Transferring at-risk babies in-utero or neonatally: a decade's experience from a peripheral consultant maternity unit.

All maternity cases in which babies were transferred in-utero (n = 82) or neonatally (n = 273) from the William Smellie Memorial Maternity Hospital to a regional neonatal intensive care unit during 1980-89 were studied to detect changing trends and outcomes. The proportion of babies transferred in-utero has increased and most of these transfers appear to have been justified. Forty-seven per cent of babies transferred neonatally were mature infants (greater than 37 weeks) so that the need for intensive neonatal care would have been difficult to predict. Perinatal mortality has fallen in line with national rates, mainly due to the decline in mortality of premature babies transferred neonatally. The results do not sustain the argument for further increasing in-utero transfers.


Nasal mass in a pediatric patient.

The consultants agreed that the differential diagnosis should focus on congenital masses, including an encephalocele, glioma, dermoid, hamartoma, hemangioma, rhabdomyosarcoma, neurofibroma, and nasolacrimal duct cyst. There was some disagreement as to which is the best way to evaluate the mass, ranging from an MRI (Dr. Reilly), to CT scan (Dr. Cotton), to both MRI and CT (Dr. Koopman). Blood tests to evaluate pituitary function could be indicated if there was a sphenoid defect (Dr. Reilly). None of the experts would biopsy this lesion. All would proceed with a definitive resection. One surgeon would defer surgery for several months and then perform the resection via a biocoronal craniotomy (Dr. Reilly). A combined anterior craniotomy and external ethmoidectomy would be planned by another (Dr. Koopman). The third consultant would combine an anterior craniotomy with a mid-face degloving, external rhinoplasty, or lateral rhinotomy approach (Dr. Cotton). Routine perioperative antibiotics would only be used by two of the surgeons (Drs. Reilly and Koopman). If a CSF leak were encountered there are several options. A small lesion could be allowed to close on its own (Dr. Reilly). If the leak occurred while the bicoronal incision was still open or if the leak were large, it could be repaired from above (Drs. Reilly and Koopman). One surgeon would proceed with a repair from above even if the leak were encountered during the intranasal approach (Dr. Cotton). Only one surgeon would restrict postoperative activity with intubation and sedation or paralysis (Dr. Koopman). Regarding follow-up, no one was concerned about the final pathology report.(ABSTRACT TRUNCATED AT 250 WORDS)


The use of general anaesthesia and sedation in general dental practice: a survey in Glasgow, United Kingdom.

One hundred and sixty four of the 240 general dental practitioners on the Greater Glasgow Health Board family practitioner list returned a postal questionnaire on the current use of General Anaesthesia and sedation in their practices. Thirty three per cent offered GA sessions but nearly a half were in the process of withdrawing the service. The majority of the respondents (74.4 per cent) felt that a simple sedation method would attract patients. An inhalation technique was considered the most appropriate for general dental practice by 62 per cent of the dentists.


Epithelial-myoepithelial carcinoma of salivary gland with metastasis to lung: report of a case and review of the literature.

A 63-year-old man was initially seen with multiple pulmonary nodules 14 years after a left parotidectomy for an epithelial-myoepithelial carcinoma of salivary gland. Eight and 18 months after parotidectomy, the patient had local recurrence of his salivary gland tumor. He remained disease-free before being seen with pulmonary nodules, which were evaluated by open lung biopsy. The pathologic features of the pulmonary nodules were identical to the salivary gland tumor resected 14 years earlier. This is the fourth reported case of epithelial-myoepithelial carcinoma of salivary gland metastasizing to a distant site.


An audit of acute asthma admissions to a respiratory unit.

A criterion based audit was performed on 90 admissions with acute asthma to a specialist respiratory unit using the guidelines set by the British Thoracic Society. Three main areas were audited including: documentation of severity markers in the case notes on admission, acute treatment given on admission, and further investigations performed. Case notes were found to be deficient in documentation of objective severity markers such as peak expiratory flow rate (52% recorded) and blood gases (72% recorded), as well as subjective markers such as speech (27%), air entry (58%) and exhaustion (4%). Of the total 90 admissions, 78% were identified as having at least three out of five objective markers for acute severe asthma. Most of these severe cases (93%) were given corticosteroids but none were prescribed greater than 35% concentration of inspired oxygen. The majority of admissions had a chest radiograph (87%), and 56% had measurement of serum potassium. These results show that even in a specialised respiratory unit, guidelines such as those produced by the British Thoracic Society are not in general being adhered to. It also indicates that assessment of severity is inadequate, particularly for peak flow measurement, and that management is deficient in established treatments such as the use of high flow oxygen. As a result of the audit, a severity marker stamp for the case notes along with guidelines for treatment have been implemented in order to improve the quality of care delivered to patients admitted with acute asthma.


Geriatric respite care--present practice and the potential for improvement.

A prospective Audit of patients admitted for geriatric respite care was undertaken. Information was obtained from patients, staff and carers for 125 consecutive admissions over a 20 week period. The 87 clients admitted had a mean age of 79.6 years and 83% had a high physical/mental dependency. In contrast to some previous studies mortality was very low (less than 2%). One hundred and nine (87%) admissions were discharged home. Respite admission bed use was classified as shared care (971 days, n = 19), planned respite (937 days, n = 50) and crisis respite (809 days, n = 18). The shared care and planned group did not show significant differences in patient dependency or carer profile. On a population basis, geriatric respite care was required on a bed per 1,000 population aged 75 and over. Patients viewed as inappropriate for geriatric care were most frequent in the crisis respite group, with the Geriatric Unit at times meeting shortfalls in other services. The sharing of key information between families/carers and community/hospital was, at times, deficient. The need for increased publicity about the service and for a carer support group was identified. Most families were satisfied with the care received but specific ways of improving the service were suggested.


The Chief Scientist reports.... Pattern of decline in prevalence of anencephaly and spina bifida in a high risk area.

The results of three studies spanning the period 1964 to 1989 were aggregated in an attempt to identify secular trends which might contribute to aetiological understanding of anencephaly and spina bifida (ASB). All data related to the prevalence of ASB in a geographically defined population in Glasgow, a known high risk area of neural tube defects. Multiple sources of ascertainment were employed to identify affected cases, whether live births, still births or induced abortions following prenatal diagnosis. The birth prevalence of ASB dropped by 82%, from 5.63 per 1,000 births in 1964-1968 to 1.04 per 1,000 births in 1979-1989, while the pregnancy prevalence (adjusted by including induced abortions) declined by 46%, from 5.63 per 1,000 births in 1964-1968 to 3.02 per 1,000 births in 1979-1989. Thus, prenatal screening contributed just under half of the observed decline in ASB birth prevalence. The pregnancy prevalence appeared to decline throughout the 1970's and early 1980's, and to increase again, temporarily, in the mid-1980s. These data could be interpreted as being broadly consistent with socio-economic hypotheses of ASB aetiology.


Hospital strategy and financial performance.

Five archetype strategies are studied involving productivity, diversification, or a hybrid approach. Manager opinions, staffing ratios, and profitability data bring the strategy effectiveness issue into perspective. Hospitals employing the productivity/defender strategy, specializing in fewer product lines, experienced less decline in profitability in recent years. Excess diversification appears to exhibit the most rapid declines in profitability.


Application of continuous quality improvement techniques to the treatment of patients with hypertension.

This article reports how continuous quality improvement (CQI) techniques were applied to physician care of patients with hypertension. A physician task force at an ambulatory care center used CQI methods to address the needs of two important "customer" groups: (1) third party payors and (2) patients with hypertension. Treatment standards were defined that can also serve as a customer-oriented product description. The task force found patients' blood pressures generally well controlled. Future studies will focus on appointment making, giving advice, and the doctor's examination as subprocesses that strongly influence patient satisfaction.


Hospital board effectiveness: relationships between board training and hospital financial viability.

This study examined whether hospital governing boards that invest in board education and training are more informed and effective decision-making bodies. Measures of hospital financial viability (i.e., selected financial ratios and outcomes) are used as indicators of hospital board effectiveness. Board participation in educational programs was significantly associated with improved profitability, liquidity, and occupancy levels, suggesting that investment in the education of directors is likely to enhance hospital viability and thus increase board effectiveness.


Evaluating user satisfaction in a hospital environment: an exploratory study.

This article demonstrates the usefulness of user satisfaction measurement to pinpoint potential problem areas as well as to document application areas with satisfied users in hospital information systems. It discusses the rationale of measuring user satisfaction and the instruments to carry out the measurement procedure. It, then, reports the results of implementing a previously developed, documented, and validated user satisfaction measurement instrument in a hospital environment.


Strategic planning in rural health care organizations.

Is strategic planning associated with higher levels of performance in health care organizations? Is strategic planning effective? This article examines strategic planning's impact on rural hospital and rural nursing facility performance, organizational characteristics, and strategy. The findings suggest that strategic planning in rural hospitals is strongly associated with higher profits, operating margins and planning effectiveness, and associated to a lesser extent with lower costs and higher revenues per patient day. However, strategic planning does not appear to be associated with higher performance in nursing facilities. The implications for strategic planning in rural health care organizations are discussed.


The movement toward vertically integrated regional health systems.

Due to existing internal forces, a movement toward vertically integrated regional health systems is imperative in order to ensure the future viability of our health care system. However, in order for these systems to be successful, they must first overcome several imposing barriers.


[Extracutaneous malignant melanomas: clinical aspects and biology].

Approximately 5% of all malignant melanomas originate from primarily non-cutaneous sites. They are preferentially distributed along the choroid, the meninges, the subserous space of the oesophagus and the intestinal tract, at transitional areas of mucous membranes, and along organ capsules, the periadventitial tissues of major blood vessels, and, occasionally, muscle fasciae. Little is known about their biological behaviour; the prognosis, however, generally has to be considered less favourable than that of primary cutaneous malignant melanomas, probably at least in part because they are often not discovered until they are in advanced stages. There are no specific clinical signs suggestive for non-cutaneous malignant melanomas; symptoms vary with the site of manifestation of the tumours. Interpretation of these clinical data based on results from comparative anatomical studies leads to the conclusion that extracutaneous malignant melanomas in humans are residuals of phylogenetically old, extensive and well-developed non-cutaneous pigment cell patterns demonstrable in a variety of lower vertebrates, which result from interactions between organogenesis and pigment cell development during ontogeny. This demonstrates that consideration of fundamental principles of developmental biology can give diagnostic clues to the localizations at which primary non-cutaneous malignant melanomas may be suspected and can thus facilitate decisions about what diagnostic procedures are necessary.


[Human behavior in the solar radiation field with reference to ultraviolet exposure].

There is a causal relation between solar ultraviolet radiation and skin cancer. For epidemiological investigations, quantification of the UV exposure is essential. To set up a risk assessment for the whole population, a representative survey was performed in Austria. The questionnaire refers to three sectors of everyday life: work, recreation and holidays; in addition the use of solaria is asked about for a further investigation. The UV exposure caused by humans' behaviour in the field of solar radiation was analysed from various demographic aspects. For some subpopulations the UV exposure sustained during work, recreation and holidays was compared. Groups with high occupational UV exposure show a weaker tendency to stay outdoors during leisure time and holidays than groups characterized by high UV exposure in their leisure time, who also prefer sun-intensive activities during holidays.


[Immunogenetic studies of familial occurrence of progressive systemic scleroderma and circumscribed scleroderma].

Two different forms of scleroderma in one family are described: the mother suffers from systemic sclerosis and her daughter from linear morphoea. The observed HLA antigens indicate that systemic sclerosis and morphoea have various features in common. The immunogenetic data can be used to calculate the aetiological and preventive fractions, which together with environmental hazards and other risk factors describe the HLA-associated potential for provocation of scleroderma.


[Osteomalacia as an apparently rare side effect of oral fumaric acid therapy. Secondary DeToni-Debré Fanconi syndrome in the adult].

A case of fully reversible tubular toxicity with consecutive metabolic osteopathy following systemic fumaric acid therapy is reported. This secondary effect of oral fumaric acid therapy obviously occurs very rarely, never having been described before. A 46-year-old female patient with a long history of recurrent palmoplantar psoriasis underwent oral treatment with fumaric acid and its esters in accordance with the Schäfer method, preceding attempts at curative treatment with conventional antipsoriatic agents having proved unsatisfactory. Two months later, the patient started to experience arthralgia, back pain in the early hours of the morning and myalgia with increasing frequency, progressing to disablement in moving and walking and, finally, to total immobility. Not until 9 months later was the reason for these severe disabilities found: they stemmed from hypophosphataemic osteomalacia as a result of a complex disturbance of the renal tubular system. The clinical symptoms and the results of laboratory chemistry tests returned to normal as soon as fumaric acid medication was discontinued. Two attempts at reexposure confirmed the causal relationship. Oral fumaric acid medication should never be administered without clinical and chemical controls.


[Quantitative analysis of recurrence and spontaneous regression of basalioma parts left in situ].

To some extent, parts of basalomas found remaining in situ following tumour excision tend to spontaneous regression. This is a well-known phenomenon and has significance for the recurrence of incompletely excised tumors. The present study involved a quantitative investigation of the relationship between recurrence and spontaneous regression. Following precisely defined excision of basalomas, the entire exterior of the excised material was examined by contrast microscopy in HE-stained paraffin sections (3-dimensional histology). Whenever tumour outgrowths were found, it was possible to document exactly their type, localization, extent, and depth of invasion. In 66 such cases no follow-up operation was performed, but only a follow-up examination after a minimum of 31 and a maximum of 113 months (average: 60 months). Only 50% of these undisturbed tumour outgrowths resulted in a recurrence during the follow-up period. A very high rate of spontaneous regression (71%) was found among the solid tumour outgrowths, but a significantly lower rate (19%) among the fibrosing tumours. Moreover, regression was dependent on the tumour remnant's mass and the clinical diameter of the tumour removed. It was independent of the depth of infiltration. Although the rate of spontaneous regression of tumour outgrowths persisting after therapy is relatively high, it cannot be predicted in individual cases. It is not possible to be certain that tumour removal has been achieved unless micrographic surgery has been continued until complete absence of tumour is proved. In all procedures that are not subsequently monitored, an unacceptably high rate of recurrence must be expected, especially in the case of fibrosing basaloma. This is commented on at length.


[HMB 45 positive balloon cells in combined nevi].

The combined naevus is made up of two components, one resembling a melanocytic naevus, the other a blue naevus. Clinically, these naevi do not give any obvious cause for concern. Histological examination shows that the combined naevus consists of a superficial melanocytic naevus and a deep-seated spindle cell blue naevus. There is a rare variant in which the pigmented spindle cells of the "blue" naevus are replaced by large balloon cells varying in melanin content. These combined naevi, because of the large cells with abundant cytoplasm, closely resemble malignant melanoma. As a further aid to diagnosis we used the monoclonal antibody HMB 45. In our study, the vesicular cells in all seven combined naevi examined reacted strongly with HMB 45. It is suggested that HMB 45 is not always helpful in differentiating between melanoma and naevi.


[A lupus-vulgaris like atypical mycobacteriosis caused by Mycobacterium xenopi (lupus xenopi)].

A case of lupus-vulgaris-like infection caused by Mycobacterium xenopi in a 62-year-old immunocompetent female patient is presented. A large cutaneous infiltration was seen in the right periorbital region. Histological examination revealed a granulomatous reaction of epithelioid cells and giant cells. M. xenopi was isolated from biopsy material and tuberculosis could be excluded. Isoniazid was effective in healing the lesion within a year. Such infections are well known for other mycobacteria but to our knowledge had not yet been described for M. xenopi. The characteristics of human infections with M. xenopi are summarized in a review of the literature and criteria for the diagnosis of atypical cutaneous mycobacterioses are proposed.


[Erosive pustular dermatosis of the scalp after zoster ophthalmicus and trauma].

Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. The differential diagnosis of EPDS includes folliculitis decalvans, sterile eosinophilic pustulosis Ofuji, pustular psoriasis vulgaris, trichophytosis, Perifolliculitis capitis abscedens et suffodiens, pemphigus vulgaris and cicatricial pemphigoid. We present the cases of a 74-year-old woman suffering from EPDS following herpes zoster ophthalmicus and of a 54-year-old man in whom EPDS followed a head injury.


[Erythema nodosum and non-Hodgkin lymphoma].

A 36-year-old woman presenting with erythematous painful tender inflammatory nodular lesions on both knees, shins and ankles is reported. Erythema nodosum (EN) was diagnosed. Further clinical examination revealed hilar lymphadenopathy. A lymph node was removed for histological examination, and a centroblastic non-Hodgkin lymphoma was diagnosed. Remarkably, in this patient EN occurred before the haematological malignancy was detected.


[Eccrine hamartoma of the sweat glands simulating localized unilateral hyperhidrosis].

We report on the case of a 31-year-old woman who presented with localized unilateral hyperhidrosis on her lower right arm. Histological features showed a hamartoma of the eccrine sweat glands. Because she was afraid of being overweight, the patient took an appetite depressant. Under this self-medication complete cessation of the localized hyperhidrosis was observed.


[Rhabdomyosarcoma: differential diagnosis of cutaneous tumors in childhood].

Primary rhabdomyosarcoma can arise in the skin, but there are few reports on this common childhood malignancy in the dermatological literature. We report on a male infant with a cutaneous tumour growing on the right nasal bridge since his 10th week of life. Clinically the tumour mimicked pilomatrixoma. Histological and immunohistological examination of the skin tumour and of subsequent lymph node metastases revealed rhabdomyosarcoma of the alveolar growth pattern. Our patient died at the age of 4 years of disseminated organ metastases.


Estimates of absorption of radiofrequency radiation by the embryo and fetus during pregnancy.

This paper reports that the specific absorption rate induced in the embryo or fetus can exceed that recommended for the general public when the mother is exposed to radiofrequency radiation at the occupational limits. This result applies to two-tiered radiofrequency radiation standards where a factor of 5 differentiates occupational and nonoccupational exposure limits. Using simple axisymmetric geometries for the pregnant worker, and assuming plane wave exposures, a finite element method provides estimates of prenatal exposure. Various layered shapes are used to model skin, fat, uterus, blood, embryonic, and fetal tissues. Applying current exposure limits given by IRPA, ANSI, and SAA, the results indicate that overexposures to the embryo or fetus can occur from early pregnancy at 80-100 MHz, and in late pregnancy across the range 300-1500 MHz.


Beta-ray dose distributions from point sources in an infinite water medium.

The ACCEPT Monte Carlo code has been used to calculate radial dose distributions around isotropic point sources of monoenergetic electrons between 0.01 and 10 MeV in an infinite water medium. The results were averaged over beta spectra to derive distributions for 147 beta emitters of which 32 are presented. More extensive tables of distributions will be presented in a report. Distributions for monoenergetic electrons agree with recent ETRAN-code calculations of Berger and Seltzer within 2%, except at very short distances where there are differences up to several percent. Results calculated by the EGS4 code differ by up to a few percent. Distributions for beta emitters are in excellent agreement with both experimental results and ETRAN and EGS4 calculations, except at very short distances.


Study of 222Rn permeation through polymer membranes: application to continuous measurement of 222Rn in water.

Membranes that exclude water but are permeable to radon can extend the range of environments where many radon detection systems could operate. We have studied the permeation of 222Rn through polypropylene membranes separating air and water phases. The permeation coefficient and the activation energy were calculated for various conditions. Potential applications, such as in situ detection of radon in water, are discussed.


Residential radon exposure and lung cancer in Swedish women.

A case-control study was undertaken to investigate the role of residential radon exposure for lung cancer. The study included 210 women with lung cancer diagnosed from 1983-1986 in the county of Stockholm and 191 hospital and 209 population controls. Interviews provided information on lifetime residences and smoking. Radon concentrations measured in 1,573 residences of the study subjects showed a lognormal distribution with arithmetic and geometric means of 127.7 and 96.0 Bq m-3, respectively. Lung cancer risks tended to increase with estimated radon exposure, reaching a relative risk of 1.7 (95% confidence interval: 1.0-2.9) in women having an average radon level exceeding 150 Bq m-3 (4 pCi L-1). Stronger associations were suggested in younger persons and risk estimates appeared to be within the same range as those projected for miners. However, further studies are needed to clarify the level of risk associated with exposure to residential radon.


Daily intakes of 232Th and 238U in Japanese males.

Diet samples were collected by a duplicate portion method from 31 locations in Japan and were analyzed by inductively coupled plasma mass spectrometry. Average daily intakes per adult male were estimated at 1.7 mBq for 232Th and 8.8 mBq for 238U.


Decorporation of plutonium by oral administration of a partially lipophilic polyaminocarboxylic acid.

A new, orally administered, partially lipophilic polyaminocarboxylic acid chelator was tested for its ability to remove incorporated 239Pu deposits in rats. Animals were injected with 239Pu-citrate and 14 d later were treated for an additional 10 d with docosyl-triethylenetetraminepentaacetic acid (C22TT) added to the diet. There were significant reductions in the 239Pu content of selected organs in the chelated animals compared with controls. These results suggest that this class of chelators should be studied further for their ability to remove plutonium deposits from the body when given orally.


Exact calculation of probabilities of false positives and false negatives for low background counting.

The purpose of this paper is to demonstrate the derivation and use of exact formulas, and their algorithms, for calculating the probabilities alpha of Type I errors, and beta of Type II errors, for low blank total counts (Poisson-distributed). The calculations are carried out to examine the alpha and beta probabilities at low blank levels of the decision level (DL) and minimum detectable amount (MDA) formulations as adopted in the Health Physics Society Standard, "Performance Criteria for Radiobioassay." These formulations are consistent with those published by L.A. Currie, which have received wide acceptance in defining lower limits of detection (LLD). Although Currie's formulation was derived assuming a normal distribution in net counts, the behavior of the distribution of net counts at low count levels, which is a distribution of the difference between two Poisson variates, is such that the MDA formulation in the standard could be considered acceptable for the purpose of providing one simple formulation of MDA. The derivations in this note can also be useful in other problems involving differences in Poisson variates, such as those in certain population studies.


Gamma distribution and house 222Rn measurements.

The statistical distribution of 222Rn measurements from basements and first floors of homes in northeastern Pennsylvania was investigated. The gamma distribution was statistically significantly superior to the normal distribution (p less than 0.005) in describing the frequency distribution of the logarithm of observed 222Rn levels. The fit to the data was closer both in the central portion and in the upper tail. The gamma distribution has certain characteristics that make it generally useful in the study of environmental toxic agents where several different exposures over a lifetime occur and must be combined, as for risk assessment or for statistical power calculations for epidemiologic studies.


Effect of sorption barriers on the radon fluence rate from soil.

The fluence rate of radon from soil as affected by active sorption barriers [activated carbon (AC) and mordenite], soil moisture content, and temperature was measured over a period of 964 d. (To limit the level of radon in indoor environments, an active sorption barrier potentially could be mixed with soil placed adjacent to the substructures of buildings.) AC, mixed with the top layer of soil in columns, markedly reduced the fluence rate of radon from soil over the entire time of the experiment and at all moisture contents and temperatures examined. Mordenite, on the other hand, was not effective in decreasing the fluence rate. AC also has a relatively high sorption capacity for aqueous lead species. (Stable lead isotopes are end-products in the uranium and thorium decay series of which radon isotopes are members.) Thus, the long-term (decades) efficacy of AC in sorbing radon in a soil environment will not be compromised by the blocking of its sorption sites by lead.


Compliance with EPA guidelines for follow-up testing and mitigation after radon screening measurements.

A survey was taken of 314 individuals, 55 of whom had residences that exceeded the EPA action level of 148 Bq m-3 (4 pCi L-1) of radon as measured by a medical center radon testing service. The survey was designed to assess whether these individuals followed the 1986 EPA guidelines for follow-up testing and mitigation. The survey indicated 41% of respondents performed follow-up tests and 16% of the respondents performed some form of mitigation. Some respondents had performed mitigation after inadequate or no follow-up radon tests. There was a positive relationship between follow-up testing and mitigation and higher initial radon screening values.


Photon shielding for 241Am surface and point sources.

To determine radiation protection requirements for work with actinide elements, a method for rapidly estimating effective dose-equivalent rates from low-energy photons has been developed. This paper describes results obtained from a personal computer program that incorporates the point kernel technique to predict radiation fields from shielded and unshielded sources containing 241Am. Information generated has been used to determine procedures and to design facilities for handling actinides at Argonne National Laboratory's site at the Idaho National Engineering Laboratory. Area or point sources can be treated; effects of Compton scattering in air and in solid shields are considered. Users can select an appropriate response function; their choice has a strong influence on predicted dose rates from unshielded sources.


A model for radon gas adsorption on charcoal for open-faced canisters in an active environment.

It was previously suggested that the calibration factor (CF) relating the detected activity (A) of the radon decay products 214Bi and 214Pb within a charcoal canister to the radon concentration (CR) in air be defined as CF = A/(E x DF x CR), where E is the counting efficiency of the detector for 214Bi and 214Pb gamma rays, and DF is a factor accounting for decay during the time (tD) from the end of the exposure until the canister is counted; i.e., DF = exp(-lambda RPtD), where lambda RP is the physical decay constant for radon. With CF defined as above, a kinetic model for the adsorption of radon gas on charcoal in humid air predicts that CF (in m3) can be written for CR in Bq m-3, A in cpm, and E in cpm Bq-1 as CF = alpha[1-exp(-delta t)] + beta[1 - exp(-delta t)]M(t), where alpha, beta, and delta are free parameters, t is the canister exposure time in hours, and M(t) is the canister water mass gain in grams in time t. For CF data for the U.S. Environmental Protection Agency's open-faced canisters in an active (with respect to air flow) environmental chamber, delta = (0.046 +/- 0.002)h-1, and exp(-delta t) much less than 1 for t greater than or equal to 3 d. Also, alpha = (0.342 +/- 0.002)m3, and beta = -(0.0123 +/- 0.0001)m3g-1.


Residential radon exposure and lung cancer: an overview of ongoing studies.

This review paper summarizes the ongoing case/control studies of residential radon exposure and lung cancer. Discussion is offered in the areas of lung cancer risk factors, sample size requirements, radon exposure assessment, and meta-analysis. This is an important topic that deserves a "best effort" study design.


Radiation exposure inside reinforced concrete buildings at Nagasaki.

In this study, the radiation doses to occupants of two reinforced concrete buildings at Nagasaki, who survived the immediate effects of the nuclear weapon detonation, are determined using state-of-the-art radiation transport techniques. The radiation doses at all locations in the buildings are calculated using the Three-Dimensional Oak Ridge Discrete Ordinates Radiation Transport Code which was constructed especially for this task. This code represents a new and unique capability that has been previously reported. This study resulted in case-by-case lists of doses to occupants and an uncertainty analysis. These data have been used in a companion study as the basis for determining a new value of the dose producing a 50% risk of fatality.


Estimation of median human lethal radiation dose computed from data on occupants of reinforced concrete structures in Nagasaki, Japan.

This paper presents an estimate of the median lethal dose for humans exposed to total-body irradiation and not subsequently treated for radiation sickness. The median lethal dose was estimated from calculated doses to young adults who were inside two reinforced concrete buildings that remained standing in Nagasaki after the atomic detonation. The individuals in this study, none of whom have previously had calculated doses, were identified from a detailed survey done previously. Radiation dose to the bone marrow, which was taken as the critical radiation site, was calculated for each individual by the Engineering Physics and Mathematics Division of the Oak Ridge National Laboratory using a new three-dimensional discrete-ordinates radiation transport code that was developed and validated for this study using the latest site geometry, radiation yield, and spectra data. The study cohort consisted of 75 individuals who either survived > 60 d or died between the second and 60th d postirradiation due to radiation injury, without burns or other serious injury. Median lethal dose estimates were calculated using both logarithmic (2.9 Gy) and linear (3.4 Gy) dose scales. Both calculations, which met statistical validity tests, support previous estimates of the median lethal dose based solely on human data, which cluster around 3 Gy.


Benchmark test of transport calculations of gold and nickel activation with implications for neutron kerma at Hiroshima.

A benchmark test of the Monte Carlo neutron and photon transport code system (MCNP) was performed using a 252Cf fission neutron source to validate the use of the code for the energy spectrum analyses of Hiroshima atomic bomb neutrons. Nuclear data libraries used in the Monte Carlo neutron and photon transport code calculation were ENDF/B-III, ENDF/B-IV, LASL-SUB, and ENDL-73. The neutron moderators used were granite (the main component of which is SiO2, with a small fraction of hydrogen), Newlight [polyethylene with 3.7% boron (natural)], ammonium chloride (NH4Cl), and water (H2O). Each moderator was 65 cm thick. The neutron detectors were gold and nickel foils, which were used to detect thermal and epithermal neutrons (4.9 eV) and fast neutrons (> 0.5 MeV), respectively. Measured activity data from neutron-irradiated gold and nickel foils in these moderators decreased to about 1/1,000th or 1/10,000th, which correspond to about 1,500 m ground distance from the hypocenter in Hiroshima. For both gold and nickel detectors, the measured activities and the calculated values agreed within 10%. The slopes of the depth-yield relations in each moderator, except granite, were similar for neutrons detected by the gold and nickel foils. From the results of these studies, the Monte Carlo neutron and photon transport code was verified to be accurate enough for use with the elements hydrogen, carbon, nitrogen, oxygen, silicon, chlorine, and cadmium, and for the incident 252Cf fission spectrum neutrons.


Navajo birth outcomes in the Shiprock uranium mining area.

The role of environmental radiation in the etiology of birth defects, stillbirths, and other adverse outcomes of pregnancy was evaluated for 13,329 Navajos born at the Public Health Service/Indian Health Service Hospital in the Shiprock, NM, uranium mining area (1964-1981). More than 320 kinds of defective congenital conditions were abstracted from hospital records. Using a nested case-control design, families of 266 pairs of index and control births were interviewed. The only statistically significant association between uranium operations and unfavorable birth outcome was identified with the mother living near tailings or mine dumps. Among the fathers who worked in the mines, those of the index cases had histories of more years of work exposure but not necessarily greater gonadal dosage of radiation. Also, birth defects increased significantly when either parent worked in the Shiprock electronics assembly plant. Overall, the associations between adverse pregnancy outcome and exposure to radiation were weak and must be interpreted with caution with respect to implying a biogenetic basis.


Estimates of embryonic and fetal doses from 239Pu.

Previously reported studies on the transfer of 238Pu from the maternal circulation to the developing embryo and fetus in rats and guinea pigs have provided data for developing dosimetric models. The highest concentrations of 238Pu were measured in the yolk sac. In late gestation, preferential uptake of 238Pu in liver and bone was observed. The data obtained, together with other published information, have been used to estimate in utero doses to hemopoietic tissues, taking account of transfer to the blastocyst/egg cylinder, yolk sac, liver, and bone marrow. From animal data, the concentration ratios relative to maternal liver for these tissues were taken to be 0.1, 2, 0.01, and 0.02, respectively, and were applied to periods of human gestation of 0-2.5 wk, 2.5-6 wk, 6-12 wk, and 12-38 wk, respectively. Doses to fetal tissues from 239Pu were calculated for chronic ingestion by the mother for a total of 1.8 kBq 239Pu during the year of pregnancy, giving a committed effective dose to the mother of 1 mSv. On this basis, the total in utero dose to hemopoietic tissue was about 2 microSv compared with red bone marrow doses of 34 microSv to the mother for the year. The yolk sac and bone marrow dominated in utero doses. The total dose to hemopoietic tissue in the offspring to age 70 y, taking into account the activity present at birth and including in utero doses, was estimated as 24 microSv compared with a maternal dose to red bone marrow of 2.5 mSv. An acute maternal intake of 1.8 kBq by ingestion during the period of yolk sac hemopoiesis would result in the highest in utero dose, estimated at about 36 microSv. However, activity at birth would be lower, giving only a small additional dose.


The measurement of activity-weighted size distributions of radon progeny: methods and laboratory intercomparison studies.

Over the past 5 y, there have been significant improvements in measurement of activity-weighted size distributions of airborne radon decay products. The modification of screen diffusion batteries to incorporate multiple screens of differing mesh number, called graded screen arrays, have permitted improved size resolution below 10 nm such that the size distributions can now be determined down to molecular sized activities (0.5 nm). In order to ascertain the utility and reliability of such systems, several intercomparison tests have been performed in a 2.4 m3 radon chamber in which particles of varying size have been produced by introducing SO2 and H2O along with the radon to the chamber. In April 1988, intercomparison studies were performed between direct measurements of the activity-weighted size distributions as measured by graded screen arrays and an indirect measurement of the distribution obtained by measuring the number size distribution with a differential mobility analyzer and multiplying by the theoretical attachment rate. Good agreement was obtained in these measurements. A second set of intercomparison studies among a number of groups with graded screen array systems was made in April 1989 with the objective of resolving spectral structure below 10 nm. Again, generally good agreement among the various groups was obtained although some differences were noted. It is thus concluded that such systems can be constructed and can be useful in making routine measurements of activity-weighted size distributions with reasonable confidence in the results obtained.


A nuclear incident at a power plant in Sosnovyy Bor, Russia.

Several radionuclides were identified in the surface air in Finland following a nuclear incident in Sosnovyy Bor on 24 March 1992. In addition to gases, the release contained small uranium fuel particles. The radionuclide concentrations were of the same order of magnitude as the concentrations detected in Northern Finland in 1987 after the nuclear explosion in Novaya Zemlya (1 mBq m-3) but five orders of magnitude smaller than the concentrations during the Chernobyl accident in 1986. The radiological consequences in Finland were insignificant. However, studies show that even a minor release, across the sea and more than 100 km away, can be detected and important information, including the time of the incident and the composition of the release and the burn-up of the damaged fuel, can be revealed by the most accurate radioactivity measurements.


137Cs uptake with cafeteria food after the Chernobyl accident.

After the Chernobyl accident, the activity concentrations of radiocesium were measured in both the meals served at the cafeteria of a research center and in the employees eating there. The time-dependent means of monthly 137Cs activities in meals and people show a similar distribution pattern with highest values between March and July 1987, i.e., only 1 y after the accident. In meals, the highest activities were found when the menu consisted of pork, milk, or milk products. The 50-y cumulative effective dose calculated from the whole-body measurements is 0.21 mSv for male and 0.15 mSv for female employees. Cafeteria food contributed only a small share to this exposure.


Risk of leukemia caused by diagnostic x-rays.

Using BEIR V risk estimates and age-specific population dose estimates, we estimate that approximately 12% of leukemias may be attributable to diagnostic x-rays. Earlier estimates were markedly lower (< or = 1%) because of their use of earlier risk coefficients, different dose rate effectiveness factors, and, in one case, a methodological error.


Radiation protection design for a clinical positron emission tomography imaging suite.

Radiation exposures due to patient sources, a pneumatic transport system, and gas lines in a positron emission tomography imaging facility are estimated for heavy clinical work loads. For simple source approximations and estimated study activities and times, exposure rates are computed that are larger than those anticipated in traditional nuclear medical imaging facilities. Measurements of exposure rates indicate that such an approach will result in conservative estimates of exposure by a factor of 1.2-6.3. Exposure rates due to gas lines may be kept at reasonable levels by careful planning of the routing of the line and by using high flow rates and small bore tubing. If reasonable care is taken to maintain the system so that only a limited number of failures occur, the doses due to pneumatic transport system operation are also small. The nonextremity doses to personnel and other individuals not involved in radiotracer preparation are estimated to be highest due to exposure to the patient sources. Shielding for 511 keV photons may help to minimize exposure. Several practical suggestions are given for further reducing exposure to personnel.


The use of formal and informal home care by the disabled elderly.

Using data from the Channeling experiment, this article analyzes the factors associated with the amount of formal and informal home care received by the disabled elderly. The amounts of formal and informal home care used increase with disability, as well as with other measures of need for care. The use of formal care increases, and the use of informal care decreases, with income. The availability of immediate family increases reliance on informal care and reduces reliance on formal care. The findings have implications for the design of proposed programs to expand publicly financed home care for the disabled elderly.


Home care for the disabled elderly: predictors and expected costs.

While interest in publicly funded home care for the disabled elderly is keen, basic policy issues need to be addressed before an appropriate program can be adopted and financed. This article presents findings from a study in which the cost implications of anticipated behavioral responses (for example, caregiver substitution) are estimated. Using simulation techniques, the results demonstrate that anticipated behavioral responses would likely add between $1.8 and $2.7 billion (1990 dollars) to the costs of a public home care program. Results from a variety of cost simulations are presented. The data base for the study was the 1982 National Long-Term Care Survey.


Program factors that influence utilization of adult day care.

Health planners, policymakers, and providers urgently require methods and information that explain the factors that affect health services utilization. This information is especially critical for planning programs that are effective in maintaining the burgeoning elderly population in community care. In this study, correlation and regression analyses examined the characteristics of adult day care (ADC) centers that were associated with utilization as operationalized by demand for and actual attendance in 822 centers. Community, client population, services and activities, and structural characteristics were associated with demand per center whereas the social environment of the ADC center was not. The attendance rate was most strongly affected by services and activities and structural characteristics. The significance of the study, its limitations, and future directions for research are discussed.


Mammography referrals for elderly women: is Medicare reimbursement likely to make a difference?

Data from a survey of primary care physicians practicing in Long Island, New York in 1990 show that physicians report that they are less likely to refer all of their elderly female patients--those 75 years of age and older--for routine screening mammograms than their patients age 50 to 75. According to physicians' self-reports, out-of-pocket costs to the patient for screening mammography are not considered a major deterrent to referrals in this age group. Physicians' decisions to refer elderly patients are affected by the patients' state of health and are associated with the specialty of the physician: obstetrician/gynecologists (OBGYNs) are more likely to make routine referrals of elderly patients for screening mammography than are family practitioners and general internists. The results of this analysis suggest that the new Medicare reimbursement for biennial screening mammograms will not result in immediate increases in utilization by elderly women, unless their physicians become more convinced of the utility of widespread mammographic screening for the elderly patient.


A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume jointly affect mortality rate and to examine ruptured and unruptured aneurysms separately; (2) a six-year data base is used to study the "practice makes perfect" hypothesis and the "selective referral" hypothesis; and (3) the degree of specialization of high-volume surgeons is contrasted with that of other surgeons. The results demonstrate a significant inverse relationship between hospital volume and mortality rate for unruptured aneurysms. Further, very few surgeons substantially increased their aneurysm surgery volumes in the six-year study period. Weak selective referral effects were found for both surgeons and hospitals, and higher-volume aneurysm surgeons tended to have much higher specialization rates.


Governing board structure, business strategy, and performance of acute care hospitals: a contingency perspective.

Contingency theory suggests that for a hospital governing board to be effective in taking on a more active role in strategic management, the board needs to be structured to complement the overall strategy of the organization. A survey study was conducted to examine the strategies of acute care hospitals as related to the structural characteristics of their governing boards. After controlling for organizational size and system membership, results indicated a significant relationship between the governing board structure of 109 acute care hospitals and their overall business strategy. Strategy also accounted for more of the variance in board structure than either organization size or system membership. Finally, the greater the match between board structure and hospital strategy, the stronger the hospitals' financial performance.


Age distribution and turnover of physicians in nonmetropolitan counties of the United States.

Using data for 1975 to 1985 from the Area Resource File (ARF), net number changes in different age groups of physicians practicing in nonmetropolitan counties are examined. Small net increases are seen in the higher age groups in most county size categories but the most striking change is large increases in the age groups up to age 44. Family practitioners show a net decline in all county size categories for ages 45-54, but these are offset by increases in medical specialists. In counties of less than 25,000 population, the rate of turnover of physicians over the 1983-1988 period was 25 percent; physicians exiting these counties had a mean age of 52.3 years. The data indicate that aging of physicians in rural counties should not affect maintenance of current supply in the short run, but that increasing the physician-to-population ratio in areas with less adequate supply will be difficult, particularly if the rate of increase of younger physicians in nonmetropolitan counties does not continue.


Taking the mystery out of rhythm interpretation: atrial electrograms.

To verify cardiac rhythms in which diagnosis from conventional surface recordings was unclear. Approximately five electrograms were recorded each week from randomly selected patients who had undergone cardiac surgery in a two-year period from 1989 to 1991. A 1000 bed acute care medical facility that provides care to more than 1300 patients per year after open heart surgery. Adult patients in the surgical intensive care unit or stepdown units who were recovering from coronary artery bypass grafting, valve replacement or repair, aneurysm resection, and/or atrial and ventricular septal defect repairs. The atrial electrogram was used to diagnose various dysrhythmias. The most frequent application was the verification of atrial flutter, atrial fibrillation, and junctional rhythm. Another use was to differentiate between ventricular tachycardia and supraventricular tachycardia with aberrant conduction. Critical care clinicians caring for patients who have undergone cardiac surgery must be proficient at rapid, accurate rhythm interpretation to give appropriate treatment. The use of atrial electrograms can be extremely helpful in rhythm interpretation and clarification for this population of patients.


Accuracy of heart rate assessment in atrial fibrillation.

To determine the most accurate technique to measure the heart rate during atrial fibrillation by use of three counting intervals, 15, 30, and 60 seconds, and two methods, apical and radial pulse measurement. A quasi-experimental, repeated measures factorial design was used to determine absolute error (amount of error ignoring direction of error) between heart rates obtained from six randomly ordered pulse measurements taken of one man in chronic atrial fibrillation by the 94 nurses in the sample and the heart rate recorded by simultaneous electrocardiographic (ECG) and plethysmographic (pleth) recordings. Nurses in four groups comprised the sample; registered nurses (N = 29), licensed practical nurses (N = 23), nursing students (N = 21), and registered nurses with advanced degrees who are clinical specialists and in faculty positions. The heart rate of the man varied from 57 to 111 beats/min (mean 81 beats/min). The mean absolute error rates for the six measurements ranged from 8 beats/min to 20 beats/min, all considered to be important when a 10% error was used as the criteria for clinical significance. The apical method was significantly more accurate than the radial method regardless of whether the ECG or pleth standard was used (ECG--F1.90 = 72.91, p less than 0.0001; pleth--F1.144 = 4.68, p = 0.036). The 60-second counting interval was significantly more accurate regardless of the standard (ECG--F2.180 = 5.19, p = 0.006; pleth--F2.88 = 3.95, p = 0.02). Atrial fibrillation occurs in 2% to 4% of people over 60 years of age and is one of the most difficult dysrhythmias to count. Accurate counts are important when making clinical decisions, yet measurement of heart rate in this study was quite inaccurate. The 60-second count and the apical method were the most accurate statistically, although differences in counting interval error rates were not clinically significant.


Symptom distress in cardiac transplant candidates.

To examine symptom frequency and distress in heart transplant candidates. Prospective, two-site study with a correlational design. Large Midwestern and large Southern medical center. Convenience sample of 175 adult patients (mean age 52 years, 85% men) awaiting heart transplantation. Fifty percent of the patients had ischemic cardiomyopathy and 47% had dilated cardiomyopathy. The Heart Transplant Symptom Checklist (Grady, Jalowiec, & Grusk, 1988), a 92-item self-administered instrument that measures how much patients are bothered by symptoms on a four-point rating scale, was developed by the research team for the study. Cronbach alpha reliability for the total scale was 0.95. The most frequent and distressing symptoms for patients awaiting heart transplantation were tiredness, difficulty breathing when walking or doing something, difficulty sleeping, and weakness in the whole body. Patients who had more symptom distress were unable to work. Higher symptom distress correlated significantly with higher stress, less life satisfaction, lower quality of life, and more functional disability. Heart transplant candidates experience symptoms that may affect their ability to work and are associated with more functional disability and lower quality of life. Identification of the most frequent and distressing symptoms helps nurses and other health care providers to better assess and intervene with patients who are heart transplant candidates.


Myocardial infarction size and scar dimensions: the influence of activity.

The purpose of this study was to determine myocardial infarct size and scar dimensions in experimentally infarcted rats that were randomly assigned to a moderate, mild, or no exercise condition after infarction. Pretest-posttest control group design (experimental). 57 male Harlan Sprague Dawley rats between 62 to 64 days of age and weighing 220 to 290 gm at the onset of the study. Infarction size, scar thickness, thinnest portion of scar. Mild exercise versus moderate exercise versus no exercise. No differences were found in infarct size, scar thickness, or thinnest portion of scar among the three groups. This study establishes that treadmill exercise, begun after an appropriate period of recovery, does not necessarily increase infarct size or scar thinning in the rat model. Further, animal and human studies are needed to fully explore the benefits and hazards of cardiac rehabilitation or exercise testing before or soon after discharge.


Positioning effects on arterial oxygen and relative pulmonary shunt in patients receiving mechanical ventilation after CABG.

To examine the effects of three different positions on arterial oxygen and relative pulmonary shunt in patients after coronary artery bypass graft (CABG) who are receiving mechanical ventilation with an effective tidal volume of 15 ml/kg and a minimum of 5 cm H2O positive end-expiratory pressure. Repeated measures, counterbalanced. Adult cardiovascular intensive care unit in a major tertiary referral hospital. Convenience sample of 30 patients who had undergone CABG, 90% of whom had postoperative atelectasis. Partial pressure arterial oxygen (PaO2) and relative pulmonary shunt (areas of low ventilation-perfusion ratio). Supine, right lateral, and left lateral positions with head of bed elevated 30 degrees. No statistically significant differences in arterial oxygen and relative pulmonary shunt were found among the three positions. For a selected cohort, positioning may not be an important consideration in arterial oxygenation in patients who have undergone CABG and are receiving mechanical ventilation with a high tidal volume and positive end-expiratory pressure.


The effect of positioning on arterial oxygenation in children with atelectasis after cardiac surgery.

To determine the effect of body position on arterial oxygenation in children with unilateral atelectasis after cardiac surgery. Prospective, quasi-experimental, random assignment. Midwestern university-affiliated tertiary pediatric medical center. 25 children who underwent cardiac surgery and who presented with unilateral atelectasis within 2 weeks of operation. Age range was one month to 10 years (mean 34 months). The partial pressure of oxygen. Data collection was initiated within 24 hours of the diagnosed unilateral atelectasis. Arterial blood gases were drawn from intraarterial lines after subjects were placed for 15 minutes in the supine, right lateral, and left lateral decubitus positions (atelectatic lung dependent or nondependent), the order being randomized. Analysis of variance for repeated measures was used in the data analysis. The mean PaO2 for the supine, nondependent, and dependent positions were 115, 118, and 112, respectively. No statistical differences at p less than 0.05 level of significance were demonstrated for the body positions under study. Age and degree of atelectasis were analyzed as covariates to determine the possible correlation with the PaO2 and the change in PaO2. Age inversely correlated with the PaO2, r = -0.24 (p less than 0.05), indicating the older subjects had a lower PaO2. The degree of atelectasis demonstrated correlation with the change in PaO2, r = -0.26 (p less than 0.05) indicating the subjects with greater degree of atelectasis had a lesser change in PaO2. These results differ from similar studies on the effect of positioning in adult subjects. This finding suggests that the effect of positioning of children who have had cardiac surgery should be evaluated on an individual basis with close monitoring for changes in clinical condition and oxygen saturation and periodic arterial oxygen blood sampling until further studies can provide conclusive direction.


The experience of dyspnea during weaning.

To compare the degree of dyspnea experienced by ventilator-dependent patients receiving synchronized intermittent mandatory ventilation (SIMV) versus T-piece or pressure support ventilation (PSV) weaning. The relationship between self-reported perceptions of dyspnea and physiologic variables observed during weaning trials was examined. Variables included heart rate, respiratory rate, minute ventilation, and oxygen saturation as measured by a pulse oximeter. Quasi-experimental, counterbalanced design with repeated measures. Medical intensive care unit of a large university-affiliated medical center. Nine mechanically ventilated patients diagnosed with chronic obstructive lung disease. The patients were admitted for respiratory failure between May 1990 to November 1990. Six tolerated SIMV 4 versus T-piece trials; three were placed in the SIMV 8 versus PSV trials. Each patient's perception of dyspnea was measured using a visual analog scale (VAS) at the initiation and at 5-minute intervals of 20-minute weaning trials. Physiologic indicators were noted simultaneously with VAS ratings of dyspnea. Findings indicated no difference in the degree of dyspnea experienced between weaning methods compared. Within-subject regression analysis on VAS scores revealed individual differences in the relationship between physiologic indicators and perceptions of dyspnea. The patient's experience of dyspnea during the weaning process can be a valuable guide to observe the patient's progress. The VAS serves as a reliable, easy-to-use tool for quantifying the patient's perception of dyspnea.


Issues in selecting and using apnea documentation systems.

The primary purpose of apnea monitoring is to ensure adequate warning of certain life-threatening respiratory and cardiac events, often in infants monitored at home. However, parents often become frustrated by frequent alarms, and other may not use the monitor at all. Unfortunately, ECRI has received a number of incident reports in which infants have died while not connected to their monitors or where a failure to monitor was suspected. We believe that some of these deaths may have been prevented if monitoring had been used properly. The most important step that parents can take to achieve effective monitoring is to faithfully follow the directions of their doctor. In an effort to ensure parental compliance, documentation capability has been added to many of today's monitors. In addition, those involved in providing patient care, especially the prescribing physicians, durable medical equipment (DME) providers, report scorers, interpreting physicians, and other clinicians, should carefully review their monitoring programs and the available documentation monitoring systems to determine how they can best meet their patients' needs. Below, we discuss the factors to consider when contemplating documented apnea monitoring and when selecting a documented monitoring system. The documentation features discussed are those we considered to be distinguishing factors among the systems evaluated in this issue and affected how we rated and ranked these units.


The febrile response in critical care: state of the science.

Fever is a dynamic alteration in thermal balance caused by effects of pyrogens on the hypothalamic thermostatic set point. Thermoregulatory function remains intact during fever, but temperatures are maintained at higher levels. Shivering and vasoconstriction drive temperatures higher while causing physical exertion and distress to the patient. Biomedical research reveals potential benefits of fever, because fever-producing cytokines stimulate host defense responses. Nursing care is aimed at making rational decisions for comfort and energy conservation while maximizing the immune response. In this article the pathophysiologic process and benefits of fever are reviewed and a conceptual approach to nursing care based on knowledge of thermoregulatory responses is proposed. Nursing care measures include assessment of alterations in thermal balance, selection of appropriate measures to modify or support physiologic responses, and evaluation of outcomes of therapy. Research-based direction for care is presented, as well as gaps in scientific knowledge.


Infection control indicators in critical care settings.

The Joint Commission on Accreditation of Healthcare Organizations has developed and is currently testing eight infection control indicators in hundreds of hospitals. The indicator set focuses on surgical wound infections, postoperative pneumonia, use of urinary catheterization, ventilator-associated pneumonia, primary bloodstream infection, endometritis, adequacy of surveillance, and employee measles immunization. Critical care unit staff members may be involved in using indicator rates. Following the trend rates should suggest organizational systems and processes of care in critical care settings that may warrant further examination and improvement.


Spotlight article: thrombolysis in unstable angina: randomized double-blind trial of t-PA and placebo. Circulation 1992;85: 150-7. (Freeman MR, Langer A, Wilson RF, Morgan CD, Armstrong PW.).

This is a well-written and executed study that indicates that infusion of t-PA in patients with unstable angina does not decrease in-hospital cardiac events and, in fact, may worsen myocardial perfusion. The small sample size requires further study replication.


Use of ex vivo binding to measure the brain concentrations of putative radioligands.

The development of radioligands capable of imaging brain receptors depends on, amongst other factors, the ability of such compounds to penetrate the blood-brain barrier. We describe an ex vivo binding technique for measuring the brain concentration of peripherally administered unlabeled compounds. This technique can be used early in the development of putative radioligands. The pharmacokinetics of brain penetration of three muscarinic antagonists are described: QNB, BrQNB and the 2-thienyl derivative of BrQNB and were found to compare favorably to previous studies using [3H]QNB. These studies demonstrate the effectiveness of ex vivo binding in assessing the brain concentration of peripherally administered unlabeled compounds.


Radiolabeled products in rat liver and serum after administration of antibody-amide-DTPA-indium-111.

Anti-human serum albumin antibody (Ab) was used as a model antibody. Ab was conjugated with DTPA using cyclic DTPA dianhydride reaction and radiolabeled with 111In. The labeled Ab was purified by affinity chromatography. Size exclusion HPLC of this product showed 62% of 111In bound to monomeric Ab and 38% of the activity bound to antibody oligomers with molecular weights ranging from 300,000 to 450,000. The labeled antibody preparation was injected into the tail vein of rats. The radioactive substances in serum and the supernatant from liver homogenates were analyzed for molecular weight and immunoreactivity. Size exclusion HPLC of the serum samples indicated that the monomeric and dimeric Abs disappeared from the serum at a similar rate over a 48 h period. In addition, a new radioactive substance with an estimated molecular weight of 35,000 appeared in the serum. The immunoreactive fraction of the circulating 111In substances decreased slowly, somewhat proportional to the appearance of the metabolite. On the other hand, the immunoreactivity of the 111In substances in the supernatant from the liver homogenate decreased rapidly and no appreciable immunoreactivity was observed after 48 h. The labeled antibody was catabolized very rapidly in the liver and the major activity in the supernatant was associated with a small molecular weight metabolite which had a HPLC retention time identical to that of DTPA-111In. The second metabolite had an estimated molecular weight of 35,000. No radioactivity was associated with transferrin.


Preparation of 123I-labeled 2'-iodospiperone and imaging of D2 dopamine receptors in the human brain using SPECT.

[123I]2'-ISP was readily prepared using a radioiodine exchange reaction with a radiochemical yield of approx. 50% after HPLC purification. The radiochemical purity of the product was more than 98% and the specific activity was 5.55-11.1 GBq/mumol. Biodistribution studies performed in mice indicated that injection of [123I]2'-ISP with albumin produced a higher gastric uptake and a lower brain uptake than injection of the radioligand in a weakly acidic solution. In addition, toxicity tests performed in mice demonstrated that acute toxic effects would be very unlikely to be encountered if 2'-ISP was used for diagnostic purposes. A preliminary imaging study with [123I]2'-ISP in a healthy human volunteer showed its specific uptake by the basal ganglia, a region of the brain known to have a high density of D2 dopamine receptors.


Accumulation of radioactivity in the pancreas after intravenous administration of [13N]ammonia.

A biodistribution study of [13N]ammonia in rats showed a high accumulation of radioactivity in the pancreas soon after the intravenous injection of this tracer. In humans, the pancreas was also clearly visualized by dynamic positron emission tomography soon after the intravenous injection of [13N]ammonia. To investigate the mechanism of the pancreatic accumulation of [13N]ammonia, in vitro studies with pancreatic slices and in vivo biodistribution and metabolism studies were carried out in rats. The results indicated that [13N]ammonia enters the pancreas from the blood by diffusion at a rate dependent on local blood flow, and then is rapidly incorporated into the amino acid fraction (mainly the glutamine fraction), followed by its incorporation into protein. These findings suggest that [13N]ammonia could be useful for diagnostic imaging of the pancreas.


A simple method for producing a technetium-99m-labeled liposome which is stable in vivo.

A new method for labelling preformed liposomes with technetium-99m (99mTc) has been developed which is simple to perform and stable in vivo. Previous 99mTc-liposome labels have had variable labeling efficiencies and stability. This method consistently achieves high labeling efficiencies (greater than 90%) with excellent stability. A commercially available radiopharmaceutical kit--hexamethylpropyleneamine oxime (HM-PAO)--is reconstituted with 99mTcO4- and then incubated with preformed liposomes that encapsulate glutathione. The incubation takes only 30 min at room temperature. Liposomes that co-encapsulate other proteins such as hemoglobin or albumin, in addition to glutathione, also label with high efficiency. Both in vitro and in vivo studies indicate good stability of this label. Rabbit images show significant spleen and liver uptake at 2 and 20 h after liposome infusion without visualization of thyroid, stomach or bladder activity. This labeling method can be used to study the biodistribution of a wide variety of liposome preparations that are being tested as novel drug delivery systems. This method of labeling liposomes with 99mTc may also have applications in diagnostic imaging.


Synthesis and biodistribution of a new radiotracer for in vivo labeling of serotonin uptake sites by PET, cis-N,N-[11C]dimethyl-3-(2',4'-dichlorophenyl)-indanamine (cis-[11C]DDPI).

A new PET radiotracer for in vivo labeling of serotonin (5-HT) uptake sites, cis-N,N-[11C]dimethyl-3-(2',4'-dichlorophenyl)-indanamine, cis-[11C]DDPI, was synthesized and its biological behavior was studied. The radiosynthesis of cis-[11C]DDPI was performed by N-methylation of cis-N-methyl-3-(2',4'-dichlorophenyl)-indanamine with [11C]iodomethane. The average radiochemical yield was approx. 8%, with an average specific activity of 600 mCi/mumol. Following intravenous administration, cis-[11C]DDPI accumulated in mouse brain regions rich in 5-HT uptake sites, such as olfactory tubercles, hypothalamus and frontal cortex. Following pre-injection of 1 mg/kg of paroxetine, a high affinity 5-HT uptake blocker, the binding of cis-[11C]DDPI in the olfactory tubercles, hypothalamus and frontal cortex was decreased by 23, 25 and 16%; this corresponds to 73, 82 and 59% of the specific binding in these regions. These results suggest that the accumulation of cis-[11C]DDPI in the tissues rich in 5-HT sites is a result of specific binding of cis-[11C]DDPI to 5-HT uptake sites. Due to the relatively high non-specific uptake and slow clearance of this compound from non-specific binding sites, the ratio between specific and non-specific binding increased slowly with time, reaching 1.5:1 at 60 min after injection.


[75Se]selenite and [75Se]selenate fluctuations during the development of murine hepatoma.

The distribution of selenate and selenite selenium in C57L/J mice during the progression of BW7756 murine hepatoma was investigated using intra-ocular injection with the oxyanions labeled with 75Se radioisotope. Comparison is made with the normal distribution of selenium studied by the RIXRF method. The trace elemental profiles, TEP, for the two oxidation states are compared in healthy and disease states. It has been found that the presence of tumor significantly changes the level of tracer in various uninvolved organs. These changes are prominent in the early growth phase of the tumor. The two oxidation states show differences in the TEP for kidney, spleen, stomach and testes.


Synthesis and evaluation of high affinity, aryl-substituted [18F]fluoropropylbenzamides for dopamine D-2 receptor studies.

The potent dopamine D-2 ligands (S)-2,3-dimethoxy-N-[(1-ethyl-2-pyrrolidinyl)methyl]-5(3- [18F]fluoropropyl)benzamide (18F-1) and (S)-2,3-dimethoxy-N-[(1-ethyl-2-pyrrolidinyl)methyl]-5-(3- [18F]fluoropropyl)-6-hydroxybenzamide (18F-2) were prepared in high specific activity and 5-25% overall radiochemical yields. Benzamide 1 possessed a lower in vitro binding affinity for the D-2 receptor than salicylamide 2, but the in vivo striatal-to-cerebellar radioactivity concentration ratios (St/Cb) in rats and dogs were nearly identical for the two compounds. Compound 18F-2 was more lipophilic than 18F-1, and its increased penetration into and retention by striatal tissue was matched by an increase in non-specific binding in the cerebellum. Cerebral cortex radioactivity concentration levels in dogs were similar to cerebellum levels. The binding of 18F-labelled 1 and 2 displayed regional brain distribution patterns consistent with known dopamine D-2 receptor densities and was selectively blocked in the striatum of rats by dopamine D-2 antagonists. The binding of 18F-1 was found to be stereoselective, as the 18F-labelled (R)-enantiomer displayed no selective retention in the striatum of dogs. High levels of radioactivity were found in the bones of rats following the injection of 18F-1 and 18F-2, indicating that in vivo defluorination had occurred; however, no bone radioactivity was observed in dogs following the injection of these radioligands. Compound 18F-1 was displaced from the striatum of dogs by both d-amphetamine-stimulated dopamine release and haloperidol at doses of 1 and 0.5 mg/kg, respectively, while compound 18F-2 was displaced from the dog striatum only by haloperidol at these doses. The radioligand 18F-2 holds promise for positron emission tomography studies of the dopamine D-2 receptor system based upon its selective, potent binding and resistance to displacement by endogenous dopamine.


Specific biodetection of a murine spontaneous mammary carcinoma with labelled anti-human blood group-A monoclonal antibody.

The expression of cell surface antigens of the spontaneous transplantable M3-murine tumour was studied by means of the monoclonal antibody (MAb) B2C114 which recognizes the human blood group-A carbohydrate antigen. Following radioiodination the MAb retained their immunoreactivity and demonstrated a significantly higher in vitro binding with isolated M3-tumour cells as compared with a control antibody. B2C114 revealed 10(6) antigenic sites per cell, with a constant affinity of 5.1 x 10(9)/M. Biodistribution studies showed that B2C114 discriminated between malignant tumour and mouse normal tissues. Radioimmunodetection of Balb/c mice bearing s.c. M3-tumour showed that tumour was specifically defined without subtraction 1 day after injection of the radiolabelled antibody.


Synthesis and in vitro binding properties of halogenated analogues of GBR as new dopamine uptake carrier ligands.

We present the original synthesis of two halogenated analogues of the diphenyl piperazine GBR, bromo-GBR and iodo-GBR, as new dopamine uptake carrier ligands. The derivatives were purified by HPLC and chemically characterized. Bromo-GBR and iodo-GBR and iodo-GBR are potent inhibitors of [3H]GBR 12935 binding to rat striatal membrane, with Ki values of 116 and 113 nM, respectively. We prepared iodo-GBR labeled with iodide-125 from the brominated derivative and concluded that [123I]iodo-GBR could be a potential tool to explore the in vivo dopamine uptake carrier.


Comparison of the biodistribution of 75Se- and 131I-labelled monoclonal antibodies in nude mice.

A monoclonal antibody, C-215, against colon cancer, was internally labelled with [75Se]methionine. The biodistribution was studied in tumour-bearing nude mice and compared with the biodistribution of [131I]C-215. The tissue uptake was divided into three parts: antibody bound to the antigen, antibody in the extracellular space and uptake of the released radionuclide. [75Se]C-215 showed a greater amount of antigen-bound antibody in the tumour, but also a greater unspecific uptake both in tumour and normal tissue.


A study of the concept of non-radioactive unit-dosed reagent kits [cold unit doses (CUDs)] as an efficient and cost-saving method for 99mTc radiopharmaceutical preparation.

Traditionally, when preparing 99mTc-labeled radiopharmaceuticals, [99mTc]pertechnetate is added to the entire contents of a vial of reagent kit, and patient doses are subsequently withdrawn from the vial. This technique of compounding can be potentially wasteful for two reasons: (1) once reconstituted with 99mTc, most reagent kits have a relatively short shelf-life, and thus the entire contents may not be used before expiration and (2) due to a need to conserve radioactivity in many hospitals, enough [99mTc]pertechnetate is added to the reagent kit in order to retrieve only 1-2 patient doses, even though adequate chemicals (ligand, reducing agent, etc.) are present in the reagent kit to supply as many as 5-10 doses. Hence, a method for optimizing the efficient use of reagent kits would be desirable. The purpose of this study was to determine the feasibility of unit-dosing non-radioactive reagent kits and storing these cold unit doses (CUDs) for eventual labeling with 99mTc. To evaluate this concept, unit doses were prepared from reagent kits of medronate (MDP) and pentetate (DTPA). The specific variables studied in this research were the effects of storage time, storage temperature and reconstitution volume (dilution) on the unit doses. These effects were monitored by measuring the radiochemical and biodistribution properties of the unit doses following their final reconstitution with [99mTc]pertechnetate. The labeling efficiency was determined using instant thin layer chromatograph (ITLC), and the biodistribution patterns of these radiolabeled CUDs were studied in mice. The results showed the MDP- and DTPA-CUDs stored at -18 degrees C retained the properties which resulted in acceptable radiochemical purity and biodistribution in mice for as long as 30 days. On the other hand, the radiochemical purity of MDP and DTPA unit doses stored at 25 degrees C deteriorated rapidly. Mean radiochemical purities as low as 0.58-19.4% were observed on day 30. Altered biodistributions were observed in a manner consistent with the decreased labeling efficiencies. The CUDs of lower dilution (3 mL) appeared to be more stable than the CUDs of higher dilution (10 mL). However, the effect of reconstitution volume was much less significant than the temperature effect on the CUDs. In conclusion, the concept of unit-dosing non-radioactive reagent kits appears to provide an efficient and cost-saving method for preparing infrequent and emergency radiopharmaceutical doses. The study also showed that the storage temperature of these unit doses is critical to the success of the procedure. The volume of reconstitution has a minimal impact on the stability of CUDs if stored at the appropriate temperature.


In vivo studies of ethanol on prolactin and luteinizing hormone in rats and mice.

The interaction of ethanol (EtOH), prolactin (Prl) and luteinizing hormone (LH) was examined in two studies. In the first study, adult male C57B1/6J mice were given a single intraperitoneal injection of either vehicle or Prl at 5, 10 and 20 mg/kg and a significant dose-related suppression of ethanol consumption was found. This injection did not cause any differences in food intake or body weight. Additionally, a 5 mg/kg dose of Prl was also given to adult male Long Evans Hooded rats and, similarly, there was a significant suppression of ethanol consumption. In a second study, when rats were given a free choice between water and 5% EtOH, three subgroups were found regarding the amount of EtOH consumption: low, medium and high. After 2 weeks of free choice, hypothalamic, but not serum Prl and LH levels, were significantly increased in EtOH-imbibing groups compared to controls. These findings suggest important interactions between EtOH consumption and ambient levels of Prl and LH.


Preparation and biological behaviour of some neutral 99mTc-carbonyl dithiocarbamates showing rapid hepatobiliary excretion.

A simple procedure for the preparation of 99mTc-carbonyl complexes of dithiocarbamates in high yield and radiochemical purity has been developed and used for the preparation of 99mTc-carbonyl complexes of bis(2-hydroxyethyl)dithiocarbamate and bis(2-hydroxypropyl)dithiocarbamate. These complexes were found to be extremely stable and their biological behaviour was studied in mice and compared to that of the 99mTcN- and the 99mTc-complexes [prepared by dithionite (dit) reduction] of the same ligands. The carbonyl complexes were found to be efficient hepatobiliary agents and cleared more rapidly than the corresponding 99mTcN- and 99mTc(dit)-complexes.


Investigation of tumor metastatic potential with N-[18F]fluoroacetyl-D-glucosamine.

In order to investigate the metastatic potential of tumors in vivo by measuring hyaluronic acid metabolism, C57BL/6 mice with B16 melanoma variants and C3H/He mice with FM3A tumor variants were evaluated using N-[18F]fluoroacetyl-D-glucosamine (18F-GlcNFAc). The uptake of 18F-GlcNFAc was slightly higher (P less than 0.05) in B16-F10 tumors (high metastatic potential) than in B16-F1 (low metastatic potential). Analysis of metabolites showed that acid-insoluble fraction was the largest one in the liver by 60 min, whereas in the tumors, phosphates fraction was the major metabolite. Slower metabolism in tumors was suggested, and it may be one of the reasons for the difficulty of detecting the characteristics of their hyaluronic acid synthesis. 18F-GlcNFAc uptake by FM3A variants showed no significant correlation with their metastatic potential. In addition, N-acetyl-D-[1-14C]glucosamine, 2-deoxy-D-[1-14C]glucose and [6-3H]thymidine failed to demonstrate any difference between tumors' metastatic variants in vivo.


Development of a liposome-encapsulated radionuclide with preferential tumor accumulation--the choice of radionuclide and chelating ligand.

Various radionuclide-ligand complexes were encapsulated in liposomes and their accumulations in tumors were studied. Increased tumor accumulation was observed with every complex in the liposome-encapsulated form. However, different accumulation levels were registered for the various radionuclides even though they were all delivered using a similar liposome formulation. Though the liposomes remained intact in the circulation, they were degraded in the tumor, liver and spleen eventually. Thus, this suggests that tumor accumulation of liposome-encapsulated radionuclides is dependent on not only the in vivo behavior of the liposomes themselves, but also the characteristics of nuclide-ligand complexes after their release from liposomes. A correct choice of radionuclides and ligands for encapsulation in liposomes would enable excellent tumor-imaging agents to be achieved.


4-[123I]iodospiperone as a ligand for dopamine DA receptors: in vitro and in vivo experiments in a rat model.

Radioiodinated spiperone is of interest for dopamine (DA) receptor studies in the living human brain by single photon emission computed tomography (SPECT). Stimulated by data obtained with [11C]-N-methyl-spiperone we synthesized 4-[123I]iodospiperone and investigated the in vitro binding characteristics of this ligand to the striatal membrane of the rat and the in vivo distribution over various rat brain regions. The in vitro binding experiments showed that this radioligand displays about 10 times less affinity for the DA receptor than spiperone and specific binding, as shown with [3H]spiperone, was not observed. Displacement by butaclamol was not observed. The in vivo studies demonstrated that both 4-[123I]iodospiperone and [3H]spiperone concentrate in striatal tissue, respectively, 1.9 and 3.5 times as high as in cerebellar tissue. Haloperidol pretreatment largely prevented this accumulation. In view of the obtained target-to-non-target ratios we believe, however, that this accumulation in brain areas rich in DA-receptors does not offer prospects for clinical receptor imaging with SPECT.


Selective localization of radioiodinated alkylphosphocholine derivatives in tumors.

We have designed and synthesized two radioiodinated analogs of hexadecylphosphocholine in order to evaluate their tumor imaging potential. 12-(m[125I]iodophenyl)dodecyl phosphocholine (NM-324) and hexadecyl-2-[N,N-dimethyl-N-(m[125I]iodobenzyl)-ammonium] ethyl phosphate (NM-326) demonstrated the ability of such compounds to localize in and thereby visualize the Walker 256 tumor in rats. However, the tumor avidity of NM-324 was far superior to NM-326. In addition, NM-324 showed excellent tumor localization in athymic mice bearing subcutaneous human tumors.


Comparison of methods for incorporating a radioiodinated residualizing cholesteryl ester analog into low density lipoprotein.

Two different methods were evaluated for incorporating [125I]cholesteryl iopanoate ([125I]CI), a non-hydrolyzable cholesteryl ester analog, into LDL. The first procedure was an organic solvent delipidation-reconstitution procedure (R[125I-CI]LDL) while the second involved incubation of detergent (Tween-20)-solubilized [125I]CI with whole plasma (D[125I-CI]LDL). R[125I-CI]LDL behaved similar to native LDL in vitro, but was markedly different in vivo, apparently due to a heterogeneity in particle size. D[125I-CI]LDL, however, was metabolized normally both in vitro and in vivo. These results, combined with the residualizing nature of [125I]CI, demonstrate that D[125I-CI]LDL is appropriate for tracing LDL uptake in vivo.


The effect of ligand structure on glutathione-mediated decomposition of propylene amine oxime derivatives.

Tetramethylpropyleneamine oxime (TMPAO) was synthesized and complexed to 99mTc. 99mTc-TMPAO samples, when challenged with reduced glutathione (GSH), were shown to have two GSH sensitive components, similar to a mixture of d,l and meso 99mTc-HMPAO. One component had a GSH-induced second-order dissociation rate constant (K2) similar to 99mTc-meso-HMPAO. Despite the presence of a large fraction of this component in these samples, brain uptake and autoradiographic studies with 99mTc-TMPAO were equivalent to 99mTc-d,l-HMPAO suggesting that both the d,l and meso 99mTc-TMPAO isomers are efficiently trapped in brain.


Synthesis, characterization and biodistribution studies of a neutral-lipophilic Tc-99m N3S2 chelate.

Diaminedithiols (DADT) are known to form neutral-lipophilic complexes with 99mTc in aqueous solutions, where they are readily formed in high yields and demonstrate excellent stability. A new triaminedithiol (TADT) ligand was synthesized, characterized and shown to form a neutral-lipophilic 99mTc-chelate. The biodistribution of this 99mTc chelate in rats showed that its uptake in brain or heart following i.v. injection of the 99mTc chelate was low, but activity taken up was retained over a long period of time. The in vivo and in vitro properties of this chelate indicate the possibility that chemical modification of this TADT ligand may produce ligand systems that form 99mTc chelates with suitable diagnostic properties.


Evaluation of 99mTc-erythromycin and 99mTc-streptomycin sulphate for the visualization of inflammatory lesions.

99mTc-erythromycin (E) and 99mTc-streptomycin sulphate (SS) were prepared with greater than 98% labelling efficiency. The labels were stable up to 24 h of testing, using ITLC-SG strips and acetone and saline as solvents. The biodistributions of both radiopharmaceuticals versus 67Ga-citrate were studied in mice with turpentine-induced abscesses at 6 days post-induction. The mice were sacrificed at 1, 3 and 6 h post-injection of 15 MBq of 99mTc-E or 99mTc-SS. Mice injected with 67Ga-citrate were sacrificed at 4 and 24 h. The maximum abscess-to-muscle ratios obtained by biodistribution studies were 2.36 +/- 1.04 (6 h), 2.38 +/- 0.38 (6 h) and 4.76 +/- 2.04 (4 h) with 99mTc-E, 99mTc-SS and 67Ga-citrate, respectively. The maximum abscess-to-contralateral tissue ratios by ROIs over respective areas on scintigrams were 2.38 +/- 0.16 (6 h), 3.21 +/- 0.14 (3 h) and 3.24 +/- 0.92 (24 h) for 99mTc-E, 99mTc-SS and 67Ga-citrate, respectively. The uptake mechanism might be infiltration into interstitial space due to increased capillary permeability.


RecA-like strand-transfer activity at the meiotic prophase in Bombyx mori.

An ATP-independent strand-transfer activity has been identified in nuclear extracts prepared from Drosophila tissue culture cells and isolated nuclei from Bombyx testes. Extraction of the activity from testes at larval stages where the majority of the cells were in meiotic prophase was only possible when the chromosome scaffold/synaptonemal complex was dissolved by addition of high concentrations of DTT (80 mM). No cross reaction was detected when partly purified extracts were assayed with antibodies against E. coli RecA protein.


Stillborns, partially monosomic and partially trisomic, in the offspring of a boar carrying a translocation: rcp(14;15)(q29;q24).

Smaller liters and an increased rate of stillbirth were observed among the offspring of a boar carrying a reciprocal translocation, rcp(14;15)(q29;q24). The translocation appeared to be of de novo origin since, according to the owner, the sire and dam of the proband boar both produced normal-sized litters and no stillbirths. The increased rate of stillbirth among offspring of the proband was due to the production of zygotes partially monosomic for chromosome 14 (14q29-qter) and partially trisomic for chromosome 15 (15q24----qter). Three out of 4 such stillborn piglets had a cleft palate. One of the 4 also had a cardiac septal defect. Two partially monosomic and partially trisomic foetuses recovered at 95 days' pregnancy appeared patho-anatomically normal. The smaller litters were assumed to be due to an early wastage of embryos having other types of unbalanced karyotypes caused by the reciprocal translocation.


Localization of the citrate synthase (CS) gene to the p12-p13 bands of chromosome 5 in pigs by in situ hybridization.

Citrate synthase (CS) is a key enzyme of the Krebs tricarboxylic acid cycle. A 1.4 kb porcine CS cDNA probe was used to chromosomally localize the CS gene in pigs by in situ hybridization. Two in situ hybridization experiments were conducted. Although the first experiment indicated a distinct signal on the 5p12-p13 bands, a secondary signal was observed on the 13q24-q32 bands. Hence, a second in situ hybridization experiment was conducted at higher stringency. The results demonstrated a consistent signal on the 5p12-p13 bands, and the signal on chromosome 13 was scattered with no prominent secondary peak. The CS gene was therefore assigned to the p12-p13 bands of chromosome 5 in pigs.


Cytochrome-b sequence variation among parrots.

The nucleotide sequence of a 307 bp fragment of the mitochondrial cytochrome-b gene was determined for 12 species of parrot, using the polymerase chain reaction and direct sequencing. Sequence divergence ranged from 26-54 differences in pairwise comparisons, with the majority of base substitutions occurring at third positions of codons. The transition:transversion ratio was determined to be higher (approximately 24.3:1) in recently divergent parrot lineages than has generally been observed in other groups. Strongly biased base composition, particularly at the third position of codons, is evident among the sequences. Phylogenetic relationships among more divergent taxa were estimated, using only transversion substitutions, while all the substitutions were useful for closely related taxa. The African genera Psittacus and Poicephalus are closely related, in contrast to the Australian genera Nymphicus, Purpureicephalus and Melopsittacus, which represent more divergent lineages. The cockatoos appear to represent an ancient lineage within the parrots.


[Preventive examination for noise-induced hearing loss in accordance with the new regulation 20].

The regulations for the testing and prevention of noise-induced hearing loss in German industry since 1974 are summarized. Current testing involves both speech and impedance audiometry. While initials studies will be directed through occupational medicine, definitive managements will be provided by otolaryngologists involved in the prevention program.


[Clinical aspects and therapy of skin malignancies in the head and neck area].

A retrospective study of 199 surgically treated skin carcinomas showed that the majority of the insufficiently resected tumors had a maximum diameter of 10 mm. A surgical concept is presented which allows reliable histological control of the tumor margins and an exact resection of any residual carcinoma. This therapeutic approach is also indicated in the management of small skin malignancies.


[Diagnosis and differential diagnosis of squamous epithelial metaplasia in the parotid gland].

The authors report a case of proliferating squamous epithelium in the necrotic edge of multifocal oncocytic adenomatous hyperplasia of the parotid gland. A correct histological diagnosis is of great clinical relevance and difficulty, since similar findings can occur in mucoepidermoid carcinoma. The various cell types in the parotid gland and their roles in neoplasia are discussed.


[The value of nuclear magnetic resonance tomography in tumor staging of laryngeal-/hypopharyngeal cancer].

Twenty-four patients with tumors of the larynx and hypopharynx were examined with magnetic resonance imaging (MRI) and laryngoscopy. The results of MRI and laryngoscopy were then correlated with the pathology reports. Diagnostic findings of 84% of the MRI studies correlated with the pathology report, while laryngoscopy provided exact classification in 79%. MRI tended to overestimate tumor size because edema or inflammatory reactions of surrounding tissues simulated tumors. However, normal mucosa also enhanced contrast medium, restricting the value of this technique. Laryngoscopy tended to underestimate tumor size, because deep extensions of tumor and cartilage involvement were difficult to detect. Nonetheless, the utility of MRI in obtaining axial, coronal and sagittal slices was found to facilitate the preoperative staging of tumor extensions.


[Psychosomatic findings in patients with contact granuloma--initial results].

In a prospective study, 33 patients with vocal cord granulomas were seen in a psychosomatic interview and given questionnaires. Results showed the significance of psychosomatic factors in the occurrence of vocal cord granulomas. Psycho-social stress situations, particularly in private lives, and losses of emotionally significant persons were of prime importance. Two types of personalities--a narcissistic and a psychosomatic type--were represented about equally. In the personality structure of the patients, compulsive behavior was diagnosed most frequently while depressive features occurred to a lesser degree. Supportive and expressive psychotherapy was indicated in two thirds of the cases.


[Language development disorders--studies of preschool children of the Leipzig special language school].

Children with severe speech disorders were examined to determine the causes of their abnormal speech development. Thirty-seven preschool and school-age children were followed up and results compared. All children had low intelligence quotients, with most of the children coming from low social backgrounds. However, both of these factors (intelligence and low social background) had no influence on the improvement of speech levels after therapy. Two-thirds of the children with moderate conductive hearing losses showed improvement after therapy, so that the effect of this hearing loss was believed to be a significant cause for the development of speech disorders. An early evaluation must be performed by a qualified phoniatrican or pediatric audiologist when children are 1.5 years old and are not able to construct words.


[Echinococcosis of the temporal bone--epidemiology, diagnosis, therapy and review of the literature].

A case of primary echinococcosis or hydatid disease of the temporal bone is reported in which no other organ system was involved. Epidemiology, diagnostic problems, clinical findings and therapy in relationship to the available literature are reviewed. In the patient described, complete surgical removal of the parasitic cysts was required as well as chemotherapy with Mebendazole.