Showing papers by "Saint Francis University published in 1994"

Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.

Abstract: Background Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. Methods We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a prehospital systolic blood pressure ≤ 90 mm Hg. The study setting was a city with a single centralized system of prehospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room. Results Among the 289 patients who received...

Painful Heel Syndrome: Results of Nonoperative Treatment

Abstract: One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.

Mechanisms of glucocorticoid action in bone cells.

Abstract: Glucocorticoids play an important role in the normal regulation of bone remodeling; however continued exposure of bone to glucocorticoid excess results in osteoporosis. In vivo, glucocorticoids stimulate bone resorption and decrease bone formation, and in vitro studies have shown that while glucocorticoids stimulate osteoblastic differentiation, they have important inhibitory actions on bone formation. Glucocorticoids have many effects on osteoblast gene expression, including down-regulation of type I collagen and osteocalcin, and up-regulation of interstitial collagenase. The synthesis and activity of osteoblast growth factors can be modulated by glucocorticoids as well. For example, insulin-like growth factor I (IGF-I) is an important stimulator of osteoblast function, and expression of IGF-I is decreased by glucocorticoids. The activity of IGF I can be modified by IGF binding proteins (IGFBPs), and their synthesis is also regulated by glucocorticoids. Thus, glucocorticoid action on osteoblasts can be direct, by activating or repressing osteoblast gene expression, or indirect by altering the expression or activity of osteoblast growth factors. Further investigation of the mechanisms by which glucocorticoids modulate gene expression in bone cells will contribute to our understanding of steroid hormone biology and will provide a basis for the design of effective treatments for glucocorticoid-induced osteoporosis.

Complex pattern of insulin-like growth factor binding protein expression in primary rat osteoblast enriched cultures: regulation by prostaglandin E2, growth hormone, and the insulin-like growth factors.

Abstract: Primary osteoblast-enriched (Ob) cultures from fetal rat bone synthesize insulin-like growth factor (IGF) I and IGF-II, which each enhance Ob function. While a number of agents modulate IGF-I production, IGF-II is constitutively expressed in this culture model. Independent of their expression, however, the activity of the IGFs can be modified by a small group of proteins termed IGF binding proteins (IGFBPs), but little is known about the regulation of individual IGFBPs that are synthesized by Ob cells. Northern blot analysis revealed that serum-deprived primary rat Ob cells express transcripts encoding IGFBP-2, IGFBP-3, IGFBP-4, IGFBP-5, and IGFBP-6, but undetectable levels of IGFBP-1 transcripts. Western ligand blots of Ob culture medium probed with 125I-IGF-I or 125I-IGF-II showed predominant IGFBPs migrating at 30/32 kDa, with minor bands at 24 and 38-47 kDa. Western antibody analysis identified IGFBP-2 and IGFBP-5 within the 30/32 kDa complex, while gel mobility shift on SDS-PAGE following deglycosylation determined that IGFBP-3 comprised the 38-47 kDa complex. By Northern analysis, 6 h treatment with prostaglandin E2 (PGE2), growth hormone (hGH), IGF-I, or IGF-II revealed a complex pattern of regulatory effects on steady-state IGFBP transcript expression. PGE2 increased the transcript levels of IGFBP-3, IGFBP-4, and IGFBP-5, (approximately 22-, approximately 2- and approximately 4-fold respectively), but had no effect on IGFBP-2 or IGFBP-6 transcripts. hGH enhanced IGFBP-3 and IGFBP-5 transcripts (each approximately twofold). IGF-I and IGF-II had no effect on IGFBP-2 steady-state transcript levels but enhanced the level of IGFBP-5 transcripts (approximately fourfold). By Western ligand blot analysis, 24 h treatment with PGE2 elevated the 24 and 38-47 kDa IGFBPs and to a lesser extent the 30/32 kDa complex, hGH elevated the 38-47 kDa IGFBPs, and IGF-I and IGF-II each increased the 30/32 kDa IGFBP complex. Therefore, a comparison of results obtained from Northern, Western ligand, and Western antibody studies indicates that multiple IGFBPs are expressed by primary rat Ob cultures. While IGFBP-2 and IGFBP-6 synthesis in Ob cultures is relatively unaffected by short-term treatment with PGE2, hGH, or the IGFs, these agents modify IGFBP-3, IGFBP-4, and IGFBP-5 expression with individual patterns of effects. In addition, some changes in IGFBP polypeptide levels that are independent of alterations in transcript expression may result from the formation of complexes between IGFs and certain IGFBPs, which could serve to store IGFs for future utilization in the formation phase of bone remodeling.

Alpha-delta sleep in patients with a chief complaint of chronic fatigue

Abstract: Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue. The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy). Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.

Cellular and clinical perspectives on skeletal insulin-like growth factor I.

Abstract: Insulin-like growth factor (IGF) I, a polypeptide synthesized by skeletal cells, is presumed to act as an autocrine regulator of bone formation IGF I stimulates bone replication of preosteoblastic cells and enhances the differentiated function of the osteoblast The synthesis of skeletal IGF I is regulated by systemic hormones, most notably parathyroid hormone and glucocorticoids, as well as by locally produced factors, such as prostaglandins and other skeletal growth factors Whereas hormones and growth factors regulate IGF I synthesis, the exact level of regulation has not been established and may involve both transcriptional and posttranscriptional mechanisms The IGF I gene contains six exons, and both exon 1 and 2 contain transcription initiation sites Extrahepatic tissues, including bone, express exon 1 transcripts, and regulation of the exon 1 promoter activity in osteoblasts is currently under study It is apparent that the regulation of IGF I gene transcription as well as the regulation of mRNA stability is complex and tissue specific It is possible that abnormalities in skeletal IGF I synthesis or activity play a role in the pathogenesis of bone disorders In view of its important anabolic actions in bone, it is tempting to postulate the use of IGF I for the treatment of disorders characterized by decreased bone mass An alternative could be the stimulation of the local production of IGF I in bone

Regulation of interstitial collagenase expression and collagen degradation by retinoic acid in bone cells

Abstract: In osteoblasts, retinoic acid (RA) modulates the synthesis of various proteins, including collagen. However, little is known about the effects of RA on the regulation of interstitial collagenase synthesis and collagen degradation. After treatment of primary osteoblast-enriched (Ob) cells from fetal rat calvariae with 100 nM all-trans-RA (tRA), collagenase mRNA levels, as determined by Northern blotting, did not change after 2 h, increased by 13- to 18-fold after 6 h, and remained elevated until 48 h. Exposure of Ob cells to 10 nM to 1 microM tRA, 13-cis-RA, and 9-cis-RA induced collagenase mRNA in a dose-dependent manner. Collagenase mRNA induction by RA was blocked by cycloheximide. RA increased the stability of collagenase mRNA in Ob cells, suggesting posttranscriptional regulation. Exposure of Ob cells to RA induced immunoreactive procollagenase in medium, as determined by enzyme-linked immunosorbent assay and Western blotting. RA action on collagen degradation was examined in [3H]proline-pulsed intact...

Evaluation of "Closed" vs "Open" Systems for the Delivery of Peptide-Based Enteral Diets

Abstract: Background: The study was designed to quantitate factors such as preparation time, waste, and contamination associated with three different feeding systems for peptide-based diets, and to determine appropriate hang times. Methods: Intensive care unit patients were randomized to receive a peptide-based diet in 1500-mL prefilled, sterile closed-system containers (CS) infused more than 24 hours, as open systems decanted from cans (OS-Can), or as open systems mixed from powder (OS-Powder). Open-system groups were provided a 12-hour supply twice daily in commercially clean 1-L bags with preattached sets. Samples were taken for culture during preparation and after infusion. Preparation time, initial and final microbial concentrations, and total waste were quantified. Results: Preparation time was significantly shorter for CS than for OS-Can or for OS-Powder (2 minutes vs 7.5 minutes vs 13.0 minutes). Initially, 100% of the OS-Powder and 30% of the OS-Can bags were contaminated, with significant contamination ex...

Regulation of Insulin-Like Growth Factor-II Synthesis in Bone Cell Cultures by Skeletal Growth Factors*

Abstract: Insulin-like growth factor-II (IGF-II) is a growth factor secreted by bone cells and presumed to act as an autocrine regulator of bone formation. Although hormones and growth factors regulate the synthesis of skeletal IGF-I, hormones do not seem to modify the synthesis of skeletal IGF-II. We postulated that skeletal IGF-II is regulated by growth factors, and we tested the effects of basic fibroblast growth factor (bFGF), transforming growth factor-beta 1 (TGF beta 1), and platelet-derived growth factor-BB (PDGF-BB) on IGF-II messenger RNA (mRNA) expression and polypeptide concentrations in cultures of osteoblast-enriched (Ob) cells from 22-day-old fetal rat calvariae. Steady state IGF-II mRNA levels were determined by Northern blot analysis, and IGF-II concentrations were determined in acidified and fractionated culture medium by a specific RIA. Treatment of Ob cells with bFGF, TGF beta 1, and PDGF-BB decreased IGF-II mRNA levels after 24-48 h. A continuous 48-h treatment with bFGF at 0.6-6 nM, TGF beta 1...

Lidocaine as a Diluent for Ceftriaxone in the Treatment of Gonorrhea: Does It Reduce the Pain of the Injection?

Abstract: Objective: To compare the pain associated with ceftriaxone sodium injections by using two different diluents, ie, lidocaine hydrochloride and sterile water. Design: Prospective study of adolescents who were culture positive for gonorrhea. Random selection of the diluent used for the intramuscular ceftriaxone therapy. Setting: Urban, hospital-based adolescent medicine Subjects: Thirty-nine adolescents and young adults, predominantly of black or Hispanic backgrounds, ranging in age between 14 and 23 years (mean age, 17.6 years; median age, 17 years), of whom 27 were females. Methods: Pain predictions were elicited from the adolescents before treatment. Pain ratings were obtained at five time intervals after the injections. All ratings were obtained by using a visual analog scale. Results: No pain prediction differences before the injection were noted between the two groups. Individual t tests showed significant pain differences between the two groups at the time after the injection and at 10- and 20-minute and 6-hour intervals. Repeated-measuresanalysis of variance models showed that the diluent effect on pain was significant. Conclusion: Lidocaine can reduce the amount of pain of an intramuscular injection of ceftriaxone when compared with sterile water as a diluent. These findings have implications not only for the treatment of gonorrhea but also for other situations where intramuscular injections utilizing a diluent may be necessary. (Arch Pediatr Adolesc Med. 1994;148:72-75)

The use of intermediate and high purity factor VIII products in the treatment of von Willebrand disease.

Abstract: Since 1985, viral-attenuated blood products have been available for the treatment of patients with hemophilia. Unfortunately, similar viral-attenuated blood products, enriched for von Willebrand factor (vWF), have not been readily available for the treatment of patients with von Willebrand disease (vWD). In the current study, we examined the clinical efficacy and in vivo properties of two viral-attenuated factor VIII products, Koate-HS and Koate-HP, in the treatment of patients with vWD. Twenty-one (21) infusions were evaluated in 17 different vWD patients (4 with type IA; 8 with Type IIA; 1 with Type IID; 4 with type III). Seven (7) patients received Koate-HS and 12 patients received Koate-HP (2 patients received both products; 1 patient was studied three times). Von Willebrand factor antigen, ristocetin cofactor, bleeding time, and the multimeric composition of vWF were determined pre- and post-infusion. Complete or partial correction of prolonged bleeding times was observed in 2 of the 6 patients tested following treatment with Koate-HS and in 7 out of 11 patients tested following treatment with Koate-HP. Surgery was performed on five of these patients, two of whom were treated with Koate-HS and three of whom were treated with Koate-HP. In the surgical patients, clinical hemostasis was achieved regardless of whether the bleeding time was corrected. We conclude that both Koate-HS and Koate-HP can be utilized successfully in the treatment of patients with vWD in spite of the lack of high molecular weight multimers of vWF in these products.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential effects of warfarin on mRNA levels of developmentally regulated vitamin K dependent proteins, osteocalcin, and matrix GLA protein in vitro

Abstract: The role of the vitamin K dependent proteins, osteocalcin which is bone specific and matrix Gla protein (MGP) found in many tissues, has been studied by inhibition of synthesis of their characteristic amino acid, γ-carboxyglutamic acid (Gla) with the anticoagulant sodium warfarin. The effect of sodium warfarin on expression of these proteins, and other phenotypic markers of bone and cartilage during cellular differentiation and development of tissue extracellular matrix, was examined in several model systems. Parameters assayed include cell growth (reflected by histone gene expression) and collagen types I and II, osteopontin, alkaline phosphatase, and mineralization. Studies were carried out in calvarial bone organ cultures, normal diploid rat osteoblast and chondrocyte cultures, and rat osteosarcoma cell lines ROS 17/2.8 and 25/1. In normal diploid cells, warfarin consistently stimulated cell proliferation (twofold). In osteoblast cultures, MGP mRNA levels were generally increased (three to tenfold). Notably, MGP mRNA levels were not affected in chondrocyte cultures, either with chronic or acute warfarin treatments. Osteocalcin mRNA levels and synthesis were decreased up to 50% in ROS 17/2.8 cells and in chronically treated (1 and 5 μg/ml sodium warfarin) rat osteoblast cultures after 22 days. Early stages of osteoblast phenotype development from the proliferation period to initial tissue formation (nodules) appeared unaffected; while after day 14, further growth and mineralization of the nodule areas were significantly decreased in warfarin-treated cultures. In summary, warfarin has opposing effects on the expression of two vitamin K dependent proteins, MGP and osteocalcin, in osteoblast cultures and MGP is regulated differently between cartilage and bone as reflected by cellular mRNA levels. Additionally, warfarin effects expression of nonvitamin K dependent proteins which may reflect the influence of warfarin on endoplasmic reticulum associated enzymes. © 1994 Wiley-Liss, Inc.

Cardiac surgery in the very elderly.

Abstract: OBJECTIVE To determine the results of cardiac surgery in the very elderly. DESIGN AND SUBJECTS A retrospective study of 56 very elderly patients (mean age 82 years, range 79-89 years) undergoing open heart surgery between 1988 and 1991. Thirty-three patients had coronary artery bypass grafting, 12 had valve replacement alone and 11 had valve replacement with an associated procedure. SETTING St Francis Xavier Cabrini Hospital, Melbourne--a large private hospital. RESULTS There were four in-hospital deaths (7%). The one-year actuarial survival rate was 88%. Of the 49 survivors, 92% were in New York Heart Association (NYHA) Class III or IV before operation, whereas 96% were in NYHA Class I or II a mean of 15 months after operation. CONCLUSION In very elderly patients with medically refractory cardiac symptoms, cardiac surgery has a tolerable mortality and provides excellent relief of symptoms.

Resuscitation of canine hemorrhagic hypotension with large-volume isotonic crystalloid: impact on lung water, venous admixture, and systemic arterial oxygen saturation.

Abstract: The objective of this study was to test the hypothesis that after hemorrhagic hypotension, reinfusion of the shed blood with threefold that volume of lactated Ringer's (LR) solution will significantly increase lung water and venous admixture and hence decrease systemic arterial oxygen saturation. A prospective, randomized, fixed-volume hemorrhage laboratory study was performed at the Oklahoma University Health Sciences Center on 18 anesthetized mongrel dogs. After 40 mL/kg of blood were withdrawn through a femoral artery catheter, the dogs were randomized either to the control group (n = 9) that received a reinfusion of the shed blood, or to the LR treatment group (n = 9) that received an intravenous mixture of the shed blood with 120 mL/kg of LR. After fluid resuscitation, pulmonary artery occlusion pressure (PAOP) and cardiac output (CO) were significantly increased in the LR group compared with control animals (PAOP, 18.7 ± 1.1 vs 13.4 ± 2.9 mm Hg; CO, 8.14 ± 1.08 vs 4.59 ± 0.47 L/min; P 2 were similar between groups. In this fixed-volume hemorrhage model, hemodiluting the reinfused shed blood with threefold the volume of LR did not significantly influence lung water, venous admixture, or systemic arterial oxygen saturation.

Activated clotting-time variability in patients undergoing coronary angioplasty

Abstract: Although the activated clotting time (ACT) is commonly used to assess adequacy of anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), there is uncertainty whether measurements on samples from the arterial and venous circulations are directly comparable. We performed ACT determinations on 115 patients undergoing PTCA at our institution. Blood samples were drawn in a sequential fashion from the arterial and femoral venous sheaths at the conclusion of each case, and ACT determination were performed in the catheterization laboratory immediately thereafter. The venous ACT exceeded the arterial value in 63 patients (55%), and was identical in only 2 instances. The arterial and venous ACT differed by more than 100 s in 10 patients. In 23 patients (20%) one ACT determination was > or = 300 s, while the value from the other circulation was < 300 s. We conclude that there is substantial variability between arterial and venous ACT determinations in heparinized patients undergoing PTCA.

Early enteral feeding of a severely burned pediatric patient.

Abstract: Early postburn duodenal feeding can provide adequate nutritional support despite increased risk of intolerance in a severely injured pediatric patient. A 3-year-old girl was admitted with 30% total body surface area thermal burns and severe inhalation injury. During admission, a pediatric feeding tube was placed into the duodenum, and enteral feeding was initiated within 12 hours after injury. Total enteral feeding provided full nutritional needs by postburn day 5 and continued to provide stable and adequate nutrition throughout administration. A full-strength isotonic formula with high concentration of dipeptides and tripeptides was used. Complications of enteral feeding did not prevent achievement of positive caloric and protein balance or repletion of nutritional stores with conscientious nutritional management. Maintenance of admission weight was achieved. This case report describes techniques in nutritional monitoring to assist in optimizing enteral nutrition management.

Fluoxetine-nortriptyline therapy of treatment-resistant major depression in a geriatric patient.

Abstract: A case of severe, treatment-resistant major depression in a geriatric patient who ultimately attained full remission on fluoxetine-nortriptyline combination therapy is reported

Leiomyomatosis peritonealis disseminata. A report of two cases.

Abstract: Leiomyomatosis peritonealis disseminata (LPD), also known as diffuse peritoneal leiomyomatosis, is characterized by the presence of multiple, small nodules scattered over the abdominopelvic viscera and peritoneum. These nodules are composed of benign smooth muscle cells. As shown in this report of two cases, the disorder occurs mostly in women of reproductive age and rarely in postmenopausal ones. LPD is a benign condition for which conservative management is indicated.

The Use of Artistic Analogies in Chemical Research and Education, Part 2

Abstract: This compilation presents examples of artistic artifacts that have served as successful visual analogies to aspects of chemistry. The authors have used them in various college-level chemistry classes, outreach programs and chemistry textbooks, as well as in journals and monographs. They include ancient Chinese, Turkish and Thai sculptures, modern sculptures and a medieval fresco. These examples illustrate the chemical concept of chirality, the periodic table of the elements and molecular systems such as buckminsterfullerene, nanotubes and quasicrystals.

Images in cardiovascular medicine. Multiple coronary emboli from a calcified rheumatic aortic valve.

Abstract: A 51-year-old woman with known rheumatic aortic and mitral valve disease developed progressive exertional angina. Cardiac catheterization demonstrated severe aortic stenosis, mild aortic insufficiency, moderate mitral stenosis, and normal left ventricular function. Cardiac catheterization was not associated with chest pain or ECG changes suggesting coronary embolism during the procedure. Coronary arteriography (A) showed two bizarre intraluminal filling defects (arrows) narrowing the proximal left anterior descending coronary artery (LAD) and a large circumflex marginal (LCx) branch by about 80%. The patient underwent an aortic valve replacement, open mitral commissurotomy, and aortocoronary bypass grafting to the LAD and LCx (Dr S. Chawla). B shows the intraluminal calcium embolus (arrow) as seen through the wall of the marginal branch. This was removed by direct arteriotomy; however, attempts at removing the proximal LAD embolus with a Fogarty catheter were unsuccessful. Otherwise, the coronary arteries appeared perfectly normal. C shows the calcified aortic valve and the arrow points to the calcium emboli removed from the LCx branch. The patient has done well after surgery.

Maternity homes for adolescents: A national portrait

Abstract: Study Objective: The extent to which maternity homes across our nation provide services for homeless, pregnant girls is unknown. We initiated the first investigation to identify and describe all of the group residential facilities in the United States for pregnant adolescents under the age of 18 years. Design: We created a national list of maternity homes on a state-by-state basis through information gathered from local human services departments, local WIC offices, and from maternity homes that were aware of others in their region. We contacted an official at each maternity home by telephone to confirm the nature of the facility and to seek their participation in the project by answering a 28-item questionnaire to be sent by mail. Unreturned questionnaires were followed by a reminder letter and a duplicate questionnaire. The collected data were then organized and tabulated. Results: From all 50 states, we found and contacted by telephone 215 maternity homes admitting girls under the age of 18 years (the number of homes ranged from 19 in California, to 0 in Wyoming) and a total of 174 (81%) completed and returned our postal questionnaire. Of responding homes, 10% had been in operation 100 years or more, 29% admitted girls dependent on illicit drugs or alcohol, 59% functioned as part of a larger organization, 20% were unlicensed, 89% received private donations, 23% received federal funds, and 42% offered private rooms. The most frequent maternal bed capacity was eight. Typically they had from two to four full-time employees. Benefits provided included childbirth classes (84%), social services (90%), dietary counseling (49%), accredited, on-site schooling (35%), and vocational training (54%). Prenatal care was mostly provided through private physicians (63%) and hospital-based prenatal clinics (59%), with 99% of deliveries in hospitals. The most frequent age of residents was 16 years, staying an average of 4.7 months antepartum and 2.4 months postpartum. The most frequent maximum allowed length of stay was up to 9 months. The mean number of babies bora per responding home in 1991 was 29.4. Conclusion: In the United States, maternity homes for adolescents are an important source of services for approximately 6,000 pregnant teens each year.

Trends in Appropriate Adult Functioning and Biasing Risks in Longitudinal Follow-Ups of Boys With Conduct Disorders

Abstract: Multiple telephone follow-up interviews have been conducted for a number of years for boys with conduct disorders treated at the Saint Francis Academy These follow-ups are done 2 years and 5 years after treatment completion and again after the boy's 24th birthday An overall appropriate adult functioning (AAF) score is obtained for each boy contacted Because the attrition rate is very low, these data provide an opportunity to investigate the stability of treatment effects over time A substantial attempt was made to investigate the possibility that mean group changes in AAF over time might be due to differential attrition effects Two separate analyses indicated that an attrition effect was not a major influence in AAF score changes AAF was relatively stable between the 2- and 5-year follow-ups and showed some improvement