Alan Gregg and the rise of general hospital psychiatry

The authors review the forces that encouraged the entry of psychiatry into the general hospital in the 1930s. Those forces, which included concern about increasing health care costs, pressure to reform medical and psychiatric education, and the growth of dynamic psychiatry and psychosomatic medicine, are described. The activities of Alan Gregg, Director of the Medical Sciences Division of the Rockefeller Foundation during that era are highlighted. Gregg encouraged research in neurobiologic correlates of psychiatric illness and funded psychiatric units in eight general hospitals in the United States. The authors suggest that the development of general hospital psychiatry was strongly influenced by Alan Gregg and his support for a medical model of psychiatric illness. In addition to other forces that spurred the growth of general hospital psychiatry, the authors suggest that Gregg's influence significantly aided psychiatry's entrance into the general hospital.     

Detection of Trichomonas vaginalis in pregnant women with the InPouch TV culture system.

Trichomonas vaginalis causes a common genitourinary infection which is frequently asymptomatic. At present, pregnant women are not usually screened for the infection unless they are symptomatic. In the present study, we screened and obtained samples for culture from all pregnant women attending a prenatal clinic with the InPouch TV culture system and compared results with those of standard culture in Diamond's medium and slide wet mount examination. The InPouch TV culture system was as reliable as Diamond's medium in detecting T. vaginalis and may be useful and effective in a pregnancy clinic setting.     

Degradation of Soluble Immunoglobulin Aggregates in Vitro by Monocytes from Normal Subjects and from Patients with Systemic Lupus Erythematosus

The capacity of human peripheral monocytes to degrade soluble immunoglobulin (IgG) aggregates (AIgG) was studied in vitro. Under serum-free conditions peripheral monocytes from normal donors were able to degrade soluble AIgG in a linear and time-dependent fashion. Addition of fresh human or fresh guinea-pig serum to the incubation mixtures caused a marked increase in degradation of the amount of soluble AIgG available. The stimulatory effect of fresh serum was complement-mediated, because it was abolished by heat treatment of the serum and was not seen when C4- or C3-deficient sera were tested. Functional inactivation of C3 receptors on the phagocytes by trypsin also abolished the complement-mediated stimulation, suggesting cooperation between Fc and C3 receptor in degradation of soluble AIgG. No significant differences were found between monocytes from normal donors and those from patients with systemic lupus erythematosus, as far as degradation is concerned in the presence of complement.     

Long-term functional results following resection of neonatal sacrococcygeal teratoma

Purpose  Sacrococcygeal teratoma (SCT) is the most common congenital neoplasm in neonates. We wished to assess the long-term functional outcome of children undergoing SCT resection. Methods  Records of neonates diagnosed with SCT from two surgeons’ practices, and operated on between 1970 and 2006, were retrospectively reviewed. Patients/parents who consented to participate in the study received a questionnaire, focusing on fecal and urinary continence, constipation and lower extremity weakness. Results  Forty-six patients were identified. Four had died (3 from malignant tumors and 1 motor vehicle accident at 18 years). Of the 42 remaining cases, 39 were benign and 3 were malignant; 2 of the former developed malignant recurrences. Twenty-seven agreed to participate and 14 (52%) completed the questionnaire. Median age of respondents was 16.7 years (3–29), and none of the respondents had a recurrent tumor. Thirteen of the 14 respondents experienced no problem with urinary or fecal incontinence, or lower extremity weakness. The remaining patient had all three problems, but his SCT had involved the spinal cord. Of the ten patients who commented on constipation, one had significant constipation, five occasional constipation, and four no constipation. Conclusions  Functional results after resection of neonatal SCT are excellent, with only a small number of patients reporting problems with fecal or urinary continence, or lower extremity weakness. Constipation is relatively common. This information is important for counseling families with fetal or neonatal SCT.     

Prompt initiation of ART With therapeutic food is associated with improved outcomes in HIV-infected Malawian children with malnutrition

This retrospective observational study of 140 HIV-infected children with uncomplicated malnutrition in urban Malawi tested the hypothesis that initiation of antiretroviral therapy (ART) within 21 days of outpatient therapeutic feeding (prompt ART) improved clinical outcomes. Children receiving prompt ART were more likely to recover nutritionally (86% vs. 60%, P < 0.01) and had higher rates of weight gain (3.6 vs. 1.6 g/k/day; P = 0.02). Logistic regression modeling found prompt ART was associated with increased likelihood of nutritional recovery (odds ratio: 5.4, 95% confidence interval: 2.0 to 14.5). This suggests that prompt ART is associated with improved outcomes in HIV-infected Malawian children with uncomplicated malnutrition.     

Biochemical study and in vitro insect immune suppression by a trypsin‐like secreted protease from the nematode Steinernema carpocapsae

A trypsin‐like serine protease was purified by gel filtration and anion‐exchange chromatography from the excretory‐secretory products of parasitic phase Steinernema carpocapsae. The purified protease exhibited a molecular mass of about 29 kDa by SDS–PAGE and displayed a pI of 6·3. This protease exhibited high activity with trypsin‐specific substrate N‐Ben‐Phe‐Val‐Arg‐p‐nitroanilide and was highly sensitive to aprotinin and benzamidine. The purified trypsin protease digested the chromogenic substrate N‐Ben‐Phe‐Val‐Arg‐p‐nitroanilide with K_m, V_max and k_cat values of 594·2 μm , 0·496 μm /min and 22·8/s, respectively. The optimal pH and temperature for protease activity were 9 and 30°C, respectively. Internal amino acid sequencing yielded 150 amino acids and these were homologous to other trypsin sequences. In vitro investigation was carried out to monitor prophenoloxidase suppression in Galleria mellonella by the purified protease; about 38·9–52·6% suppression of prophenoloxidase was observed. The purified protease affected insect haemocyte spreading, causing cells to become spherical or round. Protease‐treated actin filaments were highly disorganized in haemocytes. In vitro, G. mellonella haemocytes recognized infective juveniles of Heterorhabditis bacteriophora; however, S. carpocapsae and Steinernema glaseri were not recognized. We provide experimental evidence that the purified trypsin has the potential to alter host haemocytes, actin filaments and to inhibit host haemolymph melanization.     

Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy

Background:  Sensitization to rats and mice can develop in laboratory animal workers exposed to only one species. Reasons for this dual sensitization are unclear but may reflect a genetic predisposition to developing allergy (atopy) or alternatively cross-reactivity between rat and mouse urinary allergens. We examined cross-reactivity between rat and mouse urine and the effect atopy has on dual sensitization in laboratory animal workers.
Methods:  In a cross-sectional study the frequency of sensitization to rat and/or mouse was analysed in 498 employees exposed to both rat and mouse at work and 220 to rat only. RAST inhibitions, western blots and blot inhibitions were carried out on a subset of five individuals to assess cross-reactivity.
Results:  Fourteen per cent of workers were sensitized to rats and 9% to mouse. Over half (62%) of rat sensitized individuals were also mouse sensitized and the majority (91%) of mouse sensitized individuals were also rat sensitized. IgE cross-reactivity was demonstrated between rat and mouse urine using RAST inhibitions. Rates of atopy did not differ between rat only sensitized individuals compared with those sensitized to both species. Sensitization to cats and rabbits was more common amongst those with dual sensitization.
Conclusions:  Dual sensitization to rat and mouse reflects IgE cross-reactivity rather than atopy. Individuals with dual sensitization are more likely to be sensitized to other animal allergens. These findings will have implications for individuals working with only one rodent species who develop sensitization and symptoms to be aware of the potential for allergy to other species.