Audiologic profiles of children with Kawasaki disease.

Kawasaki disease (KD) is an idiopathic vasculitis associated with systemic inflammation and profound immunoregulatory changes. Recent reports from Japan and the United States have documented the association of sensorineural hearing loss (SNHL) with acute KD. To further characterize the nature and prevalence of this complication, we prospectively evaluated the hearing of 40 consecutive patients with acute KD at a single institution. Standard audiometric procedures were used, including visual reinforcement audiometry and play audiometry. Auditory brainstem response (ABR) testing using clicks and tone pips (1000-4000 Hz) was performed in patients with abnormal or unreliable results on behavioral audiometry. Acoustic immittance measurements were obtained on all patients. Of the 23 males and 17 females (mean age 3.2 +/- 2.3 years, range 0.6-11.1 years), all but three were evaluated and treated with aspirin and intravenous gama globulin within 1 month of onset of fever. Seven children had test results suggesting sensorineural threshold shifts, 16 had normal hearing, and 14 had inconclusive hearing evaluations. Laboratory data in patients with hearing threshold shifts revealed significantly longer duration of fever (4.1 +/- 1.0 versus 1.9 +/- 0.5 days), and a tendency for higher temperatures and white blood cell counts at diagnosis compared to those with normal hearing. Results suggest that transient as well as persistent SNHL may be associated with the acute vasculitis of KD, and may be associated with laboratory markers indicating more severe systemic inflammation. Audiologic screening should be considered for all patients following KD.     

Inhibition of gap junctional intercellular communication by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rat hepatocytes

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a potent rodenthepatic tumor promoter. Unlike observations with the majorityof tumor promoting chemicals studied to date, most investigationshave failed to demonstrate down- regulation of gap junctionalintercellular communication (GJIC) in cultured cells by TCDD.The present study examined the effect of TCDD on GJIC in rathepatocytes in primary culture. At non-cytolethal doses TCDDinhibited GJIC In a time- (1, 4, 24 and 48 h) and concentration(1x10^–8–1x10^–14M)-dependent manner. This inhibitionoccurred within 4 h of treatment at doses of 1x10^–81x10–^–12MTCDD and persisted for up to 48 h, despite removal of TCDD.Treatment of rat hepatocytes with TCDD resulted in a decreasein hepatocyte connexin 32 mRNA, but had no apparent effect onconnexin 26 mRNA. Co-incubation of rat hepatocytes with TCDDand     

The effect of passing an "anti-immigrant" ballot proposition on the use of prenatal care by foreign-born mothers in California

This study examines whether the passage of California's Proposition 187, a proposition designed to restrict undocumented immigrants from using public services, had a negative effect on the use of prenatal care and birth outcomes. Comparisons of prenatal care use and birth outcomes before and after the passage of the proposition are made between low-education foreign-born and U.S.-born mothers using California's Birth Public Use files. Multivariate linear and logistic regressions were used to control for regional and maternal characteristics. We find a significant but small decline in the use of prenatal care by low-education foreign-born women after Proposition 187 passed; however, there was no detectable deterioration of birth outcomes. Whether future reductions in the availability of prenatal care would damage the health of children is unclear.     

Correlation of postcoital evaluation with in vitro sperm cervical mucus determinations and ureaplasma cultures

Fifteen trials were completed in 14 couples during an infertility evaluation. The postcoital test (PCT) was accomplished in a standardized manner. Also, standardized determinations of the sperm-cervical mucus penetration test (SCMPT) with the addition of cross-testing (X-test) utilizing bovine cervical mucus (BCM) and normal donor semen (NDS) were done. Male and female samples were also cultured for Ureaplasma urealyticum using U9-B indicator broth and A-7 agar. The PCT and SCMPT agreed in 87% (13/15) of the cases. Utilizing BCM and NDS, where possible, the causative factor was the cervical mucus in 54% (7/13); semen factor in 15% (2/13); both factors in 8% (1/13); and undetermined in 23% (3/13). U. urealyticum cultures were positive in 40% (6/15) of the cases. Analysis of the results revealed: (1) significant correlation between PCT and SCMPT (P less than 0.01); (2) no significant difference among the PCT, SCMPT, and X-test, indicating that the cervical mucus was the causative factor; and (3) no U. urealyticum correlation with the PCT or the SCMPT. Thus, laboratory SCMPT and X-test correlated with the PCT, providing additional information concerning the causative factor in infertility. The U. urealyticum status in cervical mucus and semen cannot be determined from the PCT nor the SCMPT.     

A double-blind study comparing an acellular pertussis-component DTP vaccine with a whole-cell pertussis-component DTP vaccine in 18-month-old children

An acellular pertussis-component diphtheria-tetanus-pertussis (AC-DTP) vaccine was compared with a currently licensed, whole-cell pertussis-component DTP (WC-DTP) vaccine for reactogenicity and immunogenicity when given as the fourth DTP immunization in sixty 18- to 24-month-old children. Reactions over the first 48 hours were significantly less common in the AC-DTP vaccine recipients, as follows (WC-DTP/AC-DTP): fever, 85%/5%; redness, 70%/12.5%; tenderness, 100%/22.5%; swelling, 35%/10%; fretfulness, 70%/12.5%; anorexia, 35%/2.5%; and vomiting, 10%/0%. Antibody responses to pertussis antigens (agglutinogens, lymphocytosis-promoting factor, and filamentous hemagglutinin), diphtheria toxoid, and tetanus toxoid in AC-DTP vaccine recipients were comparable with those in WC-DTP vaccine recipients. The AC-DTP vaccine evaluated in this trial seems to be as immunogenic as WC-DTP vaccine while being markedly less reactogenic.     

False-negative peritoneal cytology in metastatic ovarian carcinoma

Seventy-nine laparotomies for disseminated intraperitoneal ovarian carcinoma were reviewed to determine the frequency and possible causes of false-negative peritoneal cytology. Negative peritoneal cytology (defined as any reading other than positive) was found in 16 of 79 cases (20%). False-negative cytology occurred more frequently with peritoneal washings (48%) than with ascites (6%; P less than .001); with second-look surgery (50%) than at primary surgery (12%; P = .004); with peritoneal metastasis less than 0.5 cm (50%) than with metastasis greater than 0.5 cm (16%; P = .02); and with bloody cytology specimens (25%) rather than specimens without blood (0%; P = .06). Volume of peritoneal specimen, architectural grade, cytologic grade, and stage of disease (III versus IV), did not affect the frequency of false-negative cytology. The high prevalence of negative cytology associated with peritoneal washings, small tumor size, and second-look surgery suggests that negative cytology is a result of poor distribution of peritoneal washings and infrequent exfoliation of malignant cells rather than misinterpretation of malignant cells present in cytology specimens.     

A comparison of the succinylcholine induced ocular position and the postoperative alignment in strabismus

Succinylcholine was injected intraoperatively in 41 strabismus patients with congenital esotropia or intermittent or constant exotropia. Regression analyses were performed to investigate the predictive relationships between the one-, six-, and 26-week postoperative alignment and the intraoperative, succinylcholine-induced ocular position. Ocular position, determined by the interlimbal distance in millimeters, was calculated using a semi-automated, video replay analysis system. Large, statistically significant correlation coefficients were obtained for patients undergoing bimedial recessions of 4.0 to 5.5 mm and bilateral lateral rectus recessions of 5.0 to 7.0 mm. Small correlations were obtained for esotropes undergoing the recession/resection procedure and those with bimedial recessions of 6.0 mm or greater. These data support the theory that the succinylcholine-sensitive subgroup of the extraocular muscle fibers are those whose tonic contracture provide the motor component to ocular alignment. Sample sizes at present are insufficient to suggest clinical use of these data. In future research, these relationships will be tested for their ability to predict postoperative alignment and thereby, improve success rates in strabismus surgery.     

Clinical implications of orbital cellulitis

Periorbital and orbital cellulitis are clearly two distinct disorders with different etiologies. Periorbital cellulitis is well-documented as a more common infectious process limited to the eyelids in the preseptal region. In contrast, orbital cellulitis represents a more severe, but less common, infection of the orbit posterior to the septum with or without subperiosteal abscess, orbital abscess, or cavernous sinus thrombosis. A retrospective review of the clinical and laboratory data of 137 cases of orbital and periorbital cellulitis was performed. Periorbital cellulitis was documented in 98 cases (71%), in contrast to orbital cellulitis which was noted in 39 (28%) patients. All patients with orbital cellulitis received intravenous antibiotics, however, surgical therapy was necessary for progression of orbital cellulitis in 49% of patients. The majority of patients underwent incision and drainage of an abscess in the orbit. Complications as a result of orbital cellulitis occurred in nine (23%) of the patients. A distinction is made between the clinical entity of periorbital cellulitis and orbital cellulitis. Separating these clinical entities on the basis of physical examination and radiographic studies is important because the medical and surgical management of these two disease processes is different.     

Knowledge and attitudes of health care social workers regarding advance directives

This cross sectional investigation describes the knowledge and attitudes of health care social workers regarding advance directives and explores factors that influence them. As major contributors to quality patient care, the level of knowledge and attitudes held by health care social workers regarding health care policy mandates are important. Mail survey methods were used to collect data from a systematic random sample (n = 324) of social workers throughout one mid-western state. Results indicate that the majority of health care social workers have high to moderate levels of knowledge about advance directives and hold positive attitudes regarding the policy. Social workers with more experience working with the elderly had higher levels of knowledge. Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities.