on how HIV infection/AIDS affects social service agencies serving children and youth. We conducted a survey of 24 provincially funded agencies in the Metro Toronto area and discovered that 36 clients and 9 staff members were HIV-infected. Our data strongly suggest that these agencies were ill equipped to cope with issues surrounding HIV infection/AIDS. Inadequacy or absence of policy and procedures resulted in confusion regarding issues such as HIV testing, need to know, confidentiality, duty to warn, staff and client education, and universal precautions for infection control. In order to effectively deal with the psychosocial, legal, ethical and education needs of clients and staff, agencies must be pro-active in developing policy and procedure.     

Coronary artery bypass grafting in a predominately black group of patients

The preoperative profiles of a predominately non-white group of patients undergoing coronary artery bypass grafting were reviewed. Data were obtained from a retrospective analysis of medical records of 163 patients operated on at Howard University Hospital between July 1983 and July 1986. The analysis was carried out primarily to determine whether patients requiring myocardial revascularization were somehow different from their non-black counterparts. Ninety-one percent of the patients were black, 5 percent white, 0.5 percent Hispanic, and 3.5 percent others (Iranian, Filipino, etc).     

Feasibility and accuracy of a fiberoptic catheter for measurement of venous oxygen saturation in newborn infants

The current parameters of oxygenation, arterial oxygen saturation and arterial oxygen pressure represent the availability of oxygen to the tissues. Venous oxygen saturation reflects oxygen extraction and could be a more useful indicator of tissue oxygenation. Therefore, we tested the feasibility and accuracy of a fiberoptic catheter, inserted into the right atrium via the umbilical vein, to measure venous oxygen saturation continuously. In 24 of 36 (67%) infants the catheter could be placed into the right atrium. Blood samples were withdrawn through the catheter, analyzed with a hemoximeter and compared with simultaneously recorded oximeter values. The fiberoptic catheter readings correlated significantly with hemoximeter values and the mean difference of the 116 paired samples was −0.37%. We conclude that the success rate and complications of the fiberoptic catheter were similar to previously published results. The oxygen saturation readings accurately represented oxygen saturation in the right atrium in newborn infants.     

The effects of ethanol on brain blood flow in awake dogs

Ethanol produces a generalized decline in brain flow in awake dogs. The reduction in flow is most marked and persistent in the cerebellum. In the anesthetized animal with brain blood flow already depressed, this effect is obscured. The possible relationship of these findings to the acute and chronic effects of ethanol on the central nervous system in humans is discussed.     

Varices from portal hypertension: correlation of CT and angiography

Two hundred abdominal CT and angiographic examinations were performed on 137 patients with portal hypertension. These patients were being evaluated before or after a distal splenorenal shunt. CT increased the detection of umbilical and retroperitoneal varices. Angiography better detected peripancreatic varices and cavernous transformation. Both modalities together added more information than either alone in identification of coronary and/or gastroesophageal, retrogastric, and perisplenic-mesenteric varices. This additional anatomic information helped in the patient's management pre- and postoperatively.     

Clinical stage B prostate carcinoma: staging with MR imaging

Magnetic resonance (MR) imaging studies were performed in 29 patients with clinical findings of stage B prostatic carcinoma with use of both T1 and T2-weighted spin echo sequences. MR imaging findings were correlated with surgical/pathologic results in 18 patients who underwent an operation. Periprostatic fat, periprostatic venous plexus, seminal vesicles, and lymph nodes were assessed from MR imaging studies. When each was assessed independently, the periprostatic fat signal had a sensitivity of 29%, specificity of 100%, and accuracy of 85% in detecting extracapsular tumor extension, whereas the periprostatic venous plexus had a sensitivity of 57%, specificity of 86%, and accuracy of 80%. MR imaging had a sensitivity of 50%, specificity of 97%, and accuracy of 89% for detecting seminal vesicular involvement. When all four anatomic features were taken into consideration, MR imaging had an accuracy of 89% (16 of 18 patients) in differentiating stage B from stage C or D disease (sensitivity 87%, specificity 90%). Our data indicate that MR imaging is a promising method for staging prostatic carcinoma.     

Effects of partial plasma exchange transfusion on blood flow velocity in large arteries of arm and leg, and in cerebral arteries in polycythaemic newborn infants

Continuous wave Doppler velocimetry was performed in brachial, femoral and cerebral arteries in four preterm, four small-for-gestational-age (SGA) and eight appropriate-for-gestational age (AGA) polycythaemic newborns before and at 3 and 24 h after partial plasma exchange transfusion and in 18 matched controls at 3 and 24 h after birth. In peripheral arteries, end-diastolic flow velocity was zero in all eight AGA controls, but only in two of the other infants. Consequently, mean flow velocity and red cell transport in AGA controls were significantly lower than in the other five groups, which did not differ. Partial plasma exchange transfusion did not influence flow velocities and red cell transport in peripheral arteries, but normalized the flow velocities in cerebral arteries in all three subgroups of polycythaemic infants, which were lower than in control infants. Cerebral red cell transport in controls increased significantly between 3 and 24 h, and in polycythaemic infants between 0 and 3 h after partial plasma exchange transfusion. In conclusion, reduction in haematocrit had different effects on blood flow velocity and red cell transport of peripheral and cerebral vessels, suggestirng that the increased cerebral blood flow velocity after partial plasma exchange transfusign is not simply due to a reduction in viscosity or oxygen content of the blood. The lower peripheral blood flow velocities in normocythaemic AGA infants as compared to all other groups, suggest that the level of maturity is an important determinant for the capacity to regulate blood flow.     

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.