Negative Histories Research Articles

Tympanic Electrocochleography for Diagnosis of Meniere's Disease

Tympanic electrocochleography (ECOG) is a noninvasive technique for recording cochlear potentials with an electrode placed on the tympanic membrane. Electrocochleography is used clinically in the evaluation of patients for endolymphatic hydrops. This study was undertaken to obtain normative data for ECOG responses to clicks and tone bursts and to determine clinical indicators that result in high test specificities. Three cochlear potentials were measured; the eighth nerve compound action potential, the cochlear microphonic, and the summating potential. The subjects were 53 normal hearing adults with negative histories for symptoms of Menière's disease. The ECOG responses were measured with a silver wire-rayon wick electrode that was placed on the tympanic membrane under direct microscopic visualization. Stimuli were condensation, rarefaction, and alternating polarity clicks and 1- and 2-kHz tone bursts. Measures that appear to be useful in the evaluation of endolymphatic hydrops include the summating potential to action potential ratio, action potential latency difference to condensation and rarefaction clicks, and the tone-burst-evoked summating potential. Relationships among these measures were investigated, and abnormal criteria were determined that result in test specificities of 95%. Menière's disease is viewed as a progressive disease in which ECOG characteristics vary with the disease state. Cases are presented to illustrate ECOG responses in various stages of the disease. The normative data presented in this article are useful for the detection of Menière's disease in its early stages.

Prevalence of chronic obstructive pulmonary disease in elderly Finns

The prevalence of chronic obstructive pulmonary disease (COPD) in the elderly is poorly known. The aim of this study was to determine the prevalence of COPD and to analyse the factors associated with it in an elderly Finnish population. The population consisted of persons resident in Lieto, Finland, born in or before 1926. One thousand one hundred and ninety-six individuals (488 men and 708 women, 93% of those eligible) participated in the survey, which was carried out in 1990-91 at the Lieto Health Centre. The methods included a nurse's interview and spirometry with a bronchodilator test. The participants were also clinically examined, and the number of subjects with COPD was determined using simple diagnostic criteria. Sixty-one men and 21 women with COPD were found. Thus the prevalence was 12.5% for the men and 3.0% for the women. In both sexes only about 2% of those who had never smoked suffered from COPD, but among the current smokers the prevalence was 35% for the men and 13% for the women. In a stratified analysis COPD was commonest among those with a low social status and histories of smoking and working in dusty occupations. In a majority the obstruction was only minimally reversible when tested with salbutamol inhalation. The study confirmed that the prevalence of COPD in the elderly with negative histories of smoking is low, and emphasizes the importance of reducing smoking as the only effective preventive measure.

Pulmonary histopathology in cocaine abusers

Lung histopathology was reviewed from 52 autopsies with positive toxicologic tests for cocaine from the medical examiners' offices in Dallas and Austin, TX. The median patient age was 34.7 years, and the male to female ratio was 2:1. Twelve individuals primarily used the drug intravenously and six primarily smoked it, but in most patients usage history was not known. The most frequent manner of death was accidental, consisting predominantly of cocaine overdoses. Other frequent manners of death included both natural causes and homicides. Subjects with chest trauma were excluded from the study. Twenty-three age-matched control cases with negative cocaine histories and toxicologic tests also were obtained from medical examiner autopsies. Histopathologic findings in the cocaine abuse group included acute hemorrhage, 58% ( P = .05); chronic hemorrhage, 40% ( P < .01); interstitial pneumonitis/fibrosis, 38% ( P < 0.01); congestion, 88% ( P < .01); and intra-alveolar edema, 77% ( P < .01). These changes were remarkably consistent regardless of locale or method of use. Our findings demonstrate that pulmonary hemorrhage is more frequent than suggested by clinical hemoptysis and that chronic pulmonary diseases such as interstitial fibrosis may develop in long-term users.

Haemorrhage in intracerebral arteriovenous malformations: detection with MRI and comparison with clinical history.

Fifty-one patients with 59 angiographically proven cerebral arteriovenous malformations (AVMs) were examined by high-field MRI to detect blood breakdown products. Results were correlated with the history of intracranial bleeding. Evidence of previous episodes of haemorrhage was seen in 10 of 12 patients (83.3%) with verified bleeding, in 4 of 9 patients (44.4%) with symptoms which could suggest bleeding and in 6 of 30 patients (20%) with negative histories. Because of the known rebleeding rate and the increased risk of associated complications, identification of the subgroup who had had haemorrhage and should therefore be considered for surgery may be beneficial. MRI can make a contribution to management by demonstrating prior haemorrhage in patients with an inadequate clinical history.

Neuropsychological function and psychosocial deficit in adolescents with chronic neurological impairment

Research on childhood chronic illness suggests that children with brain-related conditions show elevated risk for psychosocial maladjustment. This study explored how neuropsychological dysfunction might contribute to such maladjustment in adolescents with chronic neurological impairment. Comprehensive neuropsychological assessments were conducted with 31 impaired adolescents and 16 contrast subjects with negative neurologic histories. Groups were balanced on age, socioeconomic status, and race. Psychosocial functioning was assessed via the Achenbach Child Behavior Checklist, Woodcock-Johnson achievement, and work history. The neurological group demonstrated lower scores on almost all neuropsychological indices, more internalizing symptoms, and lower reading and math achievement. Memory continued to distinguish the two groups when IQ was controlled. Neuropsychological indices showed strong relationships to psychosocial adjustment, but these were not independent of IQ. Findings point to the broad effects of neuropsychological dysfunction on psychosocial adjustment in neurologically impaired adolescents but do not support the contribution of specific neuropsychological domains as opposed to a general ability factor.

Sensitization to Blomia tropicalis and Lepidoglyphus destructor in Dermatophagoides spp-allergic individuals

Serum was collected from 77 atopic subjects from Cartagena, Colombia, who had a positive skin test (≥3 mm) to either Dermatophagoides farinae (Df) (73) or D. pteronyssinus (Dp) (70). Twenty-nine healthy volunteers with negative allergy histories and negative skin tests were used as control subjects. RAST and RAST-inhibition assays were used to study the prevalence of specific IgE to Blomia tropicalis (Bt), Lepidoglyphus destructor (Ld), and Df. RAST results were considered positive when a serum bound ≥1% of the total counts added; 69 atopic subjects (89.6%) were positive to Df, 66 (85.5%) to Bt, and 46 subjects (59.7%) were positive to Ld. RAST results, analyzed by regression analysis, revealed the following correlation coefficients: Df versus Bt, r = 0.59; Df versus Ld, r = 0.44; and Bt versus Ld, r = 0.52. RAST-inhibition assays with a serum pool of 11 individuals highly allergic to all three mites (mean specific IgE to all mites, ≥18.2 percent total counts bound) demonstrated considerable cross-reactivity between Bt and Ld and moderate cross-reactivity between Df and Bt and Ld. Bt, Df, and Ld possess unique, as well as common, allergens. Sensitization to Bt and Ld is very common in mite-allergic individuals in Cartagena, Colombia.

Manifest Hostility may Affect Habituation of Cardiovascular Reactivity in Blacks

In a study of cardiovascular reactivity to dietary manipulation of sodium and calcium, we pretested 30 young black normotensive males who were equally divided by positive and negative parental histories of hypertension with a 12-item anger questionnaire we devised and the Cook-Medley Hostility, Manifest Hostility, Overcontrolled Hostility, and Inhibited Hostility scales of the Minnesota Multiphasic Personality Inventory. Contrary to expectations, we found no correlation of resting blood pressure or cardiovascular reactivity to repeated mental demands with the two measures of inhibited hostility. We did, however, find resistance to habituation of cardiovascular reactivity in subjects with high Manifest Hostility and positive family histories of essential hypertension. Our findings suggest that vulnerability to hypertension may be revealed by the perseveration of blood pressure reactivity to repeated mental challenge. We propose that the perseveration of blood pressure reactivity is a disinhibitory phenomenon caused by a difficulty in the management of multiple inhibitory demands that disrupts the natural course of habituation and could be an important etiologic factor in essential hypertension.

Calcium Attenuates Cardiovascular Reactivity to Sodium and Stress in Blacks

The roles of dietary and behavioral factors in the etiology of hypertension are not well understood. Vulnerability to hypertension is thought to be affected by a complex interaction of nutritional, genetic, neurophysiological, and psychosocial influences. We studied cardiovascular reactivity to sodium and stress in a group of 29 normotensive young men who were vulnerable to hypertension by virtue of familial and/or racial factors. Subjects with positive and negative parental histories of hypertension were provided all meals for five days during which blood pressure was monitored before each meal. Two groups were given 300 mEq/day dietary sodium with either 1100 mg/day or 410 mg/day dietary calcium. A third group consumed a 10mEq sodium diet with low dietary calcium. On the fifth day of the diet all subjects were tested for cardiovascular reactivity using a modified Stroop test as a mentally challenging task. Adaptation of systolic blood pressure (SBP) from the first to the fifth breakfast was most pronounced in subjects consuming high calcium with high sodium. Perseveration of SBP reactivity to repeated mental challenge was found in subjects who consumed high sodium with low calcium and in subjects with positive parental histories of hypertension. The perseverative phenomenon was particularly well-defined in subjects who had the highest urinary excretion of calcium. Our findings suggest a prophylactic influence of dietary calcium and its retention on cardiovascular reactivity to sodium and stress. We also elucidate a theoretical proposition concerning the role of neurophysiological inhibitory capacity in the transition from normotension to the chronic dysregulatory state of essential hypertension.

Computer‐Aided Three‐Dimensional Reconstruction and Measurement of the round Window and its Membrane

This study was performed to clarify the complex three-dimensional shape of the round window and its membrane, and to measure these structures by using the computer-aided three-dimensional reconstruction method we developed. The equipment used included a personal computer, a high-resolution, 14-inch color monitor, and a digitizer. Materials consisted of five normal temporal bones obtained from five individuals with negative otologic histories who had been 5 months and 14, 15, 18, and 59 years old at death. Round window membranes were found to be convex to the middle ear side when viewed in the coronal plane, but to be concave when viewed in the sagittal plane; thus the membrane in most cases seemed to be shaped like a saddle, tapered toward the vestibular end. The average maximal diameter, sagittal length, horizontal width, and surface area of the round window were 2.32 +/- 0.19 mm, 2.08 +/- 0.22 mm, 1.76 +/- 0.10 mm, and 2.70 +/- 0.43 mm2, respectively. The average surface area of the round window membrane was 2.98 +/- 0.43 mm2.

Childrearing history, marital quality, and maternal affect: Intergenerational transmission in a low-risk sample

AbstractIn order to test the hypothesis that the relation between childrearing history and parental behavior varies as a function of marital quality, retrospectively reported childrearing histories obtained from 92 middle- and working-class mothers-to-be in the last trimester of pregnancy were used to predict maternal positive and negative affect when children were 3-years-old. As anticipated on the basis of findings from high-risk samples, the intergenerational transmission process appeared to vary as a function of marital quality, with problematic histories predicting negative maternal affect when marriages were less positive/more negative and supportive histories predicting positive maternal affect when marriages were more positive/less negative. Unanticipated results also revealed that reports of supportiveandrejecting parenting in childhood were associated with low-negative maternal affect when marriages were of high quality. These findings were interpreted in terms of buffering and gatekeeping processes, whereby marital quality defines both conditions of continuity and discontinuity with respect to the intergenerational transmission of parenting. Follow-up analyses revealed that physical attractiveness might determine which women with more problematic childrearing histories end up in more positive/less negative marriages that function protectively with respect to the intergenerational transmission of parenting. These results are particularly relevant to the study of developmental psychopathology not only by revealing risk and protective factors, but also by showing that processes at work in high-risk samples also seem to function under lower risk conditions.

Transfusion-Related Non-A, Non-B Hepatitis in Elective Spine Deformity Surgery Patients in Gothenburg, Sweden

This study presented a retrospective analysis of the incidence and clinical course of non-A, non-B hepatitis in patients after receiving homologous blood transfusion for elective spine deformity surgery, at Sahlgren Hospital. The medical records of all patients who underwent surgical procedures for scoliosis and spondylolisthesis between January 1, 1971 and December 31, 1986 were reviewed. From this group, 918 patients with negative medical histories for prior homologous blood transfusion, hepatitis, or the exposure to hepatotoxic medications were selected. All of the patients received two or more units of homologous blood and were followed for at least 1 year postoperatively. Eight hundred fifty-nine (94%) of the patients were either personally interviewed or contacted by mail. The group included 697 scoliosis patients (average age 16.2) and 162 spondylolisthesis patients (average age, 16.8). The scoliosis and spondylolisthesis patients received an average of 5.6 and 3.4 units of homologous blood, respectively. Three patients (0.35%) developed posttransfusion hepatitis, all non-A non-B. The incubation period was 9 to 12 weeks. Presenting symptoms varied widely, ranging from no symptoms to marked icterus. Two of the three patients went on to develop chronic persistent hepatitis, which was confirmed by liver biopsy. The incidence identified in this retrospective study was low when compared with an overall incidence of 4 to 15%, as presented in several larger prospective studies. Non-A, non-B hepatitis is a major risk associated with the homologous transfusion of blood and must be considered one of the more serious complications in surgery for spinal deformity.

Reliability of salt-sensitivity testing in normotensive subjects

We examined the reliability of dietary salt-sensitivity testing by repeatedly studying the effects of a high (220 mmol/day) and low (20 mmol/day) salt diet in 15 normotensive subjects. Reliability of classification of salt-sensitivity as described by the kappa statistic was 0.87 implying an almost perfect strength of agreement between the two parts of the study. Whereas only 20% of the subjects with negative familial histories of hypertension were salt-sensitive, this was the case with 68% of the subjects with positive familial histories. Our results show that salt-sensitivity can be reliably tested in normotensive subjects and that it is related to a familial history of hypertension.

Language and motor findings in benign megalencephaly.

9 children between the ages of 5 and 12 yr. whose head circumferences were greater than the 98th percentile and showed negative CT scans and histories for disease associated with increased brain size were studied. A battery of language, articulation, intelligence, and motor tests were administered to subjects and in each case to a sibling whose head circumference was normal. Analysis showed few differences in intelligence and language comprehension between the megalencephalic children and their siblings. Significant differences were observed in motor proficiency, with over 50% of the megalencephalic children scoring below the 10th percentile for their age group. Three megalencephalic children displayed articulation errors. All subjects had at least one parent whose head circumference exceeded the 98th percentile. These results suggest a relationship between benign megalencephaly and developmental motor difficulties.

Computer-aided three-dimensional reconstruction and measurement of the round window niche.

The goal of this study was to clarify the three-dimensional shape of the round window niche and to measure this structure three-dimensionally using the computer-aided reconstruction method we developed. The equipment used in this study included a personal computer (NEC 98-XA), a high-resolution 14-inch color CRT, a digitizer (Hitachi HDG-1111), and a printer. We studied five normal temporal bones obtained from five individuals with negative otologic histories, who had been 5 months and 14, 15, 18, and 59 years old at death. In each case the round window niche was located posteroinferior to the round window. The round window niches had wide openings to the middle ear cavity that became narrower near the aperture; thus, the round window niche seemed to be shaped like a pouch. The maximal diameter of the round window niche was 2.98 +/- 0.23 mm. The shortest distance between the aperture of the round window niche and the margin of the round window was 0.66 +/- 0.16 mm. The volume of the round window niche, on average, was 4.65 +/- 0.67 mm3. The volume of the round window niche was found to be correlated with the area of the round window.

Management of Varicella Exposure in a Neonatal Intensive Care Unit

We describe the management of an exposure to varicella in a neonatal intensive care unit. Thirty-seven hospital staff members with negative histories of varicella were tested by enzyme-linked immunosorbent assay for antibody to varicella zoster; all were seropositive. None were restricted from clinical duties, were given varicella-zoster immune globulin, or developed disease. Although only 1 of 38 cord serum samples from normal term infants was seronegative, 10 of 22 neonatal intensive care unit infants were seronegative. The high rate of seronegativity among these patients was related to chronological age older than 2 months and to multiple transfusions of packed red blood cells. This probably reflects natural catabolism of maternal antibody and loss of antibody in serum removed from these infants for diagnostic tests. Infants lacking antibody were given varicella-zoster immune globulin. Antibody levels following administration of varicella-zoster immune globulin were directly related to the dose administered.

Phonological Systems of Speech-Disordered Clients with Positive/Negative Histories of Otitis Media

Spontaneous object-naming utterances of two groups of articulation-disordered clients, who were considered to be normal in all areas except speech, were analyzed for phonological error patterns. Subjects with histories of recurrent otitis media during their first 24 months evidenced stridency deletion (in consonant singletons and in consonant clusters) significantly more than did the subjects who had negative otitis media histories. The most prevalent error pattern for both groups pertained to deviations involving /r,/ target phonemes. Limitations of retrospective studies and implications for future research are discussed.

Renal Abnormalities at the Prehypertensive Stage of Essential Hypertension

An approach to evaluating the genetic components of essential hypertension using an animal model, the Milan hypertensive strain (MHS) of rats, and studies in human families with positive and negative histories for high blood pressure are described and discussed. Differences at renal and cellular levels between MHS and its normotensive control strain, MNS, show many similarities to those between offspring from hyper- and normotensive families in humans. These include, with respect to the former group of each species, lower erythrocyte volume and Na content, higher Na-K cotransport across red blood cell (RBC) membranes higher Na excretion after load, and greater pressor effect in transplanted kidneys. A novel protein found in rat RBC cytoskeleton appears to have a function in Na-K cotransport and it may, eventually, be possible to demonstrate in man.

Renal Abnormalities at the Prehypertensive Stage of Essential Hypertension

Summary: An approach to evaluating the genetic components of essential hypertension using an animal model, the Milan hypertensive strain (MHS) of rats, and studies in human families with positive and negative histories for high blood pressure are described and discussed. Differences at renal and cellular levels between MHS and its normotensive control strain. MNS, show mane similarities to those between offspring from hyper- and normotensive families in humans. These include. with respect to the former group of each species. lower erythrocyte volume and Na content, higher Na-K cotransport across red blood cell (RBC) membranes higher Na excretion after load, and greater pressor effect in transplanted kidneys. A novel protein found in rat RRC cytoskeleton appears to have a function in Na-K cotransport and it may. eventually. he possible to demonstrate in man.

Varicella in hospital personnel: A challenge for the infection control practitioner

Five unrelated cases of chickenpox (varicella) occurred in a 1-month period involving one physician, two house staff members, one medical student, and a nursing assistant at a large Veterans Administration medical center. This required immediate identification of susceptible employees and patients to prevent transmission to other personnel and patients. Negative history is not a reliable predictor of susceptibility. Of the fifty contacts reporting negative histories, only five persons (10%) were actually negative by antibody testing. No secondary cases of varicella occurred. These incidents suggested that more rapid prescreening of key hospital personnel with negative histories who have direct patient contact might be helpful in identifying susceptible employees in the future.

Family history of alcoholism does not predict neuropsychological performance in alcoholics.

We examined the relationship of history of alcoholism in first-degree relatives to neuropsychological performance of alcoholics abstinent from several weeks to several years. Eighty-four men were assigned to four groups based on "strength" of family history of alcoholism. The groups were: (1) "strong history," a parent plus another first-degree relative positive; (2) "moderate," parent only positive; (3) "weak," nonparent first-degree relative only positive; and (4) "negative," no first-degree relative positive. There were no significant between-group differences in NP performance. In other analyses there were no NP differences between alcoholics classified positive or negative purely on basis of paternal alcoholism, and no differences between subjects who had multigenerational versus unigenerational versus negative familial histories of alcoholism. It is concluded that genetic loading for alcoholism does not significantly affect the NP status of abstinent alcoholic groups equated for education, drinking history, and medical risk.