Oxidative metabolism in platelets, platelet aggregation, and hematology in patients undergoing multiple hyperbaric oxygen exposures.

Repeated hyperbaric oxygen (HBO2) treatments at 2.2 ATA for 90 minutes each are used to treat chronically ill patients with problem wounds, but there are concerns about the cytotoxicity of oxygen to blood cells and platelet function during prolonged HBO2 therapy. We recruited 31 consenting patients scheduled for multiple HBO2 treatments to evaluate oxidative metabolism in platelets, platelet aggregation, and hematology (mean age +/- standard error, 61 +/- 2.6 years, 20 males, 11 females). Venous blood was collected before and after the 1st and 20th HBO2 treatments. No effect of HBO2 was observed on red cell counts, hematocrit, hemoglobin, mean red cell volume (MCV), platelet counts, basal levels of lactate production by platelets, ferric reducing ability of plasma (FRAP), or plasma protein. The capacity for oxidative metabolism (lactate ratio) in platelets was not affected by HBO2, except in smokers where it increased by the 20th HBO2 treatment. Mean lymphocyte count was increased by 38% after the 20th treatment. There was also a 23% increase in platelet protein content, and a 24% increase in arachidonic acid-dependent platelet activation. Collagen-dependent platelet aggregation was unaffected. Blood glucose showed HBO2-dependent variability, but remained in the normal range. Plasma lactate levels decreased significantly from 3.2 to 2.5 mmol/l by the end of the study. Overall, we found no evidence that 20 HBO2 sessions caused adverse effects on platelet aggregation or oxidative metabolism in platelets, red or white cell counts, or total antioxidant status of the plasma.

Investigation of neutrophils in the gut lumen by assay of granulocyte elastase in whole-gut lavage fluid.

BACKGROUND: Intestinal neutrophils can be studied by radiolabelling techniques and by cytology of whole-gut lavage fluid. Our aim was to evaluate the use of a biochemical test for the presence of these cells in whole-gut lavage fluid. METHOD: Whole-gut lavage was performed by having the patients drink a polyethylene-glycol-electrolyte solution; the clear fluid passed per rectum after complete bowel cleansing had been collected. In 203 patients granulocyte elastase was assayed in sonicated unfiltered lavage fluid, using the specific enzyme substrate L-pyroglutamyl-I-prolyl-L-valine-p-nitroanilide. Free granulocyte elastase was also assayed in filtered (that is, cell-free) lavage fluid in 39 of the 43 patients in whom the enzyme was present in unfiltered fluid. In 47 of the patients, cells were also separated by density gradient centrifugation, and counted. RESULTS: Granulocyte elastase concentration correlated significantly with cell count (r = 0.80, p < 0.001). Granulocyte elastase concentration was high (> 100 nkat/l) in fluid from 25 of 68 inflammatory bowel disease patients and 6 of 135 others with radiation colitis, diverticulitis, pericolic abscess, and use of non-steroidal anti-inflammatory drugs. In patients with detectable total granulocyte elastase, cell-free granulocyte elastase was present in 11 of 29 with inflammatory bowel disease and 1 of 10 others. CONCLUSION: Whole-gut lavage fluid samples can readily be used to investigate luminal inflammatory cells.

Investigation of neutrophil migration into the gut by cytology of whole gut lavage fluid.

OBJECTIVE: Radiolabelling studies have shown that neutrophils migrate into the gut lumen in inflammatory intestinal diseases. We aimed to establish whether whole gut lavage fluid can be used to investigate intestinal neutrophilia. DESIGN: A prospective single centre study comparing inflammatory bowel disease patients, patients with other gastrointestinal diseases and normal controls. METHODS: Gut lavage with a polyethylene glycol-based solution was performed in 56 patients (29 with inflammatory bowel disease). Gut lavage fluid samples were collected when the rectal effluent was clear. Cells were then separated by density gradient centrifugation, counted, and cytospin preparations examined. RESULTS: High cell counts (> 3.7 x 10(5)/ml), predominantly neutrophils, were present in 12 out of 29 inflammatory bowel disease patients and in two out of 27 others. High cell counts and luminal neutrophilia characterized active ulcerative colitis and active colonic Crohn's disease, but not active small bowel Crohn's disease, or inactive disease. CONCLUSION: Whole gut lavage fluid samples can be used to investigate luminal inflammatory cells. We observed previously unrecognized differences between small bowel and colonic Crohn's disease using this method. The mechanisms of neutrophil migration into the gut lumen may differ with disease distribution.

Focal gingival hyperplasia in a horse.

A diagnosis of gingival hyperplasia in a 22-year-old Quarter Horse gelding was confirmed by histologic examination. Clinical signs included difficulty eating hay, and a large, intraoral soft tissue mass measuring 13 x 8 x 4.5 cm. The mass was located in the mucosa on the lingual aspect of the caudal left portion of the mandible, ventral to the base of the tongue, and covered the second and third lower molars, extending rostrally along the buccal mucosa to the premolars. The left maxillary second and third molars were overgrown with sharp edges. Lateral radiography of the mandible revealed absence of the left third molar, with associated bony irregularity and sclerosis. The horse was positioned in right lateral recumbency under general anesthesia, and the entire mass was resected. It was speculated that the lesion developed secondary to chronic irritation from opposing teeth and food-packing after loss of the lower third molar; this would not be an unexpected development in a species with continuously advancing molars.

The effect of sucralfate pretreatment on the pharmacokinetics of ciprofloxacin.

Based on the results of our study of norfloxacin-sucralfate coadministration, we suspected that sucralfate would interact also with ciprofloxacin if the drugs were administered concurrently. Therefore, we decided to give a 1-g dose of sucralfate at 6 and 2 hours before a single 750-mg dose of ciprofloxacin and evaluate its effect on the bioavailability of ciprofloxacin. Twelve healthy, male volunteers received ciprofloxacin alone and with sucralfate pretreatment in a randomized, balanced, crossover design. Blood and urine samples were collected over 24 hours after ciprofloxacin administration, and drug concentrations were assayed by high-performance liquid chromatography. When sucralfate was given at 6 and 2 hours before ciprofloxacin, an average 30% decrease in ciprofloxacin's bioavailability was noted (p less than 0.05). Four of the 12 subjects, however, had decreases in the agent's area under the curve of more than 50% with sucralfate pretreatment. The results of this study suggest that ciprofloxacin and sucralfate should not be administered concurrently until a dosing interval is found that will avoid this potential interaction.

Family dysfunction and the psychological impact of child sexual abuse.

This paper presents the view that family dysfunction in intra- and extra-familial child sexual abuse can be considered apart from the sexual trauma and can be seen as having important independent psychological consequences. Family dynamics are discussed as they relate to both types of sexual abuse and as they relate to the context of disclosure of the events. A direct link is suggested between such dynamics and the psychological problems experienced by the child victims. Recommendations for research and therapy are also made.

Nursing management of the woman with osteoporosis.

One accompaniment of loss of ovarian function for many women is osteoporosis. Care of women who suffer a hip fracture as a result of osteoporosis has become a public health issue and focuses on a possible lack of patient education regarding health maintenance. Nurses can play a key role in the care of women with osteoporosis by knowing about possible causative factors and by having a broad understanding of patient management, including how important patient education is to the maintenance of health.

Is arson an aggressive act or a property offence? A controlled study of psychiatric referrals.

Arsonists seen for psychiatric assessment were compared to property offenders and to violent offenders on a number of clinical measures. It was found that arsonists were a mixture of the two groups but the majority aligned with property offenders in personality, diagnosis, criminal and violence history, family background, alcohol and drug use as well as in sexual behaviour. Significantly 18% of arsonists were mentally retarded. The act of arson was examined in detail using reliable ratings. While there was no obvious motive in two-fifths of the cases, revenge with underlying anger was most frequently a recognized motive for arson. The provocateur for the act of arson was not always readily identifiable and in over half the cases more than one person or an institution was the stimulus for the fire. Directions for future study were discussed.

Diagnosis of killers seen for psychiatric assessment. A controlled study.

109 killers, 38 nonviolent offenders and 54 community controls were compared on psychiatric diagnosis, the MMPI, Cattell 16 PF, IQ and clinical neurological results. Killers did not differ from nonviolent offenders on diagnosis or personality in general. Only higher MMPI Hysteria scale scores differentiated the killers from the other groups. IQ tended to be lower and neurological findings more often positive in homicide cases than in controls. Results suggest that previous uncontrolled research on homicide has been misleading.

The role of alcohol, drugs, suicide attempts and situational strains in homicide committed by offenders seen for psychiatric assessment. A controlled study.

The use of alcohol and drugs at the time of offence, suicide attempts and situational strains were compared in 109 killers and 38 nonviolent offenders seen for psychiatric assessment. More killers than nonviolent offenders used alcohol and drugs at the time of their offence but there was no difference in previous attempts at suicide nor in situational strains. Killers, however, did have more recent frustrations than the other group. Results suggest that the use of intoxicants in violence-prone individuals is the most important factor in homicide.

The Clarke SHQ: a clinical sex history questionnaire for males.

The development of a 225-item sexual history questionnaire is reported. The frequency, desire for, and disgust for a wide range of sexual behaviors, including anomalous behavior, were examined. Twenty-four scales were derived from factor analysis of the items. The scales were represented by modest unitary factors but were relatively free of bias from age, education, intelligence, social desirability, and defensiveness. The scales generally discriminated clinically relevant groups from control subjects and therefore meet a clinical need in the assessment of anomalous sexual behavior. The instrument also appears to be useful in examining hypotheses for research. Among these observations was the continuity between exhibitionism and heterosexual pedophilia and the apparent bisexuality of some homosexual males. The scale allows for the assessment of the preferences of sexually inexperienced males as well.