William C. Tallent Outpatient Clinic

The pathophysiology of lymphocytic colitis (LC) is not completely understood. Current hypotheses implicate abnormal mucosal immune response to luminal antigens in combination with genetic predisposition. Five cases detail the outcomes of adding serum-derived bovine immunoglobulin/protein isolate (SBI) for the nutritional management of these unresponsive LC patients. SBI's unique mechanism includes binding microbial components and maintaining normal GI immune balance which makes it a candidate therapy in LC patients. Five patients were administered SBI for LC. All patients were female with an average age of 71±7.1 yrs. Patient 1 was admitted to the hospital with 20-24 bowel movements (BM) per day with cramps and urgency. Biopsies from a colonoscopy were consistent with LC. She was placed on mesalamine and methylprednisolone without any change. Patient 2 had tried and failed multiple tapering doses of budesonide for 2 yrs with continual multiple, loose stools per day. Patient 3 had been diagnosed with IBS-D for 15 yrs and failed all over-the-counter options. Recent biopsies, however, indicated LC. Patient 4 had a poor response to steroids and psyllium fiber for 2.5 yrs with a history of fecal incontinence (FI). Patient 5 had a diagnosis of LC for 1.5 yrs; she had a history of anal fistula repairs with multiple loose BM in the a.m. accompanied by intermittent episodes of FI. She had no response to mesalamine, loperamide or antibiotics. Incorporating SBI dramatically improved symptoms for all patients. Patient 1 was discharged from the hospital on SBI 5g QD and continued on 1.2g mesalamine having 4 formed BM without cramping, urgency or bleeding. However, if the patient missed more than two days of SBI, she quickly experienced 10-14 watery BM daily. Patient 2 first began SBI 5g BID with budesonide, but was able to discontinue the steroid while maintaining normal BM on SBi monotherapy. Patient 3 was placed on budesonide and SBI 5g QD normal BM within a week. Patient 4 began SBI 5g QD in addition to psyllium fiber and at follow-up reported formed stools with no episodes of FI. After initiating SBI 5g QD, Patient 5 reported 1-2 formed BM without FI. All patients are currently maintained on SBI in combination with the therapies indicated above for more than 6 months. No side effects have been experienced on SBI during that time. The exact manner in which SBI manages LC is not known. The outcomes of these cases, however, suggest that LC patients may benefit from the distinct nutritional proteins in SBI for management of their conditions. Larger, well-controlled studies in patients with LC and/or FI should be performed to corroborate these findings.

To assess diagnostic performance of dedicated breast magnetic resonance (MR) imaging at breast imaging centers by using a dedicated 1.5-T breast MR system that used high-spatial-resolution, high-contrast-resolution spiral trajectory acquisitions. The study was institutional review board approved and HIPAA compliant, with waiver of informed consent. Diagnostic performance was retrospectively assessed for 934 consecutive screening (n=347) and diagnostic (n=587) examinations performed from April 2006 to December 2007 in women aged 25-89 years old from four sites for which dedicated breast MR imaging reports and ground truth (biopsy for cancer cases, 1-year follow-up with negative results for cases with negative findings) were available. The sensitivity, specificity, and receiver operating characteristic (ROC) for breast MR imaging were determined. The sensitivity and specificity for the dedicated breast MR imaging system were 92% (92 of 100) and 88.8% (741 of 834). For all cases, the negative predictive value (NPV) was 98.9% (741 of 749). The NPV for screening cases was 100% (326 of 326). The area under the ROC curve was 0.942. Of the 93 cases with false-positive findings seen at dedicated breast MR imaging, 25 (27%) were high-risk histologic findings for which excision is often recommended. The false-positive rate was 93 of 834 (11.2%) for all cases, but only 16 of 326 (4.9%) for the screening cohort. High accuracy was achieved by using dedicated breast MR imaging.

s: Ninth International Congress of Therapeutic Drug Monitoring and Clinical Toxicology: Louisville, Kentucky April 23-28, 2005

We apply chaotic time series analysis (CTSA) to human electroencephalogram (EEG) data. Three epoches were examined: epileptic seizure, non-seizure, and transition from non-seizure to seizure. The CTSA tools were applied to four forms of these data: raw EEG data (e-data), artifact data (f-data) via application of a quadratic zero-phase filter of the raw data, artifact-filtered data (g- data) and that was the residual after subtracting f-data from e-data, and a low-pass-filtered version (h-data) of g-data. Two different seizures were analyzed for the same patient. Several nonlinear measures uniquely indicate an epileptic seizure in both cases, including an abrupt decrease in the time per wave cycle in f-data, an abrupt increase in the Kolmogorov entropy and in the correlation dimension for e-h data, and an abrupt increase in the correlation dimension for e-h data. The transition from normal to seizure state also is characterized by distinctly different trends in the nonlinear measures for each seizure and may be potential seizure predictors for this patient. Surrogate analysis of e-data shows that statistically significant nonlinear structure is present during the non-seizure, transition , and seizure epoches.

We have received Dr Peter Flanagan's comments on our above article. His calculations for sensitivity and specificity are correct. It was an inadvertent error that data from Table 2 does not correlate with the data in Table 3. The sensitivity of Chemstrip LN is high while the specificity is low, which is in accordance with the 95% negative predictive value that we reported. We want to thank Dr Flanagan for bringing this discrepancy to our attention and to those of our readers.

No abstract available for this article.

While much literature suggested that highly elevated MMPI profiles are of questionable validity, Newmark and Sines (1972) found that even profiles with elevations ≥70 T on scales 1–9 have clinical significance. The two studies reported here were designed to investigate further such “floating profiles.” In Study I, MMPI profiles from 67 male psychiatric inpatients who produced “floating profiles” were subjected to Veldman's Hierarchical cluster analysis and five floating profile subtypes were identified. In Study II the entire sample of floaters as well as the subtypes were compared with a randomly selected sample of 40 nonfloaters in terms of a number of demographic and clinical variables. Results generally suggested that individuals who produce floating profiles differ significantly from individuals who produce more traditionally “valid” profiles. Also, results supported the assumption that the floater subtypes represent unique personality types. Findings are compared with the Newmark and Sines (1972) results, and implications of the current research are discussed.