DNA diversity among clinical isolates of Helicobacter pylori detected by PCR-based RAPD fingerprinting. The RAPD (or AP-PCR) DNA fingerprinting method was used to distinguish among clinical isolates of Helicobacter pylori, a bacterium whose long term carriage is associated with gastritis, peptic ulcers and gastric carcinomas. This method uses arbitrarily chosen oligonucleotides to prime DNA synthesis from genomic sites to which they are fortuitously matched, or almost matched. Most 10-nt primers with > or = 60% G + C yielded strain-specific arrays of up to 15 prominent fragments, as did most longer (> or = 17-nt) primers, whereas most 10-nt primers with 50% G+C did not. Each of 64 independent H. pylori isolates, 60 of which were from patients in the same hospital, was distinguishable with a single RAPD primer, which suggests a high level of DNA sequence diversity within this species. In contrast, isolates from initial and followup biopsies were indistinguishable in each of three cases tested.


Adenovirus DNA replication facilitates binding of the MLTF/USF transcription factor to the viral major late promoter within infected cells. The activity of the adenovirus major late promoter is substantially increased as the infection proceeds from the early to late phase. To gain insight into the regulation of this promoter, we analyzed protein-DNA interactions by in vivo DMS and DNasel footprinting during the course of adenovirus infection. Little or no protein interaction at promoter sequences was detected early (5 hr) after infection but strong interactions at the major late transcription factor (MLTF/USF) binding site and at the TATA box were evident late (12 hr) after infection. Comparison of in vivo and in vitro footprints revealed that the in vivo interaction late after infection results from binding of the cellular transcription factor MLTF/USF. Nuclear extracts prepared from uninfected cells as well as cells harvested at 5 and 12 hr after infection contained similar levels of MLTF/USF footprint activity, therefore the lack of a detectable interaction early after infection is not due to reduced levels of the factor early in the viral growth cycle. Viral DNA replication was required for MLTF/USF binding at the major late promoter. These results indicate that DNA replication participates in the regulation of adenovirus late gene expression by facilitating the binding of a transcription factor to the major late promoter.


Synthesis of oligodeoxyribonucleotides containing degenerate bases and their use as primers in the polymerase chain reaction. Heptadecaoligodeoxyribonucleotides containing one or more of the bases, 6H,8H-3,4-dihydropyrimido[4,5-c][1,2]oxazin-7-one (P), 2-amino-6-methoxyaminopurine (K), and hypoxanthine (I) and combinations of P with K and I have been synthesised on a DNA synthesiser. The stability of duplexes containing these basemodified oligomers with P/A, P/G, K/C and K/T; P/A, P/G, I/C, I/T and I/A, I/G, I/C, I/T base pairs were compared by measuring their melting transition (Tm) values. Oligomers containing both P and K and P and I were more stable than those with I alone or with mismatches. These oligomers together with one with a P base at the 3'-end were used as primers in polymerase chain reaction (PCR) experiments. They were all effective primers except one with I alone and a triple mismatch. Thus the use of the degenerate bases P and K in primer design is established.


The dyad palindromic glutathione transferase P enhancer binds multiple factors including AP1. Glutathione Transferase P (GST-P) gene expression is dominantly regulated by an upstream enhancer (GPEI) consisting of a dyad of palindromically oriented imperfect TPA (12-O-tetradecanoyl-phorbol-13-acetate)-responsive elements (TRE). GPEI is active in AP1-lacking F9 cells as well in AP1-containing HeLa cells. Despite GPEI's similarity to a TRE, c-jun co-transfection has only a minimal effect on transactivation. Antisense c-jun and c-fos co-transfection experiments further demonstrate the lack of a role for AP1 in GPEI mediated trans-activation in F9 cells, although endogenously present AP1 can influence GPEI in HeLa cells. Co-transfection of delta fosB with c-jun, which forms an inactive c-Jun/delta FosB heterodimer that binds TRE sequences, inhibits GPEI-mediated transcription in AP1-lacking F9 cells as well as AP1-containing HeLa cells. These data suggest novel factor(s) other than AP1 are influencing GPEI. Binding studies reveal multiple nucleoproteins bind to GPEI. These factors are likely responsible for the high level of GPEI-mediated transcription observed in the absence of AP1 and during hepatocarcinogenesis.


Structural effect of donor DNA on the initiation of recombination for double strand break repair in human nuclear extracts. The effect of the structure of donor DNA molecules on the initiation of recombination for double strand break repair in human nuclear extracts, was investigated here. A unique double strand break was introduced into M13 duplex derivatives by digestion with restriction enzymes. After coincubation of the cleaved DNA in human nuclear extracts, with a plasmid containing M13 sequences spanning the break, double strand break repair was estimated by the plating efficiency in JM109 (RecA1) bacteria. We first confirm that a short heterologous insert (8bp) close to the break on the recipient cleaved M13 DNA inhibits recombination with circular as well as with linear donor molecules. The results indicate that, with these substrates, recombination is initiated at the level of the break, requires uninterrupted homology on both sides of the break, and is associated with a decreasing gradient of gene conversion. When the heterologous insertion is located on the plasmid donor DNA, similar results are obtained with a circular donor DNA. In contrast, with a linear donor molecule, bearing the insert, homology requirements, in the region of the break in M13 DNA, are abolished. This last result suggests that recombination could be initiated at the extremities of the linear donor DNA.


The selective isolation of novel cDNAs encoded by the regions surrounding the human interleukin 4 and 5 genes. We have developed modifications to direct cDNA selection that allow the rapid and reproducible isolation of low abundance cDNAs encoded by large genomic clones. Biotinylated, cloned genomic DNAs are hybridized in solution with amplifiable cDNAs. The genomic clones and attached cDNAs are captured on streptavidin coated magnetic beads, the cDNAs are eluted and amplified. We have applied this protocol to a 425kb YAC that contains the human IL4 and IL5 genes. After two cycles of enrichment twenty-four cDNAs were evaluated, all of which were homologous to the YAC. DNA sequencing revealed that nine cDNAs were 100% homologous to the interferon regulatory factor 1 (IRF1) gene. Six clones were 70% homologous to the murine P600 gene, which is coexpressed with IL4 and IL5 in mouse Th2 cells. The nine remaining clones were unique within the sequence databases and were non redundant. All of the selected cDNAs were initially present at very low abundance and were enriched by as much as 100,000-fold in two cycles of enrichment. This modified selection technique should be readily applicable to the isolation of many candidate disease loci as well as the derivation of detailed transcription maps across large genomic regions.


Differential ASF/SF2 activity in extracts from normal WI38 and transformed WI38VA13 cells. The normal human fibroblast cell line WI38 and a transformed derivative, WI38VA13, differentially splice fibronectin pre-mRNA in vivo. As a first step to understand the molecular basis for this regulation of splicing, we examined the ability of WI38 and WI38VA13 nuclear extracts to splice model adenovirus and globin pre-mRNAs. Adenovirus RNA splicing was detected in WI38VA13 but not in WI38 extracts. Likewise, when supplemented with a HeLa post-nuclear supernatant (S100), human beta-globin RNA splicing was detected in WI38VA13 but not in WI38 extracts. The splicing defect in WI38 extracts was associated with a reduced ability to form splicing complexes and with a corresponding decrease in the interaction of U2 small nuclear ribonucleoprotein (snRNP) with the branchsite. These defects did not correlate with a decrease in 65 kD U2AF binding since equivalent U2AF level and activity were detected in WI38 and WI38VA13 extracts. Rather, WI38 extracts displayed reduced ASF/SF2 activity and contained a low level of 30 and 40 kD SR phosphoproteins. Moreover, addition of purified ASF/SF2 dramatically increased splicing complex formation in WI38 extracts. These results raise the possibility that variations in the level and activity of ASF/SF2 and other SR proteins play a role in the regulation of fibronectin splicing.


The estimation of distances between specific backbone-labeled sites in DNA using fluorescence resonance energy transfer. A series DNA helices of twenty-four base pairs has been prepared for the study of fluorescence resonance energy transfer. Each of the DNA helices contains two phosphorothioate diesters (one in each strand) at pre-selected sites for introduction of the desired donor and acceptor fluorophores. The phosphorothioate-containing oligodeoxynucleotides have been prepared as pure Rp or Sp derivatives or as deastereomeric mixtures. Fluorescein and eosin are employed as the respective donor and acceptor fluorophores. A series of donor-acceptor pairs was generated by labeling of the appropriate phosphorothioate diester with the desired fluorophore and annealing the two complementary DNA strands (one containing the acceptor and one containing the donor fluorophore) to form the double-stranded helix. The 24-mer helices containing two covalently attached fluorophores exhibited some thermal destabilization and the extent of this destabilization was dependent upon the stereochemical orientation of the fluorophore. The Sp derivatives direct the fluorophore out, away from the the DNA helix, while the Rp derivatives direct the fluorophore toward the major groove. As expected, the Sp labeled duplexes were more stable than the corresponding Rp labeled sequences. However, all of the duplex structures formed were stable under the conditions used to measure energy transfer. Energy transfer could be observed with these complexes from the quenching of the donor fluorescence in the presence of the acceptor fluorophore. Using Förster's theories, distances separating the fluorophores could be calculated that were generally in reasonable agreement with the distances expected in an idealized B-form DNA helix. However anomalous results were obtained for one donor/acceptor pair where the expected distance was less than 20 A. Fluorescence anisotropy values determined in solutions of varying viscosity were quite high suggesting that the fluorophores did not experience complete freedom of movement when attached to the DNA helix.


Yeast RNC1 encodes a chimeric protein, RhoNUC, with a human rho motif and deoxyribonuclease activity. The yeast Saccharomyces cerevisiae contains an endoexonuclease yNucR that has been implicated in both recombination and repair. We describe the isolation and characterization of the corresponding gene. Within the predicted N-terminal half of the protein there is extensive homology (approximately 50%) with human rho genes, which are related to the ras oncogene, particularly in the proposed GTP-binding region. The C-terminal region, which is related to the Escherichia coli recC protein, presumably encodes the endoexonuclease activity. The yNucR may thus represent a new class of GTP-binding proteins. Because of the chimeric nature of the polypeptide, this protein is renamed RhoNUC (rather than the original yNucR) and the gene is RNC1 for Rho-associated-NuClease. Over expression of the gene leads to altered cell growth and nuclear morphology. We propose that the gene plays an important role in cell development as well as DNA repair/recombination.


Addressing infrequent cancer screening among women. National health policies must be revised to support basic health services for all Americans, a breadth of cost-effective health practitioners, and a system that provides comprehensive, coordinated care in decentralized locations. State and local advocacy groups should increase consumers and policy-makers awareness about inadequate cancer screening. Educational institutions should address cancer prevention for practitioners in training. Practice institutions should employ nurses and nurse practitioners more effectively, as well as institute computerized feed-back and reminder systems. More rigorous research on the effect of educational messages on client beliefs, affect, and screening behavior are needed to guide interventions for cancer control.


AAN working paper. Wellness and health promotion of the elderly. One of the missions of the American Academy of Nursing is to formulate strategies for health policy. To arrive at these strategies, Academy members share their thoughts, knowledge, and imagination in working groups at Academy meetings. The Expert Panel on Older Adults, one of these working groups, asked for interested members to formulate a policy paper on wellness and health promotion of the elderly for presentation at the AAN meeting in Los Angeles last October. This was done, and AAN members at that meeting shared their views on the paper. Now, this draft is being published here to invite all Nursing Outlook readers to review and comment on the policy recommendations that have been formulated. We encourage feedback so your ideas can be considered in the development of the paper. The paper will be submitted for approval to the AAN Committee on Health Policy Reform.


Measurement of safe sex behavior in adolescents and young adults. The aim of this project was to develop an instrument to measure use of safe sex practices among adolescents and to conduct initial evaluation of the psychometric properties of the instrument. The Safe Sex Behavior Questionnaire (SSBQ) was designed to measure the frequency of use of safe sex practices and was assessed for content validity, reliability, and construct validity through a series of tests. The content validity index computed for the SSBQ was 98%. Initial reliability computed for sums of items of the total scale was .82 among 89 college freshmen. Using a second sample of 531 subjects, the SSBQ was factor-analyzed separately for males and females and five similar factors emerged for each gender. Reliability coefficients for sums of salient items for each factor ranged from .52 to .85. Using a third sample of 174 subjects, construct validity was assessed by correlating the SSBQ with measures of general assertiveness and general risk-taking. The resulting correlations were appreciable and in the predicted directions, thus providing support for the construct validity of the instrument.


A randomized trial of a health care program for first-time adolescent mothers and their infants. To test the effectiveness of a special health care program for adolescent mothers (17 years old or younger) and their infants, 243 mother-infant pairs were randomly assigned to one of two groups. All of the mothers were unwed, on Medicaid, and black. The control group received routine well-baby care. The experimental group received routine care and services that included rigorous follow-up, discussions with the mother about her plans for return to school and use of family planning methods, and extra health teaching. The dropout rate in the experimental group (60%) was significantly less after 18 months than the control group (82%). In spite of the high dropout rate, 91% of the mothers were located for the 18 month follow-up interview. The repeat pregnancy rate in the experimental group was 12% after 18 months, and 28% in the control group. There was no significant difference in the percentage returning to school. After 12 months, the infants in the experimental group were more likely to be fully immunized (33%) than the infants in the control group (18%). Mothers in the special care program who continued to attend clinic used the emergency room less than the mothers who continued to attend in the control group. These results suggest that a comprehensive health care program is one way to bring about better outcomes for both adolescent mothers and their infants.


Nursing practicum: empowering strategies. The concepts embodied by the practicum are best summarized by students themselves: "Through practicum, I have become more independent and my clinical instructor guided me to independence. I have grown in my own knowledge, skills, performance and confidence in myself." "This course was wonderful--it allows for independence in the clinical area and choice related to the area of study. It improved and developed my self-motivation." "Practicum promotes independence with guidance from faculty and preceptors when needed. The independence promotes decision-making by the student. The course pulls together a lot, if not all, the things taught in school." "I really liked writing my own learning contact and the opportunity to build confidence in my nursing practice."


Preventability of infant mortality in a rural community. Preventability of infant mortality in a rural southern county was examined with a Delphi technique using case summaries of infant deaths during a selected four-year period. The first two rounds were aimed at developing a consensus of panelists' opinions about problems leading to the high infant mortality rate in the study area. From these opinions, an Infant Mortality Preventability Decision Tree and a Problem List was developed. Panelists used these in Rounds III and IV to evaluate the case summaries. There were significant differences in the preventability ratings between physicians and nurses, indicating the importance of assessing individuals' philosophies of preventability when working with an interdisciplinary team of health care providers.


Parental division of infant care: contextual influences and infant characteristics. The purpose of this study was to explore the relationship of maternal employment to division of parental infant caregiving and whether infant characteristics predicted maternal and paternal caregiving during the first year. Subjects were 351 families with healthy infants from normal pregnancies. Measures included a newborn and 1-month Brazelton Neonatal Behavioral Assessment, Child Care Activities Scale at 1, 6, and 12 months, Bates Infant Characteristics Questionnaire at 6 and 12 months, and selected demographics. Mothers provided the majority of infant care though fathers' proportion increased with employment of mothers. Controlling for demographics, infant characteristics were infrequent predictors of maternal caregiving and predicted a small amount of paternal caregiving variance.


Determinants of career attainments of doctorates in nursing. The career attainments of graduates of doctoral programs in nursing during two academic career stages after the doctorate were examined. Educational associations and work experiences were the most important determinants of postdoctoral career attainments. The quality of the doctoral program attended and predoctoral work experiences significantly influenced initial institutional quality, which in turn influenced current institutional quality. The current institutional quality, then, had direct effects on current attainments in the areas of professorial rank, publication productivity, and income. Graduate school quality was the most important factor in first institutional quality, as it tracked faculty into certain strata of the higher educational hierarchy. Consistent with the academic stratification system in higher education, those in high quality programs attained lower professorial ranks but higher publication productivity and higher recognition than those who gained employment in unranked schools.


Psychosocial variables, race, and intention to seek care for breast cancer symptoms. This study was designed to assess whether the influences of affect, utility, norm, and habit on intention to seek care promptly for a breast cancer symptom were conditional upon race. Ninety-six participants (68% Caucasian and 32% African American) in community settings completed measures of psychosocial, demographic, and clinical variables, and intention to seek care promptly for a breast lump. Controlling for education, financial coverage for health care, and family history of breast disease, the interactions of both utility and norm with race significantly explained intention. The positive influence of utility on intention was stronger among Caucasians than African Americans, but significant among both groups. The positive influence of social norm on intention was significant for Caucasians, but not for African Americans.


Relaxation to reduce dyspnea and anxiety in COPD patients. The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease (COPD) patients. Twenty-six adult COPD patients with dyspnea were randomly assigned to two groups. The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly. Skin temperature, heart rate, and respiratory rate were recorded for all subjects during a total of four weekly sessions. Anxiety, dyspnea, and airway obstruction were measured at the beginning and end of the study. The relaxation group achieved the preset relaxation criteria. Dyspnea, anxiety, and airway obstruction were reduced in the relaxation group while the control group remained the same or became worse.


Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence. Approximately 200 studies that examined the relationship between fruit and vegetable intake and cancers of the lung, colon, breast, cervix, esophagus, oral cavity, stomach, bladder, pancreas, and ovary are reviewed. A statistically significant protective effect of fruit and vegetable consumption was found in 128 of 156 dietary studies in which results were expressed in terms of relative risk. For most cancer sites, persons with low fruit and vegetable intake (at least the lower one-fourth of the population) experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors. For lung cancer, significant protection was found in 24 of 25 studies after control for smoking in most instances. Fruits, in particular, were significantly protective in cancers of the esophagus, oral cavity, and larynx, for which 28 of 29 studies were significant. Strong evidence of a protective effect of fruit and vegetable consumption was seen in cancers of the pancreas and stomach (26 of 30 studies), as well as in colorectal and bladder cancers (23 of 38 studies). For cancers of the cervix, ovary, and endometrium, a significant protective effect was shown in 11 of 13 studies, and for breast cancer a protective effect was found to be strong and consistent in a meta analysis. It would appear that major public health benefits could be achieved by substantially increasing consumption of these foods.


Vitamin supplement use and risk for oral and esophageal cancer. In a hospital-based case-control study, 290 oral cancer cases and 133 esophageal cancer cases were queried as to smoking status, alcohol consumption, and dietary exposures, including vitamin supplement history. Among oral cancer cases, vitamin E use appeared to exert a protective effect. Vitamins C and E had protective effects among esophageal cancer cases. When stratified by smoking status, the protective effect of vitamin C use in esophageal cancer was significant only among current smokers, as was vitamin B use. A reduced risk of oral cancer was correlated with multivitamin use and increasing vegetable consumption, as was vegetable/fruit consumption and vitamin C supplementation. Among esophageal cancer cases, increasing meat consumption and vitamin C use were associated with a significantly reduced cancer risk.


The role of dietary phytosterols in colon carcinogenesis. Epidemiological and experimental studies have shown that increased intake of plant foods and decreased meat consumption are correlated with a decreased risk for colon cancer. Many components of plant foods are suggested to mitigate colon carcinogenesis, including vitamins, minerals, and dietary fiber. Phytosterols are a common component of plant foods consumed in relatively large quantities by vegetarians, who are at lower risk for colon cancer development than individuals on a Western diet low in phytosterols. In addition, phytosterols have been shown experimentally to inhibit colon cancer development. Dietary cholesterol, although structurally similar to the phytosterols, is correlated etiologically to the incidence of colon cancer, with changes in serum cholesterol levels and fecal bile acid profiles suggested to increase susceptibility to colon tumorigenesis. The objective of this paper is to discuss the effect of dietary phytosterols on cholesterol and bile acid metabolism and how these effects may lead to a decreased risk for colon cancer development.


Stability of fusarin C: effects of the normal cooking procedure used in China and pH. Fusarin C (FC) is a naturally occurring mutagen found on Fusarium moniliforme-contaminated corn. In Linxian, China, an area of exceptionally high incidence of esophageal cancer, the milled corn is made into small cakes called wotou, which are steamed. It has been suggested that FC may play a role in the etiology of esophageal cancer, but this has been questioned, in part, because of the thermal instability of FC. We therefore measured the effects of temperature on FC stability, mimicking the cooking process. FC was extracted from the wotou and quantitated by both reverse-phase high-performance liquid chromatography and the Ames assay. After wotou were steamed for 30 minutes, 11% and 3% of the initial FC remained, as detected by the two assays, respectively. The milled corn, when moistened with water, had a pH of 6.1, which was lowered to 5.3 when it was inoculated with F. moniliforme and cultured for three weeks. Pickled vegetables are sometimes added to the wotou, which further reduces the pH. To determine the effects of pH on FC, it was heated in solution, with the pH varied between 4 and 8. Its stability was very pH dependent, decomposing more rapidly as the pH increased. Because ingested FC would also be subjected to the low pH of the stomach, it was treated for 30 minutes at 37 degrees C and pH values ranging from 1.0 to 7.0. FC was stable (less than 15% decomposition) under these conditions. If FC is a significant health threat, it could most easily be destroyed by cooking at slightly basic pH values.


Effect of dietary butylated hydroxytoluene on nuclear envelope cytochrome P-450 during the initiation and promotion stages of hepatocarcinogenesis. The anticarcinogenic effect of the dietary antioxidant butylated hydroxytoluene (BHT) correlates with a preservation of nuclear envelope (NE) cytochrome P-450 in rats undergoing chemically induced hepatocarcinogenesis. This effect of BHT on NE cytochrome P-450 was observed during both the initiation and the promotion stages of hepatocarcinogenesis. Complex interactions between the two different mechanisms of action of BHT (i.e., enzyme induction and antioxidant activity) may account for some of the differences between the patterns of response to BHT observed during initiation and promotion.


(-)-Epigallocatechin-3-gallate in Camellia sinensis leaves from Himalayan region of Sikkim: inhibitory effects against biochemical events and tumor initiation in Sencar mouse skin. Recently, we and others showed that the components of green tea may be useful cancer chemopreventive agents. It has been suggested that (-)-epigallocatechin-3-gallate (EGCG), the major constituent in green tea, may possess antitumor-promoting and/or anticarcinogenic effects in rodent tumor bioassay systems. During the chemical analysis of various green tea products, we found a traditionally preserved preparation of green tea used by tribes in the Himalayan region of Sikkim, India that was rich in EGCG. EGCG was isolated from this tea product, and its inhibitory effects were evaluated against the binding of topically applied 3H-labeled polycyclic aromatic hydrocarbons (PAHs) to epidermal DNA and 12-O-tetradecanoylphorbol-13-acetate (TPA) caused induction of epidermal ornithine decarboxylase (ODC) activity in Sencar mice, the short-term markers of tumor initiation and tumor promotion, respectively. Preapplication of EGCG resulted in significant inhibition (p less than 0.05) in the binding of [3H]PAH to epidermal DNA. Similarly, the topical application of EGCG resulted in significant inhibition (p less than 0.005) in TPA-caused induction of epidermal ODC activity. In further studies, we assessed the anti-skin tumor-initiating effect of EGCG in Sencar mice in an initiation-promotion protocol. The application of EGCG before challenge with 7,12-dimethylbenz[a]anthracene as tumor initiator resulted in significant reduction both in percentage of mice with tumors and number of tumors per mouse compared with a non-EGCG-pretreated group of animals. The results of the present study suggest that the green tea preparation from Sikkim may be a good source for the isolation of EGCG and that this compound may have significant potential as a cancer chemopreventive agent.


Esophageal cancer and diet--a case-control study. It has been estimated that approximately 40% of human cancers may be associated with dietary factors. The relationship is more significant in esophageal cancers. Case-control studies involving 35 subjects of early-diagnosed esophageal cancers showed low mean blood levels of retinol, zinc (p less than 0.001), folic acid (p less than 0.01), and albumin (p less than 0.05). Relative risk was significantly higher for low levels of retinol and zinc. Diet, in general, in both groups reflected poor intake of several nutrients.


Codependency: characteristics, risks, progression, and strategies for healing. Codependency and caring are issues concerning nurses practicing in the 1990s. Questions about "caring" and "caring too much" at one's own expense are examined. Characteristics, roles, and risk factors for codependency are identified. Strategies for healing are suggested for nurses who "care too much."


Differences in patient rating of care provided by BSN and ADN students. Nursing has discussed widely and with fervor the level of education required to provide quality nursing care for clients. No clear consensus has developed but studies tend to show that especially in the hospital setting, baccalaureate (BSN) and associate degree (ADN) nurses initially practice at a similar level. No studies identified compared patient ratings of BSN and ADN nurses. In this study ratings of care provided by BSN and ADN students were compared. Patients, students and instructors rated the student sample using Watson's Patient Satisfaction Rating Scale. Using Pearson correlations and t-tests, the overall satisfaction with care was assessed as "very positive" by patients, faculty and students alike. A significant correlation was found between faculty and patient ratings. Results support earlier findings and demonstrate similarities rather than differences in care provided by the two levels of students. Implications for nursing education and practice are discussed.


Impact of a growing elderly population on nursing. Medical advances have promoted longer, healthier lives with fewer diseases and more treatable illnesses for humans. Long-term care and chronic illnesses are becoming more common, increasing the need for nursing care of a growing elderly population. Nurses in all areas of specialization must be prepared to face these challenges and provide health care in an ethical manner.


Said another way. An ethical issue for a profession for all seasons. Often the spoken word does not lend itself to written record. Sometimes, however, the message is such that spoken or written, the value of the statement is such that we wish to revisit it often. My goal in this article is to get nurses to reflect on issues that confront us daily and give us the opportunity to return for further reflection as we mature through the seasons of our own professional growth.


Coping strategies of family caregivers in hospice homecare. Although stresses associated with family caregiving during illness have been well-documented, little attention has been focused on how families cope with hospice home care of a relative with advanced cancer. A longitudinal, qualitative study examined the experiences of hospice caregiving families. This article focuses on coping strategies identified by hospice families caring for their dying relative at home. Semistructured interviews and observations were conducted with 14 individuals from 10 families. Fifty-five interviews were audiotaped and transcribed. Constant comparative analysis was used to search inductively for recurrent themes. Specific coping strategies were used with each of the three areas of stress identified by families. "Windows of time," social comparison, cognitive reformulation, and avoidance were used to cope with the overall caregiving experience. "Taking one day at a time" helped to manage uncertainty. Acceptance and rationalization helped families to deal with changes in a relative's mental status. Social support was used with all three areas of stress. Identifying effective coping strategies that families are using directs the development, testing, and implementation of nursing interventions that enhance coping of hospice caregiving families.


Cutaneous toxicity associated with high-dose cytosine arabinoside. High-dose cytosine arabinoside (HDAC) is used to treat adults with acute and chronic leukemia and non-Hodgkin's lymphoma. Although HDAC is associated with various toxicities, cutaneous toxicity in particular leads to alterations in comfort, interference with daily living activities, and increased risk of infection. The incidence of cutaneous toxicity ranges from 3%-72%. A review of the literature revealed a variety of terms describing this toxicity, which begins as erythema and progresses to painful swelling, bullae formation, and desquamation. The etiology is unclear, and the severity is related to the number of consecutive doses. Interventions specific to prevention and treatment of this toxicity were found to be minimal, with no interventions scientifically examined. The challenge for nurses is to explore measures that will minimize the complications, treat the manifestations, and document the impact of these problems on quality of life.


Appraisal of illness, symptom distress, self-care burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer. Cancer recurrence may present unique stressors for patients receiving chemotherapy. The objectives of this exploratory study were to (1) describe perceptions of symptom distress, self-care burden, appraisal of illness, and mood in patients undergoing chemotherapy, (2) identify differences in these perceptions according to stage of illness (new versus recurrent cancer), and (3) test a theoretical model of the mediating effects of appraisal. Subjects completed a modified Symptom Distress Scale, the Self-Care Burden Scale, the Family Hardiness Index, the Appraisal of Illness Scale, the short form of the Profile of Mood States, and a self-report form that included personal and illness characteristics and questions about the subjects' current situation. The 60 subjects were outpatients being treated for initial cancer (n = 28) or recurrent cancer (n = 32). Those with recurrence had higher symptom distress and health deviation self-care burden scores and more stressful appraisals; mood scores were low and did not differ between groups. Appraisal, symptom distress, and perceived seriousness predicted 36% of variance in affective mood, with appraisal partially mediating the effects of symptom distress. Somatic mood (36%) was best predicted by symptom distress and universal self-care burden (USCB). Economic status, symptom distress, and recurrence status predicted 49% of appraisal variance. Symptom distress was predicted best by recurrence and symptom control; USCB was predicted best by economic status and perceived dependency. Results suggest the need for different nursing interventions for the two groups. Further model testing is recommended.


Willa Cather and the spirit of nursing.

Willa Cather and the spirit of nursing. Willa Cather, believed to be one of America's first feminist novelists, wrote of strong, Nebraskan women who, at the start of the Industrial Age, struggled to maintain their basic values as pioneers in the face of oppression. Similarly, many nurses today fight to retain their basic values as nurses in the face of oppression from the dominant medical culture. The values shared by Cather's pioneers and some nurses of today include utilizing a woman-identified perspective, achieving power through intimacy, and encompassing multiple ways of knowing. The journey of Cather and her characters is discussed as a model for fighting oppression by maintaining the core values of one's profession--be it as nurses or as pioneers.


Malignant pericardial effusions: pathophysiology and clinical correlates. Cardiac tamponade resulting from malignant pericardial effusions is a life-threatening oncologic emergency. As many as 21% of all patients with cancer may be at risk for this complication. A malignant effusion often signifies progressing disease, creating stress and anxiety for patients and their families. By understanding the pathophysiology and pertinent risk factors, the nurse may identify an effusion before it progresses to cardiac tamponade. The goal of management is removal of fluid, restoration of hemodynamic functioning, and prevention of fluid reaccumulation. Emotional support and reassurance, as well as accurate information regarding the disease and treatment, also are critical in assisting patients to adapt to these changes in disease status.


Undergraduate preparation of the oncology nurse. Determining appropriate cancer-related content for undergraduate nursing curricula requires careful consideration of content that is needed versus content that is desired for the nurse generalist. Studies have indicated a wide variety of topics and time allotment for this content among schools of nursing. Innovative strategies using games, computers, preceptors, and elective courses have allowed schools of nursing to include more comprehensive coverage of oncology-related topics. Issues concerning clinical oncology nursing opportunities for undergraduate studies still need to be clarified. Undergraduate students must be afforded the legitimacy of their status as novices in nursing and in the specialty of oncology. Didactic and clinical experiences should result in the knowledge and skills needed to develop professionally from novice to expert.


Continuing education for oncology nurses. Continuing education plays a key role in the development of the expert oncology nurse. It also is the primary way to help maintain and expand the nurse's expertise. This paper uses the nursing process as the framework for discussion of the development of continuing education activities. Assessing learners' needs is necessary for the development of programs that are learner responsive. Program planning is a multistep process that includes determining priorities, purposes and objectives, instructional methods, resources, budget, and evaluation criteria. A wide range of instructional methods can be considered for program implementation. Evaluation may be conducted at several levels of program development and outcome. Each of these areas is an important component in the success of program development.


Characteristics of the expert oncology nurse. Oncology nursing is a specialty that continuously incorporates new technologic advances into everyday practice. These advances, coupled with an increasing acuity level of the patient with cancer, generate a demand for excellence. The successful development of the expert oncology nurse will be imperative in meeting these challenges. This paper provides a practical framework for examining expertise and describes characteristics of the expert oncology nurse.


Ocular side effects of chemotherapy: nursing management. Ocular side effects may be unfamiliar to oncology nurses but are important because of their potentially devastating effects on vision. Presently, more than 20 chemotherapy agents have been reported to cause eye toxicities. Chemotherapy-induced ocular side effects can be manifested on a range of minor, transient irritation to irreversible, complete blindness. This article reviews these ocular complications, their causative agents, their effect on eye structures and function, and nursing management. Oncology nurses can play a vital role in the identification of symptoms and in the management of these eye complications.


Human bites in children.

Human bites in children. Human bites are common during childhood and usually result from fights or aggressive play with another child. Bites may present as indentation marks, scratches, abrasions, contusions, or lacerations. Most human bite wounds are sustained on the upper extremities, followed by the face and neck, the trunk, and the lower extremities. Infection is the most common complication. Cultures of an infected bite wound yield an average of five microorganisms. This article reviews the current recommendations on the management of human bite wounds in children.


Follow-up of patients with occult bacteremia in pediatric emergency departments. Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. Of the patients who returned to the ED, 49% did so because they were notified of the positive blood culture result. The mean time interval for these patients from registration at the initial visit to report of positive blood culture result was 30.0 hours and, from registration at the initial visit to follow-up visit, was 42.7 hours. Thirty-seven percent of those who returned did so because a follow-up visit was scheduled at the initial encounter, and 13% returned because of persistent illness. Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)


The usefulness of pulse oximetry in evaluating acutely ill asthmatics. To examine the usefulness of pulse oximetry in determining the severity of acute asthma, the arterial oxygen saturation (SaO2) of 196 acutely ill asthmatic children was measured while the children were being treated in the emergency department (ED). The measure of severity used was the disposition from the ED--discharge or hospitalization--after receiving standard ED care. The mean pretreatment SaO2 of the 172 children discharged was 96.4% (range, 84-100%), and that of the 24 children admitted was 94.4% (range, 85-100%). A Receiver Operating Characteristic curve indicated that the optimal cutoff point for identifying disposition was an SaO2 of 93%. The sensitivity of an SaO2 < or = 93% was 35%, and the specificity was 92%. We conclude that SaO2 lacks the sensitivity to differentiate the child who will respond to ED therapy from the child who will require further inpatient care.


Quality of pediatric care at a freestanding emergency facility. The last decade has seen the introduction of freestanding emergency facilities, which provide an alternative to hospital emergency departments. The contribution made by these facilities to the clinical welfare of patients depends on their availability to deliver quality medical care without the need for frequent referral. This study describes the clinical experience of one such facility with pediatric patients and attempts to assess the quality of their care.


Albuterol overdose: a case report and differential diagnosis. The increase in the use of selective beta 2 agonists as first-choice agents in the therapy of asthma has resulted in a concomitant increase in overdoses and other therapeutic misadventures. This case describes a 22-month-old child who ingested a large overdose of albuterol, resulting in an acute syndrome consisting of agitation, tremulousness, marked hyperglycemia of > 320 mg/dl (17.8 mmol/L), ketonuria, and hypokalemia. Such toxicity has generally been reported only in diabetics or pregnant patients. These findings and a brief review of the pharmacology and toxicology of beta 2 agonists are detailed, with special emphasis on the differential diagnosis of overdoses characterized by hyperglycemia, hypokalemia, agitation, and tremulousness. A system of ordering the relative toxicity of these (and other) drugs is proffered using the exposure-case fatality rate (ECFR) as a crude measure of clinical toxicity (while delineating its shortcomings). Applying the ECFR (using American Association of Poison Control Centers' data base) to beta 2 agonist overdoses indicates that the resulting clinical syndrome, while troublesome, generally results in a benign outcome.


The Romano-Ward syndrome: a case presenting as near drowning with a clinical review. Patients with the Romano-Ward syndrome, a form of congenital long Q-T syndrome (LQTS), present with syncopal episodes and are at risk for sudden death. Patients with LQTS may be misdiagnosed if the physician is unaware of this entity. The risk of sudden death makes recognition important so that appropriate therapy can be initiated. A case is discussed in which the patient presented following a near-drowning episode. Family history revealed a familial "seizure disorder." After analysis of the patient's and father's ECGs, the diagnosis of Romano-Ward syndrome was made. A review of the literature was done, concentrating on presentation, pathophysiology, electrocardiographic findings, etiology, diagnosis, prognosis, and treatment of congenital LQTS. This paper is presented to emphasize the importance of physician awareness of LQTS because of the risk of sudden death. Proper diagnosis can lead to treatment that is effective in reducing mortality by more than 90%.


Evaluation of the patient with neck complaints following tonsillectomy or adenoidectomy. The emergency physician should be cognizant of the potential postoperative complications of tonsillectomy or adenoidectomy. Two unusual cases are presented to illustrate the differential diagnosis of the postoperative complaint of neck stiffness.


Mass illness at an intermediate school: toxic fumes or epidemic hysteria? The report of an acute illness involving a large number of clustered children will undoubtedly provoke an urgent emergency care response or, in some instances, a mass casualty or disaster response. While responding to the perceived needs of those involved, the professionals caring for these children must consider epidemic hysteria along with the other causes of mass illness. Since the early recognition of epidemic or mass anxiety hysteria can have tremendous impact on the ease of treating this problem, that awareness is quite important.


Risk factors for childhood sledding injuries: a case-control study. We report the results of a case-control study designed to identify modifiable risk factors for childhood sledding injuries. Cases included all children injured while sledding (n = 17) during a five-day winter storm who presented for care to a Seattle pediatric emergency department. Two controls were chosen randomly for each case from children who presented to the same emergency department during the ensuing two months for any illness that did not require hospitalization. To qualify as controls, children had to have sledded during the same five-day period but not sustained an injury requiring medical attention. Data were collected on cases and controls using a telephone questionnaire. Analysis of risk factors revealed a significant increase in risk of injury for children who sledded in streets versus those who sledded in a park (OR = 5.1; 95% CI = 1.1-24.1), those who sledded without adult supervision (OR = 5.6; 95% CI = 1.1-26.9), and those whose parents had an annual income > or = $50,000 (OR = 5.7; 95% CI = 1.5-20.8). No difference in risk of injury was found regarding the type of sled used, the number of children, or their position on the sled or for those children with a history of prior sledding experience. We conclude that safe alternatives to sledding in the streets and an increase in adult supervision may reduce the number of childhood sledding injuries.


Erroneous diagnosis within the cranial vault. The majority of pediatric neoplasias of the brain are midline growths in the posterior fossa. These mass lesions lead to obstruction of cerebrospinal fluid circulation and cause increased intracranial pressure. Affected children typically present with insidious complaints of headache and vomiting. Ataxia, cranial nerve palsies, or pyramidal tract signs may be present at the time the diagnosis is entertained. In the reports describing pathognomonic clinical features of posterior fossa tumors, an accelerated presentation with minimal prodromal events has not been emphasized. This report details the case of a child with a cerebellar medulloblastoma who presented with abrupt onset of fever, nuchal rigidity, and altered mental status. Emergency department misdiagnosis occurred.


[Effect of captopril on glutathione level in the liver and paracetamol-induced liver damage in rats]. Captopril, an inhibitor of angiotensin converting enzyme is widely used in the treatment of hypertension and congestive heart failure. It contains active sulfhydryl group and shares other structural feature with cysteine, the main substrate of glutathione. Experiments were undertaken to examine the effect of captopril on concentration of endogenous glutathione in the liver and to examine the ability of captopril to protect against paracetamol-induced hepatotoxicity. Single doses of captopril (30 mg/kg) given to male Sprague-Dawley rats produced a significant time dependent depletion of hepatic glutathione: at 3 h--16% (controls--10% as the effect of fasting; p less than 0.02), at 5 h--25% (controls--17%; p less than 0.02). Pretreatment of rats with single doses of captopril (30 mg/kg) 2 hours prior to administration of toxic doses of paracetamol (2500 mg/kg) produced a significant depletion of hepatic glutathione level as compared with animals without pretreatment with captopril (median: 2.95 mumol/g liver and 3.50 mumol/g liver, respectively; p less than 0.01). This was not accompanied by a difference in the hepatotoxic effect of paracetamol as assessed by histological staging of necrosis. Studies on covalent binding of paracetamol showed that neither captopril at the doses 30 mg/kg, nor penicillamine (20 mg/kg) affected covalent binding of paracetamol metabolites to cell protein. The results suggest that captopril despite its structural similarity to cysteine depletes hepatic glutathione level and does not protect against paracetamol hepatotoxicity.


[Changes in the parameters of respiratory function tests in Raynaud's disease]. Patients with Raynaud's phenomenon can demonstrate arterial spasm not only in hands but also in other organs. The aim of this study was to investigate pulmonary function in 15 patients with Raynaud's disease and in 8 healthy controls before and after cold pressor test. Before the cold pressor test no significant differences in pulmonary parameters between the patients and the controls were observed. After cold pressor test, a statistically significant decrease in diffusing capacity (DLCO) was observed in the study group, but not in the controls. Total lung capacity (TLC) was also slightly decreased. No significant changes of specific diffusing capacity (D/VA) and flow-volume curve parameters (FEF50, FEF25) were noticed.


[Hepatitis B virus DNA polymerase activity in various clinical forms of HBV infection]. The aim of the study was to test the clinical value of HBV DNA polymerase (DNAp) determination in patients with various forms of HBV infection, namely: acute hepatitis, chronic hepatitis, cirrhosis and healthy HBV carriers. The determination of DNAp was found to be particularly useful in patients with chronic HBV infection with active virus replication (HBeAg+) independent of histopathological changes.


[Effect of coronary artery patency after myocardial infarction on ventricular late potentials]. This study evaluated the relation between patency of the infarct related artery and the presence of ventricular late potentials (VLP) on the signal-averaged electrocardiogram (ECG). 44 patients (pts) after myocardial infarction (MI) (35 men, 9 women; mean age 50 years) were studied by coronary angiography. measurement of ejection fraction and signal-averaged ECG. The infarct-related artery was closed in 15 pts and open in 29 pts. There was no difference in age, previous MI and location of infarct between the two study groups. Thrombolytic therapy in acute stage of MI was significantly often (p less than 0.05) in pts with open (59%) than closed (13%). The incidence of VLP was significantly higher (p less than 0.05) in group of pts with closed (40%) than open artery (7%). These data indicate that patency of the infarct-related artery has a beneficial effect on the electrophysiologic substrate for serious ventricular arrhythmias.


[Effectiveness of empirical antibiotic therapy in the control of infections in patients with acute leukemia during severe neutropenia]. The clinical efficacy of empiric antibiotic treatment regimen for infection in 38 neutropenic patients with acute leukemia during induction and intensification therapy was evaluated. The therapy, which was applied in 74 episodes of fever in patients with neutrophil count less then 0.5 G/l, consisted of three sets of antibiotics (gentamycin + carbenicillin or azlocillin, amikacin + cephradine++ or cefuroxime, netilmicin+cefotaxime or ceftazidime) used one after another in case of persistence of fever in spite of 72 hours of treatment: In addition, flucytosine was applied in case of stable fever after 72 hours of antibiotic therapy. Flucytosine was replaced by amphotericin after 72 hours of ineffective treatment. The response rate of 68% and 96% was observed for patients during induction and intensification chemotherapy respectively. Low clinical efficiency of gentamicin and carbenicillin/azlocillin during induction treatment indicates that the therapy with antibiotics of broader range of activity is needed for this group of patients.


[Our experience with the diagnosis of peritonitis complicating a long-term program of peritoneal dialysis]. Among 37 patients (pts) with irreversible renal failure treated in years 1980-1990 with chronic peritoneal dialysis there were 18 treated with continuous ambulatory peritoneal dialysis (CAPD) and 19 treated with standard intermittent peritoneal dialysis (SIPD). Mean frequency of peritonitis (P) was 1 episode per 9.0 patients-months. The important symptoms for early diagnosis of P were as follows: cloudiness of peritoneal effluent (PE) and high (more than 50%) percentage of polynuclear cells in the smear of PE sediment. Positive results of PE culture were obtained only in 50% of P episodes in years 1980-1985, mostly in pts treated with CAPD (17/21 pts). In the period of 1986-1990, in pts treated mostly with SIPD (15/16 pts), positive results were obtained in 80% of P. Improvements of bacteriological diagnosis of P, especially in pts treated with CAPD, were discussed. "Prophylactic" cultures of PE were found to be of no value.


[2 cases of Sneddon syndrome].

[2 cases of Sneddon syndrome]. Two cases of Sneddon syndrome (S.s.) in a 33 and 53-year-old women who developed arterial hypertension, cerebral ischaemic signs and who have livedo reticularis or livedo racemosa, are reported. The authors describe clinical, radiological and biological features of this rare disease, as well as diagnostic investigations including the measurements of the antiphospholipid antibodies (APA). The possible role of APA in the pathogenesis of S.s. is discussed.


Two FMRFamide-like peptides from the free-living nematode Panagrellus redivivus. Peptides of the FXRFamide family, where X = M, I or L, are broadly distributed among invertebrates. Two such peptides were purified and sequenced from the free-living nematode, Panagrellus redivivus. Immunohistochemical techniques localized FMRFamide-like material in several regions of these organisms, including the nerve cords and, most prominently, in paired groups of cells located caudally to the base of the pharynx. RIA determinations gave an estimate of 2.8 nmol immunoreactive peptide/g of an acetone extract of P. redivivus. Four sequential HPLC purification steps, followed by sequencing by automated Edman degradation and FAB-MS, led to the identification of Ser-Asp-Pro-Asn-Phe-Leu-Arg-Phe-amide (SDPNFLRFamide) and Ser-Ala-Asp-Pro-Asn-Phe-Leu-Arg-Phe-amide (SADPNFLRFamide) as members of the FXRFamide family in this nematode.


Potent inhibition of gastric acid secretion by intravenous interleukin-1 beta and -1 alpha in rats. The influence of human and rat recombinant interleukin-1 (hIL-1 beta and -1 alpha and rIL-1 beta) on acid secretion was investigated in conscious pylorus-ligated rats. Intravenous injection of either hIL-1 beta, hIL-1 alpha or rIL-1 beta dose dependently inhibited gastric acid output with an ED50 of 0.05 microgram, 0.5 microgram and 2.2 micrograms, respectively. The antisecretory action of IL-1 beta was associated with an increase in circulating levels of gastrin. hIL-1 beta-induced inhibition of acid secretion was dose dependently reversed by peripheral injection of the IL-1 receptor antagonist, IL-RA, with a dose ratio of 1:10(3) for complete reversal. The inhibitory effect of hIL-1 beta was blocked by indomethacin and was not modified by IV injections of the CRF receptor antagonist, alpha-helical CRF(9-41), or the monoclonal somatostatin antibody CURE.S6, or by systemic capsaicin pretreatment. These results show that systemic hIL-1 beta-induced inhibition of gastric acid secretion is mediated through IL-1 receptors and prostaglandin pathways, and does not involves CRF receptors, afferent fibers, or changes in circulating gastrin or somatostatin levels.


LHRH in the ferret: pubertal decrease in the number of immunopositive arcuate neurons. This study correlated a region-specific change in the number of luteinizing hormone-releasing hormone-immunopositive (LHRH+) neurons with pubertal development in male ferrets. There were 50% fewer LHRH+ cell bodies in the arcuate nucleus of peri- and postpubertal ferrets than in prepubertal ferrets; this significant decrease represented a 15% reduction in the overall number of LHRH+ neurons. Intracerebroventricular colchicine did not reveal additional numbers of LHRH+ neurons in the arcuate nucleus, indicating that the pubertal decrease in arcuate LHRH+ cell bodies was not due to rapid transport of peptide. These results suggest that LHRH of arcuate origin may inhibit release of LHRH via ultrashortloop negative feedback in prepubertal ferrets. Cessation of peptide production in half of the arcuate LHRH neurons at puberty could result in a reduction in this inhibitory signal that permits the pubertal increase in LHRH/LH release. Alternatively, LHRH of arcuate origin may have a nonpituitary role. In either case, these data provide evidence for heterogeneity of function among LHRH+ neurons.


Selective ablation of spinal afferent neurons containing CGRP attenuates gastric hyperemic response to acid. The gastric mucosa, in particular submucosal blood vessels, are innervated by afferent neurons containing neuropeptides such as calcitonin gene-related peptide. Stimulation of sensory neurons innervating the gastric mucosa increases submucosal blood flow. Since sensory neurons supplying the stomach are of dual origin from nodose and dorsal root ganglia, we examined the effect of selective ablation of either the vagal or spinal sensory innervation to the upper gastrointestinal tract on the increase in gastric mucosal blood flow in response to acid back diffusion into the gastric mucosa. Perineural application of capsaicin to the celiac/superior mesenteric ganglia, but not to the vagus nerves, significantly inhibited by 53% the hyperemic response to acid back diffusion. Tissue levels of immunoreactive calcitonin gene-related peptide in the gastric corpus were significantly reduced (by 73%) by periceliac capsaicin treatment, but unaffected by perivagal capsaicin treatment. These data suggest that spinal capsaicin-sensitive afferents containing calcitonin gene-related peptide immunoreactivity are involved in mediating increases in gastric mucosal blood flow. This increase in gastric mucosal blood flow mediated by sensory neurons may act as a protective mechanism against mucosal injury, similar to responses seen in other tissues such as skin.


Purification and chemical characterization of caudodorsal cell hormone-II from the egg-laying controlling caudodorsal cells of Lymnaea stagnalis. Caudodorsal cell hormone-I (CDCH-I), a 36 amino acid peptide synthesized by the caudodorsal cells (CDCs), is one of the major neuropeptides present in the cerebral ganglia of the freshwater snail, Lymnaea stagnalis. This peptide induces ovulation and egg-mass formation, and, in addition, acts on neuronal circuits involved in the control of overt egg-laying behavior. cDNA cloning studies revealed that there is a CDCH gene family comprising two genes coding for CDCH-I and the related yet distinct CDCH-II, respectively. In the present study, using sequential high performance gel permeation and reversed phase high performance liquid chromatography, we have isolated and sequenced the peptide CDCH-II. This neuropeptide has the following sequence: Ser-Ile-Thr-Asn-Asp-Leu-Arg-Ala-Ile-Ala-Asp-Ser-Tyr-Leu-Tyr-Asp-Gln-His- Lys-Leu - Arg-Glu-Gln-Gln-Glu-Glu-Asn-Leu-Arg-Arg-Arg-Phe-Tyr-Glu-Leu-Ser-Leu-Arg- Pro-Tyr - Pro-Asp-Asn-Leu. The sequence differs from those predicted by the cDNA sequence encoding preproCDCH-II at two positions, suggesting the polymorphism of CDCH-II exists in L. stagnalis.


Naloxone blocks opioid peptide release in periaqueductal gray and amygdala elicited by morphine injected into N. accumbens. Previous studies from this laboratory suggested that the periaqueductal gray (PAG), nucleus accumbens, and amygdala might take part in a serial, unidirectional mesolimbic loop to play their roles in pain modulation. It has been proposed that morphine injected into one of these nuclei would cause the release of opioid peptides in one nucleus after another. This working hypothesis was examined in the present study by perfusing simultaneously the PAG and the amygdala after microinjection of morphine into the N. accumbens. It was found that microinjection of morphine increased the content of immunoreactive enkephalins (ir-ENK) and immunoreactive beta-endorphin (ir-beta-EP) in the perfusate of the PAG and the amygdala. When the perfusion fluid contained 3 microM of naloxone, the increase of ir-ENK and ir-beta-EP was reduced significantly. These results indicate that the three nuclei were not serially connected in a unidirectional loop.


Control of pepsin secretion by regulatory peptides in the rat stomach: comparison with acid secretion. Previous studies of the control of pepsin secretion by neurohumoral agents showed some discrepancies between in vitro (isolated cells) and in vivo experiments. In the present work, the effects on pepsin secretion of CCK, pentagastrin, secretin, VIP, neurotensin, histamine, and methacholine were reinvestigated in conscious gastric fistula rats, in comparison to acid secretion. ED50's and doses inducing maximal responses were measured to directly compare the potency and efficacy of these substances. Methacholine was the most efficient (maximal response = 4.5 x basal level, ED50 = 1.3 mumol/kg.h) and CCK the most potent (ED50 = 1.9 nmol/kg.h) stimulant, whereas secretin was a potent (ED50 regulators of pepsin secretion in the rat. Pentagastrin and histamine did not stimulate pepsin output, as found by others with isolated chief cells in vitro. Neurotensin and large doses of VIP marginally inhibited pepsin secretion.


Evidence against autocrine feedback regulation of cholecystokinin secretion in man. To determine whether exogenous cholecystokinin (CCK) inhibits endogenous CCK release, cholecystokinin-8S (CCK-8S) was infused intravenously during continuous intraduodenal stimulation of endogenous CCK by a meal. CCK was measured in plasma by 2 region-specific radioimmunoassays employing antibodies T204 and 1703. AB T204 binds to carboxy-terminal CCK peptides containing the sulphated tyrosyl region, including CCK-8S, and AB 1703 to carboxy-terminal CCK peptides containing at least 14 amino acid residues. Meal-stimulated plasma CCK concentrations remained elevated during the entire infusion period. CCK-8S infusion further increased meal-stimulated plasma CCK concentrations, when measured with AB T204, while meal-stimulated plasma CCK concentrations were not suppressed by CCK-8S infusion, when measured with AB 1703. It is concluded that meal-stimulated endogenous CCK release is not affected by the effects of intravenously administered CCK-8S. These data suggest that autocrine feedback regulation of CCK release is not operative in man.


Pseudononapeptide bombesin antagonists containing C-terminal Trp or Tpi. Seven new antagonists of bombesin (Bn)/gastrin-releasing peptide (GRP) containing C-terminal Trp or Tpi (2,3,4,9-tetrahydro-1H-pyrido[3,4-b]indol-3-carboxylic acid) in a reduced peptide bond were synthesized by solid phase methods and evaluated biologically. The reduced bond in four [Leu13 psi(CH2NH)Trp14]Bn(6-14) analogs was formed by reductive alkylation at the dipeptide stage. In the case of three [Leu13 psi(CH2N)Tpi14]Bn(6-14) analogs, the Trp dipeptide with reduced bond was reacted with formaldehyde to form the corresponding Tpi derivative. These Tpi-containing analogs have a new reduced bond which is structurally more constrained. Leu13 psi(CH2N)Tpi14 analogs inhibit [125I][Tyr4]bombesin binding to Swiss 3T3 cells with IC50 values of 2-4 nM, compared to 5-10 nM for Leu13 psi(CH2NH)Trp14 analogs. Leu13 psi(CH2N)Tpi14 analogs are also more potent than Leu13 psi(CH2NH)Trp14 analogs in growth inhibition studies using Swiss 3T3 cells. The two best bombesin antagonists of this series, [D-Trp6,Leu13 psi(CH2N)Tpi14]Bn(6-14) (RC-3415) and [Tpi6,Leu13 psi(CH2N)Tpi14]Bn(6-14) (RC-3440), inhibited GRP-stimulated growth of Swiss 3T3 cells with IC50 values less than 1 nM. RC-3440 was also active in vivo, suppressing GRP(14-27)-stimulated serum gastrin secretion in rats. Bombesin/GRP antagonists, such as RC-3440, containing the new reduced bond (CH2N) reported herein are very potent.


Atrial natriuretic factor (ANF) binding sites in frog kidney and adrenal. Atrial natriuretic factor (ANF) binding sites were localized and quantified in kidney and adrenal of the frog Rana temporaria by quantitative in vitro autoradiography. [125I]-rat ANF(99-126) binding was present in kidney glomeruli and in the outer layer of interrenal tissue in the adrenal gland. ANF binding exhibited positive cooperativity with a half-maximal binding concentration (EC50) of 102 +/- 16 pM in glomeruli and 93 +/- 19 pM in interrenal tissue (n = 8). The corresponding maximal binding capacities (Bmax) were 1.33 +/- 0.16 and 1.21 +/- 0.36 fmol/mm2. [125I]-Rat ANF(99-126) binding was competitively displaced by unlabeled ANF analogues with an intact disulfide bridge showing a lower affinity than the iodinated ligand. The presence of ANF binding in glomeruli and steroidogenic interrenal cells suggests physiological functions of ANF for the osmomineral regulation in the frog by influencing glomerular filtration rate and adrenal steroid secretion.


Comparison of TRH and its analog (NS-3) in thermoregulatory and cardiovascular effects. The effects of TRH and its metabolically stable analog NS-3 [(3R,6R)-6-methyl-5-oxo-3-thiomorpholinylcarbonyl-L-histidyl-L-pro linamide tetrahydrate] on thermoregulation and circulatory control have been investigated. Both NS-3 (1-100 ng/kg ICV) and TRH (0.1-10 micrograms/kg ICV) increased rectal temperature and metabolic rate with a transient cutaneous vasoconstriction in conscious rabbits. They also increased arterial blood pressure, heart rate, respiratory rate, and renal sympathetic nerve activity (RSNA) in urethane-anesthetized rabbits. Ten ng/kg of NS-3 and 10 micrograms/kg of TRH had comparable hyperthermic, pressor, and tachycardic activities, while the relative potency of NS-3 to increase RSNA was greater and that to increase metabolic rate was smaller than the other effects. In conclusion, NS-3 was more potent than TRH in all of the effects measured, but there was a dissociation in the relative potency of NS-3 in the different autonomic effects.


Pepsin-mediated processing of synthetic precursor-like sequence yields neurotensin-like peptide. A 15 amino acid synthetic peptide, which spanned the dibasic cleavage site C-terminal to neurotensin (NT), in its 170-residue canine precursor, was synthesized by solid-phase methods. Using this substrate in combination with a radioimmunoassay specific for the C-terminal region of NT, a simple assay was developed to monitor protease-mediated cleavage of the Leu8-Lys9 bond in the substrate. Hog pepsin and the related enzymes, rhizopus pepsin, bovine cathepsin D, and mouse renin, were found to be effective in this assay, pepsin cleaving only this bond to liberate the NT-like sequence. The pH dependence of the reaction indicated that pepsin, cathepsin D, and renin exhibited significant activity at pH's characteristic for secretory vesicles (pH 5.5-6.5). In addition, pepsin and cathepsin D were shown to process the native precursor at pH's as high as 5.5. These results, although not proof, are consistent with the idea that endoproteases with pepsin-like specificity may be involved in the processing of the NT precursor in neural/endocrine cells.


The use and reliability of psychiatric diagnosis in forensic settings. The clinical professional encounters conflict whenever he or she enters the courtroom. The psychiatrist's approach must not be simply diagnostic or simply legal. We cannot shed our clinical identity; indeed, the court depends on our clinical identity and expertise in its search for the truth. The psychiatric expert must be able to translate his or her findings for the court, but these findings must come from clinical experience, not some solely legal perspective. The legal system needs our knowledge about the interfaces of mental illness, function, and behavior. After we provide our opinions, however, the legal issues must be left to the lawyers and the final determinations left to the judge or jury.


Heart and plasma atrial natriuretic peptide (ANP) in response to long-term endurance training in rats. Long-term endurance training effects on heart and plasma ANP were investigated in male Wistar rats. Maximal O2 uptake (VO2max) was significantly higher in trained groups, when they are used as their own control. After 3, 4, and 5 weeks of endurance training, VO2max was respectively increased by 7.7% (p less than 0.05), 13.7% (p less than 0.01), and 18.4% (p less than 0.001). Plasma ANP and glomerular ANP receptor density showed no clear variations in trained rats. However, cardiac ANP content decreased significantly in left and right atrial tissues by 35-36% (p less than 0.05) after 5 weeks of training. ANP immunoreactivity was investigated to show the distribution of ANP within the atria. ANP was found in diffuse and granular forms. The diffuse pattern (immature ANP) disappeared in cardiocytes of trained rats, while the granular form persisted, especially in the left atrial tissue. These data suggest that chronic endurance training might cause a decrease in ANP synthesis with no change in ANP storage. Such results are in agreement with the hypothesis that the left atrium could be especially involved in long-term fluid volume control.


Vasopressin, corticosterone levels, and gastric ulcers during food-restriction stress. Corticosterone levels and ulcers were compared in vasopressin-containing (LE) and vasopressin-deficient (DI) rats under ad lib and food-restricted conditions. In the ad lib situation, DI and LE rats had similar corticosterone levels and no ulcers. After 1 day of food restriction, the corticosterone levels were elevated in DI and LE rats, with a significantly higher level in LE rats. No ulcers were present in either strain. After 2 days of food restriction, the corticosterone levels were similar in DI and LE rats. The level in DI rats was comparable to that of the preceding day, but the level in LE animals dropped significantly from the previous day. Significant ulceration was evident in DI rats, but absent in LE rats. Following 3 days of food restriction, the corticosterone level in LE rats had returned to the ad lib level, whereas, for DI rats, an elevated level was maintained. There were no ulcers in LE rats, but they were present in DI rats. Thus LE and DI rats responded differently to the stress of food restriction. The mechanism underlying the response is most likely related to changes in the hypothalamic-pituitary-adrenocortical axis and its reaction to stress.


Pharmacological characterization of angiotensin II binding sites in the canine pancreas. High affinity 125I-angiotensin II (Ang II) binding sites were characterized in the canine pancreas. Total binding increased with protein concentration and equilibrium was reached within 60-90 min at 22 degrees C. Specific binding was saturable and averaged 70% of total. Scatchard analysis of binding yielded a KD of 0.48 +/- 0.18 nM with a Bmax of 32.8 +/- 6.5 fmol/mg protein (mean +/- SEM, n = 6). The addition of the reducing agent dithiothreitol increased specific binding two-fold. The rank order of displacement of 125I-Ang II binding by native angiotensin peptides was Ang II greater than or equal to Ang III greater than AngI greater than Ang(1-7) much greater than Ang(1-6). The use of the specific Ang II antagonists CGP 42112A, PD 123177, and DuP 753 revealed that the pancreas expresses two receptor subtypes. The majority of Ang II binding sites in the pancreas could be classified as type 2 (AT2), although type 1 (AT1) sites were also detected. In vitro autoradiography revealed binding sites localized over islet cells, acinar and duct cells, as well as the pancreatic vasculature. In addition, the autoradiographic studies confirmed the predominance of the AT2 receptor subtype throughout the pancreas.


Mentally disordered offenders. Patterns in the relationship between mental disorder and crime. Five patterns among mentally disordered offenders are distinguished by the relationship between mental disorder, on the one hand, and criminality, on the other. Pattern 1 offenders are those for whom crime is a response to psychotic symptoms, most often delusions or hallucinations. Pattern 2 offenders commit crimes motivated by compulsive desires, such as sex offenses by paraphiles and offenses regarded as evidence of disorders of impulse control. Pattern 3 offenders are those with personality disorder for whom the crime is merely one example of a maladaptive pattern of voluntary and knowing behavior. Pattern 4 offenders have coincidental mental illness that is unrelated to the crime. Pattern 5 offenders are those who become mentally disordered or feign mental disorder as a result of their crimes, such as those who dissociate upon seeing what they have done, those who become depressed in prison, those who become psychotic on death row, and those who malinger mental illness. Although these categories do not determine whether offenders are responsible for their behavior, some unknown proportion of Pattern 1 offenders do meet legal criteria for insanity, depending on the facts of each case and the applicable legal standards. It is arguable whether or not Pattern 2 offenders ever meet legal criteria of insanity. Offenders evidencing only Patterns 3, 4, or 5 are not candidates for an insanity defense.


Angiotensin II binding sites in frog kidney and adrenal. Angiotensin II (AII) binding sites were localized and quantified in kidney and adrenal of the frog Rana temporaria by quantitative in vitro autoradiography. AII binding was present in kidney glomeruli and in interrenal tissue of the outer zone of the adrenal gland. Saturation experiments showed that [125I]-[Val5]AII binds to a single class of binding sites with a dissociation constant (Kd) of 548 +/- 125 pM in glomeruli and 593 +/- 185 pM in interrenal tissue (n = 8). The corresponding maximal binding capacities (Bmax) were 2.48 +/- 0.71 and 3.05 +/- 1.02 fmol/mm2, respectively. AII binding was displaced by unlabeled angiotensin analogues in the rank order: [Sar1]AII greater than human AII greater than [125I]-[Val5]AII = [Val5]AII = human AIII much greater than human AI. The AII binding sites in glomeruli and interrenal tissue suggest an influence of AII on glomerular filtration rate and adrenal steroid secretion to take part in osmomineral regulation of the frog.


Capsaicin does not attenuate bombesin-induced suppression of operant responding for food reward. Systemic treatment with capsaicin, a neurotoxin which damages unmyelinated peptide-containing sensory neurons, has been shown to attenuate bombesin (BBS)-induced suppression of food intake. To determine whether capsaicin-sensitive fibers mediate the effect of BBS on appetitive motivation, we examined BBS-induced suppression of operant responding in rats pretreated neonatally with capsaicin (50 mg/kg; SC) or control vehicle. At 8-10 weeks of age, rats were trained to bar press for food. After achieving a stable level of performance, the animals were injected with BBS (10 micrograms/kg), normal saline, or prefed with 20 Noyes 45-mg pellets. Animals were then tested in an operant chamber on an FR 5 schedule of reinforcement for one hour. The results indicated that BBS suppressed bar pressing, regardless of whether animals were pretreated with capsaicin or control vehicle. These findings are inconsistent with the hypothesis that BBS induces satiety via capsaicin-sensitive neurons. The results suggest the possibility that more than one mechanism may mediate the effects of BBS: a neural mechanism involved in consummatory responses and a humoral mechanism involved in the operant response.


Major affective disorders and forensic psychiatry. Major mental illnesses, such as major affective disorders and schizophrenias, form a relatively small diagnostic group among mentally disordered offenders. The major affective disorders are less common when compared with schizophrenics among such offenders. Yet, some of the most violent crimes, such as murder, attempted murder, and serious assaults, especially intrafamilial violence, are committed by major affective disorder patients. The offenses by this group of patients are committed while suffering from active symptoms of the illness. As such, a substantial majority is not considered fully criminally responsible for the offense. Many such offenders are found not guilty by reason of insanity and are sent to psychiatric hospitals.


Single-step isolation and sequencing of vasopressin and oxytocin precursors. The pre- and post-Golgi processing of preprovasopressin and prepro-oxytocin was evaluated by microsequencing for incorporated radiolabel. 35S-Cysteine and 3H-fucose were microinjected into rat supraoptic nuclei (SON), and proteins and peptides related to the biosynthesis of vasopressin (VP) and oxytocin (OT) were isolated at various times from the supraoptic nuclei and neural lobe by employing a one-step procedure of high performance liquid chromatography (HPLC). These proteins and peptides were recognized through their binding to specific antibodies against VP, OT, and rat neurophysins (RNPs), and by their binding to ConA-Sepharose. Two immunoreactive glycoproteins related to VP biosynthesis were recovered from the SON and both contained fucose and had a 35S-cysteine placement consistent with the location of the hormone sequence at the N-terminus. SDS-electrophoresis revealed the major protein form to be 21,000 daltons and the minor protein form to be 19,000 daltons. One nonglycosylated protein of 16,000 daltons related to oxytocin biosynthesis was recovered from the SON, and this protein also had a 35S-cysteine placement consistent with an N-terminal OT sequence. These data provide the first sequential evidence that prior to, or shortly after, packaging in the Golgi the preprohormones of VP and OT have lost their entire leader-peptide structures.


The forensic psychiatric aspects of schizophrenia. This review of the literature does seem to reveal an association between schizophrenia and a variety of antisocial behaviors that include violent crime, and even homicide, especially in North America. The literature consistently shows that since the 1950s, schizophrenics have been involved in crime and arrested more frequently than the general population, they are overrepresented in correctional settings, and they represent the majority of those found not guilty by reason of insanity. Many authors cite changes in mental health policies, particularly de-institutionalization, as one of the major causes of these phenomena. It is important to note that a history of prior arrests and of being male, poor, unskilled, uneducated, and unmarried are perhaps the best predictors of antisocial behaviors in the mentally ill and in the general population alike. Schizophrenic drift and increased family pathology in schizophrenic families, however, may predispose people suffering from schizophrenia to these demographic variables. Interestingly, these variables do not seem as relevant in the emergency room or inpatient wards where violence seems to be mainly affected by the severity of psychopathology, substance abuse, neurologic signs, and the environment within the mental health setting. The implications for the practice of psychiatry are diverse. Clearly clinicians in both hospitals and community mental health settings must have experience, training, and an awareness of the literature relating to the prevention, causes, and management of violence. It behooves us in the mental health field, having vociferously supported the community mental health movement, to assist police in the management of the mentally ill who are now in the community, perhaps by the use of mobile crisis intervention teams and by a considerably increased amount of effort and cooperation. Correctional services require urging to develop resources for identifying and tracking the mentally ill so as to be able to provide programs and continuity of care. Community mental health and criminal justice systems need to cooperate in planning the transition of mentally abnormal offenders from prisons into the community and then providing support and after-care for them. One exemplary program that has developed and benefited from the coordination and planning at the interministerial level is the Inter-ministerial Project (IMP) program in Vancouver. This program identified the people whose histories revealed repeated admissions to both correctional and mental health facilities, bouncing between one and the other. Using a case management approach with a limited caseload, clinicians were able to reduce the number of admissions to both types of facilities. This program should serve as a model for other jurisdictions.(ABSTRACT TRUNCATED AT 400 WORDS)


The involvement of schizophrenic insanity acquittees in the mental health and criminal justice systems. This article described the mental health and criminal justice involvement of a large group of schizophrenic insanity acquittees and the program designed to manage and treat these individuals. Most insanity acquittees in our system are chronically mentally ill individuals who fit well into the psychosocial rehabilitation models that have developed over the past 15 years. In addition, the use of conditional release and monitored care in the community appears to be the most realistic approach to this group of individuals who show a high degree of involvement with the mental health and criminal justice service systems. This research has continued implications for the development of outpatient civil commitment and for the attempt to give people as much liberty as they are capable of handling while being realistic about their capacities to survive in the community.


Substance abuse and criminal behavior.

Substance abuse and criminal behavior. As forensic psychiatry develops as a clinical subspecialty, clinical skill in understanding, treating, and predicting violent behavior will become more important. This article addresses the importance of understanding the relationship between substance abuse and violent behavior. This article also discusses morbidity and mortality in substance abuse, the demographics of substance abuse and criminality, and the clinical aspects of the forensic psychiatric evaluation.


Effect of vasopressin administration and deficiency upon 3H-AVP binding sites in the CNS and periphery during development. Arginine8-vasopressin (AVP, 40 micrograms/100 g b.wt., SC) was administered to male Long-Evans (LE) pups from day 1 to 7 of life and the pups were sacrificed on day 8 or 60. 3H-AVP binding was performed on membranes prepared from the liver, kidney, and septum. No significant changes were observed in the kidney or septum of animals 8 or 60 days old. However, the chronic AVP treatment did result in a significant increase in the density of 3H-AVP binding sites in the liver when compared to control day 8 pups (control 44 +/- 2 vs. AVP 56 +/- 3 fmol/mg protein), with no change in affinity. This effect was maintained into adulthood, as the day 60 AVP-treated LE rats also showed a significant increase in liver 3H-AVP binding sites compared to control (control 186 +/- 9 vs. AVP 239 +/- 14 fmol/mg protein), with no change in affinity. A comparison of 3H-AVP binding sites in 8-day-old LE, heterozygous Brattleboro (HET-BB), and homozygous Brattleboro rats (HOM-BB) was performed to assess the effect of complete (HOM-BB) and partial (HET-BB) VP deficiency on binding sites in the CNS and periphery. The liver again was the only tissue in which a change in 3H-AVP binding characteristics was noted. The HOM-BB rat (Bmax 144 +/- 6 fmol/mg protein) displayed a significant increase in AVP binding sites from the LE rat (Bmax 100 +/- 7 fmol/mg protein), while the 3H-AVP binding sites in the HET-BB rat liver (Bmax 69.8 +/- 9 fmol/mg protein) were significantly lower than LE rats. Thus hepatic AVP receptors appear most sensitive to the presence or absence of vasopressin during the early postnatal period.


Arson in review. From profit to pathology. Arson is a crime committed by thousands of people throughout our nation for nearly every reason, justification or excuse known to mankind ... Arson is one of the easiest crimes to commit but the hardest to prevent or prove ... Arson is a crime which involves little skill, as the weapon used is legally carried and too readily available ... Unlike many other covert criminal activities, the impact of increased major arsons has a direct visible effect on the lives of the average citizen. Insurance premiums are raised, property is destroyed, people are killed or maimed, and the quality of life in the area affected by arson is diminished considerably. These statements, taken from US Senate hearings on arson in the late 1970s, are as true and as troubling today as they were over a decade ago. Many who set fires need mental health services of some kind, a fact alluded to even in popular literature. Dick Francis, a well-known author of British mysteries, writes, "There are people in this world who cause trouble because it makes them feel important. They're ineffectual, eh? in their lives. So they burn things ..." But nobody wants these arsonists in their midst. Psychiatric facilities do not want them so they end up in prison: Yet another case has been reported of a mentally disordered person being sent to prison because there is no other institution willing to receive her ... a severely mentally disordered woman aged 22 [was sentenced] to life imprisonment for arson ... in default of other appropriate facilities ... to protect the public. And general hospital emergency rooms cannot find anyplace to send them: "The hardest patients to sell are the repeaters with bad reputations, the firesetters and those who are potentially violent." Any arson episode is an act the magnitude of which the perpetrator cannot predict accurately. Once set, the fire is no longer responsive to the desires or dictates of the firesetter. To address the problem of arson in our times, arson investigators for law enforcement agencies and for insurance companies, fire chiefs, and mental health professionals must develop a joint commitment to public education, cooperative plans for prevention and intervention, and a shared research agenda.(ABSTRACT TRUNCATED AT 400 WORDS)


The pathological gambler as criminal offender. Comments on evaluation and treatment. Over the past three decades, gambling has been the nation's fastest growing industry. Although there is now some leveling off, states are still turning to legalized gambling to address financial problems without having to raise taxes. In addition, there is new technology that produces more rapidly addicting games. States are accepting some responsibility and, as of this writing, 12 of them have funded some programs in public education, research, training, and treatment. Although there are only a half dozen inpatient programs and very few qualified counselors and therapists, we can anticipate the development of clinics, residential programs, halfway houses, and alternative sentencing programs. The National Council on Problem Gambling has developed guidelines for the certification of gambling counselors. In addition to the training of mental health professionals, workshops are needed for attorneys, judges, probation and parole officers, and prison administrators. Initially, the task of assessing and diagnosing the pathological gambler was left to a small number of experts. Starting with DSM-IV, there will be clear and reliable criteria available to the professional community. These criteria, which are the product of thorough testing, should easily discriminate the pathological gambler from other types of gamblers. Most of what we have learned about pathological gambling has come in the last 5 years. A major impetus for research has been the Journal of Gambling Studies, which began publication in 1985. A review of the nature and course of the disorder, including the studies of criminal behavior, leads one to conclude that the majority of pathological gamblers (at least 70% to 80%) commit offenses late in the disorder and that these offenses are strictly gambling related. This is a population which is essentially nonviolent and which turns to property crimes out of desperation over gambling losses and their sequelae. The minority (in one study 14%) of gamblers with antisocial personality disorder--the group for whom treatment would be least likely to be effective--can be recognized easily both by the pattern of offenses and by diagnostic criteria for antisocial personality. Once this group is excluded, treatment for the others, in combination with restitution, community service, and some form of monitoring, would seem beneficial both for the individual and for society. Once they have stopped gambling, pathological gamblers are frequently hard-working people, whose mathematical skills and intelligence, high energy, and need to excel make them extremely valuable at their jobs. The alternative, imprisonment, may very well reinforce the disorder.(ABSTRACT TRUNCATED AT 400 WORDS)


Homicide, infanticide, and filicide.

Homicide, infanticide, and filicide. Homicidal behavior appears to be a heterogeneous phenomenon. Although the causative role of mental illness in relation to homicide remains a controversial and debatable issue, recent studies indicate that a significant number of homicidal adults suffer from serious mental illness, more specifically psychosis. Most reports that attempt to correlate the presence of identifiable risk factors and homicide yield inconclusive or unreplicated results. In addition to supporting the need for further research in the area of aggressive behavior and violence, prevention also should involve the use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.


The paraphilias. The extent and nature of sexually deviant and criminal behavior. This article presents data that indicate that paraphiliacs tend to carry out a variety of paraphilic behaviors and cross a number of boundaries within individual paraphilias. These data contradict earlier theories that postulated that paraphiliacs compulsively repeat the same category of paraphilia over time without crossing into other categories of paraphilic acts as a result of specific early life experiences or specific emotional conflicts. This article suggests that a more parsimonious explanation is that individuals with paraphilias have a general deficit of control, leading them to carry out a variety of paraphilic behaviors with a variety of victims.


Incest perpetrators. Their assessment and treatment. The multitude of articles published in the last decade in the area of intrafamilial sexual abuse highlight the complexity of the issue--both its assessment and treatment. Although no unique profile of an incest perpetrator exists, a review of studies revealed problems in the areas of sexual satisfaction, psychological functioning, interpersonal relationships, and family of origin. As well, incest families have been reported to be dysfunctional, with power imbalances; control struggles; indirect, unclear communication; and inappropriate coalitions among family members. Based on these observations, a wide range of treatment interventions now exists, including offender-oriented cognitive/behavioral therapies and a family-focused multimodal systems approach. Although questions remain to be answered in regard to the effectiveness and process of treatment, efforts limited to the recognition of these problematic families are no longer adequate. The focus must move to prevention through the early identification of individuals at risk both for offending and being part of an incest family structure; the implementation of proven, cost-effective, proactive intervention strategies; and the continuing dissemination of information to the public.


The evaluation and treatment of sexual violence, necrophilia, and asphyxiophilia. At first sight the phenomena discussed in this paper may seem to have little in common. Yet on close scrutiny it becomes apparent that there is an interesting degree of overlap. Although sexual assaults in general clearly involve multiple causes or factors, social and cultural as well as individual, many sexual aggressors do show psychological or biologic abnormalities which require careful evaluation. Continued empiric study of the variables discussed in this paper is therefore important. The clinical as well as laboratory study of paraphilias with dangerous tendencies to themselves or others is also essential for a better understanding of the causes and relationships between these disorders.


Clinical aspects of forensic assessment of juvenile offenders. Juvenile delinquency is a major public health problem with far reaching consequences not only on the child and the family but also on society generally. Although most individuals who commit crimes as adolescents will stop by age 18, a core group of young offenders go on to be chronic adult recidivists. The group at risk can be identified by early onset and frequency of deviant and delinquent behaviors. This group is associated with impoverished environments, inadequate financial and social resources, family dysfunction, exposure to violent abuse and neglect, genetic loading for psychiatric disorder, and parental criminality. Because of the combination of social disadvantages and externalizing behaviors, this group is difficult to evaluate and treat in normal mental health settings. Court-mandated assessment and treatment offer a unique opportunity to access this high-risk group and provide services not otherwise available. Assessments of severely conduct-disordered children reveal significant levels of co-occurring psychiatric disorders. Thorough assessment to evaluate underlying psychopathology may reveal treatable disorders that may greatly improve general functioning and reduce further recidivism.


[Transient diabetes mellitus with ketoacidosis in a child during the treatment of acute lymphoblastic leukemia with L-asparaginase]. A case of a 11-year girl with the acute lymphoblastic leukemia is presented. Patient was treated with L-asparaginase and developed a transient but lasting several weeks diabetes mellitus with ketoacidosis as a sequelae of this therapy.


[Anti-kappa elastin antibody titer in the sera of patients with hyperlipoproteinemia type II, III and IV]. Titre of antibodies against elastin degradation product (kappa-elastin) was measured in patients with atherogenic types of hyperlipoproteinemia. The hemagglutination technique was used. A significant decrease in titres of the tested antibodies was found. It was the most prominent in IIa, III and IIb types of hyperlipoproteinemia and rather mild in IV type. The authors attempted to explain causes of antibodies titres decrease in tested patients and relate their results with those of other authors.