Continued chemosensitivity to cisplatin/carboplatin in ovarian carcinoma despite treatment with multiple prior platinum-based regimens

While it is well recognized that individuals with ovarian cancer who have previously responded to platinum-based therapy can achieve a second response to cisplatin or carboplatin at the time of relapse, limited data exist in the oncologic literature regarding the number of times this process can be repeated. We briefly report here three patients with ovarian cancer currently being cared for in the Gynecologic Oncology program of the Cleveland Clinic Foundation who have achieved four (1 patient) or five (2 patients) separate clinical responses to cisplatin or carboplatin-based chemotherapy and have survived >4 years since the date of first relapse. This experience emphasizes the point that platinum resistance cannot be defined based on total treatment courses or the number of prior platinum-based regimens delivered, but only by objective evidence of failure of the drugs in an individual patient.

Low-dose intravenous ondansetron (8 mg) plus dexamethasone: an effective regimen for the control of carboplatin-induced emesis

Twenty-nine patients with gynecologic malignancies were treated with a fixed low dose of intravenous ondansetron (8 mg) plus dexamethasone (20 mg) in an effort to develop an effective and less expensive antiemetic regimen for the control of carboplatin-induced emesis. Twenty-six (90%) of the women participating in this trial experienced complete control of both acute nausea and vomiting (developing within the first 24 h after chemotherapy administration), while 27 (93%) patients exhibited either complete or major control (< or = 2 episodes of vomiting, < or = 5 episodes of retching, minimal interference with eating) of emesis. On the basis of our experience in this trial, we conclude that the combination of low dose (8 mg) intravenous ondansetron plus dexamethasone is a well-tolerated and highly cost-effective antiemetic strategy for individuals receiving carboplatin-based chemotherapy.

Genistein inhibits both estrogen and growth factor-stimulated proliferation of human breast cancer cells

Genistein is a naturally occurring dietary protein tyrosine kinase (PTK) inhibitor that is hypothesized to be responsible for the lower rate of breast cancer observed in Asian women consuming soy. Although genistein is a potent in vitro PTK inhibitor, its mechanism of action in vivo is not known. In vivo, breast cancer growth is regulated by estrogens and peptide growth factors, such as epidermal growth factor (EGF), the receptor of which has intrinsic PTK activity. Therefore, genistein may block mammary epithelial cell growth by interfering with signal transduction events stimulated by estradiol or growth factors. The effect of genistein, related isoflavones, and other tyrosine kinase inhibitors on fetal bovine serum-, estradiol-, and EGF-stimulated cell growth and signal transduction pathways was examined in five human breast cancer cell lines. Genistein inhibited the growth of these cells by each of the growth stimuli with IC50 values ranging from 2.6 to over 20 micrograms/ml. Growth inhibition by genistein was cytostatic and reversible at IC50 concentrations. Related isoflavones were less potent growth inhibitors than genistein, whereas the synthetic PTK inhibitor tyrphostin A25 was an equally potent growth inhibitor. The mechanism of genistein growth inhibition in human breast cancer cells did not depend on the presence of functional estrogen receptor signaling pathways or on inhibition of EGF-receptor PTK activity. Furthermore, genistein (< or = 20 micrograms/ml) did not decrease constitutive or EGF-induced tyrosine phosphorylation as determined by Western blotting with antiphosphotyrosine antibodies. These data suggest that although genistein inhibits the growth of breast cancer cells in culture, it does so without gross inhibition of PTK activity.

Paclitaxel delivered as a 3-hr infusion with cisplatin in patients with gynecologic cancers: unexpected incidence of neurotoxicity

In an effort to develop a paclitaxel plus cisplatin combination chemotherapy regimen which can be easily employed in the outpatient setting, 38 patients (median age, 59; range, 39-72) with gynecological malignancies (20 ovarian; 6 primary peritoneal; 12 endometrial) seen at the Cleveland Clinic Foundation from June 1993 to May 1995 were administered 170 cycles of paclitaxel (135 or 175 mg/m2) over 3 hr followed by cisplatin (starting dose 75 mg/ m2). Of the 33 patients with elevated CA-125 levels prior to the initiation of chemotherapy, all experienced > 50% decreases in this antigen level, while 23/33 (70%) had > 90% reductions. In general, nonneurologic side effects were mild in severity and easily manageable. Unfortunately, 71% of the patients developed neurologic toxicity, with one-fifth of the treated population experiencing severe neurotoxic side effects (grade 3-4). We conclude that paclitaxel administered over 3 hr at a dose of 135 or 175 mg/m2, followed by cisplatin (75 mg/m2), is a highly active regimen in gynecologic malignancies. Unfortunately, in our experience, the incidence and severity of neurotoxicity with this regimen is considerably greater than that reported with paclitaxel administered over 24 hr in combination with cisplatin. As a result of the observed toxicity profile, this drug delivery schedule for cisplatin and paclitaxel cannot be recommended for general clinical use.

Pitfalls and outcomes from accelerated wear testing of mechanical heart valves

In 1990 Sorin Biomedica introduced a new bileaflet heart valve called the Bicarbon valve. This design was reported to eliminate wear in the hinge mechanism. Clinical quality Sorin Bicarbon, CarboMedics, St. Jude Medical, Duromedics and Jyros valves were obtained to test this claim and to compare the wear in the pivot of this new valve to other available heart valves. The valves were visually inspected then subjected to 4,000 cycles at a physiological beat rate in vitro. The valves were re-inspected then subjected to 400 million cycles in a Reul type accelerated wear tester. Scanning electron microscope photographs were taken of all contact areas at 40, 80, 120, 160, 200, 240, 280 and 400 million cycles. Wear marks on the inflow side of the Sorin, CarboMedics and St. Jude leaflets were measured and compared. Orifice wear was not quantified because of difficulty with measuring inside complex depressions. After 4,000 cycles of testing at a physiological beat rate the CarboFilmTM coating on the Sorin orifice showed signs of erosion. The other valve components only exhibited minor burnishing after 4,000 cycles. Following completion of 400 million cycles in an accelerated wear tester, approximately ten years in vivo, all valves showed significant wear. The inflow face of the pivot on the Sorin Bicarbon leaflets exhibited the deepest wear marks. The CarboFilm coating on the Sorin Bicarbon orifices was removed from most areas of leaflet contact. The transition between the remaining coating and the eroded areas created a rough edge. The tips of the Sorin leaflets contacted the bottom of the orifice pivot, in contrast to the St. Jude Medical and CarboMedics designs, which had minimal contact between the leaflet and the orifice.

Continuous subcutaneous administration of mesna to prevent ifosfamide-induced hemorrhagic cystitis

Hemorrhagic cystitis is a major potential toxicity of ifosfamide that can be prevented by administering mesna along with the cytotoxic agent. Mesna is generally administered by the intravenous route, although experience with oral delivery of the drug has increased. The continuous subcutaneous administration of mesna has the advantage of not requiring intravenous access. In addition, subcutaneous delivery of the neutralizing agent will not be associated with the risk of inadequate urinary mesna concentrations, such as in a patient taking oral mesna who experiences severe ifosfamide-induced emesis and is unable to absorb the drug. Limited clinical experience with continuous subcutaneous mesna administration suggests it is a safe, practical, and economic method of drug delivery that permits ifosfamide to be administered successfully in the outpatient setting.

A school-based mental health clinic for adolescent mothers

TOPIC

The Department of Mental Health Nursing at Oregon Health Sciences University mental health program at an alternative high school for teenage mothers and their children.

PURPOSE

To provide direct mental health services to approximately 50% of the student population. Mental health concerns apparent with this population of young mothers and their children include issues of violence and abuse, depression, developmental delay, and conduct disorder. This paper describes the successes and failures of this mental health program in hopes of helping other schools of nursing establish similar school-based mental health programs in their communities.

CONCLUSIONS

Teenage mothers need a safe haven where they can experience trust and acceptance. In the therapeutic atmosphere of this school-based program, young women were able to explore their feelings regarding past violence, learned to nurture their children, and gained an increased sense of self-efficacy.

Control of carboplatin-induced emesis with a fixed low dose of granisetron (0.5 mg) plus dexamethasone

In an effort to develop a cost-effective antiemetic regimen for carboplatin-based chemotherapy, we examined a fixed (0.5 mg) low dose of granisetron (a new 5-HT3 (serotonin) antagonist) plus dexamethasone (20 mg) in 23 patients with gynecologic malignancies receiving this antineoplastic drug. Nineteen (83%) patients experienced complete control of acute emesis (nausea and vomiting) while 22 (96%) individuals demonstrated complete or major control (< or = 2 episodes of vomiting, < or = 5 episodes of retching, minimal interference with eating) of emetic events. We conclude that this fixed low-dose granisetron plus dexamethasone regimen is a safe, convenient, and cost-effective antiemetic program for individuals receiving carboplatin-based chemotherapy.

Improved outcome by identification of high-risk nonocclusive mesenteric ischemia, aggressive reexploration, and delayed anastomosis

BACKGROUND

The factors associated with outcome of patients with nonocclusive mesenteric ischemia are poorly defined.

METHODS

Over a 7-year period, 34 consecutive patients with nonocclusive mesenteric ischemia were identified.

RESULTS

The mean age of the study patients was 63 years (range 31 to 94); 21 of 34 (62%) were men. The mean delay in diagnosis was 31 hours (range 7 hours to 6 days). Seven of 34 (21%) underwent preoperative visceral arteriography. Two of these 7 required surgery, and both died as a result of intestinal infarction. The remaining 27 had the diagnosis made at celiotomy. Among the 29 who were explored, 16 of 29 (55%) had intestinal infarction. Twenty-one of 29 (72%) had segmental bowel injury whereas 8 of 29 (28%) had massive injury. Among those with segmental infarction, primary anastomosis was performed in 12 of 21 patients (57%); 5 of the 12 (42%) died. Nine of 21 patients (43%) underwent delayed anastomosis; 2 of the 9 (22%) died. No patient with massive injury underwent primary anastomosis. Second-look laparotomy was performed on 22 of 29 (76%). Eleven of those 22 (50%) had a further bowel resection. Overall, 16 of 29 (55%) who underwent surgery for nonocclusive mesenteric ischemia are alive.

CONCLUSIONS

Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups, aggressive reexploration, and delayed intestinal anastomosis.

Radical hysterectomy for cervical cancer: the effect of shorter length of stay on outcome

BACKGROUND

The surgical treatment for limited cervical cancer (radical hysterectomy and pelvic lymph node dissection) has remained essentially the same for 40 years, but economic pressures have resulted in shorter length of hospital stay, and precautions against infectious diseases have resulted in less use of blood products.

PURPOSE

To determine if recent changes in hospital practices have affected outcomes, and if obese patients are at greater risk of complications.

METHODS

Retrospective review of 100 surgical cases grouped by time period (1981 through 1987 and 1988 through 1993) and by patient weight (< 80 kg and > or = 80 kg).

RESULTS

Comparing the two time periods, the mean operative time remained the same (199 minutes), but use of blood products declined (mean 2.1 vs 1.5 units; P < .01), as did the mean length of hospital stay (10.6 vs 7.4 days, P < .01). The rate of postoperative complications decreased significantly (P < .01), and the 5-year survival rate remained 91%. Obese patients received more blood transfusions than did nonobese patients (2.6 vs 1.6 units; P = .02), but their mean operative time and hospital stay did not significantly differ. The rate of postoperative and long-term complications did not differ significantly between the two weight groups.

CONCLUSIONS

Surgical treatment of limited cervical carcinoma continues to be safe and effective.

Evaluation of the biochemical targets of genistein in tumor cells

Although data from epidemiological studies and cancer models suggest that genistein plays an important role in cancer prevention, the biochemical target(s) of genistein action is (are) not known. Genistein is a potent in vitro inhibitor of protein tyrosine kinase (PTK) activity, especially that of the epidermal growth factor receptor (EGF-R), having little effect on serine/threonine kinases. This led to the suggestion that genistein might exert its anti-cancer effects through inhibiting the activity of EGF-R PTK, or other crucial PTK's in vivo. Subsequent studies on intact tumor cell lines demonstrated that EGF-R and other growth factor receptors are able to transmit mitogenic signals in the presence of genistein. In fact, it is difficult to detect decreases in the tyrosine phosphorylation of discrete proteins after genistein treatment. Other mechanisms for the effect of genistein have been suggested from in vitro and cell culture data. Genistein not only inhibits the activity of purified topoisomerase II in vitro, but also leads to the accumulation of protein-associated single strand breaks in whole cells. Genistein also inhibits the production of reactive oxygen species which may lead to tissue damage and DNA modification. Additionally, genistein acts as a weak estrogen, modifies cellular differentiation programs, inhibits angiogenesis. modulates cell cycle events and may precipitate apoptosis. However, few of the above mechanisms in tumor cells are sensitive to the physiological serum concentrations of genistein (< 18.5 mumol/L, or < 5 micrograms/mL). Primary, nontransformed human mammary epithelial cells, which have a much greater sensitivity to genistein, would be a better system for the study of these mechanisms.

The C-terminal tripeptide of glycosomal phosphoglycerate kinase is both necessary and sufficient for import into the glycosomes of Trypanosoma brucei

Glycosomal phosphoglycerate kinase (gPGK) of Trypanosoma brucei differs from the cytoplasmic isozyme (cPGK) in its higher isoelectric point characterized by clusters of positive charges along the polypeptide chain, and a 20 amino acid C-terminal extension ending in serine-serine-leucine (SSL). While a C-terminal SSL tripeptide is apparently not capable of directing luciferase to the peroxisomes in mammalian cells [J. Cell Biol. 108 (1989), 1657-1664], we show here that it is sufficient for the import of luciferase as well as an unrelated protein, beta-glucuronidase, into the glycosomes of T. brucei, as determined by immunoelectron microscopy. The analysis of luciferase-gPGK fusion proteins indicates that the only targeting signal for import of gPGK into the glycosome resides in this C-terminal SSL sequence.

Genistein and biochanin A inhibit the growth of human prostate cancer cells but not epidermal growth factor receptor tyrosine autophosphorylation

The effect of the isoflavones, genistein, daidzein, and biochanin A on the growth of the LNCaP and DU-145 human prostate cancer cell lines has been examined. Genistein and biochanin A, but not daidzein, inhibit both serum and EGF-stimulated growth of LNCaP and DU-145 cells (IC50 values from 8.0 to 27 micrograms/ml for serum and 4.3 to 15 micrograms/ml for EGF), but have no significant effect of the EGF receptor tyrosine autophosphorylation. In contrast, tyrphostin 25, a specific EGF receptor tyrosine kinase inhibitor, inhibits EGF-stimulated growth and EGF receptor tyrosine autophosphorylation in these whole cells, but does not inhibit serum-stimulated growth. These data suggest that the mechanism of action of genistein and biochanin A does not depend on inhibition of EGF receptor tyrosine autophosphorylation, but on a more distal event in the EGF receptor-mediated signal transduction cascade.

Genistein inhibition of the growth of human breast cancer cells: independence from estrogen receptors and the multi-drug resistance gene

The effect of isoflavones on the growth of the human breast carcinoma cell lines, MDA-468 (estrogen receptor negative), and MCF-7 and MCF-7-D-40 (estrogen receptor positive), has been examined. Genistein is a potent inhibitor of the growth of each cell line (IC50 values from 6.5 to 12.0 micrograms/ml), whereas biochanin A and daidzein are weaker growth inhibitors (IC50 values from 20 to 34 micrograms/ml). The isoflavone beta-glucosides, genistin and daidzin, have little effect on growth (IC50 values greater than 100 micrograms/ml). The presence of the estrogen receptor is not required for the isoflavones to inhibit tumor cell growth (MDA-468 vs MCF-7 cells). In addition, the effects of genistein and biochanin A are not attenuated by overexpression of the multi-drug resistance gene product (MCF-7-D40 vs MCF-7 cells).

Kinetics and quality assurance: prescription therapy through kinetic modeling

With recent startling statistics showing an increase in mortality risk of dialysis patients in the United States compared to other countries, managers and practitioners have been motivated to carefully examine not only the dialysis prescription, but what is actually delivered to the patient. In October 1990, prior to ANNA's Clinical Concerns in Nephrology meetings in Cincinatti and San Antonio, attendants were invited to participate in an education session examining the monitoring and evaluation of prescription therapy for peritoneal and hemodialysis. The title of the session was "The Nurse's Role in Prescription Therapy--What Does it Really Mean?" The sponsor was Fresenius USA, Inc. This educational offering gave the nephrology nurse the opportunity to learn how to manage the delivery of care based on the theory of kinetic modeling for peritoneal and hemodialysis therapy. Quality assurance indicators, data collection tools, and the latest technology were described for the monitoring and evaluation of the adequacy of therapy. The following article is adopted from the original transcripts of the five-member panel of experts who participated in the session. We appreciate the willingness of the speakers to share this timely and important material with the ANNA Journal readers.

Oxytocin selectively increases holding and licking of neonates in preweanling but not postweanling juvenile rats

Preweanling rats exhibit components of maternal behavior (MB) after brief periods of contact with neonates; the latency of onset of MB rises considerably after weaning. Oxytocin (OXT) stimulates MB in adult rats. The effects of intracisternal (IC) administration of OXT (2 micrograms) on pup-directed and other behaviors in preweanling and postweanling juvenile rats were tested. Compared with saline and no treatment, OXT significantly increased active holding of pups in preweanling but not postweanling juvenile rats. No other components of adultlike MB were stimulated by OXT. OXT also decreased inactive touching of pups and robustly increased selfgrooming in juveniles at all ages tested. It is concluded that OXT facilitation of active pup-holding and licking in preweanling rats may be an extension of OXT-induced self-grooming to pups and may also be related to OXT activation of MB in adult rats.

Psychological aspects of orthognathic surgery: how people respond to facial change

This study was undertaken to explore the motivations and problems shared by adult orthognathic surgical patients over the age of 25. Objective findings included demographic information and reasons for seeking surgery. The majority of 65 respondents cited functional problems as their primary reason for seeking treatment. Eighty-nine percent were pleased with esthetic changes, and 83% responded that the functional problem had been corrected. For most, the greatest discomfort related to the surgery was the postoperative intensive care unit. Two of the most common side effects of the surgery were the loss of sensation in the lips and chin area and a short period of depression. Women had depression more often than men but were more enthusiastic about the final results of the procedure. Two major areas of interest to surgeons emerged from the research. First, although women have functional problems, the majority seem to have a desire for cosmetic improvement. Having a functional problem seemed to provide the psychological permission necessary to spend the time and money for a cosmetic change. The second point focused on the need for good communication between surgeon and patient. The patients who were more positive toward the procedure and more satisfied with the results were those who were better informed and who thought they had a good system of communication with the orthodontist, surgeon, and their respective staffs.

Effect of abscisic acid and callus size on regeneration of american and international rice varieties

Embryogenesis and plant regeneration of Texas and international rice, Oryza saliva (L.), varieties (both indica and japonica types) were induced in culture on a regime consisting of the use of ABA or BAP in the subculture medium and small (10 mg) callus pieces on the regeneration medium. Ten 10 mg callus pieces on regeneration medium resulted in a 2- to 10-fold increase in plant regeneration over single 100 mg pieces. Plant regeneration of Texas rice cultivars (Lemont, Rico I, Rexmont and Skybonnet) and Taipei 309 was enhanced by the use of ABA in the subculture medium with a 2-fold and a 3- to 10-fold increase in plant regeneration with 2.6 mgL(-1) and 26 mgL(-1) ABA in the subculture media, respectively. Regeneration of plants from callus of IR36 and IR64 was not enhanced by ABA but by the use of BAP and Trp in the subculture medium or by 2,4-D alone. The subculture medium containing BAP and Trp produced a 5-fold increase in plant regeneration rate from IR64 callus and was equal to subculture medium containing only 2,4-D for IR36 callus. Both Lemont and IR36 were previously reported to be difficult to regenerate or non-regenerative, however, the use of ABA or BAP in the subculture medium, small callus pieces and visual selection of embryogenic callus allowed the regeneration of up to 20 and 22 plants from 100 mg of Lemont and IR36 callus, respectively.

Transformation of Zea mays L. Using Agrobacterium tumefaciens and the Shoot Apex

Agrobacterium tumefaciens is established as a vector for gene transfer in many dicotyledonous plants but is not accepted as a vector in monocotyledonous plants, especially in the important Gramineae. The use of Agrobacterium to transfer genes into monocot species could simplify the transformation and improvement of important crop plants. In this report we describe the use of Agrobacterium to transfer a gene into corn, the regeneration of plants, and detection of the transferred genes in the F(1) progeny. Shoot apices of Zea mays L. variety Funk's G90 were cocultivated with A. tumefaciens EHA 1, which harbored the plasmid pGUS3 containing genes for kanamycin resistance (NPT II) and beta-glucuronidase (GUS). Plants developed from these explants within 4 to 6 weeks. Fluorometric GUS assays of leaves and immature seeds from the plants exhibited low GUS activity. Both NOS and GUS gene fragments were amplified by polymerase chain reaction in the DNA isolated from the F(1) generations of one of the original transformed plants. Southern analysis showed both GUS and NPT probes hybridized to DNA in several of the F(1) progeny, demonstrating the incorporation of GUS and NPT II genes into high molecular weight DNA. These data establish successful gene transfer and sexual inheritance of the genes.

Oxytocin selectively increases holding and licking of neonates in preweanling but not postweanling juvenile rats

Preweanling rats exhibit components of maternal behavior (MB) after brief periods of contact with neonates; the latency of onset of MB rises considerably after weaning. Oxytocin (OXT) stimulates MB in adult rats. The effects of intracisternal (IC) administration of OXT (2 micrograms) on pup-directed and other behaviors in preweanling and postweanling juvenile rats were tested. Compared with saline and no treatment, OXT significantly increased active holding of pups in preweanling but not postweanling juvenile rats. No other components of adultlike MB were stimulated by OXT. OXT also decreased inactive touching of pups and robustly increased selfgrooming in juveniles at all ages tested. It is concluded that OXT facilitation of active pup-holding and licking in preweanling rats may be an extension of OXT-induced self-grooming to pups and may also be related to OXT activation of MB in adult rats.

Community-based approach to weight loss: the Pawtucket "weigh-in"

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Perioperative and long-term prognostic value of intravenous dipyridamole thallium scintigraphy in patients with peripheral vascular disease

The prognostic value of long-term risk stratification of patients with peripheral vascular disease who undergo intravenous dipyridamole thallium scintigraphy has not been well studied. We screened 131 patients with peripheral vascular disease who underwent intravenous dipyridamole thallium testing to determine cardiac event rates over an average follow-up of 18 +/- 10 months. Of the 131 patients, 111 subsequently had peripheral vascular surgery. The patients with abnormal thallium scans after dipyridamole had a significantly higher risk of death or myocardial infarction, both in the perioperative phase (7% versus 0%; p less than 0.001) and at late follow-up (17% versus 6%; p less than 0.01). The risk of a cardiac event was two-fold greater when a reversible as compared to a fixed thallium defect was present. Multivariate analysis selected the number of thallium segments with perfusion defects, prior history of angina pectoris, and chest pain during dipyridamole testing as perioperative predictors of a cardiac event. A reversible thallium defect was the only predictor of death or nonfatal myocardial infarction during late follow-up. Thus intravenous dipyridamole thallium scintigraphy is a useful noninvasive test for risk stratification of patients before peripheral vascular surgery and provides prognostic information as to the risk of a cardiac event in the 2-year period after the test. A reversible thallium defect is associated with a significant increased risk and would indicate that coronary angiography should be considered and preoperative coronary revascularization.

Nontraumatic prehospital cardiac arrest ages 1 to 39 years

Clinical and autopsy records were retrospectively reviewed for 105 patients between the ages of 1 and 39 years who came in to the emergency department with nontraumatic cardiac arrest. There were 65 male (62%) and 40 female patients (38%). Forty-eight percent of the patients were resuscitated. Long-term survival rate was 23%. The most common presenting rhythm was ventricular fibrillation (45%). Cardiac diseases constituted the most common cause of arrest (38%). Atherosclerotic coronary artery disease represented 50% of all cardiac causes. The second most common etiology was overdose or toxic exposure (21%). Witnessed arrest and an etiology of primary cardiac dysrhythmia for arrest were statistically significant factors related to favorable outcome. Asystole as the initial cardiac rhythm was a negative prognostic indicator. Age, sex, race, bystander cardiopulmonary resuscitation, and paramedic response time were not significant prognostic factors for long-term survival.

Effects of interocular blur suppression ability on monovision task performance

Suppression of anisometropic blur induced by monovision contact lenses was examined in 18 presbyopic subjects. Suppression ability was quantified by reducing the contrast of a bright test target, viewed by subjects wearing a monovision correction, until the blurred image was suppressed. Subjective success with monovision was evaluated using a patient survey and no correlation to blur suppression ability was found. Objective success was evaluated in terms of performance at three near work tasks, each requiring a different level of stereoscopic localization. A significant correlation was found between card filing performance (requiring a moderate level of stereopsis) and blur suppression ability. Correcting either the dominant or non-dominant eye for near in the monovision correction did not significantly affect blur suppression ability. There was no evidence for adaptation to monovision in terms of increasing blur suppression ability over time.

Multiple idiopathic root resorption: diagnostic considerations

Multiple idiopathic root resorption is a specific entity that must be delineated from all other resorptive processes. We present a case report and discuss the diagnostic possibilities that must be considered before arrival at this diagnosis.

Promoting the selection of healthy food through menu item description in a family-style restaurant

We describe an attempt to influence the selection of menu items in a family-style restaurant. Three different messages, varying in content and emphasis, were used to promote one food special each intervention day. One message emphasized that the specials were particularly healthful, being relatively low in fat, sodium, and cholesterol. A second message stressed flavor and added that the choice was healthful. A third, nonspecific message made no mention of taste or health factors, but simply noted that there was a daily special. Results indicated that restaurant patrons selected healthful specials when the message noted that the choice was healthful but emphasized flavor. Patrons were apparently more open to information about the palatability of the food than its healthfulness per se. These results have implications for point-of-purchase health promotion efforts in general, especially those involving food-labeling programs in restaurants and grocery stores.

Enzyme-linked immunosorbent assay for Campylobacter pyloridis: correlation with presence of C. pyloridis in the gastric mucosa

Antibody to Campylobacter pyloridis was measured by ELISA in the sera of 160 patients from whom gastric biopsy specimens were also obtained. The antigen was an acid-glycine extract of C. pyloridis, and titers ranged from 80 to 22,000 ELISA units (EU). Of 117 patients in whom C. pyloridis was detected microbiologically or histologically, 87 (74%) had a titer greater than or equal to 300 EU, and only one had a titer less than 150 EU. Of 43 patients in whom C. pyloridis was not detected, only two (5%) had a titer greater than 300 EU. Thus, for a titer of 300 EU the ELISA test had a specificity of 97% and a sensitivity of 81%. At 150 EU the specificity was 78%, and the sensitivity was 99%. Histological diagnosis of active chronic gastritis was associated with a high median ELISA titer (485 E), chronic gastritis with a much lower titer (150 EU), and normal histology with a titer of 110 EU. Discriminating use of this serological test could be of assistance to detect C. pyloridis in the gastric mucosa.

Evaluation of two community-wide smoking cessation contests

The Pawtucket (Rhode Island) Heart Health Program is designed to effect a community-wide change in heart disease morbidity and mortality by reducing smoking prevalence and other behavioral risks for this disease. The initial emphasis of the Pawtucket Heart Health Program was on the development of risk factor programs within specific churches, work sites, and other organizations in the community. At the end of 9 months of programming, however, only one organization had elected to begin a stop-smoking program. Given the community smoking prevalence of 43.4%, it was decided that larger-scale interventions would be required if a significant public health impact was to be realized. Therefore, a community-wide campaign was mounted to recruit as many participants as possible into the "Up in Smoke" cessation program. A lottery was attached to this program, with the contingency based on program attendance rather than cessation per se. One hundred three participants, including residents of neighboring communities, enrolled in three Up in Smoke lottery groups. At a 3-month follow-up, only 11 (7%) of smokers from the Up in Smoke lottery reported that they were not smoking (10% of those actually contacted). For a variety of reasons, the "Quit and Win" approach was later adopted by the Pawtucket Heart Health Program as the primary smoking intervention. One month after the end of the contest, 20% of those contacted reported not smoking. The percentage of quitters for the Up in Smoke program increased while the Quit and Win rate decreased over longer periods of follow-up. These and other data were compared with those of participants of a screening program conducted concurrently. Lotteries in general and face-to-face recruitment in large crowds were shown to be effective recruiting methods for large-scale smoking cessation programs.

Theory and delivery of health programming in the community: the Pawtucket Heart Health Program

The Pawtucket Heart Health Program is one of the community studies examining whether population-based efforts to lower cardiovascular risk factors will reduce cardiovascular morbidity and mortality. The Pawtucket Heart Health Program intervention is based on a blend of social learning theory, community organization models, community psychology tenets, and diffusion research. This model allows for multifaceted programs that target individuals, groups, organizations, and the entire community to alter their cardiovascular risk through managing blood pressure, lowering blood cholesterol, quitting smoking, increasing fitness, and maintaining desirable weight levels. A dominant feature of the intervention is the emphasis that it places on volunteers for program delivery. The role of volunteers in providing direct services to help citizens lower their blood pressure and lose weight is highlighted to demonstrate the feasibility and effectiveness of these services. In addition, church-based programming which utilizes volunteers to manage and direct programs is also presented as an example of community-based health promotion efforts that promote collective efficacy.

Vectors for expression and amplification of cDNA in mammalian cells: expression of rat phenylalanine hydroxylase

We have constructed two recombinant plasmid vectors for direct expression and amplification of cDNA in mammalian cells. Each vector carries two dominant selectable markers (the bacterial neo gene and the mouse DHFR gene), a promoter sequence (viral LTR in pAV009/A+, and sheep metallothionein promoter in pMT010/A+), a polyadenylation signal sequence, and a Bam HI site to allow insertion of cDNA. We have used these vectors to prepare recombinant clones for the expression of rat phenylalanine hydroxylase (PH) in LTK- cells. Selection of transformants with neomycin followed by selection of the transformants in methotrexate led to a 30- to 60-fold amplification of the DHFR marker and co-amplification of the PH cDNA, with a corresponding increase in the level of PH mRNA and enzyme polypeptide. The expressed enzyme has a subunit molecular weight of 50,000 which corresponds to the W- allele of rat liver PH. PH activity was detected in the transfected cells by enzymatic measurement of the conversion of [14C]phenylalanine to [14C]tyrosine, and by growth of these cells in a tyrosine-free culture medium. Expression of rat PH in cell culture should facilitate the analysis of the biochemical properties of this enzyme.

Multivariate evaluation of health attitudes and behaviors: development and validation of a method for health promotion research

Many self-reported measures of health status, attitudes, and knowledge used by clinicians and researchers suffer from a variety of shortcomings, including limited empirical justification, excessive complexity, assessments of nonmodifiable historic or hereditary factors, and limited utility for public health program planning. The Health Attitudes and Behavior Scale is an instrument designed to overcome many of these shortcomings and direct public health professionals toward more efficacious interventions. One hundred sixty-four subjects responded to true-false and Likert scale items related to health beliefs, attitudes, and behavioral practices. A principal component analysis of the Likert items yielded six components, tentatively labeled (a) Lack of Social Support, (b) Hurdles to Health, (c) Health Attitudes/Weight Concerns, (d) Positive Environment, (e) Disease Concerns, and (f) Time and Work Pressure. Analyses of these scales using coefficient alpha indicated adequate internal consistency for each of them. These scales were then related to demographic variables of age, educational level, sex, and marital status. Next, these scales were correlated with individual true-false items reflecting self-reported behavioral practices or health histories. A component analysis of the true-false items yielded four principal components labeled (a) Organizational Health Concerns, (b) Smoking and Exercise Concerns, (c) Coronary and Weight Concerns, and (d) Blood Pressure and Risk Factor Programs. Finally, a cluster analysis yielded six typical profiles reflecting different levels of the original six components. Of interest is the fact that the Lack of Social Support and Time and Work Pressure scales had a very limited integration into the overall patterns. The assumption that organizational and environmental factors can have an important impact on health was supported. The need for further research in this area is also discussed.

Cardiac arrest under age 40: etiology and prognosis

Between January 1979 and December 1982, 84 patients between the ages of 1 and 39 years presented to the emergency department in a state of cardiac arrest. There were 58 male patients (69%) and 26 female patients (31%) in the group. Presenting rhythms were ventricular fibrillation (37%), asystole (37%), idioventricular rhythm (14%), heart block (4%), bradycardia (4%), ventricular tachycardia (3%), and electromechanical dissociation (3%). Thirty-two percent had bystander CPR. Of 21 patients initially resuscitated (25%), only four (5%) survived to discharge from the hospital. All survivors were neurologically intact. Seventy-five of the 80 patients who died (90%) underwent autopsy. Cause of death in the five remaining patients was inferred from clinical history. Etiologies of the cardiac arrests were the following: toxic exposure or ingestion (26%), atherosclerotic heart disease (23%), undetermined (11%), pulmonary embolism (6%), hemorrhage (6%), epilepsy (2%), cardiomyopathy (7%), myocarditis (2%), pneumonia (4%), and one case each of airway obstruction, asthma, peptic disease, and septic shock. Diverse etiologies should lead to a diagnostic search for reversible conditions in young patients. The prognosis for hospital discharge is poorer in the young population than is reported in our overall cardiac arrest population; however, numbers of neurologically intact survivors are similar in the young and the overall cardiac arrest population.

The role of calmodulin in human renal cell carcinoma

Calmodulin is a ubiquitous intracellular calcium binding protein which has been shown to be associated with cell cycling. Previous studies using animal tumor models have suggested a positive correlation between tumor calmodulin content and rate of tumor growth. We studied the role of calmodulin in renal cell carcinoma (RCC) cell lines and compared this with short term normal fetal kidney cell lines. The effects of calmodulin inhibition was determined using the calmodulin inhibitor W13 (Naphthalene-sulfonamide) and its less active partner W12. Cell size, calmodulin content and inhibition studies using W13 did not reveal any simple correlations for the RCC cell lines, although the RCC lines did have a higher content than the fetal kidney cell lines. Calmodulin content determination of RCC and normal adult kidney tissue failed to show any difference. We conclude that, contrary to previous reports using animal models, there is no simple relationship between tumor growth rates and calmodulin content for human RCC.

Anterior mediastinal haematoma and left haemothorax on well-controlled oral anticoagulant therapy

An anterior mediastinal haematoma and left haemothorax developed in a hypertensive diabetic patient on oral anticoagulant therapy. This occurred in spite of well-controlled anticoagulation and the absence of other evidence of systemic bleeding. Angiography and daily chest X-ray follow-up were not only sufficient to confirm the diagnosis, but also avoided hazardous interventional procedures.