Platelet aggregation,disc haemorrhage and progressive loss of visual fields in glaucoma

Platelet aggregationin vitro, deterioration of visual field defects (VFD) and the prevalence of disc haemorrhages (DH) were assessed in 49 patients with primary open angle glaucoma (POAG) and compared with the findings for 67 individuals with suspected glaucoma (GS) in a seven-year follow-up study (range 5.8 to 8.2 years). The percentage patients with spontaneous platelet aggregation (SPA) was higher for POAG patients with visual field deterioration (60%) than both POAG patients without progressive loss of visual fields (12.5%; P<0.005) and those with suspected glaucoma (22.4%; P<0.005). The occurrence of DH was higher among POAG patients with progressive loss of visual field (28%) compared to the GS group (8.4%; P<0.025) and the group of patients consisting of POAG patients without deterioration of VFD and GS (9.9%; P<0.05). DH also occurred more often in patients with low tension glaucoma (41.6%) than in the remaining POAG patients (13.5%; P<0.05). No relation between the patients with SPA and the patients with DH was observed.Abbreviations NPB normal platelet behavior - SPA spontaneous platelet aggregation - DH disc haemorrhage     

Prognostic value of preoperative tests in the surgical treatment of ascites with the implant of Le Veen shunts in cirrhotics.

In the period of January 1978 to October 1988, 32 Le Veen shunts (LVS) were implanted in 20 patients, out of which 16 were alcoholic cirrhotics and 4 postnecrotic cirrhotics. In the present study, we correlated preoperative laboratory data of these patients with their postoperative evolution, comparing the clinical results of patients who survived more than 30 days (13 patients = 65%) with the results of those who died within the same period (7 patients = 35%). For that matter, 14 laboratory tests were performed in order to measure the serum levels of hematocrit, hemoglobin, urea, creatinine, sodium, potassium, bilirubin, albumin, AST, ALT, alkaline phosphatase, fibrinogen, gamma GT and prothrombin activity. After statistical analysis, we observed that 6 of the 14 tests performed could be considered of prognostic value in the following decreasing order of importance: fibrinogen, alkaline phosphatase, prothrombin activity, urea, gamma GT and bilirubin. We observed that all the 7 patients who died prematurely presented 3 or more of these levels altered, when compared with standard values. Based on these data, we concluded that serum levels of fibrinogen, alkaline phosphatase, urea, gamma GT, bilirubin and activity of prothrombin proved to be important factors in determining the prognosis of immediate survival in cirrhotic patients who underwent LVS implantation. We also concluded that when 3 or more of these factors are altered, the implant of LVS is contraindicated, whatever clinical criteria for indication and contraindication were taken into account.     

Family intervention according to Roy]

The author presents a care plan based upon Sister Callista Roy's conceptual model, that is recognized as well suited to the family system. This, the first of two-part series, focuses on the first two steps of the care plan--the theoretical and practical aspects of data collection and data analysis. The subjects are a single mother and her son. During the first level of evaluation of the family system, the nurse observes and explores the family system's behavior as well as that of each of the family members using the four modes of adaptation: physiological needs, self-concept, role function, and interdependence relations. During the second level of evaluation, the nurse identifies observed and reported stimuli or factors within the family environment that influence observed behaviors. During the data analysis, the nurse determines if the reported or observed behaviors are adaptive or non-adaptive toward maintaining the bio-psycho-social integrity of the family. The nurse also determines if the behaviors allow for achievement of identified goals. The nurse establishes links between the behaviors and the stimuli, classes and organizes the findings, and formulates an appropriate nursing care plan. Next month's article will focus on the planning, implementation and evaluation of the nursing care plan. It will focus equally on the ways in which the nurse can facilitate the family's adaptation.     

Culture and pain: a Mesoamerican perspective.

Culture has been identified as a factor that influences a person's reaction to and expression of pain. Research in the area of pain and culture has not established a clear link between cultural meanings and attitudes associated with pain and pain behaviors. The purpose of this ethnohistoric study was to explore the beliefs related to the experience of pain within ancient Mesoamerica. The six themes that emerged from this study represent efforts related to the discovery of the epistemics of cultural meanings of pain in contemporary Mesoamerican cultures, specifically Mexican-Americans. These findings serve as a benchmark from which to understand Mexican-American meanings, expressions, and care associated with pain.     

Low incidence of cardiac hypertrophy in essential hypertensives with no retinal changes.

120 subjects, 90 hypertensives and 30 age-matched controls, were evaluated by fundoscopy and echocardiography to assess the degree of target organ involvement. The hypertensive patients were divided into 3 groups (mild, moderate, severe hypertension) according to their diastolic blood pressure levels. No significant difference was demonstrated in left ventricular mass among the 3 groups. Moreover, no relationship was demonstrated between the degree of hypertension and the severity of fundoscopic changes. Our findings indicate that patients with no retinal changes show a low probability of left ventricular hypertrophy and that patients with left ventricular hypertrophy show a high probability of retinal involvement. Our data indicate that fundoscopy is more sensitive than echocardiography in the recognition of the hypertensive disease.     

A new peroxisomal disorder with fetal and neonatal adrenal insufficiency.

A boy with a new type of adrenoleukodystrophy is described. This was characterised by fetal and neonatal adrenal insufficiency, a neurological picture as seen in neonatal adrenoleukodystrophy, but with a normal number of peroxisomes in the liver and a peroxisomal dysfunction limited to the very long chain fatty acids and pristanic acid.     

Comparative cell culture effects of shape memory metal (Nitinol), nickel and titanium: a biocompatibility estimation.

Nitinol is an equiatomic alloy of nickel and titanium which has been attracting increasing interest in the field of biomedical engineering. To quantify toxicity as a preliminary evaluation of biocompatibility, inhibition of mitosis in human fibroblasts in tissue cultures exposed to test materials is an accepted screening method, although a dose-effect relationship had never been investigated. In this experiment, the effect of an increasing dose exposure to Nitinol, nickel or titanium on human fibroblasts in cell cultures was tested in subgroups in comparison with a control group. The results showed that nickel induces a significant (p < or = 0.05) inhibition of mitosis in human fibroblasts, whereas no significant effects of this kind were found for titanium or Nitinol. According to the results of these studies, Nitinol is to be considered in this respect biocompatible and comparable to titanium, which would seem to justify application as a surgical implant.     

Crown of microfilaments in the extending cytoplasmic processes of medulloblastoma glial progenitors.

Microfilaments and microtubules play a part in the extension of neuronal processes but their roles in the formation of glial processes have not yet been determined. The objectives of this study were to determine the organization of microfilaments in differentiating glial progenitors (RB2 cells) and to study the effects of microfilament or microtubule disruption on process extension. Intense F-actin staining (crown of microfilaments) was observed at the leading edge of a small extending conical tip in differentiating RB2 cells, but was absent in process-bearing TE671 rhabdomyosarcoma cells. No significant difference was noted in the mean number of TE671 cells with processes treated with a microfilament disrupter from that of similarly treated controls. In contrast, a significant difference was noted in the mean number of RB2 cells with processes after microfilament disruption treatment from that of similarly treated controls. Microtubule disruption arrested extension and caused process retraction in both cell types. The results of this study demonstrate that microtubules play an equally important part in the extension and stabilization of the RB2 and TE671 processes. Moreover, the crown of microfilaments concentrated in the glial RB2 process (and not in the TE671 process) may be critical to its extension during differentiation.     

Poly(2,6-Dimethyl-1,4-Phenylene oxide)/crosslinked polystyrene semi-interpenetrating networks: Synthesis and properties

Semi-interpenetrating networks (semi-IPN's) based on linear poly(phenylene ether)s and crosslinked polystyrene can be prepared by reactive moulding of crosslinkable polymeric mixtures. These materials show thermomechanical properties which strongly depend on both the ratio of the two polymeric matrices and the degree of crosslinking in the polystyrene network. Samples based on a 50/50 weight ratio of poly(2,6-dimethyl-1,4-phenylene oxide)/crosslinked polystyrene show glass transition temperatures (T_g) which are very dependent on the degree of crosslinking. It is therefore possible to obtain materials with desired T_g, ranging from the T_g of the corresponding linear blend to that of poly(2,6-dimethyl-1,4-phenylene oxide) alone.