Changes in Larval Morphology in the Evolution of Benthic Development by Patiriella exigua (Asteroidea: Asterinidae), a Comparison with the Larvae of Patiriella Species with Planktonic Development

Patiriella exigua (Lamarck) is a small asterinid sea star that deposits large eggs onto the substratum. Development is lecithotrophic and entirely benthic, proceeding without parental care. The embryos develop to the brachiolaria stage before hatching and there is no trace of a bipinnaria larva. In its early stage the larva of P. exigua resembles a planktonic brachiolaria in having one long central brachium and two short lateral brachia. By hatching, the brachia are equal in length, giving the larva a tripod-like appearance. Comparison of the larva of P. exigua with the brachiolaria of Patiriella species with planktonic development supports the hypothesis that the tripod larval form results from differential growth of the lateral brachia. At hatching, the P. exigua larva has a well-developed attachment complex composed of a large adhesive disk and three muscular brachia; the latter bear a striking resemblance to adult tube feet. This hypertrophic elaboration of the brachiolar complex is an adaptation for permanent benthic attachment. Internally, one large enterocoel forms at the anterior end of the archenteron. The archenteron then closes to form the rudiment for the adult gut. Metamorphosis involves gradual resorption of the brachiolar complex concomitant with formation of the first tube feet. The adhesive disk plays a major role in attachment during late metamorphosis but is gradually reduced to a plug of tissue as the tube feet become functional. Juvenile P. exigua are negatively geotactic and float on the water surface, behavior that may act as a mechanism for dispersal. The similarity of the early larva of P. exigua to planktonic brachiolariae suggests that the evolution of benthic lecithotrophy by this species involved modification of a planktonic larval form. These modifications include elimination and reduction of larval feeding structures, formation of one rather than three enterocoels, and hypertrophy of the brachiolar complex to form a tripod larva. Heterochronies in the ontogeny of P. exigua include the delay in hatching to the brachiolaria stage and the accelerated development of the juvenile form and adult skeleton.

Prediction of amputation wound healing with skin perfusion pressure

PURPOSE

The purpose of this study was to determine whether laser Doppler skin perfusion pressure (LD-SPP) could accurately predict amputation wound healing.

METHODS

We studied a total of 62 limbs in 52 patients (28 men and 24 women) with a mean age of 62.2 years (range 34 to 93 years). From this, 39 limbs underwent major amputation (15 above-the-knee, 24 below-the-knee), and 23 limbs underwent minor amputations (4 transmetatarsal and 19 toes). There were five postoperative deaths, leaving a total of 57 limbs available for analysis.

RESULTS

Three of 13 above-knee amputations failed to heal. Twenty-one of 23 below-knee amputations healed. Three of four transmetatarsal amputations failed to heal and eight of 17 toe amputations failed to heal. Binary table analysis showed that an LD-SPP value of 30 mm Hg or greater had a negative predictive value (healing occurred) of 90%. An LD-SPP value of less than 30 mm Hg at the amputation site had a positive predictive value (healing failure) of 75%, (p < 0.001, chi square analysis). For major amputations, negative predictive value was 100%, and positive predictive value was 83%, (p < 0.001). For minor amputations, negative predictive value was 75% and positive predictive value was 66.7%, (p < 0.09).

CONCLUSION

These data support the use of the LD-SPP test in the selection of major amputation level consistent with healing in ischemic limbs. Further study of the value of this parameter in the determination of minor amputation wound healing is necessary.

"In-situ" Teicoplanin for central venous catheter infection

Infection of central venous catheters (CVC) is a relatively common occurrence in immunocompromised patients, management of which has included I.V. antibiotics +/- removal of catheter. We have previously demonstrated that intracatheter administration of Amikacin empirically, successfully eradicated all bacterial infections except those due to S. epidermidis. A study was subsequently undertaken to treat gram positive cocci infections of CVC with intracatheter Teicoplanin. Eleven patients attending a single institution with documented gram positive cocci infection of CVC over a one year period were included in the study. Teicoplanin was instilled with heparinised saline once daily into the infected lumen of the CVC and allowed to remain for 24 hours. Treatment was continued for 48 hours after negative cultures were reported. Teicoplanin was successful in eradicating infection in 100% of cases. Mean duration of treatment was six days (range 4-9 days). Four patients subsequently developed a further infection, a mean of 13 weeks from first infection, only one of which was due to the same organism and this was successfully treated by a further course of Teicoplanin. No side effects were reported and catheter life was prolonged a mean of 132 days after completion of treatment. The use of Teicoplanin in this way for treatment of gram positive cocci infection of CVC is highly effective; once daily administration of antibiotic enables treatment to be given on an outpatient basis, thereby minimising hospital admission.

Reproductive behaviour in schizophrenia relative to other mental disorders: evidence for increased fertility in men despite decreased marital rate

Using case register data, the overall marital rate among 5158 patients with mental illness was found to be comparable to the general population. The proportion of those ever married was markedly reduced in the schizophrenic group relative to those with a manic or neurotic illness. Men with schizophrenia had a particularly low rate of marriage. The overall marital fertility of the 3 groups was comparable to each other and appeared to be higher than that in the general population. In the schizophrenic group only, married men, particularly those with a family history of mental disorder, produced more children than married women. Men might represent a more fertile group of schizophrenic patients with some biological advantage of increased fecundity, which may help to compensate for negative selection pressures.

Immunological events in regressing genital warts

Little is known of the in vivo role of the immune system in controlling human papillomavirus infection in the genital tract. The authors have studied 125 closely monitored patients with genital warts. Of these 125 patients, wart regression was seen in 28 patients. This study provides evidence that clearance of human papillomavirus from the genital tract is characterized by an active cell-mediated immune response. Regressing warts (n = 14) contained significantly more T lymphocytes (P < .05, Wilcoxon rank sum test) and macrophages (P < .01) than did nonregressing controls (n = 14). CD4-positive lymphocytes predominated in regression, both within the wart stroma and the surface epithelium, where there was a significant change in the ratio of CD4+ to CD8+ cells (P < .01). Lymphocytes in regression also showed greater expression of activation markers, and the majority were of the "antigen-experienced" phenotype. There was no difference in Langerhans cell numbers, although there was significant induction of the immune accessory molecules HLA-DR and ICAM1 (P < .05) on keratinocytes, and E-selectin and VCAM1 (P < .05) on endothelial cells in regressing warts. The changes in regression are consistent with a delayed-type hypersensitivity reaction to foreign antigen, and the ability to induce and mount such a response may be a critical determinant of effective natural immunity to the genital HPVs. Specific targeting of delayed-type hypersensitivity responsiveness may increase the efficacy of strategies for immuno-intervention against HPV infection in the genital tract.

Screening for cervical abnormalities in women with anogenital warts in an STD clinic: an inappropriate use of colposcopy

An audit of the use of colposcopy in women with anogenital warts was performed. Fifty women attending a clinic for sexually transmitted diseases in a District General Hospital with anogenital warts were examined by cervical cytology and colposcopy for cervical infection by human papillomavirus (HPV) or epithelial abnormality indicating cervical intraepithelial neoplasia (CIN) or both. Collated results showed a high prevalence of both conditions in these 50 women; 20 (40%) had evidence of cervical infection by HPV and 11 (22%) epithelial abnormalities consistent with CIN 1 or 2. However, neither CIN 3 nor invasive disease was detected. Colposcopy in this setting was shown to be a specific but insensitive tool and its role in the routine management of women with anogenital warts at our institution is not warranted.

Detection and inheritance of RFLPs in Eucalyptus nitens

The level of polymorphism using genomic and cDNA probes with a number of restriction enzymes and the inheritance of the RFLP loci was investigated in E. nitens. The polymorphism detected with 366 genomic and cDNA probes and three to six restriction enzymes was analysed in three-generation outbred pedigrees. No difference in the level of polymorphism detected with genomic versus cDNA probes was observed. There was a difference in the efficiency of detection of polymorphism with six different restriction enzymes, with three of the enzymes (BglII, DraI and EcoRI) showing substantially more polymorphism than the others. There was no significant correlation between the size of the DNA fragments generated by the enzymes and the detection of polymorphism. Several cases of restriction-site mutations resulting in a polymorphism were observed. The inheritance of 69 loci was analysed in two pedigrees resulting from interpopulational crosses. The majority of the loci segregated according to expected ratios with distortion observed in only 3% of loci. Probes from the cDNA library detected a greater proportion of loci with more than two alleles than did probes from the genomic library. The high polymorphism, large number of alleles, and ease of interpretation of RFLPs in E. nitens means that they will be useful in a range of applications such as genetic linkage maps and paternity analysis.

Further evidence for anomalies in the hand-prints of patients with schizophrenia: a study of secondary creases

Finger and palm prints from 46 ICD-9 schizophrenic patients and 43 age and sex matched normal controls were examined independently and blind to diagnosis, by four raters. Seven prints were judged to have very high densities of secondary creases. These abnormal prints were all from the schizophrenic group. Patients with high densities of creases were more severely ill, having had more than five admissions to hospital and higher doses of neuroleptic medication. There was a trend for such patients to have had a complicated obstetric history and an earlier onset of their illness.

Meningococcal disease in childhood--a regional study in Ireland

A retrospective study of microbiology laboratory records of culture-confirmed cases of meningococcal disease in children under 14 years of age, admitted to four Dublin hospitals, was conducted for the period 1981-1991 inclusive. The study aimed to describe the epidemiology of meningococcal disease in childhood and to assess the potential of meningococcal group A and C vaccine in preventing disease. There were 406 cases of meningococcal disease of which 319 (78.6%) were in children under 5 years of age. The meningitis to septicaemia ratio was almost 4:1 (320 vs. 86 cases). Of the 406 cases, 216 (53.2%) cases occurred during the period November to March. The age-specific annual incidence rates for the Eastern Health Board region served was 64.2 per 100,000 under 1 year of age and 24.6 per 100,000 under 5 years of age. A relative increase in disease caused by meningococcal serogroup C was observed during the period of the study. Only 15% all cases could have been prevented by a policy of universal meningococcal group A and C immunisation at 2 years of age. Such a policy, therefore, is not recommended. A vaccine for preventing disease caused by meningococcal group B is urgently required.

Oral sumatriptan compared with placebo in the acute treatment of migraine

This multicentre, double-blind, parallel-group study compared the efficacy, safety and tolerability of oral sumatriptan, given as a new film-coated tablet, with placebo in the acute treatment of migraine. Patients were randomised unequally (1:2) to receive placebo or sumatriptan. Eighty-eight patients received placebo (plus an optional dose 2 h later if the headache persisted plus a further optional dose for recurrence within 24 h) and 162 patients received sumatriptan 100 mg (plus an optional 100 mg dose at 2 h and an optional 100 mg dose within 24 h). Sumatriptan was significantly more effective than placebo at relieving headache (defined as reduction in severity from severe or moderate pain to mild or no pain) at 2 h (51% versus 31%, P = 0.003) and 4 h (71% versus 35%, P < 0.001). Fewer sumatriptan-treated patients required a second dose compared with placebo-treated patients (49% versus 74%, P < 0.001). More sumatriptan-treated patients were completely pain free compared with placebo-treated patients at both 2 h (24% versus 12%) and 4 h (48% versus 18). Patients receiving sumatriptan reported earlier onset of headache relief than patients receiving placebo. Headache relief in sumatriptan-treated patients was similar, irrespective of the type of migraine (with or without aura) or the time of treatment < or = 4 h or > 4 h after onset of migraine). Sumatriptan was more effective than placebo at relieving nausea, vomiting and photophobia/phonophobia. Few patients were evaluable for treatment of headache recurrence, and statistical analysis was not possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Urethane anesthesia reverses the protective effect of noncompetitive NMDA receptor antagonists against cocaine intoxication

The present experiments examined whether pretreatment with the noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonists, MK-801 and dextrorphan, could antagonize cocaine-induced convulsions and lethality in conscious Sprague-Dawley (SD) rats and whether urethane anesthesia alters the observed interactions. Conscious, restrained male SD rats received continuous i.v. infusions of cocaine hydrochloride (1.25 mg/kg.min) until convulsions and death occurred. Cocaine doses of 21.2 +/- 1.8 and 29.5 +/- 2.5 mg/kg caused convulsions and death, respectively, in saline treated rats (n = 8). Convulsions were absent in MK-801 (1 mg/kg, i.v.; n = 8) pretreated rats; the lethal cocaine dose was 44.0 +/- 2.7 mg/kg (p < 0.05). In contrast, urethane anesthesia (1.2 g/kg, i.p.) decreased the dose of cocaine required to cause toxicity, compared to that in saline controls (24.8 +/- 0.8 mg/kg, n = 13), in MK-801 (2.0 +/- 0.3, n = 7; p < 0.01) and in dextrorphan mg/kg, n = 13), in MK-801 (2.0 +/- 0.3, n = 7; p < 0.01) and in dextrorphan (25 mg/kg, i.v.; 13.1 +/- 1.4, n = 6; p < 0.01) pretreated rats. Pressor responses with little change in heart rate were evident during cocaine infusion in vehicle pretreated rats. Bradycardiac responses were noted to cocaine in groups following NMDA receptor blockade. Reversal of the pressor response to cocaine was noted in MK-801 pretreated animals, while dextrorphan pretreatment moderated cocaine-induced increases in blood pressure. Ventilatory support protected against cocaine lethality in urethane anesthetized rats, indicating that respiratory failure is the proximate cause of death with cocaine infusion. However, artificially ventilated rats, pretreated with MK-801, were more sensitive (lethal cocaine dose, 76.6 +/- 8.0 mg/kg, n = 5) than vehicle pretreated rats (129.4 +/- 15.8 mg/kg, n = 6), indicating that MK-801 may increase both the respiratory and the cardiac toxicity of cocaine in urethane anesthetized rats. Interactions between NMDA receptors and cocaine are modified by urethane anesthesia.

Interferon alpha and doxorubicin in malignant mesothelioma: a phase II study

BACKGROUND

Malignant mesothelioma is a tumour which is generally resistant to chemotherapy. While the addition of interferon to chemotherapy improves response rates in some other malignancies, such a combination has not been evaluated in the treatment of mesothelioma.

AIMS

To assess the anti-tumour effects and toxicity of interferon-alpha combined with doxorubicin in the treatment of pleural mesothelioma.

METHODS

Twenty five patients (mean age 54 +/- 11 years) were enrolled in a phase II study. All patients had a confirmed histological diagnosis, measurable tumour, a life expectancy of at least three months, and no prior chemotherapy or interferon. Interferon alpha-2a, 9 x 10(6) U sc daily, was administered together with doxorubicin 25 mg per m2 i.v. weekly, for 12 weeks. Response status was assessed by tumour measurements on clinical examination and thoracic CT scans before and after treatment.

RESULTS

A partial response was observed in four patients (16%; 90% CI, 8-30%), 11 remained stable, while six had progressive disease. Four patients withdrew within the first month because of toxicity. The median survival of all patients was 11 months (95% CI, 3-19). Dose modification as a result of toxicity was required in all patients. Lethargy, weight loss, leukopenia and vomiting were the most common side effects.

CONCLUSIONS

The combination of interferon-alpha and doxorubicin showed only modest activity and was associated with significant toxicity. It cannot be recommended in the treatment of malignant pleural mesothelioma.

The economic burden of unrecognized vasodepressor syncope

BACKGROUND

The objective of this study was to describe the cost of prior diagnostic evaluation in patients referred for evaluation of syncope whose history was typical of vasodepressor syncope.

METHODS AND RESULTS

Thirty consecutive patients who were referred for evaluation of syncope of undetermined origin and whose history was highly suggestive of vasodepressor syncope participated in this study. These 30 patients represented 19% of 158 patients referred for evaluation of syncope during the period of enrollment. All patients had positive results of an upright-tilt test, confirming the diagnosis of vasodepressor syncope. At the time of evaluation, the type and results of all diagnostic tests that had been performed prior to referral were recorded for each patient. The cost of diagnostic testing was then determined based on the 1991 cost of these tests at the University of Michigan Medical Center. A mean of 4 +/- 2 major diagnostic tests were performed before referral to the University of Michigan Medical Center. The mean and median costs of diagnostic testing per patient prior to referral were $3,763 +/- 3,820 and $2,678 (range: 0 to $16,606) respectively. Six patients underwent no major diagnostic tests prior to referral and, therefore, the cost of major diagnostic testing was zero in these patients. In the remaining patients, the mean and median costs of diagnostic testing per patient were $4,704 +/- 3,713 and $3,777 (range: $1,025 to $16,606) respectively.

CONCLUSIONS

The results of this study demonstrate that a diagnosis of vasodepressor syncope can be established clinically in approximately 20% of patients referred to a university hospital for evaluation of syncope of undetermined origin. Failure to recognize the clinical features of vasodepressor syncope in these patients resulted in up to $16,000 of unnecessary diagnostic testing. A greater awareness of the clinical features of vasodepressor syncope may, therefore, result in significant economic savings.

Randomized comparison of the effects of tamoxifen, megestrol acetate, or tamoxifen plus megestrol acetate on treatment response and survival in patients with metastatic breast cancer

BACKGROUND

The antioestrogen tamoxifen and progestins act via different receptors and may therefore have complementary effects against human breast cancer. This possibility was tested in a randomized study which compared the effects of tamoxifen, standard-dose megestrol acetate, and these two agents in combination, in patients with metastatic breast cancer.

PATIENTS AND METHODS

184 post-menopausal patients with metastatic breast cancer were randomized to initial treatment with either tamoxifen (TAM) 40 mg daily, megestrol acetate (MA) 160 mgm daily, or the combination of the two administered simultaneously. Patients crossed over to the alternative single agent on relapse or disease progression. Patients were evaluated for response, time to initial and ultimate treatment failure, and survival.

RESULTS

There were no significant differences between the three groups with respect to response rates, nor the other parameters. Patient survival was significantly associated with age > 60 years, ER positive status, and the absence of visceral metastases.

CONCLUSIONS

TAM and MA are both equally effective in response induction as initial treatments and the combination has no advantage. Sequential treatment is still optimal, TAM being the preferred initial agent in view of the reported side effects with MA.

The ethics of role conflict in research

While engaged in interviewing stroke patients, nurses found their research responsibilities conflicting with traditional patient care values. At the termination of the pilot project, the nurses, doubting their role, shared their concerns with the research team. They made recommendations regarding the appropriateness of tools and training needs of research assistants. Unresolved role conflict motivated the nurses to review the literature, seeking answers to the issue. Other nurses have experienced this same conflict. While nursing has been referred to as a profession that complements art with science, in practice, altruism may conflict with maintaining research integrity. The nurse, when functioning as a researcher, may find situations where a choice needs to be made whether to implement nursing interventions or continue the research protocol. The difficulty remains in deciding when the patient advocate role takes precedence over other legitimate concerns. Even though the ANA Code for Nurses with Interpretive Statements requires that the nurse participate in research to advance the profession's body of knowledge, the code's primary principle mandates respect for the rights of the individuals the nurse serves. Research need not be undertaken at the expense of human dignity. If conflicts develop, nursing's primary responsibility is to the individual. Concern for the individual always takes precedence over maintaining research integrity. Nurses are "advocates, where trust, compassion, and empathy encompass all our nursing endeavors, including research" (p. 161). While striving to achieve research goals, nurses must not lose sight of the traditional values inherent in nursing.

Clinical features and management of recurrent balanitis; association with atopy and genital washing

OBJECTIVE

To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to institute rational management.

DESIGN

Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis were studied. All patients were asked whether they had a history of atopic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area for bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months.

SETTING

Outpatient genitourinary medicine clinic, St Mary's Hospital, London, UK.

RESULTS

In 31 (72%) of the patients a diagnosis of irritant dermatitis was made. In comparison with the remaining patients, they had a greater lifetime incidence of atopic illness and more frequent daily genital washing with soap. For 28 (90%) of these patients, use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily. For the remaining 12 patients, a variety of diagnoses were made. Biopsy proved a well tolerated and diagnostic investigation, but the isolation of microbial pathogens from preputial swabs was irrelevant to management.

CONCLUSION

A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis.

A new method for the concentration of Cryptosporidium oocysts from water

A novel method for the concentration of Cryptosporidium oocysts from water has been developed, based upon the precipitation of calcium carbonate. A 10 l water sample is treated by adding solutions of calcium chloride and sodium bicarbonate and raising the pH value to 10 with sodium hydroxide. Crystals of calcium carbonate form and enmesh particles in the Cryptosporidium oocyst size range. The crystals are allowed to settle, the supernatant fluid is discarded and the calcium carbonate precipitate dissolved in sulphamic acid. The sample can be concentrated further by centrifugation. Recoveries of oocysts from seeded samples of deionized, tap and river water were in excess of 68%.

The importance of bleomycin in combination chemotherapy for good-prognosis germ cell carcinoma. Australasian Germ Cell Trial Group

PURPOSE

In an effort to maintain the excellent long-term results achieved with combination chemotherapy for good-prognosis germ cell carcinoma, but to reduce the toxicities encountered, a randomized trial was conducted comparing cisplatin and vinblastine with or without bleomycin.

PATIENTS AND METHODS

Two hundred eighteen assessable patients with a good prognosis were randomized to receive induction chemotherapy with cisplatin 100 mg/m2 intravenously (IV) day 1 and vinblastine 6 mg/m2 IV days 1 and 2 every 3 weeks (PV) with or without bleomycin 30 mg intramuscularly (IM) weekly (PVB) for a maximum of 12 weeks. Once maximum response was achieved, patients with a complete remission (CR) received two courses of consolidation chemotherapy, while those with residual abnormalities and normal tumor markers underwent surgical resection whenever possible.

RESULTS

Toxicities encountered in this study were clearly greater for those patients who received bleomycin, with significantly more leukopenia, thrombocytopenia, anemia, alopecia, and renal and pulmonary toxicities. The proportion of patients who achieved CR and had no evidence of disease (resection of all viable malignancy) was 89% for PV and 94% for PVB (P = .29). After a minimum of 4 years of follow-up, relapses have occurred in 7% of patients who received PV and 5% who received PVB. A total of five patients on each therapy arm were successfully treated with further salvage chemotherapy and surgery. Thus, deaths from progressive malignancy have occurred in 15% of patients on PV and 5% on PVB (P = .02), a rate that was partly offset by the higher proportion of toxic deaths with PVB (P = .06).

CONCLUSION

Despite the toxicities encountered with bleomycin in cisplatin-based combination chemotherapy for these patients, complete deletion of this drug compromises therapeutic efficacy.

Routine monitoring of Cryptosporidium oocysts in water using flow cytometry

A flow cytometric method for the routine analysis of environmental water samples for the presence of Cryptosporidium oocysts has been developed. It uses a Coulter Epics Elite flow cytometer to examine water samples and to separate oocysts from contaminating debris by cell sorting. The sorted particles are then rapidly screened by microscopy. The method has been evaluated and compared with direct epifluorescence microscopy on 325 river, reservoir and drinking water samples. The technique was found to be more sensitive, faster and easier to perform than conventional epifluorescent microscopy for the routine examination of water samples for Cryptosporidium.