A comparative study of family functioning among Vietnamese and Cambodian refugees

This study was designed to determine the extent of family problems among a clinic population of Cambodian and Vietnamese refugees, and to identify similarities and differences between the two groups. All 107 patients with adolescent children from a total clinic population of 298 were interviewed using a semistructured questionnaire, results were tabulated, and statistical methods were applied. The types of problems with children described by parents were classified into the dimensions of communication, personal behaviors, school performance, social behaviors, and antisocial behaviors. There were significantly more problems described by Vietnamese parents as compared with Cambodian parents. Vietnamese parents reported significantly more dissatisfaction with life in the United States. For both ethnic groups, parents' relationships with their adolescent children were a major source of concern and had a major impact on parents' perceptions of their own health. Yet, there were important ethnic differences between these refugee groups in how patients perceived their problems.

Ceroid granulomas in the female genital system

Three cases of ceroid granulomas of the female genital system are presented, involving the cervix in two and lesions in the ovaries and bowel serosa in the other. Ceroid granulomas are unusual and interesting lesions formed when suitable substrates accumulate within macrophages to such an extent that a relative lack of biological antioxidants results and auto-oxidation and conversion to ceroid is favoured. This may occur in the setting of haemorrhage and necrosis, whether from tumour necrosis or associated with endometriosis. Other sources of lipids and lipoproteins include bile, meconium and vernix caseosa.

Weekly and yearly rhythms in plasma fibrinogen in hospitalized male military veterans

The variation in plasma fibrinogen level demonstrating prominent circaseptan and circannual cycles is clinically relevant. There is a correlation between increasing level of fibrinogen and other hemostatic factors and risk of myocardial infarction and sudden death. The circaseptan and circannual cycles in fibrinogen concentration described in this study may help to explain further the variation in frequency of coronary events. Furthermore, the recent demonstration of a circadian pattern in the efficacy of tissue plasminogen activator, with peak efficacy occurring at 2000 hours--10 hours after the peak incidence of myocardial infarction--implies that further patterns to coronary artery syndromes may be predicted and the treatment efficacy may rely on demonstrated circaseptan and circannual cycles of these events.

Acetaldehyde-modified lysozyme function: its potential implication in the promotion of infection in alcoholics

Incubation of lysozyme with acetaldehyde (0.44 M) at room temperature for 2 h produces a 62% inhibition of enzymic activity. Because the active site cleft contains tryptophyls, asparagine, glutamine, and an arginine residue, and because acetaldehyde reacts with indoles, amides, and guanidines, it is suggested that these sites are likely ones for alkylation. The epsilon-amino groups of lysines on the surface of the molecule are also susceptible to covalent modification. Total acetylation of lysozyme has been reported to inactivate the enzyme. These results suggest the possibility that inactivation of a fraction of the lysozyme activity by acetaldehyde may decrease the effectiveness of the enzyme in chronic alcoholics, thereby leading to an increased potential for susceptibility to bacterial infection.

Analysis of apatite deposits on substrates

Calcium phosphate coatings, important for medical implant applications can occur in several different phases. Because of differences in properties of these phases it is imperative to be able to identify their presence in a substrate's coating. In this study we characterized hydroxy apatite (HA) surfaces applied by four different coating procedures. Included were plasma sprayed, sputtered, a composite, and a composite overlayed with plasma sprayed. It was found that a combination of reflectance infrared and Raman spectroscopy could be utilized to make an in situ characterization of the calcium phosphate phases. It was shown that plasma sprayed and sputtered coatings of HA lost OH and thus decreased in crystallinity, while composite coatings remained unchanged from the original HA powder.

Periodontal microflora of HIV positive subjects with gingivitis or adult periodontitis

The subgingival microflora of 39 HIV+ subjects with gingivitis or adult periodontitis was cultured quantitatively anaerobically for bacteria, spirochetes, and mycoplasma and aerobically for yeasts. Isolates were characterized by conventional biochemical tests, polyacrylamide gel electrophoresis of soluble proteins, cellular fatty acid profiles, immunofluorescence, and immunodiffusion. In general, the same types of bacteria were isolated from the subgingival crevice of HIV+ subjects as we previously had isolated from the subgingival crevice of non-HIV subjects. A statistically significant difference was found between the composition of the flora of HIV+ subjects with adult periodontitis (AP) and concurrent studies of a non-HIV+ AP population. Mycoplasma salivarium was significantly elevated in the HIV+ subjects examined. Yeasts were isolated from only 10% of the samples and from 13% of the HIV-positive subjects at 0.05 to 0.0002% of the total cultivable count when present.

Increased activity of 6-phosphogluconate dehydrogenase and glucose-6-phosphate dehydrogenase in purified cell suspensions and single cells from the uterine cervix in cervical intraepithelial neoplasia

The activities of 6-phosphogluconate dehydrogenase and glucose-6-phosphate dehydrogenase have been measured in squamous epithelial cells of the uterine cervix from normal patients and cases of cervical intraepithelial neoplasia (CIN). A biochemical cycling method, which uses only simple equipment and is suited to routine use and to automation, was applied to cells separated by gradient centrifugation. In addition, cells were examined cytochemically, and the intensity of staining in the cytoplasm of single whole cells was measured using computerised microcytospectrophotometry. Twenty per cent of cells in samples from normal patients (n=61) showed staining intensities above an extinction of 0.15 at 540 nm, compared to 71% of cases of CIN 1 (n=14), 91% of cases of CIN 2 (n=11) and 67% of cases of CIN 3 (n=15). The cytochemical data do not allow definitive distinctions to be made between different grades of CIN whereas the biochemical assay applied to cell lysates shows convincing differences between normal samples and cases of CIN. There are no false negatives for CIN 3 (n=14) and CIN 2 (n=10) and 11% false negatives for CIN 1 (n=9) and 14% of false positives for normal cases (n=21). The results of this preliminary study with reference to automation are discussed [corrected].

Periodontal health in 200 HIV-positive patients

Two hundred HIV-positive subjects were surveyed to determine their periodontal health status. Particular attention was given to the occurrence of a severe and rapidly progressing form of periodontal disease designated "HIV-associated periodontitis", which has been reported as being unique to AIDS patients. Among the subjects comprising the cohort, 85 subjects had good gingival health, 59 subjects exhibited gingivitis, 49 cases of adult periodontitis were observed, 5 subjects presented with advance adult periodontitis, and 2 cases of necrotizing ulcerative periodontitis (NUP) were found within the group. The periodontitis of the patients in this survey did not have unique or pathognomonic characteristics which could set their periodontal disease apart from the periodontal disease seen in HIV negative population.

The policy practice interface in Wales

The National Health Service in Wales, through the work of the Welsh Health Planning Forum (WHPF), has developed a new and exciting way of planning and managing its services. This encourages consumers to exert influence from the individual right through to the national level. Furthermore, managers are required to seek out and involve people, and to take advice from consumer-led groups. In this paper, Jeremy Felvus and colleagues describe briefly this new way of working and give practical examples of its impact on strategy development at all levels.

Heart of the matter

Nearly half of all deaths in Wales are from cardiovascular disease. Christopher Riley and colleagues set out how health planners aim to change all that with protocols for health gain.

The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees

All 322 patients at a psychiatric clinic for Indochinese refugees were surveyed to determine the presence of posttraumatic stress disorder (PTSD). If PTSD was not diagnosed at the time of initial evaluation, a structured reinterview was performed. Seventy percent of the patients (N = 226) met the criteria for a current diagnosis of PTSD, and an additional 5% (N = 15) met the criteria for a past diagnosis. The Mein had the highest rate of PTSD (93%) and the Vietnamese the lowest (54%). Of the patients with PTSD who were enrolled in the clinic before March 1988, 46% (N = 87) were given a diagnosis of PTSD only after the reinterview. PTSD is a common disorder among Indochinese refugees, but the diagnosis is often difficult to make.

Analysis of anticancer drugs in biological fluids: determination of taxol with application to clinical pharmacokinetics

Taxol, a novel antimitotic, antitumor agent is currently undergoing Phase 1 clinical trials for the treatment of various tumors. An isocratic HPLC method has been developed for the determination of taxol in human plasma and urine. The method was then applied to the clinical pharmacokinetics of taxol following 6-h intravenous (i.v.) infusions at doses of 175 and 225 mg m-2. A mobile phase of methanol-acetate buffer (0.02 M, pH 4.5) (65:35, v/v) was used to elute a C8 column with detection at 227 nm. The sample preparation involved extraction with t-butyl methyl ether followed by further clean-up of the sample by solid-phase extraction. The method was linear from 0.10-10 microM injected, with a chromatographic run time of 6 min. The results obtained from the clinical study indicate that the plasma pharmacokinetics of taxol are best characterized by a two compartment open body model. Additionally, the present study resulted in the detection of a previously unreported peak which may be a metabolite of taxol.

Examples of complementary roles of abdominal CT and radiocolloid liver imaging

Two cases are reported in which well-defined lesions of the liver were seen in radiocolloid liver imagings but not in the concurrent abdominal CT images. The results of autopsy confirmed the diagnosis of hepatoma in one and metastatic disease in the other. The third case, referred for a Tc-99m SC liver-spleen image because of a suboptimal abdominal CT owing to artifact, showed a normal liver. In certain clinical situations, radiocolloid imaging provides a complementary role to CT in the detection or confirmation of hepatic lesions and, in occasional patients, is superior to CT.

Changes in serum copper and zinc during treatment with anticancer drugs interfering with pyridoxal phosphate

Hexamethylmelamine, pentamethylmelamine and procarbazine are anticancer drugs known to interfere with pyridoxal phosphate. This paper presents results on copper and zinc serum levels during the treatment with each of these drugs used as single agents. Six NZW rabbits weighing 2.7-4.5 kg were used in these experiments. Hexamethylmelamine and procarbazine were administered by gastric gavage and pentamethylmelamine by intravenous route at the daily doses of 100 mg, 30 mg and 50 mg/kg of body weight respectively for up to four days. Blood samples were collected in metal free tubes at fasting state before and during the treatment. Student's paired t-test was used for statistical analysis. The pretreatment serum copper concentration significantly (p = 0.05) increased and conversely the serum zinc concentration significantly (p = 0.05) decreased during each drug treatment. Consequently the copper/zinc ration significantly increased from 0.32, 0.33 and 0.27 to 1.16, 0.63 and 1.13 for hexamethylmelamine, pentamethylmelamine and procarbazine respectively. These results indicate, that daily administration of three anticancer drugs interfering with pyridoxal phosphate causes changes in serum copper and zinc levels with inversed relationship between both changes.

Nursing students' stereotypes of married and unmarried pregnant clients

The purpose of this study was to investigate the effects of information about a pregnant client's marital status on nursing students' initial perceptions of the client, attributions of group stereotypes to the client, predictions of client behavior, data sought, and verbal responses toward the client. Forty-three undergraduate nursing students from a large Midwestern university volunteered to participate. Subjects were randomly assigned to one of two experimental groups, the "married client" or "unmarried client." Subjects viewed a videotape of a nurse interviewing a pregnant client and were administered a series of questionnaires. Following this, they were asked to respond in writing to five statements made by the videotaped client. Videotapes were identical except that one group was told they were viewing an unmarried woman and the other group was told the client was married. Results indicated that students evaluated the married client more positively than the unmarried client. Students' perceptions were consistent with several cultural stereotypes. In addition, students predicted that, if hospitalized, the unmarried client would have greater difficulty than the married client. There were no differences between groups in the information they would seek from the client or in responses towards the client.

Detection of antibodies to the human immunodeficiency virus by a rapid fluorescence-labelled immunosorbent assay

The development and assessment of a fluorescence-labelled immunosorbent assay for the detection of antibodies to the human immunodeficiency virus is described. Test serum is incubated in microtitre wells on which antigens have been coated. If present in the test serum, antibodies to the human immunodeficiency virus bind to the solid-phase antigens. In turn the antibodies are quantified with anti-human immunoglobulin labelled with fluorescein. Positive samples produce an intense fluorescence which is measured in a spectrofluorimeter. When used to test a panel consisting of normal serum and antibody-positive serum from infected patients the assay proved to be 100% specific and to have a sensitivity of 100%. The assay has many of the advantages of micro enzyme-linked immunosorbent assays, but does not suffer from the drawbacks associated with the use of an enzyme label. It requires fewer manipulations and is quicker to carry out than an equivalent enzyme-linked test.

Intense bone imaging agent uptake in the soft tissues of the lower legs and feet relating to ischemia and cold exposure

We present a patient with diffuse and intense uptake in the soft tissues of both lower legs and feet seen on 99mTc-HMDP bone scintigraphy. This finding presumably resulted from compromised blood supply to the lower legs plus a cold environment. The extraosseous bone imaging agent localization was presumably related to an existing ischemic condition that was exacerbated by cold. Differential diagnosis of the scan pattern should be differentiated from the artifact of socks contaminated by radioactive urine.

Paget's disease mimicing skeletal metastases in a patient with coexisting prostatic carcinoma

We present a 93-year-old man with prostatic carcinoma whose 99mTc-HMDP skeletal images showed multiple areas of abnormally increased radioactivity in the bone and virtual absence of renal activity. These findings were interpreted as representing multiple skeletal metastases. When correlated with concurrent radiographs, the abnormalities were found to be due to Paget's disease. Multiple areas of bone involvement are not rare in Paget's disease. We reemphasize that an abnormal bone scintigram should always be correlated with regional radiographs to rule out conditions other than malignancy.

Additional extrarenal abnormalities seen in Tc-99m DTPA renal flow study

During 99mTc-DTPA renal flow studies, extrarenal abnormalities have been found to include aortic abnormalities (aneurysm, ectasia, thrombosis, and abruptly decreased flow), splenic abnormalities (enlarged, small, or absent spleen), hepatic arterialization, and very slow circulation. In addition to the above abnormal findings, we add three more extrarenal pathologies that may be concomitantly found with renal flow study: pleural effusion(s), malignancy of the abdomen, and anemia and/or skeletal metastases.

Group therapy with Southeast Asian refugees

This report describes a one-year experience with a new program of group therapy for Southeast Asians who were treated in a psychiatric program for Indochinese refugees. Cultural factors involving communication styles, respect for authority, and traditional social relationships greatly influence the group process. Socialization experiences which encouraged traditional activities and practical information were the most acceptable medium by all the groups. Psychological issues of losses, cultural conflicts, and persistent discussion of somatic symptoms were voiced throughout the activities. Formal group psychotherapy was periodically useful in some groups. Flexibility, meeting concrete needs, keeping a bicultural focus, and maintaining the individual therapy sessions contributed to the acceptance by the patient.

On the use of fluorescent labels in immunoassay

The principles and use of fluorescent labels in immunoassay are reviewed. Comparison is made with radio- and chemiluminescent immunoassays. Possible fluorescent labels are listed. The following types of assay are described: separation fluoroimmunoassay, immunofluorometric assay, fluorescence enhancement and fluorescence quenching assay, fluorescence polarization immunoassay, fluorescence energy transfer immunoassay, fluorescence protection immunoassay, alternative binding immunoassay, release fluoroimmunoassay and time-resolved fluorimetry and phosphorimetry.

Homogeneous fluoroimmunoassay using Lucifer yellow VS: determination of albumin plasma

Non-separation fluoroimmunoassays are well suited to automation. The potential sensitivity of such assays has not been realised because the most commonly used label (fluorescein) has absorption and emission spectra which coincide with those of blood constituents and because it has a very small Stokes shift. Lucifer yellow VS has a larger Stokes shift than fluorescein and an emission maximum at longer wavelength. We describe an energy transfer fluoroimmunoassay for plasma albumin in which Lucifer yellow VS is used to label albumin and rhodamine B isothiocyanate is used to label anti-albumin antibodies. The assay shows good correlation with a dye-binding method for albumin and has sensitivity and precision which compare favourably with similar assays using a fluorescein label.

A low-cost colorimeter

A need for a colorimeter with low capital and maintenance costs has been suggested for countries with foreign exchange problems and no local medical instrumentation industry. This paper puts forward a design for such a device based on a domestic light-bulb, photographic filters and photovoltaic cells. The principle of the design is the use of a balancing technique involving twin light paths for test solution and reference solution and an electronic bridge circuit. It is shown that proper selection of the components will allow the cost objectives to be met and also provide acceptable linearity, precision, accuracy and repeatability.

Direct determination of calcium and magnesium in serum using flow-injection analysis and atomic absorption spectroscopy

The use of flow-injection analysis for the direct determination of calcium and magnesium in blood serum and plasma is described. An inexpensive rotary valve is used to inject the serum sample (4 microliters) into a flowing non-segmented stream of reagent which carries the sample slug through a long narrow-bore coil--where it gradually disperses--and into the nebuliser of an atomic absorption spectrometer. This on-stream sample dilution removes the need for predilution of the sample. The resulting absorbance signals are recorded as peaks less than 40 seconds after sample injection. Analytical recoveries and precision are good for both elements and the results by flow-injection analysis compare well with established routine methods.

Use of Lucifer yellow VS as a label in fluorescent immunoassays illustrated by the determination of albumin in serum

The use of a new label for fluoroimmunoassay is described. Lucifer yellow VS is a highly fluorescent vinyl sulphone dye which, under mild conditions, forms covalent bonds with amino and sulphydryl groups but is extremely stable in water. A large Stokes shift (110 nm) and an emission maximum at 540 nm give Lucifer yellow further advantages over the more commonly used labels. The use of the dye as a label has been demonstrated by developing a heterogeneous fluoroimmunoassay for human serum albumin. The fluoroimmunoassay gave comparable results to those obtained using a less specific colorimetric dye-binding assay (r = 0.97, n = 20). The advantages, limitations, and other potential uses of Lucifer yellow are discussed.

Serum iron and total iron-binding capacity determination by flow-injection analysis with atomic absorption detection

The deproteinised sample (150 microliters) is 'injected' into a continuously flowing stream of deionised water which is pumped, via a capillary tube, to the nebuliser of an atomic absorption spectrophotometer. Analytical readout is obtained, in the form of transient peaks, 6 s after sample injection. Before injection traces of haemoglobin are removed from the serum by treatment with trichloroacetic acid-ascorbate solution. This protein precipitant facilitates rapid removal of haemoglobin bound iron without the need for heating. After centrifugation the supernatant solution is introduced into the flowing stream by use of a novel inexpensive 'injector'. Analytical recovery and precision are good, and results compare well with those obtained by a standard AutoAnalyzer procedure.

Controlled dispersion analysis: flow-injection analysis without injection

Flow-injection analysis is a precise, elegant, and economical technique, but its most troublesome feature is the mode of injection of the sample slug. We describe an alternative approach in which the sample is aspirated by the sample probe. In the simplest version the probe normally rests in reagent; when sampling is to take place, the pump is stopped and the probe is transferred to the sample container. The pump makes a predetermined angular movement, the probe is returned to reagent, and the pump is restarted. In more advanced versions the same approach is combined with the merging zone technique. The system is economical, precise, and capable of full automation in a multichannel discretionary analyzer.

Controlled dispersion analysis: flow-injection analysis without injection

Flow-injection analysis is a precise, elegant, and economical technique, but its most troublesome feature is the mode of injection of the sample slug. We describe an alternative approach in which the sample is aspirated by the sample probe. In the simplest version the probe normally rests in reagent; when sampling is to take place, the pump is stopped and the probe is transferred to the sample container. The pump makes a predetermined angular movement, the probe is returned to reagent, and the pump is restarted. In more advanced versions the same approach is combined with the merging zone technique. The system is economical, precise, and capable of full automation in a multichannel discretionary analyzer.

Zinc and copper determination in microsamples of serum by flow injection and atomic absorption spectroscopy

A new approach to the direct determination of copper and zinc in serum and plasma is described. The sample is injected into a continuously pumped stream of water which is fed into the nebuliser of an atomic absorption spectrophotometer. Analytical results are obtained as a series of sharp peaks on a chart recorder. Analytical variables have been investigated, and the proposed method gave results comparable to those obtained using a conventional method based on precipitation of serum proteins with trichloroacetic acid. The proposed method takes less time to perform and was found to give more precise results than the conventional method. In addition, the flow injection analysis method can be performed using microsamples (10-100 microliters) and is thus ideally suited for use on children.

Simultaneous enzyme immunoassay of two thyroid hormones

We describe an enzyme immunoassay in which the two thyroid hormones, triiodothyronine and thyroxin, are measured simultaneously in a single tube. The method involves labeling the two with separate enzymes (beta-galactosidase and alkaline phosphatase, respectively), whose catalyzed reactions can easily be distinguished from each other by absorption spectrophotometry, with o-nitrophenyl-beta-galactoside and phenolphthalein monophosphate as substrates. Performance of this dual assay method compares well with that of conventional single-hapten enzyme-labeled assays, and results compare well with those by two single-hapten radioimmunoassays. The dual assay has certain advantages over single-hapten methods: smaller sample volume, lower reagent cost, and shorter overall assay time. As presented here, the use of enzyme labels to measure two (or more) haptens simultaneously represents a significant advance in the use of immunoassay techniques.