Effect of estradiol on chlamydial genital infection of female guinea pigs.

Female guinea pigs were treated daily with 1 mg of beta-estradiol-3-benzoate intramuscularly beginning 14 days before intravaginal inoculation with the chlamydial agent of guinea pig inclusion conjunctivitis and continuing during the course of the infection. Treatment with estradiol was found to markedly influence the course of genital infection with the chlamydial agent of guinea pig inclusion conjunctivitis, producing infections of greater intensity and longer duration than those in control animals. Moreover, pathogenesis was altered in that ascending infection was observed, resulting in endometritis, cystic salpingitis, and cystitis. Infection in the controls was limited to the cervix and vagina. Estradiol treatment increased the apparent number of infected cells in the cervix and vagina as detected by histopathology and immunofluorescent staining. Humoral and cell-mediated immune responses to the chlamydial agent of guinea pig inclusion conjunctivitis were comparable in estradiol-treated and untreated animals. These data indicate that hormonal manipulation may have profound effects on the course of chlamydial genital infections.     

Paradoxical excitement to sedative-hypnotics in mentally retarded clients

The relationships among "paradoxical" excitement to sedative--hypnotic medication, self-injurious behavior, and perinatal trauma were evaluated. Mentally retarded patients were classified as either paradoxical or normal responders to sedative-hypnotics. Paradoxical responders to these medications have a lower MA, a history of perinatal trauma, self-injurious behavior (SIB), and aggressive behavior when compared to normal responders. These findings confirmed and extended previous reports that a type of SIB may be indexed by paradoxical response to sedative-hypnotics. Results also suggested that perinatal trauma may be of etiological importance in the development of SIB. Because perinatal trauma or fetal distress results in excessive levels of B-endorphin, in utero, an impaired endogenous opiate system may be a critical factor maintaining a syndrome of SIB. Thus, these data may indicate psychopharmacological markers of SIB that may have both treatment and etiological significance.     

Perioperative transfusions associated with colorectal cancer surgery : Clinical judgment versus the hematocrit

We prospectively studied 123 patients with colorectal cancer in order to identify determinants of perioperative blood transfusions and unnecessary transfusions. Transfusions were considered unnecessary if the preoperative hematocrit reading exceeded 36% or the discharge hematocrit level exceeded 33%. Age, sex, admission hematocrit reading, operative procedure, specimen length, duration of surgery, estimated blood loss, tumor size, tumor differentiation, nodal status, Dukes' staging, and attending surgeon were evaluated in relation to perioperative blood transfusion using stepwise logistic regression. Fifty-one (41%) of the 123 patients in the study were transfused and 35 patients (28%) received at least 1 unnecessary unit of blood. Advanced age, low admission hematocrit reading, high estimated operative blood loss, prolonged procedures, and lengthy specimens were significantly related to the administration of blood. Excessive intraoperative transfusions and the practice of administering blood in pairs of units accounted for the unnecessary transfusions. This study indicates that factors that influence clinical judgment and thereby the decision to transfuse a patient are not accurate indicators of when blood should be given. Greater use of pre-transfusion hematocrit testing, especially in the operating room and before transfusing a second unit of blood, will dramatically reduce blood usage in elective colorectal cancer surgery.

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Resumen Hemos estudiado en forma prospectiva 123 pacientes con cáncer colorrectal con el objeto de identificar factores determinantes de transfusiones sanguíneas perioperatorias y de transfusiones innecesarias. Se consideró que las transfusiones eran innecesarias si el hematocrito preoperatorio excedía 36% o si el hematocrito de egreso excedía 33%. La edad y sexo, el hematocrito de admisión, el tipo de procedimiento operatorio, la longitud del especimen resecado, la duración de la operación, la magnitud estimada de la pérdida de sangre, el tamaño del tumor, el grado de la diferenciación del tumor, el estado de los ganglios, la clasificación Dukes del tumor y el cirujano, fueron valorados en relación con el volumen de transfusión perioperatoria utilizando el método de regresión logística escalonada. Cincuenta y uno (41%) de los 123 pacientes fueron transfundidos y 35 (28%) recibieron por lo menos una unidad de sangre innecesaria. La edad avanzada, un hematocrito bajo en el momento de la admisión, la escimación de una alta pérdida de sangre, los procedimientos prolongados y los especimenes de gran longitud aparecieron como factores significativamente relacionados con la administracion de sangre. Las transfusiones intraoperatorias excesivas y la práctica de administrar sangre en pares de unidades fueron responsables de las transfusiones innecesarias. Este estudio indica que los factores que influencian el juicio clínico, y por consiguiente la decisión de transfundir a un paciente, no son indicadores precisos de cuando se debe administrar sangre. Una mayor utilización del hematocrito pretransfusión, especialmente dentro de la sala de operaciones y antes de transfundir una segunda unidad de sangre, logrará disminuir en forma dramática el uso de sangre en cirugía electiva para cáncer colorrectal.

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Résumé Les auteurs se sont livrés à une étude prospective de 123 malades atteints de cancer colorectal dans le but d'identifier les facteurs qui ont été à l'origine de transfusions pré-, per-, et postopératoires et de transfusions inutiles. Les transfusions ont été considérées comme inutiles lorsque l'hématocrite préopératoire dépassait 36 pour cent ou qu'il excédait 33 pour cent au moment de la sortie de l'opéré. Pour apprécier la valeur de la transfusion périopératorie ont été pris en compte les divers facteurs suivants : l'âge, le sexe, le taux de l'hématocrite à l'admission, le type de l'intervention, la longueur du spécimen, la durée de l'opération, la quantité de sang perdu, la taille de la tumeur, le degré de différenciation du cancer, l'état des ganglions, le stade évolutif (classification de Dukes), la qualification du chirurgien. Cinquante et un des malades (41%) furent transfusés et 35 parmi eux (28%) reçurent inutilement au moins une unité de sang. L'ae avancé de l'opéré, le taux bas de l'hématocrite à l'admission, la perte importante de sang au cours de l'intervention, la longue durée de l'opération, l'importance de la pièce opératoire réséquée furent en rapport de manière significative avec l'administration de sang. Les transfusions inutiles furent le fait de l'administration excessive de sang au cours de l'opération ou de l'emploi d'unités doubles de sang. Cette étude indique que les facteurs cliniques ne constituent pas des éléments de valeur pour déterminer l'indication de la transfusion de sang. C'est le taux de l'hématocrite avant et au cours de l'intervention qu'il faut prendre en compte. L'observation de cette règle est appelée à réduire considérablement l'emploi du sang au cours de la chirurgie colorectale élective.

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Supported by the Frieda and George Zinberg Foundation and NCI-NIH grant 1 RO1-CA-35558-01.     

Lack of effect of combined low intensity laser therapy/phototherapy (CLILT) on delayed onset muscle soreness in humans

BACKGROUND AND OBJECTIVES: This study, which was approved by the University's Ethical committee, was conducted to investigate the effectiveness of Combined Low Intensity Laser Therapy/Phototherapy (CLILT) in alleviating the signs and symptoms of Delayed Onset Muscle Soreness (DOMS) over an 11-day period. STUDY DESIGN/MATERIALS AND METHODS: Thirty-six subjects (18 M: 18 F) were randomly allocated, under strictly controlled double-blind conditions, to one of three experimental conditions: Control, Placebo, and CLILT (660-950 nm; 11 J/cm2; pulsed at 73 Hz). DOMS was induced in a standardised fashion in the non-dominant elbow flexors using repeated eccentric contractions until exhaustion was reached. Subjects returned on five consecutive days, and two days during the following week, for treatment according to group, and assessment of outcome variables including range of motion, pain, and tenderness. RESULTS: While analysis of results using repeated measures and one factor ANOVA with post-hoc tests showed significant changes in all variables over time (P < 0.05) as a result of the induction procedure, there were no significant differences observed between groups. CONCLUSIONS: CLILT failed to show any beneficial treatment effect on DOMS, at least at the parameters used here. These results therefore provide no evidence for the claimed biostimulating effects of such therapy.     

Untersuchung zur Kategorisierung des mandibulären Wachstumspotentials von Petrovic,Lavergne und Stutzmann

Zusammenassung In der vorliegenden Studie sollte untersucht werden, ob die vonPetrovic, Lavergne undStutzmann vorgeschlagene Kategorisierung des mandibulären Wachstumspotentials für die Behandlung mit dem Funktionsregler Geltung hat. Dazu wurden die Fernröntgenaufnahmen von 140 Patienten der Angle-Klasse II nach zirka zweijähriger Behandlung mit Funktionsreglern analysiert. Im Vergleich zu 133 unbehandelten Kindern mit Angle-Klasse II trat in fast allen Rotationsgruppen eine signifikant größere Zunahme der Unterkiefergesamtlänge ein. Zwischen der Kategorie 2 mit niedrigem Wachstumpotential und Kategorie 5 mit hohem Wachstumspotential wurden keine signifikant unterschiedlichen Zunahmen der Unterkieferlänge festgestellt.

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Summary The results of the study show whether the classification of mandibular growth potential, as proposed by Petrovic, Lavergne and Stutzmann has any influence on the treatment with a function regulator. X-rays of 140 class II patients were analysed after a treatment time of approximately 2 years. In comparison with 133 class II children without any treatment, a significant increase of the overall mandibular length was observed in almost all children treated. There was no significant difference in the increase of mandibular length between category 2 (low growth potential) and category 5 (high growth potential).

     

Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain

CONTEXT: Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown. OBJECTIVES: To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome. DESIGN: Prospective observational study. SETTING AND PATIENTS: A total of 434,877 patients with confirmed MI enrolled June 1994 to March 1998 in the National Registry of Myocardial Infarction 2, which includes 1674 hospitals in the United States. MAIN OUTCOME MEASURES: Prevalence of presentation without chest pain; clinical characteristics, treatment, and mortality among MI patients without chest pain vs those with chest pain. RESULTS: Of all patients diagnosed as having MI, 142,445 (33%) did not have chest pain on presentation to the hospital. This group of MI patients was, on average, 7 years older than those with chest pain (74.2 vs 66.9 years), with a higher proportion of women (49.0% vs 38.0%) and patients with diabetes mellitus (32.6% vs 25. 4%) or prior heart failure (26.4% vs 12.3%). Also, MI patients without chest pain had a longer delay before hospital presentation (mean, 7.9 vs 5.3 hours), were less likely to be diagnosed as having confirmed MI at the time of admission (22.2% vs 50.3%), and were less likely to receive thrombolysis or primary angioplasty (25.3% vs 74.0%), aspirin (60.4% vs 84.5%), beta-blockers (28.0% vs 48.0%), or heparin (53.4% vs 83.2%). Myocardial infarction patients without chest pain had a 23.3% in-hospital mortality rate compared with 9.3% among patients with chest pain (adjusted odds ratio for mortality, 2. 21 [95% confidence interval, 2.17-2.26]). CONCLUSIONS: Our results suggest that patients without chest pain on presentation represent a large segment of the MI population and are at increased risk for delays in seeking medical attention, less aggressive treatments, and in-hospital mortality. JAMA. 2000;283:3223-3229