Analysis of early infectious complications after autologous bone marrow transplantation

We reviewed the hospital course of 35 patients who underwent autologous bone marrow transplantation. Fever and profound neutropenia developed in all. Microbiologically confirmed infection developed in 22 patients, and unconfirmed but clinically evident infection developed in six. A bacterial infection developed in 21 patients (most commonly bacteremia without a detectable focus). Mucocutaneous fungal (12 patients) and viral (13 patients) infections were common, whereas invasive fungal (two patients) and viral (one patient) infections were uncommon. New pulmonary infiltrates developed in seven patients. Six deaths occurred during the initial hospitalization for transplantation, only one of which was directly attributable to infection. Stepwise logistic regression analysis retained male gender, total body irradiation, administration of trimethoprim/sulfamethoxazole, and development of mucositis or diarrhea as predictors of decreased survival, whereas higher pretreatment albumin levels and the administration of oral nonabsorbable antifungals were associated with an increased likelihood of survival. A comparison of these infectious complications with those found in allogeneic bone marrow transplant recipients shows similarities and differences with potentially important implications for patient management.     

Comparing Treatment Intensities of Tactile-Thermal Application

The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.     

Immunotherapy with dog and cat extracts in children

Hypersensitivity to dogs and cats causes asthma in many children. In this open controlled clinical study we wanted to establish whether immunotherapy can be recommended as a supplement to conventional medical therapy in dog- and cat-induced asthma in children. Twenty-seven children with mean age 10 7/12 years and with allergy to dog or cat according to anamnesis, skin prick test (SPT), specific IgE (RAST) and bronchial provocation test (BPT) entered the study. On the basis of age and bronchial sensitivity they were randomly allocated to either immunotherapy with dog or cat extract (active group, n = 14) or conventional medical therapy (control group, n = 13). Immunotherapy comprised subcutaneous injections with an alum-adsorbed depot extract (Alutard-SQ), and a maintenance dose of 100,000 SQ-U or the maximum tolerated dose. Before entering the study and after 9 months' therapy the patients were evaluated by BPT, SPT, RAST - and IgG4 analyses. The active group showed statistically significant change in bronchial tolerance (P less than 0.02), whereas no such change was found in the control group (P greater than 0.05). The change in skin sensitivity was significantly greater in the active group than in the control group (P less than 0.05), whereas no significant differences were found in RAST and IgG4. However, a significant (P = 0.05) increase in IgG4 was seen in the active but not in the control group. Frequency and degree of side effects in this study were acceptable.     

Maturation of the electroretinogram in the dog

Dogs 1–28 days old were exposed to flashes of white light and the electrical responses recorded from the retina. A small negative wave, the a wave, was first observed on Day 10. The a wave increased in amplitude from 17 μv at Day 11 to 60 μv at Day 28. The b wave did not appear until Day 15 and had an amplitude of 32 μv and a latency of 4.78 msec. The b wave increased from 32 μv at Day 15 to 88 μv at Day 28. The greatest rate of increase in the a-wave amplitude occurred between Day 11 and Day 18. The greatest rate of increase in amplitude of the b wave occurred between Day 15 and Day 22. The a wave demonstrated a greater decrease in latency than the b wave.     

Birthweight prediction by three-dimensional ultrasonographic volumes of the fetal thigh and abdomen.

Our validation study examined a three-dimensional ultrasonographic phantom that contained irregularly shaped volume targets ranging from 0.5 to 76.1 milliliters. Four different examiners made blinded measurements from volume datasets that were acquired by 4 and 7 MHz transducers. Birthweight predictions using abdominal and thigh volumes from 18 term fetuses also were compared with two-dimensional ultrasonographic methods. In vitro volume measurements were accurate, precise, and repeatable despite a small systematic overestimation with increasing object size. Mean systematic error and precision for birthweight predictions by three-dimensional ultrasonography (-0.03% +/- 6.1%) were not significantly different from those by two-dimensional ultrasonography (-0.60% +/- 8.8%). Conventional prediction methods yielded three birthweights with greater than 15% error. By comparison, except for one infant whose birthweight indicated an 11% error, all predictions based on fetal volume parameters were within 10% of true values. Accurate birthweight predictions by fetal volume parameters appear to be technically feasible at term gestation although their practical clinical application requires further investigation. Birthweight predictions in this manner may allow remote consultants to evaluate the fetus over wide-area computer networks despite the physical absence of the patient.     

The elderly in long-term care: 1 — prevalence of dementia and levels of dependency

One thousand and twenty-three subjects in four different types of statutory accommodation were surveyed during a two-week period using the Survey version of the Clifton Assessment Procedure for the Elderly. The types of accommodation were conventional residential accommodation (CRA), elderly mentally infirm homes (EMI), geriatric wards (GER), and psychogeriatric wards (PG), all within a specific geographic area. The survey was undertaken to determine prevaalence of dementia and levels of dependency in different types of unit and to ascertain if there were significant differences between them. There was a high level of both dementia and dependency in all four types of unit, but significant differences were demonstrated between different types of unit.