The mechanism by which Pseudomonas causes excessive inflammation in the cystic fibrosis lung is unclear. We have reported that arachidonic acid is increased and docosahexaenoic acid (DHA) decreased in lung, pancreas, and ileum from cftr-/- mice. Oral DHA corrected this defect and reversed the pathology. To determine which mediators regulate inflammation in lungs from cftr-/- mice and whether inhibition occurs with DHA, cftr-/- and wild-type (WT) mice were exposed to aerosolized Pseudomonas lipopolysaccharide (LPS). After 2 days of LPS, tumor necrosis factor-alpha (TNF-alpha), macrophage inflammatory protein-2, and KC levels in bronchoalveolar lavage fluid were increased in cftr-/- compared with WT mice and not suppressed by pretreatment with oral DHA. Neutrophil levels were not different between cftr-/- and WT mice. After 3 days of aerosolized LPS, neutrophil concentration, TNF-alpha, and the eicosanoids 6-keto-PGF1alpha, PGF2alpha, PGE2, and thromboxane B2 were all increased in bronchoalveolar lavage fluid from cftr-/- mice compared with WT controls. Oral DHA had no significant effect on TNF-alpha levels in cftr-/- mice. In contrast, neutrophils and eicosanoids were decreased in cftr-/- but not in WT mice treated with DHA, indicating that the effects of DHA on these inflammatory parameters may be related to correction of the membrane lipid defect.

A 12 1/2-year experience with 227 patients who underwent coronary revascularization with bilateral internal mammary artery (IMA) and supplemental saphenous vein grafts is presented. There were 725 coronary grafts performed (3.2 per patient). Forty-four IMA grafts were sequential. In 42 patients, the right IMA was placed through the transverse sinus to revascularize the circumflex artery. Operative mortality was 4% (9 of 227 patients). Postoperative complications included sternal infection (4 patients), reexploration for bleeding (5), and diaphragmatic dysfunction (10). Postoperative arteriography in 30 patients (mean interval, 4 1/4 years) revealed that 92% (34/37) of the left IMA and 87% (26/30) of the right IMA grafts were patent. Late follow-up was complete in 207 surviving patients. Eighteen late deaths (9 cardiac and 9 noncardiac) occurred. Actuarial survival was 83% at 10 years after operation. Of 68 patients followed from 8 to 12 1/2 years (mean interval, 10 1/2 years), 69% were asymptomatic, and 28% were in New York Heart Association Functional Class II. We conclude that bilateral IMA grafting can be accomplished with low operative risk and provides excellent long-term results.

During the 1950s and 1960s, the concept of culture had currency beyond the disciplinary boundaries of anthropology and sociology. This article takes up a clinical example of the invocation of the culture concept by examining how early family therapists such as Nathan Ackerman, Murray Bowen, and Don Jackson used culture as a category of analysis during the formative years of their new field. The culture concept played an integral role in the processes by which family therapists simultaneously defined the object of their research and treatment, the family, and built their new field. Their varied uses of culture also contained tensions and contradictions, most notably between universal and relativist views of family and psychopathology and between views of family therapy as a conservative force for maintaining the nuclear family or a progressive force for overcoming social inequality.

In 1973, the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (2nd ed.; DSM-II; American Psychiatric Association, 1968). Clinicians subsequently began conducting psychotherapy with gays and lesbians not in order to change their sexuality but to address the psychological effects of homophobia and associated problems. Family-related issues such as the impact of coming out to relatives became an important dimension of psychotherapy that normalized same-sex desire, identity, and relationships, even amid contemporary invocations of family values as grounds for opposing gays and lesbians' political claims. This article examines family therapy's gradual recognition of gay and lesbian families as emblematic of the historically changing relationship among psychotherapy, sexuality, and family during the 1970s to 1990s. Although early family therapists of the 1950s and 1960s were largely unconcerned with treating homosexuality as a psychiatric problem, they also generally did not recognize same-sex relationships as a possible configuration of family life because their models presumed a heterosexual nuclear family. By the 1980s and 1990s, many family therapists came to see sexuality as a dimension of family life that might shape the issues for which couples and families sought treatment but that did not warrant treatment itself. Homosexuality's depathologization in 1973 thus signaled the opening, not the closing, of lesbian and gay issues in family therapy because the cultural trends and social movements that led to homosexuality's removal from the DSM-II would, by the 1990s, also contribute to expanding family therapists' notion of "family." (PsycINFO Database Record

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