Can a signal sequence become too hydrophobic?

We have characterized several mutants that contain alterations in the hydrophilic domain (N region) of the pseudorabies virus glycoprotein gC signal sequence. In general, our results agree with previous findings and indicate that basic residues in the N region are not essential for efficient export of gC in infected cells. While reducing the N region to a net neutral charge led to a slight impairment of membrane translocation, a substantial gC export defect was not observed until a net negative charge was introduced. However, there was one exception to this pattern. The substitution of a leucine for an arginine at the carboxyl terminus of the N region led to a considerable export defect despite maintaining a net positive charge. As a consequence of the substitution, the mutant signal sequence was 1.5 times more hydrophobic than wild type, but we found that the defect could be largely corrected if an additional alteration that lessened the overall hydrophobicity of the gC signal sequence was incorporated. We suggest that an upper limit of hydrophobicity may exist for eukaryotic signal sequences; exceeding this value could lead to an export defect.

Neural tube defects and maternal serum zinc and copper concentrations in mid-pregnancy: a case-control study

OBJECTIVE

To assess the relationship between mid-pregnancy maternal serum zinc and copper concentrations and neural tube defects.

DESIGN

A prospective case-control study during 1978-1988 within a statewide hospital-based neural tube defect screening program measuring maternal serum alpha-fetoprotein levels at mid-pregnancy.

SUBJECTS

Cases were 69 women with fetuses with confirmed neural tube defects. Controls were 592 women with fetuses without neural tube defects who were individually matched to cases for hospital, calendar date of screening, age and parity; there was a variable control-to-case ratio.

RESULTS

For both unmatched and adjusted matched analyses, mean maternal serum zinc concentration was higher in cases than controls (P = 0.02 and P = 0.03, respectively). There were no case-control differences for serum copper concentrations. Conditional logistic regression analysis showed a (statistically non-significant) 50% increase in risk of neural tube defects in women whose serum zinc concentration was more than two standard deviations above the population mean.

CONCLUSION

Within the normal range of maternal serum zinc and copper concentrations there is no variation in risk of neural tube defects. However, women with very high serum zinc levels may have an increased risk of neural tube defects. This could reflect deficient maternal-to-fetal transfer of zinc in some of those individuals. Any such phenomenon would be manifest in observational, but not experimental, studies.

Spontaneous fusions to prv43 can suppress the export defect of pseudorabies virus gIII signal peptide mutants

We have devised an enrichment scheme for the isolation of export-competent derivatives of pseudorabies virus glycoprotein gIII signal peptide mutants. Enrichment is based upon a growth advantage imparted upon gIII-containing virions compared with virions lacking the glycoprotein. Each of identified derivatives suppressed the gIII signal peptide defect by fusing the gIII gene in frame to the prv43 gene that lay immediately upstream; the result was the synthesis of a Prv43-gIII hybrid protein. The deduced Prv43 protein is predicted to span a membrane multiple times, and it appeared that the gIII portion of each hybrid used a hydrophobic domain of Prv43 protein to initiate its export. For at least two of the isolates, the hybrid protein was efficiently translocated across the endoplasmic reticulum membrane but appeared to be poorly exported out of the endoplasmic reticulum. Nonetheless, the prv43-gIII fusions encoded a gIII species that was localized to the virus envelope. Because the gIII portion of each hybrid protein must be exposed on the virion surface to provide a growth advantage, our results also suggest a preliminary membrane topology for wild-type Prv43 protein.

The use of inhaled radioisotopes for measuring the effect of sputum induction on tracheobronchial clearance rates

Inhaled radioisotopes were employed to study the role of tracheobronchial clearance in sputum induction, a technique used to diagnose Pneumocystis carinii pneumonia in patients with acquired immune deficiency syndrome (AIDS). Seven normal nonsmoking male subjects inhaled a nebulized aerosol of technetium-labelled human serum albumen, which was cleared from the lung solely by tracheobronchial clearance. The aerosol's particle size distribution ensured both alveolar and proximal airway deposition, the site of P. carinii organisms and tracheobronchial clearance mechanisms, respectively. Pulmonary emission counts were measured for 12 continuous 5-min periods before, and immediately after, sputum induction with nebulized 3% saline. A further 10-min scan was performed at 24 h to determine the alveolar fraction of deposited aerosol. Tracheobronchial clearance rates (log10[activity]/time) were calculated after log linear regression, for the time periods before, during and after sputum induction, having corrected for isotope decay and alveolar deposition. Results were analysed by the Wilcoxon rank sum test. Tracheobronchial clearance rates increased significantly in all subjects during sputum induction, with a mean 65.5% reduction in pulmonary activity over this period. Mean clearance gradients for the three time periods before, during and after sputum induction were -1.2 x 10(-3) min-1, -15.0 x 10(-3) min-1 and 0.4 x 10(-3) min-1, respectively (P < 0.025), which probably underlies the principal mechanism for success of the technique.

Characterization of the prv43 gene of pseudorabies virus and demonstration that it is not required for virus growth in cell culture

We have determined the complete DNA sequence of the prv43 gene of a swine herpesvirus, pseudorabies virus. prv43 is 1119 bp in length with a G+C content of 74.5% and is predicted to encode a multiply hydrophobic protein with a molecular mass of 38 kDa. prv43 is colinear with the herpes simplex virus type 1 UL43 locus, and the prv43 and UL43 gene products are predicted to be 47% similar and 23% identical. prv43 is an early gene, producing a 1.2-kb transcript that is easily detected at 2 hr postinfection but not at 6 hr postinfection. We have constructed a prv43 deletion mutant that does not express a prv43 transcript. This mutant did not appear to be defective for viral growth and demonstrated that the gene is nonessential for virus growth in cell culture.

Cancer pain: knowledge, attitudes of pharmacologic management

The knowledge of, attitudes toward, and perceived barriers to pharmacologic management of cancer pain were compared between oncology nurses (N = 128) and long-term care facility (LTCF) nurses (N = 72) using an 82-item questionnaire. The oncology nurses were significantly more knowledgeable about pharmacologic management of cancer pain than were the nurses in LTCFs. However, the two groups did not differ in their attitudes toward pain management, with the exception that nurses in LTCFs were more likely to believe that patients over-report their pain. LTCF nurses were more likely than the oncology nurses to believe that inadequate assessment of pain, lack of equipment, and lack of skills to use equipment were impediments to pain management.

Southern California Edison's performance standards: an employer's key to quality care delivery

One of the most significant lessons learned from this process is that setting objectives with performance standards is the key to continuous quality improvement. The critical differences between health administration and health management are threefold: (1) performance standards are developed with clarity, (2) care delivery is monitored and measured against these standards, and (3) improvements are made based on information from these measurements.

Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate

BACKGROUND

Recent studies have questioned the use of histamine (H2) receptor antagonist in stress ulcer prophylaxis because of an increased incidence of nosocomial pneumonia and subsequent death.

DESIGN

This prospective randomized study compared prophylaxis with cimetidine vs sucralfate.

SETTING

Medical/surgical intensive care unit in Springfield, Mass.

PATIENTS

One hundred fourteen patients were enrolled.

INTERVENTIONS

Cimetidine, administered as a primed continuous infusion using a 300-mg bolus followed by 37.5 mg/h, was compared with sucralfate, administered via nasogastric tube, at a dosage of 1 g every 6 hours suspended in 20 mL of sterile water.

MAIN OUTCOME MEASURES

End points of the study included nosocomial pneumonia, gastrointestinal hemorrhage, and death.

RESULTS

Fifty-six patients were randomized to receive cimetidine and their rate of pneumonia was 12.5%; upper gastrointestinal hemorrhage, 3.6%; and mortality, 33.9%. Fifty-eight patients were given sucralfate, and their rate of pneumonia was 13.8%; upper gastrointestinal hemorrhage, 3.4%; and mortality, 37.9%. There were no significant differences between these study end points. In patients who had pneumonia, 80% of isolates were aerobic gram-negative bacilli.

CONCLUSIONS

These observations suggest that the rate of nosocomial pneumonia is not increased in patients in the intensive care unit who receive prophylaxis with cimetidine to prevent stress ulcer bleeding.

Antiphospholipid syndrome in scleroderma

Scleroderma has not been described in association with the antiphospholipid syndrome (APS). Only a single manifestation, that of large vessel arterial thrombosis, has been noted in patients with scleroderma and antiphospholipid antibodies. We describe the first case report of a patient with scleroderma and a "full house" for the APS. Clinical suspicion, appropriate investigation and early treatment may help limit the progression of the vasculopathy seen with this syndrome.

Tumours of the brain and presence of antibodies to Toxoplasma gondii

The possible association between prior infection with the protozoan Toxoplasma gondii and development of brain tumours was investigated as part of two Australian population-based case-control studies of adult brain tumours. One study, based in Adelaide, South Australia, collected blood from 73 subjects with glioma, 53 subjects with meningioma and 348 controls. The other study, based in Melbourne, Victoria, collected blood from 44 subjects with glioma and 67 controls. All tumours had been verified histologically. IgG antibodies to T. gondii were measured using Enzyme Linked Immunosorbent Assay (ELISA) techniques. In both the centre-specific and combined analyses, there was no difference between subjects with glioma and controls in the prevalence of antibody test-positivity (35% test-positive in glioma versus 33% in controls, age-, sex- and centre-adjusted odds ratio (OR) = 1.00, 95% confidence interval (CI): 0.64-1.56). In the Adelaide study, there was a statistically significant increased risk of meningioma associated with antibody test-positivity (47% test-positive in meningioma versus 31% in controls, P = 0.02, adjusted OR = 2.09, 95% CI: 1.14-3.83). Our results do not support the hypothesis that antibody positivity to T. gondii is a risk factor for glioma, but suggest that it might be associated with meningioma.

The amino-terminal one-third of pseudorabies virus glycoprotein gIII contains a functional attachment domain, but this domain is not required for the efficient penetration of Vero cells

We have examined the attachment and penetration phenotypes of several glycoprotein gIII mutants of pseudorabies virus (PRV) and have identified the first one-third of gIII as a region that mediates efficient virus attachment to PK15 and Vero cells. This portion of gIII, amino acids 25 through 157 of the wild-type sequence, appeared to support attachment by binding to heparinlike molecules on cell surfaces. Virions containing the first one-third of gIII were sensitive to heparin competition and showed greatly reduced infectivity on cells treated with heparinase. PRV virions lacking the first one-third of the mature glycoprotein exhibited only residual binding to cells if challenged by vigorous washing with phosphate-buffered saline at 2 h postinfection at 4 degrees C. This residual binding was resistant to heparin competition, and strains lacking the first one-third of gIII were able to infect cells treated with heparinase as effectively as untreated cells. When we determined the penetration phenotypes for each strain, we found that gIII-mediated virus attachment was necessary for timely penetration of PK15 cells but remarkably was not required for efficient virus penetration of Vero cells. Moreover, wild-type PRV was actually prohibited from rapid penetration of Vero cells by a gIII-heparan sulfate interaction. Our results indicate that initial virus binding to heparan sulfate via glycoprotein gIII is not required for efficient PRV infection of all cell types and may in fact be detrimental in some instances.

Overall signal sequence hydrophobicity determines the in vivo translocation efficiency of a herpesvirus glycoprotein

We have described three mutant strains of Pseudorabies virus that contain mutations in the signal sequence coding region of a nonessential envelope glycoprotein, gIII. The alterations disrupt, truncate, or eliminate the hydrophobic core domain of the signal sequence. Each mutant was assayed for its ability to promote the translocation of gIII across the endoplasmic reticulum membrane and the subsequent localization of the mature form of the glycoprotein to the infected cell surface or the virus envelope. Our results confirm and extend findings in other systems that the overall hydrophobicity of the signal sequence core region is a major determinant of translocation efficiency. We were unable to correlate simply the length of the core or the average hydrophobicity of core residues with export efficiency. Because our work involved the use of infectious virus mutants, we were able to identify a virus defect associated with a complete block in gIII export. This defect will facilitate a pseudo-reversion analysis of gIII signal sequence function.

A suburban focus of endemic typhus in Los Angeles County: association with seropositive domestic cats and opossums

Thirty-three cases of locally acquired murine typhus were reported in Los Angeles County residents from May 1984 through February 1988. Only eight cases were reported over the previous 20-year period. Thirty (91%) cases resided within a suburban area encompassing approximately 50 km2 in northcentral Los Angeles or had contact with an animal from this area. Serologic testing (complement fixation and indirect fluorescent antibody) of selected animals in close association with human cases revealed a high prevalence of seropositivity among domestic cats and opossums. Nine (90%) of 10 resident cats tested had demonstrable antibody titers compared with none (0%) of 20 cats from a control area (P < 0.001). Suburban typhus cases were more likely than neighborhood controls to own a cat or dog (odds ratio = 6.9, 95% confidence interval = 1.8, 25.9, P = 0.002). Sixteen (42%) of 38 opossums trapped in close proximity to the residences of cases were seropositive versus none (0%) of 36 opossums from control areas (P < 0.001) A low frequency (2.8%) of seropositivity was found in commensal rodents, and the classic vector of murine typhus, Xenopsylla cheopis, was not found. Ectoparasite indices form seropositive opossums revealed heavy infestations with the cat flea, Ctenocephalides felis (mean flea count = 104.7), a species that readily bites humans. These data provide evidence that a suburban focus of murine typhus exists in Los Angeles that differs substantially from the classic transmission cycle, and that cats, opossums and C. felis may play an important role in the occurrence of human cases.

The quiet epidemic

While the incidence of mental health and substance abuse problems in our society is dramatically high, perhaps even more shocking is the low percentage of those who receive treatment. And though there has been much debate over the cost of providing mental health coverage, attention must be given to the burdens created by not providing necessary care.

Knowledge of, attitudes toward, and barriers to pharmacologic management of cancer pain in a statewide random sample of nurses

The knowledge of, attitudes toward, and perceived barriers to pharmacologic management of cancer pain were examined in a random statewide sample of nurses (N = 790), using an 82-item questionnaire. Although only 7% of the nurses reported working in oncology settings, 59% of the nurses reported having worked with patients with cancer in the last 6 months. The scores on the knowledge test ranged from 11% to 93% correct, with a mean percent correct of 56.4% (+/- .92). Nurses reported relatively liberal attitudes toward pain management, yet also reported believing that 22% of patients over report pain. Results are discussed with respect to implications for practice and education.

Amalgam fillings, diagnostic dental x-rays and tumours of the brain and meninges

A population-based case-control study of incident brain tumours in adults in Adelaide, South Australia considered possible associations of exposures to amalgam fillings and diagnostic dental X-rays with subsequent development of glioma and meningioma. The study, conducted in 1987-1990, recorded data from 110 subjects with glioma, 60 with meningioma and 417 controls. Principal findings were unexplained decreased risks for glioma associated with both exposure to amalgam fillings (age- and sex adjusted relative risk = 0.47, 95% confidence interval: 0.25-0.91; P = 0.02) and to diagnostic dental X-rays (adjusted relative risk = 0.42; 95% confidence interval: 0.24-0.76; P = 0.004), and a possible increased risk for meningioma in males exposed to dental X-rays. The choice of the unexposed comparison group is important in determining if an increased risk is associated with panoramic or full-mouth X-rays in glioma.

First experimental sutureless end-to-end laser anastomosis of the large bowel. Short-term results

Completely sutureless end-to-end large bowel anastomoses were successfully created in New Zealand white rabbits (n = 26) by using a low-energy (0.4-W wave of power) Nd:YAG laser to produce welded anastomoses. In this study, the short-term integrity, degree of narrowing, macroscopic appearance, and microscopic findings were compared with those of the conventional interrupted one-layer anastomosis (n = 24) at zero, one, four, and seven days after surgery. Two rabbits in the laser group died from leakage. All remaining animals had an uneventful postoperative course. The bursting pressures in the laser group at zero, one, and four days were lower than those in the control group. The narrowing index of the laser anastomosis was higher than that of the suture anastomosis at four and seven days. However, the laser anastomoses showed fewer adhesions, no instances of bowel obstruction, and histologic healing with less fibrosis. The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.

Identification of immunodominant Trypanosoma musculi antigens recognized by monoclonal antibody and curative immunoglobulin G2a antibody

Trypanosoma musculi obtained from normal or irradiated (900 rad) hosts or from in vitro cultures were lysed and analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Similar protein banding patterns with a molecular weight (mol. wt) range from 34 to 68 kDa were observed between the two bloodstream forms. In comparison, lysates of cultured parasites showed a unique banding pattern of antigens within the same mol. wt range. Western blot of bloodstream form lysates, probed with immune plasma (IP), revealed a wide range of parasite proteins. However, when probed with the IgG2a-enriched fraction of IP, a major band of approximately 66 kDa was detected on the blot. Several bands of higher mol. wt were also observed. When anti-T. musculi monoclonal antibodies were used to probe the blot, the 66 kDa protein was again recognized. Using indirect fluorescence, live bloodstream form parasites were analysed by flow cytometry and the p66 protein was determined to be a surface molecule. Finally, lysates of 35S-methionine-labelled trypanosomes were immunoprecipitated with Sepharose linked anti-T. musculi monoclonal antibodies and the eluted ligand analysed by SDS-PAGE and autoradiographed. The 66 kDa band was identified, therefore confirming that this protein was of parasite origin.

Mental health: meeting needs with case management

Present structures encourage a service-led provision of care. The purchaser-provider split does have the advantage of targeting those most in need and of promoting an individualised service led by client needs. For those with a long-term mental illness, however, a rigid split does not allow multiple needs to be met comprehensively, nor does it allow the work of engaging clients with appropriate services to be based on direct care. Case management is suggested as a flexible means of overcoming these problems.

Risk factors for tumors of the brain and meninges: results from the Adelaide Adult Brain Tumor Study

A population-based case-control study of incident primary brain tumors in adults was carried out in Adelaide, Australia in the period 1987 through 1990. It included 110 subjects with newly diagnosed primary glioma, 60 subjects with meningioma and 417 controls selected from the Australian Electoral Roll and frequency-matched to cases for age (within 2 years), sex and postal code. Some interesting new associations were found: (1) an increased risk of glioma in women who reported working with cathode-ray tubes (relative risk = 4.1, 95% confidence interval: 1.3-13.2); (2) a decreased risk of glioma in those with a history of allergic diseases (relative risk = 0.5, 95% confidence interval: 0.3-0.9); and (3) an increased risk of meningioma in those exposed to passive smoking from a spouse, especially amongst females (relative risk = 2.7, 95% confidence interval: 1.2-6.1). A pooled analysis of the multi-center group of studies to which the present study belongs should allow more confident claims concerning risk factors for brain tumors.

Identification of the site of severe colon bleeding by technetium-labeled red-cell scan

In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium-labeled red-cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

Measurement of bone mass

The clinical attraction of being able to measure bone density in a precise and accurate manner is clear. With this information, clinicians can identify osteopenic postmenopausal women, assess the effects of disease on the skeleton, and examine the effect of therapy. Significant advances have been made in the last decade in methodology of bone-mass measurements, leading to a number of safe, precise, and accurate techniques. The field continues to change and, for example, dual photon absorptiometry, which itself was a major advance, has now effectively been superceded by dual energy X-ray absorptiometry. It is predicted that such methodology will continue to find an expanding role and will soon be considered part of routine clinical practice. A brief review of the various methodologies that have commonly been used for bone-mass measurements is presented.

Adenoma-carcinoma sequence of the large bowel

Fifty-two surgically removed large bowel specimens and 3 colonoscopically removed polyps with mucosal carcinomas were studied. Among 36 frank colorectal carcinomas, six (17%) had a focus of adenomatous remnant. The average size of carcinomas without adenomatous remnant was 56.0 mm and of those with adenomatous remnant was 44.3 mm. Four (67%) of 6 submucosal carcinomas and all of 4 mucosal carcinomas showed an adenomatous remnant. The average size of submucosal carcinomas was 17.7 mm and that of mucosal carcinomas was 16.3 mm. The smaller and less advanced the carcinoma, the more likely it was to show an adenomatous remnant, suggesting that carcinomas arise in adenomas and destroy surviving benign tumour as they grow. Coexisting adenomas were seen in 19 of 46 neoplasm-bearing patients (41%) and 1 of 9 patients (11%) without neoplasms. Average sizes of adenomas with moderate and mild atypia were 13.0 mm and 8.2 mm respectively, which were smaller than the sizes of submucosal and mucosal carcinomas. Although the numbers were small, these findings support the concept of adenoma-carcinoma sequence. Twenty-one flat elevations were collected during the study. Ten were neoplasm (9 adenomas and an early carcinoma), ten were metaplastic polyps and one was a histologically normal mucosal protrusion. The atypism of 10 flat adenomas increased with increasing size, as with ordinary adenomas. As 10 of 55 adenomas (18.2%) were flat adenomas, which are difficult to detect during routine colonoscopic examination, colonoscopists should make every effort to discover flat adenomas, which seem to play an important role in the adenoma-carcinoma sequence.

The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Two kinds of diverticular disease

Two kinds of acquired diverticular disease were identified. The more common variety presented with pain, bowel symptoms or fistulae, and the less common with bleeding. The former patients rarely had a history of bleeding and among the latter pain and bowel symptoms were uncommon. In contrast to the few, chiefly sigmoid, diverticular often found in the former group, barium enemas of those presenting with bleeding usually showed densely packed and extensive diverticula. Even where there was no history suggesting perforation or evidence of it at operation, specimens resected for the more common form of diverticular disease invariably showed histological evidence of previous perforation. There was no histological evidence of previous perforation in those specimens resected for bleeding. This retrospective clinical, radiological and histological study supported the idea that there are two kinds of diverticular disease, one associated with perforation and its sequelae, the other associated with bleeding.

Acute respiratory illness in Adelaide children. II: The relationship of maternal stress, social supports and family functioning

In a community-based study we investigated the relationships between maternal stress, maternal social supports, family functioning and proneness to acute respiratory illness (AR1) in childhood. 'Prone' and 'not prone' children were identified from the responses to a mail questionnaire sent to the addresses of a randomly selected group of Adelaide children who had been born in 1983. 'Prone' children (n = 255) were defined by a respiratory score (based on frequency and severity of reported symptoms in the preceding 12 months) in the top quintile of the distribution, while 'not prone' children (n = 227) were defined by a score in the bottom 20% of the range. Further information was obtained from a questionnaire administered at a home visit. Maternal stress levels were determined from a combination of major life events, minor life events and psychological distress. Maternal stress was significantly associated with respiratory proneness in a stepwise multiple logistic regression (adjusted odds ratio/high versus low = 3.8; 95% confidence interval 2.0-7.2; p = 0.000), while controlling for the effects of maternal smoking, group child care, early chest illness, number of siblings, breastfeeding, occupation, sex, age, home heating, birthweight and parental history of respiratory illness. Family dysfunction was associated with respiratory proneness in bivariate analyses but not after adjustment for the effects of other psychosocial factors in multivariate analyses. Lack of maternal social support was not associated with having a child who was prone to respiratory illness. These findings raise a number of questions about the nature and direction of the relationship between parental psychological status and child health.

Nature, nurture, nutrition: interdisciplinary programs to address the prevention of malnutrition and dehydration

Malnutrition and dehydration are common problems in nursing home patients. One explanation for this may be the large number of patients requiring feeding assistance. The Dysphagia Team at the Department of Veterans Affairs Medical Center in Miami, Florida served as the primary source in the expansion of a nutritionally supportive environment to assist in the prevention of malnutrition and dehydration in patients with feeding/swallowing disorders. "Silver Spoons," a program in which volunteers provide supervised feeding, "Happy Hour," a time each day during which an atmosphere is provided that encourages socialization and hydration, and "Second Seating," during which lunch is provided for patients who require modification of eating style, food texture, or timing are described. Analysis of the program's outcomes show it to be timely, pleasing to patients, and cost-effective.

Evaluation of rigid container systems for sterilization

The packaging of surgical instruments, medical devices and procedure trays for sterilization is indeed important. There are three choices for packaging.

The first two methods use traditional over-wrap packaging, with either reusable flat wraps of muslin or tightly woven textiles, or one of several types of nonwoven disposable wraps. Reusable wrappers must be monitored by labor-intensive inspection, delinting and frequent patching, and are easily contaminated. In addition, disposable wraps can develop tears and holes compromising the sterility of the contents. Thus, both reusable and disposable wrappers have drawbacks.

Pax chirurgica--the surgical peace

Peace is a time for planning and building. It is not merely the absence of war, the destroyer. Surgery has been seen as a war against disease, which must be cut out. Even during peace, trauma is a war of epidemic proportions. Medical professionals now believe prevention is better than cure, and in surgery, much attention is paid not merely to excision, but to repair, reconstruction, and transplantation. Only when there is global peace is it possible for international scientific societies to flourish. Peace provides the opportunity for clinical trials on a large scale and for the exchange of scientists, surgeons, and surgical trainees. The Society has established a Secretariat, a central bureau where requests about acquisition of new skills or details of research opportunities may be directed, advertised, and relayed.

How to apply for charitable status

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New rectum and new anal canal: two cases of ileal reservoir-cutaneous anastomosis

Two patients who had total proctocolectomy for ulcerative colitis 4 and 10 years ago respectively have each been given a new rectum and anal canal, the lower end of a J ileal reservoir being brought through the pelvic floor muscles and joined to a skin wound made in the perineum.

Endotoxemia produces an increase in arterial but not venous lipid peroxides in sheep

Our purpose was to determine the effect of an endotoxin-induced lung injury on circulating lipid peroxides. We measured both malondialdehyde (MDA) and conjugated dienes (as optical density at 233 nm) in aortic and venous plasma and lung lymph in 10 unanesthetized sheep given 1 microgram/kg of Escherichia coli endotoxin. Total lipids and prostanoids 6-ketoprostaglandin F1 alpha and thromboxane B2 were also measured. Six control sheep were also studied. Animals were monitored for a 12-h period and then killed, and lung tissue MDA was determined. A two-phase endotoxin response was noted with an initial pulmonary hypertension followed by a steady-state increase in protein-rich lung lymph flow (QL) between a 3- and 6-h period. Aortic plasma MDA was significantly increased from a base line of 4.8 +/- 1.4 to 8.9 +/- 1.6 and 7.5 +/- 1.3 nmol/ml at 1 and 4 h post-endotoxin. Aortic plasma conjugated dienes increased in all 10 sheep post-endotoxin. Venous levels of both MDA and conjugated dienes were not significantly increased. Lung QL increased two- to three-fold. Lung lymph MDA increased significantly at 1 h post-endotoxin. Lymph conjugated dienes decreased. Plasma and lymph lipid peroxide levels returned to base line by 12 h in most animals. However, tissue MDA remained significantly increased in all sheep from base line of 45 +/- 9 to 85 +/- 14 nmol/g tissue. We conclude that both MDA and conjugated dienes are transiently released into aortic plasma during endotoxin-induced oxidant lung injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical evaluation of a new controlled-release formulation of naproxen in osteoarthritis and rheumatoid arthritis. Canadian Multicentre Study Group

A two-part multi-centre study was carried out to assess the efficacy and tolerability of a new controlled-release (CR) naproxen tablet in the treatment of osteoarthritis and rheumatoid arthritis. Patients already receiving naproxen on a regular basis were first enrolled in a 6-week randomized double-blind trial comparing the controlled-release tablet (750 mg or 1000 mg once-a-day) to the standard marketed tablet (375 mg or 500 mg twice-a-day). At the end of this phase, patients in both treatment groups were eligible to enter the long-term phase involving 28 weeks of open-label treatment with controlled-release naproxen at the previously established dose level (750 mg or 1000 mg once-a-day). A total of 404 patients entered the initial double-blind phase, 320 of whom continued into the open-label phase. Twenty-nine (14%) naproxen patients and 23 (11%) naproxen CR patients were withdrawn prematurely from the double-blind phase, 87 (27%) patients from the open-label phase. Parameters of efficacy and tolerability were evaluated at base-line, during the double-blind phase (after 3 and 6 weeks of treatment), and during the open-label phase (after 20 and 34 weeks of treatment). The entire study population showed significant improvements in overall disease activity and severity of pain, but with no statistically or clinically significant differences between the two treatment groups; nor were there significant differences among treatments in incidence of adverse events. The patients treated with naproxen CR for an additional 28 weeks showed either no change or continued improvement in arthritic symptoms and no signs of toxicity. It was concluded that, in osteoarthritis and rheumatoid arthritis patients, once-a-day controlled-release naproxen tablets can be substituted for standard naproxen tablets without loss of efficacy or tolerability.