Assessing quality of life in Mexican-American children with asthma: impact-on-family and functional status.

OBJECTIVE: To assess the internal consistency reliability and construct validity of two questionnaires, the Impact on Family (IOF) and the Functional Status II (R) (FSIIR), in a Mexican-American population of children with asthma. METHODS: We interviewed 115 Hispanic parents of children with asthma and compared the IOF and FSIIR scores and reliability coefficients for the following subgroups: English or Spanish language and high or low educational level. We assessed the construct validity of the IOF Total score and FSIIR Illness score by examining the relationship between these scores and other health status variables. RESULTS: The IOF Total score and FSIIR Illness score demonstrated acceptable construct validity and reliability for language and education subgroups, although several of the IOF subscales had low reliability. CONCLUSIONS: IOF Total score and FSIIR Illness score can be recommended for use by Spanish- and English-speaking Mexican-American respondents.

MT1-MMP-deficient mice develop dwarfism, osteopenia, arthritis, and connective tissue disease due to inadequate collagen turnover.

MT1-MMP is a membrane-bound matrix metalloproteinase (MT-MMP) capable of mediating pericellular proteolysis of extracellular matrix components. MT1-MMP is therefore thought to be an important molecular tool for cellular remodeling of the surrounding matrix. To establish the biological role of this membrane proteinase we generated MT1-MMP-deficient mice by gene targeting. MT1-MMP deficiency causes craniofacial dysmorphism, arthritis, osteopenia, dwarfism, and fibrosis of soft tissues due to ablation of a collagenolytic activity that is essential for modeling of skeletal and extraskeletal connective tissues. Our findings demonstrate the pivotal function of MT1-MMP in connective tissue metabolism, and illustrate that modeling of the soft connective tissue matrix by resident cells is essential for the development and maintenance of the hard tissues of the skeleton.

Detection of a chemotactic factor for neutrophils in extracts of female Onchocerca volvulus.

Neutrophilic granulocytes and macrophages are the dominant inflammatory cell types observed in the vicinity of and attached to adult Onchocerca volvulus in the subcutaneous nodules. Crude extract from female O. volvulus was examined for chemotactic activity for peripheral neutrophils from healthy individuals by use of an endogenous component chemotactic assay in Boyden chambers. Significant chemotactic responses of neutrophils were detected using O. volvulus extracts at > or = 15 microg/ml in a dose-dependent manner. Checkerboard analysis demonstrated low chemokinetic in addition to chemotactic activity. Neutrophil migration was also elicited by excretory-secretory products of vital females. Fractionation of the female worm extract by FPLC revealed two components with chemotactic activity, one with a molecular mass less than 12 kDa and another with a molecular mass of > 200 kDa. Immunohistological examination of onchocercomas containing only one adult alive filarial worm demonstrated that neutrophils were accumulated near and attached to the cuticle of immature females, females producing microfilariae and males.

Porin mutants with new channel properties.

The general diffusion porin from Rhodopseudomonas blastica was produced in large amounts in Escherichia coli inclusion bodies and (re)natured to the exact native structure. Here, we report on 13 mutants at the pore eyelet giving rise to new diffusion properties as measured in planar lipid bilayer experiments. The crystal structures of seven of these mutants were established. The effects of charge-modifying mutations at the pore eyelet are consistent with the known selectivity for cations. Deletions of 16 and 27 residues of the constriction loop L3 resulted in labile trimers and pores. The reduction of the eyelet cross section by introducing tryptophans gave rise to a closely correlated decrease of the conductivities. A mutant with six newly introduced tryptophans in the eyelet closed its pore in a defined manner within seconds under a voltage of 20 mV, suggesting the existence of two states. The results indicate that the pore can be engineered in a rational manner.

Chemotherapy for onchocerciasis: results of in vitro experiments with promising new compounds.

An improved short-term in vitro culture system was used for the routine screening of hundreds of promising new compounds with the target organism, the filarial nematode Onchocerca volvulus. The most active leads were identified among the pyrimidinylguanidines, amidine derivatives, the imidazolinylhydrazones, thiosemicarbazone derivatives and thiadiazole derivatives. Single compounds of these leads demonstrated strong macrofilaricidal efficacy in minimum effective dose trials down to 0.1 microM and in experiments evaluating the minimum time of exposure after less than 6 h exposure. In the group of the pyrimidinylguanidines we found a significant correlation of structure and activity: change of a single side-group in the molecules had dramatic influence on compound activity. Most of the new compounds that were active on the macrofilariae did not show significant activity on microfilariae (mf) in in vitro trials. Only one compound with significant activity against female O. volvulus worms killed mf at very low concentrations. Some of the promising leads will be processed in further trials on a preclinical level with predictive cattle models.

Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy.

BACKGROUND: Esophageal perforation is one of the most dreaded complications in therapeutic gastrointestinal endoscopy. We assessed the frequency of esophageal perforation after endoscopic procedures in a highly specialized endoscopy unit and compared clinical outcomes in patients undergoing either surgical or conservative management. METHODS: From January 1985 to June 1996, 1011 instrumental endoscopic procedures (dilatation and bougienage) were performed in our department. The computerized complication database was searched to identify all patients with esophageal perforation during this same period, and their records were reviewed. RESULTS: Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant disease. CONCLUSIONS: The current concept in management of esophageal perforations comprises surgical as well as medical treatment. In well-selected cases, non-operative treatment can be considered with favorable results.

Fluoroscopically guided laser lithotripsy versus extracorporeal shock wave lithotripsy for retained bile duct stones: a prospective randomised study.

BACKGROUND AND AIMS: To compare extracorporeal shock wave lithotripsy (ESWL) and laser induced shock wave lithotripsy (LISL) of retained bile duct stones to stone free rate, number of therapeutic sessions, and costs. PATIENTS: Thirty four patients were randomly assigned to either ESWL or LISL therapy. The main reasons for failure of standard endoscopy were due to stone impaction (n = 12), biliary stricture (n = 8), or large stone diameter (n = 14). METHODS: An extracorporeal piezoelectic lithotripter with ultrasonic guidance and a rhodamine 6G laser with an integrated stone tissue detection system were used. LISL was performed exclusively under radiological control. RESULTS: Using the initial methods complete stone fragmentation was achieved in nine of 17 patients (52.4%) of the ESWL group and in 14 of 17 patients (82.4%) in the LISL group, or combined with additional fragmentation techniques 31 of the 34 patients (91.2%) were stone free at the end of treatment. In comparison LISL tended to be more efficient in clearing the bile ducts (p = 0.07, NS). Significantly less fragmentation sessions (1.29 v 2.82; p = 0.0001) and less additional endoscopic sessions (0.65 v 1.6; p = 0.002) were necessary in the LISL group. There were no major complications in either procedure. CONCLUSIONS: Compared with ESWL, fluoroscopically guided LISL achieves stone disintegration more rapidly and with significantly less treatment sessions, which leads to a significant reduction in cost.

Implementation of individualized patient education for Hispanic children with asthma.

An educational program known as the Childhood Asthma Project (CAP) was implemented to reduce morbidity among Hispanic children with chronic asthma. Seventy-three children, ages 6-16, participated in 4 program phases: baseline assessment, one-on-one child-centered education, application, and maintenance. During baseline assessment, child and parent asthma beliefs and behaviors were evaluated and used to create educational modules on symptom recognition, peak low meters, medications, and precipitating factors in Spanish and English. Children learned the importance of self-management, practiced using inhalers and peak flow meters and charted peak flow recordings. Videotapes provided peer modeling by showing Hispanic children with asthma performing self-management tasks. During the application phase, patients practiced self-management behaviors at home and reviewed progress with a nurse educator. During maintenance, the success of self-monitoring was reviewed at follow-up appointments. Recommendations for designing health education interventions for Hispanic children are provided.

Cholestatic jaundice due to Ormond's disease (primary retroperitoneal fibrosis).

A case of a 51-year-old man, who presented with cholestatic jaundice due to common bile duct compression produced by primary retroperitoneal fibrosis, is reported. The patient was operated on two years earlier because of hydronephrosis, when the disease was diagnosed. Cholangiopancreatography revealed a "double duct sign", disclosing another benign cause for this radiographic sign, that once was considered to be pathognomonic of pancreas cancer. The bile duct stricture was managed by the insertion of an endoscopic endoprosthesis. This is the first report of jaundice due to Ormond's disease and the third, due to retroperitoneal fibrosis.

-Bile duct stenoses and leakage after cholecystectomy: endoscopic diagnosis, therapy and treatment outcome-. / Gallengangsstenosen und -lecks nach Cholezystektomie: Endoskopische Diagnostik, Therapie und Behandlungserfolg.

Minimal invasive methods compete with surgical treatment in the therapy of complications after cholecystectomy. In this retrospective study we evaluate the efficacy of endoscopically placed biliary stents in 35 patients (25 female, ten male) with biliary strictures and/or leakage after cholecystectomy. 27 patients received a 10- or 11.5-French endoprosthesis, eight patients needed a percutaneous-transhepatic-cholangio-drainage (PTCD). Four patients (11.4%) underwent a surgical therapy. Endoscopic therapy was successfully completed in 23 patients (65.7%), at which we noticed a superior result in patients with early incidenced stenosis/leakages after cholecstectomy. During a follow-up period of 1-109 months (median 28 months) two recurrent strictures (5.7%) were observed. As a complication we have seen a prosthesis-dislocation after PTCD. None of the patients died of complications related to endoscopic therapy.

Expression of porin from Rhodopseudomonas blastica in Escherichia coli inclusion bodies and folding into exact native structure.

The homotrimeric membrane channel porin from Rhodopseudomonas blastica was expressed without signal sequence in Escherichia coli. The protein assembled in inclusion bodies in the cytosol, from which it could be recovered using urea and detergents. After purification by anion-exchange chromatography, the protein crystallized under wild-type conditions. The X-ray structure was determined at 2.2 angstroms resolution, and a comparison with the known wild-type structure showed that the recombinant porin is identical at the atomic level. The method yields porin and designed mutants thereof in 100 mg amounts, allowing for detailed functional and mechanistic studies.

Dependence of eosinophil granulocyte infiltration into nodules on the presence of microfilariae producing Onchocerca volvulus.

Onchocercomata with a single live or dead worm were analyzed to elucidate the infiltration of eosinophils. Females were classified according to the presence or absence of microfilariae in their uteri and in the nodular tissues. Immunohistochemical staining was performed using antibodies against eosinophil cationic protein, peroxidase, and major basic protein. Very few eosinophils were detected in nodules containing females without microfilariae or male or dead worms only, whereas eosinophils were abundant in all nodules with females producing microfilariae. The occurrence of eosinophils was not related to the age of the worm. Occasionally, degenerated or dead microfilariae attacked by activated eosinophils were found. By examination of onchocercomata with or without microfilariae from the same patient, it was excluded that the occurrence of eosinophils was dependent mainly on the host's immune status. In conclusion, live adult Onchocerca volvulus do not elicit an invasion of eosinophils as long as they do not produce microfilariae. The absence of eosinophilia does not exclude onchocerciasis.

A taxonomy for lay risk perceptions of dentistry.

OBJECTIVE: This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely affect dental care, (2) investigate the possible influence of lay risk perceptions on dental care and (3) permit the evaluation of risk communication strategies in dentistry. METHODS: We reviewed the literature regarding risk perception and risk communication in health care and technology. We then selected a set of variables that could be measured in a study of the general public and organized these in a taxonomy to suggest likely relationships among the variables. RESULTS: The central relationship of the proposed taxonomy is between a lay person's perception of dental risk and a set of measurable outcomes that could affect that person's dental care. The taxonomy lists three possible influences on the lay person's risk perception: attributes of the individual, attributes of the dental procedure or technology perceived as risky, and attributes of the dental practice. CONCLUSIONS: Systematic testing of the proposed variables should demonstrate whether lay risk perceptions substantially influence dental care, and if so, which factors most strongly influence risk perceptions. A model of lay risk perceptions of dentistry then could be developed and strategies could be devised to minimize the detriment, if any, to dental care from risk perception.

Differences in eosinophil and neutrophil chemotactic responses in sowda and generalized form of onchocerciasis.

Extravasation of host's leukocytes from blood vessels into inflammatory tissues represents a prerequisite for a subsequent interaction with invaded parasites. The migratory responses of eosinophilic and neutrophilic granulocytes in the polar forms of the filarial infection onchocerciasis were investigated. The hyporeactive, generalized form, the chronic hyperreactive (sowda) form and persons without signs of onchocerciasis from a hypoendemic area for onchocerciasis were compared. Eosinophils from sowda patients responded more strongly to the inflammatory mediator platelet-activating factor (PAF) than those from generalized patients and persons without onchocerciasis. The most significant differences were found between the sowda group and a subgroup of the generalized form with 16-80 microfilariae/mg skin (P<0.05) while patients with low microfilarial density exhibited chemotactic responses similar to the sowda group. In contrast to the strong eosinophil response, neutrophils from sowda patients appeared unreactive to PAF and the tripeptide activator formyl-methionyl-leucyl-phenylalanine (fMLP), thereby differing from both other groups. Laboratory data confirmed a state of hyperreactivity in sowda patients similarly found in generalized patients with low microfilarial density and contrasting with those with a microfilarial density of 16-80 mf/mg. The results revealed an inverse chemotactic responsiveness of eosinophil and neutrophil granulocytes in sowda patients and strengthened the observation of a spectrum of host's responsiveness in onchocerciasis.

[Anastomotic recurrence with tumor stenosis after Billroth II gastrectomy for adenocarcinoma: implantation of 2 metal stents as palliative therapy]. / Anastomosenrezidiv mit Tumorstenose bei Z.n. Magenresektion nach Billroth-II wegen Adenokarzinom: Implantation zweier Metallstents als Palliativtherapie.

We report on a 70 year old patient with a great relapse in the region of the anastomosis after a palliative, subtotal gastrectomy with Billroth-II-gastrojejunostomie because of an adenocarcinoma one year before. He was unable to swallow fluids or solid food. The possibility of a sufficient gastroenteroanastomosis was certainly limited (great tumor-mass left during operation). So we implantated two metal stents in the afferent and the efferent limb, respectively. The patient's vomiting completely relieved and he was able to swallow fluid food again. After that treatment the patient's quality of live noticeably increased. Furthermore, by stenting the afferent limb a sufficient drainage out of the duodenum could be reached, thereby preventing an increasing cholestasis.

[Ultrasound-guided extracorporeal piezoelectric lithotripsy of bile duct calculi]. / Ultraschallgesteuerte extrakorporale piezoelektrische Lithotripsie (EPL) von Gallenwegskonkrementen.

AIM: Extracorporeal shock-wave lithotripsy (ESWL) with underwater spark discharge and stone localisation via x-ray has become established in the treatment of difficult bile duct stones. First results with the piezoelectric lithotripter (EPL) in our department have also been promising. METHOD: Between 1989 and 1993 we were able to treat 79 patients (mean age 76 years) with problematic bile duct stones with the EPL. Twenty-seven patients had solitary stones, 52 patients presented with multiple stones. Seventy-one patients received a nasobiliary tube to decompress the biliary system. For extracorporeal lithotripsy, we used a piezoelectric lithotripter (Piezolith 2300, R. Wolf, Knittlingen, Germany). RESULTS: Visualisation of the stones by ultrasound and ensuing treatment were possible in 71 out of 79 patients (90%), and complete stone removal was achieved in 62 patients (78.5%) after 7,595 shock-waves were applied per patient on average. In 55 patients, endoscopic extraction of fragments was performed to avoid fragment complications. Nearly all patients in whom extracorporeal lithotripsy failed were cleared of their stones by additional use of intracorporeal electrohydraulic lithotripsy. Three patients received palliatively an endoprosthesis and two patients were referred to surgery. CONCLUSION: EPL with sonographic stone localisation and mild sedo-analgesia is a valuable adjunct in the treatment of difficult biliary tract calculi. It is a worthwhile alternative especially for elderly patients who would be at high risk on general anaesthesia.

Light and electron microscopy studies on Onchocerca jakutensis and O. flexuosa of red deer show different host-parasite interactions.

Adult filariae of two intranodular Onchocerca species of red deer (Cervus elaphus) were examined at the ultrastructural level. In all, 90 nodules of O. flexuosa and 20 nodules of O. jakutensis were studied by histology. O. jakutensis caused cystic and pus-filled nodules in which the female and male worms were motile. Female worms possessed a thick cuticle and a well-developed somatic musculature. The basal lamina of the muscular syncytia was connected with the transhypodermal fibers through long protrusions. The epicuticle had only few protuberances and no visible surface coat. Female O. flexuosa showed morphological features similar to those of other intranodular filariae. A surface coat could not be detected. In 24% of 33 nodules with young live female worms and 40% of 38 nodules with older live female O. flexuosa the worms were surrounded by giant cells apparently attacking a cuticle. This was found even in nodules obtained from animals no older than 9 months. It is probable that the lack of a surface coat protecting the female worm and the inability to move due to the reduced somatic muscles lead to an early elimination of O. flexuosa by the host's immune system.

Implementation of a physician education intervention. The Childhood Asthma Project.

OBJECTIVES: To increase pediatric residents' knowledge of the Guidelines for the Diagnosis and Management of Asthma (GDMA) developed by the Expert Panel of the National Asthma Education Program and to increase the residents' confidence in their ability to implement these guidelines. Emphasis was placed on the diagnosis and treatment of Hispanic children with asthma, a population at increased risk for morbidity. SETTING: A continuity care clinic located in an urban ambulatory care facility. SUBJECTS: Forty-four pediatric residents: 17 first-year residents, 15 second-year residents, and 12 third-year residents. METHODS: Residents participated in a multicomponent asthma management curriculum that stressed active learning strategies, including the following: focus groups, computer-based testing, lectures, hands-on skill development seminars, role modeling by attending pediatricians, provision of GDMA pocket cards and posters, access to peak flowmeters and spirometry, and an interactive computer-based module. Content focused on pulmonary function testing with spirometry and peak flowmeters, stepwise use of medications, recognition of asthma symptoms and triggers, and cultural considerations that impact asthma management. Pediatric faculty and fellows also participated in a series of asthma seminars to increase the likelihood that faculty would role model the GDMA and provide appropriate feedback to residents. RESULTS: Pediatric residents demonstrated significant increases in knowledge about evaluation of asthma, pulmonary function testing, and clinical management, displayed significantly enhanced levels of confidence, and were enthusiastic about the asthma management curriculum, rating it significantly higher than 15 other content areas in the general pediatric curriculum.

Assessment of physicians' information needs in five Texas counties.

In 1990, a questionnaire was mailed to all physicians in four counties in the lower Rio Grande Valley of Texas and to a random sample of physicians in Bexar County, Texas (San Antonio). Two hundred and eighty of 573 Valley physicians (48.9%) and 162 of 273 Bexar County physicians (59.3%) responded to the survey, for an overall response rate of 52.2%. The two groups were compared primarily to determine differences between physicians who have access to established medical libraries and physicians who practice in remote areas without local access to medical information. Demographic variables, professional practice characteristics, and patient characteristics were compared. Information resource use, particularly reasons for use and non-use of MEDLINE, was explored. Questions also were asked about the availability of various types of information technology. The results indicated that differences in the health care profile did not affect the information usage of the physicians but that differences did exist between the two groups in the use of MEDLINE and libraries. There was no statistically significant difference in either group's rating of experience with using databases, with more than 40% in each group rating themselves as not at all experienced.