The infant with possible biliary atresia: Evaluation by ultrasound and nuclear medicine

Twenty-eight infants with jaundice were evaluated with ultrasound and radionuclide scans. Comparison of these studies with pathologic, surgical and clinical examinations demonstrated good correlation between ultrasonic and radionuclide studies. Ultrasound is an important preliminary study in the workup of such patients. Combined imaging provides the most information in a patient with suspected biliary atresia.     

Patients' views of the burden of asthma: a qualitative study

OBJECTIVES: To explore the burden of asthma on the lives of people presenting to hospital emergency departments for asthma treatment. DESIGN: A qualitative study. Consenting individuals with asthma who presented to emergency departments were interviewed in-depth, and interviews were taped, transcribed and thematically analysed. Questionnaire data on medication use, respiratory health and asthma knowledge were also collected. Asthma severity was determined from the medical records. SETTING: A tertiary teaching hospital and a suburban hospital during March and April 2000, and a rural hospital during July and August 2000. PARTICIPANTS: Sixty-two participants (19 male and 43 female), aged 18-70 years. RESULTS: The burden of asthma was broad, affecting social life, personal relationships, employment and finances. The cost of asthma medication was an issue for nearly two-thirds of participants. Individuals performed their own "cost-benefit analysis" for medication use, weighing up expense, perceived side effects and potential benefits. As a consequence, several participants chose to alter their medication dose, or not to take prescribed medications. For some participants, asthma directly contributed to diminished employment opportunities. CONCLUSIONS: To achieve a therapeutic partnership, doctors need to be aware of the substantial social, personal and financial burden of asthma for their patients. They should also recognise that patients' perceptions of treatment cost may compromise treatment adherence.     

Bone resorption in cholesteatoma: Epithelial-mesenchymal cell interaction and collagenase production

Clinical evidence has shown that chronic otitis media with cholestentoma causes greater bone resorption than otitis media without cholesteatoma. What is the role of the epithelium and its products on the morbidity of cholesteatoma? We have studied the mechanism of collagenase production in cultures of rat epidermal cells and skin fibroblast-like cells under various conditions. The epithelial cells significantly induced mesenchymal cells to produce collagenase. We conclude that interaction between epithelial cells and fibroblast-like cells enhances production of collagenase. This enhancement of proteolytic activity may be crucial in the series of molecular events resulting in bone resorption associated with cholesteatoma.     

Cavitation of anterior mediastinal masses in children with histiocytosis-X

Four children with histiocytosis-X had large solid mediastinal masses at diagnosis. Follow-up studies in three showed large air cysts occupying the sites of the original masses; the fourth patient had small air cysts at the periphery of the mass. All patients survived. One patient was explored and the large air cysts were in the mediastinum with adherence to the adjacent lung. Lesser pulmonary involvement was noted in the lungs of three of the four patients. Cavitation within mediastinal masses in histiocytosis-X appears to reflect two processes. The first is necrosis within the masses themselves. The second is involvement of adjacent lung with adherence of lung and pleura to the mediastinum allowing air to fill the mediastinal cavities. Presented at the Society for Pediatric Radiology Meeting, Las Vegas, Nevada, March 1984     

The latest trends in the taste assessment of pharmaceuticals

To date, the most widely used method for measuring the taste characteristics of pharmaceutical preparations is psychophysical evaluation by a taste panel. However, conventional chemical analyses, on the basis of release studies, have been shown to be useful subsidiary methods. More recently, novel in vitro taste assessment apparatus and methodologies have been developed for high-throughput taste screening and quality control. Biomimetic taste sensing systems (BMTSSs), such as multichannel taste sensors or electronic tongues with global selectivity, have been welcomed by both pharmaceutical scientists and the industry as a whole. As we discuss here, the emerging in vitro approaches for assessing taste characteristics of taste masked drug and drug products will result in a decreased reliance on human panel tests.     

Cardiac sequelae in Brooklyn after the September 11 terrorist attacks

BACKGROUND: Terrorism, such as the attacks on the World Trade Center (WTC) on September 11, 2001, result in higher stress-related disorders, especially in those persons in close proximity. HYPOTHESIS: Cardiac events resulting from the September 11, 2001 tragedy have not been detailed near the WTC. METHODS: Patients admitted to the Telemetry and Coronary Care Units at New York Methodist Hospital 4 miles from the WTC 60 days prior to and after the September 11 attacks were analyzed. In all, 1,653 admissions were reviewed: 427 records pre 9/11/2001 and 422, 393, and 411 records in the post-9/11/2001, pre-9/11/2000, and post-9/11/2000 data sets, respectively. Patients were categorized based on diagnosis: acute myocardial infarction (MI), unstable angina (UA), tachyarrhythmia (TA), and others (including syncope and congestive heart failure). RESULTS: There was a significant difference in the proportion of the various cardiac diagnoses post 9/11/01 (p = 0.008 by chi-square analysis). Compared with pre 9/11/2001, there were significantly more patients with acute MI (15.5 vs. 11.2%) and TA (19.9 vs. 13.6%) but fewer with UA (39.6 vs. 47.3%) after the terrorist attacks. The distribution of cardiac events during a similar period of time in 2000 revealed no such pattern. CONCLUSIONS: There was a significant increase in acute MI and TA and a smaller increase in UA after the September 11 attacks. The difference did not appear to be due to temporal variation. It appears that stress likely contributed to an increase in TA by itself or with ischemia, resulting in progression of UA to acute MI.