Outcome following heart transplantation in Maori and Polynesian patients: a comparison with European New Zealanders.

Aim: To compare demographic, clinical and outcome data of Maori and Polynesian with New Zealand European heart transplant patients.

Methods: A retrospective analysis was made of data from the 104 patients who underwent heart transplantation at Green Lane Hospital over a period of twelve years, of whom 79 were European, 23 Maori/Polynesian, and two Asian. Clinical characteristics, blood group, HLA matching and outcomes of recipients were compared.

Corrected TIMI frame counts correlate with stenosis severity and infarct zone wall motion after thrombolytic therapy.

Background: The majority of patients with patent infarct-related arteries after thrombolytic therapy have slower than normal flow, which relates to myocardial perfusion.

Methods: To evaluate the relationships between blood levels of creatine kinase (CK) and the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC), infarct artery stenosis, and left ventricular function, we studied 397 patients with a first myocardial infarction who underwent angiography at 3 weeks. TIMI flow grades, the CTFC, infarct artery stenosis, and infarct zone wall motion (by contrast ventriculography using the centerline method) were assessed, and CK levels (in units per liter) were measured hourly for the first 4 hours after streptokinase (1.

The program for professional values and ethics in medical education.

Background: Medical educators are very interested in the teaching and evaluation of professional attitudes and behaviors among medical students, residents, and faculty. At Tulane University School of Medicine, we created the Program for Professional Values and Ethics in Medical Education (PPVEME) to return the focus of our curriculum to the physician-patient-community relationship and to the nurturing of professionalism.

Description: PPVEME brings together students, residents, and faculty into learning teams that create longitudinal curricula about five themes: integrity, communication, teamwork, leadership, and service.

A comparison of the short and long forms of the Multiple Affect Adjective Check List-Revised (MAACL-R).

Brief, reliable, and valid assessment instruments are very important for clinical psychology research and practice. The possible equivalency of a short form and the long form of the Multiple Affect Adjective Check List-Revised (MAACL-R; Zuckerman & Lubin,1985) was studied by correlating both forms of the MAACL-R with the State Trait Personality Inventory (Spielberger,1995); the Affect Balance Scale (Bradburn,1969); and the Sensation Seeking Scale (Zuckerman,1978). Reliability and validity of the two forms were equivalent.

Identification and sub-typing of Mycobacterium avium subsp. paratuberculosis and Mycobacterium avium subsp. avium by randomly amplified polymorphic DNA.

A commercially available kit consisting of twenty 10-mer random primers was evaluated to allow selection of a suitable primer that would permit identification and sub-typing of Mycobacterium avium subsp. paratuberculosis and Mycobacterium avium subsp. avium by randomly amplified polymorphic DNA (RAPD).

Intravenous immunoglobulin in acute rheumatic fever: a randomized controlled trial.

Background: Acute rheumatic fever (ARF) remains the leading cause of acquired heart disease in children worldwide. No therapeutic agent has been shown to alter the clinical outcome of the acute illness. Immunological mechanisms appear to be involved in the pathogenesis of ARF.

ELISA and fecal culture for paratuberculosis (Johne's disease): sensitivity and specificity of each method.

The sensitivity and specificity of the ELISA and fecal culture tests for paratuberculosis in dairy cattle are examined. ELISA and fecal culture data from seven dairy herds where both fecal cultures and ELISA testing was done concurrently are included. A cohort of 954 cattle including 697 parturient adults, cultured every 6 months from 10 herds followed over 4 years served as the basis to determine fecal culture sensitivity.

Parallel faecal and organ Mycobacterium avium subsp. paratuberculosis culture of different productivity types of cattle.

Faecal (at least 3 months before slaughtering) and organ examinations were carried out in 611 animals (497 dairy, 69 dual-purpose and 44 beef cattle) originating from eight paratuberculosis infected cattle herds. The diagnosis in cattle was established by routine intestinal culture (ileum and the adjacent lymph nodes) after slaughter. In selected 132 animals, post-mortem intensive culture was performed on tissue samples collected from the gastrointestinal tract (duodenum, jejunum, ileum, ileocecal valve, caecum, rectum) and the corresponding lymph nodes, submandibular, retropharyngeal, tracheobronchial, liver and supramammary lymph nodes, kidney, liver and spleen.

The pathology of spontaneous paratuberculosis in the North American bison (Bison bison).

Gross and histopathologic examinations were performed on 70 North American bison (Bison bison) from a Mycobacterium avium paratuberculosis culture-positive herd. The bison examined were part of a breeding herd totaling 2,800 animals. Eight of 70 (11%) animals had gross findings of intestinal mucosal thickening, and 16 of 70 (23%) of the animals had enlarged mesenteric lymph nodes.

Development of a random response scale for the multiple affect adjective check list-revised.

A scale was constructed to identify random responses on the Multiple Affect Adjective Check List-Revised. Items chosen were the 14 least frequently checked items and 14 most frequently checked items, plus the seven most frequently checked negative items and the seven least frequently checked positive items (total=42). The Random Response Scale successfully differentiated random protocols from those produced by 420 college students, and scores on the scale were significantly higher for the college students than for the random sample.

Fatal Clostridium botulinum toxicosis in eleven Holstein cattle fed round bale barley haylage.

Twenty-two lactating Holstein cattle in Tennessee had clinical signs of intoxication with preformed Clostridium botulinum toxin. These signs included weakness, paralysis of the tongue and chest muscles, abdominal breathing, and, in 11 of the 22 cows, death. Differential diagnoses included hypocalcemia, hypomagnesemia, carbohydrate overload, and several toxicoses including mycotoxin, lead, nitrate, organophosphate, atropine or atropine-like alkaloid, and botulism.

An outbreak of type C botulism in 12 horses and a mule.

A USDA Early Response Team investigated deaths of several horses and a mule in northern Arizona at the request of local animal health officials. Thirteen animals (12 horses and 1 mule) housed at 5 facilities in a 7.4 square mile area died between August 1998 and January 1999.

Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study.

Objective: To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke.

Design: Observational study.

Setting: Auckland Hospital, Auckland, New Zealand.

Type C botulism in dairy cattle from feed contaminated with a dead cat.

Four hundred twenty-seven of 441 adult Holstein dairy cattle from a 1,200-cow dairy died over a 1-week period during early spring 1998. Affected animals were from 4 late lactation pens, one of which included the bull string. Signs included weakness, recumbency, watery diarrhea, and death.

Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction.

Objectives: To evaluate the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) as a predictor of late survival after myocardial infarction.

Background: Thrombolysis in Myocardial Infarction flow grades predict late survival after myocardial infarction. The CTFC provides a more reproducible measurement of infarct-related artery blood flow than the TIMI flow grade, and has been linked to 30-day outcomes, but it has not yet been established how the CTFC correlates with late survival.

Additional study of the Youth-Depression Adjective Check List.

Replicated and extended aspects of determinations of reliability and validity for the State version of the Youth-Depression Adjective Check List. Students from Grades 9 through 12 (64 girls and 41 boys) completed the State version and the Adolescent Activities Checklist on each of 12 consecutive days and completed the Trait version, the Reynolds Adolescent Depression Scale, the Multiple Affect Adjective Check List--Revised Grade 6, and the Adolescent Activities Checklist at the beginning and the end of the study. Good reliability and validity of the State version were confirmed and extended, and preliminary information on characteristics of the Trait version of the Youth-Depression Adjective Check List also was presented.

Cardiac allograft vasculopathy: the green lane hospital experience 1987-1998.

Aims: To determine the prevalence of cardiac allograft vasculopathy in heart transplant recipients at Green Lane Hospital and to examine potential risk factors for vasculopathy.

Methods: We retrospectively reviewed the coronary angiograms of all cardiac transplant recipients. Angiography was usually performed one, two and five years after operation.

Mood as in index of psychiatric inpatients' progress in group therapy.

In a study of the use of the Multiple Affect Adjective Check List--Revised and a set of scaled questions at the end of each group therapy session, the following results were found: (1) This checklist is sufficiently reliable and valid for use in psychiatric inpatient settings. (2) For patients who attended all 10 group therapy sessions there was a significant decrease in negative mood and a significant increase in positive mood from Sessions 1 to 10. (3) For patients who attended 10 consecutive sessions, there were significant increases from Sessions 1 to 10 in the perception that the therapist was trying to help them, they felt close to other members of the group, they felt hopeful of getting well, they openly tried to help another group member, and they openly expressed their feelings during the sessions.

Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression.

We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcome, on 4-year survival. The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina).

Spirometry in primary care practice: the importance of quality assurance and the impact of spirometry workshops.

Objective: To determine the quality of spirometry performed in primary care practice and to assess the impact of formal training.

Design: Randomized, controlled prospective interventional study.

Setting: Primary care practice, Auckland City, New Zealand.

Hepatic encephalopathy associated with paratuberculosis in a goat.

A 3-year-old pregnant Nubian goat that was examined because of weight loss, weakness, and change in attitude was determined to be infected with Mycobacterium paratuberculosis. Signs of depressed attitude, trembling, and ataxia were consistent with hepatic encephalopathy, which was confirmed by detection of hyperammonemia. These signs were consistent with histopathologic lesions in the liver and brain.

Resource allocation. The cost of care: two troublesome cases in health care ethics.

With the cost of health care rising rapidly, both physicians and administrators regularly face resource allocation decisions. Under these conditions of relative scarcity, the equitable and appropriate distribution of limited resources becomes an ethical as well as a financial issue. Through ethical analysis, physician executives can assist their physician colleagues and fellow administrators to find rationally defensible answers to questions regarding the distribution of limited resources.

Predicting discharge from Airforce basic training by pattern of affect.

We compared the efficacy of the state form of the MAACL-R (Zuckerman & Lubin, 1985) in predicting success in Air Force basic training. Results of discriminant functions analyses showed that the Anxiety, Depression, Hostility, Positive Affect, and Sensation Seeking scales of the state MAACL-R efficiently predicted success in basic training. The need to incorporate state measures into studies of prediction is discussed.

Effects of early captopril administration after thrombolysis on regional wall motion in relation to infarct artery blood flow.

Objectives: To determine whether early administration of captopril lessens infarct zone regional wall motion abnormalities when infarct artery blood flow is abnormal.

Background: The interaction between angiotensin-converting enzyme (ACE) inhibitor therapy, ventricular function and infarct artery blood flow has not been well described.

Methods: A total of 493 patients aged < or = 75 years with first infarctions, presenting within 4 h of symptom onset, were randomized to receive 6.