Showing papers by "University of Tennessee Health Science Center published in 1983"

The Relationship of Personality to Affective Disorders: A Critical Review

Abstract: Although characterologic constellations such as obsessionalism, dependency, introversion, restricted social skills, and maladaptive self-attributions are popularly linked to the pathogenesis of depressive disorders, the evidence in support of this relationship remains modest. Indeed, many of these attributes may reflect state characteristics woven into the postdepressive personality. Current evidence is strongest for introversion as a possible premorbid trait in primary nonbipolar depressions. By contrast, driven, work-oriented obsessoid, extroverted, cyclothymic, and related dysthymic temperaments appear to be the precursors of bipolar disorders. Other personalities, while not necessarily pathogenic in affective disorders, nevertheless may modify the clinical expression of affective disorders and their prognosis.

Interleukin 1 stimulation of collagenase production by cultured fibroblasts.

Abstract: Interleukin 1 is a monokine that exerts biological effects on a variety of target cells in vitro. In this report, interleukin 1 has been found to be capable of stimulating collagenase production by cultured dermal fibroblasts. The concentrations of interleukin 1 that stimulate fibroblast collagenase production are similar to those that stimulate mouse thymocyte proliferation. Analyses by high performance liquid chromatography indicate that interleukin 1, rather than a contaminating monokine, is responsible for this effect on fibroblasts. Interleukin 1, released in vivo by macrophages infiltrating sites of tissue damage or inflammation, may function to stimulate the release of collagenase by connective tissue fibroblasts.

The value of demonstration and role of the pharmacist in teaching the correct use of pressurized bronchodilators.

Abstract: The use of an improper technique with metered-dose inhalers decreases the efficacy of the bronchodilators being administered. There is evidently a need for patients to watch a demonstration. Twenty-nine adult asthmatic patients from an allergy clinic were divided into three groups, each receiving a different form of instruction: an information sheet, personal instruction or a videotape presentation. Subsequently each patient was tested for correct use of the inhaler. There was no difference in mean scores for inhalation technique between the groups instructed in person and by videotape, but both were significantly better than the mean score of the group given only an information sheet. There was also no significant change in the scores at a follow-up test in the groups who saw the technique demonstrated. These results indicate the need for and value of the demonstration of proper technique with pressurized inhalers. A pharmacy-generated education system using videotape equipment or personal instruction by a pharmacist could readily solve the problem.

Mouse sciatic nerve regeneration through semipermeable tubes: a quantitative model.

Abstract: The regeneration of transected mouse sciatic nerves using semipermeable acrylic copolymer tubes to enclose both stumps has been qualitatively assessed from 1 to 30 weeks post-operative. Quantitative morphometric analysis of electron micrograph montages of complete transverse sections of the segment regenerated between stumps has permitted determinations of the percents of total area occupied by the various tissue constituents--blood vessels, epineurium, perineurium, endoneurium, myelinated axon/Schwann cell units, and unmyelinated axon/Schwann cell units. Significant differences were found in the total cross-sectional area of segments regenerated through tubes of 1.0 mm versus 0.5 mm internal diameters. Segments regenerated with the distal stump inserted in the tube contained significantly greater percentages of neural units and were significantly larger at 8 weeks post-operative compared to segments regenerated for 9-10 weeks with the distal stump avulsed. The morphometric method permits rapid quantitation of sizeable electron micrograph montages which at 1300 X permit all types of tissue components, including the unmyelinated axons, to be visualized.

Low-dose D-penicillamine therapy in rheumatoid arthritis. A controlled, double-blind clinical trial.

Abstract: Two hundred twenty-five patients with active severe rheumatoid arthritis were admitted to a multiclinic, controlled, double-blind trial comparing the use of 500 mg D-penicillamine per day, 125 mg D-penicillamine per day, and placebo. One hundred seventy-one patients completed at least 30 weeks of therapy. The 500 mg D-penicillamine group demonstrated statistically significant improvement over the placebo group in grip strength, average circumference of swollen proximal interphalangeal joints, and patient assessment. While the trend was for greater improvement with the larger dose of D-penicillamine, there was no statistically significant difference among the 3 groups in duration of morning stiffness, walking time, physician's assessment, number of swollen joints, or scores for tender and swollen joints. The slight increase in efficacy of higher dose D-penicillamine was associated with increased toxicity.

Interaction of human plasma fibronectin with cariogenic and non-cariogenic oral streptococci.

Abstract: The interaction of purified human plasma fibronectin (Fn) with bacteria was studied with a variety of oral streptococci. Each of the strains of Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguis, and Streptococcus mitis tested was aggregated by Fn to various degrees, depending on the concentration of Fn added to the test mixtures. Binding assays performed with radiolabeled Fn and various strains of streptococci demonstrated various capabilities to bind Fn, and the amount of Fn bound by each strain was paralleled by its Fn-induced aggregation, with S. mutans 6715 giving the highest values in both assays. Because of the avid binding of Fn by certain strains of potentially cariogenic streptococci, we investigated the possibility that Fn may be present in human saliva and may be adsorbed from saliva onto artificial tooth pellicles. Immunoreactive Fn was detected in paraffin-stimulated whole saliva by enzyme-linked immunosorbent assays of saliva adsorbed onto gelatin-coated cuvettes and by immunoelectroblots (Western blots) of salivary components separated on sodium dodecyl sulfate-polyacrylamide slab gels. Furthermore, immunoreactive Fn was found to be present in artificial tooth pellicles formed by incubating hydroxyapatite beads with whole human saliva. These results demonstrate that certain strains of oral streptococci bind to and are aggregated by Fn. The presence of Fn in artificial tooth pellicles suggests that this macromolecule may play a role in the attachment of potentially cariogenic and other oral streptococci to dental tissues.

Late postpartum eclampsia: an update.

Abstract: Eclampsia occurring more than 48 hours postpartum has been observed in an unusual number of patients. From August 1977 to November 1982 at E. H. Crump Women's Hospital and Perinatal Center (Memphis), there were 132 documented cases of eclampsia, of which 36 (27%) occurred postpartum. Seventeen (47%) of these occurred more than 48 hours postpartum. Preeclampsia was diagnosed before the onset of convulsions in 12 patients, all of whom received intravenous magnesium sulfate postpartum. The mean duration of postdelivery magnesium sulfate therapy was 32 hours (range 24 to 72 hours). Headaches and visual disturbances were reported by all 17 patients before onset of convulsions. Physical and laboratory findings immediately after the convulsions were consistent with eclampsia. Treatment consisted primarily of intravenous magnesium sulfate. Neurologic consultation was obtained to rule out a neurologic disorder, and metabolic studies were also done. Electroencephalograms were done on 15 patients; eight of them showed patterns consistent with encephalopathy.

Evaluation of T lymphocyte subpopulations in children with nephrotic syndrome.

Abstract: We have evaluated lymphocyte subsets both quantitatively and functionally in children with nephrotic syndrome. Ten children had minimal change nephrotic syndrome (MCNS), seven had focal segmental glomerular sclerosis (FSGS) and four had recovered from MCNS. Two patients with FSGS had decreased OKT4+ cells and a decreased T4/T8 ratio. Patients with active MCNS synthesized significantly less IgM in vitro than did normal subjects (P less than 0.005). In vitro IgG synthesis was significantly decreased in patients with active nephrotic syndrome whether it was due to MCNS or FSGS. Co-culture studies involving lymphocyte subsets suggested that both patients with decreased percentages of T4+ cells had decreased T helper cell activity as well. The results of this study support previous speculation about abnormal immune function in some patients with nephrotic syndrome.

Transplantation for polycystic kidney disease.

Abstract: During the 4-year period from June 1977 to May 1981, a total of 108 patients with polycystic kidney disease and 2440 nonpolycystic patients received cadaver renal allografts in the Southeastern Organ Procurement Foundation (SEOPF) Prospective Study. There were no significant differences between the groups with and without polycystic disease in terms of recipient blood group, history of splenectomy, or preformed antibody status. As a group, transplanted polycystic patients underwent native nephrectomy more often, had a better HLA match, received less antilymphocyte serum (ALS), and were slightly older than nonpolycystic patients. Although proportionately fewer polycystic patients received pretransplant transfusions than nonpolycystic patients (P = .002), transfusion was associated with a significant increase in graft survival in the polycystic group (P less than .05), as well as in the nonpolycystic group (P less than .0001). Gene frequency analysis showed no HLA-A, or -B antigen linkage with polycystic disease. No significant differences existed between the polycystic and nonpolycystic groups in terms of overall graft and patient survival. However, transplanted polycystic patients died more frequently from bacterial sepsis (P less than .05), especially from gram-positive organisms (P = .01). Pretransplant bilateral nephrectomy did not affect the incidence of sepsis. However, following graft failure, patients with bilateral native nephrectomy had a greater incidence of severe anemia (50% versus 39%) and death (58% versus 25%; P less than .05) than those with unilateral nephrectomy or no nephrectomy. Treatment with ALS did not significantly improve graft survival in those with polycystic disease. A strong positive correlation was found between patient death and treatment with ALS only in the polycystic group (P less than .01). These findings indicate that the use of pretransplant bilateral native nephrectomy and posttransplant ALS should be judicious in the polycystic patient because they may be associated with increased morbidity and mortality.

Characterization of Solubilized Opiate Receptors from Human Placenta

Abstract: A solubilized opiate receptor from human placental membranes binds [3H]etorphine saturably, reversibly, and stereospecifically. The binding activity is shown to be truly soluble because it migrates between two soluble proteins on Sepharose CL-6B. The solubilized macromolecular complex behaves as a molecule with an apparent Stokes radius of 70 A and contains a protein as an essential constituent. The solubilized receptors bind [3H]ethylketocyclazocine with high affinity in a saturable and stereospecific manner. Naloxone inhibits [3H]etorphine and [3H]ethylketocyclazocine binding to the solubilized receptor. Sodium inhibits [3H]etorphine but not [3H]naloxone binding. These observations indicate that the solubilized receptor from human placental membranes is active and retains properties of membrane-bound receptors.

Psychological sequelae of head trauma

Abstract: Head trauma is a significant health care problem. Treatment of the head trauma patient requires assistance from many different disciplines in order to maximize recovery of function. The fact that one fourth or more of head trauma patients are impaired in recovery because of psychological factors suggests that appropriate treatment programs are not being implemented in the United States. Organic factors can produce many of the symptoms reported by head trauma patients. However, these factors are more likely to contribute indirectly to such symptoms, and their influence declines as recovery progresses. Recovery from head trauma follows identifiable stages. During the period of coma, the extent of the organic disturbance is sufficient to impair brain-stem functions. Once consciousness is regained, there is a period of gross memory dysfunction. Coma and posttraumatic amnesia represent the acute phase of recovery, during which patients are often hospitalized and receive intense medical care. Once gross functions return, intense medical care is no longer needed. However, the head trauma victim has not returned to a premorbid status at this point. This phase, between recovery from posttraumatic amnesia and stabilization or recovery of premorbid level of functioning, can best be considered the chronic phase of recovery. The chronic phase of recovery is characterized by defects in cortical functions, including impaired intellectual functions, memory weakness, difficulty in processing complex stimuli, slowed reaction time, and other deficits. While these deficits may not be profound, they do correlate with the severity of injury and the degree of eventual recovery. This observation lends further credence to the presence of underlying disturbance of neurologic functioning. During this chronic phase of recovery, head trauma patients may have made good physical recovery and may feel well enough to return to work. However, they frequently process less information and may experience difficulty with tasks that require attention and effort. Such patients tire rapidly and experience stress symptoms, such as headaches and irritability. These symptoms correspond to environmental demands, but they also reflect underlying neurogenic weaknesses. Emotional sequelae that often emerge during the chronic phase of recovery may be related to the patient's reduced ability to cope with environmental stress. Therefore it is not surprising that emotional sequelae appear to correspond more to environmental demands than to severity of injury per se.(ABSTRACT TRUNCATED AT 400 WORDS)

Biological profile and response to anti-pneumocystis agents of Pneumocystis carinii in cell culture.

Abstract: Although the growth characteristics of Pneumocystis carinii have been described in several cell culture systems, the response of this organism to the drugs of choice, trimethoprim-sulfamethoxazole and pentamidine isethionate, have not been described in vitro. The effect of various concentrations of drugs against P. carinii on the growth of this potentially hazardous opportunistic organism as well as the methodology for in vitro assay of these agents have been detailed. Fluorescence profiles illustrating size ranges of trophozoites and cysts derived from cell culture are described.

Avoidance of negative percutaneous lung biopsy using contrast-enhanced CT.

Abstract: Fluoroscopically guided percutaneous biopsy of pulmonary masses is an accepted procedure, but large neoplasms often have necrotic areas which, if aspirated, do not afford a pathologic diagnosis. Such tumors may require multiple punctures or procedures to establish a diagnosis. A prebiopsy contrast-enhanced CT scan selectively demonstrates the extent of peripherally located, viable tumor tissue. Three cases of initially frustrated lung biopsies in which viable, diagnostic tissue was localized for fluoroscopic aspiration using the contrast-enhanced CT scan are presented.

Therapists' and chronic pain patients' perceptions of treatment outcome.

Abstract: Pain is a complex phenomenon which is influenced by multiple factors; likewise, assessment of chronic pain patients' response to treatment is influenced by many variables. A physician, psychologist, physical therapist, and occupational therapist rated the extent of recovery of 40 chronic pain patients who had spent 4 to 6 weeks in an inpatient chronic pain treatment program. Each patient also rated his/her own degree of improvement. In addition, therapists and patients reported which factors were the primary determinants of their outcome ratings. Although therapists rated the patients as significantly more improved than the patients rated themselves, there was still a high degree of similarity between therapists' and patients' view of recovery. Therapists and patients were in high agreement concerning which patients were classified as treatment successes or failures. Furthermore, activity level and ability to cope with pain were frequently endorsed by therapists and patients as important determinants of recovery rating. Contrary to a previous report, the results of this study suggest that pain patients are not necessarily poor judges of (their own) treatment results. Perhaps more importantly, this study supports the use of a broad-based multidimensional approach to assessing treatment outcome for chronic pain patients.

Rectal gastric mucosa heterotopia as a cause of hematochezia in an infant

Abstract: J.S.C. was a 6-month-old white male when first admitted to LeBonheur Children's Hospital for evaluation of rectal bleeding. He had a history of intermittent passage of dark blood since the age of 10 weeks. This bleeding was associated with symptoms of "colic," but with no abdominal distention, vomiting, or bleeding from other sites. Although his stools were normal between attacks, during one they became loose and frequent with passage of clots of blood. He had been evaluated in other hospitals with colonoscopy, proctoscopy, upper gastrointestinal series, two 99Tc pertechnetate scans for ectopic gastric mucosa within a Meckel's diverticulum, 15 barium enemas, and laparotomy without a diagnosis. During one episode of bleeding, he developed hypovolemic shock requiring resuscitation. Many formula changes had been tried without effecting relief from the symptoms. Gestational, perinatal, and neonatal histories were normal. Family history revealed that both the patient's father and paternal grandfather had intermittent painless rectal bleeding throughout childhood, ending spontaneously in late adolescence. In addition, the father had digital anomalies like those of the patient. Because of an injury which required resection of his rectum, proctoscopy on the father was impossible. At the time of evaluation he was a white male at the 90th percentile for weight and the 50th percentile for

A simplified method for placement of internal ureteral stents.

Abstract: In the last few years, antegrade percutaneous placement of ureteral stents by the radiologist has been popularized [1 -3]. The most commonly used stent device is the double pigtail catheter, a design of simple elegance [4]. However, technical difficulties in traversing the soft tissues of the back and positioning of the pigtail in the renal pelvis occur commonly. Two refinements in technique that address these problems are described here. First, difficulty in negotiating noncompliant soft tissues and renal parenchyma is greatly decreased by use of a Desilets-Hoffman sheath (Cook). Second, excellent control of the final position of the pigtail in the renal pelvis may be achieved by use of a suture threaded through two side holes in the middle of the proximal pigtail curve.