Current incidence of acute neurologic complications after open-heart operations in children

Background. Previously, neurologic dysfunction was estimated to complicate 25% or less of pediatric open-heart operations. We sought to determine the current incidence and spectrum of early postoperative neurologic complications.

Methods. We undertook a retrospective review of all patients undergoing open heart operations in 1 year at our institution with the goal to identify all neurologic complications occurring in the early postoperative period.

Results. Open-heart operations were performed in 706 children. Sixteen children (2.3%) had neurologic complications develop, including 9 (1.3%) with definite clinical seizures, 1 with suspected seizures and bilateral subdural hemorrhage, 2 with coma after cardiac arrest, 2 with transient mild choreoathetosis, 1 with facial palsy, and 1 with persistent irritability. Causes of seizure were cyclosporin A toxicity posttransplant (4), cerebral ischemia post cardiac arrest (3), and unknown (2). In infants less than 1 year of age, the incidence of seizures was 1.2%.

Conclusions. This review suggests a decrease in acute neurologic morbidity after pediatric open heart operation. Clinical seizures remain the most common complication. Posttransplant, cyclosporin-associated seizures have emerged as an important etiologic category, coincident with an increase in cardiac transplantation in children.     

Fractures of the olecranon: a 15- to 25-year followup of 73 patients

The incidence of olecranon fractures in adults and the long-term outcome of closed olecranon fractures in 45 women and 28 men (mean age, 54 and 36 years at the time of fracture, respectively), were examined at a mean of 19 years after the fracture. The uninjured elbows served as controls. Thirteen percent of the original fractures were displaced less than 2 mm, 65% more than 2 mm, and 22% were multifragmental. Primary treatment consisted of mobilization in 4%, application of a plaster cast in 12%, and open reduction and internal fixation in 84% of the elbows. The incidence of an isolated fracture of the olecranon in individuals older than 16 years was 1.15 per 10,000 person-years. Eighty-four percent of the 73 patients had no complaints at followup, 12% had occasional pain, and 4% had daily pain. Ninety-six percent had an excellent or good outcome. Elbow flexion and extension were reduced but most patients had no or only occasional subjective complaints. Radiographic signs of degenerative changes were found in more than 50% of the formerly fractured elbows, which was more than in the uninjured (11%). Radiographic signs of osteoarthritis were found in 6% of the formerly fractured elbows versus zero percent in the uninjured, of which only two patients had a poor outcome. Isolated, closed fractures of the olecranon in adults have a favorable, long-term outcome.     

Low accuracy and low consistency of fourth-graders' school breakfast and school lunch recalls

OBJECTIVE: To determine the accuracy and consistency of fourth-graders' school breakfast and school lunch recalls obtained during 24-hour recalls and compared with observed intake. DESIGN: Children were interviewed using a multiple-pass protocol at school the morning after being observed eating school breakfast and school lunch. SUBJECTS: 104 children stratified by ethnicity (African-American, white) and gender were randomly selected and interviewed up to 3 times each with 4 to 14 weeks between each interview. STATISTICAL ANALYSIS: Match, omission, and intrusion rates to determine accuracy of reporting items; arithmetic and/or absolute differences to determine accuracy for reporting amounts; total inaccuracy to determine inaccuracy for reporting items and amounts combined; intraclass correlation coefficients (ICC) to determine consistency. RESULTS: Means were 51% for omission rate, 39% for intrusion rate, and 7.1 servings for total inaccuracy. Total inaccuracy decreased significantly from the first to the third recall (P=0.006). The ICC was 0.29 for total inaccuracy and 0.15 for omission rate. For all meal components except bread/grain and beverage, there were more omissions than intrusions. Mean arithmetic and absolute differences per serving in amount reported for matches were -0.08 and 0.24, respectively. Mean amounts per serving of omissions and intrusions were 0.86 and 0.80, respectively. APPLICATIONS/CONCLUSIONS: The low accuracy and low consistency of children's recalls from this study raise concerns regarding the current uses of dietary recalls obtained from children. To improve the accuracy and consistency of children's dietary recalls, validation studies are needed to determine the best way(s) to interview children.     

The female sexual pain disorders: genital pain or sexual dysfunction?

Vaginismus and dyspareunia have been typically classified as sexual dysfunctions. In practice and research, this conceptualization has led to a focus on sexual and interpersonal issues after biological causes were excluded. Although this approach has been very useful, it has not led to significant theoretical or therapeutic progress in the last 20 years. We propose a reconceptualization of vaginismus and dyspareunia as pain disorders that interfere with sexuality rather than as sexual disorders characterized by pain. This reconceptualization focuses the clinician and researcher on the central phenomenon—pain. It also suggests new approaches to research and treatment. Data from diagnostic, etiologic, and therapeutic studies will be presented to illustrate these points.     

Red wine phenolic compounds reduce plasma lipids and apolipoprotein B and prevent early aortic atherosclerosis in hypercholesterolemic golden Syrian hamsters (Mesocricetus auratus)

The effects of a red wine phenolic extract (PE) on plasma lipoproteins and early atherosclerosis were studied in hamsters. Hamsters (n = 32) were divided into 4 groups of 8 and fed an atherogenic diet for 8 wk. They received by force- feeding 7.14 mL/(kg. d) PE in 2.6 mol/L ethanol (E + PE) or PE in water (W + PE), mimicking a moderate consumption of red wine or alcohol-free red wine [30.4 mg/(kg. d)], or 2.6 mol/L ethanol (E-PE) or water (W-PE) as their respective controls. Plasma cholesterol and triglyceride concentrations were lower in groups that consumed PE. The decrease in plasma apolipoprotein (Apo) B concentration was due mainly to PE and was significantly lower in Group E + PE than in Group E-PE (-7.5%) and in Group W + PE than in Group W-PE (-40%). Apo-A1 was not affected. PE significantly increased plasma antioxidant capacity by 9% in Group E + PE and 18% in Group W + PE compared with their respective controls. Liver glutathione peroxidase activity was 67% greater in the group receiving PE in water compared with the group given water; there was no effect when PE was given in ethanol relative to its control. Aortic fatty streak area (AFSA) was significantly reduced in the groups receiving PE in ethanol (-32%) or PE in water (-29%) in comparison with their respective controls. Ethanol significantly reduced AFSA by 60% (Group E-PE vs. Group W-PE) or 62% (Group E + PE vs. Group W + PE). These data suggest that ethanol is a complementary component of phenolics in the benefits of red wine for hamsters and that chronic ingestion of PE in ethanol prevents the development of atherosclerosis through several mechanisms. With moderate consumption of red wine, ethanol can improve the effects of phenolic compounds. However, alcohol-free red wine appears to be a very good alternative to red wine.     

Cohort study of mortality among leather tanners in the Lower Valdarno area

BACKGROUND: Epidemiological studies of tanners have shown increased risk for a number of cancer sites, namely: lung, bladder, kidney and urinary organs as well as stomach, intestine, pancreas, nose and nasal cavities, together with leukemias and soft tissue sarcomas. OBJECTIVE: To study cause specific mortality of leather tanners in Tuscany (Valdarno Inferiore area). METHODS: The cohort included 4874 workers (4150 males and 724 females) employed in 92 tanneries operating in 1996 (Valdarno Inferiore Tanneries Census) which were also operating on 31-12-1970. Ascertainment of vital status was completed for all individuals on 31-12-1998 (end of follow-up), and the cause of death was known for all deceased subjects. Demographic and work history data were obtained from factory payrolls. Regional mortality rates were used for comparison to calculate SMR (Standardised Mortality Ratio) and 90% Confidence Intervals (CI). In addition to the overall cohort analysis, for men only separate analyses were completed for finishers, chrome tanners and vegetable tanners. RESULTS: The study showed an increased mortality from lung cancer among finishers, Standardised Mortality Ratio (SMR) 145, 19 observed (obs) (90% Confidence Intervals, 90% CI 95-212), from bladder cancer in the overall cohort (SMR 134, 9 obs, 90% CI 70-233) and among finishers (SMR 125, 2 obs, 90% CI 22-393) and from pancreatic cancer among finishers (SMR 120, 2 obs, 90% CI 21-379). Mortality from lymphoemopoietic cancer is above expected, and the increase is mainly due to myeloid leukaemia, both in males (SMR 208, 5 obs, 90% CI 82-437) and females (SMR 599, 2 obs, 90% CI 106-1887). No deaths from soft tissue sarcoma were observed. A new finding of the study was the increased mortality from cancer of the endocrine glands (SMR 566, 4 obs, 90% CI 194-1297), psychiatric disorders (SMR 195, 6 obs, 90% CI 85-385) and blood diseases (SMR 329, 4 obs, IC 90% 112-752). CONCLUSIONS: The observations of increased lung cancer mortality among finishers, of bladder cancer in the overall cohort and among finishers, as well as an increase in pancreatic cancer among the latter, confirm previous epidemiological findings among tanners. The increase in myeloid leukemia mortality for both males and females, and the absence of deaths from cancer of the connective tissue, which includes soft tissue sarcomas, are worthy of note. The results should be valued with caution, given the small number of cases and the novelty of some observations.     

Influence of school, class, ethnicity, and gender on agreement of fourth graders to participate in a nutrition study

This article describes the methods used to recruit fourth-grade children for a school-based study concerning the accuracy of their school breakfast and lunch recalls, and it reports the impact of school, class, ethnicity, and gender on agreement to participate. A total of 522 children (27% White Males [WM], 30% White Females [WF], 21% Black Males [BM], 22% Black Females [BF]) was available to recruit from 22 classes at six public schools in one district in a southeastern state during the 1999-2000 school year. Across classes, 45% to 95% of children agreed to participate (n = 376, 25% WM, 30% WF, 22% BM, 23% BF) with 72% overall. Logistic regression indicated class as a marginally significant predictor of participation (p < 0.04), but failed to indicate school, ethnicity, or gender as significant predictors. Other specific factors that may influence children's participation need to be investigated and results shared to help improve recruitment efforts for future school-based studies.     

Receipt of clinical preventive medical services among psychiatric patients

A total of 267 patients who were receiving care for psychiatric and substance use disorders at a university medical center completed a self-report instrument assessing their previous receipt of clinical preventive services. High rates of mammography and Pap tests within the past year were observed (76 and 77 percent). Rates of immunization (hepatitis B and tetanus vaccines) varied from 11 percent to 78 percent. Rates of preventive counseling for sexual practices, diet, and avoidance of alcohol were lower than 25 percent in all groups. Only 6 percent of all patients reported having been screened for gun ownership, despite the high risk of suicide among gun owners.     

Protease-activated receptors upregulate cyclooxygenase-2 expression in human endothelial cells

We have previously shown that the serine protease thrombin and other G protein-coupled agonists acutely enhance synthesis and release of prostacyclin from human umbilical vein endothelial cells (HUVEC) through activation of cPLA2 alpha. Here, we show that thrombin and other physiological endothelial cell agonists upregulate COX-2 induction in HUVEC. Thrombin treatment caused a rapid and sustained increase in prostacyclin (PGI2) synthesis from HUVEC. Thrombin and a selective protease-activated receptor-1 (PAR-1) peptide (TRAP) evoked dose- and time-dependent increases in COX-2 protein expression which were equivalent to that induced by the proinflammatory cytokine IL-1 alpha. Quantitative and real-time PCR analysis showed enhanced COX-2 mRNA expression in thrombin- or TRAP-stimulated HUVEC whereas COX-1 expression was unaffected. A PAR-2 agonist peptide also induced COX-2 protein and mRNA expression with kinetics distinct from those of thrombin, and promoted PGI2 release. These results demonstrate that regulation of COX-2 induction is an important functional response of HUVEC to PAR activation and suggest that PARs promote sustained upregulation of prostanoid production in human endothelium.