Diagnosis of Huntington disease: A model for the stages of psychological response based on experience of a predictive testing program

Persons diagnosed as affected with Huntington's disease (HD) may have similar stages of psychological response to the clinical presentation of the illness. Here we describe a model of these stages of response based on our experience during a predictive testing program for HD. During the warning Stage, asymptomatic persons are aware of their risk status for HD and develop defenses which favor adaptation to their genetic risk. In response to the initial signs and symptoms of HD (the Incipient Stage) unconscious working through of this realization occurs while it is still kept out of conscious awareness. When symptoms become obvious such that recognition of disease onset is inevitable (Break-through Stage) the possibility of the diagnosis of HD is assimilated. After the delivery of the diagnosis during the Adjustment Stage, short-and long-term adaptive responses to living with HD occur. Recognition of the stage of psychological response of a patient who presents with HD is important prior to delivering a clinical diagnosis. In a significant minority of cases, the psychological readiness lags behind the clinical symptomatology and premature presentation of diagnosis may result in significant untoward adverse events. Understanding of the stages of response may provide a frame-work for evaluating the psychological state of the person with HD and determining their readiness to receiving the diagnosis. This model may have relevance to the psychological responses of patients to the diagnosis of other late onset autosomal dominant disorders. © 1993 Wiley-Liss, Inc.     

Treatment of experimental Escherichia coli infection in mice with colicine V.

Concentrated non-toxic preparations of colicine V were obtained by filtering centrifugates of soft-agar cultures of a Col V+ K12 strain of E. coli through Millipore filters in which the colicine V was retained. These preparations, given subcutaneously, favourably influenced the course of disease in mice infected intraperitoneally with a pathogenic strain of E. coli that was very sensitive to colicine V in vitro. A beneficial effect was noted even when treatment was delayed until the mice were visibly ill.     

Effects of extracorporeal circulation upon blood lipids

A lipid profile (total lipids, free fatty acids, triglycerides, and serum lipase) and evidence of fatty emboli were studied in patients undergoing cardiopulmonary bypass with median sternotomy or thoracotomy and with or without cardiopulmonary bypass. Although hyperlipemia developed in all patients, there was no statistical difference between the thoracotomy and median sternotomy groups. A marked rise in all four lipid profile factors occurred when both cardiopulmonary bypass and median sternotomy were utilized. Examination of the sputum and urine for evidence of fat and funduscopy for evidence of fat embolization proved to be useless. The postoperative rise in lipid profile factors showed no statistically significant effect on the incidence of neurological or pulmonary complications. A Pall blood filter was used in a second group of patients undergoing cardiopulmonary bypass, but the incidence of neurological or pulmonary complications was similar.     

Zur krebserzeugenden Wirkung von Aminophenanthrenen und ihren Derivaten

Zusammenfassung 1-, 2-, 3- und 9-Amino-phenanthren erzeugen nach Fütterung an weibliche Sprague-Dawley-Ratten Mammatumoren mit etwa gleicher Wirksamkeit. Von den entsprechenden Acetaminen ist nur 2-Acetaminophenanthren wirksam; 2-, 3- und 9-Aminophenanthren-N-dipropylphosphat sind unwirksam. — Im Injektionstest an der Maus (CF-1-Stamm, Versuchsdauer 250 Tage) zeigen von den genannten Verbindungen nur 3- und 9-Acetaminophenanthren eine schwache Wirksamkeit.

---

On the carcinogenic activity of amino-phenanthrenes and their derivatives

Summary 1-, 2-, 3- and 9-Aminophenanthrenes produce mammary cancer with approximately the same activity when fed to female Sprague-Dawley rats. Among the corresponding acetamines only 2-acetaminophenanthrene is active. 2-, 3- and 9-Aminophenanthrene-N-dipropylphosphates are inactive. — Among the above mentioned compounds only 3- and 9-acetaminophenanthrene show a weak activity when injected into mice of CF-1-strain. The duration of the experiment was 250 days.

     

Polyclonal rabbit antithymocyte globulin triggers B-cell and plasma cell apoptosis by multiple pathways

BACKGROUND: Polyclonal antithymocyte globulin (ATG) is widely used as an anti-T-cell agent for induction and treatment of acute cellular rejection in solid organ transplantation. The authors recently demonstrated that rabbit (r) ATG can be used in combination with plasmapheresis to effectively treat antibody-mediated renal allograft rejection. This observation suggested that rATG may have anti-B cell activity. METHODS: The authors tested the complement-independent, apoptosis-inducing properties of rATG on CD27- naive B cells, CD40 ligand-activated B cells, and plasma cells in vitro by annexin V staining, subdiploid DNA content, caspase activation, and loss of mitochondrial membrane polarity. Potential surface targets for rATG were assayed by competitive inhibition of monoclonal antibody binding. RESULTS: Rabbit ATG strongly induced apoptosis in vitro against naive, activated B cells and bone marrow resident plasma cells at clinically relevant concentrations (1-100 ng/mL). The authors found rATG activity against numerous B-cell surface proteins and observed that crosslinking of CD30, CD38, CD95, CD80, and HLA-DR likely accounts for this activity. F(ab)2 fragments of rATG showed 90% of the activity of the intact molecule, suggesting participation of the Fc fragment. Inhibition of caspase- and cathepsin-dependent apoptotic pathways partially inhibits rATG-induced B-cell apoptosis. Immunohistochemical staining of pediatric thymi demonstrated the presence of CD20+ B cells and CD138+ plasma cells within the thymic parenchyma, which accounts for the anti-B-cell activity in rATG. CONCLUSIONS: Polyclonal rATG induces complement-independent apoptosis of naive, activated, and plasma B cells. This effect appears to involve the caspase- and cathepsin-mediated apoptosis pathways.     

Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study

AIMS: To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum. METHODS: Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum. RESULTS: At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain. CONCLUSION: Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.