Assessment of neuroactive steroids in cerebrospinal fluid comparing acute relapse and stable disease in relapsing-remitting multiple sclerosis.

Previous studies have reported an involvement of neuroactive steroids as neuroprotective and anti-inflammatory agents in neurological disorders such as multiple sclerosis (MS); an analysis of their profile during a specific clinical phase of MS is largely unknown. The pregnenolone (PREG), dehydroepiandrosterone (DHEA), and allopregnanolone (ALLO) profile was evaluated in cerebrospinal fluid (CSF) in relapsing-remitting multiple sclerosis (RR-MS) patients as well as those in patients affected by non-inflammatory neurological (control group I) and without neurological disorders (control group II). An increase of PREG and DHEA values was shown in CSF of male and female RR-MS patients compared to those observed in both control groups. The ALLO values were significantly lower in female RR-MS patients than those found in male RR-MS patients and in female without neurological disorder. During the clinical relapse, we observed female RR-MS patients showing significantly increased PREG values compared to female RR-MS patients in stable phase, while their ALLO values showed a significant decrease compared to male RR-MS patients of the same group. Male RR-MS patients with gadolinium-enhanced lesions showed PREG and DHEA values higher than those found in female RR-MS patients with gadolinium-enhanced lesions. Similary, male RR-MS patients with gadolinium-enhanced lesions showed PREG and DHEA values higher than male without gadolinium-enhanced lesions. Female RR-MS patients with gadolinium-enhanced lesions showed DHEA values higher than those found in female RR-MS patients with gadolinium-enhanced lesions. Male and female RR-MS patients with gadolinium-enhanced lesions showed ALLO values higher than those found in respective gender groups without gadolinium-enhanced lesions. ALLO values were lower in male than in female RR-MS patients without gadolinium-enhanced lesions. Considering the pharmacological properties of neuroactive steroids and the observation that neurological disorders influence their concentrations, these endogenous compounds may have an important role as prognostic factors of the disease and used as markers of MS activity such as relapses.

Long-term goals and normalization strategies of children and families affected by HIV/AIDS.

Decreasing morbidity and mortality of HIV/AIDS has created a growing population of parents and children who are long-term survivors. Using symbolic interaction and ethnographic methods, this study explores families' long-term goals and normalization strategies and the relevance of the published attributes of the concept of normalization for families affected by HIV disease. Findings indicate that treatment complexity and the need for stigma management prevent families from defining their lives as normal, but they do deliberately use normalization strategies to achieve the following goals: health maintenance for members with HIV, facilitation of children's school participation, and enhancement of the emotional well-being of all family members.

Parental encouragement, protection, and advocacy for Mexican-American children with chronic conditions.

Families face great challenges in caring for a child with a chronic condition, yet little is known about intrafamilial relationships, especially among Mexican Americans. An interpretive study, using symbolic interaction, with 25 adult informants, representing 19 mostly Mexican-American families, is reported. Findings include description of the process, "Keeping My Child Close to Me," by which parents, particularly mothers, provided protection, encouragement, and advocacy for their chronically ill child. Families were close and willing to jointly sacrifice to meet their special needs; however, some strains resulted from differences in perceptions between spouses and lack of attention to siblings during times of focus on the child with a chronic condition.

Religious faith in Mexican-American families dealing with chronic childhood illness.

PURPOSE: To explore Mexican-American family experiences with chronic childhood illness, from the perspective of parents, and report findings about the influence of religious faith on families' spiritual and secular responses to illness. Mexican-Americans are often characterized as religious, fatalistic, and passive, but families' perceptions of the consequences of their daily faith and its meaning in the face of chronic childhood illness is not well understood. DESIGN: Descriptive. The sample included 25 parents from 19 families living with children with a variety of chronic conditions. Data were collected in 1995-1996. METHODS: Interpretive, using symbolic interaction as the framework, and in-depth interviewing for data collection. FINDINGS: Parents professed a variety of beliefs and devotional practices. Six unifying dimensions of religious faith were related to parental caretaking and decision making for the family: (a) God determined the outcome of the child's illness, (b) God and health care for the child were closely linked, (c) parents took an active role in facilitating God's will, (d) families had obligations to God, (e) intercession with God by others was often sought by or offered to the family, and (f) faith encouraged optimism. CONCLUSIONS: Families were not fatalistic in the sense of feeling outcomes were predetermined and unalterable. Family members took spiritual and secular actions to assure the best possible familial and professional care for their child and sought to influence God's good will on behalf of the child and family.

[24-hour blood pressure measurement in children and adults with type I diabetes mellitus: relation to duration of diabetes, obesity, albuminuria]. / 24-Stunden-Blutdruckmessung bei Kindern und Jugendlichen mit Diabetes mellitus Type I: Beziehung zu Diabetesdauer, Ubergewicht und Urinalbuminausscheidung.

Early antihypertensive therapy in patients with diabetes mellitus reduces cardiovascular risk and improves long-term prognosis. Therefore, mildly hypertensive patients have to be discriminated from patients with "white coat" hypertension. 24-h-blood pressure profiles were recorded in 153 patients (age 7.9-26 years, duration of diabetes 0-21 years). The fraction of elevated blood pressure readings allows to classify these profiles independent of the age of the patient. This parameter was not related to either duration of diabetes or nocturnal excretion of albumin. In contrast, blood pressure correlated significantly with age- und sex-adjusted weight (z-score). Among 38 patients with elevated blood pressure recordings during outpatient visits, 24 (63%) displayed a normal 24-h-profile (less than 30% of blood pressure values are above the 95% limit for the respective age). These data indicate that hypertension might be independent of the metabolic derangement during the first years of diabetes.

Scrotal implantation of the inflatable penile prosthesis.

Erectile impotence has been a problem for the patient and a frustration for the physician since the beginning of medical history. The inflatable penile prosthesis rapidly is becoming the standard for treatment of organic erectile impotence. A technique is described for implantation through a single midline scrotal incision. Intra-abdominal reservoir placement is possible through this incision. The technique shortens operative time and hospital stay, and minimizes postoperative patient discomfort. Of the 31 patients who have been managed in this way the postoperative course for 18 is more than 12 months. The results as judged by patient and sexual partner have been excellent to date.

Oral calcium tolerance and urinary cyclic AMP in urolithiasis.

Oral calcium tolerance and urinary cyclic AMP testing was used in the evaluation of 61 unselected patients with stones. The oral calcium tolerance test was easy to perform and was useful in defining several distinct metabolic abnormalities contributing to calculous formation. Oral calcium tolerance testing is more precise than twenty-four-hour urinary calcium determination and should provide a means of determining proper medical treatment of urolithiasis. Urinary cyclic AMP was disappointing as a measure of parathormone activity.