Community-acquired pneumonia: the clinical dilemma.

Community-acquired pneumonia (CAP) is the sixth most common cause of death in the United States. Despite its frequency and mortality, specific etiologic diagnosis remains a major clinical challenge. The organisms most commonly implicated in CAP are Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Haemophilus influenzae, Chlamydia pneumoniae (TWAR), and viruses.

Pancreatic injuries in children.

Pancreatic injuries over an 11-year period were reviewed. Pedestrian motor vehicle accidents accounted for 45% of the injuries. Diagnosis was made clinically and on raised serial serum amylase levels.

Tumor necrosis factor alpha priming of phospholipase D in human neutrophils. Correlation between phosphatidic acid production and superoxide generation.

Tumor necrosis factor alpha (TNF) primes human neutrophils (PMN) for enhanced superoxide (O2-) production if cells are subsequently stimulated with the chemotactic peptide, n-formyl-Met-Leu-Phe (fMLP). fMLP activates phospholipase D to form phosphatidic acid (PA), and a correlation may exist between PA production and O2- generation in PMN. Therefore, we assessed the ability of TNF to prime phospholipase D activation in PMN stimulated with fMLP.

Tumor necrosis factor-alpha priming of phospholipase A2 activation in human neutrophils. An alternative mechanism of priming.

The cytokine, TNF-alpha, interacts with human neutrophils (PMN) via specific membrane receptors and primes leukotriene B4 (LTB4) production in PMN for subsequent stimulation by calcium ionophores. We have further examined the effects of TNF-alpha on arachidonic acid (AA) release, LTB4 production, and platelet-activating factor (PAF) formation in PMN by prelabeling cells with either [3H]AA or [3H]lyso-PAF, priming with human rTNF-alpha, and then stimulating with the chemotactic peptide, FMLP. TNF-alpha, alone, had little effect; minimal AA release, LTB4 or PAF production occurred after PMN were incubated with 0 to 1000 U/ml TNF-alpha.

Investigation and management of blunt renal injuries in children: a review of 11 years' experience.

Over an 11-year period, 333 patients aged 6 months to 13 years were investigated for suspected blunt renal trauma. Ninety-one renal injuries were demonstrated. All patients who had preexisting pathology sustained major (ie, grade III or IV) injuries and all those who required surgery presented with 4+ or macroscopic hematuria with or without loin signs.

The influence of caregiving and bereavement support on adjusting to an older relative's death.

This study examines the influence of both caregiving social support to an impaired older relative and bereavement social support to a surviving caregiver on that caregiver's bereavement adjustment. Although past research has considered the link between bereavement support and adjustment to a loved one's death, the influence of support to the care recipient has not been investigated. Analyses of prospective panel data from 73 spouse and adult-child caregivers show caregiving support characteristics to be more important for bereavement adjustment than support provided to the surviving caregiver after their relative's death.

Cypress (Cupressus sempervirens) pollen allergens: identification by protein blotting and improved detection of specific IgE antibodies.

On the basis of results of an investigation of the effects of different treatments employed, a dialysed and reduced extract of Cupressus sempervirens was separated electrophoretically on sodium dodecylsulphate-polyacrylamide gels before being transferred and then fixed with glutaraldehyde to nitrocellulose membrane. Probing with sera from 91 subjects allergic to C. sempervirens pollen followed by detection of bound IgE antibodies with [125I]-labelled anti-human IgE revealed 17 IgE-binding proteins in the molecular weight range 14-96 kilodaltons (kDa).

Empirical and clinical focus of child and adolescent psychotherapy research.

The present study evaluated the characteristics of research on child and adolescent psychotherapy. Published studies (N = 223) of psychotherapy from 1970 to 1988 were codified to characterize research, clinical, and methodological characteristics. The major results indicate that (a) treatment research focuses almost exclusively on the impact of treatment techniques with scant attention to influences (child/adolescent, parent, family, therapist) that may moderate outcome and (b) several characteristics of the children/adolescents and methods of treatment delivery and approaches depart markedly from those evident in the practice of treatment.

Topical anaesthesia for repair of minor lacerations.

One hundred traumatic skin wounds were sutured under topical anaesthesia using a solution of lignocaine, adrenaline, and cocaine, and the effectiveness of the anaesthesia produced was assessed on a behavioural scale. The procedure was tolerated well by 63 patients, poorly by 11, and in 26 the response was uncertain. The response correlated well with age and with the field of anaesthesia measured from the wound margin.

Paediatric trauma care.

Paediatric trauma care varies in different countries. In South Africa injury is the leading cause of death in the 5-14-year-old age group--1.5-3.

Five years' experience of injured children.

This study was undertaken to analyse admission data on all patients seen in the Red Cross War Memorial Children's Hospital Trauma Unit during the period 24 April 1984 - 31 March 1989. Data were retrieved from computerised records completed on admission and were reviewed descriptively. Variations in age, sex and population group pattern for different causes of injury were evaluated together with data on the nature and place of injury and time seen.

Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography--an unresolved problem.

Over a 6-month period 5 patients with obstructive jaundice developed Gram-negative septicaemia, all within 48 hours of undergoing endoscopic retrograde cholangiopancreatography. The sepsis proved fatal in 3 patients, despite prompt decompression of the obstructed biliary system. In all cases the organism responsible was Pseudomonas aeruginosa and the source of infection appeared to be a contaminated water-bottle attached to the endoscopic apparatus.

Influenza A virus alters structural and biochemical functions of the neutrophil cytoskeleton.

Influenza A virus (IAV) has previously been shown to alter chemotactic, oxidative, and secretory functions of polymorphonuclear leukocytes (PMNL). Because of the role of cytoskeletal proteins in these processes, studies were carried out to determine if IAV altered the PMNL cytoskeleton. PMNL were incubated with buffer of IAV, stimulated with f-met-leu-phe (FMLP), fixed and stained with NBD-phallacidin (NBD-Ph) and studied by flow cytometry.

Intraluminal proteolytic activation plays an important role in replication of type 1 reovirus in the intestines of neonatal mice.

Oral inoculation of suckling mice with reovirus serotype 1 (strain Lang) results in the conversion of intact virions to intermediate subviral particles (ISVPs) in the intestinal lumen. Digestion of virus in vitro with chymotrypsin or trypsin reveals two distinct forms of ISVPs, while the predominant species of ISVPs found in the small intestinal lumen appears to be identical to the chymotrypsin product. The in vivo conversion of virions to ISVPs was blocked by pretreatment of mice with protease inhibitors, resulting in inefficient replication of reovirus in intestinal tissue.

Immunization with baculovirus-expressed VP4 protein passively protects against simian and murine rotavirus challenge.

A baculovirus-expressed VP4 protein derived from the simian rhesus rotavirus (RRV) was used to parenterally immunize murine dams. VP4-immunized dams developed high levels of neutralizing antibodies against RRV and low levels of cross-reactive neutralizing antibodies against human strains Wa, ST3, and S2 and animal strains SA-11, NCDV, and Eb. Newborn mice suckled on VP4-immunized dams were protected against a virulent challenge dose of the simian strain RRV and against murine rotavirus Eb.

An evaluation of arbaprostil at multiple doses for the treatment of acute duodenal ulcer: a randomized double-blind placebo-controlled international trial.

Six hundred and thirty patients were enrolled in a randomized double-blind placebo-controlled trial evaluating two arbaprostil dosages (25 micrograms and 50 micrograms) qid for 4 wk for the treatment of acute duodenal ulcers. The healing rates in the placebo, 25-micrograms, and 50-micrograms treatment groups were 39%, 51%, and 60%, respectively. Smoking was found to adversely affect the healing rates in all the treatment groups.

The transition from caregiving to bereavement: the relationship of care-related strain and adjustment to death.

This study examines two competing hypotheses about the relationship between care-related strain and the difficulty adjusting to the impaired relative's death. One hypothesis, and the limited available empirical evidence, suggests that family members who perceive caregiving as stressful will experience some relief when their relative dies because care responsibilities end. An alternative hypothesis, derived from several conceptualizations, posits the opposite relationship, with greater care-related strain predictive of greater strain during bereavement.

[Screening for colorectal neoplasms].

We screened groups at high risk for colorectal neoplasms, determining the efficacy of the leukocyte adherence inhibition test (LAI) for early detection, in comparison with that of the fecal occult blood (Hemoccult) test and sigmoidoscopy or colonoscopy. Those screened included 549 first-degree relatives of patients with colorectal cancer, 190 patients with a past history of colorectal adenoma or carcinoma and 67 with a past history of breast or gynecological cancer or inflammatory bowel disease. 146 normal volunteers served as controls.

NS35 and not vp7 is the soluble rotavirus protein which binds to target cells.

Recent studies using radiolabeled rotavirus lysates have demonstrated a 35-kilodalton viral protein that binds specifically to the surface of MA104 cells (N. Fukuhara, O. Yoshie, S.

Longitudinal impact of interhousehold caregiving on adult children's mental health.

The wear-and-tear hypothesis of caregiving (the longer care provided, the more psychological strain on caregivers) was examined using panel survey data from 112 adult children providing interhousehold care to an impaired elderly parent. Measures included subjective caregiving stress and perceived caregiving effectiveness ("wear") and depression and affect balance ("tear"). Contrary to the hypothesis, data revealed variability in children's adaptation to caregiving, improvement rather than deterioration being the norm.

Parasitic infestation in Cape Town children. A random study of 101 patients.

Over a 12-month period random stool specimens were collected from 101 children admitted to the trauma unit of the Red Cross War Memorial Children's Hospital, Cape Town. The majority of the children were resident on the Cape Flats or in Mitchell's Plain. Examination of the stools showed evidence of parasitic infestation in 46 of the children, of whom 39 harboured Ascaris lumbricoides (8), Trichuris trichiura (11) or both (20).

Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior.

The present study evaluated alternative treatments for children (N = 112, ages 7-13) referred for severe antisocial behavior. Children were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children.

Hematologic changes induced by intravenous administration of diacetoxyscirpenol in pigs, dogs, and calves.

Diacetoxyscirpenol (DAS) was given IV to pigs (0, 0.5, and 1.0 mg/kg of body weight), cattle (0 and 0.