Age-related changes in oxygen saturation over the first year of life: A longitudinal study

Stability of oxygen saturation depends on maturation and function of individual components of the respiratory system. The aim of this study was to record and analyse comprehensive oxygen saturation data in a longitudinal study over the first year of life. Detailed sleep studies were performed on 15 normal infants eight times in the first year of life. The accrued oxygen saturation data were analysed on a computerized oximetry data analysis system. Results show the mean sleep saturation levels trending upwards and stabilizing by 185 days. There was an inverse curvilinear relationship between mean age and median desaturation time and the median number of desaturations at ≥95, ≥92 and ≥90% saturation. The mean cumulative desaturation time ≥90% in the first 4 months was 11.08 min (range 2.5–36.57 min). This study demonstrates monotonic patterns of increasing saturation and decreasing number and time of desaturations ≥95% and ≥90% but a random pattern of desaturations ≥85% occurs across the first 6 months of life. Cumulative desaturation times over the first 4 months of life were high and could be important to the development of maturity of the respiratory system. After 6 months, all indices of saturation and desaturation point to a stable and mature respiratory system.     

Aggregated early intervention effects for Down's syndrome persons: patterning and longevity of benefits

ABSTRACT. Pooled findings from 21 early intervention demonstration studies for Down's syndrome infants and children yield consistency of short-term benefits in the growth of liner motor skills, simple social repertoire and DQ/IQ scores, hut conflicting evidence in support or not of benefits in the gross motor, linguistic and cognitive/ academic domains. Support for the tenacity of gains, on follow-up to the early years of primary schooling, is disappointing. It is recommended that: (1) intervention programmers view the key working assumptions and ideological positions governing present practices more critically; (2) intervention curricula reflect the unique biological and behavioural properties of the syndrome, taking into account individual differences which are independent of etiological label; and (3) care delivery systems be based more fully on multidisciplinary collaboration, especially between the health sciences and education fields.     

Stelazine-induced pigmentation

A case of a West Indian patient is reported who developed abnormal blue-grey pigmentation on exposed areas of skin following treatment with low dose stelazine. Oculocutaneous melanosis is a well-recognized side-effect of prolonged phenothiazine treatment. In this condition the areas of skin exposed to sunlight develop a violaceous, blue-grey or slate-grey colour in more severe cases. These characteristic changes are rarely seen now. We describe the case of a patient who developed pigmentation while taking a low dose of stelazine for 5 years.     

Reduction by Pyridostigmine Pretreatment of the Efficacy of Atropine and 2-PAM Treatment of Sarin and VX Poisoning in Rodents

Reduction by Pyridostiginine Pretreatment of the Efficacy ofAtropine and 2-PAM Treatment of Sarin and VX Poisoning in Rodents.KOPLOVITZ, I., HARRIS, L. W., ANDERSON, D. R., LENNOX, W. J.,AND STEWART, J. R. (1992). Fundam. Appl. Toxicol. 18, 102–106. This study concerned the effect of pyridostigmine pretreatmenton (a) the antidotal efficacy of atropine and 2-PAM in sarin,tabun, and VX poisoning in mice and guinea pigs and on (b) theoxime-induced reactivation of VX-inhibited whole blood acetyicholinesterase(AChE) of guinea pigs. One hour prior to organophosphate (OP)challenge with sarin, tabun, or VX, animals were given oraldoses of pyridostiginine to induce approximately 30 and 60%inhibition of whole blood AChE; controls received vehicle. Micewere challenged im and guinea pigs sc with the OP compounds.Treatment with atropine (11.2 mg/kg to mice; 32 mg/kg to guineapigs) plus 2-PAM (25 mg/kg) was given im at 10 sec postchallengein mice and 1 min postchallenge in guinea pigs. In the reactivationexperiments, pyridostigmine or saline was given im to guineapigs 30 min prior to VX (8.24 µg/kg, sc), atropine (16mg/kg) was given im at 1 mm, and 2-PAM (25 mg/kg) at 16 minpostchallenge. Pyridostigmine significantly enhanced the efficacyof atropine and 2-PAM against tabun in both species. In contrast,pyridostigmine reduced or did not increase the efficacy of atropineand 2-PAM against sarin or VX in both species. Recovery of VX-inhibitedAChE by 2-PAM was decreased significantly in pyridostigminepretreated animals. The results suggest that pyridostigminepretreatment may adversely effect the efficacy of atropine and2-PAM as antidotes for VX and sarin intoxication.     

Terminal electrocardiographic patterns in experimental anoxia,coronary occlusion,and hemorrhagic shock

Electrocardiographic records of dog hearts at the stage of termination of effective pumping in experiments upon generalized anoxia, coronary occlusion, and hemorrhagic shock have been collected and studied.In nineteen general anoxia experiments from which terminal electrocardiograms are available, pacemaker stoppage or cessation of A-V conduction was the first gross manifestation of cardiac failure detectable in electrocardiograms in each case except one. Ventricular fibrillation occurred prior to stoppage in one. Of these nineteen animals, there were twelve with intact chests and seven with chests open for study upon the heart muscle. In a larger series of anoxic dogs with open chests and direct observation of the heart, making a total of more than sixty animals, there have been no further deaths by ventricular fibrillation, all hearts having stopped via pacemaker and conduction failure. The frequency with which pacemaker failure preceded conduction failure, and vice versa, was approximately equal in the nineteen experiments with terminal records.In occlusion of the anterior descending coronary artery there were twenty-five fibrillations during fifty occlusion trials, and four additional fibrillations upon releases of the occluding clamp. Fibrillation occurred, therefore, in fifty per cent of the occlusions, or fifty-eight per cent of trials if fibrillations upon release are included.In nine hemorrhagic shock experiments seven hearts failed by pacemaker stoppage, another probably did also, and one stopped via ventricular fibrillation.The experimental conditions which produce a gradual overall diminution in the functional capacity of the cardiac tissues without predisposition to ectopic ventricular systoles produced failure of the pacemaker or of A-V conduction, but very rarely induced ventricular fibrillation. The experimental condition (coronary occlusion) which predisposes to trains of ectopic ventricular systoles produced a high percentage of ventricular fibrillations. The reasons are discussed.Observations in a few representative clinical papers are reviewed and compared with the experimental observations. Considerable agreement with the experimental patterns and with the conclusion stated in the preceding paragraph was found.     

The reactivity of various human sera with mumps complement fixation antigens

Human sera taken at various stages of mumps have been analyzed in regard to their reactivity with two serologically distinct complement fixation antigens which were derived from the infected chick embryo. Antibodies to the soluble or S antigen appear earlier in the disease and, as a rule, reach high levels before antibodies against the virus-bound or V antigen commence to rise. In early convalescence, both antibodies reach high levels. Subsequently antibodies against the S antigen decrease usually at a faster rate than those against V, so that after a period of several years, frequently only anti-V may be left. These findings were found helpful in diagnostic procedures. The use of both the V and S antigens has permitted the early diagnosis of manifestations of mumps in the absence of parotitis, such as meningoencephalitis, since the finding of high levels of anti-S and of low titers of, or no, anti-V is considered diagnostically significant for the first few days of illness. For the determination of resistance the use of the V antigen appears more useful. Following vaccination or skin testing, antibodies against both antigens may develop; those against V increase more regularly and to higher titers than those against S.     

Should equity in health be target number 1?

Policy measures to reduce socioeconomic health differences (SEHD)must be preceded by an analysis of the possibilities and desirabilityof a reduction. This paper argues that it is necessary to pursueequality in health, conceived as equal opportunities to achievehealth. This principle is justified as part of the principleof maximizing individual freedom of choice, and requires thateveryone has the opportunity to be as healthy as possible. Bymeans of this principle a distinction can be made between unjust,unavoidable, and acceptable health inequalities. The determinantsof SEHD which lead to inequalities considered unjust must besubject to policy. These are living conditions (physical andsocial environment and health care) and conditions of choice(e.g. the knowledge of an individual about the health risksof a certain behaviour). Even if SEHD are considered inequities,sometimes conflicting interests will make it difficult to proposea health policy to redress these inequities. These are partlythe consequence of the intersectoral character of a policy aimedat equality of opportunities to attain health, in which theimportance of health has to be weighed against other goals.Moreover the impact of such a policy on the individual freechoice has to be critically weighed. Finally in the contextof health care policy, conflicts between the principle of equalityand maximizing health can be expected.     

Pseudoangiosarcomatous carcinoma: a clinicopathological study of seven cases

Seven cases of carcinoma mimicking angiosarcoma occurring in skin (3 cases), breast (3) and lung (1) are described. The cutaneous, pulmonary and one of the breast carcinomas were poorly differentiated and squamous in type; the other two breast tumours were poorly differentiated ductal carcinomas with focal squamous differentiation. Histologically, the pseudoangiosarcomatous pattern was due to complex anastomosing channels and spaces lined by neoplastic cells. The spaces contained hyaluronic acid. The neoplastic cells exhibited cytokeratin positivity but yielded negative results with the endothelial cell markers, factor VIII-related antigen and CD 34 (QB-END/10). Two breast tumours showed binding of UEA-1. Ultrastructurally, unequivocal epithelial differentiation was demonstrated in six of the cases. Pathogenetically, these tumours appeared to be variants of acantholytic squamous cell carcinoma. Recognition of this unusual form of carcinoma is important, as an incorrect diagnosis of angiosarcoma may lead to inappropriate treatment and prognostication.     

Detection, isolation and characterization of cell free HLA A and B antigens from human amniotic fluid

Cell-free HLA A and B antigens, paternal and maternal, have been detected in human amniotic fluids obtained from women at 16-18 weeks'gestation. Fractionation of amniotic fluid samples on sephadex showed that HLA A and B antigen activity was mainly in the 40,000 to 70,000 mol. wt. fractions. Lentil lectin sepharose 4B affinity chromatography of 30,000 to 70,000 sephadex molecular weight fraction of amniotic fluids isolated proteins which gave 2 bands, M and N, on discontinuous polyacrylamide gel electrophoresis (disc PAGE without SDS). SDS disc PAGE of the LcH bound glycoproteins recovered from amniotic fluids indicated 4 main protein bands approximately 12,900, 32,000, 52,600 and 78,500 mol. wt. Schiff's stain of the SDS gels showed that all the proteins except the 12,900 mol. wt. polypeptide contained carbohydrate.
It was suggested that the 12,900 and 32,000 mol. wt. proteins obtained on disc PAGE gels represented the 2 subunits of the HLA A and B antigen molecule, i.e., β₂,-microglobulin and the allospecific heavy chains, similar to the papain-solubilized moiety of membrane antigens. In the absence of SDS the 2 polypeptides migrate in polyacrylamide gels as l protein band M, representing the intact (undissociated) antigen molecules. Enzyme linked immunosorbent assays were proposed for the estimation of cell-free HLA antigens.