Proteins synthesized and secreted by the guinea-pig conceptus during early pregnancy in relation to corpus luteal maintenance.

Guinea-pig conceptuses obtained on Day 15 of pregnancy were cultured for 24 h in the presence of [3H]leucine. Proteins present in the culture medium were purified by dialysis, desalted, and subjected to analysis by gel filtration chromatography, ion-exchange chromatography, and polyacrylamide gel electrophoresis. The major non-radioactive protein present co-chromatographed with serum albumin. Fresh protein synthesis occurred as indicated by the incorporation of [3H]leucine, and the proteins produced were acidic in nature. Many radioactive proteins in relatively similar amounts were produced, with protein of molecular weights 28.8 and 98.2 kDa (as determined on Sephacryl S-300HR) and of molecular weights 8.4 and 14.7 kDa (as determined on Sephadex G-75SF) being synthesized in marginally greater quantities. Consequently, from the profile of proteins synthesized and secreted, no obvious candidate emerged as the anti-luteolytic factor synthesized and secreted by the guinea-pig conceptus during early pregnancy which inhibits endometrial PGF2 alpha synthesis and maintains corpus luteal function.


Effect of guinea-pig conceptus and its secretions on endometrial prostaglandin output.

The co-culture of Day-15 guinea-pig conceptuses or Day-15 pregnant guinea-pig endometrium with Day-15 non-pregnant guinea-pig endometrium had no inhibitory effect on PGF2 alpha output from the non-pregnant endometrium. Unpurified proteins secreted by the Day-15 guinea-pig conceptuses, or these proteins purified by Blue Sepharose CL-6B and ion-exchange column chromatography also had no inhibitory effect on PGF2 alpha output from Day-15 non-pregnant guinea-pig endometrium cultured in vitro. However, following the further purification of guinea-pig conceptus secreted proteins on Sephadex G-75SF, the proteins present in fraction F3:4 inhibited PGF2 alpha output from the Day-15 non-pregnant guinea-pig endometrium during the first 6 h of culture. The major protein present in F3:4 had a molecular weight of 38.2 kDa on SDS-PAGE. Proteins present in F3:4 formed only a minor proportion of the total proteins secreted. Nevertheless, the anti-luteolytic factor secreted by the guinea-pig conceptus may be this 38.2 kDa protein, but further study is required.


The effects of platelet-activating factor on the output of prostaglandins from the guinea-pig uterus.

Platelet-activating factor (PAF) significantly increased the output of prostaglandin (PG) F2 alpha from the guinea-pig uterus during the mid-cycle phase (Days 6-10), but only had a small, non-significant stimulatory effect on the outputs of PGE2 and 6-keto-PGF1 alpha. PAF significantly increased the outputs of PGF2 alpha, PGE2 and 6-keto-PGF1 alpha from the guinea-pig uterus during the later phase of the cycle (Days 15-17). Lack of extracellular calcium did not affect the stimulatory effect of PAF on uterine PG output. However, TMB-8 (an intracellular calcium antagonist) prevented the increases in uterine PG output produced by PAF at both phases of the cycle. These results suggest that the stimulatory effect of PAF on uterine PG output in the guinea-pig is dependent upon the mobilization of intracellular calcium but is not dependent upon the uptake of extracellular calcium. Also, the weak stimulatory effect of PAF on PGE2 output from the uterus during the mid-cycle phase indicates that, if PAF is involved in implantation in guinea-pigs, it probably does not act via PGE2. Also, the lack of an inhibitory effect of PAF on uterine PGF2 alpha synthesis and release suggests that PAF is not the anti-luteolytic factor produced by the guinea-pig conceptus during early pregnancy.


Carbonate inhibition of leukotriene D4-dipeptidase in human serum.

Human serum contains an inhibitor of leukotriene D4 (LTD4) dipeptidase which was separated from the enzyme by ultrafiltration (Amicon, YM-10). Removal of the inhibitor resulted in a 3- to 5-fold increase in total LTD4-dipeptidase activity in the material retained by the filter. Inhibitor activity (which was assayed with a partially purified LTD4-dipeptidase) was recovered in the filtrate. Ultrafiltration of serum using YM-3, YM-1, and YC-05 membranes suggested an inhibitor molecular weight of less than 500. Elution of inhibitor activity from a Bio Gel P2 gel filtration column was identical to the elution pattern of pure carbonate. The inhibitor was heat stable (95 degrees C, 30 min), stable in 0.1 N NaOH, but rapidly inactivated by 0.1 N HCl at both 4 degrees C and 30 degrees C. Partially purified LTD4-dipeptidase was inhibited by carbonate and phosphate but not by nitrate, sulfate, or chloride. Based on these observations it was concluded that the inhibitor of LTD4-dipeptidase in human serum either was carbonate or required carbonate. The relative concentrations of LTC4, LTD4, and LTE4 appear to be important parameters in determining the duration and intensity of LT mediated reactions. The relative concentration of carbonate in serum or extracellular fluids might, therefore, be a factor in modulating localized LT mediated responses.


The effect of ascorbic acid on arachidonic acid and prostaglandin E2 metabolism in B16 murine melanoma cells.

Ascorbic acid (Asc), arachidonic acid (AA) and prostaglandin E2 (PGE2) are reported to be important in maintaining the stability of the cell matrix. Asc has also been shown to influence fatty acid (FA) and PGE2 synthesis, with the result that effects of Asc on cell growth are suggested to be mediated through the metabolism of these two compounds. This study examined the effect of Asc, supplemented over the concentration range of 0-100 micrograms/ml, on the in vitro cell growth of non-malignant LLCMK (monkey kidney) cells and malignant B16 murine melanoma cells. The effects of Asc supplementation on AA and PGE2 levels in the cell stroma and membrane fractions of the two cell types was also determined. Asc had no significant inhibitory or stimulatory effect on the growth of either the B16 or LLCMK cells. The total percentage AA composition determined in the B16 control cells (combined stroma and membrane fractions), was similar to that determined in the LLCMK control cells. Asc supplementation of the B16 cells, resulted in an inverse relationship between B16 cell growth and total percentage AA composition. PGE2 concentration in the control B16 cells (combined stroma and membrane fractions) was significantly higher than that detected in the control LLCMK cells. No PGE2 was detected in the B16 stroma fraction, with all appearing to be located in the membrane fraction. However, upon the supplementation of the B16 cells with increasing Asc concentrations, PGE2 appeared to be mobilized from the membrane fraction, resulting in increasing PGE2 levels in the stroma fraction relative to the membrane fraction. This was accompanied by a significant decrease in PGE2 concentration, in the membrane fraction. B16 cell growth and total (stroma and membrane fractions) PGE2 concentration in these cells was inversely related, when cultures were supplemented with increasing levels of Asc. Asc supplementation of the LLCMK cells did not appear to have any significant effect on AA or PGE2 metabolism in these cells.


The mechanisms for the effects of dietary lipid modification on autoimmune diseases: the role of membrane lipid composition in antigen presenting cells.

Several mechanisms have been proposed to explain the effects of dietary lipid modification on autoimmune diseases. One of these being the modification of cell membranes which affects immune functions. In order to further define this mechanism, the author proposes that dietary lipid modification could affect antigen presentation, an immune function responsible for initiating cell-mediated immune responses in body defense or autoimmune diseases, through membrane lipid composition modification.


[Antiarrhythmic amidinohydrazone substituted benzophenones. 2. Preparation and determination of configuration of (Z)- and (E)-2-amino-5-chlorobenzophenone amidinohydrazone salts].

The configurational isomers of the 2-amino-5-chlorbenzophenoneamidinohydrazones could be obtained as TLC pure samples by fractionating crystallization of the product mixture. The determination of their configuration by comparison of the UV spectra with the corresponding oximes could be confirmed by X-ray structure analysis.


The synthesis and anti-neoplastic activity of N2-isobutyryl-2'-deoxyguanosine-N7-cyanoborane derivatives.

N2-Isobutyryl-2'-deoxyguanosine-N7-cyanoborane derivatives were observed to be potent antineoplastic agents and to be active against a number of human tissue culture tumor cells, e.g. Tmolt3 leukemia, HeLa-S3 uterine carcinoma. Selective agents were active against colon adenocarcinoma, osteosarcoma and glioma growth. These agents preferentially inhibited both DNA and RNA synthesis of L1210 cells. De novo synthesis of purines was significantly inhibited at the regulatory sites of PRPP amido transferase and IMP dehydrogenase. Other sites of inhibition were thymidylate synthetase, OMP decarboxylase and thymidine kinases. The agents also significantly reduced deoxyribonucleotide levels and caused DNA strand scission.


[Synthesis of N-(2-carboxy-thieno(2,3-b)pyridin-3-yl)-amidines by the reaction with 4-oxo-4H-pyrido(3',2':4,5)-thieno(3,2-d)-1,3-oxazines with secondary cycloaliphatic amines].

4-Oxo-4H-pyrido[3',2':4,5]thieno[3,2-d]1,3-oxazines react with secondary cycloaliphatic amines to give besides the expected bisamides the amine salts of N-(2-carboxy-thieno[2,3-b]pyridine-3-yl)amidines. These compounds showed inhibitory activity against different lipoxygenases, but a small chemical stability.


[Potential cardiotonics. 16. Molecular and crystal structures of three polymorphic forms and a hydrochloride monohydrate of 3-cyano-2-morpholino-5-(pyridin-4-yl)pyridine (AWD 122-14)].

The results of an X-ray structure analysis of the alpha-modification were the starting point for the prediction and establishment of further polymorphic and pseudopolymorphic, respectively, forms of AWD 122-14. A complete structure determination of the gamma- and delta-modifikation as well as of a hydrochloride monohydrate could be carried out. Molecular parameters, conformational flexibility, and intermolecular interactions are discussed in this paper.


Reduced degradation of biological active peptides during in vitro aging of endothelial cells.

Endothelial cells under in vitro cultivation show an age-dependent decrease in peptide-cleavage activity. After a number of passages, the rates of Leu-enkephalin and bradykinin decomposition by cultivated cells were diminished as compared to their counterparts before in vitro aging. In addition, these cells have been found to be less capable of converting angiotensin I into angiotensin II. Such phenomena could be interpreted as correlated with age-related disturbances concerning the regulation of vascular functions in vitro.


AIDS acquired by drug consumption and other noncontagious risk factors.

The hypothesis that human immunodeficiency virus (HIV) is a new, sexually transmitted virus that causes AIDS has been entirely unproductive in terms of public health benefits. Moreover, it fails to predict the epidemiology of AIDS, the annual AIDS risk and the very heterogeneous AIDS diseases of infected persons. The correct hypothesis must explain why: (1) AIDS includes 25 previously known diseases and two clinically and epidemiologically very different epidemics, one in America and Europe, the other in Africa; (2) almost all American (90%) and European (86%) AIDS patients are males over the age of 20, while African AIDS affects both sexes equally; (3) the annual AIDS risks of infected babies, intravenous drug users, homosexuals who use aphrodisiacs, hemophiliacs and Africans vary over 100-fold; (4) many AIDS patients have diseases that do not depend on immunodeficiency, such as Kaposi's sarcoma, lymphoma, dementia and wasting; (5) the AIDS diseases of Americans (97%) and Europeans (87%) are predetermined by prior health risks, including long-term consumption of illicit recreational drugs, the antiviral drug AZT and congenital deficiencies like hemophilia, and those of Africans are Africa-specific. Both negative and positive evidence shows that AIDS is not infectious: (1) the virus hypothesis fails all conventional criteria of causation; (2) over 100-fold different AIDS risks in different risk groups show that HIV is not sufficient for AIDS; (3) AIDS is only 'acquired,' if at all, years after HIV is neutralized by antibodies; (4) AIDS is new but HIV is a long-established, perinatally transmitted retrovirus; (5) alternative explanations disprove all assumptions and anecdotal cases cited in support of the virus hypothesis; (6) all AIDS-defining diseases occur in matched risk groups, at the same rate, in the absence of HIV; (7) there is no common, active microbe in all AIDS patients; (8) AIDS manifests in unpredictable and unrelated diseases; and (9) it does not spread randomly between the sexes in America and Europe. Based on numerous data documenting that drugs are necessary for HIV-positives and sufficient for HIV-negatives to develop AIDS diseases, it is proposed that all American/European AIDS diseases, that exceed their normal background, result from recreational and anti-HIV drugs. African AIDS is proposed to result from protein malnutrition, poor sanitation and subsequent parasitic infections. This hypothesis resolves all paradoxes of the virus-AIDS hypothesis. It is epidemiologically and experimentally testable and provides a rational basis for AIDS control.


Pokeweed antiviral protein: ribosome inactivation and therapeutic applications.

Pokeweed antiviral protein (PAP) is a ribosome-inactivating protein (RIP) that inactivates ribosomes by the removal of a single adenine from ribosomal RNA. The studies summarized in our review concern the nature and application of this novel therapeutic agent. We describe how researchers continue to elucidate the structure and biologic activity of RIPs. Pokeweed antiviral protein is among the RIPs that have been conjugated to selective monoclonal antibodies for the treatment of several human cancers and viral diseases. Clinical trials using PAP immunotoxins for the treatment of leukemia have been particularly encouraging.


Activation of lymphokine genes in T cells: role of cis-acting DNA elements that respond to T cell activation signals.

Activation of T cells is initiated by the recognition of antigen on antigen presenting cells to exert the effector functions in immune and inflammatory responses. Two types of helper T cell (Th) clones (Th1 and Th2) are defined on the basis of different patterns of cytokine (lymphokine) secretion. They determine the outcome of an antigenic response toward humoral or cell-mediated immunity. Although lymphokine genes are coordinately regulated upon antigen stimulation, they are regulated by the mechanisms common to all as well as those which are unique to each gene. For most lymphokine genes, a combination of phorbol esters (phorbol 12-myristate 13 acetate, PMA) and calcium ionophores (A23187) is required for their maximal induction. Yet phorbol ester alone or calcium ionophore alone produce several lymphokines. The production of the granulocyte-macrophage colony stimulating factor (GM-CSF) is completely dependent on the two signals. We have previously found a cis-acting region spanning the GM-CSF promoter region (positions -95 to +27) that confers inducibility to reporter genes in transient transfection assays. Further analysis identified three elements required for efficient induction, referred to as GM2, GC-box and conserved lymphokine element (CLE0). GM2 defines a binding site for protein(s) whose binding is inducible by PMA. One protein, NF-GM2 is similar to the transcription factor NF-kB. GC-box is a binding site for constitutively bound proteins. CLEO defines a binding site for protein(s) whose optimum binding is stimulated by PMA and A23187. Viral trans-activators such as Tax (human T cell leukemia virus-1, HTLV-1) and E2 (bovine papilloma virus, BPV) proteins are other agents which activate lymphokine gene expression by bypassing T cell receptor (TCR) mediated signaling. The trans-activation domain of E2 and Tax is interchangeable although they have no obvious sequence homology between them. The viral trans-activators appear to target specific DNA binding protein such as NF-kB and Sp1 to cis-acting DNA site and promote lymphokine gene expression without TCR-mediated stimulation.


Spin labeled cysteines as sensors for protein-lipid interaction and conformation in rhodopsin.

In stoichiometric amounts, the spin label N-tempoyl-(p-chloromercuribenzamide) reacts rapidly with one cysteine residue in membrane-bound bovine rhodopsin. This residue is distinct from the two reactive cysteines previously used as attachment sites for spectroscopic labels, and is on the external surface of the protein near the cytoplasmic membrane/aqueous interface. The spin-labeled side chain has revealed a light-induced conformational change in membrane-bound rhodopsin that is apparently not associated with protein aggregation. The changes are reversible upon the addition of 11-cis retinal, and the magnitude of the change is dependent on the identity of the phospholipid in the surrounding bilayer. Alteration of lipid composition has a much larger effect on bleached rhodopsin than rhodopsin itself, indicating that the former is more readily deformable in response to changes in bilayer properties. This is consistent with the loss of 11-cis retinal binding energy in opsin compared to rhodopsin. These results provide direct structural evidence that the conformation of a membrane protein can be modulated by the lipid properties.


Sensitivity increase in the photophobic response of Halobacterium halobium reconstituted with retinal analogs: a novel interpretation for the fluence-response relationship and a kinetic modeling.

Phoborhodopsin (also called sensory rhodopsin II) is a photoreceptor protein which mediates photophobic responses of Halobacterium halobium to blue-green light. Under conditions where the synthesis of the chromophore retinal is inhibited, the photophobic system is reconstituted in vivo by incorporation of all-trans retinal or retinal analogs into the apoprotein of phoborhodopsin. Retinal analogs which retard the cyclic photoreaction kinetics of phoborhodopsin increase significantly the sensitivity of the photophobic response. This supports the previously reported hypothesis that signal amplification occurs during the lifetime of intermediate states of the photocycle. The sensitivity increase caused by the chromophore substitution is observed in cells at several different growth stages, i.e. the naturally occurring chromophore (all-trans retinal) does not produce maximal sensitivity at any stage of the culture growth. These results are difficult to interpret in terms of the proposal by Marwan et al. (J. Mol. Biol. 199, 663-664, 1988) that only a single photon is sufficient to cause the photobehavioral response in cells containing native phoborhodopsin. A new interpretation for the fluence-response curves is described based in part on their Poisson statistical analysis. Further, a kinetic model which relates the receptor photochemical reaction cycle to the behavioral response is developed, which accounts for both the sensitivity increase and the shape of the fluence-response curves.


Molecular mechanisms in visual pigment regeneration.

The photochemical bleaching of vertebrate rhodopsin results in the cis to trans isomerization of the 11-cis-retinal protonated Schiff base. Hydrolysis of the Schiff base leads to the formation of opsin and all-trans-retinal. In order for vision to proceed, the enzymatic trans to cis isomerization of a retinoid must occur. Since retinoids exist as alcohols, aldehydes, or esters in the eye, there are potentially nine different routes for isomerization. Moreover, 11-cis-retinoids are approximately 4 kcal/mol higher in energy than their all-trans isomers. Thus, not only must the isomerization route be defined, but an energy source must be identified to power this process. It was discovered that the energy is provided for in a minimally two-step process involving membrane phospholipids as the energy source. First, all-trans-retinol (vitamin A) is esterified in the retinal pigment epithelium by lecithin retinol acyl transferase to produce an all-trans-retinyl ester. Second, this ester is directly transformed into 11-cis-retinol by an isomerohydrolase enzyme, in a process that couples the negative free energy of hydrolysis of the acyl ester to the formation of the strained 11-cis-retinoid.


Photoreceptor cell types in the retina of various vertebrate species: immunocytochemistry with antibodies against rhodopsin and iodopsin.

Types of photoreceptor cells in the retinas of 36 species of vertebrates (5 classes, 14 orders) were investigated immunocytochemically with monoclonal antibodies against chicken iodopsin (Io-mAb) and antiserum against bovine rhodopsin (Rh-As). In mammals, Rh-As labeled the outer segments of some photoreceptor cells in striped squirrels (a diurnal mammal) and those of most photoreceptor cells in mice (a nocturnal mammal), while Io-mAb labeled any photoreceptor cells in either of them. In all species of birds studied, Io-mAb labeled the principal and accessory members of double cones and single cones with a red oil droplet. Rh-As labeled single cones with a yellow or clear oil droplet in addition to rods. In turtles, both Rh-As and Io-mAb labeled single cones with a red or clear oil droplet and the principal (with a yellow oil droplet) and accessory members of double cones. This suggests that the visual pigments in these cones of turtles have common epitopes with bovine rhodopsin and chicken iodopsin. In Japanese grass lizards, single cones with a yellow oil droplet and double cones were immunoreactive to both Rh-As and Io-mAb. In snakes, rods and cones could not be distinguished but both positively and negatively stained cells were observed by the use of each antibody. In geckos, however, all photoreceptor cells were immunonegative to Io-mAb. In all species studied in amphibians, Rh-As labeled rods but not cones. Neither rods nor cones reacted with Io-mAb. In fishes, almost all species studied had well developed cones, and some of these cones were labeled by Rh-As. However, Io-mAb labeled the outer segments of some cones only in loaches. Rh-As labeled photoreceptor cells in all species of fishes studied. Thus, Rh-As recognized the outer segments of rods in all species studied from fishes to mammals, whereas the epitope recognized by Io-mAb is conserved in some species of fishes, most species of reptiles and all species of birds studied.


Interaction of rhodopsin, G-protein and kinase in octopus photoreceptors.

Light induced phosphorylation of octopus rhodopsin was greatly enhanced by guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S), suggesting that the kinases are involved in regulating interaction between rhodopsin and G-protein. We determined phosphorylated peptides of octopus rhodopsin in the presence or absence of GTP gamma S. Possible phosphorylation sites for octopus rhodopsin enhanced by GTP gamma S were Thr329, Thr330 and/or Thr336, which suggest that the G-protein associates with cytoplasmic loops including C-terminal peptide in the seventh helix of octopus rhodopsin.


Photobleaching difference absorption spectra of human cone pigments: quantitative analysis and comparison to other methods.

Four human cone pigment apoproteins were expressed by transfection of human tissue culture cells with the corresponding complementary DNA clones. Following reconstitution of the cone pigments by incubation with 11-cis retinal, photobleaching difference absorption spectra were obtained for the blue pigment, the green pigment, and two polymorphic variants of the red pigment. These spectra were analyzed to determine the wavelengths of maximal absorbance and the bandwidths. The recombinant cone pigment spectra were compared to human cone spectral sensitivities and cone pigment absorption spectra determined by microspectrophotometry, single-cell electrophysiology, reflection densitometry, electroretinography, and psychophysical color and brightness matching.


Modeling rhodopsin, a member of G-protein coupled receptors, by computer graphics. Interpretation of chemical shifts of fluorinated rhodopsins.

An attempt has been made to construct a 3-D model of rhodopsin, a member of G-protein coupled receptors. Sequence homology of rhodopsin with the latter was a factor considered in the modeling procedure. The constructed model has been used to compare currently available specific protein/substrate interaction information, the shape of the binding cavity derived from shape of binding retinal isomers and analogs and challenged to explain recently available results from a series of fluorinated rhodopsins.


Bacteriorhodopsin reconstituted from two individual helices and the complementary five-helix fragment is photoactive.

Bacteriorhodopsin (bR), a light-driven proton pump, consists of a bundle of seven membrane-spanning alpha-helices connected to each other by short extramembranous loops. Previously it has been shown that bR can be reconstituted from three fragments corresponding to the first helix, the second helix, and the remaining five helices, and that this reconstituted material reforms the native structure of bR. In this study, it is shown that the native function is also recovered. Low-temperature spectroscopy was used to examine the photochemical properties of bR reconstituted from three fragments. At room temperature at pH 6, the reconstituted material shows essentially the same absorption spectrum as native bR, while upon raising the pH at room temperature or cooling the sample in glycerol, a second, blue-shifted peak appears. The pH and temperature dependence of the absorption spectrum indicates that the reconstituted bR is in an equilibrium between two pigments, which we call P560 and P480. Both pigments convert to their own K intermediates, which differ in absorption maxima, upon illumination with green light at -180 degrees C. Each K intermediate can be reverted to its initial state by light. Similarly, both pigments convert to their own M intermediates upon irradiation with yellow light at -77 degrees C. The M intermediate of both species can be reverted only to P560 by light. Both pigments are therefore photoactive. These unique photochemical properties of bR reconstituted from three fragments may be attributable to the lack of a covalent linkage in the loop connecting the A and B helices, and thus possibly to a change in the orientation of the B helix.


Biosynthetic incorporation of m-fluorotyrosine into bacteriorhodopsin.

Halobacterium halobium, grown in a defined medium where tyrosine had been largely replaced with m-fluorotyrosine, biosynthetically produced purple membrane. Analysis of this membrane by high pressure liquid chromatography of phenylthiocarbamyl derivatized amino acids of membrane acid hydrolysates revealed that up to 50% of the tyrosine was present as the m-fluorotyrosine form. Yields of the purple membrane decreased as the level of incorporation increased. The experimental purple membrane showed a single 19F NMR resonance at -61.983 ppm (relative to trifluoroacetic acid). The bacteriorhodopsin (bR) in the purple membrane was normal as assayed by gel electrophoresis, isoelectric focusing, circular dichroic spectra, and UV-visible spectra. However, the fluorinated tyrosine bacteriorhodopsins at near neutral pH exhibited slightly slower rates of proton uptake and a slower M-state decay with biphasic kinetics reminiscent of alkaline solutions of bR (pH > 9). These results imply that the tyrosines in bacteriorhodopsin may play a role in the photoactivated proton translocation process of this pigment.


Conformational energetics and excited state level ordering in 11-cis retinal.

Semiempirical molecular orbital theory and semiclassical solvent effect theory are used to analyze the conformational and electronic properties of the 12-s-cis and 12-s-trans conformers of 11-cis retinal. The goal is to examine the influence of solvent environment on the equilibrium geometries of these conformers as well as to provide a perspective on the electronic transitions that contribute to the four band systems that are observed in the 200-500 nm region of the optical spectrum. We conclude that the 12-s-cis isomer is more stable in vacuum, but that the 12-s-trans conformer is preferentially stabilized in both polar and nonpolar solvent environment due to dispersive as well as electrostatic interactions. This observation is in substantial agreement with previous literature results. In contrast, our analysis of the excited state manifold indicates that the spectral features observed in the absorption spectrum are associated with a complex set of overlapping transitions. A total of 18 pi*<--pi transitions contribute to the four bands, and in some cases, conformation changes the relative contribution of the individual transitions that define the overall band shape. This study provides the first definitive assignments for all four band systems.


Solvent and temperature effects on the excited singlet state absorption of diphenylbutadiene.

Nanosecond excited state absorption spectra of all-trans-1,4-diphenyl-1,3-butadiene (DPB) and a rigid s-cis DPB analog, 1,4-diphenyl-1,3-cyclopentadiene, were obtained in several hydrocarbon solvents at room temperature and low temperatures. Analysis of the excited state absorption spectra of these two molecules suggests the presence of excited state s-cis rotamers in DPB at room temperature.


Photosensitivities of iodopsin and rhodopsins.

The relative photosensitivity and the molar extinction coefficient of a highly purified iodopsin (chicken red sensitive cone visual pigment) solubilized in a mixture of 3-[(3-cholamidopropyl)-dimethylammonio]-1-propanesulfonate and phosphatidylcholine (CHAPS-PC) were measured using bovine rhodopsin solubilized in 2% digitonin as a standard and compared with those of chicken and bovine rhodopsins. The photosensitivity obtained (1.08) was close to those of rhodopsins (chicken, 1.04; bovine, 0.99) in CHAPS-PC. The molar extinction coefficient of iodopsin (47,200) was 1.15-1.17 times higher than those of rhodopsins (chicken, 40,500; bovine, 41,200). The oscillator strength of iodopsin (0.60) calculated from the extinction coefficient was nearly identical to that of chicken rhodopsin (0.61), suggesting that the chromophore of iodopsin is similar in configuration to rhodopsin. In contrast, the difference in quantum yield between iodopsin (0.62) and chicken rhodopsin (0.70) suggests that the chromophore-opsin interaction after absorption of a photon by the chromophore may be different.


Depressive attributional style and the dexamethasone suppression test: relationship to the endogenous/melancholic distinction and to each other.

The dexamethasone suppression test (DST) and the depressive attributional style questionnaire (ASQ) were administered to 105 depressed patients prior to participation in a double-blind outpatient study and to 29 normal controls. The depressed patients were classified into three groups (1) met criteria for both research diagnostic criteria for definite endogenous depression and DSM III melancholia; (2) met criteria for neither, and (3) met criteria for one but not both. The group that met criteria for both RDC endogenous depression and DSM-III melancholia had a statistically greater frequency of abnormal DST versus the group that met neither criteria and the normal controls. With regard to ASQ, patients who met both criteria had statistically higher bad event internality scores but statistically lower bad event stability and globality scores as opposed to the group that met neither criteria. In general, normal controls had significantly lower bad event ASQ scores than the three depressive groups. There was no correlation between ASQ and DST, as both DST suppressors and nonsuppressors had similar ASQ scores and there was no correlation between ASQ bad event attributions and initial severity of depression.


Serious suicide attempts in the elderly.

A retrospective study was carried out including all those patients who, over the last 6 years (n = 257), required admission to our hospital for medical or surgical reasons following attempted suicide. The authors examined a series of clinical and demographic variables. Thirty-eight patients over 65 years of age were compared with 120 patients aged between 30 and 64 years and 99 aged under 30 years. When compared with the other two groups, a significantly higher proportion of elderly patients were widowed and showed affective disorders and concurrent physical illness.


Clinical study of schizophrenia--application of jacksonism.

Factors influencing prognosis and relapses in schizophrenia were investigated systematically. The results were agreed with Jacksonism. Data were collected from 166 patients who suffered relapses and were readmitted to hospital from November 15, 1971, to December 31, 1974. The psychiatric symptoms were classified from A to G, positive to negative. The initial symptoms were divided into 4 groups. There was interrelation between the somatic and psychiatric symptoms; in the initial symptoms and prognosis, courses, and psychiatric symptoms. Based on my results, I suggest that an evolutional and hierarchical interpretation, which Jackson emphasized, in the correlation between brain and mind is applicable in the psychopathology of schizophrenia.


Specificity of Schneider's first rank symptoms for schizophrenia in Malay patients.

The frequency of Schneider's first rank symptoms (FRS) was studied in 221 Malay patients with functional psychosis. The prevalence of FRS in schizophrenia was 26.7%. The most common symptoms were voice arguing, passivity phenomena and somatic passivity. In the absence of organic brain dysfunction, the specificity of FRS for schizophrenia was 87.8%, and their positive predictive value was 90.6%. These findings indicate that although FRS is not pathognomonic of schizophrenia, their presence should be regarded as strongly suggestive of schizophrenia in the absence of organic etiology. FRS do not however occur with sufficient frequency to have potential diagnostic in schizophrenia.


Stability of psychiatric diagnoses among acutely ill patients.

A survey of patients admitted four or more times to the same acute care psychiatric hospital over a period of 3 years revealed that only 56 of 162 (34%) of such patients were discharged with the same diagnosis on each admission. Instability of diagnosis occurred despite the fact that previous diagnoses were known and that only relatively few diagnoses contributed to this degree of chronicity. Schizophrenia and mania were the most stable diagnoses with considerable overlap between them. Organic disorders were a variable diagnosis, often made in the context of chronicity, substance abuse or uncertainty. A diagnosis of substance abuse usually occurred in the context of other comorbid diagnoses which sometimes took precedence. Instability of diagnosis will continue so long as the diagnostic system is based so heavily on clinical criteria.


Coexistence of the Ekbom syndrome and lilliputian hallucination.

A patient who showed Ekbom's syndrome, i.e. delusions of parasitosis, and also lilliputian hallucination is described. She was diagnosed as senile dementia based on the diagnostic criteria of DSM-III-R and cerebral imaging techniques. When she was 74 years, she felt a mowworm-like wriggle in her stomach and their travels all over her body. When she was 78 years, she saw dressed-up dwarfs dance or march on her abdomen. Since the case showed simultaneously delusions of parasitosis and lilliputian hallucinations, it cannot be denied that she has undetected lesions in the brainstem. In this case, the delusions and hallucinations seem to have occurred as a part of psychopathological signs of senile dementia.


Who needs treatment? A nationwide psychiatric case identification study.

'Case' identification has been considered a major issue in cross-sectional psychiatric epidemiologic surveys. The question is: what is a 'case' and how reliable and valid can criteria be selected? This paper deals with this issue with respect to our experience obtained from a cross-sectional home survey on psychosocial issues and mental health carried out in Greece, with a nationwide probability sample of 4,292 respondents. Mental health status was assessed by use of the CES-D and Langner scales. A high proportion (29%) of respondents was characterized by a degree of mental impairment scoring above the cut-off points in both scales. In order to identify the true psychiatric 'cases', a total of 9 clinical and help-seeking criteria were selected after examining their discriminant power. Finally, a much lower proportion of the sample was identified as probable (7.2%) and definite (8.0%) psychiatric cases in need of care.


Periodic psychosis of puberty: a review on near-monthly episodes.

Published cases of periodic psychosis of puberty and related papers were reviewed. The clinical picture is near-monthly recurrence of episodes of stupor or excitement lasting about 1 or 2 weeks, which are accompanied by delusion and in some cases also by hallucinations or confusion. This condition was found to occur more commonly in girls than in boys, and in half of the girls reported the episodes tended to start a few days before menses. Adolescents with mental retardation were more commonly affected, and this suggests that organic brain damage may play a role in the etiology in some cases. Short-term prognosis is usually favorable, but at long-term follow-up, nearly half of them were found to be suffering from affective or schizophrenic illness. The clinical importance of recognizing this psychosis early in the course of illness is emphasized.


[The pathology of soft tissue sarcomas].

Soft tissue sarcomas are rare and can cause considerable difficulty in diagnosis and differential diagnosis as well as in estimation of the prognosis. These problems are due in part to the wide histological diversity, which is a consequence of intratumoral heterogeneity. The best known example of a very heterogeneous soft tissue tumor is malignant fibrous histiocytoma (MFH). Regular application of ancillary techniques, including electron microscopy and immunohistochemistry, has made it possible to reduce the number of unclassified cases from more than 10% to about 5%. Further progress in this direction is to be expected from cytogenetic studies, since for some of the tumor types characteristic chromosomal abnormalities have been established. Prognosis has been related to the grade of malignancy, but recent studies show that in many soft tissue sarcomas it will also be possible to correlate prognosis with DNA ploidy. By contrast, overexpression of the multidrug resistance gene mdr-1 does not seem to play an essential role in soft tissue sarcomas.


[Magnetic resonance tomography of soft tissue tumors].

Soft tissue tumors are relatively often seen on MR tomography, although they make up a fairly small proportion of malignant lesions. To date, most soft tissue tumors have been investigated by MRI because of its unique soft tissue contrasts and its flexibility in slice orientation. But is MRI really adequate for staging and defining soft tissue tumors, or what role does it have pre-therapeutic work-up? Most malignant soft tissue tumors give rise to somewhat similar MRI findings and may not be sufficiently well characterized. On the other hand, some benign lesions can be clearly identified and staged. The goal of this paper is a critical discussion of the ability of MRI to define a lesion's degree of malignancy, to evaluate diagnostic criteria, and to describe requirements in the set-up of the investigation.


[Imaging techniques in the preoperative diagnosis of soft tissue tumors. A comparison of MRT, CT, sonography, angiography and conventional x-rays].

In a study on 51 patients with histologically confirmed soft tissue tumors (STT), we retrospectively evaluated the preoperative use of imaging procedures (MRI, CT, ultrasound, angiography, plain film) for identification of tumor size, delineation, and determination of malignancy and tissue type. The findings were correlated with intraoperative findings and histological diagnosis. The overall diagnostic method of choice for preoperative imaging of STT is MRI, followed by CT. Ultrasound, although sensitive, lacks the required specificity. Angiography and plain film can only be used for specific indications, as they generally do not make it possible to stage the tumor. Combining our results with those from the more recent literature, we propose a diagnostic algorithm according to which MRI would generally be performed for preoperative staging of STT. CT and plain film should only be used if bony infiltration is suspected; angiography is indicated for planning intraarterial chemotherapy or embolization or if vascular infiltration is probable.


[Radiologic diagnosis of the recurrence of soft tissue sarcomas].

We report about the diagnosis of recurrent soft tissue tumors in more than 350 patients using magnetic resonance tomography (MRT) and computed tomography (CT) during the last 5-6 years. MRT turned out to be the method of choice having a sensitivity of about 85% and a specificity of 60-70%, provided that a high resolution technique is used and a paramagnetic contrast agent (gadolinium-DTPA (Gd)) is applied. By performing "dynamic Gd-sequences" a quantification and of the perfusion of a recurrent tumor is possible. Even MRT does not produce a definite tumor-specificity. The alterations of imaging concerning surgical treatment or therapeutic irradiation are extensively discussed. Practical suggestions for the daily routine diagnostic in case of uncertain clinic or symptoms are given.


[Radiotherapeutic strategies for soft tissue sarcomas in adults].

Soft tissue sarcomas account for under 1% of all cancers in adults. Most soft tissue tumours are benign, only about 1% being characterized clinically and histomorphologically as malignant neoplasms. Since these tumours are often treated by excisional biopsies without any further diagnostic imaging, precise planning of postoperative irradiation therapy is often difficult to achieve. Therefore, all soft tissue tumours with a short history should be regarded as malignant until the contrary has been proven. In general, the mode of tumour resection should be postponed until CT or MR diagnosis is complete and a biopsy of the tumour has been carried out. Whereas benign lesions need only marginal tumour resection, malignant lesions require considerable safety margins. In soft tissue sarcomas of the extremities, which account for 50-60% of all sarcomas, a wide local resection followed by postoperative irradiation with about 66 Gy can guarantee local control rates above 80% and preserve the function of the limb. Radical surgery alone can achieve the same local control, but without the high level of functional integrity. In the case of marginally resectable tumours, preoperative irradiation can induce partial tumour remission and thus allow definitive limb-sparing tumour resection. Recently, multimodal and neoadjuvant therapeutic strategies have been developed. The efficacy of these experimental strategies is not yet proven.


[Primary amyloid tumor of the lung].

Primary idiopathic amyloidosis may be a diagnostic problem because of its low incidence and its variable manifestations. The clinical and radiographic findings in a patient with accidentally discovered primary amyloidosis of the lung are presented. The extensive mediastinal and hilar lymph-node enlargement was striking. Peripheral bronchial carcinoma was initially suspected because of the radiographic and CT findings. Various patterns of pulmonary amyloidosis have to be considered in the differential diagnosis of nodules and interstitial changes of the lung.


Studies on iron deficiency anemia, rickets and zinc deficiency and their prevention among Chinese preschool children.

The incidence of iron deficiency anemia, rickets, and zinc deficiency is very high in Chinese preschool children and a method for prevention is urgently needed. From our studies, it can be seen that a soft drink powder is a convenient vehicle for the supplementation of iron, zinc, calcium, vitamin D, riboflavin, and ascorbic acid. Table salt is also a good, low-cost carrier for iron and zinc, and cow's milk can only be used for the enrichment of vitamins A and D. In our study the therapeutic dose of iron was lower than 3 mg/kg body weight recommended by the WHO Expert Committee. As ascorbic acid can enhance the absorption of iron in the body, so 300 mg vitamin C was added to 100 g of soft drink powder containing 100 mg of elemental iron. Ten g of powder is not only enough for the prevention of iron deficiency anemia but it can also cure iron deficiency anemia within 3 months. One hundred mg of iron in 100 g of table salt is an adequate level, because an adult or a child taking 10 or 5 g of salt will receive 10 and 5 mg of elemental iron respectively. This dosage is adequate for the prevention of anemia. From our results, 10 mg of zinc daily is enough for the prevention and treatment of zinc deficiency in preschool children. Four hundred IU of vitamin D (from fortified soft drink powder or enriched fresh cow's milk) orally-administered daily, is a good way to prevent rickets in infants and young children.


Zinc: a perinatal point of view.

Zinc is a metal with great nutritional importance, particularly during periods of rapid growth due to its intervention in cellular replication as well as in the development of the immune response. A review of studies by several authors trying to determine the normal behaviour of zinc during pregnancy and early infancy is done, in an attempt to establish adequate circulating levels, in order to be able to identify zinc deficiency correctly and provide appropriate treatment. However, the information is very contradictory and no real conclusion can be reached.


The production of menaquinones (vitamin K2) by intestinal bacteria and their role in maintaining coagulation homeostasis.

Vitamin K is an essential cofactor necessary for the production of clotting factors II, VII, IX, and X in humans and has recently been found to be an essential factor for many other proteins in the body. There are two sources of this essential vitamin, including vitamin K1, or phylloquinone which is primarily found in green leafy vegetables and vitamin K2 or menaquinone which is synthesized by certain intestinal bacteria. The precise contribution of the bacterially synthesized menaquinone to overall vitamin K requirements in man is unknown. This paper reviews the available literature regarding the production and liberation of menaquinones from bacteria, the animal experiments which have been done to examine the absorption of menaquinones and the indirect and direct evidence in humans regarding utilization of menaquinones. The preponderance of the evidence suggests that bacterially synthesized menaquinones, particularly in the ileum can and do play a significant role in contributing to vitamin K requirements in humans to prevent clinically significant coagulopathy, especially during periods of episodic dietary lack of the vitamin.


Self-medicating practices for managing chronic pain after spinal cord injury.

Spinal cord injured (SCI) persons often experience chronic pain. Methods of dealing with pain that the SCI client found helpful in the past may not be beneficial after the injury. This article describes a study of self-medication for the purpose of pain relief. Over-the-counter, prescription, or illicit drugs or alcohol are among the agents employed in self-medication. The rehabilitation nurse has a role in helping the SCI person to identify appropriate methods of managing chronic pain throughout life.


Negotiating self-care in rehabilitation nursing.

The authors conducted a study to examine nurse and patient perceptions of self-care and the performance of self-care in rehabilitation settings. The grounded-theory method was used to conduct and analyze in-depth interviews of 12 nurses and 12 rehabilitation patients. Every nurse and every patient had expectations regarding who would control each aspect of the patient's self-care. When these expectations were noncongruent, negotiation usually occurred. Successful negotiation resulted in a balance of self-care, the optimal balance between nurse and patient control.


The effect of an inpatient arthritis rehabilitation program on self-assessed functional ability.

Self-assessed functional ability of patients with arthritis was measured prior to their participation in a 6-day inpatient arthritis rehabilitation program. Self-assessed functional ability was rechecked at discharge and again at the follow-up, which took place 5 to 10 weeks after discharge. Patients at five different centers completed the modified Health Assessment Questionnaire (HAQ) at admission (n = 97) and again at discharge (n = 95). Thirty-six of those patients completed the follow-up questionnaire. The disability index was significantly lower at discharge than at admission and significantly lower at follow-up than at discharge. Pain severity was significantly lower at discharge than at admission but was not significantly different at follow-up than at discharge. McNemar's test, a modification of the standard chi-square, was used to compare patients' reliance on the assistance of others to perform functional tasks at admission versus at discharge. Reliance on others for help was significantly lower on discharge than on admission for grooming, arising, eating, walking, hygiene, reaching, and gripping/opening. This study concludes that participation in the inpatient rehabilitation program significantly reduced disability, pain, and the need for assistance from others.


The influence of the family's perception of disability on rehabilitation outcomes.

The family plays an important role in facilitating positive rehabilitation outcomes with a disabled client. Thus, families must be involved in the rehabilitation process. For this to occur, the nurse must identify the characteristics of the family unit. This article presents a framework that supports the assessment of the family unit.


Patient discharge planning documentation in an Australian multidisciplinary rehabilitation setting.

This article, drawing on data from 17 case studies, addresses problems in documentation of discharge planning in an Australian multidisciplinary rehabilitation center and the ways these were, or could be, overcome. The problems identified in the case studies were not specific to one discipline; they were due to inadequately defined guidelines and responsibility and poorly designed forms, and they possibly reflected the tendency for members of practice-oriented disciplines to see documentation as low on their list of priorities.


Evaluating the effects of a family education intervention.

The role of the family is regarded as one of the key variables influencing rehabilitation outcomes. Rehabilitation literature ranks family education as one of the important elements of a rehabilitation program--but as the cost of health services escalates, it is becoming increasingly important to justify the expenditure of resources for family education. Little was found in the literature about how to demonstrate or evaluate the benefits gained from family education interventions, and no instrument that had been used for this purpose was identified. The Family Assessment Device (FAD) (Epstein, Baldwin, & Bishop, 1983) is a self-report instrument that was cited in the literature (Bishop & Miller, 1988) as a way to measure changes in family functioning that resulted from a clinical intervention. It seemed possible that the FAD also might be used to evaluate the effects of an educational intervention for families. A study was designed using the FAD to evaluate the outcome of a family education series provided by an outpatient rehabilitation program for head-injured patients; however, the expected improvements in family functioning, evidenced by changes in mean scores on the FAD, did not occur. While the results of this study were disappointing, it may be that the FAD could serve as the prototype in the development of an instrument designed specifically to measure the effects of a family education intervention during rehabilitation.


[Genotoxic activity test of sodium fluoride in vitro].

The artificial drinking water fluoridization provided as a mass preventive measure against dental decay poses another substantial problem which is a possibility of genotoxic action. Up to this date, this matter remains still obscur and is discussed with more or less intensity from time to time. The mentioned fact supported authors to study the impact of short-term 24 hrs sodium fluoride (NaF) action in concentration range of 0-500 mg.1(-1) drinking water in the frame of so-called minimal testing set (analysis of chromosomal aberrations in human peripheral lymphocytes, Ames test). For the initial NaF concentration applied, the reference value of 1 mg per 1 liter artificial fluoridization was estimated. The use of Ames test with TA 98 and TA 100 Salmonella typhimurium (+/- S9) strains showed no significant increase in revertants responsible of NaF mutagenic activity in any of applied concentrations (0-1300 mg per 1 Petri dish; = 0-520 mg.l-1 converted to the basic supplementative dose). Cytogenetic analysis of peripheral lymphocytes showed more sensitivity than prototrofic salmonella test. Yet one order higher NaF concentration than its application norm 1 mg.l-1 (i.e. 11 mg.l-1) has induced the occurrence of 3.8% ABB after single addition for 24 hrs to the "healthy" blood cultivated in vitro at short-term. This accounts for a value close to the level of statistically significant difference with regard to the application norm recommended. This level has been even exceeded as for a total count of fragments and exchanged parts. Thus the two orders higher NaF concentration (110.0 mg.l-1) resulted in a strong increase of cells with chromosomal aberrations for all of indicators observed; e.g. 27.5% ABB. Based on literary sources, obtained results and properly experience in practical proceeding artificial fluoridation, the authors concluded that the latter is not adequate to the up-to-date status of knowledge. Besides of economical and technical problems, those scientific are mainly concerned with making doubtful the auto-presumed genotoxic inertness for chronic users of fluoridated drinking water. Author's opinion is that when necessarily provided, the artificial fluoridization of drinking water should be proceeded selectively (in accord with real requirements of an appropriated population group, its age structure and location), temporarily and with intermittent checkout of fluoridization application regimen. To conclude, authors recommend further observation with use of biological model situations in vivo.


[Antimicrobial activity of composite filling materials].

Antimicrobial effects of several composite fillers are monitored in response to a mixed aerobic and anaerobic microbial flora of the oral cavity. None of observed both self-polymerizing and photopolymerizing composites showed antimicrobial effects.


[Skin hypersensitivity: intradermal hypersensitivity to allergen extracts and its relation to the place of residence].

A retrospective review of 308 clinical files of patient to respond at immunological and clinical allergic service of the Centro Medico 20 de Noviembre, ISSSTE for suffer with allergica illnes, realized by aeroalergens sensitization and determination frequency (intradermoreactions mediated) and relation to area living. The patients was highly sensitive at dust and dermatophagoides (75 and 40% respectively) others aeroalergen caused sensitization in the Capriola dactylon (37%), Amarantus palmieri (35.5%), Fracxinus (34.6%), Ambrosia elatior (33%), Candida (21.4%), Penicillium (18.1%), Mucor y Rizopus (17.8% each one).


[Cytotolerance for Nimetic Grip (ESPE), a material used for fixation of dental bridge plates].

Providing in vitro experimentation on cells, the authors monitor general biologic effects of the fixation composite Nimetic Grip (ESPE). Cytotoxicity of three components of supplied package is tested with both dynamic identification of contact cytotoxicity and macro contact test. Those concerned are composite cements. Nimetic Grip Opak and Transparent as well as Nimetic Bond adhesive varnish. All the observed materials were shown to induce morphologic changes on HEp-2 cells.


[The importance of pollinosis in the Valley of Mexico].

The climatic conditions and the vegetation in the valley of Mexico are analyzed in virtue of their modification during the last few years which have consequently altered the surrounding ecological systems. In this article, we were particularly interested in describing the botanical characteristics of the gimnospermas, an abundant vegetation in Mexico.


[Effective dosage equivalents in evaluating radiation burden in patients in stomatologic roentgenology].

Risk coefficients are the main quantitative parameter when determining the extent of X-ray load in patients investigated with roentgenography. A concept of effective dose equivalent HE is used for this purpose. The present study is aimed on the determination of the HE for both orthopantomography and routine extra-oral roentgenogram of the mandibula. Measurements were performed on Alderson Rando phantom. The resulting effective dose equivalent for investigation with orthopantomograph represented 99.0 mu Sv and 80.9 mu Sv for the extra-oral projection, respectively. Based on the results obtained, the load with dental X-ray was shown to be disproportionately high.


[In vitro transfer of immunity against PPD with dialyzable extract of leukocytes from human colostrum].

The aim of this study is to demonstrate the transference of PPD hypersensibility in an in vitro model, with dialysable colostral leukocyte extract (DCLE) of PPD+ and PPD-mothers, through measurements of leukocyte migration inhibition factor activity (LIF) from blood obtained of the umbilical cord of newborns from PPD+ mothers. The results show that DCLE PPD+ incubated with leukocytes of newborns from PPD- mothers had inhibition of leukocyte migration compared with migration of leukocytes incubated with DCLE PPD-. These results suggest that in this in vitro model, DCLE transfers hypersensibility to PPD.


[Occupational disease at an allergy service].

26 nurses were included in a prospective study mean age of 37.2 years old. 14 of them participated either in the application or preparation of allergenic extracts (vaccines) for several months (range 3-60). The other 12 were taken as control subjects. In both groups, we obtained atopic background, clinical evaluation, seric IgE, nasal smears, skin test with glicerinated antigens, positive and negative control. The study concluded allergy sensibilization occurs in those nurses working at the allergy service mainly in those whom referred genetic background for atopy.


Laser therapy for endobronchial tumours.

Endobronchial laser therapy has been performed at Knightswood Hospital, Glasgow since 1983. During the period 1983 to 1990, 62 patients underwent a total of 149 laser treatments. The principal indications for therapy were tracheo-carinal stridor (24%), dyspnoea due to bronchial occlusion (60%) and haemoptysis (13%). Squamous carcinoma accounted for 80% of the lesions. Over 75% of patients had already received some form of prior therapy (radiotherapy 71%, chemotherapy 8%, surgical resection 11%). Laser therapy reduced stridor in 67% of patients with tracheal and carinal tumours and produced symptomatic improvement in 72% of patients with bronchial obstruction but without evidence of lobar collapse. Haemoptysis was controlled in all but one of patients treated. Two patients (3.2%) died during laser treatment following severe haemorrhage.


Skin lesion removal: practice by general practitioners in Grampian Region before and after April 1990.

The introduction of new GP contracts in April 1990 incorporated a financial incentive to undertake minor surgical procedures. Previous reports have noted large increases in the number of GP-derived skin specimens after April 1990. Our present study intended to address whether similar changes have occurred in Grampian Region as well as, more specifically, noting whether there have been changes in the quality of practice following the 1st April 1990. A retrospective study of skin biopsies removed by general practitioners in Grampian Region was undertaken. Cases were selected from four periods of six months (1st April to end of September) in 1987, 1988, 1989 and 1990. All skin specimens sent by general practitioners to the Department of Pathology, Aberdeen Royal Infirmary, were included. Following April 1990 there was a two-fold increase in skin specimen numbers--an increase significantly greater than increases observed over previous years (p < 0.01). Of particular note was the contribution made to this increase by Aberdeen City GPs whose contribution rose five-fold (p < 0.0001). Non-benign lesions (ie malignant plus carcinoma-in-situ-) represented 6% of lesions excised. A non-benign clinical diagnosis or an indication of suspicion was written on only one third of request forms for histopathologically diagnosed non-benign lesions. The proportion of histologically incompletely excised lesions rose over the four years (p < 0.01); moreover the increase in total numbers of lesions resulted in a striking increase in the actual numbers of incompletely excised lesions after April 1990.


Persuasion, coercion, medical paternalism or the Mental Health Act: the dilemma of detention in the general hospital.

This paper describes the cases of three patients where the question of the need for formal detention arose due to mental disorder, apparently primarily due to physical illness, which in each case required further investigation and treatment in a general hospital. It states some of the issues facing those caring for patients under these circumstances and offers advice on overcoming some of the problems.


Could it be myotonic dystrophy? Myotonic dystrophy presenting with atrial flutter.

Myotonic dystrophy is a well recognised and well defined multisystem disorder which is inherited in an autosomal dominant fashion through a locus on chromosome 19. The disease itself is characterised by rigidity and degeneration of skeletal muscle, cataract formation, gonadal atrophy, frontal baldness and mental retardation. Like many inherited disorders there is a variable expression and so diverse clinical presentations can occur.


Patterns of unhealthy eating behaviours in a middle aged Scottish population.

This paper examines unhealthy eating in a middle aged Scottish population. Data from a 1989 survey of 500 Scottish men and women aged 45 to 59 years are used to explore inter-relations among five items of unhealthy eating, smoking and alcohol consumption. The results show that unhealthy eating behaviours are highly correlated, indicating strong links among certain nutrition habits. The findings also reveal that such patterns of unhealthy eating vary considerably between males and females. Finally, unhealthy eating behaviours were also found to be significantly associated with smoking and alcohol consumption. Implications of these findings for future research in epidemiology and health promotion are considered.


Crescentic glomerulonephritis: experience of a single unit over a five year period.

Crescentic glomerulonephritis is a well defined pathological lesion occurring in a range of renal and systemic diseases. We have retrospectively reviewed the aetiology, clinical features and outcome in 60 patients presenting over a five and a half year period. Most patients were elderly (median age 61 years, range 16-84 years). The majority presented with severe renal impairment, 32 requiring dialysis at admission. The degree of glomerular crescent formation on biopsy was closely related both to initial dialysis dependence and the ensuing response to immunosuppression. Forty-three patients received immunosuppressive treatment. A beneficial response was seen in 40% of patients requiring dialysis, and in 88% of those with less severe renal impairment. A high early mortality was apparent (30% within three months), exclusively affecting elderly patients (all > 60 years), with advanced renal failure (all dialysis dependent), the majority of whom (15 out of 18) had been immunosuppressed. The results suggest that the benefits of immunosuppression in this group may be outweighed by the complications of treatment.


Medical clinic referral letters. Do they say what they mean? Do they mean what they say?

Consecutive general practitioner referrals to three general medical clinics were examined prospectively to assess whether the reason for referral was being correctly interpreted by consultants. The resultant data revealed that although this was not always the case, such misunderstandings did not appear to affect subsequent management. Explicit reasons for referral in the referral letter however could improve both the quality and value of out-patient consultations.


Creutzfeldt-Jakob disease in Scotland and Northern Ireland 1980-1989.

The epidemiological and clinical features of Creutzfeldt-Jakob disease have never before been studied in Scotland and Northern Ireland. Case records for those dying with this diagnosis were obtained for the period 1980-89. Over the ten year period, 25 definite or probable cases were identified, giving an annual incidence of 0.37 cases/million. There were more cases in the second half of the decade, and this was most likely due to increased ascertainment. One pair of cases occurred in close proximity to each other. Sex distribution showed an excess of males (male:female ratio = 1.8:1). Mean age at onset was 65.2 years, and mean duration of disease was 5.3 months. The presenting symptoms and clinical features were similar to those noted in previous studies of other populations. There was no excess of cases in occupations linked to food, farming, or medical/paramedical work.


Abscess formation as a complication of chickenpox.

Chickenpox is a common infectious disease of childhood. Skin lesions may occasionally become secondarily infected with bacteria. Large abscess formation is reported complicating a mild case of chickenpox in a previously healthy patient.


Atrial myxoma: a rare cause of progressive exertional dyspnoea.

A 40 year old man suffered eight years of vague but disabling symptoms, initially thought to be related to post viral fatigue syndrome, but ameliorated by the removal of a large atrial myxoma. The diagnosis of atrial myxoma is notoriously difficult, but should be excluded by echocardiography if there are predominant symptoms of progressive exertional dyspnoea, even in the absence of cardiological signs.


Preclinical leads for innovative uses for etoposide.

Amplification of oncogenes in human tumors has been associated with a poor prognosis. Microscopically visible amplified oncogenes can be located either within chromosomes in homogeneously staining regions, or in an extrachromosomal compartment in double minutes (DMs). The DMs are composed of submicroscopic circular DNA (episomes), which have multimerized to form the microscopically visible DMs. When amplified oncogenes are located in an extrachromosomal location, they are vulnerable to loss from the cell. In this study we have found that the topoisomerase II inhibitor etoposide, in concentrations easily achievable clinically, causes a significant decrease in the number of DM-containing amplified oncogenes in three different human tumor cell lines. The elimination of amplified oncogenes from the cell could be accompanied by less aggressive tumor behavior.


Etoposide/cisplatin-based chemotherapy for patients with metastatic poorly differentiated carcinoma of unknown primary site.

Patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA) of unknown primary site comprise a sizable minority (25% to 35%) of patients with carcinoma of unknown primary site. Some of these neoplasms are highly responsive to combination chemotherapy, and a minority of patients are curable. Between 1978 and 1982 we treated 67 patients with combination chemotherapy, most of whom received PVB (cisplatin/vinblastine/bleomycin) with or without doxorubicin. Thirty-eight patients (56%) responded to treatment, with 15 (22%) attaining complete responses (CRs). Nine patients (13%) are long-term disease-free survivors. Since that time, we have incorporated etoposide into our treatment program because of its synergism with cisplatin and its marked activity against several other neoplasms including germ cell tumors. Seventeen patients with PDC or PDA of unknown primary site received second-line therapy with etoposide/cisplatin after failing to respond to PVB. Ten of these patients had partial responses, with a median response duration of 5 months (range, 2 to 12). Eighty-five previously untreated patients with PDC or PDA received etoposide/cisplatin combinations as initial treatment; 57 of 78 evaluable patients (73%) responded to therapy, and 24 (31%) achieved CRs. Sixteen patients (19% of entire group) remain disease-free a median of 28 months (range, 9 to 66) after therapy. Etoposide is active against poorly differentiated carcinoma of unknown primary site. These results indicate that initial treatment with etoposide/cisplatin combinations is equivalent or superior to our previous results with PVB.


Etoposide in the treatment of non-Hodgkin's lymphomas.

Although etoposide has become one of the most active drugs for the treatment of non-Hodgkin's lymphoma, its optimal use remains to be determined. Nevertheless, it has been used judiciously in a wide variety of treatment settings, including management of aggressive non-Hodgkin's lymphoma, in combinations testing an aggressive approach for the treatment of advanced indolent lymphomas, integrated combined-modality therapy for localized aggressive lymphoma, salvage therapy, and induction regimens with autologous bone marrow transplantation. It has also been used in assorted combinations attempting to maximize antitumor efficacy while minimizing toxicity in elderly patients with lymphomas. This paper reviews the studies using etoposide in these various management situations.


Etoposide pharmacology.

Etoposide, a podophyllotoxin derivative, has demonstrated antitumor efficacy in a number of human malignancies, including lymphomas, germinal tumors, and lung cancer (especially small cell). Etoposide's antineoplastic activity is achieved through DNA strand breakage, which likely results from the formation of a complex involving drug, DNA, and the DNA unwinding enzyme, topoisomerase II. The drug's steady state volume of distribution ranges from 5 to 17 L/m2, and it is highly bound to plasma protein with an average free plasma fraction of 6%. A number of etoposide metabolites have been confirmed or postulated. Several cell lines have been shown to acquire resistance to etoposide through membrane transport changes. Considerable intrapatient variability exists in pharmacokinetic parameters following intravenous (IV) and oral dosing. Approximately 30% to 40% of unchanged IV drug is excreted in the urine, whereas biliary excretion appears a minor route of drug elimination. The bioavailability of oral etoposide averages 50%, although wide variability exists both among and within different patients. Bioavailability decreases as the dose of oral etoposide is increased. Several recent studies have attempted to correlate etoposide plasma concentrations with toxicity (primarily myelosuppression) in hopes of using this information to optimize drug dosing.


Etoposide in the treatment of leukemias.

Etoposide (VP16-213), a topoisomerase II inhibitor, has produced complete responses in 17% of previously treated patients with acute nonlymphocytic leukemia (ANLL) but has little activity in acute lymphoblastic leukemia. As salvage therapy for relapsed ANLL etoposide produces 28% complete responses in combination with amsacrine, 49% with 5-azacytidine, and 51% with anthracycline. It has been successfully combined with high-dose cytarabine as a salvage treatment. In a randomized trial in previously untreated patients with ANLL, etoposide significantly prolonged remission duration. Etoposide has been used to intensify postinduction therapy with or without bone marrow rescue, but its exact role in that setting has not been clarified. Because of its schedule dependency in other tumors, etoposide should be investigated using different schedules in ANLL.


Etoposide in gastric cancer.

Etoposide has modest single-agent activity (21% partial response rate) in patients with previously untreated metastatic gastric carcinoma. The use of etoposide in combination with agents like doxorubicin, cisplatin, and 5-fluorouracil with or without leucovorin has been of increasing interest to oncologists. Such combinations have been reported to produce overall response rates as high as 60% to 70%, with complete response rates as high as 20%, in patients with advanced measurable gastric carcinoma. Etoposide-containing regimens have also been used preoperatively in potentially resectable patients. In these studies, approximately 60% of treated patients may be rendered disease-free following resection. Preoperative (neoadjuvant) therapy has not yet been shown in phase III studies to be superior to surgery alone. Significant myelosuppression is the major toxicity of etoposide-based chemotherapy. Such chemotherapy deserves further evaluation in the treatment of gastric cancer.


High-dose etoposide (VP-16)-containing preparatory regimens in allogeneic and autologous bone marrow transplantation for hematologic malignancies.

High-dose etoposide has been added to total body irradiation, cyclophosphamide, carmustine, or busulfan in preparatory regimens for allogeneic or autologous bone marrow transplantation for patients with leukemia, Hodgkin's disease, lymphoma, or multiple myeloma. The treatment results are encouraging, indicating that etoposide may be a valuable addition to the previously established regimens. Etoposide should be incorporated into collaborative, prospective trials to define its ultimate role in bone marrow transplantation.


Role of etoposide in treatment of breast cancer.

Etoposide has played a prominent role in the treatment of many common and uncommon malignancies. The use of etoposide in the treatment of breast cancer is still experimental. Early work using etoposide as a single agent in previously treated patients suggests this drug is inactive in the dose and schedules tested. The sole trial using etoposide as a single agent in untreated patients suggests a modest overall response rate of 15%. Perhaps more promising has been the use of etoposide in both cisplatin and noncisplatin-containing combinations. Early data suggest these combinations display at least additive effects and perhaps some synergy. Ongoing cooperative group trials are evaluating cisplatin/etoposide combinations in minimally pretreated patients with metastatic breast cancer. While trials using high-dose etoposide in combination with other drugs as ablative treatment for breast cancer have been reported, etoposide's poor performance in pretreated patients calls such practice into question; the contribution of etoposide to such therapy is therefore conjectural.


New perspectives on the toxicity of etoposide.

Etoposide has been used in the treatment of a wide variety of neoplasms, including small cell lung cancer. Kaposi's sarcoma, testicular cancer, acute leukemia, and lymphoma. Its current therapeutic use is limited by myelosuppression, particularly neutropenia. Pharmacodynamic studies of etoposide show that this toxicity can be modeled using a modified Hill equation, and that the dose intensity of etoposide can be successfully increased by adaptive control using this model. Significant influences on the degree of myelosuppression include pretreatment leukocyte count, performance status, extent of prior erythrocyte transfusions, and serum albumin level. In the past 5 years, interest has developed in a distinct subset of acute nonlymphocytic leukemia that is associated with prior exposure to etoposide. This syndrome has been described in several studies, and is characterized by the lack of a preleukemic phase, M4 or M5 morphology, and distinct translocations involving the chromosome 11q23 region.


Granulocyte-macrophage colony-stimulating factor with dose-intensified treatment of cancer.

GM-CSF decreases the hematopoietic toxicity of both nonablative and marrow ablative intensive chemotherapy regimens. Data are limited at this time, particularly in regard to optimal schedules and GM-CSF dosing regimens with particular chemotherapy programs. The importance of GM-CSF scheduling in relationship to chemotherapy is becoming more clear. The dose-intensive regimens supported by GM-CSF produce a high complete remission rate in several types of malignancy. Evidence that these remissions will be durable is still lacking. Future directions will include filling some of these voids in our knowledge, as well as exploring various cytokine combinations for improved hematopoietic recovery and other chemotherapeutic regimens for improved antitumor effect. The near complete cytoreduction produced by these dose-intensive regimens may also create a better setting for attempts at therapeutic immunomodulation. Yet another, but more difficult, task will be to identify those situations where progenitor cell replacement is beneficial and appropriate.


Epidemiology by computer.

Collecting epidemiological data from a large community sample has, in the past, been a costly and time-consuming exercise. This paper outlines a methodology for undertaking such research by using a set of standard psychiatric questionnaires, including a computerised version of the Diagnostic Interview Schedule Screening Interview on a portable laptop computer. The study of 1009 country South Australian subjects found that this technique provided prevalence estimates similar to those obtained from the more established Diagnostic Interview Schedule, with the added benefit that all interviews were successfully carried out by lay interviewers under minimal supervision, in the subject's home.


Trends in psychiatric hospitalization and changes in admission patterns in two counties in Denmark from 1977 to 1989.

Based on data from the nationwide Danish Psychiatric Case Register, trends in admission rates and treatment-day rates were studied in two Danish counties between 1977 and 1989. During the observation period, the number of available beds in the counties investigated decreased from 1.78 to 1.10 per 1000 inhabitants aged 15 years or more. Over the same period, the admission rates decreased by 20% for in-patients and 38% for day-patients. At the same time, treatment-day rates for in-patients decreased by approximately 50% and treatment-day rates for day-patients by 32%. The decrease was seen in all age groups both for admission rates and treatment-day-rates. Rates for short-term hospitalization showed a steeper decrease than those for long-term hospitalization. For schizophrenia, admission rates increased except among men under 25 years of age, and treatment-day rates decreased in all age groups. Affective disorders, neuroses, personality disorders, and alcohol and drug abuse showed the most pronounced decreases in admission rates and treatment-day rates. The same trend was seen for treatment-day rates for organic disorders. A marked decrease in admission rates was seen in the provincial towns. Treatment-day rates decreased markedly in city areas, and less so in rural areas.


Prediction of hospitalization within a psychiatric community care system--a five-year study.

Within a comprehensive community care system, we examined which patients became hospitalized during long-term treatment. We studied 60 consecutively admitted, and mainly chronic psychotic patients over 5 years. Full and partial hospitalizations were assessed by means of a hospitalization index. This index was significantly lower in the 2nd to 5th years after admission than in the 1st year. Sociodemographic and clinical characteristics failed to predict hospitalizations during the 1st year. Patients' age, gender and last occupational status were related to hospitalizations in the following 4 years. A better prediction of hospitalizations was allowed by treatment data obtained during the 1st year. It is suggested that long-term prognosis should be based mainly upon experience with a patient in a given care system, rather than on a patient's history and characteristics as known before treatment.


Inpatient care in an eastern and a western European area. A comparative case-register study.

Inpatient point-prevalence and admission rates in both mental hospitals and psychiatric wards in general hospitals in East Bohemia and in Drenthe (the Netherlands) were compared. A higher point-prevalence rate was found in Drenthe as there was a higher rate of long-stay patients. However, in East Bohemia the admission rates were higher for all diagnostic categories, except for neuroses, the admission rates for neuroses were twice as high in Drenthe. The differences were explained by the availability of complementary in-patient services and more developed out- and day-patient facilities in Drenthe.


The validity of the 28-item General Health Questionnaire in a Nigerian antenatal clinic.

The 28-item General Health Questionnaire (GHQ-28) was validated against the Psychiatric Assessment Schedule (PAS) using data collected during a prospective study of psychiatric disorders associated with childbirth among 277 Nigerian women attending an antenatal clinic. Using the results of correlational analyses of the total scores on the GHQ and on the PAS and the traditional validity coefficients of sensitivity, specificity, and misclassification rate, the instrument was shown to be a valid tool for the detection of psychiatric morbidity in this population. With a sensitivity of 82% and a specificity of 85%, the revised scoring method devised by Goodchild and Duncan-Jones performed better in discriminating 'cases' from 'non-cases' than the conventional scoring method, which values respectively, of 75% and 83%. In a discriminant function analysis, only three of the four subscales of the instrument contributed to its discriminating power.


Explaining social class differences in psychological health among young adults: a longitudinal perspective.

The relationship between psychological health and occupational class was investigated in the large British sample of 23-year-old subjects from the 1958 birth cohort study. Odds of poor psychological health indicated by (1) the Malaise Inventory and (2) seeking help for a psychological problem between ages 16 and 23] were significantly greater in classes IV and V than in classes I and II: odds ratios were (1) 3.90 and 5.84, (2) 2.32 and 2.33 for men and women, respectively. Explanations for these differences were examined using longitudinal data representing 'inheritance' at birth, socio-economic background, educational achievement, earlier health and behaviour. The analyses suggested that each of these contributes to class differences in psychological health. Behaviour at age 16 (identified from the Rutter Behaviour Scale) was particularly notable for both psychological measures, as were educational achievement (for Malaise) and unemployment (for psychological morbidity needing specialist help). Mechanisms by which such factors might operate are discussed. Having accounted for earlier circumstances, class differences were no longer significant, except for Malaise in women. In this case an odds ratio of more than twofold remained after adjusting for earlier circumstances.


Jewish Americans and mental health: results of the NIMH Epidemiologic Catchment Area Study.

Data from the Epidemiologic Catchment Area Study showed that the overall lifetime rate of psychiatric disorder among Jews did not differ from the rate among non-Jews. However, there was a significant difference between Jewish and non-Jewish samples when comparing the distribution of specific psychiatric disorders. Compared with Catholics and Protestants, Jews had significantly higher rates of major depression and dysthymia, but lower rates of alcohol abuse. Jews were more likely than Catholics or Protestants to seek treatment with mental health specialists and general practitioners. These differences remained statistically significant after adjusting for sex, age, race and socioeconomic status.


Behavioural correlates of expressed emotion in staff-patient interactions.

Staff members working in community facilities for patients with long-standing mental illness were assessed using a modification of the Camberwell Family Interview designed to measure their attitudes towards their key patients. This enabled an evaluation of their levels of expressed emotion (EE). Staff members and their patients took part in a direct interaction task 2-4 weeks later. This was deliberately focused on low-conflict issues, and each interaction was audiotaped. The presence of the nuclear symptoms of schizophrenia in the mixed diagnosis sample was the only patient attribute associated with high-EE attitudes. Staff rated high in EE were more likely than low-EE staff to make negative statments during the interaction, and less likely to make supportive ones. Patients with low-EE keyworkers were more likely to volunteer statements of self-affirmation during the interaction. Low-EE staff tended to focus on positive aspects of the patient's life. During interviews and interactions, low-EE keyworkers did not dwell on their own negative feelings (if any) or on those expressed by the patient. This characteristic is probably a salient feature of successful therapeutic relations with clients suffering from long-term mental illness.


Use of an adsorption enzyme immunoassay to evaluate the Haemophilus ducreyi specific and cross-reactive humoral immune response of humans.

Serodiagnosis of chancroid is limited by the cross-reactivity of Haemophilus ducreyi with Haemophilus influenzae and Haemophilus parainfluenzae. This research describes an adsorption enzyme immunoassay (EIA) that assesses the humoral immune response of North Americans and Africans to H. ducreyi. Adsorption effectively removed anti-H. influenzae and anti-H. parainfluenzae antibodies, revealing that North American control sera had no residual anti-H. ducreyi reactivity. However, African control sera still had a residual anti-H. ducreyi response. Assessment of the duration of the humoral immune response in sera from African patients with chancroid showed that the humoral antibodies persisted for up to 8 months after the diagnosis. This may explain the lack of specificity of the adsorption EIA in areas where chancroid is endemic. The detection of the humoral immune response was affected by the strain of H. ducreyi used, with indigent strains being most useful. Using H. ducreyi 35000 for Canadian sera, the sensitivity of the adsorption EIA was 100% and the specificity was 88%. For African sera, H. ducreyi strain R018 was used, and the adsorption EIA had a sensitivity of 81% and a specificity of only 23%. These data reveal that the existing humoral response in a country where chancroid is endemic differs from that in a country where it is not, and that care must be used interpreting unadsorbed humoral immune responses. The adsorption EIA approach may prove useful as an epidemiologic tool for definition of existing (past and present) levels of exposure to H. ducreyi.


High-risk sexual behavior in the general population. Results from a national survey, 1988-1990.

The responses of 2,896 adults who completed the General Social Survey (1988-1990), a nationally representative household probability sample of the United States adult population, were analyzed. Three outcome variables were examined: engaging in sexual intercourse with two or more partners, with five or more partners, or with a stranger in the past year. Age, marital status, gender, pattern of alcohol consumption, and race have the strongest and most consistent relationship with having multiple sexual partners or sex with a stranger. Marriage reduces the odds of having 5 or more sexual partners by a factor of 90% (odds ratio, OR, = 0.10). For each single year increase in age, the odds of having multiple partners or sex with a stranger also decrease (OR = 0.95). Alcohol consumption, on the other hand, increases the odds of sexual risk behavior by a factor of 2 to 3 in the three models. Men are more likely to have 5 or more sexual partners (OR = 7.17) and sex with a stranger (OR = 5.62) than women; and blacks are more likely to have multiple partners (OR = 2.82) than members of other racial or ethnic groups. In the United States last year, an estimated 3 to 6 million adults had sex with 5 or more partners and an estimated 5 to 8 million had sex with a stranger.


Effects of broadening the gold standard on the performance of a chemiluminometric immunoassay to detect Chlamydia trachomatis antigens in centrifuged first void urine and urethral swab samples from men.

Traditionally, evaluations of nonculture assays for Chlamydia trachomatis are based on a comparison with urethral culture in men and cervical culture in women as the standard for positivity of infection, but it is known that culture may be less than 100% sensitive. A chemiluminometric immunoassay, Magic Lite (Ciba Corning, Medfield, MA) that detects C. trachomatis antigens was performed on centrifuged first void urine samples and urethral swabs collected from men attending a sexually transmitted disease (STD) clinic. Immunoassay performance was compared to urethral culture and also to a broader gold standard: an infected patient with positive culture results or a confirmed positive Chlamydiazyme enzyme immunoassay (Abbott, Chicago) result. Two studies were performed on a retrospective group of stored first void urine samples from 200 men and a prospective group of urethral swabs and first void urine samples from 199 men. Expanding the gold standard showed that a urethral swab assayed by culture had a sensitivity between 70.3% and 87.5%, with the following effects on immunoassay performance in the prospective study: the sensitivity of urethral swabbing was reduced from 96.2% to 78.4% (specificity increased from 96.0% to 98.1%) and first void urine sensitivity increased from 92.3% to 94.6% (specificity went from 87.9% to 93.8%). In the retrospective study, sensitivity of first void urine testing went from 91.4% to 92.5%, with a corresponding increase in specificity from 93.9% to 96.9%. This maneuver had relatively little impact on the negative predictive values, but dramatically increased the positive predictive values, for both samples.(ABSTRACT TRUNCATED AT 250 WORDS)


Prior episode of sexually transmitted disease and subsequent sexual risk-reduction practices. A need for improved risk-reduction interventions.

Persons with a history of a sexual transmitted disease (STD) are at increased risk for infection with human immunodeficiency virus (HIV). The extent to which women with a previous history of a STD report currently practicing protective behaviors against STD transmission is examined. Specifically, whether having experienced one or more previous episodes of an STD was related to current STD/HIV preventive practices was studied. Of the study group, 36% had at least one prior STD episode. Results of bivariate analysis show no relationship between previous STDs and current STD/HIV preventive practices: 47% of women with no previous STD episode, 64% of women with 1 previous episode, and 46% of women with 2 or more previous STD episodes reported currently practicing moderate to high levels of STD/HIV prevention methods. To adjust for potentially confounding variables, logistic regression analyses were also performed. The logistic regression model included age, alcohol use with sex, drug use with sex, marital status, and perceived risk of becoming infected with an STD in the next year. Results from the logistic regression analyses also showed no relationship between prior STD episode and current level of preventive practices against STD/HIV. Variables found to be significantly associated with level of STD/HIV preventive practices were marital status, age, and drug use with sex. These findings suggest that greater advantage should be taken of the opportunities presented when women are diagnosed with an STD to teach individuals at risk of acquiring STDs or HIV to practice risk-reduction behaviors.


Age at first coitus. A marker for risky sexual behavior in women.

This study examines whether riskier sexual behavior or duration of sexual experience explains why women who become sexually active earlier in life have a higher prevalence of sexually transmitted disease (STD). Responses to a self-administered questionnaire on risk behavior from 4,342 single women attending Planned Parenthood clinics in Pennsylvania were analyzed. Logistic regression was used to control for years of sexual activity, race, and amount of education. Women who became sexually active between the ages of 10 and 14 years were almost 4 times more likely to report having 5 or more sexual partners in the past year (OR = 3.8; 95% CI = 2.6-5.6); 3 times more likely to report having sex with bisexual, intravenous drug-using, or human immunodeficiency virus (HIV)-infected men (OR = 3.5; 95% CI = 2.4-5.0); and twice as likely to report a history of STD within the last 5 years (OR = 2.3; 95% CI = 1.8-3.0) compared with women who became sexually active when they were 17 years of age or older. The analysis suggests that age at first intercourse is a useful marker for risky sexual behavior and history of STD.


Successful response of metronidazole-resistant trichomonal vaginitis to tinidazole. A case report.

Treatment of metronidazole-resistant Trichomonas vaginalis infection is complicated by the lack of an effective alternative therapeutic regimen. Data on the susceptibility of the organism to metronidazole and other nitroimidazoles are important in managing intractable cases. A case of trichomonal vaginitis with true resistance to metronidazole that responded to treatment with tinidazole is reported.


Sexual patterns and human immunodeficiency virus infection among homosexuals in Taiwan.

Between 1988 and 1991, 64 homosexual men and 43 bisexual men were screened for human immunodeficiency virus (HIV) in Southern Taiwan; 5 of them were found to carry HIV antibodies. According to a self-administered questionnaire completed before screening, the average age of the men in the study group was 27 years, and the average duration of practiced homosexuality was 3.8 years. Occupations included student, merchant, laborer, officer, and soldier, and many of the men (45/107) had some junior college or university level education. A relatively high proportion (48/107) of these subjects reported having only 1 sexual partner, and there was a significant association between HIV antibody status and number of sexual partners (P = 0.025). Of the 107 subjects, 58 had practiced anal intercourse and more than a third of them (37/107) indicated that they had participated in receptive anal intercourse, 42 in insertive anal intercourse, and 21 in both of the above. All five carriers of HIV had practiced receptive anal intercourse, in which transmission of HIV from inserter to receptor was highly likely (P = 0.004). Of the men who came forward for HIV testing, the bisexual men tended to be older and often married.


Evaluation of treatment with single-dose ampicillin/sulbactam with probenecid or ceftriaxone in patients with uncomplicated gonorrhea.

This study compared ampicillin/sulbactam plus probenecid with ceftriaxone for treatment of uncomplicated gonorrhea. Of the 297 men and women who were enrolled and randomized to receive either ampicillin/sulbactam (1.0 g/0.5 g) with probenecid (1 g) or ceftriaxone (0.25 g), 274 patients were evaluable. Both ampicillin/sulbactam and ceftriaxone were administered by intramuscular injections. Patients were gonococcal contacts, had positive culture results for Neisseria gonorrhoeae, or had clinical evidence of gonorrhea. Specimens for gonococcal cultures were collected from the cervix (female patients), urethra, rectum, and pharynx at pretreatment and test-of-cure visits. The presence of N. gonorrhoeae and a test-of-cure visit were required for drug efficacy analysis. Of the 274 evaluable patients, 195 (71.2%) had positive culture results for N. gonorrhoeae. Cure was achieved in 93 (94.9%) of 98 patients receiving ampicillin/sulbactam with probenecid and in 96 (99.0%) of 97 patients receiving ceftriaxone. Penicillinase-producing N. gonorrhoeae strains were found in 21 (10.8%) patients; these were eradicated by either ampicillin/sulbactam with probenecid (N = 9) or ceftriaxone (N = 12). Overall, the two drug regimens were very well tolerated and no serious adverse effects were noted. Ampicillin/sulbactam with probenecid may be useful as single-dose therapy in patients with uncomplicated genitorectal gonorrhea.


Behaviors of crack cocaine users and their impact on early syphilis intervention.

The impact of crack use on syphilis intervention was investigated by reviewing records of persons diagnosed with early syphilis when voluntarily attending County Health Department clinics in Detroit, Michigan and Dallas, Texas between August 1989 and August 1990. The sample was stratified and data were analyzed using multivariate techniques. Compared with men who did not use crack, male crack users were more likely to report having four or more sexual partners during their critical period for acquiring or passing on infection (odds ratio, OR = 4.33; 95% confidence interval, CI = 2.08, 8.99). Among men, having a large number of sexual partners during this period was associated with a lower percentage of contacts being examined (OR = 11.8; 95% CI = 2.91, 47.5). Among women, having four or more sexual partners during their critical period and a lower partner examination rate were both associated with crack use; crack use was strongly associated with exchanging sex for money or drugs. We conclude that crack use has the largest impact on syphilis intervention through its association with having large numbers of sexual partners.