Porcine brachial artery tortuosity for in vivo evaluation of neuroendovascular devices.

We report a novel model of arterial tortuosity in the porcine brachial artery for testing of endovascular devices in the flexed forelimb position. This provides an ideal vascular territory for an in vivo assessment of guidewires, microcatheters, and endovascular implants because it closely mimics the challenging curvature at the carotid siphon.

The effect of intracranial stent implantation on the curvature of the cerebrovasculature.

BACKGROUND AND PURPOSE: Recently, the use of stents to assist in the coiling and repair of wide-neck aneurysms has been shown to be highly effective; however, the effect of these stents on the RC of the parent vessel has not been quantified. The purpose of this study was to quantify the effect of intracranial stenting on the RC of the implanted artery using 3D datasets. MATERIALS AND METHODS: Twenty-four patients receiving FDA-approved neurovascular stents to support coil embolization of brain aneurysms were chosen for this study. The stents were located in the ICA, ACA, or MCA. We analyzed C-arm rotational angiography and contrast-enhanced cone beam CT datasets before and after stent implantation, respectively, to ascertain changes in vessel curvature. The images were reconstructed, and the vessel centerline was extracted. From the centerline, the RC was calculated. RESULTS: The average implanted stent length was 25.4 ± 5.8 mm, with a pre-implantation RC of 7.1 ± 2.1 mm and a postimplantation RC of 10.7 ± 3.5 mm. This resulted in a 3.6 ± 2.7 mm change in the RC due to implantation (P < .0001), more than a 50% increase from the pre-implantation value. There was no difference in the change of RC for the different locations studied. The change in RC was not impacted by the extent of coil packing within the aneurysm. CONCLUSIONS: The implantation of neurovascular stents can be shown to have a large impact on the RC of the vessel. This will lead to a change in the local hemodynamics and flow pattern within the aneurysm.

Temporal evolution of susceptibility artifacts from coiled aneurysms on MR angiography: an in vivo canine study.

BACKGROUND AND PURPOSE: Intracranial aneurysms treated by coiling have a risk for recurrence, requiring surveillance imaging. MRA has emerged as an attractive technique for postcoiling aneurysm imaging. Previous research has evaluated MR imaging artifacts of the coil mass in vitro. Our aim in this study was to evaluate MR imaging artifacts of coiled aneurysms in vivo with time. MATERIALS AND METHODS: Four sidewall aneurysms were created in each of 4 dogs. Aneurysms were embolized receiving only 1 type of coils. After embolization, the animals were transferred to MR imaging, which included axial 3D TOF MRA (TEs, 3.5, 5, and 6.9 ms), phase-contrast MRA, and coronal CE-MRA. MR imaging studies were repeated at 1, 4, 6, 8, 14, and 28 weeks. We calculated an OEF: OEF = V(A)/V(CM), where the numerator represents the volume of the MR imaging artifacts and the denominator is the true volume of the coil mass measured by 3D RA. RESULTS: OEFs were largest immediately after embolization and showed a gradual decay until approximately 4 weeks, when there was stabilization of the size of the artifacts. By 4 weeks, there was mild coil compaction (average coil mass volume decrease of 7.8%); however, the OEFs decreased by 25% after 4 weeks (P < .001). CONCLUSIONS: MR imaging susceptibility artifacts change with time, being maximal in the postembolization setting and decaying until 4 weeks. The clinical implications of this study are that baseline MRA for comparison with future imaging should be acquired at a minimum of 1 week after the procedure.

The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy.

BACKGROUND: Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge. METHODS: One hundred and three families participated. Forty children undergoing food challenges to access resolution of allergy, and their mothers, completed validated questionnaires to measure generic and food specific quality of life, stress and anxiety prior to challenge, on the day of investigation and 3-6 months later. Sixty-three children with no clinical indication to challenge (i.e. in the opinion of the allergist had persistent allergy) acted as comparison group completing questionnaires 3-6 months apart. RESULTS: Mothers reported raised anxiety on the day of challenge (P = 0.007), but children were less anxious. The children (P = 0.01) and mothers (P = 0.01) had improved food-related, but not general, QoL 3-6 months following challenge. Children reported lower anxiety levels following the challenge (P = 0.02), but anxiety remained unchanged in mothers. The improvements in maternal and children's QoL and anxiety levels were irrespective of the challenge outcome and despite co-existing food allergies in 50% of children. CONCLUSIONS: Mothers experienced increased anxiety on the day of food challenge, unlike the children, perhaps reflecting the differences in their perceived risks. Food challenges are associated with improved food-related QoL in the following months even in those with a positive challenge.

The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review.

Food allergy affects 6% of children but there is no cure, and strict avoidance of index allergens along with immediate access to rescue medication is the current best management. With specialist care, morbidity from food allergy in children is generally low, and mortality is very rare. However, there is strong evidence that food allergy and food hypersensitivity has an impact on psychological distress and on the quality of life (QoL) of children and adolescents, as well as their families. Until recently, the measurement of QoL in allergic children has proved difficult because of the lack of investigative tools available. New instruments for assessing QoL in food allergic children have recently been developed and validated, which should provide further insights into the problems these children encounter and will enable us to measure the effects of interventions in patients. This review examines the published impact of food allergy on affected children, adolescents and their families. It considers influences such as gender, age, disease severity, co-existing allergies and external influences, and examines how these may impact on allergy-related QoL and psychological distress including anxiety and depression. Implications of the impact are considered alongside avenues for future research.

Impact of peanut allergy on quality of life, stress and anxiety in the family.

BACKGROUND: Peanut allergy (PA) is known to impact on quality of life (QoL) of the sufferer, but little research has focused on all family members. We therefore sought to establish the impact of PA on QoL and reported anxiety of children with clinically confirmed PA, their parents and older siblings. METHODS: Forty-six families, who had a child with PA, completed QoL (PedsQL or WHOQOL-BREF), anxiety (SCAS or STAI) and perceived stress (PSS) scales. PA children completed a PA specific QoL questionnaire (Pediatr Allergy Immunol 2003;14:378). Parents and sibling also completed QoL proxy questionnaires for the PA child (PedsQL, Pediatr Allergy Immunol 2003;14:378). RESULTS: Mothers rated their own psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse than fathers rated theirs, and had higher scores than fathers for anxiety (P < 0.05) and stress (P < 0.001). Children with PA had significantly poorer physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and general QoL (P < 0.05) than their siblings did, and greater separation anxiety (P < 0.05). The majority of differences were between girls with PA and female siblings. Mothers felt that there was a greater impact on QoL for their PA child, compared with that reported by siblings, fathers or the PA children themselves (P < 0.01). CONCLUSIONS: Mothers report that they have significantly poorer QoL and suffer more anxiety and stress than fathers do; this inter-parental difference may be an important feature of family stress caused by PA. Siblings have a similar view of how QoL affects the PA child as the PA child does, while mothers may possibly overestimate this impact.

Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community?

BACKGROUND: The severity of allergic reactions to food appears to be affected by many interacting factors. It is uncertain whether challenge-based reactions reflect the severity of past reactions or can predict future risk. OBJECTIVE: To explore the relationship of a subject's clinical history of past reactions to the severity of reaction elicited by a low-dose, double-blind, placebo-controlled food challenge (DBPCFC) with peanut. METHOD: Cross-sectional questionnaire assessment of community-based allergic reactions and low-dose DBPCFC in self-selected peanut-allergic subjects. Reaction severity was assessed using a novel scoring system, taking account of the dose of allergen ingested. RESULTS: Forty subjects (15 males, 23 children, 23 asthmatics by history) were studied. Only the most recent community reaction predicted the severity of reaction in the DBPCFC, but even this association was weak (r=0.37, P=0.03). Peanut-specific IgE (PsIgE) and skin prick test (SPT) weal size were not associated with community score but PsIgE level correlated well with the challenge score (r=0.6, P=0.001). Asthma did not affect the eliciting dose or challenge score directly but the association of PsIgE and challenge score was stronger in those without asthma (r=0.72, P=0.001) than in those with asthma (r=0.48, P=0.02). CONCLUSIONS: The scoring system developed appears to improve the sensitivity of assessment of reactions induced by DBPCFC. This is the first prospective study showing an association between PsIgE levels and clinical reactivity in DBPCFC, an effect that is more pronounced in non-asthmatics. This finding has important implications for the clinical care of subjects with food allergy. There is a poor correlation between the severity of reported reactions in the community and the severity of reaction elicited during low-dose DBPCFC with peanut.

Presentation of allergen in different food preparations affects the nature of the allergic reaction--a case series.

BACKGROUND: Characterization of fatal and non-fatal reactions to food indicates that the majority of reactions are due to the ingestion of prepared foods rather than the non-processed allergen. In an ongoing study that used a double-blind placebo-controlled food challenge to investigate peanut allergy and clinical symptoms, the observed reaction severity in four of the first six subjects was greater than anticipated. We hypothesized that this was due to differences in the composition of the challenge vehicle. OBJECTIVE: The aim was to investigate whether the severity of observed challenge reactions would be repeated on re-challenge with a lower fat challenge vehicle. METHODS: Peanut-allergic subjects were re-challenged with a lower fat recipe after reacting more severely than was anticipated to an initial peanut challenge. Similar challenge vehicle recipes were used, the only difference being the lower fat content (22.9% compared with 31.5%). The peanut content of the two recipes was analysed using RAST inhibition studies and ELISA tests. RESULTS: Three of four subjects reacted to much smaller doses of peanut protein on re-challenge (mean dose equivalence - 23 times less peanut) with the lower fat recipe. RAST inhibition showed that neither recipe altered epitope recognition. The higher fat recipe required twice as much peanut to cause 50% inhibition. ELISA detected far lower levels of peanut in the higher fat recipe (220 000 parts per million (p.p.m.)) than in the lower fat recipe (990 000 p.p.m.). CONCLUSION: The fat content of a challenge vehicle has a profound effect on the reaction experienced after allergen ingestion. This is another factor to be considered in assessing the risk of certain foods to food-allergic consumers and adds another dimension to clinical, research and regulatory practice.

Similarities in body image in sisters: the role of sociocultural internalization and social comparison.

The sociocultural theory of body image disturbance states that Western women experience pressure from sources such as parents, peers, and the media to maintain thinness. Social comparison theory emphasises the role of comparing one's appearance to others. Body image disturbance; awareness and Internalization of sociocultural messages regarding thinness; and sibling social comparisons were examined in 41 closest-in-age sisters through self-report questionnaires. Sisters showed similar levels of body image disturbance and sociocultural awareness and internalization. Sibling comparisons were negative for younger sisters but neutral or positive for older sisters. Sociocultural internalization predicted body dissatisfaction in both sisters, and body size distortion in younger sisters. Negative sibling comparisons during teenage years predicted body size distortion and body dissatisfaction in younger sisters, and preference for thinness in older sisters.

Chromosome numbers in Compositae. XVIII.

Chromosome numbers and other cytogenetic data were determined from microsporocytes in 316 collections including 13 tribes of Compositae, mostly from Africa, Australia, Mexico, Central America, and South America. First reports are provided for 66 species and the genera Cassinia (2n ≈ 14(II)), Feldstonia (2n = 11(II)), Gochnatia (2n ≈ 23(II)), and Pseudoconyza (n = 10). In addition, new chromosome numbers are established at the generic level in Acourtia, Calea, Craspedia, Gnaphalium, Helipterum, Liabum, Leucheria, Smallanthus, Trixis, and Viguiera and at the specific level in 13 additional species.

Comparison of staples and sutures for cardiorrhaphy in traumatic puncture wounds of the heart.

The purpose of this study was to compare the traditional method for repair of cardiac lacerations using sutures and pledgets (S/P) with repair using a skin stapling device (SSD) performed by emergency medicine residents. In a prospective, randomized, non-blinded animal study, 20 anesthetized mongrel dogs were instrumented and underwent left lateral thoracotomy, pericardiotomy, and cardiac exposure. In set 1, a standardized 8-mm right ventricular stab wound was made with a #10 scalpel; emergency medicine residents then immediately performed emergent cardiorrhaphy by either S/P (n = 5) or SSD (n = 5) technique. In set 2, 10 dogs received standardized 8-mm right ventricular stab wounds followed by repair and then received a second stab wound to the same right ventricle that was subsequently repaired by the same operator using the alternate technique. All dogs were observed for 60 min for gross blood loss, hemodynamic instability, and integrity of repair. The results demonstrate that SSD cardiorrhaphy was significantly faster (29 +/- 11 sec in set 1; 14 +/- 6 sec in set 2) than S/P repair (201 +/- 10 sec in set 1; 196 +/- 59 sec in set 2). No appreciable differences in blood loss or repair integrity were noted in either group. Two operators in the S/P group suffered needle puncture injuries. In conclusion, cardiorrhaphy by SSD is faster to perform, has similar repair integrity, and has less risk of accidental contaminated needle injury than does traditional S/P repair when performed by emergency medicine residents.

Experience with generally accepted centrifugal pumps: personal and collective experience.

BACKGROUND: The data presented are a brief summary of The International Registry for Mechanical Ventricular Assist Pumps and Artificial Hearts and a summary of the personal experience of the Minnesota Thoracic Associates at the Minneapolis Heart Institute with the use of the Sams centrifugal pump from May 1985 to September 1994. METHODS: Ventricular support with the use of centrifugal pumps for postcardiotomy shock consisted of cannulation of the left atrium and aorta for left ventricular support and the right atrium and pulmonary artery for right ventricular support, or the combination of the two for biventricular support. RESULTS: The average survival and discharge rate recorded by the National Registry for postcardiotomy syndrome was 25.3%. Our experience at Minnesota Thoracic Associates was 54%. The National Registry reported 45.7% of the patients being weaned from the device or receiving transplants and 25.3% of the patients ultimately discharged from the hospital. Sixty-five percent of the patients in our experience either were weaned from the device or received a transplant for an overall discharge rate of 42%. The average effective hospital cost per survivor was almost $400,000.00. CONCLUSIONS: It is our belief that when considering the cost analysis of temporary devices, one must conclude that a more economical approach for the treatment of end-stage cardiac disease would be aggressive development of a permanent ventricular assist device.

Operative considerations in implantation of the Perma-Flow graft.

The Perma-Flow coronary bypass graft (Possis Medical, Inc, Minneapolis, MN) currently is undergoing expanded clinical trial. From November 1992 through June 1994 we have used this artificial conduit in 8 patients without autologous alternatives. These cases allowed the establishment of a technical basis for successful implantation of this graft. All studied coronary anastomoses are patent.

Use of a diary technique to investigate psychosomatic relations in atopic dermatitis.

Previous research on the relationship between stress and atopic dermatitis has employed retrospective approaches such as interviews and measurement of life events and daily hassles. These studies have yielded inconsistent results. In the current study, 50 atopic dermatitis sufferers completed a diary for a fortnight, recording their daily emotional states and skin condition. The results of meta-analyses indicated that both interpersonal stress and depression were significantly related to changes in skin condition. Meta-analyses of lag sequential analyses indicated that interpersonal stress on Day X predicted skin condition on Day X + 1 and that this relationship was reciprocal. Depression was predicted by the skin condition of the previous day but this relationship was not reciprocal. These results were integrated and their implications for psychosomatic relationships between stress, depression, and atopic dermatitis were discussed.

Mechanical circulatory assistance after heart transplantation.

From October 1985 through December 1989, 92 heart transplant procedures were performed in 89 patients. Nine patients (aged 19 to 66 years; 7 male, 2 female) required mechanical circulatory support after transplantation because of primary idiopathic organ failure (n = 2), implant difficulty (2), poor organ quality (2), or acute right heart failure (3). Devices used included the intraaortic balloon pump (6), centrifugal right ventricular assist device (2), left ventricular assist (1), biventricular assists (2), and total artificial heart (1). Two patients required multiple devices. One patient underwent retransplantation. Implant time ranged from 1 to 18 days. One early death occurred owing to right heart failure 6 days after transplantation, 7 hours after removal of a right ventricular assist device, for an overall mortality of 11%. The remaining 8 patients are alive 4 months to 28 months after transplantation. The actuarial 1-year survival of 89% +/- 10% compares well with the survival of 87% +/- 4% for the entire transplant group. All surviving patients are in functional class I. Echocardiographic examination in all patients revealed left ventricular ejection fraction to be normal in 7 and depressed in 1. Extending the criteria for organ donors or difficulty with the implant procedure can lead to early organ failure, which may be reversible with circulatory assistance allowing excellent survival.

Comparison of three cold hardiness tests for conifer seedlings.

Greenhouse-cultured, container-grown ponderosa pine (Pinus ponderosa var. scopulorum Engelm.), interior Douglas-fir (Pseudotsuga menziesii var. glauca (Beissn.) Franco), and Engelmann spruce (Picea engelmannii (Parry) Engelm.) were cold acclimated and deacclimated in growth chambers over 19 weeks. Cold hardiness was measured weekly by a whole-plant freeze test and by two quick tissue tests: freeze-induced electrolyte leakage of needles, and differential thermal analysis of buds. The whole-plant freeze test provided results in 7 days, and indicated differences in cold hardiness among stems, buds, and needles. Although the whole-plant freeze test could accurately measure cold hardiness, it was not precise, and it required destructive sampling. Results from freeze-induced electrolyte leakage and differential thermal analysis were available in 2 days and 1 hour, respectively. The freeze-induced electrolyte leakage test was a precise, sensitive and objective predictor of changes or differences in tissue cold hardiness. To determine actual cold hardiness, results could be calibrated to the response of the same tissue in the whole-plant freeze test. The speed and objectivity of differential thermal analysis made this test useful for rapid, general assessment of cold hardiness status, but calibration was difficult, and precision varied.