Massage therapy by mothers and trained professionals enhances weight gain in preterm infants

BACKGROUND: The method of "massage therapy" has consistently shown increased weight gain in preterm infants. The weight gain was apparent during massages administered by professionals. AIMS: To replicate the results of increased weight gain in the course of "massage therapy" in preterm infants, and utilize a new, cost-effective application of this method by comparing maternal to nonmaternal administration of the therapy. STUDY DESIGN: Random cluster design. SUBJECTS: The study comprised 57 healthy, preterm infants assigned to three groups: two treatment groups--one in which the mothers performed the massage, and the other in which a professional female figure unrelated to the infant administered the treatment. Both these groups were compared to a control group. RESULTS: Over the 10-day study period, the two treatment groups gained significantly more weight compared to the control group (291.3 and 311.3 vs. 225.5 g, respectively). Calorie intake/kg did not differ between groups. CONCLUSIONS: Mothers are able to achieve the same effect size as that of trained professionals, allowing cost-effective application of the treatment within the neonatal intensive care unit.     

Driving performance in patients with mild to moderate glaucomatous clinical vision changes

The purpose of this study was to determine the relationship between clinical measures of visual function and driving-related skills in patients with glaucoma who had good visual acuity in at least one eye and mild to moderate visual field loss. METHODS: Twenty-five patients with glaucoma and twenty-nine age-equivalent normally sighted control subjects were included in the study. We tested each patient on an interactive driving simulator and collected vision data, including Lighthouse visual acuity, Goldmann and Humphrey visual fields, and Pelli-Robson contrast sensitivity. Information about real-world accident history for the previous 5-year period was obtained. RESULTS: The glaucoma patients did not have significantly more simulator or real-world accidents than the normally sighted group. There were no significant differences between the groups in performance on seven of the eight simulator indexes that were measured. Of the clinical visual function measures, only lower contrast sensitivity in the eye with better contrast sensitivity correlated with driving skills, including slower speeds (r(24) = 0.58, p < or = 0.01), more lane boundary crossings (r(24) = -0.54, p < or = 0.01), and longer braking response times (r(24) = -0.60, p < or = 0.01) for the patient group. CONCLUSION: Reduced contrast sensitivity may be important in indicating the level of driving skills for individuals with glaucoma, who have normal or near-normal visual acuity and mild to moderate visual field loss.     

Cases from the Osler Medical Service at Johns Hopkins University. Herpetic keratitis

Presenting features

A 38-year-old man with a history of intravenous drug use was admitted to the hospital for treatment of an arm abscess. He noted that his right eye was “blood shot” and painful, but denied recent ocular trauma. He had photophobia and felt that his vision had become worse. Physical examination revealed a red right eye; there was hyperemia of the conjunctiva without surrounding vesicles, and the cornea was cloudy (Figure 1). Visual acuity was normal in the left eye but decreased (20/200) in the right eye. Fundoscopic examination was otherwise unremarkable. The rest of the physical examination was normal except for a tender painful swelling and cellulitis on the left forearm. Laboratory findings revealed antibodies to human immunodeficiency virus (HIV).What is the diagnosis?     

Homocysteine levels and decline in physical function: MacArthur Studies of Successful Aging

PURPOSE: To test whether elevated homocysteine levels are associated with an increased risk of decline in physical function in older persons. METHODS: We performed a prospective cohort study of 499 highly functioning men and women aged 70 to 79 years who were enrolled in the MacArthur Studies of Successful Aging. We measured total homocysteine levels and performance-based physical function at baseline; physical function measures were repeated an average of 28 months later. A summary measure of physical performance from tests of balance, gait, lower body strength and coordination, and manual dexterity was developed, and a change score was calculated as the difference in scores from 1988 to 1991. RESULTS: The mean (+/-SD) homocysteine level was 11.6 +/- 4.3 micromol/L. With each SD increase in homocysteine, there was an increased risk of being in the worst quartile of decline in physical function (odds ratio = 1.5; 95% confidence interval: 1.2 to 1.9) in analyses that adjusted for age, sex, baseline physical performance, smoking status, vitamin B(12) levels, and incident stroke. Similar results were seen when change in physical performance was treated as a continuous variable. CONCLUSION: Older persons with elevated plasma homocysteine levels are at an increased risk of decline in physical function.     

Cases from the Osler Medical Service at Johns Hopkins University: cardiac valvular lesions in Wegener's granulamatosis

Presenting features

A 65-year-old man presented to the emergency department with hemoptysis and hematuria. During the preceding 3 weeks, he had developed fevers, weakness, and myalgias that were increasingly debilitating. He subsequently developed frank hemoptysis and gross hematuria over 3 days. He denied contact with persons who were ill, recent travel, or dental procedures. His past medical history was unremarkable except for elevated serum cholesterol levels, for which he had been taking simvastatin for many years.On presentation, he was acutely ill, with a temperature of 38.8°C, a pulse of 90 beats per minute, a blood pressure of 132/88 mm Hg, and a respiratory rate of 18 breaths per minute. Examination of the head and neck revealed episcleritis and no oral ulcers. Examination of the heart was normal. Chest examination demonstrated bilateral coarse breath sounds with diffuse rhonchi. Skin examination revealed palpable purpura over the extensor surface of the right elbow.Laboratory studies included the following values: serum urea nitrogen, 158 mg/dL; creatinine, 11.7 mg/dL; total leukocyte count, 16.1 × 10³/mL; and erythrocyte sedimentation rate, >130 mm/h. Urinalysis was notable for 35 red blood cells per high-power field. A chest radiograph showed patchy infiltrates in the right upper and lower lobes. An electrocardiogram (ECG) revealed normal sinus rhythm at a rate of 94 beats per minute with normal intervals.The patient was admitted to the hospital with a presumptive diagnosis of vasculitis. He was treated with broad-spectrum antimicrobial agents, prednisone, and cyclophosphamide, in addition to beginning hemodialysis. Antimicrobial therapy was discontinued when blood cultures remained negative at 48 hours. The clinical diagnosis of Wegener’s granulomatosis was confirmed by an antinuclear cytoplasmic antibody titer of 1:80 and antiproteinase 3 (PR3) antibodies of 143 units (positive >30 units). A skin biopsy specimen demonstrated a small vessel vasculitis consistent with the diagnosis.The patient’s symptoms improved gradually, and he was discharged on day 13 with outpatient hemodialysis. During the next 3 days, his strength increased, and he was able to walk longer distances. On the fourth day after discharge, he suffered a ventricular tachycardic arrest at the initiation of hemodialysis. He was admitted to the intensive care unit after a prolonged resuscitation effort, but he remained unresponsive. His ECG was unchanged, and troponin I assay did not suggest myocardial infarction. Blood cultures remained negative. A transthoracic echocardiogram demonstrated normal left ventricular function and no valvular abnormalities. After 10 days, he showed no neurologic improvement. The family decided to withdraw ventilatory support, and he died quickly.What is the diagnosis?     

Single-chain antigen recognition receptors that costimulate potent rejection of established experimental tumors

Tumor cells are usually weakly immunogenic as they largely express self-antigens and can down-regulate major histocompatability complex/peptide molecules and critical costimulatory ligands. The challenge for immunotherapies has been to provide vigorous immune effector cells that circumvent these tumor escape mechanisms and eradicate established tumors. One promising approach is to engineer T cells with single-chain antibody receptors, and since T cells require 2 distinct signals for optimal activation, we have compared the therapeutic efficacy of erbB2-reactive chimeric receptors that contain either T-cell receptor zeta (TCR-zeta) or CD28/TCR-zeta signaling domains. We have demonstrated that primary mouse CD8(+) T lymphocytes expressing the single-chain Fv (scFv)-CD28-zeta receptor have a greater capacity to secrete Tc1 cytokines, induce T-cell proliferation, and inhibit established tumor growth and metastases in vivo. The suppression of established tumor burden by cytotoxic T cells expressing the CD28/TCR-zeta chimera was critically dependent upon their interferon gamma (IFN-gamma) secretion. Our study has illustrated the practical advantage of engineering a T-cell signaling complex that codelivers CD28 activation, dependent only upon the tumor's expression of the appropriate tumor associated antigen.     

Fracture of dental implants: literature review and report of a case

Fracture of dental implants is a rare phenomenon with severe clinical results. In this article, the literature is reviewed and various causative factors that may lead to fracture are presented. Galvanic activity has not been mentioned before as a possible cause for implant fracture, yet, it can occur at the level of contact with the superstructure. This is illustrated by the case of a titanium implant restored with a non-precious porcelain-fused-to-metal cemented crown that fractured 4 years after loading. The radiographs show alveolar bone resorption around the fixture. Metallurgical analysis of the implant indicated that the fracture was caused by metal fatigue and that the crown metal, a nickel-chromium-molybdenum alloy, exhibited corrosion. These findings suggest a new explanation for implant fractures; cytotoxic nickel ions, leaching from the base metal alloy may cause bone resorption. This in turn leads to increased mobility, facilitating washout of the luting cement. Contact of the base metal with titanium in the presence of oral fluids produces galvanic currents that hasten corrosion and leaching out of nickel ions, thus leading to further bone resorption. Loss of bone support allows lateral bending moments that cause metal fatigue, eventually leading to fracture. Therefore, good treatment planning and appropriate case selection might have prevented this fracture. Furthermore, the use of nonprecious metal alloy for the crown's infrastructure had further contribution to the chain of events that led to the implant's fracture.