High levels of impulsivity may contraindicate midazolam premedication in children

PURPOSE: To investigate the effects of midazolam on emotional reactivity during induction of anesthesia in a pediatric day surgery setting. A secondary purpose was to determine if these effects were influenced by child temperament factors. METHODS: Forty children (age four to six years) scheduled for myringotomy were randomly assigned, in a double blind fashion, to receive either oral midazolam 0.5 mg.kg-1 mixed with acetaminophen suspension or acetaminophen alone. The Emotionality, Activity, Sociability, and Impulsivity (EASI) scale was used as a measure of child temperament. The modified Yale Preoperative Anxiety Scale (m-YPAS), an observer-rated measure of state anxiety, was employed to assess anxiety pre- and post-drug, and also at induction of anesthesia. RESULTS: Children who received midazolam reacted significantly less to induction of anesthesia than did children in the placebo control group, F (1, 38) = 7.46, P = 0.01. A significant positive association was observed between baseline levels of anxiety and observer-rated anxiety at anesthetic induction, but only in the placebo group, r = 0.58, P < 0.01. A significant positive association was observed between levels of impulsivity at baseline and observer-rated anxiety at anesthetic induction, but only in the midazolam group, r = 0.42, P < 0.05. CONCLUSIONS: Midazolam dampened adverse reactivity during anesthetic induction, particularly among children with high baseline levels of anxiety. Baseline level of impulsivity was positively associated with adverse reactions to anesthesia induction in the drug group, but not in the placebo group, suggesting that high levels of trait impulsivity may contraindicate the use of midazolam as a preoperative medication.     

Immunogenicity of a 48-Kilodalton Recombinant T-Cell-Reactive Protein of Coccidioides immitis

The outcome of coccidioidomycosis depends to a large extent on the effectiveness of the T-cell-mediated immune (CMI) response to the fungal pathogen. For this reason, identification of Coccidioides immitis antigens which stimulate T cells is important for understanding the nature of host defense against the organism and essential for the development of an effective vaccine. Here we describe the immunogenicity of a 48-kDa T-cell-reactive protein (TCRP). The antigen is expressed by parasitic cells and localized in the cytoplasm. It stimulates the proliferative response and production of gamma interferon by T cells of mice immunized with C. immitis spherules. Specific antibody reactive with the recombinant TCRP (rTCRP) was detected in sera of patients with confirmed coccidioidal infection, and the highest titers of antibody to the recombinant protein correlated with elevated titers to the serodiagnostic complement fixation antigen of C. immitis. These results suggest that the TCRP is presented to the host during the course of infection. Immunization of BALB/c and C3H/HeN mice with the rTCRP affords a modest but significant level of protection against an intraperitoneal challenge with C. immitis. It is suggested that the rTCRP may be able to contribute to a multicomponent vaccine designed to stimulate CMI response against the parasitic cycle of C. immitis.     

Relationship between cup-disc ratio and optic disc diameter: The Blue Mountains Eye Study

Purpose: To determine the effects of optic disc size on vertical cup-disc ratio in subjects free of glaucoma and other optic nerve disease. Methods: Data were collected from 3654 people, 49 years of age or older; living in the Blue Mountains, west of Sydney (NSW, Australia). Examinations performed included subjective refraction and Zeiss colour stereo optic disc photographs. Eye and camera magnification effects were corrected. Results: Mean vertical disc diameter was 1.51 mm (95% confidence interval (CI) 1.504-1.516 mm) and the mean vertical cup-disc ratio was 0.43 (95% CI 0.425-0.435). Both parameters were distributed unimodally. The cup-disc ratio was strongly associated with disc diameter Controlling for other variables, cup-disc ratio increased 0.270 (95% CI 0.250-0.290) per mm increase in disc diameter Conclusions: Vertical optic disc diameter and cup-disc ratio are distributed near normally in older Australians. Optic discs with larger vertical diameters have considerably greater vertical cup-disc ratios.     

Polystyrene Bezoar in a Patient with Polystyrenomania

A 35-yr-old man with hematemesis, epigastric pain, and no predisposing factors to delayed gastric emptying was found to have a gastric bezoar. Surgical removal was required. Pathological and biochemical examination revealed a mass composed of polystyrene. This represents an unusual composition and a newly recognized predisposing factor to bezoar formation, "polystyrenomania" from ingestion of styrofoam cups.     

The Spectrum of Chronic Liver Disease in Renal Transplant Recipients

Chronic liver disease has been reported to be an important causeof late morbidity and mortality in renal transplant recipients.We have examined the prevalence and nature of chronic liverdisease among 538 patients with functioning renal allograftsmanaged at the Western Infirmary, Glasgow, between 1980 and1989. Thirty-seven patients (7 per cent) satisfied biochemicalcriteria for chronic liver dysfunction. Liver biopsies wereobtained from 24 of these, and autopsy tissue was availablefrom three other patients. Chronic hepatitis of variable severitywas present in 15 patients, haemosiderosis in 12 patients andnodular regenerative hyperplasia in five patients. Nineteenpatients (51 percent) had serological evidence of infectionwith the hepatitis C virus, and one of these developed chronichepatitis B and D infection as well. Although a variety of chronicliver diseases occurred in our transplant population, the frequencyof serious sequelae from liver dysfunction was much lower thanthat reported from transplant centres in other countries.     

Treatment of exposed bilateral Achilles tendons with use of the Dynasplint. A case report

Third- and fourth-degree burns, which extend beyond the layers of the skin, are the most severe and difficult to rehabilitate. In this case report, a patient's recovery from exposed Achilles tendons bilaterally secondary to a severe burn injury is described. The Dynasplint, a spring-loaded orthosis designed to deliver a low-load, prolonged stretch to healing connective tissue, was used to facilitate the patient's recovery from an initial loss of -29 and -27 degrees of dorsiflexion of the right and left ankles, respectively. The patient's progress is reported from bed rest to independent ambulation at the time of discharge from the hospital.