Family dysfunction and the cancer patient: early recognition and intervention

Cancer affects the entire family, not just the patient. Dysfunctional family systems can be assessed by looking for recurrent patterns of maladaptive processes that exclude other coping mechanisms. Intervening to ameliorate the situation in such families involves development of a plan to restore equilibrium wherever possible; when appropriate, a mental-health referral may be needed for families with severe dysfunction. A physician must know how to assess and appropriately intervene in dysfunctional family systems, both when support services are and are not available for assistance. To explain recognition and anticipation of the early signs of family dysfunction to the practicing oncologist, Olsen's Circumplex Model of family functioning is presented as a theoretical frame for assessment and intervention.

Induction of multiple plasmid recombination in Saccharomyces cerevisiae by psoralen reaction and double strand breaks

DNA damage-induced multiple recombination was studied by cotransforming yeast cells with pairs of nonreplicating plasmids carrying different genetic markers. Reaction of one of the plasmids with the interstrand crosslinking agent, psoralen, stimulated cellular transformation by the undamaged plasmid. The cotransformants carried copies of both plasmids cointegrated in tandem arrays at chromosomal sites homologous to either the damaged or the undamaged DNA. Plasmid linearization, by restriction endonuclease digestion, was also found to stimulate the cointegration of unmodified plasmids. Disruption of the RAD1 gene reduced the psoralen damage-induced cotransformation of intact plasmid, but had no effect on the stimulation by double strand breaks. Placement of the double strand breaks within yeast genes produced cointegration only at sequences homologous to the damaged plasmids, while digestion within vector sequences produced integration at chromosomal sites homologous to either the damaged or the undamaged plasmid molecules. These observations suggest a model for multiple recombination events in which an initial exchange occurs between the damaged DNA and homologous sequences on an undamaged molecule. Linked sequences on the undamaged molecule up to 870 base pairs distant from the break site participate in subsequent exchanges with other intact DNA molecules. These events result in recombinants produced by reciprocal exchange between three or more DNA molecules.

Acid etching of a glass ionomer cement base: SEM study

The effects of acid-etching duration on the surface of a glass ionomer cement designed for use as an intermediary layer between composite resin and dentine were investigated. Cement topography changes occurred which could be related to etch duration. When compared with enamel etched for a similar period, undue loss of cement substance was not observed for any of the etch times used.

The role of black churches in supporting compliance with antihypertension regimens

Although considerable gains have been made in hypertension control in the United States, the rate of control in blacks is lower than in whites. It has been asserted that this low control rate in blacks is due to lack of compliance. Using previously tested and new measures, as well as chart audit, this pilot study evaluated the specific role and effectiveness of the black church in promoting compliance with antihypertension regimens. A sample of 63 hypertensive subjects from two inner-city black churches participated; 33 were from a church that had a hypertension screening project and 30 were from one that did not. Clients from the church with the project did not score higher on a self-report compliance measure than those from the church without the project. Furthermore, no relationship was found between support and compliance and blood pressure control, although relationships were seen between age and compliance scores, and between following a doctor's advice and compliance scores. The church without a screening program was viewed by clients as more supportive than the one with the program.

Rheologic predictors of the severity of the painful sickle cell crisis

Deformable sickle erythrocytes have been reported by Mohandas and Evans to be more adherent to vascular endothelium than rigid irreversibly sickled cells (ISC). To define the clinical implications of this finding we have determined genetic, hematological, clinical, and rheological characteristics of sickle erythrocytes obtained from 65 patients with sickle cell anemia and fetal hemoglobin (Hb F) levels less than 15%. The alpha-globin gene number had a significant effect on the hematological parameters, the percentage of dense cells, ISC number, and HB A2 levels. The presence or absence of alpha thalassemia, however, had no effect on the frequency and severity of the sickle cell painful crisis (r = 0.06, P greater than .05). RBC deformability, determined by an ektacytometer, showed great heterogeneity among patients with three or four alpha-globin genes. Linear regression analyses of the data showed significant positive correlation of the frequency and severity of the painful crisis with RBC deformability (r = 0.49, P less than .001), and negative correlations with the percentage of dense cells (r = -0.37, P = .002), and the percentage of ISC (r = -0.46, P less than .001). We propose that the more deformable the sickle RBC are, the greater their adherence to vascular endothelium, and the more they cause vaso-occlusive crises, RBC deformability and the percentage of dense cells (or ISC) seem to have a predictive value of the frequency and severity of painful crises in sickle cell anemia.

Expert systems for implanted pacemaker analysis

A computer-based software system has been proposed that will assist clinicians in the often difficult task of analyzing multi-channel pacemaker modified ECGs. The system contains three integrated modules. First, digital signal processing indentifies cardiac events from two sources provided by the latest pacemaker technology, intracardiac atrial and ventricular signals, activity markers, and a surface ECG. Secondly, the pacemaker's functional status at each event is analyzed by a rule-based monitor model of the pacemaker. Thirdly, Expert System (ES) techniques were used to combine the digital signal processing metrics, the pacemaker's functional status at each event, and the programmed parameters stored in the pacemaker's memory with a clinical knowledge base relating known problems and their causes. The domain specific tasks, briefly described here, that were most useful in the implementation of the ES are: data reduction, knowledge acquisition methods, knowledge representation, inferencing, and presentation of results.

The xerocytosis of Hb SC disease

Patients with Hb SC disease were found to have microcytic and hyperchromic red cell indices despite mild reticulocytosis. Iron deficiency anemia was ruled out by the finding of normal serum ferritin levels. In order to determine whether the microcytosis was due to coexistent alpha-thalassemia, restriction endonuclease mapping was performed on genomic DNA extracted from peripheral blood leukocytes. Patients with Hb SC disease had microcytic indices despite the presence of a full complement of four alpha-genes (alpha alpha/alpha alpha), suggesting that the microcytosis may be due to cellular dehydration (or xerocytosis), since the mean corpuscular hemoglobin concentration in Hb SC disease patients was significantly higher than in controls. This possibility was investigated further by the determination of RBC cation content. RBC Na levels were similar in SC and normal red cells. Hb SC RBCs, however, had significantly reduced K levels. These findings show that RBC cation content, and thus cell water, is decreased in Hb SC disease. The decreased RBC K level in the presence of normal cellular Na concentration suggests selective K loss that is not due to inhibition of the Na K pump. Ouabain-insensitive K+ efflux was increased to four times normal in SC cells. Cell dehydration was confirmed by the demonstration of increased high-density RBCs on discontinuous Stractan density gradients and by osmotic gradient ektacytometry. Cellular dehydration and its sequelae were worse in CC erythrocytes and milder in AC cells than in Hb SC red cells. Taken together, these data indicate that in Hb SC disease the RBCs are severely dehydrated and typically microcytic and hyperchromic. Hb SC RBCs seem to be dehydrated due to selective K loss. These findings suggest a functional interrelationship between Hb SC, the red cell membrane, and cation regulation.

Glyceraldehyde-3-phosphate dehydrogenase of rat erythrocytes has no membrane component

In the course of studying mammalian erythrocytes we noted prominent differences in the red cells of the rat. Analysis of ghosts by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis showed that membranes of rat red cells were devoid of band 6 or the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (D-glyceraldehyde-3-phosphate: NAD+ oxidoreductase (phosphorylating), EC 1.2.1.12). Direct measurements of this enzyme showed that glyceraldehyde-3-phosphate dehydrogenase activity in rat erythrocytes was about 25% of that in human cells; all of the glyceraldehyde-3-phosphate dehydrogenase activity in rat erythrocytes was within the cytoplasm and none was membrane bound; and in the human red cell, about 1/3 of the enzyme activity was within the cytoplasm and 2/3 membrane bound. The release of glyceraldehyde-3-phosphate dehydrogenase from fresh rat erythrocytes immediately following saponin lysis was also determined using the rapid filtration technique recently described. The extrapolated zero-time intercepts of these reactions confirmed that, in the rat erythrocyte, none of the cellular glyceraldehyde-3-phosphate dehydrogenase was membrane bound. Failure of rat glyceraldehyde-3-phosphate dehydrogenase to bind to the membranes of the intact rat erythrocyte seems to be due to cytoplasmic metabolites which interact with the enzyme and render it incapable of binding to the membrane.

Effect of polyamines on hemoglobin and globin chain synthesis

Exposure of reticulocytes to 25 mM spermidine and spermine stimulates the incorporation of 14C leucine into hemoglobin and globin polypeptide chains. These two polyamines stimulate beta chain synthesis to a greater extent than they stimulate alpha chain synthesis, thus resulting in a decreased synthetic alpha/beta globin ratio. Because of the low permeability of the red cell membrane to these polycations, less than 1.0% of extracellular spermidine and spermine accumulate within the erythrocyte, thus these effects occur at intracellular polyamine levels that are physiological. Putrescine progressively decreases hemoglobin synthesis at extracellular concentrations greater than 10 mM without affecting the synthetic alpha/beta ratio. These findings suggest a role for polyamines in the fine tuning of the alpha/beta globin ratio at the translational level.

Reduced transglutaminase-catalyzed cross-linking of exogenous amines to membrane proteins in sickle erythrocytes

In order to determine the capacity of sickle cells to undergo transglutaminase-catalyzed cross-linking of membrane proteins, human normal and sickle erythrocytes were incubated with [ring-2-14C]histamine in the presence of Ca2+ and ionophore A23187. The [14C]histamine incorporation into membrane components was observed in freshly prepared erythrocytes. Incorporation of radioactivity into spectrin and Band 3 membrane components was significantly (P less than 0.001) less in sickle erythrocytes than in normal cells. Transglutaminase deficiency was excluded by the finding of increased activity of this enzyme in sickle cells from patients with reticulocytosis. The incorporation of [3H]spermine into red cell membranes was also less in sickle erythrocytes than in normal cells under the same conditions of incubation used for [ring-2-14C]histamine. Sickle erythrocytes were more permeable to these amines than normal cells. It is proposed that the gamma-glutamyl sites of membrane proteins in sickle erythrocytes are less accessible for transglutaminase-catalyzed cross-linking to histamine and polyamines in vitro, perhaps due to prior in vivo activation of this enzyme by the increased calcium in sickle cells and/or shielding secondary to altered membrane organization.

Closed renal trauma in children

Closed renal trauma in children often results in serious injury. In a series of 100 consecutive patients with closed renal trauma treated at the Royal Children's Hospital from 1967 to 1978, 32 children required surgery. Of these, eight children came to nephrectomy, whereas in 19 children viable renal tissue was conserved by the use of techniques such as renal suture or partial nephrectomy. The remaining five children had surgery, not for trauma, but rather for preexisting hydronephrosis discovered during investigation. There was a close relationship between the classification of renal injuries and the need for surgery. In this series there were two deaths and two late complications.

A study of the sequelae of posterior urethral valves

We discuss the drainage procedures prior to valve ablation and the long-term sequelae in the upper urinary tract of 135 boys with posterior urethral valves. Cutaneous ureterostomy in infants, which had been used previously, now has been replaced largely by lower tract drainage using stab cystotomy combined with irrigation. The former technique is reserved for those few patients who do not improve. Older patients require no preliminary drainage. The long-term sequelae were studied with respect to urinary control, the fate of ureteral reflux and the state of upper tract dilatation. Of our patients 14 per cent remain incontinent owing to too radical a transurethral resection, bladder neck surgery or a gross degree of urethral dilatation found in neonates. Only 32 per cent of the renal units were presented with ureteral reflux. After valve ablation moderate or gross reflux ceased spontaneously in 29 per cent of the patients, it persisted in 35 per cent and it required antireflux surgery or nephrectomy in 36 per cent. The upper urinary tracts were dilated in 90 per cent of the renal units and most had moderate or gross dilatation, especially in infants. Of 116 united with moderate or gross dilatation, or nonfunction 65 per cent remained unchanged after valve ablation but 35 per cent improved to normal or nearly normal. In 35 units with persistent dilatation in nonrefluxing systems the dilatation was associated with pelvioureteral or vesicoureteral obstruction in 10 units, although in 25 patients no obstruction could be identified. The dilatation was considered to be a manifestation of developmental dysplasia of the ureters.

Effects of offenders' age and attractiveness on sentencing by mock juries

Pictures of physically attractive or unattractive women, who were either young or old, were attached to case reports of either a swindle or a burglary. “Juries” of three female college students each were then asked to sentence the “defendants” to between 1 and 10 yr. in jail. It was hypothesized that the young, attractive defendant would be sentenced less harshly than the old, unattractive defendant and that this effect would be more evident in a crime of burglary than a crime of swindle, as the attractiveness of the con artist might be viewed as an integral component of the crime of swindle. Older defendants were judged more harshly than young defendants and, for the burglary condition, attractive people were judged less harshly than unattractive people. However, in the swindle condition, attractiveness had no influence on the sentencing by the jury.