Spirituality, religion, and health: a critical appraisal of the Larson reports.

The four-volume corpus The Faith Factor, and Scientific Research on Spirituality and Health: A Consensus Report by Larson et al constitute the largest English-language review of research on spirituality and health. We have done a critique of the 329 systematic analyses of peer-reviewed research papers presented therein. The objectives were to determine if the Larson conclusions can be generalized; to document the understanding of the potential of qualitative research in assessing the spiritual domain; and to examine whether the definitions of religion and spirituality used by Larson et al correspond to those in general use. We conclude that their results cannot be generalized to other religious and cultural settings; that there is a need for more research focusing on age groups, cultures, religions, and clinical settings not adequately represented in studies to date; and that the need for more qualitative research methods justifies a detailed analysis of the use of qualitative methods in the studies reviewed by the Larson group. Finally, there is a need to establish a common vocabulary that bridges cultural and religious traditions, and facilitates clinical care, research, and teaching relating to spirituality, religion, and health.

Lymphangiomas in children: MR imaging.

Seventeen lymphangiomas in 15 patients were imaged with magnetic resonance (MR) to define the nature, extent, and anatomic relationships of these lesions. The MR and pathologic findings were then compared to determine the histologic basis for the signal-intensity characteristics of these lesions. The signal intensity of 13 lesions was similar to or slightly less than that of muscle on T1-weighted images and greater than that of fat on T2-weighted images. This appearance correlated with the presence of ectatic lymphatic channels containing clear fluid on histologic section. Four lymphangiomas had high signal intensity, approximately equal to that of fat, on T1-weighted images, reflecting the presence of clotted blood or small cystic spaces with a higher ratio of fat to fluid. Sixteen of 17 lesions had visible septations on MR images. The authors' experience suggests that most lymphangiomas have a characteristic appearance on MR images. The information obtained with MR imaging can help in providing a preoperative diagnosis, in planning surgical resection, and in defining recurrence.

CT diagnosis of type A aortic dissections not demonstrated by aortography.

False-negative aortography in a patient with a type A dissection is an unusual and serious diagnostic error. We report three cases of type A thoracic dissections with negative aortography but positive CT or magnetic resonance. The factors that might account for this discrepancy and the implications in the evaluation of these patients are discussed.

CT appearances of the normal and abnormal thymus in childhood.

Computed tomography in 25 children with diseases of the thymus was evaluated to determine which features are the most useful in diagnosing thymic pathology. In each case thymic shape, density, and size, particularly thickness and width, were analyzed and compared with similar data in 71 normal children with no clinical evidence of thymic abnormality. Comparison showed that most thymic diseases altered normal thymic shape and contour, and hence evaluation of gross thymic morphology alone was adequate for recognition of abnormality. Although thymic thickness was a more reliable indicator of disease than width, this measurement was rarely required for diagnosing disease. The attenuation value of the thymus was helpful occasionally in suggesting a specific diagnosis.

Imaging techniques in the evaluation of pediatric hypertension.

Moderate or severe hypertension occurs in a small percentage of hypertensive children, but it is within this group that the surgically correctable causes of hypertension are found. Since cure rates up to 90% have been reported, it is important to diagnose a secondary cause of hypertension. Excretory urography is recommended to screen for renovascular hypertension and renal parenchymal disease. Renal scintigraphy can be substituted for the urogram, but the anatomical resolution is poorer. If renovascular hypertension is suggested by abnormal results of screening examination, arteriography should be part of the evaluation. Ultrasonography is reserved primarily for evaluating neonatal hypertension which most frequently is related to thrombosis. If this diagnosis is documented, renal function should be assessed with radionuclide techniques. If a hormonally active tumor is suspected, evaluation of the adrenals and retroperitoneum is accomplished best by CT.

Oxygen-17 n.m.r. of peptides.

Peptide-17O chemical shifts of linear dipeptides with and without protecting groups in H2O, CH3OH, CH2Cl2, CHCl3, CCl4, CH3CN and DMSO were between 256-350 ppm downfield from external water. Increasing solvent H-bond donating ability correlated with shifts to higher field. The 17O resonance of several cyclic dipeptides appeared at higher field relative to comparable linear dipeptides (303-317 p.p.m. vs. 327-337 p.p.m.). Separate signals were simultaneously observed by 13C and 17O n.m.r. for cis and trans N-tert.-butyl-formamide in binary mixtures with H2O, (CH3)2CO, and CCl4. The differences in the 17O nuclear screening of the amide isomers and most probably for cis and trans peptides were independent of contributions from H-bonding at the amide or peptide linkage, apparently reflecting differences between geometric isomers in electron distribution and through space effects. Peptide-17O of Gly-Ala, Gly-Leu and Gly-Glu in aqueous solution experienced upfield shifts of 6-12 p.p.m. and 12-16 p.p.m. upon deprotonation of the C-terminal COOH and of the N-terminal NH3+ groups respectively. These observations were rationalized in terms of the attendant changes in substituent effects, especially on the pi electron donating ability of the N atom at the peptide linkage and increased partial negative charge on the peptide oxygen. Temperature studies of peptide-17O of Gly-Ala between pH 1.5-9.0 revealed a chemical shift coefficient of 0.08 p.p.m./degree K and similar behavior of T1 and T2 relaxation times. Ea for molecular rotation was 5 kcal/mol between 301-331 degrees K. Rotational correlation times, tau c, were within the range expected from the Stokes-Einstein relation.

The central canal of the spinal cord: ultrasonic identification.

An intramedullary linear echo is frequently visible on real-time intraoperative ultrasound images of the spinal cord. An ultrasonographic-anatomic correlative study of the normal spinal cord of a cadaver demonstrated that these intramedullary reflections correspond to the central canal. Twenty-one cases of spinal surgery employing ultrasound in an adjunctive role are reviewed. In cases of intramedullary lesions this echo is absent or disrupted in the scanning plane of the mass, but it is preserved when the process is extramedullary.