Aldosterone responses to angiotensin II in anorexia nervosa.

Patients with anorexia nervosa (AN) tend to have renin-angiotensin-aldosterone (RAA) abnormalities caused by abnormal behaviors such as strict dieting, fasting, vigorous exercise, self-induced vomiting and abuse of laxatives and/or diuretics. Adrenal responsiveness to angiotensin II (A II) was studied in 13 AN patients before and after therapy and in 6 normal sex- and age-matched controls: adrenal responses to postural change (1 h of walking following 1 h in a supine position) and to exogenous A II injection (A II: 10 ng/kg/min intravenous infusion for 30 min). The 24-h urine sodium concentration was significantly lower in AN patients before therapy than after therapy. Plasma aldosterone secretory response to A II was significantly higher in AN patients before therapy in both postural change and exogenous A II injection tests compared with after therapy response and that of controls. On the other hand, there was no significant difference in adrenal response to postural change or to exogenous A II between AN patients after therapy and controls. In conclusion, increased A II sensitivity caused by chronic sodium deficiency in AN patients normalized over time as the patients recovered.


Study of chronic schizophrenics using 31P magnetic resonance chemical shift imaging.

Phosphorus-31 chemical shift imaging showed regional abnormalities of in vivo 31P NMR spectra in the brains of chronic schizophrenic patients. In the left temporal region, the level of % phosphodiesters (PDE) was increased and the level of % gamma alpha beta-ATP (obtained by summation of gamma-ATP, alpha-ATP, and beta-ATP) was decreased. In the basal ganglia, the levels of % PDE were decreased and the level of % phosphomonoesters was increased. The levels of % gamma alpha beta-ATP were increased in the right basal ganglia. The level of % phosphocreatine was decreased in the frontoparietal region. These findings may represent different patterns of dysfunction of membrane phospholipid bilayers and high-energy phosphate metabolism in the specific cerebral regions.


Persistent auditory hallucinations correlate with the size of the third ventricle in schizophrenic patients.

In a study of psychotherapy in schizophrenic patients, the existence of certain clinical and anamnestic variables, such as persistent auditory hallucinations, was found to correlate with a negative outcome. To test whether these clinical variables could be a sign of organic brain abnormality, the records of 33 schizophrenic patients who had been examined by computerized tomography (CT) were investigated regarding the occurrence of these symptoms. A significant correlation was found between width of the third ventricle and the occurrence of such auditory hallucinations, which also persisted between acute phases. No correlation was found between the CT measures and other clinical characteristics, including hallucinations rated at admission by the Comprehensive Psychopathological Rating Scale (CPRS). The results are interpreted to suggest a disturbance of diencephalic brain regions in a subgroup of schizophrenic patients that are further characterized by persistent auditory hallucinations and a lack of response to psychodynamic psychotherapy.


The Meta-Contrast Technique--a projective test predicting suicide.

Sixty-nine inpatients who had attempted suicide were studied by means of the Meta-Contrast Technique (MCT), a projective test measuring personality factors, especially defensive strategies. The patients were divided into 3 subgroups, one of which was defined as stereotypy only, which denotes stereotypy (perceptual retardation) without any other coded defenses. At follow-up 7 of 8 completed suicides belonged to this subgroup and they matched various main diagnoses according to DSM-III-R. When the MCT findings of all patients were compared with 99 depressed inpatients from a previous study, the latter group more often had mature defensive strategies. In both investigations most completed suicides were found in the stereotypy only group. Our findings indicate that, regardless of psychiatric diagnosis, stereotypy without other defenses in MCT predicts suicide.


Evaluation of the effects of total sleep deprivation on cerebral blood flow using single photon emission computerized tomography.

HMPAO-single photon emission computerized tomography (SPECT) is a useful technique in studying cerebral blood flow (CBF). This method is suitable to evaluate the differences of CBF with reference to total sleep deprivation (TSD) within 24 h because of the short half-life of the radiopharmaceutical compound. In the present study, CBF before and after TSD was analysed in patients suffering from major depression. The morning before and after TSD, Tc-HMPAO-SPECT was performed in 20 patients. Hamilton Rating Scale for Depression scores and subjective ratings were obtained daily. Eleven patients responded to TSD; 9 were nonresponders. The main finding was a significant left temporal and mainly right parietal increase of CBF, which was observed in the responders only. CBF values and the severity of depression correlated inversely.


Reliability of ICD-10 research criteria: an Arab perspective.

Within a broader World Health Organization (WHO) collaborative research around the ICD-10 diagnostic criteria for research, the Regional Office for the Eastern Mediterranean (EMRO) ICD-10 research coordinating center at the Ain Shams Institute of Psychiatry presented the data collected from 8 Arab centers, which investigated a total of 233 patients using the local psychiatric interview schedules and diagnosed according to ICD-10 criteria. Interrater reliability was found to range between an almost perfect (0.81-1) to substantial agreement (0.61-0.80) (using the kappa coefficient) in diagnosing organic mental disorders, substance use disorders, schizophrenic, schizotypal and delusional disorders, affective disorders and neurotic and stress-related disorders. The categories of psychological development and child and adolescent disorders were diagnosed less frequently and the agreement between raters was lower. Though no culture-bound syndromes were encountered in any of the centers, difficulties in diagnosis using the research criteria were identified in the domain of simple schizophrenia and dissociative versus conversion disorders. These difficulties are discussed in consideration of the experience of our psychiatrists.


Recent life events and their role in suicide as seen by the spouses.

The occurrence of recent life events during the last 3 months and their significance in the suicide process as subjectively perceived by the surviving partners were studied among a subpopulation of suicide victims (n = 400) who had a spouse or a cohabitant as the informant. This subpopulation was drawn from a total suicide population (n = 1397) of 1 year in Finland. According to the partners' reports, life events during the last 3 months were reported in 85% of the suicides. Job problems (33%), family discord (32%) and somatic illness (29%) were most commonly reported. More male than female victims had experienced recent life events, and the mean number of events was higher among men than among women. There were differences between single life events in terms of how often the partners perceived them as precipitants of suicide. Separation was seen as the most critical event: in 68% of suicides with reported separation during the last 3 months the partner also rated it as a precipitant, followed by somatic illness in 57%, family discord in 44%, financial trouble in 44%, unemployment in 34%, death in 29%, job problems in 19% and illness in family in 14%.


Participation in group psychotherapy in a therapeutic community for acute patients.

A total of 2090 treatment episodes from 1977 to 1990 at a therapeutic community for acute patients were assessed for group psychotherapy participation and its associations with some patient and program characteristics, based on polytomous logistic regression analysis. Nonparticipation (4% of all episodes) or passivity (14%) were associated mainly with the program properties (such as the quality of the ward policy, first treatment episode and short treatment time), a diagnosis of personality disorder or typical schizophrenia and inferior outcome (assessed by attainment of treatment goals). The associations of moderate activity (45%) were very active (37%) as a reference, mainly personal properties (such as male gender, young age, low social and professional background and a diagnosis of schizophrenia) and inferior outcome. The results suggest that group participation, therapeutic program, patient properties and attainment of treatment goals are interrelated. The therapeutic program and leaders' skills should be developed to facilitate individualized group participation.


A review of the pharmacokinetics and pharmacodynamics of disulfiram and its metabolites.

After ingestion, disulfiram (DSF) is rapidly converted, probably in the stomach, to its bis (diethyldithiocarbamato) copper complex. Consequently, absorption and distribution via the gastrointestinal mucosa into the blood might involve both the parent drug and its copper complex. In the blood, both compounds are rapidly degraded to form diethyldithiocarbamic acid (DDC), which is unstable and is further degraded to form diethylamine and carbon disulphide. DDC is also a substrate of phase II metabolism, which involves formation of diethyldithiomethylcarbamate (Me-DDC) and the glucuronic acid of DDC. Me-DDC also undergoes oxidative biotransformation to diethylthiomethylcarbamate (Me-DTC), which is further oxidized to its corresponding sulphoxide and sulphone metabolites. Me-DTC may to act as a suicide inhibitor with a preference for the mitochondrial low Km isozyme of aldehyde dehydrogenases (ALDH 1), whereas the two S-oxidized metabolites, especially the sulfone metabolite, are more potent inhibitors not only of ALDH 1, but also of the cytosolic high Km isozyme of ALDH (ALDH 2). The inhibitory reaction between the enzyme and each of the three metabolites is characterized by a covalent adduct formation, probably with the cysteine residue at the active site of the enzymes. The adduct formed is nonreducible at a physiological concentration of glutathione, and inactivation in the presence of this endogenous tripeptide was increased by action in vitro of the sulphoxide and sulphone metabolites. Those findings are all in concordance with the in vivo observations made on DSF. In human volunteers treated with increasing doses of DSF and challenged with ethanol between each of the dosage periods, the mean plasma concentrations of Me-DTC at steady state were proportional to the DSF doses given. There was also a close relationship between increased oxidative metabolic formation of Me-DTC, high oxidative formation of acetaldehyde, and the full complements of a valid disulfiram ethanol reaction (DER). Consequently, Me-DTC in plasma may not only serve as a marker of the oxidative metabolic function of the liver, but also of the therapeutic effectiveness of the treatment in subjects at steady state. Obviously, there is a need for individual dose-titration regimens. In patients with alcohol-related severe hepatocellular damage, the oxidative P 450 catalyzed formation of the Me-DTC and probably also of its sulfoxide and sulphone metabolites is impaired, and thus inactivation of ALDH activity in the liver appears to be delayed or even completely absent. The consequence for the patient may be an insufficient DER.(ABSTRACT TRUNCATED AT 400 WORDS)


Depot preparations of disulfiram: experimental and clinical results.

Patient compliance with disulfiram is a troublesome clinical problem. Several strategies have been proposed as a solution to the problem, including subcutaneous implantation of disulfiram. However, well controlled studies of alcoholics and healthy volunteers have failed to discover a pharmacological effect of implanted disulfiram. A major reason for this failure appears to be poor absorption from an inadequate dose. Assessment of new sustained release formulation of depot disulfiram has been found to provoke a mild disulfiram-ethanol reaction (DER). Only a more severe DER would be expected to deter further drinking. If problems with absorption and appropriate dosing of disulfiram can be resolved or a depot preparation of the active metabolite of disulfiram can be prepared, implants might find continued clinical use.


Lack of bioequivalence between disulfiram formulations. Exemplified by a tablet/effervescent tablet study.

A comparison of the bioavailability of disulfiram (DSF) after administration of non-effervescent Antabuse tablets (CP Pharmaceuticals, UK) and Antabuse effervescent tablets Antabuse (A/S Dumex, DK) has been made in two cross-over studies. The first study included 6 volunteers who were given 400 mg DSF after an overnight fast. The bioavailability of DSF after administration of non-effervescent was found to be only 27% of that achieved with effervescent tablets. The second study included 24 volunteers who were given 800 mg DSF after a light standardized meal. The relative bioavailability of DSF after administration of non-effervescent compared with effervescent tablets was found to be only 34%. In addition to the difference in bioavailability of DSF after administration of the two preparations, a considerable difference was seen between the two studies. A light meal seems both to increase the bioavailability of DSF and to reduce the interindividual variation. A two to threefold increase in the bioavailability of DSF was found. Thus, the bioavailability of DSF appears to depend on both the formulation (preparation) and the mode of administration. A lack of bioequivalence between the two investigated DSF preparations was found.


Antabuse treatment for excessive users of alcohol.

Antabuse treatment has mostly been applied to alcohol dependent patients although the heavy users of alcohol are responsible for the major parts of alcohol related problems in our societies. The heavy users of alcohol should be identified both by the general practitioners and the hospital doctors in any field and the first intervention should be a health interview connected with a biological monitoring of alcohol damages and thereby many patients would be motivated for moderate drinking. If this is not the case, heavy users should be encouraged to a 6 or better a 12 months supervised treatment with Antabuse. This treatment has especially been effective in employees with work-related alcohol problems.


Long-term Antabuse treatment of alcohol-dependent patients.

Antabuse taken under supervision is effective and useful in the treatment of selected patients in the very long term. Relapses during treatment are the rule rather than the exception as is also illustrated in five case reports, but Antabuse treatment contributes to longer periods of sobriety. Continued support by nurses is necessary in the treatment of alcohol dependent patients and appointments with a psychiatrist are important for patients with alcohol dependence and psychiatric disorders. The personal perception of the severity of the drinking problem seems to be of decisive importance for compliance with the treatment. A high degree of motivation to stop drinking leads to long-term use of Antabuse, a stronger internal locus of control and a favourable outcome. Measurements of liver enzymes are useful for monitoring the treatment outcome as well as for detecting toxic effects on the liver.


Long-term Antabuse treatment: tolerance and reasons for withdrawal.

We studied 210 alcoholics, who were re-admitted to a disulfiram treatment programme after having voluntarily discontinued disulfiram therapy, primarily to ascertain whether illness, hospitalization, or serious adverse effects were the cause of the withdrawal. A simple 9-item questionnaire was used. About 70% of the patients gave either "a wish to drink again" or "no need for further treatment" as the reason. Withdrawal in the remaining patients was in no case related to adverse effects of disulfiram. The low incidence of adverse effects was confirmed in another group comprising 93 patients treated under supervision with disulfiram 600-800 mg twice a week for at least a year (i.e. total dose at least 70 g disulfiram). They were monitored by standard laboratory blood and urine tests. There were no clinically significant changes in the measures used. Indeed, many of the patients improved during the year of abstinence. These two studies add weight to the evidence that disulfiram is not a drug with a high incidence of adverse effects.


Controlled trials of Antabuse in alcoholism: the importance of supervision and adequate dosage.

Methods of using Antabuse have changed since its introduction over 40 years ago. Several randomised controlled trials have shown that Antabuse can make a statistically and clinically significant contribution to treatment outcome in alcoholism but only if its administration is carefully supervised. The recent literature is reviewed. Adequate dosage is important and the recommended maximum in some countries is often insufficient. Both prescribers and supervisors of Antabuse need to be aware of the ways in which some patients try to evade medication.


Disulfiram therapy--adverse drug reactions and interactions.

Adverse drug reactions (ADR) to disulfiram treatment have been reported as single cases, but few systematic investigations exist. In this study we analysed the spontaneous ADR reports to the Danish Committee on Adverse Drug Reactions during 1968-1991. In that period 154 ADRs to disulfiram were reported, mainly of hepatic, neurological, skin, and psychiatric reactions, in decreasing order of frequency. The safety of disulfiram, estimated on the amount produced and the number of reactions reported, corresponds to an intermediate rate of adverse reactions (1 per 200-2000 treatment year). Over the 23-year period, 14 deaths were reported in Denmark and this corresponds to a rate of 1 per 25,000 treatment year; the chief cause was liver toxicity. Reports to the WHO collaborating Centre for International Drug Monitoring in Uppsala, Sweden, showed the same ADR profile, although with a higher rate of neurological and psychiatric and a lower rate of hepatic reactions. The latency time from the start of treatment to the manifestation of the ADR differed according to organ. Hepatitis occurred with a distinct peak after 2 months of treatment, skin reactions peaked after 2 weeks, and the rate of neurological ADR increased with duration of therapy. The relation of skin reactions and hepatitis to nickel allergy is discussed, as is the dose-dependency of neuropathy. Concomitant disulfiram treatment affects the metabolism of several drugs and the dynamics of others, leading to a number of clinically important drug interactions. The disulfiram drug interactions are reviewed.


Influence of alcohol on several physiological functions and its reversibility: a surgical view.

Alcohol intake influences several physiological functions, including the haemostatic system, the cellular immune defence and the cardiac function, but to a different degree depending on the drinking habits. Restoration of these functions after withdrawal seems time related. The haemostatic imbalance normalizes within two or three weeks of soberness while the immune system requires about two months to recover. Recent studies have showed very increased postoperative morbidity after surgery in alcohol abusers, which may be explained by alcohol-induced physiological dysfunctions. Theoretically, two months of abstinence before a surgical procedure would diminish the increased postoperative morbidity among alcohol abusers. However, further investigation is necessary to establish a clinical effect of preoperative withdrawal from alcohol.


The pharmacology and toxicology of disulfiram and its metabolites.

Disulfiram (Antabuse) is one of several aldehyde dehydrogenase (ALDH) inhibitors that raise the plasma level of acetaldehyde following ethanol ingestion. The usually pleasant reaction to ethanol is thereby changed to an unpleasant one, owing to a number of bodily reactions to acetaldehyde. Populations showing genetic polymorphism with a lack of some isozymes of ALDH have exhibited an intolerance to ethanol similar to that seen with disulfiram. A normal isozyme pattern seems to be a prerequisite for the development of alcoholism, which supports the principle of disulfiram treatment. Disulfiram is an irreversible ALDH inhibitor when administered in vivo. Diethylthiomethylcarbamate (Me-DTC) is formed from disulfiram in three metabolic steps. This compound and two further oxidized metabolites appear to be active metabolites of disulfiram. Measurements of plasma Me-DTC or the reduction of leucocyte ALDH 1 activity may be valuable markers for the proper dose titration of disulfiram and the rational use of this drug. Some toxicological points are discussed.


The relative autonomy of schools and educational interventions for substance abuse prevention, sex education, and gender stereotyping.

This paper evaluates intervention programs in schools using the theoretical framework of the critical sociology of education, and most specifically, the extent to which schools are autonomous from the larger society. Three different types of intervention programs are reviewed: drug abuse prevention, sex education, and programs to change gender stereotypes, all of which were found to have limited effectiveness. Schools appear unable to change behaviors which are prevalent in a culture because they themselves are strongly influenced by that culture, and because adolescents are influenced by forces outside school. To be effective, such interventions would seem to require governmental agencies, community groups, and the media to work with the schools in order to influence the culture and thus produce behavioral changes in individuals.


Depression in Guatemalan adolescents.

A sample of 339 adolescents from the school population of three social classes in Guatemala City were administered a modified version of the Center for Epidemiological Studies Depression Scale for Children (CES-DC-M). Of the total sample, 35.1% were found to be depressed. A two-way analysis of variance (gender by social class) showed differences which approached statistical significance and reflected a significant main effect of gender but not social class. Implications of the findings are discussed.


The Adolescent Life Change Event Scale: its development and use.

A variety of instruments have been used by researchers from several disciplines to assess life change events in adolescents. Most instruments have not been tested for validity and reliability, and have been used in one-time studies, with limited effort to synthesize all studies using the particular instrument. Because of the number of requests, over more than a decade, to use the Adolescent Life Change Event Questionnaire, the authors have attempted to review all known studies using this instrument as a preliminary step toward further testing of the questionnaire for validity and reliability. Twenty-five studies, involving a total of 4,024 adolescent subjects from nine states, were reviewed. Findings included gender and age differences in number of events experienced and the perceived stressfulness, and a relationship between events experienced and suicidal ideation. Recommendations are made regarding future development and use of the instrument.


A longitudinal evaluation of computer-assisted instruction on contraception for college students.

This study assessed changes in contraceptive knowledge of 58 white female undergraduate college students following use of a computer-assisted instruction (CAI) program on contraceptive methods. The CAI program consisted of a personal-computer-based instructional lesson covering facts about and appropriate use of oral contraceptives and barrier methods, and myths about sexuality and sexually transmitted diseases. Baseline contraceptive knowledge was first compared with 171 white female undergraduate students. This comparison indicated that, overall, there were knowledge deficits regarding the safety of oral contraceptives and what to do if oral contraceptives are not used correctly. At immediate posttest, significant knowledge gains were observed for danger signs associated with using oral contraceptives, the rationale for triphasic and biphasic pills, potential medication synergism, health benefits of using oral contraceptives, potential contraceptive effect of withdrawal, and the reasons women stop using the pill. At six-month follow-up, students evidenced long-term knowledge gains on duration of pill use, the rationale for triphasics and biphasics, appropriate contingencies for missing two days of the pill, danger signs associated with using contraceptives, medication synergism, and health benefits of using oral contraceptives. The results of the evaluation are considered in the context of the widely held assumption that young women's contraceptive failure is unrelated to knowledge deficits about methods of birth control.


An empirical investigation of adolescent suicidal ideation.

Four hundred nine high school students were surveyed to determine the percentage who had experienced suicidal ideation. The sample was then divided into high- and low-suicidal-risk groups. High-risk subjects were found to have significantly poorer quality friendships, lower self-esteem, and had experienced more life stress in the previous year.


Identity formation and social maladaptation in foster adolescents.

The literature on identity formation in individuals from socially devalued racial and ethnic groups in the United States is summarized. Implications are discussed for a particular segment of at-risk adolescents--those in foster care residential group homes--who have received little published attention. The majority, in large urban centers, are African-American or Latino. These young people bear a disproportionate burden of such societal problems as unintended pregnancy and childbearing, academic underachievement and early educational discontinuation, substance abuse, and, ultimately, homelessness and more individually and socially costly forms of dependency (criminal justice, welfare, or mental health systems). It is postulated that their social maladaptation is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial socialization.


Eating disorders among adolescent female athletes: influence of athletic participation and sport team membership.

Female athletes have been identified as a potential risk group for the development of eating disorders. Although adolescents in general are particularly vulnerable to the onset of eating disorders, little research has examined the problem among high school female athletes. The present study explored this population by comparing female athletes and nonathletes in terms of (a) behavioral and psychological traits associated with eating disorders and (b) use of pathogenic weight control techniques (laxatives, vomiting, fasting, and diet aids). Sport-by-sport comparisons were also investigated to determine if athletes in specific sports were more at risk. Moreover, in an attempt to link athletic participation and eating disordered behavior, the gender-role orientation of athletes was examined. Results indicated that (a) athletes were more likely than nonathletes to possess certain behavioral and psychological correlates of eating disorders, (b) there were few differences among the various sport teams, and (c) gender-role orientation was generally not a critical variable. Although group comparisons yielded limited significant differences, athletes nevertheless reported traits associated with eating disorders as well as use of pathogenic weight control techniques. The unique contributions of the sport context and coaching practices exacerbating disordered eating are discussed.


Coming of age in a heterosexist world: the development of gay and lesbian adolescents.

The general developmental struggles of gay and lesbian adolescents are described as delineated in recent research. Three developmental areas were selected as a focus: the consolidation of sexual identity and the effects of both parental and peer relationships on gay adolescents' development. Weaknesses are noted in current research and theory, and suggestions are offered which could facilitate the development of both homosexual and heterosexual youth.


Satanism as a response to abuse: the dynamics and treatment of satanic involvement in male youths.

Male youths from abusive family environments may be particularly vulnerable to recruitment into satanic cults. Families that are abusive, devalue or invalidate the abused child's feelings, blame the child for the family's problems, and view the world in rigidly moralistic terms create environments in which the youths are likely to identify with the aggressor and label themselves as evil. These youths, who may have poor social skills and feelings of anger, low self-esteem, self-blame, depression, powerlessness, and isolation as a result of the abuse, may use satanic involvement as a means of legitimizing their experience and differentiating from a negatively enmeshed and/or abusive family system. In this paper, the etiological factors and treatment approaches of ten hospitalized boys who had voluntarily involved themselves in repeated group satanic activities during their adolescence are described, and two case illustrations are given. Recommendations for understanding and treating such cases are provided.


Psychosocial factors associated with teenage pregnancy in Jamaica.

The self-esteem and perceived maternal care and control of 134 Jamaican schoolgirls and 108 pregnant adolescents and teenage mothers were compared. The girls were 14 through 17 years of age, from working-class backgrounds, and living in rural and urban areas. Adapted versions of the Coopersmith Self-Esteem Inventory and the Parental Bonding Instrument were administered. Results indicated that the two groups did not differ in perceived maternal care and control. However, the self-esteem of urban schoolgirls was significantly higher than that of their once-pregnant counterparts. This was also true of the total sample. Urban teenagers without father figures were nearly 2.7 times more likely to have been pregnant than were those living with adult male relatives. Thus, father-figure absence and low self-esteem may combine as risk factors for teenage pregnancy in urban Jamaica.


Arresting youth crime: a review of social skills training with young offenders.

Social skills training has become a popular means of providing treatment for young offenders. This paper reviews the literature on social skills training with delinquent populations, with specific consideration of six questions. It was concluded that there is a lack of information on social skills training with young offenders in an outpatient setting. Future directions for research are discussed.


Satanism among adolescents: empirical and clinical considerations.

This paper reviews the literature on adolescent involvement in satanism. Results from a pilot study are presented along with a case study to illustrate factors that may alert practitioners to adolescents who are susceptible to satanic influences. Interventions for dealing with this adolescent subpopulation are discussed.


The relationship between parenting styles and young adults' self-concepts and evaluations of parents.

In the present study, 123 college students were surveyed in order to assess their self-concepts, evaluations of parents, and perceptions of their parents' parenting styles. Notably, the students' self-concepts were found to vary directly with perceived level of parental warmth, but did not vary as a function of their parents' level of restrictiveness. Fathers and mothers were found to be rated more highly if they were perceived as being warm and permissive rather than hostile and restrictive. Finally, opposite-sex parents' level of warmth also correlated with how each parent was evaluated. Some explanations for these findings are offered.


The Pre-Adult Health Decision-Making Model: linking decision-making directedness/orientation to adolescent health-related attitudes and behaviors.

In light of the broad consequences of the acquired immunodeficiency syndrome (AIDS) epidemic, as well as the increased rates of sexually transmitted diseases (STDs), pregnancy, and alcohol and drug abuse among adolescents, there is a great need to understand how adolescents make health decisions. This paper presents a model for adolescent health behavior, the Pre-Adult Health Decision-Making Model (PAHDM), which takes into account the differential information processing from peer sources, parent sources, or through critical or reflexive self-analysis. Also presented is a review of the large corpora of psychological and sociological literature on adolescent development, adolescent health behaviors, and, more specifically, AIDS and other STDs as a public health problem. The need for additional research in the area of adolescent health decision-making, and for a health behavior model that is specific to the "lifeworld" of the adolescent, is stressed.


The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies.

The present study examined the relationship between adolescents' attitudes toward suicide and their psychosocial background. It also evaluated the association between attitudes toward suicide and the subjects' own suicidal tendencies. A questionnaire assessing these issues was administered to 525 Israeli adolescents. Results indicated that significantly more females, nonreligious adolescents, those exposed to suicidal behavior, and those with increased suicidal risk held more accepting attitudes. Ethnic origin, socioeconomic status, and living in intact/nonintact families were not associated with adolescents' attitudes toward suicide.


Sexuality in youth culture: identity and change.

The sexual decisions of adolescents are, as Brooks-Gunn and Furstenberg have suggested, filtered through at least three culturally determined screens: the meaning of sexuality, the process of male-female negotiations, and adolescents' perception of danger. In making sexual choices today, young people must consider not only issues of identity, personal growth, and relationships, but also the growing danger of AIDS. A ten-year study of the sexual behavior of college students in Kelowna, British Columbia, Canada, shows that students choose among three sexual subcultures: celibacy, monogamy, and free experimentation. Since 1980, there has been some shift away from casual sex toward committed partnerships, but the basic outlines of this sexual "plural society" have remained unchanged. Despite AIDS, most students have not adopted careful sexual practices, either in number of partners or use of condoms. North American data suggest that this pattern is typical of most colleges and universities throughout Canada, although students on many U.S. campuses have become more careful. This study explored the reasons behind sexual choices, and investigated whether the possibility of contracting AIDS will eventually lead adolescents to better balance their needs for sex, love, freedom, and self-preservation. Working against the choice of caution is the fact that, in our culture, sexual expression is an important element of becoming an adult.


Social sensitivity in adolescents and adults with learning disabilities.

This study investigated social sensitivity and self-concept in students with learning disabilities (LD) and their non-learning-disabled (non-LD) peers. Thirty students each from public junior and senior high schools and a community college participated in the study; at each grade level, half were identified as learning disabled and half experienced no learning problem. Students were individually assessed in 30-minute interviews for their accuracy in interpreting the thoughts and feelings of actors in tape-recorded stories depicting two adults in happy angry, anxious, and sad interactions. A questionnaire assessing four dimensions of self-concept in learning situations (motivation, task orientation, problem-solving ability, and class membership) was also administered. LD students at all grade levels were significantly less accurate at interpreting social situations than were their non-LD peers, and had significantly lower self-concepts. These results support the need for remediation efforts specifically aimed at social skills for overcoming social deficits in adulthood.


Longitudinal diagnosis of memory disorders.

Early referral for specialist assessment is becoming more common with memory disorders and dementia: the mean Mini-Mental State Examination (MMSE) score of new patients at our clinic rose from 18.7 to 20.7 between 1986 and 1990. The clinical diagnosis of mild to moderate dementia has been recognized to be difficult, but several studies have reported cross-sectional diagnosis. We examined the number of visits required to establish a clinical diagnosis of dementia in the first 125 patients attending a Memory Disorders Clinic who had at least two visits (six months apart) and the stability of the diagnoses. Just under half of the patients required at least two visits to establish the clinical diagnosis. The MMSE was not a good guide to the number of visits required but the diagnosis at the first visit remained stable in all patients who scored < or = 10/30. Sixteen per cent of patients interchanged between the categories of Alzheimer's, mixed and vascular dementias. Possible age-associated memory impairment progressed to dementia in six of eight cases, and depression to dementia in three cases. The diagnosis of mild to moderate dementia should not be restricted to a cross-sectional approach, but should involve serial clinical, psychological and affective assessments.


Age and blood pressure measurement: experience with the TM2420 ambulatory blood pressure monitor and elderly people.

The accuracy of the TM-2420 ambulatory blood pressure monitor was assessed in elderly people. Ninety-four subjects (44 men and 50 women), aged 60-94 with systolic blood pressure (SBP) of 97-208 mmHg and diastolic blood pressure (DBP) of 45-109 mmHg, including 23 with isolated systolic hypertension, were studied in three centres. The monitor was compared simultaneously with pairs of observers using the Hawksley random zero sphygmomanometer. The standard deviation of the difference (SDD) between observers was 4.2 mmHg (SBP), 2.9 mmHg (DBP). The mean difference was 0.49 mmHg (SBP) and 0.27 mmHg (DBP). The SDD between the monitor and the average of the observers' readings was 6.7 mmHg (SBP), 5.5 mmHg (DBP); the mean differences were 4.4 mmHg (SBP) and 4.8 mmHg (DBP). There were no significant differences between the two versions of the monitor used (5 and 7) or between the three pairs of observers. The monitor was equally accurate in isolated systolic hypertension (SDD observers and monitor 6.2 mmHg for SBP, 3.9 mmHg for DBP, mean differences 4.3 mmHg for SBP, 4.5 mmHg for DBP). Twenty-four-hour ambulatory blood pressure monitoring was carried out in 129 subjects aged 60-79; 89% of the monitoring attempted were successful with error rates of < 10%. The mean error rate was 3.8%. The device was well tolerated with only 4.7% of the subjects not completing a monitoring.


Misclassification of dementia by the mini-mental state examination--are education and social class the only factors?

The 1988 Melton Mowbray Study of the Elderly comprised an initial screen with the Mini-Mental State Examination (MMSE) followed by a detailed clinical assessment using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) for all those scoring 21 and under on the MMSE, a one in two sample of those scoring 22 or 23 and a one in ten of the remainder. A total of 1579 subjects completed the initial screen with 438 subjects undergoing the CAMDEX assessment. Analysis of those subjects who were found to be free of dementia at the clinical assessment (n = 155) demonstrated that the very elderly, those from the manual social classes and subjects with visual impairments had an increased chance of being misclassified as demented by the MMSE. Low educational level and various measures of physical disability also showed a tendency to result in misclassification as falsely positive by the MMSE when viewed alone but these effects appeared to be due solely to their association with extreme age and/or manual social class.


Spinal dural arteriovenous malformations--a treatable cause of progressive paraparesis in elderly people.

Spinal dural arteriovenous malformations (SDAVMs) were first described in 1977. They present with a progressive paraparesis, principally in men aged 60 years and over. They are usually dorsolumbar in situation and are thought to be acquired lesions which produce symptoms by obstructing the venous drainage of the spinal cord. There are no pathognomonic clinical features and diagnosis depends on a high level of clinical suspicion and myelography extended into the dorsal region. The condition is probably underdiagnosed and may be quite a common cause of progressive leg weakness in elderly people. Surgical treatment is relatively simple, safe, and if carried at an early stage can lead to dramatic neurological recovery. This paper reports nine cases seen over a period of 7 years. All the patients showed marked neurological improvement after surgery.


The association of age with the activity of alcohol dehydrogenase in human liver.

Ethanol is principally oxidized in the liver by the cytosolic enzyme alcohol dehydrogenase (ADH). We have examined the effect of age and sex on alcohol dehydrogenase activities in human liver obtained from 16 healthy subjects, age range 45-88 years. There was no correlation between ADH activity, whether expressed as activity per mg cytosolic protein or per gram wet weight liver, and age. Activities were similar in men and women. These results suggest that, in common with activities of other hepatic drug metabolizing enzymes, age has no effect upon the activity of ADH in human liver.


Caring for elderly dependents: effects on the carers' quality of life.

This study describes a survey of 256 informal carers and elderly people they support, and examines the impact of the caring role upon quality of life. Carers reported that many aspects of their physical and mental health as well as their social and family lives were affected by their caring. For many the caring activity was unremitting. Overall, daughters were the most likely to report deleterious effects on their lives. Dominant factors associated with stress were the relationship between carer and dependent, sex of the carer and effects on social and family life. While relationship and sex were also associated with anxiety, loneliness was the dominant factor associated with anxiety and depression. Older age of the dependent was associated with stress, carer's disability was associated with anxiety, and depression in the elderly person was associated with depression in carers. These findings indicate that community services and future policies should be oriented towards the needs of carers and their families and not solely to the needs of frail elderly people. In particular there is a need to consider an increase in the provision of flexible planned respite care.


Registered private nursing homes in Scotland: referral and assessment practice.

The results on referral to and assessment for nursing homes, taken from a national survey of all registered private nursing homes in Scotland, are reported in this paper. The findings challenge the view that nursing homes do little by way of assessing potential candidates and that what is done is somehow at variance with the type of assessments carried out in the public long-stay sector. The implications for the future of the traditional view of which professionals should be involved in the assessment of candidates for nursing homes are discussed as are the criteria they might use to make their assessments.


Impact of vitamin A supplementation on the incidence of infection in elderly nursing-home residents: a randomized controlled trial.

The aim of this study was to determine if vitamin A supplementation reduces the incidence of bacterial infections among elderly nursing-home residents. One hundred and nine patients were enrolled into a double-masked, placebo-controlled trial at an academically affiliated nursing home. Fifty-six patients received a single capsule containing 1,000 IU of vitamin A (placebo) and 53 received a single capsule containing 200,000 IU of vitamin A. Antibiotic-treated infections were enumerated for 90 days after dosing and infection rates were expressed per 1000 days of follow-up. There were 42 antibiotic-treated infections altogether, 21 in each group. The infection rates in the vitamin A and placebo groups were 4.7 and 4.3 per 1,000 days of follow-up, respectively (relative risk 1.1; 95% CI 0.6, 2.0). The findings of this study do not support a role for vitamin A supplements for the prevention of infections among frail elderly nursing-home patients.


Aortic stenosis in elderly people: an evaluation of clinical and echocardiographic diagnosis.

In a prospective study to assess the sensitivity and specificity of clinical diagnosis against echocardiographic diagnosis in elderly people, 41 patients were studied in two 6-month periods. Overall clinical and echo diagnosis agreed in 75% of cases, but the clinical diagnosis of aortic stenosis was poor in the initial period. Adapting the lessons which were learnt in this initial period in a repeat of the study, the sensitivity of clinical diagnosis of aortic stenosis improved from 0.38 to 0.75. Additional information was gained in 50% of cases by echocardiography, and enabled the clinician to modify treatment in 50% of cases. Aortic stenosis in elderly people may be without clinical signs. Routine echocardiography increases the sensitivity of the clinical diagnosis, and may have major therapeutic implications for the elderly patient.


Geriatric follow-up by home visits after discharge from hospital: a randomized controlled trial.

The aim of this prospective, randomized and controlled trial was to carry out and evaluate a model for follow-up by home visits after discharge from hospital of persons aged 75 years or more. The trial was a feasibility study in which hospital staff, district nurses, and general practitioners already working within the hospital and the primary health sector participated, with changes in the usual organization. On the day after their discharge from hospital, 163 patients were visited in their homes by the district nurse. Two weeks later, they were evaluated at home by their general practitioner. For 181 control patients, discharge took place according to the usual procedures. Endpoints were evaluated one year after discharge. Significantly more patients from the control group had been admitted to nursing homes as compared with the trial group (25/10, p < 0.05); the control patients stayed 2700 days at institutions, the trial group 1950 days. It is proposed that this simple and practicable follow-up routine be introduced in connection with discharge of elderly persons from hospital.


Legionnaires' disease in elderly people: the first sign of an outbreak in the community?

Legionella pneumophila is responsible for up to 5% of cases of community-acquired pneumonia and mainly affects people aged over 50 years. The confirmation of legionellosis in two elderly patients living close to each other prompted a search for other cases. A total of eleven subjects with legionnaires' disease was recognized. The clinical findings are described and the diagnosis of legionellosis is discussed. Environmental investigations pointed to a cooling tower in the local town centre as the probable source of infection.


The career status of deaf women. A comparative look.

Discrepancies in labor force, occupation, and earnings outcomes were observed between men and women in a follow-up study of 4,900 deaf high school graduates who had responded to annual surveys conducted from 1982 to 1989. Reasons for the disparities were sought by further examination of the postsecondary programs undertaken, degrees earned, labor force activities, jobs held, and socioeconomic status. Despite efforts to expand career awareness and postsecondary programs for deaf people, deaf women continue to pursue a relatively narrow range of programs, leading to stereotypical female careers. Moreover, when women earn less than a bachelor's degree, they experience high underemployment and unemployment relative to deaf men and hearing peers. Without concerted intervention, this condition may be exacerbated as the labor market demands that workers be more professionally and technically trained in career areas where deaf females are yet underrepresented.


Deaf adolescents' metacognitive knowledge about school-related reading.

Twenty-nine prelingually and profoundly deaf adolescents were interviewed individually to assess their metacognitive knowledge about school-related reading. A descriptive analysis of the data indicated that the students' schemata for school-related reading were largely skill-based and passive. The schemata apparently lacked mature metacognitive knowledge that would enable the students to gain the most from their reading instruction and become more sophisticated independent readers. Further research on classroom reading instruction is needed.


Complete Signed and Cued French. An original signed language-cued speech combination.

Over the past 11 years, the Center Comprendre et Parler and the associated Ecole Intégrée of Brussels have developed an original combination of Cued Speech and signs called Complete Signed and Cued French (CSCF). CSCF uses the advantages of both methods while avoiding their drawbacks. The purpose of this practice is to enable deaf children to progress simultaneously in signed and spoken language. The approach is flexible, respects each child's learning rhythm, and ensures that expressive skills do not lag too far behind comprehension abilities. It avoids polemical issues and irrational choices of exclusivity (oralism vs. signs) and prepares access to bilingualism.


The effects of adjunct questions in prose for deaf and hearing students at different reading levels.

In two studies, the author investigated interactions among adjunct question position, reading ability, and direct versus indirect learning outcomes for deaf postsecondary and hearing middle-school students. Adjunct questions were inserted immediately preceding or following brief sections of instructional prose for the purpose of focusing and cognitively activating the readers. Different effects were observed for deaf and hearing readers and for different levels of assessed reading ability. The findings are discussed in terms of reading ability, adjunct activities while reading prose, and direct versus indirect instructive effects.


Let's talk about it. Using conversation to facilitate language development.

For centuries, educators have searched for the best way to teach language to deaf students. Throughout this time period, no one specific approach has emerged. In this article, we examine and justify the use of conversational approaches to teach language to deaf students. Classrooms for deaf students are often not conducive to conversation. We suggest that to promote conversation in classrooms, teachers must reexamine how they teach as well as how they structure their classrooms and curriculums. The article closes with descriptions of activities that teachers can use to encourage conversation in their classrooms.


The ability of deaf students to understand text. A comparison of the perceptions of teachers and students.

Sixteen deaf high school students and nine of their teachers, two deaf and seven hearing, were interviewed for their perceptions of the interest and difficulty of three types of text. Students read and retold the texts and reported on their use of metacognitive strategies and comprehension monitoring and assessment. In this paper, we compare the perceptions of the teachers and students. The teachers in this study underestimated the extent to which their students could comprehend independently, often based on insubstantial evidence. The text perceived to be most difficult by both teachers and students was also considered the most interesting to students, but not to teachers. This text also fostered the greatest use of a variety of metacognitive strategies, suggesting that difficult materials should not be avoided or simplified for deaf students.


Intuitive parenting as a model for understanding parent-infant interactions when one partner is deaf.

This paper reviews the concept of intuitive parenting, with particular focus on its applicability to parent-infant dyads in which the parent or child is deaf. Although the conceptual model discussed in this paper was developed primarily from observations of hearing dyads, it has the potential to contribute to our understanding of early adaptive processes in other populations as well. Examples of nonconscious or intuitive parental behaviors are presented in terms of the ways they help infants adapt to the postnatal environment and in the later transition from preverbal to verbal stages of development. In addition, implications are drawn for difficulties in parent-infant interactions that may occur as a result of deafness in the parent or child.


Protective glove material permeation by organic solids.

A method has been developed for the determination of permeation characteristics of glove materials by organic solids. The system employs a stainless steel exposure cell and allows rapid and uniform contact of either solid disks or powders with minimal membrane bowing. A gas chromatograph equipped with a flame ionization detector was used for monitoring the permeation process, which provided detection limits of 0.9-1.2 ng for the organic solids evaluated. By using an automated system for instrument control and data collection, breakthrough times, steady-state times, and steady-state permeation rates have been determined for five common glove materials when exposed to nine organic solids.


Heat stress of women doing manipulative work.

Six women were exposed to nine environmental conditions, ranging from 26.0 to 35.8 degrees C effective temperature (ET), in a climatic chamber. They were involved in manipulative work in a seated position for a duration of 3 hr. The O2 uptake, heart rate, deep body (Tc) and skin temperature (Tsk), sweat loss, and perception of thermal comfort were noted. The O2 uptake increased with the time of exposure at different heat levels. The work energy demand, which was 19% of VO2max at 26 degree C ET, increased to 35% of VO2max at 35.8 degrees C ET. However, the work output declined with the increase in ET. Thus, the elevated metabolic demands were the results of the thermal stimuli. The Tsk was greatly influenced by the environmental heat; the Tc changes were gradual. The highest mean Tsk attained was 37.3 degrees C at 33.8 degrees C ET when the gradient of Tc-Tsk was only 0.5 degrees C. The rate of change in mean Tsk for 31.6 to 33.8 degrees C ET was much faster compared to the range between 26.0 and 31.6 degrees C ET. From 32.1 degrees C ET onward the Tc and heart rates rose rapidly, while the sweating rate tended to fall, indicating some hindrance for evaporative cooling. Also, thermal sensations were noted as extremely hot for the conditions 32.1 to 35.8 degrees C ET with the increase in exposure duration.


The effect of contaminant source momentum on a worker's breathing zone concentration in a uniform freestream.

Several factors affecting breathing zone concentration were examined in a paint spray booth by using a tracer gas method. The variables in the study include contaminant momentum, the presence of a flat plate downstream of the worker, the distance between the contaminant source and the body, and the worker's motion. A dramatic reduction in breathing zone concentration was observed when the spray gun emitted contaminants with high momentum. Reductions of 30-50% were observed because of the other variables. The source momentum effect was studied, subsequently, in a wind tunnel by measuring the breathing zone concentration of a mannequin with various flows through jets of different diameter, at varying freestream velocities. A functional relationship was determined between nondimensional breathing zone concentration and contaminant source momentum. This relationship is supported by numerical simulations. The effect of contaminant momentum on the near-wake flow field is discussed in conjunction with results from the numerical simulations.


Penetration of several filter materials by asbestos as a function of fiber dimensions.

The purpose of this research was to determine the penetration of several filter materials commonly used in building air-handling systems by asbestos fibers. An airstream containing tremolite asbestos fibers was passed through these materials and the upstream and downstream fiber concentrations were measured by membrane filtration and scanning electron microscopy. The penetration of these materials was determined as a function of asbestos fiber diameter and length at two typical air velocities. For glass fiber filter materials, the maximum penetrations were 3.5% and 0.1% compared with American Society for Testing and Materials dust spot efficiency ratings of 80% and 90%, respectively. Thus, the glass fiber filters appear to be capable of greatly reducing the concentration of asbestos fibers in a building air-handling system. Roll and panel filter materials consisting of polyester fibers exhibited penetrations from 15% to nearly 90%. Thus, roll and panel filters tested are not recommended for this purpose.


A new sampling technique that allows quantitative fit testing by using the employee's own respirator.

A new, in-mask sampling technique has been developed that enhances current quantitative respirator fit test methods. This new sampling technique eliminates the need for a permanently modified (probed) respirator for conducting fit tests. With this new technique, a sample was drawn from the breathing zone inside the respirator by means of a sampling adapter, which was temporarily attached between one of the air-purifying filters and the facepiece before a fit test was performed. To ensure that the performance of the respirator was not altered, the sampling adapter was designed so that all major functional aspects of the respirator were unchanged. This new sampling technique was evaluated on human test subjects by simultaneous sampling from a probed respirator by using two quantitative respirator fit test instruments. One instrument sampled through a conventional respirator probe; the other used the new method. Test results show that equivalent fit test data were obtained with both sampling techniques.


Angiotensin-converting enzyme inhibitors as cardioprotective agents.

This discussion of documented and possible cardioprotective effects of angiotensin-converting enzyme (ACE) inhibitors examines the variety of sites along the pathway to end-stage heart disease at which they might intervene. In addition to their antihypertensive activity, their effects on left ventricular hypertrophy, lipid profiles, and insulin sensitivity are discussed in comparison to the effects of other classes of antihypertensive agents on these risk factors. The ability of ACE inhibitors to prevent the progression of congestive heart failure and reduce mortality is documented and a summary of data demonstrating benefits of their use in postmyocardial infarction patients with low ejection fraction is presented.


Thrombolytic, antiplatelet, and antithrombotic agents.

The relative efficacy and safety of individual thrombolytic agents, administered alone and with antiplatelet and antithrombotic drugs, in the treatment of acute myocardial infarction are presented. The clinical benefits and risks of treatment choices are discussed in relation to the mechanisms of the formation and prevention of thrombus and thrombolysis. It is concluded that streptokinase, tissue plasminogen activator (t-PA), and anisoylated plasminogen-streptokinase activator complex (APSAC) significantly reduce mortality and improve left ventricular function equally, despite differences in the rate at which they achieve vascular patency, their durations of action, and the extent to which their use is associated with adverse events. The questions of how best to minimize reocclusion/reinfarction, bleeding, and stroke are discussed, with particular focus on the beneficial use of aspirin and the unresolved issue of how best to use heparin.


Cholesterol-lowering drugs as cardioprotective agents.

A detailed overview of the various forms of hyperlipidemia/dyslipidemia that constitute a major risk factor for coronary heart disease and a detailed discussion of the various types of cholesterol-lowering drugs are presented. The importance of identifying the type of dyslipidemia with respect to the choice of treatment is emphasized, as is the use of nonpharmacologic intervention, i.e., diet, exercise, and weight loss. The appropriate use and benefits of bile acid sequestrants, nicotinic acid, fibric acids, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, and probucol are individually discussed, whereas nonpharmacologic approaches used in conjunction with the drugs are recommended emphatically.


A view from Europe.

The pharmacologic approach to coronary protection, defined here as the prevention or delay of sudden death and myocardial infarction (without negatively affecting noncardiac mortality), is critically discussed. The value of pharmacologically treating mild hypertension and mild hypercholesterolemia is questioned, and the need for well-designed, randomized clinical trials with definitive endpoints to determine a drug's cardioprotective capability is emphasized. Based on such studies, it is concluded that some (but perhaps not all) beta-receptor antagonists as well as aspirin have been shown to protect against sudden cardiac death. Trials of thiazide diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors have not shown a reduction in sudden cardiac death, despite having individual benefits with respect to other aspects of cardiovascular disease. The demonstration that some beta blockers are cardioprotective is discussed in terms of the pathophysiology of sudden cardiac death, and differences in the pharmacokinetic profiles of individual agents.


Calcium antagonists as cardioprotective agents.

The potential role that calcium antagonists play toward enhancing cardioprotection is discussed, while recognizing that they are much more heterogeneous than other classes of antihypertensive or antianginal agents. Similarities and differences between the mechanisms of action and clinical effects of individual drugs are discussed. Among these is the ability of some of them to reduce left ventricular hypertrophy rapidly while simultaneously and uniquely increasing right ventricular wall thickness. Although the clinical importance of this as a potential cardioprotective effect is undetermined, the renal protective effect of some calcium antagonists is discussed in detail.


The anti-tumor effect of a small polypeptide from Coriolus versicolor (SPCV).

A new small polypeptide was isolated from the crude extraction of polysaccharide peptide of Coriolus versicolor (Cov-1) by HPLC and CIEF. It has a smaller molecular weight (10K) compared with that of PSP (100K) and was named small peptide of Coriolus versicolor, SPCV. It was found that SPCV possesses potent cytotoxic effect on human tumor cell lines of HL-60, LS174-T, SMMU-7721, and SCG-7901. The IC50 of SPCV on HL-60 was 30 micrograms/ml. The inhibition rates of leukemia cells and SCG-7901 were significantly higher in SPCV treated group than that in PSP and PSK groups. SPCV also has immunopotentiating effect as it increased WBC and IgG levels. Pretreatment of SPCV for two weeks decreased the incidence of tumor mass in nude mice inoculated with tumor cells.


Immunomodulatory activity of various fractions derived from Physalis angulata L extract.

The immunomodulatory effects of Physalis angulata L. extract fraction VII (PA-VII), PA-VII-A, PA-VII-B and PA-VII-C were investigated in this study. The results showed that PA-VII and PA-VII-C strongly enhanced blastogenesis response, PA-VII-B had moderate activity, and PA-VII-A exerted only slight effect on cell proliferation. A synergistic effect was observed when the suboptimal dosage of phytohemagglutinin (PHA) or lipopolysaccharide (LPS) was added to the culture. Furthermore, PA-VII and PA-VII-C possessed stimulatory activity on B cells and less effect on T cells. The antibody responses were also augmented by PA-VII, PA-VII-B and PA-VII-C, but not by PA-VII-A. The enhancement of antibody response could be observed both in BALB/c and C3H/HeJ mice.


Pharmacological actions of "kyushin," a drug containing toad venom: cardiotonic and arrhythmogenic effects, and excitatory effect on respiration.

The cardiotonic and arrhythmogenic effects, and the excitatory effect on respiration of "Kyushin," a drug containing toad venom, were studied in comparison with those of digoxin. In anesthetized rabbits, the maximum rate of rise of left ventricular systolic pressure (max dP/dt) was measured as an index of cardiotonic effect, and the respiratory flow was measured as an index of respiratory function. Intraduodenal (i.d.) administration of 80 mg/kg "Kyushin" produced a cardiotonic effect and an excitatory effect on respiration, but i.d. administration of 16 mg/kg digoxin produced only a cardiotonic effect, and conversely inhibited respiration. In anesthetized open-chest guinea pigs, myocardial contractile force was measured as an index of cardiotonic effect and the arrhythmogenic effect was evaluated from the appearance of arrhythmic myocardial contraction. By i.d. administration of a 20% ethanol suspension or solution, "Kyushin" and digoxin showed a cardiotonic activity with doses higher than 40 mg/kg and 0.25 mg/kg, respectively. The arrhythmogenic doses of "Kyushin" and digoxin by i.d. administration were 2560 mg/kg and 2 mg/kg, respectively, suggesting that the safety margin of "Kyushin" is broader than that of digoxin.


Pharmacological and pathological studies on hepatic protective crude drugs from Taiwan (V): The effects of Bombax malabarica and Scutellaria rivularis.

Bombax malabarica DC and Scutellaria rivularis B. were extracted in boiling water and concentrated into 1g/ml solution to investigate their hepatoprotective effect. Carbon tertrachloride (CCL4) was injected into rat subcutaneously with a dose of 3.0 ml/kg to induce experimental acute hepatotoxicity in the animal. The activities of serum glumtamic-oxaloacetic transaminase (SGOT) and serum glutamicpyruvic transaminase (SGPT) were measured after 72 hours of CCL4 administration. The hepatopathological changes of the liver tissue were observed simultaneously with liver enzyme activities determination. The pharmacological effect of B. malabarica and S. rivularis of Taiwan was compared with that of the Bupleurum chinense from mainland China. B malabarica (p < 0.001), S. rivularis (p < 0.001) and B. chinense (p < 0.05) all demonstrated a significant reduction in the CCL4-induced SGOT and SGPT. Pathological studies of these three drugs extracts demonstrated a marked hepato-protective effects on CCL4-induced liver fatty degeneration and cell necrosis.


Effects of Tokishakuyakusan, Keishibukuryogan and Unkeito on DNA polymerase alpha activity in PMS-treated immature rat uterus incubated in vitro.

We have recently found that Tokishakuyakusan (TS), Keishibukuryogan (KB) or Unkeito (UT) inhibits in vivo DNA polymerase alpha activity in the rat uterus stimulated by PMS. In this study, uteri resected 24 h after injection of PMS on day 27 of age were incubated in vitro with 20 micrograms/ml of extract of TS, KB or UT for 4 h. The DNA polymerase alpha activity in uteri tended to decrease after the addition of TS, KB or UT with significant difference (P < 0.05) compared with TS-, KB- and UT-untreated control groups. These results suggest that TS, KB or UT, especially KB, tends to inhibit directly the enzyme activity in rat uterus.


Crude drugs used for the treatment of diabetes mellitus in Taiwan.

A survey of hypoglycemic effective crude drugs in the market in Taiwan revealed 24 species of crude drug prescriptions, 34 kinds of crude drugs derived from 48 species of medicinal plants belonging to 25 families, all concerned with the treatment of diabetes mellitus. This paper updates a list of anti-diabetic crude drugs used as a remedy for the treatment of diabetes mellitus in Taiwan by means of ethnobotanical and pharmacological studies. Results showed that many of these crude drugs have hypoglycemic effects. Further investigation will be made.


Pyrrolizidine alkaloid composition of three Chinese medicinal herbs, Eupatorium cannabinum, E. japonicum and Crotalaria assamica.

The pyrrolizidine alkaloid composition of three Chinese herbs, "pei lan", "cheng gan cao" and "zi xiao rong," identified respectively as Eupatorium cannabinum, Eupatorium japonicum (Compositae) and Crotalaria assamica (Leguminosae), were studied by fast atom bombardment mass spectrometry and gas chromatography-electron impact mass spectrometry. Viridiflorine, cynaustraline, amabiline, supinine, echinatine, rinderine and isomers of these alkaloids were found in the Eupatorium species. Monocrotaline was the only pyrrolizidine alkaloid detected in the Crotalaria species.


Astragalus membranaceus stimulates human sperm motility in vitro.

Poor sperm motility is an important cause of male infertility. In an attempt to identify Chinese medicinal herbs that might improve human sperm motility in vitro, we screened water extracts of 18 herbs with a trans-membrane migration method which measured the percentage of sperm that moved across the 5 micron pores of a Nucleopore membrane from a semen-drug mixture into phosphate buffered saline during 2 hours incubation. Astragalus membranaceus was the only herb that showed a significant stimulatory effect. At 10 mg/ml, it increased the motility of sperm in semen to 146.6 +/- 22.6% of control. It also increased the motility of washed sperm to 138.2 +/- 13.8% of control. Purification of the active component(s) from this herb as well as its application in assisted reproduction technology await further investigation.


The effect of Ninjinyoeito on Werner's syndrome skin fibroblasts.

The effect of Ninjinyoeito on three cases of Werner's syndrome fibroblasts was investigated. In all three cases, groups which were treated with Ninjinyoeito showed improved life-span doubling levels compared to groups which were not treated with Ninjinyoeito. Also, all of the treated group in all three cases showed significantly higher values in the rates of DNA synthesis including two cases which showed significantly higher rates of protein synthesis.


Pharmacotherapeutic effects of kuei-chih-fu-ling-wan (keishi-bukuryo-gan) on human uterine myomas.

Kuei-chih-fu-ling-wan (Keishi-bukuryo-gan; KBG), a traditional Chinese herbal remedy contains five components: bark of Cinnamomum cassia Bl. (Lauraceae), root of Paeonia lactiflora Pall. (Paeoniaceae), seed of Prunus persica Batsch. or P. persiba Batsch.var.davidiana Maxim. (Rosaceae), carpophores of Poria cocos Wolf. (Polyporaceae), and root bark of Paeonia suffruticosa Andr. (Paeoniaceae). This prescription has been frequently used in the treatment of gynecological disorders such as hypermenorrhea, dysmenorrhea and sterility. We previously reported that KBG might act as a LH-RH antagonist and a weak anti-estrogen on the uterine DNA synthesis in immature rats. In the present study, we investigated the effects of KBG on 110 premenopausal patients with uterine myomas. Clinical symptoms of hypermenorrhea and dysmenorrhea were improved in more than 90% of the cases with shrinking of uterine myomas in roughly 60% of the cases.


A case report of Moyamoya disease: successfully treated with Chinese medicine.

The incidence of Willis' ring obstruction (Moyamoya disease) in Japan is higher than in Europe and North America. The therapeutic technique usually employed is either surgery or Western drug treatment. But these methods are still not satisfactory. We attempted to apply Chinese medicinal treatment to a patient with Moyamoya disease. This patient was referred to our department because of the ineffectiveness of Western drug treatment. The patient made satisfactory progress with Gui-Zhi-Fu-Ling-Wan and Xiao-Xu-Ming-Tang. We also noticed the improvement of the "stagnated blood condition." Whole blood viscosity was decreased and the blood flow rate in the bulbar conjunctiva was increased.


Acupuncture in gonarthrotic pain--"Bachmann's knee program".

In a retrospective study 35 patients with gonarthrotic pain were treated with acupuncture at the outpatient unit of the Department of Anaesthesia and Intensive Care in the University of Vienna. The subjective effectiveness of the treatment using a standard method on the knee demonstrated that patients reported an explicit improvement of their ailments. Therefore, we can unreservedly recommend this program, which was only augmented through additive "locus dolendi" treatment if indicated.


Acupuncture and the nervous system.

Acupuncture is based on neuroanatomy and neurophysiology. At each acupuncture point, there are peripheral nerves and terminals. Acupuncture will be useful for further understanding of the nervous system. A conceptual view of acupuncture's physiology is presented.


Changing relationship between pharmacists and physicians.

The changing professional relationship between pharmacists and physicians in the United States from the beginning of the nineteenth century to the present is described. Throughout the nineteenth century, physicians intruded heavily on the pharmacist's domain, and medicine often viewed pharmacy with condescension. Toward the century's end, pharmacists gained more respect and recognition as the medical and pharmaceutical sciences grew and physicians found themselves relying on pharmacists. Hundreds of years of friction were not easily forgotten, though, and the two professions continued to hurl charges and countercharges and vie for power. With the emergence of the pharmacist as a full member of the health-care team and the crush of medical information in the twentieth century, greater cooperation is occurring, although irritations persist, especially in the areas of physician dispensing and therapeutic interchange. Improvements in the relationship between pharmacists and physicians were driven by growth in their fields and the trend toward specialization. As tensions ease, patient care should benefit.


Prospective physician review of orders for colony-stimulating factors.

A program is described in which physicians prospectively review orders for the use of colony-stimulating factors (CSFs) at a tertiary-care private teaching hospital. Hospital officers and administrators and the heads of medical subspecialties were presented with three options for managing the use of CSFs. Prospective review by physicians was selected, and a task force of medical subspecialists was established to develop criteria for use and to review orders. Initially, every order was prospectively reviewed, but criteria were developed under which some orders do not require physician review. CSF use is documented retrospectively by a drug-use evaluation pharmacist and reviewed for appropriateness by the physician task force. Between March and October 1991, 115 patients were given courses of CSFs, and the use of the physician review system resulted in appropriate use of the drugs for 98% of the oncology patients and 61% of the patients infected with the human immunodeficiency virus. The prospective physician reviewer system has been accepted by the medical staff at the facility and has helped to ensure appropriate use of CSFs.


Peer review as a quality assurance mechanism in three pharmacist-run medication-refill clinics.

A peer-review system for monitoring pharmacists' practice in medication-refill clinics is described. Pharmacist practitioners trained in pharmacology, therapeutics, and physical assessment provide services in three medication-refill clinics associated with a 350-bed Department of Veterans Affairs (VA) medical center. The clinics serve patients who have exhausted their prescribed drugs before their next appointment with a physician. During a clinic visit, the pharmacist assesses the patient and the drug therapy and either consults an attending physician or writes new prescriptions. The pharmacist documents his or her activities in the medical record. The peer-review mechanism involves quarterly audits in which the chart notes written by the pharmacists are reviewed by other pharmacists. Five indicators of the quality of care are used in the peer reviews. The results are presented to the ambulatory-care and quality assurance pharmacy committees for analysis and discussion. The peer-review system has resulted in better compliance by the pharmacists with the quality indicators and clinic procedures, suggesting that the quality of care has also benefited. Peer review is used successfully to evaluate and monitor the care provided by pharmacists in medication-refill clinics associated with a VA medical center.


Obtaining drugs from foreign markets.

Guidelines are presented for pharmacist coordination of the importation for use by institutionalized patients of drugs not currently approved by the FDA. A prerequisite for importation of foreign drugs is that traditional therapies have failed or are not an option. Steps that are required for drug importation and administration include completing an investigational new-drug application, obtaining institutional review board approval, obtaining informed consent, contacting a customs broker or the local FDA district import program manager, arranging for drug shipment, and documenting receipt and administration of the drug. Conditions are described under which portions of this process may be waived. By helping to ensure compliance with FDA requirements, pharmacists can expedite drug importation for institutionalized patients.


Computer-based patient simulations: hospital pharmacists' performance and opinions.

The performance of pharmacists in using an interactive computer-based patient simulation program and their attitudes toward the simulations are reported. The Institutional Patient Medication Simulation program is designed to enhance and evaluate the medication problem-solving skills of pharmacists. Each simulation consists of patient data-gathering, case question, and therapy decision modules with initial assessment and monitoring nodes. Five simulations were tested: gout, urinary-tract infection, congestive heart failure, antimicrobial prophylaxis in surgery, and hypertension. Pharmacists from nine hospitals were recruited for the study. Participants were asked to perform the simulations within a specified period and to complete attitudinal questionnaires. Of the 91 pharmacists who volunteered, 72 (79%) completed the simulations and the questionnaires. The practitioners indicated that the simulations adequately tested their knowledge and that they would recommend them to colleagues. Performance scores for data gathering were less than 70%, with no significant differences among the simulations. Case question scores exceeded 80% and again were consistent among simulations, whereas therapy decision scores were more variable, with the lowest scores being recorded for antimicrobial-related simulations. Pharmacists with more hospital experience tended to perform better. Pharmacists completing a patient simulation program found the simulations to be worthwhile. Performance scores indicated some difficulty in gathering patient data and showed that correct therapeutic decisions may not always occur even if adequate information is obtained.


Investigational drug information through a hospitalwide computer system.

A hospitalwide computer system that combines protocol-specific information on investigational drugs with order entry is described. A large university teaching hospital had in place a computerized clinical information system. Among other uses, physicians used the system for direct entry of total parenteral nutrient solution orders and associated laboratory tests; labels are produced automatically. Personnel from the pharmacy and information services departments met to discuss how to apply the computer system to investigational drug information. The application they designed has three components: protocol information, order entry, and patient monitoring. Protocol information, including all the standard drug data plus regulatory and investigator information, is displayed as a report on the user's terminal. The order-entry pathway allows the research pharmacist to predesign medication labels that are specific to each study and include all required information. This saves time, ensures accurate labeling, and provides a means for generating patient charges. The patient-monitoring component provides information to the research pharmacist in a daily report to assist in locating subject patients and to monitor compliance with protocols. The system has improved the access of health-care professionals to investigational drug information and decreased the time pharmacists spend dispensing these agents. The system has been well received, although up to three weeks is needed to bring the information online. A hospitalwide information system is effective in disseminating information on investigational drugs and facilitating order entry.


Fat emulsion particle-size distribution in total nutrient admixtures.

The fat particle-size distribution in and physical stability of two commercially available lipid emulsions before and after their use in total nutrient admixtures (TNAs) are reported. Four TNAs without electrolytes and four TNAs with electrolytes were prepared; each type of TNA was prepared with Liposyn II and with Intralipid. Particle size was measured in the < 1-micron range by using photon correlation spectroscopy and in the 2-60-microns range by using light blockage. Admixtures with or without electrolytes were stored for two or nine days at 4 degrees C followed by one day at 25 degrees C. For the fraction of fat particles of < 1 micron in diameter, Intralipid and Liposyn II had a mean particle size of 374 and 313 nm, respectively. The admixtures containing electrolytes showed a decrease in mean particle size of about 7%. Admixtures with Intralipid contained 2 x 10(7) particles larger than 2 microns per milliliter (1.7% of total fat), compared with 1 x 10(6) particles per milliliter (0.05-0.15% of total fat) for admixtures with Liposyn II. The addition of electrolytes increased the particle counts for Liposyn II-containing admixtures. Upon storage, Intralipid-containing admixtures with electrolytes showed an initial increase followed by a decrease in the mean diameter of particles of < 1 micron. All the admixtures were stable in terms of pH and visual appearance. Intralipid-containing admixtures with electrolytes showed a decrease in the number of particles in the 2-60-microns size range, while Liposyn II-containing admixtures with electrolytes showed an increase.(ABSTRACT TRUNCATED AT 250 WORDS)


Stability of ceftazidime (with arginine) and of cefuroxime sodium in infusion-pump reservoirs.

The stability of ceftazidime (with arginine) and cefuroxime sodium was studied after storage in infusion-pump reservoirs at freezing and refrigerated temperatures and subsequent simulated administration over 24 hours at near-body temperature. Polyvinyl chloride reservoirs and glass vials were filled with ceftazidime (with arginine) or cefuroxime sodium at various concentrations, diluted in sterile water. Three reservoirs each of ceftazidime 30 and 60 mg/mL and of cefuroxime 22.5, 30, 45, and 60 mg/mL were stored for various times and at various temperatures. Three glass vials each of ceftazidime or cefuroxime 30 and 60 mg/mL were stored for 30 days at -20 degrees C, followed by 4 days at 3 degrees C and 24 hours at 30 degrees C. Samples obtained periodically during storage and during simulated administration were analyzed with high-performance liquid chromatography. Both drugs maintained at least 90% of their initial concentration under all of the test conditions except simulated administration at 30 degrees C, during which degradation accelerated. In portable infusion-pump reservoirs, ceftazidime 30 and 60 mg/mL and cefuroxime 30 and 60 mg/mL were stable for 30 days at -20 degrees C followed by 4 days at 3 degrees C; ceftazidime 30 and 60 mg/mL was stable for 10 days at 3 degrees C; and cefuroxime 22.5 and 45 mg/mL was stable for 7 days at 3 degrees C. However, the drugs may need to be administered over less than 24 hours when the pump reservoir is worn on the patient's body.


Stability of ceftazidime in plastic syringes and glass vials under various storage conditions.

The stability of ceftazidime solutions (100 and 200 mg/mL) in plastic syringes and glass vials under various storage conditions was examined. Solutions of ceftazidime 100 and 200 mg/mL in sterile water were placed in polypropylene plastic syringes or glass vials and stored (1) at 21-23 degrees C for up to 8 hours, (2) at 4 degrees C for up to 96 hours, (3) at -20 degrees C for 28 days and then 21-23 degrees C for up to 8 hours, (4) at -20 degrees C for 28 days and then 4 degrees C for up to 96 hours, (5) at -20 degrees C for 91 days and then 21-23 degrees C for up to 8 hours, or (6) at-20 degrees C for 91 days and then 4 degrees C for up to 96 hours. Samples were withdrawn from each syringe and vial at designated times and assayed by high-performance liquid chromatography. Solutions were judged to be stable if drug concentrations remained above 90% of the initial values. The number of particles in each container under each storage condition was also evaluated. Ceftazidime was stable under all storage conditions. In all containers, particulate matter was within USP specifications for small-volume injections, with no change in particle count as a result of the freezing and thawing. Ceftazidime in sterile water in either glass vials or plastic syringes is stable for 8 hours at room temperature or 96 hours at 4 degrees C when such storage occurs (1) immediately after constitution, (2) after 28 days of frozen storage, or (3) after 91 days of frozen storage.


Stability of ranitidine hydrochloride with aztreonam, ceftazidime, or piperacillin sodium during simulated Y-site administration.

The stability of ranitidine hydrochloride after being mixed with commonly used i.v. beta-lactam antibiotics and administered by simulated Y-site injection was studied. Solutions of ranitidine 1 mg/mL (as the hydrochloride salt), aztreonam 16.7 mg/mL, ceftazidime 20 mg/mL (with sodium carbonate), and piperacillin 30 mg/mL (as the sodium salt) were prepared by reconstitution in i.v. mini-bags. To simulate Y-site injection, 2 mL of ranitidine hydrochloride was mixed with 2 mL of each antibiotic in glass test tubes. These admixtures were prepared in triplicate and stored at room temperature under fluorescent light. Concentrations of each drug in each admixture were determined by stability-indicating high-performance liquid chromatography immediately and after one, two, and four hours. Aztreonam, ceftazidime, and piperacillin each retained more than 95% of the original concentration for at least four hours when mixed 1:1 with ranitidine. Ranitidine retained more than 90% of its original concentration for at least four hours when combined with each of the other drugs. Ranitidine 1 mg/mL (as the hydrochloride salt) and aztreonam 16.7 mg/mL, ceftazidime 20 mg/mL (with sodium carbonate), or piperacillin 30 mg/mL (as the sodium salt) were stable for at least four hours during simulated Y-site administration.


Association of intrauterine fetal growth retardation and learning deficits at age 9 to 11 years.

We examined the association of fetal and newborn complications, socioeconomic status, and home environment with learning deficits as assessed between 9 and 11 years of age. A total of 218 high-risk newborns have been assessed at 1, 4, and 9 to 11 years of age. Fetal and newborn complications included 77 newborns with growth retardation. Socioeconomic variables included parental occupation and education. Outcome measures at 9 to 11 years included the Woodcock Reading Mastery Test and the Wide Range Achievement Test. Motor and cognitive development was assessed by a neurologic examination, the Bruininks-Oseretsky Test of Motor Proficiency, and the Wechsler Intelligence Scale for Children. Behavior was assessed with the Achenbach Child Behavior Check List and Connor's Teacher Rating Scale. Learning deficits were identified in 77 of the 218 children (35%). Children with learning deficits had lower full-scale IQ scores and behavioral problems of inattention and anxiety. Both fetal growth retardation and the father's occupation score were independently associated with these learning deficits. Fetal growth retardation, socioeconomic status, and behavioral characteristics of inattention and anxiety are associated with less favourable academic achievement at 9 to 11 years of age.


Asphyxial complications in the term newborn with severe umbilical acidemia.

Our purpose was to determine the relationship of umbilical acid-base status and Apgar score to neonatal asphyxial sequelae in infants with severe acidemia (pH < 7.00). The obstetric and neonatal course of 129 term, nonanomalous singleton infants with umbilical pH < 7.00 was reviewed. There were three stillbirths (failed resuscitation). Seventy-two of 126 (57%) were admitted to the neonatal intensive care unit. Thirty-eight percent had pulmonary dysfunction, 26% renal dysfunction, 31% cardiac dysfunction, and 31% hypoxic ischemic encephalopathy (seizures and hypotonia, n = 29; seizures only, n = 3; hypotonia only, n = 10). There were five neonatal deaths. In 109 cases umbilical arterial values were available, and among these infants there was a significant increase in the incidence of seizures with declining pH from 9% (5/57), with a pH of 6.90 to 6.99, to 80% (8/10), with a pH of 6.61 to 6.70. Respiratory acidemia (PCO2 > 65, base deficit < 10) was identified in 28 of 109 (26%), all but six occurring in the pH range above 6.90. Compared with infants with comparable umbilical artery pH, infants with respiratory acidemia did not differ significantly with respect to asphyxial end-organ injury in general (8/35 vs 6/22), but there was a trend toward a lower incidence of hypoxic ischemic encephalopathy (6/35 vs 1/22, p = 0.06). All infants with definite abnormal outcome (five neonatal deaths and 10 severe neurologic deficit) had seizures, hypotonia, and at least one other organ system dysfunction. Twenty-four of 29 infants (83%) who developed seizures had a 5-minute Apgar score < 7, but only 12 of 29 (41%) had a 5-minute Apgar score of < or = 3. Two infants with Apgar scores of 6 and 7 at 5 minutes and no evidence of nonasphyxial comorbidity subsequently manifested profound neurologic deficit. Infants with severe umbilical acidemia can be separated with regard to risk of hypoxic ischemic encephalopathy and abnormal neurologic outcome by consideration of the severity and composition of the acidemia and evidence of other end-organ dysfunction. Even in this pH range the Apgar score is not highly predictive of asphyxial complications.


Morbidity of failed labor in patients with prior cesarean section.

The aim of our study was to determine whether the reported increased morbidity associated with failed attempted vaginal birth after cesarean section is attributable to the presence of a uterine scar alone or to labor preceding a cesarean section. Primiparous women (N = 237) who underwent repeat cesarean section after a failed trial of vaginal birth after cesarean section were retrospectively compared with 1582 nulliparous women who underwent a primary cesarean section after a failed trial of labor. There were no significant differences in maternal or neonatal morbidity between the two groups except for an increase in the prevalence of thin meconium in patients undergoing primary cesarean section. Our results suggest that the presence of a previous cesarean section scar does not increase the overall baseline morbidity associated with cesarean section after labor.


Effect of recreational exercise on midtrimester placental growth.

The purpose of our study was to test the hypothesis that regular recreational exercise increases the rate of growth in placental volume in the midtrimester of human pregnancy. Serial measurements of placental volume were obtained between the fourteenth and twenty-sixth gestational week in 18 subjects who exercised regularly throughout the midtrimester and in 16 matched controls with an ultrasonographic system equipped with a fixed-base, articulated-arm, 3.5 MHz B-mode transducer. Placental volumes were significantly greater in the women who maintained a regular exercise regimen throughout the midtrimester. At 16 weeks (mean +/- SD) volumes were 141 +/- 34 cm3 and 106 +/- 18 cm3 in the two groups. This difference increased at 20 weeks (265 +/- 67 cm3 vs 186 +/- 46 cm3) and again at 24 (410 +/- 87 cm3 vs 270 +/- 58 cm3) weeks' gestation because of a significant between-group difference in the rate of growth in placental volume over this time interval (34 +/- 8 cm3/wk vs 21 +/- cm3/wk). We conclude that the hypothesis is correct and speculate that the change in growth rate represents an adaptive response to the intermittent stimulus of a reduction in regional blood flow.


Rapid prenatal diagnosis by fluorescent in situ hybridization of chorionic villi: an adjunct to long-term culture and karyotype.

This series was designed to assess in a pilot study the feasibility of using fluorescence in situ hybridization on chorionic villi. We constructed probes derived from specific subregions of human chromosomes 21, 18, 13, X, and Y that give a single copylike signal when used in conjunction with suppression hybridization. In a blind series of 47 samples all, including one trisomy 21, were correctly identified. The samples were correctly classified as disomic for five chromosomes. The combination of chromosome-specific probe sets composed primarily of cosmid contigs and optimized hybridization and detection allowed accurate chromosome enumeration in uncultured human chorionic villi; these results are consistent with those obtained by traditional cytogenetic analysis and suggest a use for fluorescence in situ hybridization as an adjunct to karyotyping when rapid results are needed.


The smaller than expected first-trimester fetus is at increased risk for chromosome anomalies.

Intrauterine growth retardation associated with fetal chromosome anomalies is usually documented on ultrasonography late in the second trimester. However, we believe and attempt to document here that the impact of aneuploidy on fetal growth is evident much earlier (i.e., the aneuploid fetus may appear smaller than dates on ultrasonography even in the first trimester). For the population referred to our center for chorionic villus sampling from January 1988 to July 1991, we compared gestational age as calculated from the last menstrual period to that derived from fetal size as measured by crown-rump length. A cutoff of 7 days was chosen to select the study group. The remainder of our chorionic villus sampling population in which fetal size was expected was used as controls. We also divided those chorionic villus sampling patients by when a fetal death was observed by size. In the study period 3194 chorionic villus sampling procedures were performed and in 277 (8.7%) fetal length was smaller than expected by at least 7 days. Sixty (1.9%) chromosome anomalies were diagnosed by first trimester chorionic villus sampling in the study period. The frequency of chromosome anomalies was 4.3% in the study group and 1.7% in controls (p < 0.004). The more aberrant the karyotype on "postmortem chorionic villus sampling," the greater the growth retardation tended to be. In our chorionic villus sampling population a fetal crown-rump length smaller than dates is associated with a significant increase in risk of chromosome anomalies. Moreover, the larger the size-dates discrepancy, the higher the possibility that the aneuploidy affecting that pregnancy is of the severe or lethal type.


Measurement of amniotic fluid volume: accuracy of ultrasonography techniques.

Our purpose was to determine amniotic fluid volume by the dye-dilution technique and compare it with the amniotic fluid index, largest vertical pocket, and two-diameter pocket (defined as vertical x horizontal of the largest vertical pocket). This prospective study involved 40 women undergoing amniocentesis in late pregnancy to detect fetal lung maturity or evidence of chorioamnionitis. The amniotic fluid volume was quantified ultrasonographically by means of the amniotic fluid index, largest vertical pocket, and two-diameter pocket. During amniocentesis the fluid volume was calculated by the dye-dilution technique of Charles and Jacoby. Ultrasonographic measurements by amniotic fluid index, largest vertical pocket, and two-diameter pocket correctly predicted normal amniotic fluid and hydramnios (74%). A new measurement, two-diameter pocket, gave a significantly more accurate estimate of oligohydramnios than did amniotic fluid index (p < 0.002) or largest vertical pocket (p < 0.0003). All three indices are moderately accurate in identifying normal amniotic fluid volume and hydramnios. Two-diameter pocket is the most accurate test to predict oligohydramnios.