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Confidence and confusion: the health care system in the United States. | Results from the latest "Health Confidence Survey" show that Americans generally appear to be happy with their health care system experiences. Satisfaction with the care received over the past two years and with current health insurance plans remains high and virtually unchanged since the 1998 survey. Close to nine out of 10 respondents were satisfied with their health plan in 1999 as well as the quality of care received. Confidence in many aspects of the health care system is high--94 percent of Americans | 10666781 | [
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Confidence and confusion: the health care system in the United States. | report being confident that their pharmacist will fill their prescription correctly; 90 percent are confident they will be able to see a health care specialist; as needed; and 89 percent have confidence in the quality of care that hospitals deliver. Confidence is not as high; however; for belief in the confidentiality of medical records or that a fair review will be be received if health insurance coverage is denied. While Americans are highly confident in most aspects of the health care system today; they | 10666781 | [
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Confidence and confusion: the health care system in the United States. | continue to be less so for the next 10 years and even less so once they become Medicare eligible. Confidence in the future of health care may be low because Americans appear to be uncertain about managed care and what constitutes a managed care plan. While 71 percent of those enrolled in a managed care plan label it as a PPO or HMO; only 21 percent reported that they are currently enrolled ina managed care plan. The fact that so many Americans do not know that their health plan is a managed care plan lends | 10666781 | [
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Confidence and confusion: the health care system in the United States. | support to our contention that these plans; benefits managers; employers; policymakers and the media have failed to educate enrollees and the general public about the features and potential advantages of such plans. | 10666781 | [
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KIDS COUNT: identifying and helping America's most vulnerable. | Using data from the 1999 KIDS COUNT Data Book; compiled and published by The Annie E. Casey Foundation; the most recent state figures (1996) are compared with corresponding data from 1985 to assess the trends in child well-being in each state during the decade. The 10 key indicators used to rank states are taken fro federal government statistical agencies and reflect the best data available for each of the measures. Between 1985 and 1996; child well-being improved across the country in seven of the indicato | 10666782 | [
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KIDS COUNT: identifying and helping America's most vulnerable. | rs (infant mortality rate; child death rate; rate of teen death by accidents; homicide and suicide; percent of teens who are high school dropouts; percent of teens not attending school and not working; percent of children living with parents who do not have full-time; year-round employment; and percent of children living in poverty). The three areas of children's well-being that worsened during the time period were; the percent of low birth-weight babies; teen birth rate; and percent of families with childr | 10666782 | [
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KIDS COUNT: identifying and helping America's most vulnerable. | en headed by a single parent. While many of America's children have experienced improvements in their well-being; there is a large number of children who have been left behind. The focus of the 1999 KIDS COUNT Date Book is on the 9.2 million children who have been identified as "high risk." These children have four or more family disadvantages that put them at greater risk of experiencing poor outcomes. These kids are not benefiting from the continuing economic boom in the 1990s. The District of Columbia; L | 10666782 | [
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KIDS COUNT: identifying and helping America's most vulnerable. | ouisiana and Mississippi had the largest share of high-risk kids; ranging from 39 to 21 percent of their respective populations; and Utah the lowest; with just 5 percent. Long-term family-centered strategies that are multi-dimensional and community-wide are recommended to help promote family change. | 10666782 | [
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Cardiac catheterizations: average inpatient charges, 1998. | In 1998 the average change for an impatient cardiac catheterization (CC)was $12;450 among 13;922 group health insured over age 30. Among the 29 states in which at least 150;CCs were performed; the average total charge ranged from $24;000 in California; which was 93 percent above the U.S. norm; to just over one-third of this total in Iowa ($8;810). The second highest average charge was reported in Texas ($20;140; 62 percent above the norm) and the second lowest was in Maryland ($11;420; 8 percent below). On | 10666780 | [
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Cardiac catheterizations: average inpatient charges, 1998. | average; the hospital proportion of the total CC charges accounted for 80 percent but ranged from 86 percent in California to 71 percent in Maryland. Physician fees averaged $2;450 across the country and ranged from $3;830 in Texas (56 percent above in average) to $2;140 in Iowa (13 percent below the norm). Length to stay averaged 3.2 days; with patients in Iowa remaining in the hospital for 5.6 days and those in Washington 2.9 days. Per diem costs averaged $3;850 and were the highest in California; $6;470 | 10666780 | [
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Cardiac catheterizations: average inpatient charges, 1998. | (68 percent above the average) and $1;570 in Iowa (59 percent below). | 10666780 | [
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[Heck cattle in the Oostvaardersplassen: risk for infectious diseases or not?]. | This article discusses risk analysis of infectious diseases in a cattle population. Heck cattle living in nature reserve 'De Oostvaardersplassen' were studied as an example of the risk analysis approach. Twenty-five adult cattle were tested for every infectious disease agent that the risk analysis indicated might be prevalent. All sampled cattle tested positive for Bovine Herpesvirus 1; whereas the prevalence of antibodies against other infectious disease agents was below the level that was assumed to be th | 10666788 | [
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[Heck cattle in the Oostvaardersplassen: risk for infectious diseases or not?]. | e threshold for spread of the disease to cattle in the surrounding areas. Risk management of infectious diseases was expressed in a so-called 'low-risk profile'. The risk of introduction or spread of infectious diseases was estimated to be very low as long as the population was kept strictly enclosed. | 10666788 | [
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[Transfusion medicine: debate, field of application, the stakes]. | Transfusion medicine has aroused much controversy as to the definition of its field of application; as the Etablissement Français du Sang (EFS) is being set up. One argument put forward by supporters of transfusion medicine in hospital--including nominal attribution and clinical immunohematology--is the possible influence of blood component producers on the decisions of prescribers. The EFS considers transfusion medicine as the rationale underlying a therapeutic chain applied to blood products and possibly | 10666791 | [
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[Transfusion medicine: debate, field of application, the stakes]. | to cell therapy products; within a coherent structure. Any disruption in the chain would result in reduced visibility at each stage of the chain; diluted responsibilities; and less efficient communication between blood collection and actual needs. It is; however; extremely important to clearly distinguish between the activities related to the production of biological products for therapeutic use from the activities of evaluation; in the setting of clinical protocols; which are the clinicians' responsibility | 10666791 | [
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[Transfusion medicine: debate, field of application, the stakes]. | . The EFS views the production of blood components as one of the various aspects of its missions as a transfusion medicine operator. The involvement of blood transfusion centers in the development of biotechnologies is a historical reality which justifies EFS's ambition to integrate cell therapy activities within its field of competence. The EFS; with its 18 blood transfusion centers; will have to play a part in health care; research and teaching networks; at the regional or inter-regional level. Irrespecti | 10666791 | [
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[Transfusion medicine: debate, field of application, the stakes]. | ve of the progress achieved in substitution products and the evolution to be expected in transfusion-related jobs; transfusion as a discipline must maintain its coherence to be able to better assume its responsibilities. | 10666791 | [
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[Scientific bases of education in transfusion medicine]. | Transfusion medicine is a medical speciality which deals with all aspects of blood transfusion. The recent evolution of this speciality was marked by an increased collaboration with clinical medicine; the development of alternatives to allotransfusion (autotransfusion; growth factors; molecular genetics); and the technical progress in laboratory techniques. The development of basic science boosted the introduction of new techniques in the detection of virus and blood cell typing. The analysis of clinical tr | 10666792 | [
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[Scientific bases of education in transfusion medicine]. | ials allowed a better definition of guidelines for the use of blood products. The blood transfusion teaching program is limited during medical training. Specialists in transfusion medicine have to complete a post-graduate course to become certified. Continuous medical training is organised to allow the specialists to keep their accreditation. Transfusion medicine is becoming more and more complex. This complexity should not lead to breaking down transfusion medicine into several activities; but on the contr | 10666792 | [
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[Scientific bases of education in transfusion medicine]. | ary to uniting this medical speciality; within which the different actors shall remain open-minded and able to use the same 'language'. | 10666792 | [
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Vascular biosynthesis of nitric oxide: effect on hemostasis and fibrinolysis. | Nitric oxide (NO) is a multifunctional effector molecule that plays a central role in the regulation of vascular homeostasis. NO is synthesized from L-arginine by a family of enzymes called NO synthases. The principal source of NO in the vascular system of healthy mammals is the constitutively expressed NO synthase in endothelial cells. The basal endothelial formation of NO can be increased by receptor-dependent agonists (i.e.; bradykinin) in a calcium-calmodulin-dependent manner; and also by physical force | 10666793 | [
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Vascular biosynthesis of nitric oxide: effect on hemostasis and fibrinolysis. | s (i.e.; shear stress); predominantly without changes in the intracellular concentration of free calcium. Nitric oxide can diffuse toward the blood vessel wall where the major target is the smooth muscle cell. NO regulates vascular tone; and the free radical is also a potent inhibitor of smooth muscle cell proliferation; migration and synthesis of extracellular matrix proteins. NO can also diffuse toward the lumen of the blood vessel where it helps maintain blood fluidity. NO inhibits platelets' and leucocy | 10666793 | [
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Vascular biosynthesis of nitric oxide: effect on hemostasis and fibrinolysis. | tes' adhesion to endothelial cells. In addition; NO inhibits platelet aggregation and facilitates the dissolution of small platelet aggregates. However; the regulatory action of NO on blood cells is most likely limited to the luminal surface of endothelial cells since NO is rapidly scavenged by hemoglobin in erythrocytes and inactivated by oxygen-derived radicals such as superoxide anions. NO can also affect the fibrinolytic activity by regulating the release of tissue-type plasminogen activator and plasmin | 10666793 | [
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Vascular biosynthesis of nitric oxide: effect on hemostasis and fibrinolysis. | ogen activator inhibitor-1. The crucial role of vascular NO in the control of blood fluidity has been demonstrated by the regulation of the bleeding time in humans. | 10666793 | [
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[Developments in cell therapy in the year 2000]. | For the past thirty years; hematology has switched from the concept of bone marrow transplantation to the concept of hematopoietic stem cell (HSC) transplantation; from allograft to autograft; from non-manipulated graft to hyper-selection; from hematopoietic cellular therapy to immunotherapy. Indications of these transplantations are now more clear for malignant diseases and are ongoing for auto-immune diseases. A better knowledge of the HSC allows the control of their proliferation and differentiation; ope | 10666794 | [
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[Developments in cell therapy in the year 2000]. | ning the field of ex vivo expansion. Very recently; new stem cells have been identified; establishing that a differentiated cell retain its totipotency: a nervous system cell can differentiate into HSC; which will further give hematopoiesis; mesenchymental cells or hepatocytes. New tools are under development: human ES cells; biomaterials; functionalized materials; opening the field of cellular engineering in the year 2000. | 10666794 | [
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[Preoperative strategy for homologous blood salvage and peri-operative erythropoietin]. | The amount of transfused blood is related to blood loss calculated for the specific type of surgical procedure; transfusion hematocrit trigger and patient's red blood cell mass on the day before surgery. To optimise the benefit/cost and benefit/risk ratios of blood transfusion; a correct prescription must be done in accordance with the patient's red blood cell mass and surgical blood loss. Indeed; there is a clear need to define the appropriate uses of blood management methods and to seek new methods of imp | 10666795 | [
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[Preoperative strategy for homologous blood salvage and peri-operative erythropoietin]. | roving perioperative blood management. The number of moderately anaemic patients undergoing surgery is currently thought to be 20%. Where transfusion requirements are estimated at two to three blood units; as for instance in the most common types of orthopaedic surgery; preoperative haemoglobin is the key factor governing transfusion needs. In this case; the simplest approach is to prescribe Epoetin Alfa subcutaneous at a dose of 600 IU/kg/week starting three weeks before the surgery. In addition; it is imp | 10666795 | [
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[Preoperative strategy for homologous blood salvage and peri-operative erythropoietin]. | ortant in all cases to give concomitant iron supplements. Concomitant use of other methods to decrease allogeneic blood requirements is of no value. Obviously; the higher the haematocrit the day prior to surgery; the higher the patient's RBC mass and the greater the patient's permitted blood loss; decreasing the transfusion trigger. In this way; allogeneic blood loss is reduced; but without the need for the patient to attend the blood transfusion center and to undergo laboratory screening and testing of don | 10666795 | [
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[Sensitivity of screening kits for anti-HIV antibodies. 1999 update. Retrovirus Working Group of the French Society for Blood Transfusion]. | A comparative evaluation of the sensitivity of anti-HIV screening assays has been recently performed with a selected panel of 65 samples which included HIV1 group M (per-seroconversions; seroconversions and seropositives infected with genotypes A; B; C; D; E); HIV1 group O and HIV2. The results obtained with the 21 ELISA HIV1 + HIV2 screening assays are presented. Among these 21 assays; four are combined anti-HIV and p24 Ag assays. All the assays except four fulfilled the criteria defined at the beginning o | 10666796 | [
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[Sensitivity of screening kits for anti-HIV antibodies. 1999 update. Retrovirus Working Group of the French Society for Blood Transfusion]. | f the study; i.e.; positive results on all the seropositives including seroconversions and positive results on at least 50% of the per-seroconversions. The main differences were observed with the ten per-seroconversion samples; the number of positive results on such samples varying from three to ten. The constant improvement of anti-HIV screening tests which leads one to shorten the 'window' period permits and earlier diagnosis of HIV infection and a progressive decrease of the transfusional risk. | 10666796 | [
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[Erythrocyte adhesion to the vascular endothelium]. | Blood cells are in continuous contact with the vascular endothelium. Endothelial cell culture; intravital videomicroscopy allowed the investigation of blood cell-endothelium interactions in dynamic conditions. In the various diseases; diabetes mellitus; sickle cell anemia and malaria; erythrocytes have an increased adhesion to endothelial cells. The presence of advanced glycation end products (AGE) on erythrocytes of diabetics is responsible for their binding to the receptor RAGE present on the endothelium. | 10666797 | [
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[Erythrocyte adhesion to the vascular endothelium]. | The AGE-RAGE binding provokes an oxidant stress and induces the expression of the adhesion molecule. Furthermore; erythrocyte AGE induce an increase in vascular permeability. In sickle cell anemia; the increased adhesiveness and the sickling of red blood cells are responsible for thrombosis. Plasmodium falciparum infestation of erythrocytes induces knob formation at the cell surface and the P. falciparum protein binding to CD36; ICAM-1 and thrombospondin present on the endothelium; and facilitates the para | 10666797 | [
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[Quality control of labile blood products. Why and howto properly take a specimen? Labile Blood Products Group of the French Blood Transfusion Society]. | This article reviews the various techniques of sampling used for the quality control of blood cell products. The importance of this stage for the validity of quality control results is emphasized. Three sampling methods; i.e.; stripping; the sterile connection of sampling bag and the destructive method; are described in the form of operating modes and analyzed according to their advantages and drawbacks. The results of a comparative study carried out by the working group 'Blood Cell Products' of the French | 10666798 | [
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[Quality control of labile blood products. Why and howto properly take a specimen? Labile Blood Products Group of the French Blood Transfusion Society]. | Society of Blood Transfusion are presented; showing that each method is valid and permits one to obtain a representative sample of the product to be controlled. Thus the diversity of the sampling methods allows us to select the one most adapted to the product to be controlled and to the analyses to be carried out afterward. | 10666798 | [
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[Preparation of cell therapy products: contribution of closed systems]. | A phase I clinical trial is being currently performed in our institution; aiming at evaluating the feasibility and toxicity related to the administration of Herpes Simplex-thymidine kinase gene-expressing human primary T lymphocytes following allogeneic hematopoietic stem cell transplantation. The need for safe and standardized preparation conditions for gene-modified cells is crucial. We describe the closed culture system used in the current trial for ex vivo retroviral-mediated gene transfer and transduce | 10666799 | [
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[Preparation of cell therapy products: contribution of closed systems]. | d cell selection. Cell handling is performed in closed systems using sampling and transfer pack bags; culture bags and a sterile connection device which avoids opening the culture system. This closed system allows safe and reproducible ex vivo preparation of gene-modified primary T-lymphocytes for clinical use. | 10666799 | [
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Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. | Clinical signs and symptoms are an essential aspect of the diagnosis of Lyme borreliosis. Thus; a thorough knowledge of the clinical features of the disease is important. Established clinical definitions could be of help in everyday clinical practice and especially to compare the findings of different authors or groups. The characteristic sign that permits the diagnosis of Lyme borreliosis is a typical erythema migrans skin lesion. Highly suggestive manifestations are ear lobe lymphocytoma; acrodermatitis c | 10666801 | [
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Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. | hronica atrophicans and Bannwarth's syndrome. The majority of other signs and symptoms are only suggestive and; when expressed individually; may have a very limited or even symbolic value for the purpose of diagnosis. Laboratory confirmation of borrelial infection is needed; as a rule; for all manifestations of Lyme borreliosis with the exception of typical erythema migrans. In clinical practice indirect laboratory methods are usually employed. Determination of borrelial IgM and IgG antibodies by immunofluo | 10666801 | [
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Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. | rescence assays or enzyme-linked immunosorbent assays has not been standardised; and correlation of the results from different laboratories and/or different commercial tests may be poor. Immunoblotting may solve some of the many dilemmas but could (especially in Europe) raise additional questions in a field in which numerous uncertainties already exist. The reliability of methods for direct detection of borrelial infection other than culture to ascertain spirochetes in tissue specimens is open to question. | 10666801 | [
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Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. | Treatment with antibiotics is reasonable in all stages of Lyme borreliosis and for all clinical manifestations; however; it has been most effective early in the course of the illness. The choice of antibiotic depends upon many factors including the efficacy; pharmacokinetic profile; side effects; expected compliance and price. For the majority of manifestations the most effective antibiotic; the optimal dosage; and the most appropriate duration of treatment have not been exactly determined. Recommendations | 10666801 | [
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Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. | for the treatment of Lyme borreliosis in Slovenia are presented. | 10666801 | [
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Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans. | To compare the clinical efficacy and drug-related adverse effects of 14 days of treatment with cefuroxime axetil 30 mg/kg/day or phenoxymethyl penicillin 100;000 IU/kg/day in the treatment of children with erythema migrans.Consecutive patients younger than 15 years; referred to our institution in 1996 with solitary erythema migrans and without prior antibiotic therapy; were included in this prospective study. Basic demographic features and clinical data were collected by questionnaire. The efficacy of the t | 10666802 | [
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Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans. | reatment of acute disease; development of major and/or minor manifestations of Lyme borreliosis and drug-related adverse effects were surveyed at follow-up visits during the first year after the initiation of antibiotic treatment.Forty-six patients received cefuroxime axetil (group C) and 44; phenoxymethyl penicillin (group P). The two groups differed in terms of age (patients in group C were younger); but no other differences in demographic and clinical pre-treatment characteristics were present. The clini | 10666802 | [
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Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans. | cal course during the post-treatment period revealed no significant differences between the two groups: the duration of erythema migrans (7.1 +/- 7.5 days in group C; 10.6 +/- 19.3 days in group P) and the appearance of minor manifestations of Lyme borreliosis (8.8% in group C; 9.1% in group P) were comparable; no major manifestations were recorded. Twelve months after antibiotic treatment all patients were free of symptoms. The patients treated with cefuroxime axetil had more drug-related adverse effects t | 10666802 | [
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Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans. | han did those treated with phenoxymethyl penicillin (26.1% versus 6.8%; p = 0.0301). "Herxheimer's reaction" at the beginning of treatment was identified more often in group C than in group P; but the difference was not statistically significant.Cefuroxime axetil and phenoxymethyl penicillin are equally effective in the treatment of children with solitary erythema migrans; however drug-related adverse effects were more frequently observed with cefuroxime axetil. | 10666802 | [
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] |
Erythema migrans in the immunocompromised host. | From 1990 to 1996 a total of 67 adult patients with typical erythema migrans (EM) and a previously identified immunocompromised condition were investigated at the University Medical Centre; Department of Infectious Diseases; Ljubljana; Slovenia. The course and outcome of borrelial infection were compared with 67 previously healthy age and sex-matched individuals with EM who were examined at our institution in the same year. Clinical characteristics of Lyme borreliosis before treatment and the duration of EM | 10666803 | [
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Erythema migrans in the immunocompromised host. | after the institution of therapy with antibiotics including amoxicillin; azithromycin; cefuroxime-axetil; doxycycline; and ceftriaxone were comparable in both groups. The occurrence of early disseminated borrelial infection before treatment and the frequency of treatment failure (defined as the onset of severe minor or major manifestations of Lyme borreliosis; persistence of B. burgdorferi sensu lato in the skin and/or persistence of EM after treatment) were found significantly more often in immunocompromi | 10666803 | [
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Erythema migrans in the immunocompromised host. | sed patients than in the control group (16/67 versus 6/67; respectively; p = 0.0358). Re-treatment was required in 13 (19.4%) patients of the immunocompromised group and only in five (7.5%) patients of the control group (p = 0.0762). However; in spite of the more severe course and the more frequent need for re-treatment among patients whose immune system was impaired; the outcome of borrelial infection after one year was favourable in both groups. | 10666803 | [
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Erythema migrans in pregnancy. | From 1990 through to 1997; 105 pregnant women with typical EM were investigated at the Lyme Borreliosis Outpatients' Clinic of the Department of Infectious Diseases at the University Medical Centre in Ljubljana; Slovenia. Twenty-five (23.8%) patients acquired borrelial infection during the first trimester of pregnancy; eight (7.6%) of them had noticed the skin lesion before they became pregnant. In 43 (40.6%) patients the EM appeared in the second trimester; and in 37 (35%) patients in the third trimester o | 10666804 | [
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Erythema migrans in pregnancy. | f pregnancy. Two (1.9%) patients received phenoxymethyl penicillin (1 million IU t.i.d.); three (2.9%) benzyl penicillin (10 million IU b.i.d.); and 100 (95.2%) ceftriaxone (2 g daily). All patients were treated for 14 days except three (2.9%) in whom the treatment with ceftriaxone was discontinued because of mild side effects. The outcome of disease was good in all 105 patients. Ninety-three (88.6%) out of 105 patients had normal pregnancies; the infants were delivered at term; were clinically healthy; and | 10666804 | [
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Erythema migrans in pregnancy. | subsequently had a normal psychomotor development. In the remaining 12 (11.4%) patients an adverse outcome was observed. Two (1.9%) pregnancies ended with an abortion (one missed abortion at 9 weeks; one spontaneous abortion at 10 weeks); and six (5.7%) with preterm birth. One of the preterm babies had cardiac abnormalities and two died shortly after birth. Four (3.8%) babies born at term were found to have congenital anomalies; one had syndactyly at birth and three had urologic abnormalities which were re | 10666804 | [
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Erythema migrans in pregnancy. | gistered at the age of 5; 7; and 10 months; respectively. A causal association with borrelial infection was not proven in any infant. For at least some unfavourable outcomes a plausible explanation not associated with Lyme borreliosis was found. | 10666804 | [
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The outcome of Lyme borreliosis in children. | Austria is an endemic area for Lyme borreliosis. The IgG seroprevalence of healthy blood donors as investigated by a DAKO flagellum-ELISA in Graz/Styria is 13%. In order to determine whether this high seroprevalence is caused by infection in childhood; 36 children aged 3 to 18 years (mean; 10.1 years) were followed up over 2 to 20 months (mean; 11.1 months) and reinvestigated for clinical symptoms and antibodies against B. burgdorferi by a commercial flagellum ELISA and a commercial B. garinii Western blot | 10666805 | [
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The outcome of Lyme borreliosis in children. | (WB). Twenty-seven children had erythema migrans (EM); one of them with reinfection; 5 had borrelia lymphocytoma (BL); 2 EM and BL; 1 acrodermatitis chronica atrophicans and 1 ACA/circumscribed scleroderma. Before treatment with either phenoxymethylpenicillin; amoxicillin; or minocyclin for 3-4 weeks; 64% of the patients were IgM and 44%; IgG seropositive. Clinically; all but 5 patients with EM recovered from Lyme borreliosis. Among these 5 patients--one of them with reinfection of EM--3 had mild arthralgia | 10666805 | [
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The outcome of Lyme borreliosis in children. | ; 1 recurrent headache and 1 concentration disturbance. Only 2 children with arthralgia were IgM positive by ELISA and WB. One of 5 BL patients had a persistent swelling of the ear lobe although with a negative serology before and after several antibiotic treatments and at follow up. In 16 children serological investigations were performed after more than 12 months (range; 13-20 months). Eighteen percent of them had IgM antibodies by ELISA; 25% by WB; and 6% IgG antibodies by ELISA and 6% by WB. Although th | 10666805 | [
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The outcome of Lyme borreliosis in children. | ere was a decline of antibody response from 64% to 18% for IgM and from 44% to 6% for IgG as measured by ELISA; children remain seropositive for more than 1 year with or without clinical symptoms. The relevance of the association with clinical symptoms can be raised by combining several diagnostic methods. It is assumed that recurrent; often silent; infections might increase antibody titres. It should be noted that antibody titres also generally increase with the age of individuals. | 10666805 | [
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Has the presence or absence of Borrelia burgdorferi sensu lato as detected by skin culture any influence on the course of erythema migrans? | The aim of this prospective study was to compare epidemiological and clinical data in patients with a positive Borrelia burgdorferi sensu lato culture and culture-negative erythema migrans skin lesions. Of the 546 adult patients with erythema migrans seen at our institution in 1997 in whom a skin biopsy was performed and the specimen cultured for the presence of B. burgdorferi sensu lato; 235 (43%) had a positive and 311 (57%) a negative skin culture. More women than men were present in both groups and wome | 10666806 | [
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Has the presence or absence of Borrelia burgdorferi sensu lato as detected by skin culture any influence on the course of erythema migrans? | n were also significantly older than men. Tick bites resulting in culture-positive erythema migrans predominated in May (p = 0.012); while in August and September tick bites with subsequent culture-negative skin lesions were more common (p = 0.018 and 0.011; respectively). Similarly; erythema migrans lesions noticed by our patients in May were significantly more often Borrelia culture positive than negative (p = 0.004); while lesions appearing in October were significantly more often culture negative (p = 0 | 10666806 | [
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Has the presence or absence of Borrelia burgdorferi sensu lato as detected by skin culture any influence on the course of erythema migrans? | .004). In addition to these seasonal differences; the comparison of the large number of Borrelia skin culture-positive and -negative patients with erythema migrans also revealed differences in several clinical parameters including a larger diameter of skin lesions in the culture-positive group (p = 0.007 at presentation; and p = 0.039 at registration; respectively); a lesser number of multiple skin lesions (7/235 versus 27/311; p = 0.006); and a lower frequency of signs/symptoms (p = 0.039) associated with | 10666806 | [
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Has the presence or absence of Borrelia burgdorferi sensu lato as detected by skin culture any influence on the course of erythema migrans? | erythema migrans lesions in culture-positive than in culture-negative patients. We have no plausible explanation for the majority of these rather unexpected findings. Of the 59 patients who; prior to biopsy; had received brief courses of antibiotics known to be effective in the treatment of erythema migrans; 12 (20.3%) were culture positive. As anticipated; the ratio of culture positivity in pretreated patients was significantly lower (p < 0.001) than in those without antecedent antibiotic therapy. | 10666806 | [
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Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species. | There is wide divergence of opinion between physicians regarding the use of serological measures for the diagnosis and treatment of erythema migrans; the hallmark of Lyme borreliosis. We studied the outcome of an enzyme immunoassay and immunoblot (Western blot) used on the sera of patients who had suffered tick bite and erythema migrans; and had been subsequently treated with various antibiotics. Ninety-nine consecutive patients presenting with erythema migrans after tick bite were prospectively recruited a | 10666807 | [
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Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species. | t the outpatient department of two Vienna City hospitals and at the consultation office for Lyme borreliosis of the Institute of Hygiene. University Vienna. Blood samples were taken before antibiotic treatment and 3 and 6 months thereafter. Blood samples from 100 blood donors served as controls. Antibodies against Borrelia burgdorferi sensu lato were determined by enzyme immunoassay (IgG and IgM EIA) and by IgG immunoblot. The latter was performed with isolates of B. alzelii (H2) B. burgdorferi sensu strict | 10666807 | [
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Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species. | o (Le) and B. garinii (W) from Austrian patients. The 4 interpretation criteria for immunoblot results were: A (3 bands out of 8); B (2 bands out of 9); C and D (1 band out of 6). In all patients; the erythema resolved within the treatment period. No complications secondary to the borrelia infection were registered. After treatment there was no significant change in titre; nor was there a difference in the immunoblot pattern between the first; second and third serum samples. Serum antibodies to B. burgdorfe | 10666807 | [
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Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species. | ri were positive by EIA in 22.9% (IgG) and 2.5% (IgM). Immunoblot results offered by borrelia species and by the interpretation criteria; ranging between 8.3% (criterion A; strain Le) and 44.2% (criterion D; strain H2). By EIA; control samples were IgG and IgM positive in 5% and 1%; respectively. Positive immunoblot results with strain H2 were found in 9%; 13%; 18%; and 20% by the criteria A through D respectively. After antibiotic treatment of erythema migrans the immunological response appears to be abrog | 10666807 | [
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Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species. | ated. Thus; serological results are not supportive for the diagnosis of erythema migrans; not will they retrospectively prove successful antibiotic treatment of borrelia infection. | 10666807 | [
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Is IgM of diagnostic value in case of delayed intrathecal production of IgG antibodies? | The neurological manifestations of Lyme borreliosis comprise a wide range of clinical signs. However; these symptoms might have other aetiologies. Therefore detection of intrathecal production of specific antibodies is necessary to confirm the clinical assumption of neuroborreliosis (NB). In case of delayed intrathecal production of specific IgG antibodies; detection of IgM could play a role in the early diagnosis of NB. To clarify whether IgM is of diagnostic value in such cases; paired CSF serum samples f | 10666808 | [
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Is IgM of diagnostic value in case of delayed intrathecal production of IgG antibodies? | rom 176 patients with suspected NB admitted to the department of Neurology; Karl Franzens University; Graz; Austria; were tested. Testing was performed with the IDEA Neuroborreliosis Kit (Dako; Denmark) and Enzygnost Borreliosis (Behring; Germany) and results of both methods were compared. According to well defined criteria 63 of the 176 patients had defined NB and 113 were regarded as possible NB. Twelve out of 63 patients with defined NB had delayed intrathecal IgG production. Only one patient with delaye | 10666808 | [
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Is IgM of diagnostic value in case of delayed intrathecal production of IgG antibodies? | d IgG production had an intrathecal IgM production prior to IgG. In all patients with possible NB no intrathecal production of IgM was detected. At the time of the first lumbar puncture IgG intrathecal production could be detected with the IDEA seven times more often than with the Enzygnost Borreliosis. The determination of intrathecal production of IgM does not appear to be of diagnostic value in patients with delayed IgG antibody production. Therefore a consecutive lumbar puncture is more likely to confir | 10666808 | [
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Is IgM of diagnostic value in case of delayed intrathecal production of IgG antibodies? | m clinical assumption if there is strong clinical evidence of NB. | 10666808 | [
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Borrelia burgdorferi as a cause of Morgagni-Adams-Stokes syndrome. Long time follow-up study. | According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue; lethargy and syncope- Morgagni-Adams-Stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical | 10666810 | [
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Borrelia burgdorferi as a cause of Morgagni-Adams-Stokes syndrome. Long time follow-up study. | state with ECG findings; as well as with the levels of the Borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope; 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation); 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea; 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a; 3b). The authors also looked for any | 10666810 | [
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Borrelia burgdorferi as a cause of Morgagni-Adams-Stokes syndrome. Long time follow-up study. | relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years. | 10666810 | [
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Lyme borreliosis and peripheral facial palsy. | From 1994 to 1996; 114 consecutive patients older than 15 years who presented at the Department of Infectious Diseases; University Medical Centre; Ljubljana; fulfilled the criteria for inclusion into this study on the borrelial aetiology of peripheral facial palsy (PFP). The study was restricted to patients without a conceivable explanation for their PFP; erythema migrans or history of erythema migrans; clinical signs/symptoms of frank meningitis or any other neurological manifestation in addition to PFP. I | 10666811 | [
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Lyme borreliosis and peripheral facial palsy. | n 22 (19.3%) of these 114 patients borrelial infection was confirmed by one of the following: in 3 (13.6%) by the isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid (CSF); in 11 (50%) by the presence of intrathecal antibody production; and in 8 (36.4%) by seroconversion to borrelial antigens. Additional 20 (17.5%) patients interpreted as having had a probable borrelial infection; had positive (> or = 1:256) IFA IgM and/or IgG borrelial serum antibody titres; and in 9 (7.9%) patients borde | 10666811 | [
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Lyme borreliosis and peripheral facial palsy. | rline borrelial antibody titres (1:128) were found (interpreted as a possible infection). In 63 (55.3%) patients the serological tests remained negative. Lymphocytic pleocytosis was found at the first visit in 12/22 (54.5%) patients with confirmed borrelial infection; in 3/20 (15%) with probable infection; in 1/9 (11.1%) with possible infection; and in 10/63 (15.9%) patients with symptoms of unknown aetiology. Patients with confirmed borrelial infection had abnormal CSF findings significantly more often tha | 10666811 | [
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Lyme borreliosis and peripheral facial palsy. | n did patients with symptoms of unknown aetiology (p = 0.0139 for lymphocytic pleocytosis and/or elevated CSF protein levels; and p = 0.0010 for lymphocytic pleocytosis). Local and systemic signs/-symptoms were also more common in patients with confirmed borrelial infection than in those with an symptoms of unknown aetiology (p = 0.0258). In Slovenia which is a highly endemic region for Lyme borreliosis; borrelial infection is a frequent cause of PFP in adult patients. PFP may occur early in the course of L | 10666811 | [
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Lyme borreliosis and peripheral facial palsy. | B; prior to measurable antibody response; indicating the need for serologic follow-up. Abnormal CSF results and the presence of additional local and/or systemic symptoms are factors indicating a higher possibility of borrelial aetiology of PFP and should alert physicians to suspect LB. | 10666811 | [
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Lyme meningitis: a one-year follow up controlled study. | Thirty-six patients with Lyme meningitis diagnosed at the Department of Infectious Diseases; University Medical Centre; Ljubljana in 1993 and 1994 were enrolled in a prospective study. All patients had lymphocytic meningitis; negative serum IgM antibody titres to tick-borne encephalitis virus and met at least one of the following four criteria: i) isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid (2 patients); ii) intrathecal borrelial antibody production (22 patients) iii) seroconversio | 10666809 | [
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Lyme meningitis: a one-year follow up controlled study. | n to borrelial antigens (3 patients) and/or iv) erythema migrans in the period of four months prior to the onset of neurological involvement (21 patients). All patients underwent antibiotic treatment and were followed up for one year. The results of our study revealed that Lyme meningitis frequently occurs without meningeal signs and is often accompanied by additional neurological and/or other manifestations of Lyme borreliosis. During the first year after antibiotic treatment; minor and major manifestation | 10666809 | [
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Lyme meningitis: a one-year follow up controlled study. | s of Lyme borreliosis persisted or occurred for the first time in several patients. They were not infrequent even at the examination performed one year after therapy. | 10666809 | [
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Diffuse reversible alopecia in patients with Lyme meningitis and tick-borne encephalitis. | Alopecia occurring after febrile bacterial and viral infection is a phenomenon well known since the beginning of the century. To evaluate the occurrence of alopecia in tick transmitted disease; 23 adult patients with Lyme meningitis and 71 patients with tick-borne encephalitis were included in a prospective study and were followed up for one year. Diffuse alopecia occurred within three months after the outbreak of disease in 3 out of 23 (13%) patients with Lyme meningitis and in 40 out of 71 (56.3%) patient | 10666812 | [
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Diffuse reversible alopecia in patients with Lyme meningitis and tick-borne encephalitis. | s with tick-borne encephalitis. The mean duration of alopecia was 2 to 3 months and alopecia was reversible in all patients. | 10666812 | [
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The course of Lyme disease in different age groups. | Lyme disease is a multisystem infection affecting all age groups. In this study an attempt was made to determine whether the patient's age influences the course of the disease. One hundred and fifty patients with diagnosed Lyme disease were included in the study. Two serological methods were used to detect antibodies to Borrelia burgdorferi and to confirm the diagnosis: an indirect immunofluorescence assay (the Russian strain Ip-21) and Western blot. The course of Lyme disease did not differ from that seen | 10666813 | [
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The course of Lyme disease in different age groups. | in Europe and North America. However; a few clinical differences between groups were observed. In the first age group (0-15 years) the most common manifestation was flu-like symptoms with fever. Neither radiculoneuritis nor polyneuropathy was observed in this age group. Late manifestations were rare and the outcome of the disease was benign. The course of the disease in the second group (16-40 years) was most similar to that in childhood and the also outcome was similar. Carditis and erythema multiple were | 10666813 | [
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The course of Lyme disease in different age groups. | significantly more common in the second group (16-40 years) than in the other age groups. No differences were found between the third (41-60 years) and fourth (> than 60 years) group in the frequency of flu-like symptoms; erythema multiple and aseptic meningitis. However; the most important clinical sign in this group was involvement of the nervous system whereas in the third group this was joint damage. This feature deserves attention because; as a rule; the presence of an articular syndrome determines the | 10666813 | [
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The course of Lyme disease in different age groups. | prognosis of LD. | 10666813 | [
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Functional heterogeneity in the antibodies produced to Borrelia burgdorferi. | Antibodies to outer surface molecules of Borrelia burgdorferi (Osp) that have a bactericidal action in the absence of complement have been described. These antibodies are primarily monoclonal to antigenic determinants in OspA and OspB. One of these; CB2; is an IgG1 monoclonal antibody that recognizes an epitope in the carboxy terminus of OspB. The specificity of CB2 is critically dependent on the presence of a lysine (Lys) residue in position 253; not only for binding but also for killing the spirochete. Th | 10666815 | [
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Functional heterogeneity in the antibodies produced to Borrelia burgdorferi. | is antibody has been used successfully to select escape variants or mutants that are missing the Lys residue either by a mutation or by deletion as a result of premature stop codons. Other antibodies to OspA; OspB; and p39 have also been characterized with similar properties. Another important feature of CB2 is that its bactericidal action is not dependent on agglutination; since Fab fragments of the whole immunoglobulin molecule can also kill in the absence of complement synergy. The killing action of CB2 | 10666815 | [
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Functional heterogeneity in the antibodies produced to Borrelia burgdorferi. | is not inhibited by protease inhibitors; and is dependent on the presence of calcium. Upon contact with Borrelia burgdorferi; CB2 causes lysis of the outer membrane and the formation of a spheroplast. The bactericidal mechanism of this antibody is not known. The sequence of the heavy and light chain variable regions of CB2 have striking homology to murine antibodies of the autoimmune repertoire; and some of these antibodies have catalytic properties. In general; catalytic antibodies have enzymatic rates of | 10666815 | [
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Functional heterogeneity in the antibodies produced to Borrelia burgdorferi. | acceleration that are significantly less than those of proteolytic enzymes. If CB2 were a catalytic antibody; its substrate specificity may be expected to be broader. CB2 does not cleave recombinant OspB; nor does it cleave other protein substrates. Its killing activity is not dependent on proteolysis. Because the bactericidal action of CB2 involves the destruction of the outer membrane; it is possible that a phospholipase could be associated with the mechanism. The mobility of spirochetal lipids is altered | 10666815 | [
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Functional heterogeneity in the antibodies produced to Borrelia burgdorferi. | after incubation with CB2; and the bactericidal activity is reduced in the presence of phospholipase inhibitors. These studies suggest that the bactericidal mechanism of CB2; and other similar antibodies; is novel. | 10666815 | [
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Risk assessment in Lyme borreliosis. | A 3-year EU-funded project (EUCALB); initially involving 14 countries and more than 30 scientists and physicians; was undertaken with the main objective of identifying practical risk assessment criteria for Lyme borreliosis. A major part of the project was dedicated to the improvement of data quality. European case definitions were formulated and quality assurance schemes were developed for serological diagnosis and the detection of infection in ticks. Studies on the standardisation of immunoblot interpreta | 10666816 | [
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Risk assessment in Lyme borreliosis. | tion criteria are still in progress. Data on the clinical risk from tick bites were obtained and considerable progress was made in elucidating the complex ecology of the disease. A study on habitat assessment throughout Europe concluded that high risk was associated with highly heterogeneous recreational woodland and case data from both high and low incidence countries suggested that most infections were acquired in recreational areas. Considerable work is still required to relate clinical data to the epide | 10666816 | [
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