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8044327 | A retinoblastoma with an unusual aspect in a 5-year-old girl. | A five-year-old girl presented with a white, semitransparent, slightly elevated retinal lesion in the left eye, with as most probable diagnosis retinoblastoma. Fluorescein angiography showed intraretinal vascular abnormalities and leakage. On computed tomography and ultrasound no calcifications were identified. As the tumor had grown, enucleation was performed and the diagnosis of retinoblastoma was confirmed by routine histology and by immunohistochemistry. |
8044328 | Follow up of suspected choroidal naevi. | The correct diagnosis of small pigmented choroidal tumours is often difficult. We reviewed 16 cases with a mean follow-up of 58 months and illustrate the difficulties which can be encountered in correctly diagnosing small to medium-sized pigmented tumours. Of those 16 cases, 4 cases ultimately progressed and needed appropriate therapy. Some suspected melanomas grew initially but then stayed stationary for a long period of time. In doubtful cases, it is essential to document the evolution with echography, fundoscopy, fundus photographs, fluorescein-angiography, visual fields and eventually ICG-angiography. If progression is documented, appropriate treatment has to be considered. |
8044326 | Comparison between different retinoblastoma classifications. | We reanalysed the current staging systems for retinoblastoma, the classification of retinoblastoma for prognosis by Reese and Ellsworth and the new Essen prognosis classification for conservative sight-saving therapy by univariant analysis. We compared the value of those classifications with one another. |
8044325 | Local resection of uveal melanoma. | This article describes the techniques, indications, and results of local resection of intraocular melanomas using (1) the external approach with lamellar scleral dissection and hypotensive anaesthesia and (2) in the transvitreal approach (endoresection). In principle, local resection is indicated for iris and ciliary body tumours and for medium and large choroidal tumours which are not expected to do well after radiotherapy. Contraindications to local resection are optic disc involvement, significant extraocular tumour extension, and involvement of more than a third of the ciliary body or angle. |
8044329 | Diagnosis of choroidal metastasis. | In a retrospective study we examined the files of 47 patients with choroidal metastasis (56 eyes of 18 male and of 29 female patients, ranging from 29 to 85 years of age). Primary breast carcinoma is the tumour most frequently responsible for choroidal metastasis (55% of the cases). Lung cancer (13% of the cases) is the most common primary tumour in males. No primary site was found in 10% of the cases. The period between the diagnosis of the primary tumour and the onset of choroidal metastasis is clearly shorter in lung cancer than in breast cancer. Furthermore, in the latter, generalized metastasis is often already known. Choroidal metastasis develops preferentially in the posterior pole. There is no preponderance of left-side involvement. It mostly concerns a solitary tumour, although multiple foci, in one or both eyes, are found in 21% of the patients. Fluoroangiography shows different patterns, but this method is not specific enough to allow differentiation from other choroidal tumours. Diagnosis is mainly supported by history, clinical context and echography. |
8044322 | [Transfusion and cancer]. | Relationship between blood transfusion and cancer is considered from five points of view: 1) The cancer patient as a blood donor. Cancer must remain a cause of exclusion from blood donation. 2) Autologous blood transfusion for cancer patients. Predeposited autologous blood transfusion is only possible for a small number of patients. Intraoperative blood salvage carries with it the risk of disseminating tumor cells. 3) History of blood transfusion and the risk of having a cancer: a) the persistence of immune alterations following blood transfusion for years might expose the patient to an increased risk of having a cancer; b) blood transfusion might carry immunosuppressive viruses, and hepatitis viruses are related to the risk of liver cancer. 4) Cancer recurrence and blood transfusion. Conclusion of most of the published studies is that blood transfusion is associated with an increased risk of recurrence of colorectal cancer. The only realistic randomized study would compare different transfusion strategies (allogenic, leukocyte poor allogenic and autologous blood transfusion) to determine which is the best for cancer patients. 5) Post-transfusion GVH in cancer patients. Some cases have recently been published. They all can be explained by a particular HLA compatibility between the recipient and one of the blood donors. |
8044323 | Monitoring the safety of transfusion practices in the U.S. | The public demands and deserves the safest blood products to be available when and where needed. Although absolute safety in the blood supply is a desirable goal, many intervening factors may have a bearing on its final quality. In the process of obtaining blood, the procedure for donor selection/exclusion acquires pivotal relevance. Then, once the blood product is taken to the processing laboratory, there is a need that tightly and narrowly defined parameters for component preparation, infectious disease testing, handling and storage be in place and strictly adhered to. Notwithstanding these measures to increase the safety and quality of blood, the most critical factor remaining in the whole operation is the one related to physician behavior and discipline as far as appropriate criteria for the use of blood products are concerned. Transfusion Medicine Physicians must keep a constant vigilance that the appropriate criteria for transfusion are utilized in 100% of cases. This, can only be achieved by an intense and continuous scrutiny and evaluation of every request for transfusions for every patient 24 hours a day, 7 days a week basis. This approach has allowed that we identify physicians who need help and understanding as to the appropriate use of blood products, as well as information about other equally effective options and alternatives. Misconceptions about whole blood, directed donations, unusual requests for fresh frozen plasma, without the documentation of abnormalities of the coagulation profile are rapidly intercepted and aborted. These unusual and unfounded requests are forwarded to the Department of Quality Assurance to further follow up and monitoring of physician behavior in this aspect.(ABSTRACT TRUNCATED AT 250 WORDS) |
8044320 | One-year use of the Bloodloc system in an orthopedic institute. | Human error in patient or specimen identification due to fatigue, stress and lack of attention by technologists, nurses, interns, and physicians, can cause routinely safety procedures to be circumvented. Clerical errors may occur during the specimen collection, the issue of blood unit and the transfusion of blood. The introduction in an increasing number of hospital of preoperative autologous blood donation programs further increases the chance of error, because a single patient can predeposit multiple units of blood. In this cases there is a greater commitment not only to transfuse any blood unit that is ABO compatible but to transfuse the specific units the patient previously donated for his own use. Human error has been recognized as a significant cause of transfusion-associated fatalities. The persistence of the frequency and type of errors observed in spite of extensive efforts to eradicate them, suggests that errors are inevitable as long as large number of repetitive procedures are performed unless major system changes are adopted. A system (Bloodloc System) that physically prevents the possibility of error was adopted since January 1993 and cuncurrently a quality improvement program (QI) was implemented specifically designed to monitor: 1. the absence of the code on the blood samples, 2. the blood bank error in setting the Bloodloc, 3. the misidentification of blood samples, 4. any attempt to transfuse the wrong blood unit, 5. any attempt to transfuse, the wrong patients. 4895 blood units (2469 autologous and 2426 allogeneic units) were transfused to 1478 patients (849 predeposited an average of 3.3 +/- 2.0 units). The methodological errors (absence of three-letter code on the patient's specimen tube, wrong transcription of the code on the blood sample, wrong setting of the Bloodloc in the blood bank)--41 cases--were limited at the first four months of implementation of the system. In the same period however have been reported 3 potentially fatal errors which have been avoided by the Bloodloc. Two cases of misidentification of blood samples at the moment of the specimen collection, and one attempt to transfuse the wrong units to the wrong patients. The Bloodloc system is effective in preventing potential transfusion-associated fatalities caused by units or recipients misidentification. |
8044317 | [Does preoperative erythroapheresis avoid homologous transfusion?]. | The risk of transfusion-related viral infections promotes techniques intended to reduce such a risk. Preoperative erythroapheresis is an autologous blood collection technique which minimizes the inconvenience of repeated predeposit autologous donations. Erythroapheresis has been performed in 451 patients, 24 to 72 hours before surgery using a discontinuous flow cell separator (PCS+Haemonetics). The mean collected red cells volume was 485 ml (250-900) and was replaced by hydroxy-ethyl-starch (ELOHES). Homologous blood transfusion was avoided in 431 patients (95,6%). This technique is indicated for surgery with an expected blood loss between 1000 and 1500 ml or when the patient cannot be included in a preoperative blood donation programme. Preoperative erythrocytapheresis is a simple and well tolerated procedure. To have recourse to apheresis techniques allows to increase the number of autologous transfused patients. |
8044316 | [Ensuring the safety of erythrocyte concentrates using quarantine]. | We have decided that it is essential to establish a process to protect patients receiving concentrated red blood cells (CGR) from a residual risk of contamination by the HIV virus or by the hepatitis C virus. Viral inactivation techniques of labile blood products are not presently in use, only safety measures obtained by quarantine allow a reduction of this risk to a value approaching 0. We have developed, from known deep-freeze methods of red blood corpuscles, a process to place the samples of concentrated red blood cells in quarantine by means of deep-freezing. We have modified and automated the deep-freezing, thawing and washing manipulations of the red blood corpuscles in order to obtain a final product which is standardized in quantity and quality. The result of our work will show: That all the means employed are not a source of contamination of the end product. That the procedures employed may be easily adapted to all Blood Transfusion Centers. That the end-product may be used after 21 days of conservation. That the extra cost entailed by this procedure is realistic. |
8044319 | Practice of autologous preoperative plasmapheresis in Germany in 1993. | Autologous preoperative plasmapheresis which is being performed at the University Hospital of Tübingen since 1984 in advance of surgical, orthopaedic or gynecologic operations, constitutes, in combination with intraoperative autotransfusion (IAT), an optimal method to compensate high losses of intravascular volume. Unlike all other procedures which also substitute lost volume (such as infusion of electrolytic solutions or plasma expanders, haemodilution, retransfusion of preoperatively donated autologous blood, transfusion of homologous plasma or foreign blood) this method grants optimal clotting as well as intravascular retention of volume and in addition to this excludes every risk of infection. Although the therapeutic advantages of autologous preoperative plasmapheresis are well known and confirmed by our statistics (about 75% of the patients do not need any foreign blood), the method is rarely practiced in Germany and mainly performed in specialized hospitals (e.g. in the orthopaedic departments of Tübingen, Ulm, Hamburg, Hannover or Essen). This unfortunate situation is obviously due to some of the following, primarily logistic problems. First of all the procedure of autologous preoperative plasmapheresis needs relatively long planning in advance of the operation (between 2 and 4 weeks) and a number of surgeons renounces the method--even if the patient's medical condition is appropriate and no higher costs are to be expected. The above mentioned alternatives of compensating blood losses are preferred, even if they are in no way comparable in their efficiency. Secondly, in Germany autologous preoperative plasmapheresis is mostly performed by an anaesthetist, who is, however, under our laws obliged to reinfuse the plasma himself, which he has taken from a patient.(ABSTRACT TRUNCATED AT 250 WORDS) |
8044318 | Preoperative autologous plasmapheresis--9 years experience in orthopedic surgery. | Since nine years preoperative autologous plasmapheresis (PPH) is an essential part of a comprehensive autologous transfusion program in the Rehabilitation Hospital/Orthopedic University Clinic of Ulm. After v. Finck's recommendation in 1984 we started plasma-predeposit by centrifugation-plasmapheresis (PCSR, Haemonetics Comp.) in all elective orthopedic-surgical patients expecting a blood loss > 1,000 ml. Primarily this procedure was used for intra- and postoperative hemostasis stabilization and for having the ideal component to recomplete the harvested red cells by the Cell SaverR to full blood units. By clinical experience the strategy of routinely combining plasma-predeposit and wound-blood salvaging instead of full blood- or red cell's-predeposit was recognized as not only being highly effective in saving of banked blood but furthermore as being the best way of getting free from all time related problems due to the limited preservation period of red cells because donated platelet poor plasma (PPP) can easily be frozen and stored up to one year at least. In addition there is one more decisive aspect in favour of autologous fresh frozen plasma (AFFP): it may be used for the best and most physiological kind of volume replacement. In combination with a short acting artificial plasma substitute (e.g. Polygelin) for intraoperative replacement AFFP is best suitable for reestablishing and maintaining postoperative normovolemia which is essential for any kind of hemodilution practicing like we routinely do when accepting low hemoglobin concentrations (> 7,0 g/dl) to avoid homologous blood transfusions and to reduce the risk of thromboembolic complications at the same time.(ABSTRACT TRUNCATED AT 250 WORDS) |
8044313 | Viral inactivation in platelet concentrates. | Although the current risk of posttransfusion infection is very low in North America and Western Europe, there continues to be considerable interest in measures to inactivate residual viruses in blood components. The human immunodeficiency virus is of greatest concern, but hepatitis C virus is also considered to be a significant problem. HTLV-I and -II and HBV may also be transmitted by transfusion, although infrequently. It is likely that effective inactivation methods will have to reduce viral titers by about 6 orders of magnitude, including both viruses found free in plasma and those in intracellular compartments. Although it would be most desirable to have a single procedure to inactivate viruses in all blood components, it appears that different methods may be required for plasma, red cells and platelets. To date, the most promising approach for platelets appears to be photochemical inactivation. In general, photoactive compounds fall into two major groups: photodynamic dyes which are activated by visible light and act by oxygen dependent generation of reactive molecular species; and ultraviolet-activated intercalating compounds which form covalent adducts with nucleic acids. We have found that photodynamic inactivators are unable to inactivate viruses in platelet concentrates without damaging the platelets. On the other hand, we have shown that aminomethyl trimethyl psoralen (AMT), when activated by long-wavelength ultraviolet light (UVA) can inactivate more than 5 logs of model viruses and HIV while platelet in vitro properties are maintained. Further, unlike photodynamic inactivators, AMT is able to inactivate cell-associated and intracellular viruses and also prevents the replication of integrated HIV genome sequences, as demonstrated by PCR.(ABSTRACT TRUNCATED AT 250 WORDS) |
8044310 | Infarction of breast fibroadenoma in a postmenopausal woman. | Infarction of a breast fibroadenoma usually occurs in young females during pregnancy or lactation. This report describes a rare case of the total infarction of a fibroadenoma in a 58 year old postmenopausal woman. The chief complaint was a rapidly enlarged, slightly painful lump. Medullary carcinoma was suspected on palpation and mammography. Microscopically, the tumor was composed of a coarsely lobulated necrotic mass invaginated into an epithelial lined cyst. This was interpreted as an infarcted intracanalicular fibroadenoma, although the possibility of an infarcted phyllodes tumor cannot be entirely excluded. The significance of this rare event is the possible confusion with carcinoma. Extensive search for viable tissue is essential for the confirmation of the diagnosis. |
8044311 | Periosteal osteosarcoma of the femur with bone marrow involvement: a case report. | Periosteal osteosarcoma is an exceedingly rare type of chondroblastic osteosarcoma, showing rather better prognosis, and secondary bone marrow involvement is unusual. A case of a 22 year old male with periosteal osteosarcoma of the right femur with an associated bone marrow lesion is presented. The juxtacortical tumor, 16 x 11 x 9 cm, was located on the bone cortex of the upper diaphysis and extended into the surrounding soft tissues. A minimal bone marrow lesion was present, although the bone cortex was quite intact. Microscopically, the tumor consisted exclusively of atypical chondroblastic cells with a small osteoblastic area. The bone marrow lesion, interestingly, contained both multiple nodules of well-differentiated chondrosarcomatous components and a few demarcated foci of atypical spindle cells producing a fine osteoid matrix. It was reasonable to conclude, therefore, that this tumor was a periosteal osteosarcoma with an unusual secondary bone marrow lesion rather than a conventional (central) chondroblastic osteosarcoma with soft tissue invasion. The patient's good prognosis with no tumor recurrence or metastasis during more than 7 years follow-up after surgery supports this conclusion. |
8044309 | A patient with hepatic granuloma formation and angiotensin-converting enzyme production by granuloma cells during clinical relapse of hepatitis A. | Elevation of the serum angiotensin-converting enzyme (sACE) level and hepatic granulomas were found during a clinical relapse in a 22 year old patient with acute viral hepatitis type A (AVH-A). The serum transaminase level and sACE level remained high for more than 6 months. In the biopsied specimen of the liver, fibrous rings of granulomas composed of collagen types I, III, and V were observed. Furthermore, the localization of ACE was visible in the rough endoplasmic reticulum of epithelioid cells of granulomas in the liver under electron microscopy using the indirect immunoperoxidase method. These results suggest that granuloma cells in the liver caused by hepatitis A may be involved in ACE production. In addition, other diseases associated with the presence of granulomas in the liver, such as lymphoma, cytomegalovirus infection, visceral leishmaniasis, and lupoid hepatitis, were ruled out. However, the hepatic granulomas disappeared with the healing of AVH-A. In this regard, the present case is considered to be one of the very few cases of hepatic sarcoidosis. |
8044307 | Interdigitating cell sarcoma: a morphologic and immunologic study of lymph node lesions in four cases. | Interdigitating cell sarcoma is an extremely rare tumor. Its presentation and histologic appearance has varied among the reported cases. In this study, the authors investigated four cases of the hematolymphoid malignancy arising within lymph nodes, which were considered to be of interdigitating cell origin. All patients presented in the 6th to 8th decade of life with peripheral lymphadenopathy, and had a relatively indolent clinical course, without bone marrow or skin involvement. Carcinomas were observed as a second neoplasm in two of four patients. Distinctive morphologic features are proliferation of histiocyte-like cells with nuclear pleomorphism and occasionally multinucleated, paracortical distribution sparing of B-cell regions, fibrosis, sinus infiltration, and a prominent eosinophil/plasma cell infiltrates. The combination of light microscopic, fine structural, and immunohistochemical features suggested that these tumors derive from interdigitating cells; these tumor cells expressed CD68 (KP1), S-100 protein and HLA-DR, but lack CD21 (1F8), desmosomes and Birbeck granules. The diagnosis of interdigitating cell sarcoma should be considered on any pleomorphic tumor with the features described in this report. |
8044308 | A case of sarcoidosis revealed in the course of IgA nephropathy. | A 36 year old man, who had been proteinuric for 14 years due to immunoglobulin A (IgA) nephropathy, was admitted because of an acute exacerbation in renal dysfunction with hypercalcemia. He had presented with aortic regurgitation and increased pulmonary marking by chest X-ray, but laboratory examinations had failed to make an exact diagnosis. On admission, noncaseating epithelioid granulomas were disclosed by muscle and skin biopsies. Ophthalmological evaluation revealed old uveitis and retinal changes consistent with sarcoidosis. In this case, IgA nephropathy was thought to be the initial manifestation of sarcoidosis that developed latently. Sarcoidosis should be considered in a differential diagnosis of IgA nephropathy. |
8044306 | Prognostic value of argyrophilic nucleolar organizer regions (AgNOR) count in adenoid cystic carcinoma of salivary glands. | A retrospective study was performed on 34 patients with adenoid cystic carcinoma (ACC) to see if quantification of argyrophilic nucleolar organizer regions (AgNOR) was correlated with their prognosis. Mean follow-up period was 113 months. According to detailed clinical data that included tumor recurrences, metastases and patient survival conditions, two groups were classified. Group 1 consisted of 20 live patients without metastases, of whom 16 were free of disease, while group 2 comprised 14 patients with metastases among whom 12 died of tumor. The silver staining technique was applied to paraffin embedded specimens. In each case, 300 nuclei were randomly examined and the mean AgNOR per nucleus was calculated. All patients from group 2 had mean AgNOR counts greater than 4, whereas 65% of patients from group 1 had mean AgNOR counts less than 4. In addition, statistical analysis showed that the pooled mean AgNOR count in group 2 was significantly higher than in group 1 (P < 0.01). The present results suggest that silver staining technique promises to be a useful supplementary method for prognostic evaluation of salivary ACC, and may be performed before planning the treatment. |
8044305 | A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. | A clinicopathological study of surgically resected thymomas was performed using Masaoka's staging and modified Masaoka's staging systems, and the utility of these two staging systems was compared. The modification enabled adjustment for the disproportion in the number of cases between Stage I and Stage II. Analysis of survival rates, according to the tumor stage, indicated that the old classification should be reappraised, that is, division into non-invasive and invasive thymomas, although staging may contribute to the indication for postoperative radiotherapy, especially for Stage II disease. Analysis of the cases showed a wide spectrum of aggressiveness, varying from cases showing slow progression with a relatively favorable prognosis, such as the spindle cell type, to cases with rapid progression leading to tumor death in a relatively short time, such as the epithelial cell predominant and polygonal cell type. The pathological stage at the time of first surgical resection would reflect the degree of aggressiveness of thymoma in many instances. Therefore, not only staging the tumor extent but also grading of its aggressiveness are needed in order to predict the prognosis of patients with thymoma. For the latter, histology and cytopathology are helpful. |
8044304 | Immunohistochemical classification of 140 autopsy cases with systemic amyloidosis. | One hundred and forty autopsy cases of systemic amyloidosis were examined using the potassium permanganate method for distinction of amyloid A protein from other amyloid proteins and an immunohistochemical technique. Of those cases, amyloid proteins were identified in 121 cases. There were 68 cases of amyloid A-related (AA) amyloidosis and these were the most common type among the cases (56.2%). There were 39 cases of immunoglobulin light chain-related (AL) amyloidosis (32.2%), six cases of beta 2-microglobulin-related (A beta 2M) amyloidosis (5%), and five cases of transthyretin-related (ATTR) amyloidosis (4.1%). Minute areas of amyloid deposits in four cases with AA were resistant to potassium permanganate pretreatment. In A beta 2M amyloidosis amyloid deposits were either resistant or sensitive to potassium permanganate pretreatment, from case to case. The coexistence of two different amyloid proteins was seen in three cases: one case had ATTR and A kappa types, and two cases had A beta 2M and AA types. Some discrepancies were seen between the immunohistochemical typing and clinical classification of amyloidosis referred to in the Annual of the Pathological Autopsy Cases in Japan, for example, one case of AA type in myeloma-associated amyloidosis and one case of AL type in secondary amyloidosis. From the present results, the importance of the immunohistochemical method in classifying amyloidosis is stressed. |
8044303 | Enteroviral RNA in endomyocardial biopsy tissues of myocarditis and dilated cardiomyopathy. | Enteroviruses are potential etiologic agents of myocarditis and dilated cardiomyopathy (DCM). A recently developed molecular approach has offered evidence of viral infection by detecting the virus genome. The nested reverse transcriptase polymerase chain reaction (nRT-PCR) was used to detect enteroviral RNA in endomyocardial biopsy tissues of myocarditis and DCM. The authors examined 44 tissues obtained from 36 patients with myocarditis, as well as from 10 patients with non-infectious cardiac diseases as controls. Enteroviral RNA was detected in 12 of 36 patients with myocarditis. The second endomyocardial biopsy was carried out in five of the patients, in whom enteroviral RNA was detected at the first biopsy, at intervals from 3 weeks to 8 years after the first biopsy, and enteroviral RNA was found in four and had disappeared in one. In one of the four positive patients at the second biopsy, a third biopsy was carried out 5 months later (6 months after the first), and the RNA was detected. Active myocarditis became clinically and microscopically mild at the second and third biopsies. In one patient who developed DCM, enteroviral RNA was also detected at a second biopsy performed 8 years after the first. Enteroviral infection is a probable cause of myocarditis and enterovirus-infected myocarditis may progress to DCM. |
8044302 | Effect of traditional Chinese medicine (sairei-to) on monoclonal antibody-induced proteinuria in rats. | The effects of traditional Chinese medicine (Sairei-to) on monoclonal antibody (mAb) inducing proteinuria were examined. Four hundred, 200 and 100 mg/kg body weight (BW) of Sairei-to and phosphate-buffered saline (PBS) as a control were injected intraperitoneally into four groups of female Wistar rats every day from 5 days before intravenous injection of mAb to the end of the experimental period. The amount of urinary protein excretion was significantly suppressed in roughly a dose-dependent manner. For example, 116.6 +/- 89.7 mg/day of proteinuria was observed in control groups compared to 4.2 +/- 15.2 mg/day in the 400 mg/kg BW of Sairei-to treated group 2 days after mAb injection (P < 0.01). Statistically significant (P < 0.01) differences were again observed in a repeat experiment (122.1 +/- 53.7 vs 10.2 +/- 10.1 mg/day on the 2nd day) without affecting the glomerular filtration rate. No significant difference was recognized between the total amount of mAb bound to glomeruli 1 h after mAb injection in Sairei-to-treated and non-treated rats, indicating that Sairei-to pretreatment has no effects on the number or quality of antigenic molecules. The effect of Sairei-to on a non-immunological model of proteinuria was also examined. No significant reduction of proteinuria by similar Sairei-to treatment was observed in aminonucleoside of puromycin nephropathy. The authors conclude that mAb-induced proteinuria in rats is significantly suppressed by the traditional Chinese medicine, Sairei-to. |
8044301 | CA125-producing adenocarcinoma of the seminal vesicle. | A case of primary seminal vesicle carcinoma is reported. The tumor was a CA125-producing adenocarcinoma consisting of fine papillary-tubular, intricate branching or anastomosing glandular structures and was composed of small cuboidal, but occasionally hobnailed, cells with mostly clear, but occasionally granular, cytoplasm. Some tumor cells showed evidence of secretion of seromucinous materials into the interpapillary and cystic space. Immunohistochemically, almost half of the tumor cells expressed a positive reaction with anti-CA125, a common serological marker for ovarian epithelial carcinomas; however, no tumor cells expressed any other serological tumor markers such as carcinoembryonic antigen, alpha-fetoprotein, human chorionic gonadotropin, prostatic specific acid phosphatase, or prostatic specific antigen. The patient showed a high level of serological CA125, which fluctuated parallel with the growth, removal and recurrence of the tumor. The morphological and immunohistochemical findings suggested a close relationship between the present tumor and clear cell carcinoma of the ovary, which is thought to be of a Müllerian-Wolfian duct origin. |
8044300 | Three synchronous carcinomas of the papilla of Vater, common bile duct and pancreas. | Multiple carcinomas of the pancreatico-biliary tree are rare. A 53 year old Japanese man was diagnosed as having an adenocarcinoma in the papilla of Vater. During the operation, he was also found to have a polypoid mass in the common bile duct. While cutting the operative specimen into stepwise sections, a small tumor was also detected incidentally in the main pancreatic duct of the pancreatic head. Histologically, all three tumors proved to be papillary adenocarcinomas and were restricted to the mucosa. Immunohistochemically, all three tumors were positive for carcinoembryonic antigen, carbohydrate antigen 19-9, chromogranin A and serotonin, while they were negative for somatostatin. Immunoreactivity to the tumor suppressor gene p53 protein (PAb 1801) was found in all three tumors. A flow cytometric analysis of the cellular DNA content revealed all three tumors to be aneuploid. The above results suggested that these three tumors from different sites all had the same histological, immunohistochemical and flow cytometrical characteristics. |
8044299 | Primary epithelioid malignant schwannoma of the lung. | This is the first documented report of a case of primary malignant nerve sheath tumor of the lung showing an epithelioid malignant schwannoma. A 55 year old Japanese female underwent lobectomy of the middle lobe of the right lung because of a large, rounded tumorous shadow found on chest X-ray film. Light microscopic examination of the neoplasm disclosed an epithelioid malignant schwannoma with foci having a spindle-cell sarcomatous pattern. The neoplastic cells were positive for S-100 protein and neuron specific enolase by the immunoperoxidase method. Transmission electron microscopy showed basement membrane-like material surrounding the neoplastic cells and long spacing collagens in the interstitial spaces. The patient died of a recurrent tumor in the right hemithorax 5 months after undergoing lobectomy. An autopsy revealed no primary site of the neoplasm outside the lung. Furthermore, there was no evidence of neurofibromatosis. |
8044298 | Peripheral carcinoid tumor of the lung with focal melanin production. | A case of carcinoid tumor of the lung with focal melanin production was encountered in a 56 year old Japanese woman. The tumor was found 16 years previously by mass survey chest X-ray and had enlarged two-fold in the intervening period. The tumor consisted of a variety of tumor cells showing a spindle, polygonal and pleomorphic appearance with abundant vasculature in the stroma. All tumor cells showed argyrophilia, together with a few showing argentaffinity. Melanin-containing tumor cells were also present in parts. Ultrastructurally, most tumor cells possessed various numbers of neurosecretory granules and a few of them contained granular type melanosomes. Tumor cells were connected with desmosomes and a few of them contained tonofilament-like microfilaments. Only a few contained both neurosecretory granules and melanin. By immunohistochemistry, serotonin, met-enkephalin and beta-endorphin positive cells were observed scattered throughout the tumor. A few tumor cells positive for tyrosine hydroxylase were also detected. Additionally, most tumor cells were positive for keratin. On the basis of these findings, the tumor of the current case is a pulmonary carcinoid tumor with focal melanin production. |
8044297 | Anaphylactoid purpura with intestinal perforation: report of a case and review of the Japanese literature. | A 78 year old man suffering from anaphylactoid purpura complained of abdominal pain and bloody stools. Combined therapy with Prednisolone and cyclophosphamide had been given against nephrotic syndrome caused by purpura nephritis. Severe abdominal pain with symptoms and signs of pan-peritonitis necessitated laparotomy. Rectosigmoid perforation due to necrotizing angiitis (phlebitis) was also demonstrated histologically. The patient died of septicemia 18 days after surgery. Perforation of the alimentary tract rarely occurs in anaphylactoid purpura. Twenty similar cases were briefly reviewed from the Japanese literature. |
8044296 | Evaluation of malignant grade of salivary gland tumors: studies by cytofluorometric nuclear DNA analysis, histochemistry for nucleolar organizer regions and immunohistochemistry for p53. | Investigations were carried out in 109 surgically resected salivary gland tumors, 46 adenomas and 63 carcinomas for nuclear DNA content by cytofluorometry, nucleolar organizer regions (AgNOR) by histochemistry and nuclear p53 accumulation by immunohistochemistry. The mean nuclear DNA content and the incidence of aneuploidy as well as the mean number of the AgNOR in carcinomas were significantly higher than those in adenomas. In the DNA histogram pattern, the aneuploidy frequently appeared in high grade carcinoma groups (adenocarcinoma, salivary duct carcinoma, carcinoma in pleomorphic adenoma and oncocytic carcinoma). Immunohistochemical nuclear p53 accumulation was observed in 15 tumors, of which ten showed DNA aneuploidy. In high grade carcinomas, DNA aneuploidy was closely related to p53 immunoreactivity. This study revealed that combined cytofluorometric nuclear DNA analysis, histochemical AgNOR count and immunoreactivity for p53 might be quite useful for evaluating the malignant grade of salivary gland tumors. |
8044295 | Correlation of E- and P-cadherin expression with differentiation grade and mode of invasion in gingival carcinoma. | The expression pattern of two Ca(2+)-dependent cell-cell adhesion molecules, E- and P-cadherin (CD), in 25 primary gingival squamous cell carcinomas (SCC) was examined immunohistochemically. The occurrence of reduced-type expression of both E- and P-CD increased significantly with the grade of carcinoma differentiation, culminating in a complete loss of P-CD in poorly differentiated SCC. The occurrence of reduced-type P-CD expression also increased significantly with the mode of invasion, as was the case with E-CD. Furthermore, no P-CD molecules were detected in one of the six SCC having a diffuse, cord-like invasion and in three of the six having a diffuse type of invasion. These findings suggest that the down-regulation of these cell adhesion molecules closely correlates with the differentiation grade and mode of invasion of gingival SCC. |
8044294 | Pathology of pulmonary hypertension: a human and experimental study. | To clarify the histopathological characteristics of pulmonary hypertension (PH) in Japan, and to clarify the role of serotonin and endothelin in monocrotaline induced PH, human histopathological studies and experimental studies were carried out. An epidemiological study based on the Annual of the Pathological Autopsy Cases in Japan, and a morphological study on autopsy cases of congenital heart disease and idiopathic PH were performed. Plasma levels of serotonin and endothelin, vascular responsiveness to serotonin, and the effects of a selective serotonin antagonist, DV-7028, were investigated after monocrotaline injection. Plexogenic pulmonary arteriopathy was prevalent, and recurrent pulmonary thromboembolism and pulmonary veno-occlusive disease extremely rare among primary pulmonary hypertension in Japan. In secondary PH, systemic lupus erythematosus and mixed connective tissue disease were frequent and showed particularly severe intimal and medial thickening. After an injection of monocrotaline, plasma serotonin and endothelin levels were raised, and pulmonary arteries showed hyperreactivity to serotonin. DV-7028 (5-HT2 receptor antagonist) attenuated the rise in pulmonary artery pressure and the various effects of monocrotaline. There may be some genetic difference between PH in Japan and other countries. Roles for serotonin and endothelin in the initiation and progression of monocrotaline induced PH are suggested. |
8044293 | Column-switching high-performance liquid chromatographic method for the determination of a thymidylate synthase inhibitor, LY231514, an investigational agent for the treatment of solid tumors, in human plasma. | A reversed-phase, column-switching high-performance liquid chromatographic (HPLC) method is described for the determination of a new thymidylate synthase inhibitor in human plasma. The compound and an internal standard are extracted from plasma using a Certify II solid-phase cartridge. Extracts are evaporated to dryness and the residue is reconstituted with mobile phase buffer. The analytes are separated from polar interferences and buffer salts originating from the elution step on a 4-mm YMC Basic pre-column. The fraction containing the analytes is further separated on a 25-cm YMC Basic column. The analytes are detected by their absorbance at 250 nm. The limit of quantitation is 10 ng/ml. The method is linear from 10 ng/ml to 80 micrograms/ml using three standard curve ranges. Validation studies for all three ranges show the method to be reproducible. The method has been successfully used to support pharmacokinetic studies. |
8044292 | High-performance liquid chromatographic determination of iophenoxic acid in serum. | Iophenoxic acid (IPA), a marker used to investigate the feeding behaviour of bait-consuming animals has previously been indirectly determined by measuring protein-bound iodine levels in serum or plasma. For the first time a method is reported for the direct determination of IPA in biological fluids. IPA was determined in de-proteinized serum by high-performance liquid chromatography (HPLC) on a C18 column with a mobile phase of acetonitrile-water. Isocratic and gradient systems are described with limits of detection of 0.2 microgram/ml (isocratic) and 0.05 microgram/ml (gradient). Recoveries from fox serum were 85% at 0.5 microgram/ml, 95% at 5 micrograms/ml and 91% at 50 micrograms/ml. |
8044291 | Development and validation of a high-performance liquid chromatographic method for the determination of methocarbamol in human plasma. | An isocratic HPLC method was developed and validated for the quantitation of methocarbamol in human plasma. Methocarbamol and internal standard in 200 microliters of human plasma were extracted with ethyl acetate, evaporated to dryness and reconstituted in water. Separation was achieved on a reversed-phase C18 column with a mobile phase of methanol-0.1 M potassium phosphate monobasic-water (35:10:55, v/v/v). The detection was by ultraviolet at 272 nm. Linearity was established at 1-100 micrograms/ml (r > 0.999). The limit of quantitation was designed as 1 microgram/ml to suit pharmacokinetic studies. Inter-day precision and accuracy of the calibration standards were 1.0 to 3.6% coefficients of variance (C.V.) and -2.0 to +1.6% relative error (R.E.). Quality controls of 3, 20 and 70 micrograms/ml showed inter-day precision and accuracy of 2.5 to 3.6% C.V. and -0.9 to -0.4% R.E. Recovery of methocarbamol was 91.4-100.3% in five different lots of plasma. The method was shown to be applicable on different brands of C18 columns. |
8044290 | High-performance liquid chromatographic assay for ibuprofen in whole blood using solid-phase extraction. | A precise, accurate, reproducible one-step method for the high-performance chromatographic determination of ibuprofen in whole blood is described. Samples were, after haemolysis, prepared by solid-phase extraction. Analyses were performed using reversed-phase chromatography on a Separon SGX C18 column with a mobile phase of methanol-water (pH 3) and ultraviolet detection at 222 nm. The method was used for pharmacokinetic studies in rabbits. |
8044289 | Gas chromatography applied to the lactulose-mannitol intestinal permeability test. | Intestinal permeability can be modified by various illnesses, trauma and sepsis. Alterations of the intestinal wall can facilitate the diffusion of potentially harmful substances such as endotoxins, as well as bacterial translocation. We describe the validation of a capillary gas chromatographic method for the determination of mannitol and lactulose, used as intestinal permeability probes. The method is linear up to 3 g/l for mannitol and 300 mg/l for lactulose; recovery from overload samples is between 92 to 110%. Intra-assay coefficients of variation (C.V.s) were 2.7 and 6.8% for mannitol and lactulose, respectively, and inter-assay C.V.s were 8.9 and 9.3%. Normal values for 25 healthy subjects (mean +/- S.D.) were 14.5 +/- 3.1% and 0.27 +/- 0.15% for mannitol and lactulose, respectively. The GC method presented is rapid and precise. |
8044288 | Determination of urinary excretion of histamine and 1-methylhistamine by liquid chromatography. | Urinary histamine (Him) and 1-methylhistamine (MH) were determined by liquid chromatography (LC) using on-column derivatization coupled with a column-switching technique. An intact urine sample without any purification was applicable to the LC system because all steps for purification and fluorescence derivatization were fully automated. It was observed that the concentrations of Him and MH increased after hydrolysis of the urine, suggesting the presence of conjugated Him and MH. The level of total/free Him in urine was significantly higher in cancer patients than in normal subjects. Further, a significant correlation between Him and MH was observed in the hydrolysed urine of both normal subjects and cancer patients. |
8044287 | Endogenous synthesis of N-methylnorsalsolinol in rat brain during in vivo microdialysis with epinine. | The in vivo metabolic pathway for the synthesis of N-methylnorsalsolinol, an analogue of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), was studied in the rat brain. N-Methyldopamine (epinine) was perfused at the striatum of the rat brain by in vivo microdialysis. N-Methylnorsalsolinol (NMNSAL) was identified in the brain dialysate after epinine perfusion using gas chromatography-selected-ion monitoring mass spectrometry (GC-SIM-MS). We demonstrated that NMNSAL could be synthesized from epinine with an aldehyde by the Piclet-Spengler condensation reaction in the rat brain. |
8044286 | Determination of L-2-oxothiazolidine-4-carboxylic acid (Procysteine) in human plasma by high-performance liquid chromatography. | A new high-performance liquid chromatographic (HPLC) method has been developed for the determination of the cysteine prodrug, L-2-oxothiazolidine-4-carboxylic acid (Procysteine), in human plasma. Samples were mixed with 5% metaphosphoric acid and the supernatants chromatographed using a reversed-phase analytical column. Procysteine was detected spectrophotometrically at 230 nm and quantitated by comparison with a standard curve of known amounts of Procysteine (20-1000 microM) in plasma. The coefficients of variation for 48.6 microM and 676 microM control pools were 6.5 and 4.0% respectively (n = 46). Deviations from the expected concentrations were less than 2%. The method has been utilized to evaluate the pharmacokinetics of a wide range of oral and intravenous doses. |
8044285 | Determination of a new immunosuppressant, mycophenolate mofetil, and its active metabolite, mycophenolic acid, in rat and human body fluids by high-performance liquid chromatography. | Mycophenolate mofetil, a new immunosuppressant, is a morpholinoethyl ester of mycophenolic acid. A new selective, sensitive and simple high-performance liquid chromatographic method was developed for the determination of mycophenolic acid and mycophenolate mofetil in biological samples. The preparation of samples was based on liquid-liquid extraction. The compounds were separated on a CN column using acetonitrile-0.01 M phosphate buffer (1:4, v/v) as the mobile phase. UV detection was used at wavelengths 215 and 304 nm. The detection limit was 5 ng per injection volume. This method enabled pharmacokinetic and pharmacodynamic studies in humans and rats. |
8044284 | New chiral high-performance liquid chromatographic methodology used for the pharmacokinetic evaluation of dexfenfluramine. | A new chiral high-performance liquid chromatographic (HPLC) method utilizing ultraviolet (UV) detection has been developed for determining plasma and urinary concentrations of d-fenfluramine and its major metabolite d-norfenfluramine, while being able to determine the possible presence of l-fenfluramine after oral administration of enantiopure d-fenfluramine hydrochloride. Sensitivity, stability, and specificity were enhanced by derivatizing the extracted analytes with 3,5-dinitrophenylisocyanate while utilizing a Pirkle-type chiral recognition approach. In vitro and in vivo statistical data are analogous. Overall plasma inter-assay precision was less than 7% with a minimum quantitation limit of 10 ng/ml. Overall urine inter-assay precision was also less than 7% with a minimum quantitation limit of 25 ng/ml. |
8044283 | Determination of amide-type local anaesthetics by direct injection of plasma in a column-switching high-performance liquid chromatographic system using a pre-column with a semipermeable surface. | A high-performance liquid chromatographic method using column switching was applied to the direct determination of two local anaesthetics, ropivacaine and bupivacaine, in human plasma. The method is intended to be used in a combined LC-GC system; here only the LC-part is described. After addition of internal standard, the samples were filtered and directly injected into a semipermeable surface (SPS) pre-column where the analytes were strongly retained and separated from many endogenous compounds by a short washing step. The retained analytes were transferred by a buffered methanol phase from the pre-column into a carbonaceous HPLC column and they were detected by UV detection at 254 nm. The SPS pre-column could withstand numerous (> 200) direct injections of plasma samples (10 microliters). The method has a detection limit of 8.2 ng and requires a total assay time of 15 min per plasma sample. Quantitative recoveries were obtained over the range 3.3-114 micrograms/ml with inter-day precisions of 1.6-5.2% (C.V.). |
8044282 | Simultaneous determination of dihydrocodeine and its metabolites in dog plasma by high-performance liquid chromatography with electrochemical and ultraviolet detection. | An HPLC method with electrochemical and UV detection was established for the simultaneous determination of dihydrocodeine and its metabolites, dihydronorcodeine, dihydromorphine, and dihydrocodeine glucuronide, in dog plasma using N-ethylnormorphine as the internal standard. The method involved sample pretreatment with a C18-bonded disposable column, and the injected fraction was separated and detected on the C18-bonded column with serially coupled UV and coulometric detectors. Dihydromorphine was detected with the coulometric detector at 0.4 V, and dihydrocodeine and dihydronorcodeine at 0.8 V. Dihydrocodeine glucuronide was detected with UV at 210 nm. Recoveries of the studied compounds were quantitative at the individual assay ranges, and validation of the assay gave results that were satisfactory in terms of within-run or between-run precision and accuracy. Lower limits of quantitation were 2 ng/ml for dihydrocodeine and dihydronorcodeine, 0.5 ng/ml for dihydromorphine, and 200 ng/ml for dihydrocodeine glucuronide. |
8044281 | Optimization of a column liquid chromatographic procedure for the determination of plasma salbutamol concentration. | A reversed-phase column liquid chromatographic procedure with fluorescence detection for the determination of salbutamol in plasma is described. A l-ml aliquot of the sample, after the addition of bamethan as the internal standard, is passed through a Bond Elut silica extraction column. The column is selectively washed to remove neutral, acidic, and weakly basic compounds. The desired compounds are eluted with a l-ml aliquot of methanol. The eluate is evaporated under vacuum at ambient temperature and the residue is reconstituted in 40 microliters of the mobile phase which contains octanesulfonic acid as the ion-pairing reagent. The entire extract is injected onto a 150 x 4.6 mm I.D. column packed with 5-micron octylsilica particles. Peaks are detected with a fluorescence detector (excitation wavelength = 275 nm, emission wavelength = 310 nm). In the resulting chromatogram, salbutamol and the internal standard give sharp peaks that are well resolved from the extraneous peaks. The procedure allows the quantitation of salbutamol down to 0.2 ng/ml. |
8044280 | Size- and density-dependent elution of normal and pathological red blood cells by gravitational field-flow fractionation. | Elution of normal and pathological human red blood cells (RBCs) was performed by gravitational field-flow fractionation (GFFF). The reproducibility of the retention factor was lower than 10% and elution at high and low flow-rates confirmed the existence of "lifting forces". No direct correlation between size and retention was observed for normal RBCs in the absence of density information. Elution of pathological human RBCs, known to be modified in shape, density and rigidity, was performed. The elution parameters confirmed that the retention mechanism of RBCs is at least density dependent but that other factors can be involved, such as shape or deformity. Moreover, peak profile description parameters (standard deviation and asymmetry) can be qualitatively related to some biophysical parameters. Numerous elution characteristics can be linked to cell properties described in the literature and although GFFF appeared to have limited capabilities in terms of size analysis it appeared to be a versatile tool for studying cell biophysical characteristics. |
8044279 | Enhanced separation and detection of serum bilirubin species by capillary electrophoresis using a mixed anionic surfactant-protein buffer system with laser-induced fluorescence detection. | The four major bilirubin species in serum are separated by capillary electrophoresis and detected using laser-induced fluorescence detection. The optimum buffer system consists of 40 mM sodium dodecyl sulfate (SDS)-0.012 mM bovine serum albumin (BSA). The use of the SDS-BSA mixture in the mobile phase allows for the separation of four major bilirubin species at physiological pH with untreated capillaries. The results show that the use of BSA as a run buffer modifier in SDS solution improves separation efficiency and increases sample solubility via pH changes of the run buffer. The limits of detection for the bilirubin species using laser-induced fluorescence are between 30 and 150 nM, depending on the bilirubin species; not only is this approximately two orders of magnitude lower than with visible-light absorption methods, it allows the bilirubin species in normal sera to be quantitatively measured without sample pretreatment. |
8044278 | Rapid measurement of the monoamine content in small volumes of rat plasma. | A method for the simultaneous measurement of serotonin, catecholamines, and their metabolites, 5-hydroxy-indoleacetic acid, homovanillic acid, and 3, 4-dihydroxyphenylacetic acid, by ultrafiltration and microbore high-performance liquid chromatography with dual electrochemical detection in small plasma volumes was established. Unlike the traditional assays which require at least 1-2 ml of plasma for each measurement, the present method uses only a 20-microliters sample volume. Since blood loss is minimal, repeated blood sampling from a single animal as a rat becomes practicable. The present microassay provides low detection limits (signal-to-noise ratio = 3) for all analytes (0.2-0.5 pg per 5-microliters injection or 50-120 pg/ml plasma). Isocratic separation of these analytes on a microbore column is achieved within 15 min. This rapid and sensitive method can be used as a routine research tool in various physiological or pharmacokinetic studies especially in small animals. |
8044277 | Determination of urinary glucuronide conjugates by high-performance liquid chromatography with pre-column fluorescence derivatization. | A simple and highly sensitive high-performance liquid chromatographic method for the direct determination of urinary glucuronide conjugates is described. The method is based on the direct derivatization of the glucuronic acid moiety in glucuronide conjugates with 6,7-dimethoxy-1-methyl-2 (1 H)-quinoxalinone-3-propionylcarboxylic acid hydrazide. The derivatization reaction proceeds in aqueous solution in the presence of pyridine and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide at 0-37 degrees C. The resulting fluorescent derivatives are separated on a C18 column using methanol-acetonitrile-0.5% triethylamine in water (1:1:2, v/v) as mobile phase, and are detected spectrofluorimetrically at 445 nm with excitation at 367 nm. The detection limits (signal-to-noise ratio = 3) for the glucuronides are 13-48 fmol for an injection volume of 10 microliters (130-480 fmol per 5 microliters of human urine). The method was applied to the measurement of etiocholanorone-3-glucuronide and androsterone-3-glucuronide in human urine. The method is simple and rapid without conventional liquid-liquid extraction of the glucuronides from urine. |
8044275 | Toxic aldehydes formed by lipid peroxidation. I. Sensitive, gas chromatography-based stereoanalysis of 4-hydroxyalkenals, toxic products of lipid peroxidation. | An efficient analytical method is presented that does not only allow to detect and quantify 4-hydroxyalkenals, but for the first time provides a tool to look at the enantiomeric ratio of these interesting lipid peroxidation products. It involves acetylation as the only derivatization step, which can be carried out under mild conditions with acetic anhydride and gas chromatography on a chiral permethyl cyclodextrin phase. All biologically important homologues (C5-C9) can be selectively observed in a single chromatographic run. The resolution allows a reliable quantification of the enantiomers. The method was successfully applied in the stereoanalysis of 4-hydroxynonenal formed in rat liver microsomes after treatment with ADP/Fe2+. |
8044276 | Study on measurement of delta-aminolevulinic acid in plasma by high-performance liquid chromatography. | A method for the determination of delta-aminolevulinic acid in plasma of lead-exposed workers by high-performance liquid chromatography with fluorescence detection of a fluorescent delta-aminolevulinic acid derivative (2-methylidineamino-3,5-diacetyl-4,6-dimethylpropionic acid) was established. The detection limit of delta-aminolevulinic acid in plasma was 0.01 microgram/ml at a signal-to-noise ratio of 5:1. A linear correlation was obtained between the amounts of delta-aminolevulinic acid injected from 0.01 to 0.5 microgram/ml (r = 0.999). The recovery of 0.05 and 0.1 microgram/ml of delta-aminolevulinic acid added to plasma with various concentrations of delta-aminolevulinic acid in plasma ranged from 80.0 to 100.8%. This method, combined with the use of an automatic sampler, should facilitate the routine measurement of delta-aminolevulinic acid in plasma. |
8044267 | On 'being led by the nose'. Rapid detection of inborn errors of metabolism. | We reviewed and emphasized the importance of olfaction for the diagnosis of inborn errors of metabolism. The "trained" nose has a remarkable sensitivity and specificity for discriminating odors that are associated with certain inborn errors of metabolism. These odors are often the first abnormality noticed on physical examination and should prompt the pediatrician to seek confirmatory laboratory studies. |
8044266 | Prognostic significance of left ventricular diastolic indexes in beta-thalassemia major. | To define the prognostic significance of left ventricular diastolic function in patients with beta-thalassemia major by noninvasive M-mode echocardiography and Doppler measurements. Cohort analytic study. A university hospital in Taipei, Taiwan. Forty-five patients (age range, 4 to 25 years) with transfusion-dependent beta-thalassemia major followed up for 5 years. None. M-mode and Doppler echocardiography were used to determine the left systolic time interval; ejection fraction; left atrium emptying index; isovolumetric relaxation period; diastolic total period; the duration, slope, and height of the early diastolic flow-velocity peak; and the ratio between the heights of early and atrial diastolic flow-velocity peaks. All patients had normal systolic ventricular function initially, but impaired diastolic function developed, especially in the older age group who had more evidence of iron loading. In nine of those with abnormal diastolic total period (n = 10) and duration of the early diastolic flow-velocity peak (n = 12) values, regardless of age, congestive heart failure developed during the period of follow-up. Of these nine, four died within 2 years after the advent of heart failure and five remained compensated after anticongestive treatment and use of deferoxamine mesylate. The presence of an abnormal diastolic total period and duration of the early diastolic flow-velocity peak values correlated well with the prognosis. Left ventricular diastolic filling variables by echocardiography are important predictors of the outcome of patients with transfusion-dependent beta-thalassemia major and could provide useful measures in determining the effects of medication during long-term follow-up. |
8044265 | Tics and dyskinesias associated with stimulant treatment in attention-deficit hyperactivity disorder. | To determine the incidence of tics or dyskinesias (T/D) and examine associated clinical factors in children treated with stimulant medications for attention-deficit hyperactivity disorder. Cross-sectional analysis of a clinic cohort with chart review. Hospital-based clinical service within a division of developmental and behavioral pediatrics. One hundred twenty-two children with attention-deficit hyperactivity disorder treated with stimulant medication. All children currently or recently treated were included. None. Determinations were made of medication used, medication dosage, presence or absence of T/D, time of T/D onset, and history and family history of T/D. Incidence of T/D was 9.0% of children or 8.2% of medication trials. One child (0.8%) had development of Tourette's syndrome. Age, medication, dosage, history of tics, or family history of tics was not related to onset of T/D. Approximately 9% of children with attention-deficit hyperactivity disorder treated with stimulant medication had development of T/D, predominantly transient in nature, with less than 1% having development of chronic tics or Tourette's syndrome. Personal or family tic history, medication selection, or dosage was not related to onset of T/D. |
8044264 | Escherichia coli septicemia in nonperforated appendicitis. | To determine the association between nonperforated appendicitis and Escherichia coli septicemia, and the frequency with which blood cultures are obtained in the clinical setting of appendicitis. Three case reports of E coli septicemia and nonperforated appendicitis and a retrospective survey. Children's Medical Center, Dallas, Tex, a primary care and tertiary referral center. All children admitted in a 2-year period with a diagnosis of appendicitis. None. Preoperative blood cultures were obtained in 20 (21%) of 96 patients with histologic evidence of appendicitis. Fifty percent of the patients had gross or microscopic evidence of appendiceal perforation. Twelve (25%) of the 48 patients with perforated appendicitis had blood cultures obtained before the initiation of antimicrobial therapy, and in two of these patients (17%) the results were positive. Blood cultures were drawn before antibiotic therapy in four (8%) of the 48 patients with nonperforated appendicitis, and in two of these the results were positive. The blood culture isolates (coagulase-negative Staphylococcus and E coli) were the same in both groups. Nonperforated appendicitis and septicemia may be more common than formerly appreciated. Only a prospective study can determine the true incidence of septicemia in children with perforated or nonperforated appendicitis. |
8044263 | Lack of association of glucocorticoid therapy and retinopathy of prematurity. | To determine if glucocorticoid therapy alters the severity of retinopathy of prematurity (ROP). Retrospective survey. Tertiary intensive care nursery. One hundred forty-seven surviving infants with birth weight of 1.25 kg or less born July 1990 through January 1993. Maximum stage of retinopathy and the need for cryosurgery. Using logistic regression, neither corticosteroid exposure nor total corticosteroid dose was associated with either ROP greater than stage 2 or cryosurgery. The significant predictors of ROP greater than stage 2 were birth weight and the duration of supplemental oxygen therapy. The only significant risk factor for cryosurgery was gestational age. No association between corticosteroid therapy and the severity of ROP was found after controlling for traditional risk factors such as birth weight, gestational age, and duration of supplemental oxygen therapy. |
8044262 | Attitudes of pediatricians and pediatric residents toward obtaining permission for autopsy. | To investigate attending physician and resident attitudes and factors affecting autopsy consent. A validated, self-report, multiple-choice questionnaire was administered to 158 physicians. The overall response rate was 113 (72%), with 57 (85%) of 67 pediatric residents and 51 (56%) of 91 attending physicians responding. The status of five respondents was unknown. Most respondents (98%) believed autopsies provide valuable information; physicians who had graduated before 1980 were more likely to believe that the benefits of autopsy should be taught (P < or = .002). Autopsy was considered unnecessary by 20% (22/112) when the disease was known before death and by 11% (12/112) when the patient was designated "do not resuscitate." Physicians who did not attend an autopsy while in training were less likely to believe in the benefits of autopsy (P < or = .02). Factors that influenced the failure to obtain consent for an autopsy were physician belief that the family felt the body would be desecrated (30/81 [37%]); physician belief that the family would be upset (36/104 [35%]); and physician belief that little information would be obtained (19/104 [18%]). Fourteen (17%) of 81 physicians indicated that they do not ask permission for autopsy if the family is upset. Most physicians believe autopsies have benefit. If the autopsy rate is to improve, physicians in training will require increased exposure to autopsies, education regarding the potential benefits, and enhancement of interpersonal skills for successful communication with families in crisis. |
8044256 | Risk factors for bronchopulmonary dysplasia after extracorporeal membrane oxygenation. | To determine risk factors for the development of bronchopulmonary dysplasia (BPD) after treatment with extracorporeal membrane oxygenation (ECMO). Retrospective case-control study. Tertiary care level 3 neonatal intensive care unit. Seventy-three newborns treated with ECMO for severe respiratory failure during a 5-year period, who survived until day of life 28, and who did not have pulmonary hypoplasia as the initial cause for respiratory failure. None. The presence of BPD after treatment with ECMO, which was defined as oxygen and/or ventilatory requirements at day of life 28, with characteristic abnormalities seen on chest x-ray film. The age at ECMO initiation was significantly greater for patients with BPD compared with patients without BPD (mean +/- SD, 135 +/- 68 hours vs 50 +/- 37 hours; P < .001). There was an 11.5-fold increased risk for the development of BPD if ECMO was initiated at greater than 96 hours of age. The primary diagnosis of respiratory distress syndrome imparted a 5.2-fold increased risk for the development of BPD. Patients with BPD required ECMO significantly longer than patients without BPD (203 +/- 73 hours vs 122 +/- 51 hours; P < .001). These results demonstrate that delayed use of ECMO in treating neonatal respiratory failure is associated with an increased risk for the development of BPD and a longer duration of ECMO therapy. |
8044255 | Maternal-newborn human immunodeficiency virus infection in Harlem. | To determine the prevalence of human immunodeficiency virus type 1 (HIV-1) infection and its association with illicit drug use for mothers being delivered of infants at an inner-city municipal hospital. We anonymously tested the umbilical cord blood for HIV-1 antibody of 98.1% (2971/3028) of singleton infants with birth weight greater than 500 g born during 1989 and linked the results to a maternal-infant database from which all identifying information had been removed. Overall, HIV-1 seroprevalence was 3.3% (99/2971). Among HIV-1-seropositive mothers, 79% (78/99) gave no history of ever using injected drugs. Seropositivity for HIV-1 was independently associated with history of maternal cocaine use during pregnancy (odds ratio, 3.55; 95% confidence interval, 2.18, 5.78), history of ever using injected drugs (odds ratio, 6.02; 95% confidence interval, 3.14, 11.6), positive serologic test result for syphilis during pregnancy (odds ratio, 3.37; 95% confidence interval, 1.94, 5.88), and increasing maternal age per year (odds ratio, 1.04; 95% confidence interval, 1.00, 1.09). Voluntary testing programs failed to identify 71% (70/99) of all HIV-1-infected women. Infants placed into foster care were eight times more likely to be HIV-1 seropositive than those discharged to their mothers. Most HIV-1-infected mothers seem to have acquired the infection via heterosexual transmission rather than via injected drug use. Associations of maternal HIV-1 infection with cocaine use, syphilis, and increasing age probably operate through behaviors that increase maternal risk of exposure to an HIV-1-infected sexual partner or, in the case of syphilis, also through biologic factors that may predispose to HIV-1 transmission. The failure of voluntary testing to identify most HIV-1-infected mothers provides a strong rationale for routine HIV-1 testing during pregnancy and in the newborn period. |
8044254 | Timing and rate of sexual maturation and the onset of cigarette and alcohol use among teenage girls. | To test the hypothesis that the patterns of pubertal progression, early vs late puberty and fast vs slow, are associated with the age at which girls start to drink alcohol and smoke cigarettes. The study included 1463 female students, 10.7 to 18.2 years of age, who were assessed five times during the 2.7-year study. Data regarding pubertal stage, alcohol use, and cigarette use were obtained at each assessment. These data were used to calculate two indexes of pubertal development, the age at which the midpoint of puberty was achieved and the rate of progression through puberty, and the ages when each subject first drank, first drank moderate amounts of alcohol, and first smoked. Girls with earlier puberty (midpoint < 12.2 years) first reported drinking any alcohol at a median age of 12.5 years, 0.7 years younger than girls whose puberty was later. Similarly, girls with earlier puberty reported drinking moderate amounts of alcohol at a median age of 13.7 years, 0.9 years younger than girls with later puberty. Girls with earlier puberty further reported first smoking cigarettes at a median age of 12.8 years, 0.6 years younger than girls with later puberty. The rate of pubertal progression was significantly associated only with the age when girls first drank moderate amounts of alcohol. Earlier puberty is associated with a younger age of onset for both drinking and smoking among adolescent girls. |
8044253 | Eating disorders and health insurance. | Eating disorders are being diagnosed and managed by an increasing number of pediatricians and practitioners of adolescent medicine. These physicians are increasingly discovering the power and importance of their patients' health insurance status in the management of these conditions because the lack of appropriate insurance may often pose obstacles and barriers to care. This article provides an analysis of this situation through brief case presentations followed by a discussion and recommendations. |
8044251 | Renal toxicity and arterial hypertension in rats chronically exposed to vanadate. | The effects of 1, 10, or 40 micrograms/ml of vanadium, given for six or seven months as sodium metavanadate in drinking water on cardiovascular and biochemical variables and the electrolyte metabolism of male Sprague-Dawley rats were investigated. At the end of the exposure period, all animals exposed to vanadate had increased systolic and diastolic blood pressure. This effect was not dose dependent and heart rate and cardiac inotropism were not affected. The role of defective renal function and electrolyte metabolism in such effects was supported, in the rats exposed to 10 and 40 ppm of vanadium, by the following changes: (a) decreased Na, + K(+)-ATPase activity in the distal tubules of nephrons; (b) increased urinary excretion of potassium; (c) increase in plasma renin activity and urinary kallikrein, kininase I, and kininase II activities; (d) increased plasma aldosterone (only in the rats treated with 10 ppm of vanadium). The alterations in the rats exposed to 1 ppm of vanadium were: (a) reduced urinary calcium excretion; (b) reduced urinary kallikrein activity; (c) reduced plasma aldosterone. These results suggest that blood hypertension in rats exposed to vanadate depends on specific mechanisms of renal toxicity related to the levels of exposure. |
8044250 | Biological effects of inhaled magnesium sulphate whiskers in rats. | Male Wistar rats were exposed to two types of magnesium sulphate whiskers by inhalation for six hours a day, five days a week, for four weeks (sub-chronic study), or for one year (chronic study) to clarify the biological effects of the whiskers. There were few whiskers detected in the rat lungs even at one day after the exposure, suggesting that they are dissolved and eliminated rapidly from the lungs. To measure the clearance rate of the whiskers from the lungs, an intratracheal instillation was performed in golden hamsters. The half life of the whiskers in the lung was determined as 17.6 minutes by temporally measuring the magnesium concentration up to 80 minutes after the instillation. A histopathological examination indicated a frequent occurrence of adenoma and carcinoma in the year after chronic exposure, but it was not significantly different between exposed and control rats. |
8044249 | Dietary and ethanol induced alterations of the toxikokinetics of toluene in humans. | This study was undertaken to evaluate the influence of a carbohydrate restricted diet, a subacute ethanol intake, and their combined effect on the kinetics of toluene in humans. Eight healthy male volunteers were exposed by inhalation at four different occasions to 200 mg/m3 2H8-toluene for two hours at a work load of 50 W after a one week low (30%) carbohydrate (CH) diet or high (60%) CH diet with (+EtOH) or without (-EtOH) ethanol consumption (47 g ethanol) on the evening before exposure. Deuterium labelled toleune was used to measure the excretion of hippuric acid originating from toluene separately from hippuric acid from other sources. The results indicated that subacute ethanol consumption combined with a carbohydrate restricted diet, may enhance the metabolism of toluene in humans at an exposure concentration of 200 mg/m3. The cumulative amount of hippuric acid excreted in the urine up to 20 hours after the end of exposure in % of the net uptake of toluene was enhanced by 22% (p = 0.05) in the low CH + EtOH compared with the low CH-EtOH experiment. The apparent blood clearance of toluene was 37% higher in the low CH + EtOH than in the low CH-EtOH experiment, but this effect was not statistically significant (p = 0.1). There were no significant changes in the kinetics of toluene as a result of a low carbohydrate diet alone. Neither did subacute ethanol intake without the combination with a carbohydrate restricted diet influence the kinetics of toluene. |
8044248 | Morbidity follow up study of BASF employees exposed to 2,3,7, 8-tetrachlorodibenzo-p-dioxin (TCDD) after a 1953 chemical reactor incident. | The aim was to examine the long term morbidity experience of men exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). A retrospective cohort morbidity study of 158 men first exposed to TCDD between 17 November 1953 and 16 November 1954 subdivided by chloracne state and back calculated TCDD blood lipid concentration, and 161 referents. Cause specific illness absence and admissions to hospital were examined between 1953 and 1989. On an ever or never basis, thyroid disease and appendicitis were diagnosed more often in the study group; these diseases were not differentially distributed by chloracne state, but were increased in the high TCDD subgroup. An 18% increase in total illness episodes was also seen (p = 0.002); illness rates increased with severity of chloracne and higher TCDD concentration within the chloracne subgroup. There were increases in infectious and parasitic diseases (primarily ill defined intestinal infections), disorders of the peripheral nervous system and sense organs, upper respiratory tract infections, and other skin diseases. Several of these increases correlated with chloracne state and infections disease episodes increased with higher TCDD concentration as well. Occurrences of mental disorders correlated with severity of chloracne, but not TCDD concentration. Benign and unspecified neoplasms were marginally increased in the severe chloracne and high TCDD subgroups. Chronic liver disease was marginally increased in the high TCDD subgroup. Findings relative to occurrence of ulcers, chronic lung disease, and kidney and metabolic disorders were unremarkable. For various conditions, increased illness episodes were seen among TCDD exposed employees compared with referents and were associated with either or both chloracne severity and back calculated TCDD concentration. The results are derived from insurance data; hence, it is possible that heightened awareness and personal health concerns led to greater utilisation of medical services in the exposed group. The findings based on TCDD concentration should be less subject to this potential bias. |
8044247 | Occupational paternal exposure to benzene and risk of spontaneous abortion. | The purpose of this study was to evaluate the risk of spontaneous abortion among the wives of male workers occupationally exposed to benzene. The wives of 823 men working in two chemical plants at the time of the study were asked to complete a questionnaire describing their pregnancies. The analysis of the 1739 pregnancies that ended in a spontaneous abortion or a birth is presented. The firms' payroll records provided all workers' employment history, including dates. Benzene exposure, graded at two levels (< 5, > or = 5 ppm), was determined for every job, so that benzene exposure for each worker's entire professional life (at these companies) could be assessed. This information was linked to the dates of the pregnancies reported in the questionnaires to enable the exposure status of each pregnancy to be defined (1270 non-exposed and 274 exposed). The frequency of spontaneous abortion, defined as the number of spontaneous abortions divided by the total of spontaneous abortions and births was evaluated. When adjusted for tobacco consumption, mother's age and pregnancy order, the odds ratio of the association between paternal exposure to approximately 5 ppm of benzene and the risk of spontaneous abortion was close to and statistically not different from unity (OR = 1.1; 95% CI (0.7-1.8). In this study paternal exposure to benzene did not increase the risk of spontaneous abortion. |
8044246 | Association of rotating shiftwork with preterm births and low birth weight among never smoking women textile workers in China. | 1035 married women workers in three modern textile mills in Anhui, China were surveyed to investigate the association of rotating shiftwork with low birth weight and preterm birth in 1992. Information on reproductive health, occupational exposure history, and other covariates including age at pregnancy, time and duration of leave from job since pregnancy, and mill location was obtained by trained nurses with a standardised questionnaire. This analysis was limited to 845 women (887 live births), who were middle or high school graduates, never smokers, and non-alcohol drinkers. About 72% of the women worked an eight day cycle with shift changes every two days throughout pregnancy. Mean gestational age was 38.8 and 39.0 weeks for shift and regular schedule workers, respectively. Multiple linear regression was used to adjust for confounding factors including maternal age at pregnancy, order of live birth, mill location, job title, occupational exposure to dust/gases/fumes, stress, carrying and lifting of heavy loads, working in a squat position, time and duration of leave from the job since pregnancy, and indoor coal combustion for heating. The adjusted difference in gestational age associated with rotating shifts was statistically significant (beta = -0.44 (SE 0.20) weeks.) Mean birth weights were 3248 g and 3338 g for rotating shift workers and regular schedule workers respectively. The estimated effect of rotating shiftwork on birth weight was -79 (SE 42) g. When the analysis was restricted to first order live births or to production workers, the estimated effects of rotating shiftwork on both gestational age and birth weight were significant. The proportions of preterm birth (<37 weeks) and low birth weight (<2500 g), respectively, were 20% and 9% for shift workers and 15% and 6% for regular schedule workers. The adjusted odds ratio of shiftwork was 2.0 (95% CI) 1.1-3.4) for preterm birth and 2.1 (95% CI 1.1-4.1) for low birth weight. This association remained significant when the analysis was restricted to production workers or first order live births. |
8044245 | Relation between lung asbestos fibre burden and exposure indices based on job history. | Lung asbestos burden was compared with exposure indices derived from job history interviews in 42 male subjects originating from the Montréal Case-Control Study project, 12 of whom had documented asbestos exposed job histories. Job interview data consisting of a chronological timetable of job histories were translated into detailed exposure indices by an expert group of hygienists and chemists. Total and individual asbestos fibre type concentrations were quantified by transmission electron microscopy with fibre identification by energy dispersive chi ray spectrometry after deparaffinisation of tissue blocks and low temperature plasma ashing. Geometric mean or median asbestos content was higher in subjects with an asbestos exposed job history than those without for retained dose of amosite, total commercial amphiboles, and total asbestos fibre. Except for crocidolite fibre diameter, which was significantly less in the lungs of exposed workers, no consistent differences were found in measurements of fibre dimension for any fibre type. Subgroups of subjects exposed to silica, metals, or smokers and non-smokers without significant occupational exposure showed varying patterns of lung asbestos fibre type deficit compared with the asbestos exposed subgroup. There was an overall trend for higher lung asbestos content proportional to higher exposure indices for asbestos representing concentration, frequency, and reliability. These exposure indices as well as duration of exposure (in years) were independent predictors of total asbestos content in regression analyses when combined in a model with age. Stepwise regression indicated that exposure concentration was the most important variable, explaining 32% of the total variation in total asbestos content. Smoking, whether expressed in ever or never smoked dichotomy or in smoked-years, had no relation to lung asbestos content in this model. |
8044243 | Determinants of benzo(a)pyrenediol epoxide adducts to haemoglobin in workers exposed to polycyclic aromatic hydrocarbons. | The aim was to assess the determinants of benzo(a)pyrenediol epoxide adducts to haemoglobin (BaPDE-Hb) in workers exposed to polycyclic aromatic hydrocarbons (PAHs). This was a study of the correlations between the concentrations of PAHs in air, 1-hydroxyprene in urine, and BaPDE-Hb adduct concentration in the blood in 206 men working in steel foundries and one graphite electrode producing plant, taking into consideration confounding factors such as smoking and dietary habits. BaPDE-Hb adduct concentration was correlated (r = 0.26; p = 0.0002) with the airborne PAH concentration and was influenced by tobacco consumption but not by dietary habits. Benzo(a)-pyrene concentration in air, 1-hydroxypyrene concentration in urine, and duration of exposure to PAHs were not associated with the adduct concentration. Although environmental exposure to PAHs was statistically associated with BaPDE-Hb adduct concentration, differences between individual subjects in the metabolism of benzo(a)pyrene probably play an important part in determining the amount of BaPDE-Hb adducts formed. |
8044244 | Pleural plaques and exposure to mineral fibres in a male urban necropsy population. | The study aimed to evaluate the risk of pleural plaques according to the degree of past exposure to asbestos, type of amphibole asbestos, and smoking, as well as to estimate the aetiologic fraction of asbestos as a cause of plaques among urban men. The occurrence and extent of pleural plaques were recorded at necropsies of 288 urban men aged 33 to 69 years. The pulmonary concentration of asbestos and other mineral fibres was analysed with scanning electron microscopy. The probability of past exposure was estimated from the last occupation. Pleural plaques were detected in 58% of the cases and their frequency increased with age, probability of past occupational exposure to asbestos, pulmonary concentration of asbestos fibres, and smoking. The risk of both moderate and widespread plaques was raised among asbestos exposed cases, and the risk estimates were higher for widespread plaques than for moderate plaques. The age adjusted risk was higher for high concentrations of crocidolite/amosite fibres than for anthophyllite fibres. The aetiologic fraction of pulmonary concentration of asbestos fibres exceeding 0.1 million fibres/g was 43% for widespread plaques and 24% for all plaques. The median pulmonary concentrations of asbestos fibres were about threefold greater among cases with widespread plaques than among those without plaques. No increased risk of pleural plaques was associated with raised total concentrations of non-asbestos fibres. The occurrence of pleural plaques correlated closely with past exposure to asbestos. The risk was dependent on the intensity of exposure. Due to methodological difficulties in detecting past exposures to chrysotile and such low exposures that may still pose a risk of plaques, the aetiologic fractions calculated in the study probably underestimate the role of asbestos. |
8044242 | Biological monitoring of workers exposed to cobalt metal, salt, oxides, and hard metal dust. | The aim was to examine the relation between environmental and biological (blood and urine) indices of exposure to different chemical forms of cobalt. A cross sectional study was undertaken in workers exposed to cobalt metal, oxides, and salts in a refinery and to a mixture of cobalt and tungsten carbide in a hard metal producing plant. Although biological monitoring of workers exposed to cobalt oxides showed higher blood and urine concentrations than in non-exposed subjects, these indices poorly reflected the recent exposure level. By contrast, when exposure was to soluble cobalt compounds (metal, salts, and hard metals), the measurement of urine or blood cobalt at the end of the workweek could be recommended for the assessment of recent exposure. An eight hour exposure to 20 or 50 micrograms/m3 of a soluble form of cobalt would lead to an average concentration in a postshift urine sample collected at the end of the workweek of 18.2 or 32.4 micrograms of cobalt/g creatinine, respectively. |
8044241 | Relations between respiratory symptoms and sickness among workers in the animal feed industry. | The survey aimed at studying the associations between prevalent respiratory symptoms in an occupational population and sickness absence due to respiratory disorders. A cross sectional survey among male workers in an animal feed mill was conducted. A total of 303 production workers and 102 office clerks completed a questionnaire on respiratory complaints, smoking habits, and occupational history. The questionnaire was used to identify workers with respiratory symptoms in the past 12 months. During this period all spells of sickness absence were recorded. Causes of sickness were classified in broad categories encompassing respiratory symptoms, influenza, musculoskeletal disorders, and others. Logistic regression analysis showed that workers with respiratory complaints experienced a higher sickness absence than those without respiratory complaints. Adjusted for age and smoking the odds ratio (OR) for sickness prevalence was 1.9 among office clerks and 2.6 among blue collar workers. Smoking increased the risk on sickness absence with ORs of 2.4 and 1.6, respectively. When restricting the analysis to sickness due to respiratory complaints, subjects with respiratory complaints had significantly higher risks for absence prevalence and absence rate than those without respiratory complaints. There were no differences in sickness absence between workers with asthma like complaints and those with chronic bronchitis like complaints. The clear associations between respiratory complaints and prevalence and rate of respiratory sickness absence indicate that workers with respiratory complaints are at risk of temporary disability and, thus, may experience a reduced ability to cope with routine activities at work. |
8044240 | Respiratory symptoms and ventilatory function in confectionery workers. | Respiratory symptoms and ventilatory capacity were studied in a group of 288 workers (259 women and 29 men) employed in a confectionery plant. A group of workers (96 women and 31 men) not exposed to confectionery manufacture were also studied as controls. The prevalence of chronic respiratory symptoms was higher in exposed than in control workers, being greatest for confectionery workers exposed to the dust of flour, talc, and starch and the vapours of alcohol. Chronic bronchitis was reported by 7% of the women and 21% of the men, and chest tightness was reported by 27% of women and 66% of men. There was a high prevalence of acute irritative symptoms during the workshift in all groups of confectionery workers, especially for cough, dyspnoea, burning and dryness of the throat, and eye irritation. For all groups of confectionery workers there were statistically significant across shift reductions in ventilatory capacity, being most pronounced for maximum flow rate at 50% of the control vital capacity (FEF50; range 4.6-13.0%) and at 25% of the control vital capacity (FEF25; range 4.7-22.3%). Preshift values of FEF50 and FEF25 were significantly lower than predicted values. The data suggest that some workers employed in confectionery plants may develop acute and chronic respiratory symptoms associated with changes in lung function. |
8044237 | Temporal epileptic seizures and occupational exposure to solvents. | Long term exposure to organic solvents is usually not considered as a possible cause of chronic epileptic seizures. A case that shows a remarkable coincidence between exposure to organic solvents and occurrence of epileptic seizures is reported. The man was a 58 year old sign writer with lifelong exposure to a mixture of organic solvents (mainly cyclohexanone, white spirit, and isopropanol). Epileptic seizures of temporal type were occurring in relation to solvent exposure. The seizures disappeared shortly after stopping exposure but returned just after a short term re-exposure to cyclohexanone. The case history suggests that exposure to organic solvents may elicit or maintain epileptic seizures despite medical treatment. |
8044236 | Occupational risk factors for renal cell carcinoma: a case-control study. | A case-control study of 196 histologically proved cases of renal cell carcinoma and 347 controls matched for age at interview, sex, hospital, and interviewer was conducted in France between 1987 and 1991. A complete occupational history was recorded for each patient and occupations were coded blindly according to the International Standard Classification of Occupations. In women, none of the risks were significant. Among men, after adjustment for the educational level, cigarette smoking, and Quetelet index before diagnosis, significantly increased matched odds ratios (ORs) were found for sales workers (OR = 2.1, 95% confidence interval (95% CI) 1.2-4.0), managers (OR = 3.3, 95% CI 1.2-8.9), and textile workers and tailors (OR = 6.2, 95% CI 1.1-33.7). For this last occupational group, an increase in risk was found with an increased duration of exposure. |
8044235 | Incidence of cancer among anthophyllite asbestos miners in Finland. | A cohort of 736 male and 167 female workers of two anthophyllite mines in Finland was followed up through the Finnish Cancer Registry for cancer in 1953-91. Compared with the total cancer incidence of the east Finnish population, the men had a raised risk of total cancer (standardised incidence ratio (SIR) 1.7; 95% confidence interval (95% CI) 1.4-1.9), mainly attributable to an excess in lung cancer (SIR 2.8; 95% CI 2.2-3.6). The risk of lung cancer was somewhat higher among workers classified as heavily exposed (SIR 3.2; 95% CI 2.4-4.1) than among those moderately exposed (SIR 2.3; 95% CI 1.5-3.6) and the risk increased with increasing smoking and with increasing time of work with exposure. There were four cases of mesothelioma v 0.1 expected, all in men who smoked and had had a long and heavy asbestos exposure. Among women, a non-significant excess in total cancer (SIR 1.5; 95% CI 0.9-2.4) was found in the subgroup with heavy exposure to asbestos. Anthophyllite asbestos seems to have high potency in the carcinogenesis of lung cancer and low potency in carcinogenesis of mesothelioma in comparison with the other types of asbestos. |
8044234 | Benzene toxicokinetics in humans: exposure of bone marrow to metabolites. | A three compartment physiologically based toxicokinetic model was fitted to human data on benzene disposition. Two separate groups of model parameter derivations were obtained, depending on which data sets were being fitted. The model was then used to simulate five environmental or occupational exposures. Predicted values of the total bone marrow exposure to benzene and cumulative quantity of metabolites produced by the bone marrow were generated for each scenario. The relation between cumulative quantity of metabolites produced by the bone marrow and continuous benzene exposure was also investigated in detail for simulated inhalation exposure concentrations ranging from 0.0039 ppm to 150 ppm. At the level of environmental exposures, no dose rate effect was found for either model. The occupational exposures led to only slight dose rate effects. A 32 ppm exposure for 15 minutes predicted consistently higher values than a 1 ppm exposure for eight hours for the total exposure of bone marrow to benzene and the cumulative quantity of metabolites produced by the bone marrow. The general relation between the cumulative quantity of metabolites produced by the bone marrow and the inhalation concentration of benzene is not linear. An inflection point exists in some cases leading to a slightly S shaped curve. At environmental levels (0.0039-10 ppm) the curve bends upward, and it saturates at high experimental exposures (greater than 100 ppm). |
8044233 | Occupational allergy after exposure to caddis flies at a hydroelectric power plant. | A cross sectional survey was conducted in a hydroelectric power plant in which the workforce was exposed to large numbers of caddis flies. 28 of 57 employees participated. About 50% of the participants reported work related eye, nose, and sinus symptoms and wheezing. Working in locations with greater exposure to caddis flies was significantly associated with work related symptoms. 17 workers (61%) were skin prick positive to a laboratory prepared caddis fly antigen (LCFA) made from the remains of caddis flies present in the plant and 11 (39%) had positive reactions to a commercial caddis fly antigen (CCFA). Workers stationed in heavily exposed areas were 3.7 times as likely to have a positive response to the LCFA (p = 0.009) and 5.3 times as likely to have a positive response to the CCFA (p = 0.036). 13 (46%) of survey respondents reported three or more work related symptoms. 10 (91%) CCFA positive workers reported three or more work related symptoms. Pulmonary function studies revealed slight, but not significantly decreased forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratios in workers who were skin test positive to either caddis fly preparation when compared with those who were negative. One worker who was skin test positive to both antigens had a cross shift fall in FEV1 of 20% predicted. Occupational allergy to caddis flies proved to be a significant health problem at this work site. |
8044232 | Quantitative relation between emphysema and lung mineral content in coalworkers. | The relation between quantified emphysema and measured lung content of coal and silica was investigated in the lungs of 264 deceased underground coalworkers who had been exposed to mixed coal and silica dust. Lung specimens obtained at postmortem and inflated and fixed under standard conditions were used to quantify the extent of emphysema and then to measure the amount of coal and silica present in the lungs at the time of death. These data were combined with clinical and other pathological information from the subjects. Multiple regression analysis showed that the extent of emphysema (E score) had a strong positive quantitative relation with coal content of the lungs (p < 0.0003), age (p < 0.0001), and smoking (p < 0.0001). There was a significant negative interaction of uncertain biological importance between coal content of the lungs and smoking (p < 0.004; E score = -1.79 + 0.62 coal + 0.06 age + 0.21 smoking -0.17 coal x smoking; adjusted R2 = 0.25). In lifelong non-smokers emphysema was particularly strongly related to coal content and age (coal: p < 0.001; age: p < 0.002; E score = -1.56 + 0.78 coal + 0.06 age; adjusted R2 = 0.66). The relation was basically unchanged by adding a lung silica content term. Emphysema score was highly negatively correlated with forced expiratory volume in one second (FEV1; % predicted, obtained within five years of death) (r = -0.44, p < 0.0001). Degree of lung fibrosis was highly positively associated with lung silica content (chi 2(1) = 12.9, p < 0.0003). These results provide strong evidence that emphysema in coalworkers is actually related to lung coal content. The role silica in development of emphysema, however remains unclear. |
8044231 | Occupational asthma in salbutamol process workers. | Occupational asthma after exposure to salbutamol in the pharmaceutical industry has not been previously reported. The occurrence of occupational asthma is described in two pharmaceutical process workers who were likely to have inhaled doses appreciably in excess of the therapeutic dose range. The findings do not lead to an unequivocal conclusion on the mechanism of the asthma but it was probably a pharmacological consequence of high exposure. |
8044229 | Balance measured by head (and trunk) tracking and a force platform in chemically (PCB and TCE) exposed and referent subjects. | To determine comparability of methods, postural sway was measured simultaneously with a force platform and a device that registers head (and trunk) movements (head tracking). The effects of age, sex, height, weight, shoe area, and grip strength on both measurements were examined in 162 subjects. To determine whether either method had advantages in detecting abnormal balance 46 reference subjects were compared with 116 people randomly selected from 500 residents whose well water was contaminated with polychlorinated biphenyls (PCBs) and trichloroethylene (TCE) from a metal casting plant. Speed, mean radius, and distance of sway were equally reproducible with both methods. Correlation coefficients were 0.672 with the eyes closed and 0.588 with the eyes open. The balance of those exposed to PCBs and TCE was significantly worse than that of unexposed subjects by both head tracking (1.50 + 71 cm/s v 1.27 + 0.36 cm/s; p < 0.034) and the force platform (4.93 + 1.56 N (kg force) v 4.29 + 1.14 N; p < 0.013) with the eyes closed and differences were also significant with the eyes open. Head tracking and the force platform produced equivalent results. Measurement by head tracking is recommended for field studies because the device is more portable and is less influenced by weight and height. Both methods showed impaired balance associated with years of exposure to PCBs and TCE. |
8044230 | An updated cohort mortality study of workers exposed to styrene in the reinforced plastics and composites industry. | Mortality data have been updated for a further 12 years for a cohort of workers in the reinforced plastics and composites industry with exposures to styrene monomer and other chemicals. The cohort consisted of 15,826 male and female employees who were exposed to styrene for at least six months between 1948 and 1977 at 30 participating manufacturing plants in the United States. A total of 1628 deaths were reported during the extended observation period, 1948-89. Mortality from several causes showed significant increases--namely, all causes, all cancers, oesophageal cancer, lung cancer, cancer of the cervix uteri, cancer of other female genital organs, hypertensive heart disease, certain non-malignant respiratory diseases, motor vehicle accidents, and homicides. When, however, mortality data were examined in terms of duration of employment, durations of styrene exposure, and cumulative styrene exposure no upward trend was detected in any of these causes of death. Most of the increases in mortality were among workers who were employed for only six months to a year or who had very low cumulative exposure (< 10 ppm-years). Therefore, the increased mortality was not likely to be related to exposure to styrene. Several explanations for the increased mortality are offered, including low socioeconomic class, smoking, and lifestyle factors characteristic of short term workers. There was no increased mortality from lymphatic and haematopoietic cancers overall or from any specific haematological malignancies. In particular, no increase in mortality from non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, or leukaemia was found. Furthermore, detailed exposure-response analyses did not show any relation between exposure to styrene and any of these haematological malignancies. The lack of an exposure-response relation further supports the conclusion that workers in the reinforced plastics industry in this study did not experience any increased risk of lymphatic and haematopoietic cancers as a result of their exposure to styrene. |
8044228 | A study of chromium induced allergic contact dermatitis with 54 volunteers: implications for environmental risk assessment. | Over the past 60 years, dose-response patch test studies by various methods have been conducted in an attempt to identify the minimum elicitation threshold (MET) concentration of hexavalent chromium (Cr(VI)) that produces an allergic response in Cr(VI) sensitive subjects. These data are not adequate, however, to provide an accurate estimate of the MET because of the variability in the patch testing techniques and the variability in diagnostic criteria used. Furthermore, the data were not reported in terms of mass of allergen per surface area of skin (mg Cr/cm2-skin), which is necessary for conducting occupational or environmental health risk assessments. Thus the purpose of this study was to determine the MET (mg allergen/cm2) for Cr(VI) and trivalent chromium (Cr(III)) by patch testing techniques. A patch test method that delivers a controlled amount of allergen per surface area of skin was used. A group of 54 Cr(VI) sensitised volunteers were patch tested with serial dilutions of Cr(VI) and Cr(III) to determine the cumulative response rate at several concentrations. The results indicate that the 10% MET for Cr(VI) based on the cumulative response was 0.089 micrograms Cr(VI)/cm2-skin. Only one of the 54 volunteers may have responded to 33 micrograms Cr(III)/cm2-skin, otherwise Cr(III) was unable to produce allergic contact dermatitis in these highly sensitive volunteers. Two supplemental studies were also conducted to assess whether the surface area of the patch and the concentration of Cr(VI) in the patch (related to patch thickness) were likely to influence the results. The data from these studies were used to assess the risk of developing allergic contact dermatitis due to contact with Cr(VI) and Cr(III) in soil. The findings indicated that soil concentrations at least as high as 450 ppm Cr(VI) and 165,000 ppm Cr(III) should not pose an allergic contact dermatitis hazard for at least 99.99% of the people in the community who might be exposed. |
8044227 | Vascular responses in chain saw operators. | The intensive use of chain saws is associated with development of the hand-arm vibration syndrome (vibration white finger). Objective testing for cold induced vasospasm was carried out on the fingers of 12 chain saw operators and 12 matched control men from a similar working environment. Two of the chain saw operators tested positive for vasospasm in the laboratory and another three had an abnormal result. All of the control subjects tested negative. Measurements of finger blood flow at different temperatures and during vibration of the hand were similar in the chain saw operators and controls. Use of the chain saw did not cause significant alterations in the plasma concentrations of von Willebrand factor antigen in either the long or the short term. |
8044226 | Hand-arm vibration syndrome among travertine workers: a follow up study. | In a six year follow up study of the handarm vibration syndrome, 62 stoneworkers operating hand held vibrating tools in 10 travertine quarries and mills were first investigated in 1985 and then in 1991. The frequency weighted acceleration of vibration from the rock drills and stone hammers used by the travertine workers exceeded 20 m/s2, indicating a hazardous work activity according to the proposal of the EC directive for physical agents. A clinical examination and a cold provocation test were repeated with the same procedures as those adopted at the time of the first survey. The stoneworkers were divided into groups according to current work state: active stoneworkers who continued to use powered tools during the follow up (n = 21, median exposure time 22 years), and ex-stoneworkers with retirement vibration free intervals of three years (n = 22, median exposure time 27.5 years) and of six years (n = 19, median exposure time 20 years). In the group of active stoneworkers, a 38% onset a new cases of vibration-induced white finger (VWF) was found during the follow up (p < 0.01). Among the retired stoneworkers affected with VWF (n = 24), one recovered from VWF, one showed improvement, 20 remained stationary, and two deteriorated. The ex-stoneworkers experienced no significant change in sensorineural disturbances and a decrease in musculoskeletal symptoms of the upper limbs. At the cold provocation test, the currently active stoneworkers with VWF showed, on a group basis, a delayed finger rewarming time between the two examinations (p = 0.002). An abnormal response to cold provocation persisted in the fingers of the ex-stoneworkers with VWF, even in those reporting subjective improvement. These findings indicate a tendency towards the irreversibility of sensorineural and VWF symptoms in a group of ex-stoneworkers with prolonged exposure to high vibration levels in the past. The increased occurrence of VWF in the active stone workers after a few extra years of vibrating tool usage argues for an urgent implementation of preventive measures in the stone industry. |
8044224 | Appointment access: planning to benchmark a complex issue. | Kaiser Permanente-Southern California Region carried out an external benchmarking project to improve appointment access. This article provides practical guidelines for planning a benchmark project around a complex issue such as appointment access. Before conducting external site visits, team members determined the goals of the project, defined internal processes, and identified 16 key elements of access (or those factors important to member satisfaction with appointment access). Once a questionnaire was finalized, external benchmark partners were identified and on-site visits conducted. On the basis of the on-site visits, team members identified innovative and best practices for each of the 16 key elements of access. Based on these recommendations, some improvements were made across the Southern California region, such as the elimination of provisional booking. Reports of the results have also been sent to Kaiser Permanente medical centers in the region and across the country. Each medical center is encouraged to use these results to internally improve its own appointment access. |
8044223 | Benchmarking in health care: turning challenges into success. | Since 1990, more than 120 partner hospitals have participated in 15 projects using a collaborative benchmarking approach developed by SunHealth Alliance. Medical records project. Twenty hospitals focused on activities that could reduce accounts receivable days in medical records for Medicare inpatients. Thirty-five key practices, as identified by correspondence and site visits for four benchmark hospitals, were reviewed with all 20 hospitals. Pneumonia project. Four hospitals focused on reducing the length of stay and mortality rates for pneumonia (DRG [diagnosis-related group] 89) patients. Each hospital formed internal task forces, who reviewed comparative data, analyzed their hospitals' internal care processes, determined opportunities for improvement, and chose best practices for implementation-including standardizing the sputum-collection process and developing a clinical path. Meeting the challenge. Hospitals should strive for innovation, seek new goals of excellence, and share their successes with other hospitals. |
8044222 | Clinical benchmarking improves clinical paths: experience with coronary artery bypass grafting. | Clinical paths and clinical benchmarking are consistent with, and readily adaptable to, any health care organization that espouses the principles of continuous quality improvement. In its initial clinical path project, Borgess Medical Center analyzed and streamlined the processes of caring for a coronary artery bypass graft (CABG) patient. Team discussions were driven by comparative data, specialty guidelines, peer review organization guidelines, patient financial statements, patient records, and the applicable literature. One year after the CABG clinical paths were implemented, average total charges to the patient dropped from $35,700 to $32,700. Average length of stay also dropped, from 11.1 to 9.7 days. The mortality rate held stable at 2.7%. Recognizing the opportunity to further improve its CABG clinical path, Borgess participated in MediQual's CABG benchmarking project. The team followed MediQual's five phases of clinical benchmarking: focus and opportunity assessment, outcome analysis and comparison, clinical process documentation, benchmark process comparison, and action planning, implementation, and monitoring. Using benchmark data provided by MediQual, the CABG benchmark team focused on the high-risk population and identified further opportunities for streamlining the CABG clinical pathway. Several areas for improvement were identified by comparing Borgess's practices to the benchmark hospitals. Developing a clinical path before beginning to benchmark "forced" Borgess Medical Center to develop a clear understanding of its own processes. This allowed the benchmark team to easily identify variances between its CABG processes and those of the benchmark hospitals and to select which variations the hospital should adopt. |
8044221 | The analysis of clinical outcomes: getting started in benchmarking. | Computerized clinical outcomes measurement systems are now routinely available to help physicians and hospital administrators assess and improve the quality of care in their organizations. The Voluntary Hospitals of America, Pennsylvania (VHA/PA), used MedisGroups data to help understand the processes of care that contributed to different clinical outcomes at different network hospitals. A physician subcommittee decided early on (1) to focus on the best outcomes rather than the poorest and (2) to determine the variations in processes of care that might have led to either superior or inferior clinical outcomes. For two common procedures, appendectomy and cesarean section, the subcommittee identified variation within comparative outcomes data, evaluated that variation, and studied and communicated to the rest of the hospital network the process that produced the best outcomes. These pilot projects set the stage for current clinical benchmarking within the VHA/PA system. The committee of physicians learned that each hospital develops its own approach to common clinical conditions. These approaches become standardized at each hospital in the form of institutional attitudes, beliefs, policies, and procedures. The methods of evaluation and treatment by hospital staff can significantly alter the clinical outcomes for the populations served. |
8044220 | Benchmarking: finding ways to improve. | This article provides health care organizations with a benchmarking methodology to use in comparing practices and processes to identify and actualize opportunities for improvement. The 15-step model can be used to guide internal and external benchmarking activities in a variety of health care settings. Two internal benchmarking case studies are illustrated: (1) one hospital used the Baxter model to evaluate its laparoscopic cholecystectomy services, and (2) another prepared for expansion of cardiac catheterization services. Two key factors of a successful benchmarking initiative are highlighted: management commitment and involvement, and the need to understand internal practices and processes before benchmarking. |
8044219 | Collaborative benchmarking in health care. | A collaborative approach to traditional benchmarking involves the formation of a voluntary network of health care providers that cooperate in carrying out the benchmarking study. Collaborative benchmarking involves three phases: Select the benchmarking topic. Decision makers at the sponsoring organization select the benchmarking topic. Establish the benchmarking collaborative. Potential participant organizations are identified and encouraged to join the collaborative. Once the collaborative is formed, project stakeholders are identified, a charter for the study is created, and the project steering committee is established. Conduct the study. A combination of internal and external benchmarking can be used, first conducting the project within the collaborative, then repeating the study either within the industry or across industries. Regardless of the benchmarking type selected, the process follows the Plan-Do-Study-Act cycle. An example of a health care system that is benchmarking the workers' compensation process is used to illustrate the three phases of collaborative benchmarking. A second example, which describes a benchmarking project focused on the admissions process, illustrates the external benchmarking phase. Four prerequisites for effective benchmarking are leadership commitment, experience with continuous quality improvement, preparation of the organization, and identification of key processes. Organizational capacity for learning, knowledge of the customer and process variation, resource availability, and leadership understanding of benchmarking may each accelerate, or retard, the effective use of collaborative benchmarking. |
8044218 | Benchmarking applied to health care. | An operational definition of benchmarking as developed at Xerox is "finding and implementing best practices." Although benchmarking has widely spread throughout industry, it is only just beginning to find application in health care. In internal benchmarking, similar internal functions serve as pilot sites for conducting benchmarking. Competitive benchmarking, the comparison of a work process with that of the best competitor, reveals the performance measure levels to be surpassed. Functional benchmarking compares a work function to that of the functional leader. Generic process benchmarking compares the organization's basic business processes. Benchmarking can target business, support, and clinical functions. For clinical functions, there are many potential, ready-made networks of people with similar problems and interests. Benchmarking support functions is often difficult because these functions can provide the greatest competitive edge in the purely business sense. The ten-step Xerox benchmarking model is illustrated with a fictional case study involving improvement in the work processes associated with outpatient and inpatient biopsies. The principles of benchmarking are simple, and the benchmarking process is not complicated. Benchmarking is a structured framework for pursuing worthwhile goals in an organized way. |
8044216 | Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. | Given the increased use of economic evaluation to inform decision making in the health service, it is particularly important that the research methods used are critically assessed and, where possible, improved. The systematic handling of uncertainty in economic evaluation is an important area that remains methodologically underdeveloped. With the increased use of the clinical trial as a vehicle for economic evaluation, there has been recent interest in how the statistical methods routinely employed to handle uncertainty in clinical research might be applied to economic evaluation. This paper reviews the types of uncertainty that exist in economic evaluation and argues that some forms of uncertainty are not amenable to statistical methods. Sensitivity analysis is not a single approach but can take a number of different forms. The different types of sensitivity analysis are reviewed, with an indication of their strengths and weaknesses in relation to the different types of uncertainty in economic evaluation. |
8044215 | The QALY--a measure of social value rather than individual utility? | The paper examines different interpretations of the QALY concept. It is suggested that the QALY interpreted as a measure of amounts of well-life does not carry sufficient empirical meaning. As a measure of individuals' personal appreciation of outcomes in their own lives the QALY does not seem to work in comparisons of life saving interventions with interventions that improve health or increase life expectancy. For the QALY to be a generally empirically meaningful concept, it looks as though it needs to be interpreted as a measure of social value. This conclusion has direct implications for how values for health states should be elicited. |
8044214 | Optimum alcohol taxation: balancing consumption and external costs. | This paper considers alternative approaches to the evaluation of the total cost of alcohol consumption in Australia. It calculates the impact of alternative tax rates on beer, wine and spirits separately and the 'consumption cost' of these taxes in terms of the distortion caused to consumption patterns. Two separate analyses are carried out. First optimal taxation is calculated which minimises the total loss from the 'consumption cost' of taxation plus the external cost of alcohol consumption. Secondly, the benefits of life are separated from other benefits and the impact of tax expressed in terms of the cost per life year gained. Conceptualised in this way, the results of this 'tax' program may be expressed in the same way as other health programs, namely as a net cost per life year gained. Alcohol taxation may then be compared with other life saving interventions. The chief conclusion reached is that in Australia there is a very compelling case for a new tax base and for a very significant increase in the rate of alcohol taxation. |
8044212 | The uptake of childhood immunization and financial incentives to general practitioners. | Among the target-linked services introduced by the 1990 general practitioners' contract, childhood immunization in Scotland is the best suited for GPs to achieve the high target, given a centralized call and recall system and public confidence in the service. Yet over 25% of the practices in the area of the Greater Glasgow Health Board did not qualify for the high target payments in the last quarter of the 1991/92 financial year. Examining indicators of the socioeconomic characteristics of the patient population, practice profiles and the effect of financial incentives, we discuss the reasons for cross-practice variation in the uptake of this service and estimate the probability of practices which missed the high target achieving it in the future. |
8044211 | The determinants of hospital utilisation: implications for resource allocation in England. | Since 1976 various attempts have been made to ensure that NHS resources available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The current method is based on analyses of the links between observed patterns of in-patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this approach, however, and so the search continues for new analytical techniques. The purpose of this paper is to explore how household survey data about 12,729 English adults could be used to inform resource allocation decisions. Health care need indicators can be developed based on Census information and odds ratios derived from logistic regression analyses of the relationships between hospital utilization, health status, socio-demographic characteristics and area indicators of supply. The results suggest that health status is the most important determinant of hospital utilization, although demographic and socio-economic factors also have some influence. In addition to the personal characteristics of individual respondents, area correlates of health care supply are also positively associated with reported utilization. The final part of the paper illustrates how weighted population estimates might be calculated on the basis of empirically-derived indicators of health care need. |
8044210 | Psychopathy: traditional and clinical antisocial concepts. | Advances in our knowledge about the concept of psychopathy and the repeated occurrence of antisocial behaviors in the face of adversity and punishment have been limited by a complex interplay of conceptual and methodological issues that have not yet been addressed adequately by psychosocial scientists. Foremost among the problems facing clinicians and researchers interested in this topic is the lack of agreement on the meaning and labelling of the construct. Scholars have not reached consensus in describing a category within a diagnostic system that distinguishes a relatively homogeneous group of individuals sharing a set of characteristics, or a class of persons that can be identified reliably from those who exhibit other perhaps closely related behavioral abnormalities and so-called normal individuals. Disagreements about the construct in question have been sufficiently problematic that some researchers and clinicians have decided that the notion of psychopathy or APD, taken to represent a mental disorder, is simply a myth or a judgment label concocted to justify societal management of offensive and repugnant behaviors (cf., Blackburn, 1988; Lewis & Balla, 1975; Pilgrim, 1987). Scholars such as Holmes (1991) and Wulach (1983) have called for elimination of the category as a mental disorder diagnosis, because it offers an opportunity for making value assessments rather than clinically appropriate decisions. Few disorders described in our psychopathology nomenclature are associated with such markedly negative attributions as is psychopathy, whether defined in the American or British traditions. The logical underpinning of much work in the field equates psychopathy or APD with heinous forms of criminality, lifestyle criminality, and special cases of antisocial behavior. In keeping with tendencies for society to conceptualize psychopathy as extreme misbehavior and to decry its consequences is a paper by Wells (1988), which exemplifies the emotion-focused thought and rhetoric that have been mobilized in writings explaining the behaviors that are often subsumed under the psychopathy label. Given that this type of persuasion is more common than might be expected in an empirical literature, it is not surprising that some scholars have concluded that the term psychopathy is really relatively useless. On the other hand, the appeal of the realist approach to disease conceptualization, or the notion that such a disorder exists and therefore must have underlying causes, has defied elimination over the years.(ABSTRACT TRUNCATED AT 400 WORDS) |
8044201 | Messenger RNA of G-proteins alpha-subunit in rat brown adipose tissue. | The present study was addressed to quantify the steady-state mRNA levels for the alpha subunit of stimulatory (Gs) and inhibitory (Gi-1 and Gi-2) G-proteins in brown (interscapular) male rat adipose tissue (n = 6 rats). The quantification of specific mRNA, estimated using a solution hybridization RNAse protection assay, showed that the amounts of G alpha i-1, G alpha i-2 and G alpha s mRNA were 0.88 +/- 0.28 amol/microgram DNA, 76 +/- 4 amol/micrograms DNA and 460 +/- 16 amol/micrograms DNA, respectively. When the amounts of G alpha i-1 and G alpha i-2 and G alpha s mRNA in brown adipose tissue were compared with those in epididymal white adipose tissue (obtained from the same rats), G alpha i-1 and G alpha i-2 mRNA levels were very similar between brown and white adipose tissue, whereas the level of G alpha s mRNA was significantly higher in brown than in white fat tissue (P < 0.001). In conclusion, the present study shows the steady-state levels of mRNA for the alpha subunit of Gs, Gi-1 and Gi-2 in rat brown fat and suggests that the quantity of G alpha s mRNA is higher in brown than in white adipose tissue. Further studies are needed to explain the possible physiological importance of these findings. |
8044200 | Splanchnic ammonia management in genetic and dietary obesity in the rat. | Three groups of 60-day-old Zucker rats: lean (Fa/Fa), obese by diet (Fa/Fa diet-obese) and genetically-obese (fa/fa) were fed ad libitum in order to study their splanchnic ammonia management. The study was also performed in 12 h food-deprived diet-obese and lean rats, to exclude a possible effect of diet composition on the parameters studied. Ammonia concentration was higher in the hepatic, portal and arterial plasma of diet-obese rats. The intestine did not contribute to a rise in the blood ammonia levels. This increase of ammonia in the blood of diet-obese rats coincides with higher alanine levels in plasma and a net glutamine production by liver. In fa/fa rats, ammonia levels were similar to those of lean rats, except for portal ammonia, which was lower. Hepatic availability of ammonia increased dramatically in diet-obese rats, but ammonia uptake by the liver was similar to that of lean rats. Conversely, hepatic availability of ammonia in fa/fa rats was similar to that of lean animals, whereas ammonia uptake by the liver was reduced to 50% of either lean or diet-obese values. Fasting for 12 h reduced plasma ammonia concentration in diet-obese rats: ammonia levels in the hepatic vein and aorta were similar to those of lean rats fasted for 12 h, whereas they were lower in the portal vein. Furthermore, ammonia hepatic availability was in the same range as that of lean animals, whereas ammonia uptake by the liver was reduced.(ABSTRACT TRUNCATED AT 250 WORDS) |
8044199 | The effect of endurance training on the relationships between sex hormone binding globulin, high density lipoprotein cholesterol, apoprotein A1 and physical fitness in pre-menopausal women with mild obesity. | The purpose of the present study was to investigate the relationships of change in high density lipoprotein cholesterol (HDL-C) with changes in sex hormone binding globulin (SHBG), physical fitness and spontaneous dietary intake before and after endurance training. Ten pre-menopausal obese women (32 to 49 years) who had never smoked or regularly drunk alcohol participated in this study. Physical training at an intensity of lactate threshold was performed for six months at a frequency of three times per week for 60 minutes using a cycle ergometer. Together with a reduction in body weight (-4.1 kg; P < 0.05) and with increases in maximal oxygen uptake (VO2max = +3.4 ml/kg/min or +0.09 l/min; P < 0.05), the training induced some changes in both plasma lipid and lipoprotein. Although the total cholesterol (total-C), triglyceride, HDL2-C and apoprotein A1 (Apo A1) levels did not change, significant increases in HDL-C and HDL3-C, and significant reductions in Apo B, total-C/HDL-C ratio and fasting insulin concentrations were found after training. SHBG levels tended to increase after endurance training, but the changes were not significant. No alteration was observed in spontaneous dietary intake after training. A significant correlation (r = 0.648) was observed between the change in VO2 max(l/min) and the change in SHBG. In addition, changes in both VO2 max(l/min) and SHBG were significantly associated with changes in HDL-C, HDL2-C and Apo A1. The changes in dietary intake did not correlate with the changes in SHBG, VO2max, HDL-C, HDL2-C and Apo A1.(ABSTRACT TRUNCATED AT 250 WORDS) |