Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms.

We evaluated the relationship between the signs and symptoms of the clinical syndrome called veno-occlusive disease of the liver after bone marrow transplantation and the histological findings in 76 patients who later came to autopsy. Coded necropsy liver was scored for individual histological features that were correlated with prospectively assessed clinical features that the patients had exhibited during life. Patients were stratified into two groups: those with severe clinical veno-occlusive disease (n = 32) and those without. Clinically severe veno-occlusive disease was statistically correlated with several zone 3 acinar changes: occluded hepatic venules, the frequency of occluded hepatic venules x degree of occlusion, eccentric luminal narrowing/phlebosclerosis, zone 3 sinusoidal fibrosis and zone 3 hepatocyte necrosis (all p < or = 0.03). There was a significant relationship between the number of these histological abnormalities in zone 3 of the liver acinus and a clinical diagnosis of severe veno-occlusive disease (p = 0.003). The presence of ascites was significantly correlated with occluded venules, zone 3 sinusoidal fibrosis and zone 3 hepatocyte necrosis (p = 0.001). Maximum serum bilirubin in the first 20 days after transplant was significantly correlated with sinusoidal fibrosis, hepatocyte necrosis and eccentric luminal sclerosis/phlebosclerosis (p < 0.01) but not with venular occlusion. The clinical syndrome of liver toxicity (commonly called veno-occlusive disease) that results from cytoreductive therapy before bone marrow transplant is strongly correlated with a constellation of histological lesions involving structures in zone 3 of the liver acinus and the hepatic venules into which sinusoidal blood flows. This study suggests that there is no single diagnostic histological feature. The severity of clinical veno-occlusive disease appears to be proportional to the number of such histological changes and is not due solely to occlusion of small hepatic venules.

Phases of chronic pain: a model for assessment and treatment.

Chronic pain can be described as a syndrome or process of decompensation not unlike any other chronic disease or illness. As such, chronic pain patients are often difficult to work with because of the pervasive personal, social, emotional, and physical impact of the syndrome on their lives and the lives of their families. The pain curve was developed to be used as an educational instrument to assist patients in understanding the disease process, confronting denial, and self-diagnosing their illness. This curve now in use at our institution describes both the progression and the recovery of the illness. The pain curve is used as an educational tool to aid patients in addressing important recovery issues such as denial and the disease process, the progression of symptoms in a chronic illness, medication and alcohol use and abuse in the management of chronic pain, the impact on and from the family and the importance of peer support.

Prediction of hearing aid users' satisfaction.

This study raised the question of whether certain methods of hearing aid evaluation could predict subjects' satisfaction and willingness to use their aids. For this purpose, we compared two hearing aid evaluation methods on 30 subjects between the ages of 55 and 65 years, all of whom were hearing aid users for some months. Five signal-to-noise ratios were used. The results of this experiment indicated a significant and positive correlation between subject satisfaction and subject willingness to use the hearing aid. Results of multiple regression analyses indicated that both evaluation methods were better predictors of usage than of satisfaction.

Variably occlusive tape systems and the mitotic activity of stripped human epidermis. Effects with and without hydrocortisone.

This study elaborates on the effect of occlusive, partially occlusive, and nonocclusive tape systems containing hydrocoritsone on human epidermal mitotic activity that has been increased by tape stripping. The experimental variables included tape delivery systems affording total, partial (50%), or no occlusion to normal human skin. The test corticosteroid was hydrocortisone at a dose range of 1, 4, and 20 microgram/sq cm. Utilizing demecolcine cream, biopsy specimens, were taken and mitotic figures determined. Results suggest that potent antimitotic effects occur equally with semiocclusive and nonocclusive tapes containing hydrocortisone as with total occlusive tapes. Verification of the practicality of this in clinical use will depend on appropriate clinical trials in diseased states.

Effects of occlusive tape systems on the mitotic activity of epidermis. With and without corticosteroids.

This study was designed to elaborate on the effects of occlusion and corticosteroids on human epidermal mitotic activity. The experimental variables included tape delivery systems that afforded total, partial (50%), or no occlusion to normal human skin. In some experiments, hydrocortisone, flurandrenolide, betamethasone, betamethasone valerate, and fluorometholone were added to these tape systems. Using demecolcine cream, biopsies were taken, and mitotic figures were determined. Results suggest that potent antimitotic effects occur with semiocclusive and nonocclusive tapes that contain corticosteroids, and that total occlusion is not necessary for this physiological effect. This suggests the possibility that the presumably better tolerated nonocclussive and partially occlusive systems might be used as dermatological drug delivery systems.

Effect of some irritants on human epidermal mitosis.

Studies on how irritant materials might induce epidermal hyperplasia were initiated by investigating their influence on epidermal mitosis. 5% hydrochloric acid, neat dimethyl acetamide and 1% benzalkonium chloride had no effect. 5% benzalkonium chloride, however, produced a 10-fold increase in mitotic activity, while a dose response curve was seen with sodium lauryl sulphate (SLS) peaking at 1%. 1% SLS produced a remarkably uniform response for this type of assay and it is suggested that it might provide a useful model for situations of increased epidermal cell turnover such as psoriasis. It is also noted that there was apparently no direct relationship between gross inflammation and the mitotic response.

The effect of anthralin and its derivatives on epidermal cell kinetics.

An attempt was made to clarify the effect of anthralin on epidermal cell kinetics. Commercial anthralin powder was separated by column chromatography into three components: pure anthralin, 1,8-dihydroxyanthroquinotne, and anthralin dimer. The effect of these on the diurnal mitotic variation and the cell cycle of the hairless mouse epidermis was studied. Neither anthroquinone nor the anthralin dimer had any influence on these parameters. Both the chromatographically pure and commercial anthralins had similar effects. Mitotic activity was considerably reduced, although not to zero, with concomitant elimination of the diurnal peak. The G2 and S phases of the cell cycle were approximately doubled in length. Application of the pure and commercial anthralin also resulted in some irritation not seen with either the anthroquinone or dimer.