A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches.

INTRODUCTION: Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo-esophageal symptoms. METHODS: We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically-Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24-h pH-impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI-Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100]. KEY RESULTS: Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > - 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001). CONCLUSIONS: Gastric inlet patches are common and under-recognized. They can cause protracted pharyngo-esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.

An unusual case of mesenteric ischaemia.

We describe an unusual cause of diarrhoea and segmental colitis in a previous well adult man. Mesenteric inflammatory veno-occlusive disease is a rare cause of gastrointestinal tract ischaemia of unknown aetiology. We review the literature of this condition and other mesenteric venous pathologies.

Narratives of family caregiving: the process of making meaning.

Researchers across disciplines have identified meaning as an important influence on family caregivers' responses to caregiving. This Paper describes a qualitative inquiry into the process of making meaning used by caregivers. This process includes three interrelated components: expectations, explanations, and strategies. Caregivers used this process to make sense of caregiving in the larger context of their lives, interpreting both the experience of caregiving and their own affective responses. Expectations included predictions for events or behaviors. Explanations incorporated both moral and practical reasoning to account for discrepancies between predicted and actual outcomes. Strategies, actions taken to actualize expectations, were influenced both by desired outcomes and by the presence of an underlying explanation for a given course of action. This paper provides some narrative examples of the process of making meaning to illustrate the components of making meaning and the interrelationships among them.

Narratives of family caregiving: four story types.

Researchers across disciplines have recognized considerable individual variation among caregivers in their response to the experiences of caregiving. One explanation for individual variation is that caregivers make different meanings from caregiving even under externally similar circumstances. This paper describes findings from a study that combined two qualitative strategies, across-case, thematic analysis and within-case, narrative analysis, to investigate meaning in accounts of family caregiving. Themes identified in the across-case analysis were interpreted in the context of patterns identified in the narrative analysis, as well as in the overall framework of caregivers' process of making meaning. Caregivers in this study told four types of stories: stories of ideal lives, stories of ordinary lives, stories of compromised lives, and ambiguous stories. Characteristics of each story type are described, and an example of an ambiguous story is also included as an illustration of the method. Findings suggest a new approach to understanding family caregiving that incorporates the diverse meanings caregivers make of their often similar experiences.

Effects of fenretinide (4-HPR) on dark adaptation.

OBJECTIVES: To assess the alterations in dark adaptation induced by low (200 mg/d) doses of fenretinide (4-HPR), to assess whether these effects were cumulative and whether they were reversible, and to attempt to elucidate the mechanism underlying the changes in night vision. DESIGN: Case series. SETTING: Outpatient eye clinic. PATIENTS: Twenty-two women enrolled in a breast cancer chemoprevention trial, and 18 normal control subjects. INTERVENTION: Measurements of absolute luminance thresholds during dark adaptation. MAIN OUTCOME MEASURES: Parameters of an exponential model of the dark-adaptation function before, during, and after administration of fenretinide. RESULTS: The most conspicuous effect of fenretinide on dark adaptation was a significant delay in the timing of the rod-cone break (P<.001). A minimal elevation of the final cone threshold was also observed. These effects were reversible after fenretinide therapy was discontinued and did not seem to be cumulative. An inverse relationship between delay of the rod-cone break and plasma retinol concentration was found. CONCLUSION: The dose of fenretinide used in this study produced clearly measurable, but not severe, changes in night vision, which were rarely symptomatic.

"Not as bad as it could have been": assessing and mitigating harm during research interviews on sensitive topics.

Research on sensitive subjects such as perinatal loss places participants at particular risk for psychological distress. Although authors have discussed strategies for minimizing distress during interview research, less is known about the ways participants communicate and investigators respond to psychological pain incurred during the interview itself. Therefore, we describe both verbal and nonverbal indicators of distress during a phenomenological study on perinatal loss. We also offer suggestions for interviewers on ways to minimize participants' discomfort. We believe this account will help other researchers identify and reduce respondent distress during their own research.

Endings, secrets, and silences: overreading in narrative inquiry.

Qualitative researchers seek to understand the words of the people they interview and may use narrative inquiry to find meaning in the stories told by research participants. Narrative inquiry entails "overreading," a sensitivity to unspoken or indirect statement, which is central to interpretation. Some of the tools of the literary overreader are applied to two research interviews, particularly as they direct readers to attend to inconsistencies, endings, repetitions, and silence. Because overreading is also intrusive, we conclude with some considerations about how far the overreader of the research may legitimately go.

Time budget and colour preferences (with specific reference to feeding) of ostrich (Struthio camelus) chicks in captivity.

1. Time budget analysis of the typical behaviours of young ostrich chicks showed that chicks spent over 50% of their time foraging and walking. 2. Food presented in bowls was largely ignored whereas food scattered on the floor was readily taken. 3. A colour preference test showed that green was the preferred colour.

Virtual text and the growth of meaning in qualitative analysis.

Qualitative researchers frequently analyze data in the form of narrative, such as responses to open-ended interview questions. Researchers acknowledge the validity of more than one interpretation of the same narrative but, to date, have offered little justification for multiple valid interpretations. A concept for literary theory, "the virtual text" is presented to help explain the mechanism of multiple interpretations and provide a justification for their validity. An example from the first author's research is provided.

Learning from stories: parents' accounts of the pathway to diagnosis.

Although the diagnosis of a child's chronic illness is typically a stressful time for parents, the events leading up to it vary considerably across families. As part of a larger study that addressed the experience of living with chronic illness, an analysis was undertaken to identify major themes in parental reports of the events preceding their child's diagnosis of chronic illness. Data are based on accounts given by parents in 63 families from three health science centers in the midwestern United States. Narrative analysis techniques were used to identify 5 major pathways to diagnosis (direct, delay, detour, quest, ordeal) and to explore parents' perceptions of the nature and quality of their interactions with health care providers. Results are discussed in terms of their implications for initiating positive working relationships between parents and health care providers.

Factors affecting the rate of growth of ostrich (Struthio camelus) chicks in captivity.

A set of 120 ostrich eggs was imported into the United Kingdom under class 1 quarantine restrictions. The chicks hatched were initially reared in mixed size groups and weighed daily to monitor their health. Ten days after hatching the chicks were separated into four groups, based on their weight, which were kept under identical conditions, fed ad libitum and weighed daily. At the end of the 35 day quarantine period the growth rates of the chicks were correlated with their weight on day 10: the heaviest chicks remained the heaviest. In addition, the degree to which the chicks lost weight and the period for which they did so was also related to their weight on day 10. However, the smallest chicks on day 10 grew more quickly than the largest chicks. Chicks which had been helped to pip and hatch showed poor survival rates and low rates of growth. The growth rate of the ostriches appeared to be influenced by environmental factors.

Polonium metabolism in adult female baboons.

The biokinetics of polonium in nonhuman primates (Papio anubis) has been studied after intravenous injection of 210Po citrate. The urinary excretion of polonium in the baboon could be described by a single exponential function with a half-time of 15.6 days. Excretion fractions of polonium were found to be markedly different from those reported for other species, including humans. Polonium-210 was found to be distributed throughout the soft tissues of the baboon with 29% of the injected polonium being deposited in liver, 7% in kidneys and 0.6% in spleen. Retention of polonium in all tissues exhibited single exponential functions; however, the biological half-times were variable, ranging from 15 to 50 days.

Observations on the commercial production of ostrich (Struthio camelus) in the United Kingdom: incubation.

Two sets of ostrich eggs (60 and 120 eggs) were imported into the United Kingdom under class 1 quarantine restrictions. Single stage incubation was carried out and the eggs were weighed before and during incubation in order to control weight loss. In the two hatches the weight losses during the incubation of viable eggs were 13.4 per cent and 11.4 per cent, respectively. The development of the eggs was followed by candling and although only dark shadows were observed a pattern could be recognised. For the first set of eggs the average length of incubation was 45.9 days with an interval of 12.7 hours between pipping and hatching. The second set of eggs was incubated at higher temperatures than the first and the main incubation period was 43.3 days with hatching 19.2 hours after pipping. Larger eggs took longer to hatch.

Observations on the commercial production of ostrich (Struthio camelus) in the United Kingdom: rearing of chicks.

Two sets of ostrich eggs (60 and 120 eggs) were imported into the United Kingdom under class 1 quarantine restrictions. The eggs were incubated and observations were made on the growth, survival and sex ratio of the chicks hatched. The chicks decreased in weight for five days after hatching before they began a sustained period of exponential growth. They reached a liveweight of 4 kg five weeks after hatching. Female chicks grew significantly faster than male chicks. The survival rates of the chicks to three months of age were 66.7 per cent and 78.3 per cent, respectively, for the two sets of eggs, and mortality restricted mainly to the first four weeks of rearing. All the birds which died showed poor rates of growth before they died. The sex ratio of both groups was skewed 2:1 towards males.

Triangulation in qualitative research: evaluation of completeness and confirmation purposes.

The term triangulation has been applied to research strategies intended to serve two distinct purposes, confirmation and completeness. Many researchers who claim to have used a triangulated approach fail to provide evidence to show that their approach contributed to either confirmation or completeness of the data set. This paper reviews these distinct purposes and describes how triangulation of qualitative and quantitative methods was built into a study to achieve them. Analysis of data related to a single construct illustrates how data generated by qualitative and quantitative methods can provide both convergent validity and a broader understanding of one's subject matter.

Sibling perspectives on schizophrenia and the family.

Intensive audiotaped interviews with 14 adult siblings of schizophrenia patients were used to explore their experiences. Interviews focused on the ways adult siblings define and experience their sibling's mental illness and their participation in illness management. Cross-case analysis revealed that recognition of schizophrenia in a brother or sister was characterized by a pivotal, reorganizing event that redefined behavior previously viewed as difficult or different. Subjects' approach to the sibling's illness reflected three distinct patterns: collaborative, crisis-oriented, and detached. The impact of a mentally ill brother or sister on subjects' lives ranged from pervasive to discrete and was seen as emanating from the family and the sibling, but in different ways. These findings can help sensitize clinicians to the complex nature of sibling experiences as well as to the needs of siblings and their families.

[Typing of human papillomavirus (HPV) in the male and female genitalia]. / Estudo do tipo de papilomavírus humano (HPV) no aparelho genital feminino e masculino.

Diagnosis and typing of HPV was started in November 1990 at the Virology department of the National Health Institute, Lisbon. Eighty one samples from 70 patients were studied, 57 from women observed at the cervico-vulvar out patient unit of the Gynecology department of Sta Maria Hospital, Lisbon, and 13 from male contacts of some of these women. Forty nine women (86%) had colposcopic, histological or cytological evidence of HPV infection. Eleven men (85%) have clinical signs of infection and 2 (15%) had had sexual intercourse with infected partners with clinical evidence of infection. HPV DNA was detected in 43 patients (61%). Forty two were infected with HPV 6/11 (98%) and one with HPV 16 (2%). These preliminary results suggest that genital infection by HPV must also be considered a public health problem in the field of sexually transmitted diseases in Portugal.

Multicenter evaluation of a new recombinant enzyme immunoassay for the combined detection of antibody to HIV-1 and HIV-2.

A newly developed recombinant antigen-based anti-HIV-1/HIV-2 enzyme immunoassay (Abbott Recombinant HIV-1/HIV-2 EIA) was evaluated against a second generation anti-HIV-1 EIA (Abbott Recombinant HIV-1 EIA). Five thousand and twenty-nine sera from European blood donors and 403 sera from central African blood donors were used in the evaluation, along with four panels and one cohort. The panels included 99 'problem' sera, 733 sera with antibodies to HIV-1 from asymptomatic people and from patients at different disease stages, 25 serial bleeds from five plasmapheresis donors seroconverting for antibodies to HIV-1, and 202 sera with antibodies to HIV-2 collected from healthy and diseased people of European or west African origin. In addition, 734 sera collected from a west African cohort were tested. Using Western blot as the reference standard, the specificity obtained by the recombinant anti-HIV-1 EIA (HIV-i EIA) was 99.90% [99.81-99.99%; 95% confidence limits (95% CL)] with European blood donor sera; 99.50% (98.78-100%) with Central Africa blood donor sera; 92.93% (87.78-98.08%) with 'problem' sera and 99.43% (98.87-100%) with sera from a west African cohort. Using the same samples, the recombinant anti-HIV-1/HIV-2 EIA (HIV-1/HIV-2 EIA) yielded a specificity of 99.84% (99.73-99.95%), 99.50% (98.78-100%), 95.96% (92.00-99.92%) and 98.58% (97.69-99.47%), respectively. All 776 Western blot-confirmed anti-HIV-1 sera were reactive in both EIAs, and the EIA-reactive samples from seroconverting plasma donors were always observed for both assays in the same serial bleed. For HIV-2, the HIV-1 EIA yielded an overall sensitivity of 75.83% (69.93-81.72%) compared with 99.53% (98.58-100%) for HIV-1/HIV-2 EIA. The addition of a recombinant env-protein of HIV-2 to the recombinant env and core proteins of HIV-1 on the solid phase of HIV-1 EIA improved the detection of anti-HIV-2 while preserving the assay's overall specificity and sensitivity for the detection of anti-HIV-1.

The importance of acid digestion of urine prior to spontaneous deposition of 210Po.

Historically, radiochemical analysis of 210Po in urine has used spontaneous deposition of the nuclide directly from raw urine onto a suitable metal disc. Consequently, the urinary excretion fraction for Po in some current metabolic and dosimetric models is based on studies which inherently assume that metabolized (i.e., filtered out of the blood by the kidneys) 210Po is plated with the same efficiency as tracer 210Po which has been added to urine samples. Urine samples collected after intravenous administration of 210Po citrate to two species of nonhuman primates were divided and simultaneously analyzed via two methods: the historical procedure of plating 210Po from raw urine for one sample and a method which includes the addition of 208Po tracer and sample digestion with concentrated HNO3 prior to 210Po deposition for the other sample. A more significant amount of 210Po was consistently recovered when the urine was wet ashed then when it was not wet ashed. A temporal relationship was found to describe the change in the ratio of the deposition recoveries for the two methods. Possible mechanisms for this phenomenon and its dosimetric implications are discussed.