Gastrointestinal symptoms and use of medical care associated with child day care and health care plan among preschool children.

OBJECTIVES: This study examined whether out-of-home day care increases the risk of gastrointestinal symptoms for children <6 years of age and whether there is an association between gastrointestinal symptoms and medical care utilization. METHODS: The study population comprised members of 2 health plans residing in 2 South Carolina counties: 417 families from an health maintenance organization (HMO) plan; and 643 families from a Medicaid plan. Participants were followed for 18 months by either bimonthly telephone interviews or personal interviews. The survey/interview collected familial, personal, day-care and disease-related information and medical care utilization. The analyses controlled for both family characteristics and the type of health care plan. RESULTS: Children attending out-of-home day care had higher incidence rates for most gastrointestinal symptoms studied than did children staying at home (2.51 vs. 1.61 episodes of mild gastrointestinal symptoms and 1.63 vs. 1.08 episodes of moderate gastrointestinal symptoms for the HMO group; 1.72 vs. 1.28 episodes of moderate gastrointestinal symptoms for the Medicaid group). Nearly one-fourth of the annual physician visits by children younger than 6 years were attributed to gastrointestinal symptoms, and more than one-fourth of the children with gastrointestinal symptoms were prescribed antibiotics. When displaying gastrointestinal symptoms, children in the Medicaid group were significantly more likely to visit a doctor and receive antibiotics than those in the HMO group. CONCLUSIONS: Although the type of health plan has negligible influence on the frequency of reported gastrointestinal symptoms, it exerts a strong influence on medical care utilization.     

Intravitreal chemotherapy for the treatment of recurrent intraocular lymphoma

AIM: To develop and assess a protocol for the treatment of intraocular lymphoma by intravitreal injection of methotrexate and thiotepa. METHODS: A patient with intraocular non-Hodgkin's lymphoma which recurred after radiotherapy and repeated systemic chemotherapeutic regimens underwent repeated intravitreal injections of methotrexate and thiotepa. The patient was closely monitored by cytology, anterior chamber flare measurements, IL-10 and IL-6 levels. Methotrexate drug clearance studies were performed on vitreous samples taken before each injection. RESULTS: Complete tumour clearance was achieved by the third week of therapy. IL-10 and IL-6 levels quickly dropped to barely detectable levels as the tumour was cleared from the eye. Flare measurements decreased from 500 to 15 photons/s over the same time. A plot of the methotrexate levels over time revealed a first order kinetic rate of elimination with an effective tumoricidal intravitreal dose persisting for 5 days after injection. CONCLUSION: Intravitreal chemotherapy for the treatment of recurrent intraocular lymphoma appears effective in prolonging local remission of ocular disease even in the presence of an aggressively growing tumour. A single intravitreal injection of methotrexate can lead to a prolonged tumoricidal concentration lasting for a longer period than that achieved by systemic administration.     

Changes in normal speech after fatiguing the tongue.

Detrimental effects of tongue fatigue on speech have been assumed to exist based on neuromotor speech disorders. However, to address whether fatigue is a contributing cause to impaired speech requires an experimental protocol with an uncomplicated population. This study induced tongue fatigue in eight neurologically normal persons and examined changes in speech perceptually and acoustically. The fatigue task consisted of repeated cycles of 6 s of sustained maximum voluntary contraction and 4 s of rest until 50% of maximum strength could not be achieved for three consecutive cycles. Participants then produced speech that was weighted heavily with lingual-palatal consonants. Perceptual analyses of the speech revealed a statistically significant deleterious effect of induced tongue fatigue on speech precision and an incomplete reversal of this effect after a recovery period. Acoustically, the first and third spectral moments (mean and skewness) of the spectral energy for /see text/, /see text/, and /see text/ differed significantly after fatigue but in directions opposite to a priori predictions. Tendencies were found for decreased stop-closure duration and increased voice onset time for /see text/ after fatigue. Supplemental analyses revealed decreased second formant (F2) frequency for /see text/ and /see text/ and flattened F2 transition for the diphthong /see text/ after fatigue. These results indicate disruption of tongue positioning and transitioning for lingual-palatal consonants during speech after prolonged strenuous tongue exercises.     

Whole abdominal radiotherapy following second-look laparotomy for ovarian carcinoma.

AIM: The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed. METHODS: Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded. RESULTS: Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival. CONCLUSION: In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.     

鼻阻力测压与鼻声反射测量的相关性研究

目的探讨主动后鼻阻力测压仪的参数——鼻阻力(nasal resistance,NR)与鼻声反射测量仪的参数——鼻腔容积(nasal cavity volume,NV)、鼻腔最小横截面积(minimal cross sectional area,MCSA)间是否具有相关性。方法应用主动后鼻阻力测压法和鼻声反射测量法对316例有鼻阻塞的患者进行前瞻性研究。根据减充血前双侧鼻阻力(bilateral NR,BNR)将患者分为2组,组1:BNR减充血前≤0.25 Pa/cm~3·s,组2:BNR减充血前>0.25 Pa/cm~3·s。Spearman等级相关分析研究上述两种客观测量法的参数在全体研究对象及各组中的相关性。结果在使用减充血剂前、后,316例患者单侧鼻阻力(unilateral NR,UNR)与单侧鼻腔容积(unilateral NV,UNV)、单侧鼻腔最小横截面积(unilateral MCSA,UMCSA)间均存在显著性负相关(P值均=0.000);组1(104例)和组2(212例)在减充血前、后的UNR与UNV、UMCSA间均存在显著性负相关(P值均=0.000)。鼻阻力与鼻腔最小横截面积的相关系数均大于鼻阻力与鼻气道容积的相关系数。结论在有鼻阻塞的患者中,NR、NV及MCSA存在负相关,MCSA是影响NR的主要因素。     

New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty has been performed in the United States in an increasing volume since the mid-1990s. The purpose of this study is to analyze the risk of a new symptomatic vertebral compression fractures within 1 year of having an acute/subacute fracture treated with vertebroplasty. METHODS: A retrospective analysis was performed in which 253 female patients were found to have acute/subacute vertebral compression fractures secondary to osteoporosis treated with percutaneous vertebroplasty. Occurrences of new symptomatic vertebral compression fractures were recorded for a year following initial vertebroplasty. RESULTS: Fifty-five patients (21.7%) of the 253 osteoporotic women with one or more initial fractures experienced a new symptomatic vertebral compression fracture within 1 year. CONCLUSION: Roughly one-fifth of osteoporotic women with acute/subacute fracture treated with vertebroplasty will have a subsequent fracture within 1 year.     

The use of laboratory intervention to stem the flow of fresh-frozen plasma

Four methods of laboratory intervention were tested by the hospital blood bank in an effort to modify the use of fresh-frozen plasma (FFP). Over a one-year period, a utilization audit was serially initiated with feedback to physicians, a recurrent educational program was introduced for housestaff delineating guidelines for FFP use, a form was introduced requiring justification for FFP orders, and a policy was established requiring pathologist approval of FFP in patients with normal or no coagulation studies. Overall, in comparing the period following all forms of intervention (February 1986-October 1986) to the baseline period prior to any form of intervention (July 1984-March 1985), FFP use dropped 52% in the face of a 17% increase in red blood cell use. It was concluded that blood bankers can dramatically alter the use of this product using established methods for modifying physician ordering behavior.     

Effect of immunomodulating and antiviral agent of medicinal mushrooms (immune assist 24/7) on CD4+ T-lymphocyte counts of HIV-infected patients

Immune enhancement through the use of natural products is a potentially valuable therapeutic modality in HIV-infected people, especially those who are not good candidates for aggressive ARV therapy. One such immune enhancement, a medicinal mushroom product from the United States, is Immune Assist 24/7. In this study the effect of Immune Assist 24/7, which is a naturally derived immune-modulating and antiviral agent, on CD4+ T-lymphocyte counts was evaluated in 8 HIV-infected patients at the Sunyani Regional Hospital (Ghana). The subjects were administered three tablets of 800 mg Immune Assist 24/7 once daily (2.4 g/day) and peripheral blood samples were drawn at baseline, day 30, and day 60, and the CD4+ count measured. The study revealed that Immune Assist 24/7, used as a sole therapeutic agent without additional ARV drugs, significantly increased CD4+ T-lymphocyte populations in all of the patients. In one patient, the CD4+ T-lymphocyte count went from 4 at the baseline, to 170 cells in 60 days, representing an increase of more than 4000%. In another patient, the CD4+ count went from 88 to 470 cells within the same period. Even in the patients with the highest CD4+ counts of around 800, there was a significant elevation in the CD4+ count noted. This study did not deal with the effect of Immune Assist 24/7 on other immune parameters such as CD3+ T-lymphocyte count, natural killer cells count, or viral load among HIV-infected patients. These initial results are promising, and indicate the potential value of further evaluating the effects of Immune Assist 24/7 on other immune parameters and viral load among HIV patients, administered either as a sole therapeutic agent, as an adjuvant with standard ARV therapy, or in comparison with standard ARV therapy alone.