Dose-response expectancies for alcohol: Validation and implications for brief interventions.

Introduction And Aims: Brief interventions for alcohol problems are informed by elements of behavioural motivation theories and behaviour change models. However, motivations across drinking occasions have yet to be explored. This paper addresses this need and presents initial validity statistics for a new construct, Dose Response Expectancies for Alcohol Metrics (DREAM) that can be used to investigate expectancies across the drinking session and thus inform novel interventions.

Predicting death and readmission after intensive care discharge.

Background: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.

Methods: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.

Lower limits of detection using magnetic resonance imaging for solid components in cystic renal neoplasms.

Objectives: We determined the positive predictive value (PPV) for malignancy in complex renal cysts with focal nodular enhancement seen on magnetic resonance imaging (MRI).

Methods: A surgical database was reviewed to identify all patients having both a preoperative 3 dimensional (3D) renal MRI and a radical or partial nephrectomy from January 2000 through April 2004 at our hospital. A group of 21 patients were identified with focal nodular enhancement within cystic renal masses.

Polymorphonuclear leukocytes from patients with severe sepsis have lost the ability to degrade fibrin via u-PA.

Fibrin persistence in the vasculature is an important complication of sepsis that can often lead to mortality. We have previously established that polymorphonuclear leukocytes (PMN) from healthy individuals have the capacity to degrade fibrin via urokinase-type plasminogen activator (u-PA). We have also demonstrated an increase in u-PA antigen in the plasma of patients suffering from septic shock.

Fibroepithelial polyps causing ureteropelvic junction obstruction in children.

Purpose: Fibroepithelial polyps are benign mucosal projections that can be found throughout the urinary system. We review our experience with fibroepithelial polyps of the ureteropelvic junction in children to define more clearly this entity and its outcome following treatment.

Methods: We reviewed the records of all children with fibroepithelial polyps causing ureteropelvic junction obstruction treated at our institution between December 1967 and February 2002.

Plasminogen activator inhibitor 2 and urokinase-type plasminogen activator in plasma and leucocytes in patients with severe sepsis.

Proteins influencing plasminogen activation to plasmin, namely plasminogen activators tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA) and their principal inhibitors, plasminogen activator inhibitor 1 (PAI-1) and PAI-2, were measured in the plasma, the polymorph and mononuclear cell fractions taken from patients with major sepsis who were entering a general intensive care unit. The purpose of this study was to elucidate the factors favouring the persistence of fibrin in the microvasculature and thus contributing to multiple organ failure. Levels of u-PA antigen in plasma rose in sepsis and u-PA activity, not detectable in normal plasma, appeared.

Fibrinolytic changes in a patient with toxic shock syndrome; release of active u-PA.

Objective: Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis.

Design: Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome.

Setting: Intensive care unit.

Evidence for an active fibrinolytic system in normal human bone marrow.

Normal human bone marrow from patients undergoing heart surgery was analysed quantitatively for components of the fibrinolytic system, using functional and immunological assays. Marrow was found to contain considerable fibrinolytic activity, reflecting high levels of t-PA (tissue-type plasminogen activator). The t-PA was in an active form, despite the presence of the inhibitors PAI-1 and PAI-2.

Inhibitors of plasminogen activator in neutrophils and mononuclear cells from septic patients.

Leucocytes, both polymorphs and mononuclear cells, play a variety of roles in the evolution of human response to sepsis, both local and generalised. In this study, inhibitors of plasminogen activator were measured in leucocytes from normal and septic patients. Plasminogen activator inhibitor-1 (PAI-1) was identified in polymorphs from normal individuals and levels rose significantly in polymorphs from septic patients: neutrophils from normal subjects did not contain PAI-2 but this protein was detectable in significant quantities in polymorph preparations from septic patients.

Influence of white blood cells on the fibrinolytic response to sepsis: studies of septic patients with or without severe leucopenia.

In septic patients capable of normal white cell responses, high plasma levels of PAI-I, t-PA antigen and t-PA-PAI-I complex were observed. The ratios of t-PA and PAI-I were such that free PA activity was almost never observed. In patients severely leucopenic prior to becoming septic the changes were significantly less marked, so presence of leucocytes enhances the fibrinolytic inhibition occurring in sepsis.

Plasma nitrate concentrations in neutropenic and non-neutropenic patients with suspected septicaemia.

Nitric oxide (NO) is an important physiological mediator of vascular tone and is thought to be involved in the pathogenesis of septic shock. Plasma nitrate is the stable end product of NO oxidation and in part reflects endogenous NO production. We measured plasma nitrate levels in 47 episodes of suspected septicaemia in 43 in-patients (16 male and 27 female, age 15-63 years).

Sublethal percussion trauma in vitro causes a persisting derangement in the nonthrombogenic properties of brain endothelial cells.

The delivery of a blow to the head represents a transfer of energy, part of which manifests itself as a short-lived pressure change within the skull. An in vitro model was developed to test whether cerebral endothelial cell hemostatic function is altered with exposure to this type of pressure event. Human cerebral microvascular endothelium (HCME) cells were subjected to rapid (2-5 msec) changes in pressure (delta atmosphere = 1.

Chronic or recurrent meningitis. Neurosurgical perspectives.

Chronic meningitis is not a commonly encountered clinical problem in the day-to-day patient care responsibilities of neurosurgeons. It is, however, important for the neurosurgeon to be familiar with the clinical problems, diagnostic challenges, and therapeutic options required to establish a definitive diagnosis. This article concentrates on specific entities causing chronic or recurrent meningitis that may require neurosurgical participation.

Increased cerebral blood flow in idiopathic pseudotumour cerebri.

Cerebral blood flow was studied in nine patients with idiopathic pseudotumour and one patient with cortical vein thrombosis in Denver, Colorado using the 133Xe inhalation method. Globally elevated blood flows were found in all of the idiopathic pseudotumour patients averaging 149% of control values generated in the same setting. The patient with the cortical vein thrombosis demonstrated normal global flows.

Colloidal volume expansion during acute cerebral ischaemia: assessed by local cerebral blood flow and computerized power ratio index.

Colloidal volume expansion during acute cerebral ischaemia was assessed by local cerebral blood flow (CBF) and the power ratio index (PRI) in 8 anaesthetized Macaque monkeys. Focal cerebral ischaemia was produced by right middle cerebral artery occlusion. The animals were then volume expanded (to maximum cardiac output) with 6% hetastarch and then exsanguinated to baseline cardiac output.

Pulsatile versus nonpulsatile blood flow in the treatment of acute cerebral ischemia.

The effects of pulsatile and nonpulsatile perfusion on local cerebral blood flow (CBF) and on computerized mapping (CME) of electroencephalograms (EEG) in nonischemic and ischemic brain were studied using a canine stroke model. Nine anesthetized mongrel dogs were placed on normothermic right atrial-femoral artery cardiopulmonary bypass at a flow of 100 ml/kg/minute. Local CBF measurements and CME data were collected during nonpulsatile perfusion and maximal pulsatile perfusion.

Blood volume expansion with hetastarch in acute ischaemic stroke: the effects on local cerebral blood flow and computer mapped EEG.

Focal cerebral ischaemia was induced in seven anaesthetized monkeys by unilateral middle cerebral artery (MCA) occlusion. Local cerebral blood flow (CBF) and computer mapped EEG (CME) changes were then studied as blood volume and cardiac output (CO) were varied. CO was increased by colloidal volume expansion and decreased by exsanguination.

Topographic electroencephalographic study with power ratio index mapping in patients with malignant brain tumors.

A variant of electroencephalogram (EEG) power spectral mapping called power ratio index (PRI) mapping was used to monitor 15 patients with malignant brain tumors. This index is generated by dividing the low frequency (delta, theta) power by the high frequency (alpha, beta) power. Because the nonparoxysmal effect of a brain tumor on the EEG is reflected as a relative loss of high frequency power and a gain in low frequency power, utilization of the PRI has the effect of placing the epicenter of the "power dysfunction" coincident with the epicenter of the tumor.