Severe burn injury: effects on psychologic and immunologic function in noninjured close relatives.

The crucial role of close relative care givers in the rehabilitation of the patient with burns indicates that the psychologic adjustment of noninjured relatives is of concern. This study examined the stress profiles of 14 spouses and parents of patients with burns of greater than 20% total body surface area. Four standardized measures of depression, anxiety, and cell-mediated immunity were used. Tests were given at two time intervals: less than 72 hours after admission and 2 to 5 weeks later. Depression and anxiety were high at the first test period; there was a significant drop in depression (p less than 0.05) but not in anxiety at the second testing. Immune function was suppressed at the first test but improved at the second test (p less than 0.05). There were significant negative correlations between immune response and psychologic distress, indicating that immune function declined as depressive symptoms increased. These results support an interaction between psychologic distress and immunity, and provide further evidence of the stressful nature of severe burn injury on close noninjured relatives.     

Parental Reports of Psychosocial Adjustment and Social Competence in Child Survivors of Acute Lymphocytic Leukemia

Parents of 34 children ages 6 to 17 who had terminated treatment for acute lymphocytic leukemia (ALL) completed the Child Behavior Checklisff4-18 (CBCL) and the Behavior Assessment System for Children (BASC). Compared to general norms for these two rating scales, the child survivors of ALL showed significantly more problems in terms of social competence and internalizing behavior. Adolescents exhibited more difficulties in these areas than younger children. Externalizing behavior composite scores were elevated on the CBCL but not on the BASC. There were no differences found between children who had received cranial irradiation and those who had not, and age at diagnosis did not affect current functioning. Children receiving special education services scored significantly lower overall than those who were in regular classes.     

Dedicated transpulmonic approach for the repair of Fallot's tetralogy

Background To share our initial experience with cases of Tetralogy of Fallot (TOF) in whom transpulmonary artery route was exclusively used for repair of the defect. Material & Methods Twenty patients, 11 males and 9 females were carefully selected on the bases of anatomical configuration suitable for repair without trans annular patch. All underwent echocardiography. Angiocardiography was performed in patients. They had no other cardiac vascular anomaly. Results Of the 20 patients, there was one death following massive endotracheal bleeding. Four patients had low cardiac output and required prolonged inotropic support and recovered completely. All 19 survivors have been followed (1–56 months) are with echocardiography. There were no residual or recurrent ventricular septal defect (VSD), significant right ventricular (RV), outflow obstruction or tricuspid regurgitation. Four patient who underwent annualr enlargement have minimal pulmonary regurgitation. Conclusions In selected patients transpulmonic repair of TOF is feasible and safe.     

Plasma pseudocholinesterase: A potential marker for early detection of obesity

Plasma pseudocholinesterase activity, body weight and food intake showed significantly higher values in obese (ob/ob) mice than their lean littermates starting at the age of 35 days. The enzyme activity also showed a good positive correlation with age, body weight and food intake in all the mice from this age. Analysis of the data also indicated that between 35 and 58 days of age, pseudocholinesterase activity appeared to be more sensitive than body weight measurements in predicting obesity. Diabetic (db/db) mice on restricted diet, showed no significant difference in plasma pseudocholinesterase activity between the pre and post restricted blood samples. In contrast, diabetic mice on a non-restricted diet showed a significant increase in enzyme activity during the same interval of time. This suggests a relationship between hyperphagia, pseudocholinesterase and obesity.     

TNF-alpha levels in cancer patients relate to social variables

Tumor necrosis factor-alpha (TNF-alpha) is an important cytokine associated with tumor regression and increased survival time for cancer patients. Research evidence relates immune factors (e.g., natural killer (NK) cell counts, NK cell lysis, lymphocyte profile, and lymphocyte proliferation) to the frequency and quality of social relations among cancer patients. We hypothesized that disruptions in social relations would be associated with lower TNF-alpha responses, and conversely, that reports of positive changes in social relations correlate with stronger responses. A prospective design measured changes in social activity and relationship satisfaction with a partner in 44 breast cancer patients at the time of cancer diagnosis, and initial surgery and 12 months later. Results indicated that patients reporting increased social activities or satisfaction exhibited stronger stimulated TNF-alpha responses. This is the first study to link changes in patient social relations with a cancer-relevant immune variable.     

Prevalence of malignancy within cytologically indeterminate thyroid nodules

BACKGROUND: The optimal management of cytologically indeterminate thyroid nodules is controversial given the variable malignancy rates reported in this patient population. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on cytologic features. METHODS: Cytopathology reports obtained after fine-needle aspiration biopsy (FNAB) examination of indeterminate follicular thyroid lesions were examined over a 4-year period. The prevalence of malignancy on final histology was determined in 4 indeterminate cytologic categories. RESULTS: A total of 107 records were available (91 women, 16 men). The mean patient age was 45.4 +/- 16 years. Forty-eight patients (45%) underwent surgery and had histopathologic diagnosis, while 57 patients did not have surgery. The prevalence of malignancy in patients who underwent thyroidectomy was 42% (20 of 48). CONCLUSIONS: The high prevalence of malignancy within indeterminate follicular lesions may necessitate thyroidectomy for patients with indeterminate follicular lesions on FNAB examination.