Parental and primary care physicians'views on the management of chronic diseases: a study in Italy

A survey on the burden and quality of care and the parental and primary care physicians'views on management of eight chronic illnesses and disabilities was conducted from 1990 to 1993. Data were collected on 993 children and adolescents from family interviews and physicians'postal questionnaires. Approximately 70% of patients used two or more services for care management and 149 children were treated outside their region. Only 36% of the physicians were case managers and half of these agreed that better communication with other care providers could facilitate their role. A wide difference in parental satisfaction was found between medical and disabling conditions. Approximately 90% of the parents expressed satisfaction with care for children with coeliac disease (112/120), asthma (80/89) and diabetes (98/111), whereas approximately one-third of parents of children with cerebral palsy and Down's syndrome were dissatisfied (88/242 and 72/189, respectively). Primary care physicians expressed similar satisfaction with case management. Distance from hospital, the need for more information on disease management and financial aid were the sources of greatest dissatisfaction. Children with disabling diseases had more problems integrating at school than children with other chronic disorders. Closer interaction between health services, providers and families is necessary to manage the needs of disabled (Italian) children better. Chronic illness, disability, family, primary care, quality of care, special needs     

Reference ranges for bone densitometers adopted Australia‐wide: Geelong osteoporosis study

Bone densitometry reports a measure of fracture risk in comparison with young adults (T‐scores) and age‐matched peers (Z‐scores). To date, each manufacturer has provided its own reference range resulting in lack of uniformity. The Australia and New Zealand Bone and Mineral Society and Osteoporosis Australia have recognized the need to standardize the reference range and have recommended that data generated by the Geelong Osteoporosis Study (GOS) be used Australia‐wide. The GOS recruited a random, population‐based sample of adult women and measured bone mineral density (BMD) at the proximal femur and spine using a Lunar DPX‐L. These data were used to establish reference ranges for Lunar machines and, using conversion equations, for Norland and Hologic machines. The new standardized Australian reference ranges for BMD will enable consistent diagnosis of osteoporosis and categorization of fracture risk across different types of densitometers.     

REGIONAL AND LAMINAR SYNAPTIC PATHOLOGY IN FRONTAL LOBE DEGENERATION OF NON-ALZHEIMER TYPE

It has been suggested that synaptic loss may be the most powerful and proximate factor leading to dementia in a variety of dementing disorders, but whether it occurs in frontal lobe degeneration of non-Alzheimer type (FLD) and to what extent is unknown. To approach this question, quantitative immunohistochemistry with a monoclonal synaptophysin antibody was used in the present study to estimate the synaptic density in postmortem brain tissue. All six cortical layers of four brain regions from 13 cases of FLD and 10 age-matched controls were studied. A significant reduction (40%) in synaptic density restricted to the superficial layers (LI--LIII) was observed in the prefrontal cortex. In contrast, no significant change was found in the postcentral parietal area, inferior temporal area and posterior cingulate gyrus. The reported synaptic loss has a laminar and regional pattern which is consistent with that of other histopathological changes in FLD, one feature thus lending support to the other. The synaptic decrement may be the important change for the symptomatology, and also for the pathogenesis, of FLD.     

Magnetic resonance imaging of the lymph nodes: comparison with CT

This retrospective study of 144 patients was made to (a) assess the potential of magnetic resonance (MR) for demonstrating lymph nodes using spin-echo technique, (b) compare the MR results with those of CT, and (c) determine the optimal pulse-sequence interval (TR) and echo-delay time (TE) for imaging lymph nodes. The reported CT findings on normal lymph nodes were compared with MR findings in 60 patients who underwent MR imaging of the neck (20 patients), chest (20 patients), abdomen (10 patients), and pelvis (10 patients) for conditions other than lymph node disease. The results showed that CT is presently better than MR for imaging neck and abdominal lymph nodes less than 13 mm in diameter. The ability of MR to demonstrate normal-size (less than 10 mm) lymph nodes in the chest was comparable to that of CT. In addition, MR scans of 84 patients with proven abnormal lymph nodes (8 neck, 49 chest, and 27 abdomen and pelvis) were assessed: in 72 patients, these nodes had also been imaged by CT. MR and CT gave similar results with abnormal lymph nodes (greater than 13 or 15 mm), but MR displayed these nodes better because of its excellent soft-tissue contrast resolution. MR can clearly differentiate abnormal lymph nodes from normal fat, muscle, vessels, adult thymus, thyroid, and diaphragmatic crura, as well as from primary tumor and lymphoceles. Optimal demonstration of lymph nodes with MR required two sequences: one with a short TR and one with a long TR and long TE. Preliminary results indicate that MR holds great promise for the demonstration of lymph nodes in every part of the body.     

Primary gastric lymphoma versus gastric carcinoma: endoscopic US evaluation

Endoscopic ultrasonography (US) enables high-resolution imaging of the stomach and can demonstrate the different layers of the gastric wall. It has therefore been proposed for use in evaluating the extension of gastric neoplasms. It was performed in nine patients with primary gastric non-Hodgkin lymphoma and in 36 with gastric carcinoma. The US and pathologic findings were correlated in three surgical specimens of gastric lymphoma. Three different US patterns were found in gastric lymphomas: a polypoid pattern (two cases), localized (two cases) or extended (five cases) hypoechoic infiltration, and thickening with superficial ulcerations. Infiltration was confined to the second and third layers of the gastric wall in six cases and was transmural in three. The study of the gastric lymphoma specimens confirmed the accuracy of US in demonstrating the extent of infiltration. Gastric carcinomas had a more echogenic pattern and a different trend of diffusion, with no extended longitudinal hypoechoic infiltration of the superficial layers or extended hypoechoic transmural infiltration.     

Nephrolithiasis and risk of hypertension in women

Cross-sectional and prospective studies of men suggest a positive association between nephrolithiasis and hypertension. However, this association remains controversial in women. We conducted a prospective study of the relation between nephrolithiasis and the risk for hypertension in the Nurses' Health Study, a cohort of 89,376 women aged 34 to 59 years in 1980. Information on the history of nephrolithiasis, physician-diagnosed hypertension, and other relevant exposures was obtained by biennial mailed questionnaire. A history of nephrolithiasis before 1980 was reported by 2,558 women (2.9%), and a history of hypertension was reported by 11,883 women (13.3%). Among women without hypertension before 1980, 12,540 women reported a new diagnosis of hypertension between 1980 and 1992, during 711,039 person-years of follow-up. Compared with those without a history of nephrolithiasis, the age-adjusted relative risk (RR) for incident hypertension in women with such a history was 1.36 (95% confidence interval [CI], 1.20 to 1.43). After further adjustment for body mass index (BMI) and the intake of calcium, sodium, potassium, magnesium, caffeine, and alcohol, the RR was only slightly attenuated (RR=1.24; 95% CI, 1.13 to 1.37). In contrast, the occurrence of incident nephrolithiasis during follow-up was similar in women with hypertension at baseline compared with women without (adjusted odds ratio [OR]=1.01; 95% CI, 0.85 to 1.20). These data are consistent with the results obtained in men and support the hypothesis that a history of nephrolithiasis is associated with an increased risk for subsequent hypertension. Dietary factors, such as the intake of calcium, sodium, and potassium, do not explain this association. Unidentified pathogenic mechanisms common to nephrolithiasis and hypertension may be responsible for the development of both disorders.     

Monocyte-derived recruiting activity: kinetics of production and effects of endotoxin

Cultured monocytes release a factor, monocyte-derived recruiting activity (MRA), which stimulates fibroblasts, endothelial cells, and T lymphocytes to produce colony-stimulating activity (CSA). We studied the kinetics of MRA production using a technique in which MRA levels were measured in a two stage bioassay. We used umbilical vein endothelial cells as the MRA-responsive (CSA-producing) cells, and normal colony-forming unit granulocyte-macrophage (CFU-GM)-enriched bone marrow cells (T lymphocyte- and monocyte-depleted, low density bone marrow cells) as the CSA-responsive cells. MRA stimulated a 30- fold increase in CSA production by endothelial cells. MRA production was detected in supernatants from as few as 10(3) monocytes per milliliter, required the presence of fetal calf serum, and was inhibited by cycloheximide (10 to 100 micrograms/mL) and puromycin (10 to 50 micrograms/mL). Production was detectable after 24 hours of monocyte incubation, was maintained for three days, and fell to undetectable levels by seven days. With the addition of bacterial endotoxin (lipopolysaccharide [LPS]) (50 micrograms per 10(6) cells), MRA was detectable after only three hours of incubation, and levels peaked at 24 hours. Further, maximum MRA levels in the supernatants of LPS-stimulated monocytes were up to ten times greater than peak levels in the supernatants of unstimulated monocytes. Endotoxin augmented monocyte production of MRA to a greater extent than it did CSA production, indicating that the stimulation of CSA production by endotoxin may be at least partly indirect. The responsiveness of MRA production to endotoxin in vitro is consistent with the notion that MRA may be a biologically relevant regulator of CSA production by cells of the hematopoietic microenvironment.     

Prognosis in glomerulonephritis. III. A longitudinal analysis of changes in serum creatinine and proteinuria during the course of disease: effect of immunosuppressive treatment. Report from Copenhagen Study Group of Renal Diseases.

A total of 395 consecutive patients with biopsy-proven glomerulonephritis were followed up for 14 years. At the time of entry to the study the patients were classified as having one of nine states of kidney disease according to serum creatinine levels and proteinuria. The transitions of the patients between the nine states were analysed. The influence of 14 independent variables including treatment with cytostatic drugs and prednisolone was estimated by the Cox proportional hazard model. Treatment with immunosuppressive drugs had an influence that emerged within the first month and continued for the next 2 months. Subsequent treatment with cytostatic drugs in combination with prednisolone delayed further improvement. Treatment with prednisolone or cytostatic drugs as single therapy for up to 6 months increased the risk of improvement of the disease, and had no significant effect on deterioration. The beneficial effect of the treatment persisted after withdrawal of the immunosuppressive drugs. The analysis revealed only a slight influence of the histological character of the glomerular changes. Post-streptococcal glomerulonephritis carried an increased tendency for improvement. Arterial hypertension affected the process in several states of kidney disease. Heavy proteinuria increased the risk of increasing serum creatinine levels.     

抑制素βa亚基片段的合成及活性的初步测定

以固相多肽合成方法合成了抑制素β_a亚基的六个片段:Ⅰb-βA(37～39)-NH₂(Ⅰ),Ⅰb-βA(34～39)-NH₂(Ⅱ),Ⅰb-β_A(30～39)-NH₂(Ⅲ),Ⅰb-β_A(23～39)-NH₂(Ⅳ),Ⅰb-β_A(16～39)-NH₂(Ⅴ)和Ⅰb-β_A(14-39)-NH₂(Ⅵ),对产物进行了分离纯化。用垂体细胞培养方法对其中Ⅰ,Ⅱ和Ⅲ进行生物活性测定,表明它们不能抑制由LHRH诱导的FSH分泌,Ⅳ,Ⅴ和Ⅵ三个太肽片段由于难溶于中性介质,需要寻求其它方法对其进行生物活性测定。