Historical and clinical factors associated with Chlamydia trachomatis genitourinary infection in female adolescents

Five hundred sixty-eight adolescent female patients receiving routine gynecologic care at urban clinics were screened by culture for Chlamydia trachomatis infection at both the urethra and endocervix. Culture results for 562 were available from either or both sites. Positive cultures were obtained from 139 (25%). Urethral infection was not associated with either urinary tract symptoms or sterile pyuria, but urethral or endocervical infection was associated with cervical friability (P = less than 0.0001), endocervical mucopus (P = 0.0001), cervical erythema (P = 0.0002), and cervical ectopy or erosion (P = 0.01). Increased chlamydial infection rates were associated with older age (P = 0.01), history of more frequent intercourse (P = 0.01), and history of more than one lifetime partner (P = 0.023), with a marginal association for being black (P = 0.05). Method of contraception, reason for attending clinic, age at menarche, age at first intercourse, years sexually active, number of sexual partners in preceding 6 months, parity, and prior history of sexually transmitted disease were not associated with having chlamydial genitourinary infection.

Effect of recombinant human granulocyte-macrophage colony-stimulating factor on hematopoietic reconstitution after high-dose chemotherapy and autologous bone marrow transplantation

Recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) has been reported to increase the leukocyte count in subhuman primates subjected to total-body irradiation and in patients with the acquired immunodeficiency syndrome. We administered this substance to 19 patients with breast cancer or melanoma treated with high-dose combination chemotherapy and autologous bone marrow support. Groups of three or four patients were treated with 2.0, 4.0, 8.0, 16.0, or 32.0 micrograms per kilogram of body weight per day of glycosylated rHuGM-CSF by continuous intravenous infusion for 14 days, beginning three hours after bone marrow infusion. Total leukocyte and granulocyte recovery was accelerated in these patients as compared with 24 historical controls matched for age, diagnosis, and treatment. Leukocyte counts (mean +/- SD) obtained 14 days after transplantation were 1511 +/- 1003 per microliter in patients given 2 to 8 micrograms per kilogram per day, 2575 +/- 2304 in those given 16 micrograms, and 3120 +/- 1744 in those given 32 micrograms, as compared with 863 +/- 645 per microliter in the controls. No consistent effect on platelet counts was noted. Toxic effects were generally mild and not clearly dose-related in patients given 2 to 16 micrograms per kilogram per day. Edema, weight gain, or myalgias occurred in all patients given 32 micrograms per kilogram; marked weight gain, generalized edema, pleural effusions, and hypotension developed in two patients, one of whom also had acute renal failure. Our results indicate that rHuGM-CSF can accelerate myeloid recovery after high-dose chemotherapy and autologous bone marrow transplantation, over a range of doses that can be tolerated. In this setting the ability to increase the dose is limited by the development of myalgias and fluid retention.

Intensive single-agent mitoxantrone for metastatic breast cancer

Twenty-seven women with metastatic breast cancer were treated with mitoxantrone as a single agent, with the use of an intensive dose-escalating schedule. Doses were given at 0.5 mg/m2/day as an iv injection for 3 consecutive days and then were escalated each month by 2.5 mg/m2/day until maximal tolerance was reached on the basis of hematologic or cardiac toxicity. No complete responses were demonstrated. Six patients (22%) had partial responses of 5.5 months' median duration. Four of 12 patients who had not received prior doxorubicin responded (33%), whereas two of 15 patients with previous doxorubicin exposure responded (13%). Cardiotoxicity, determined by serial radionuclide ventriculography, occurred in 10 patients (37%) at a mean total mitoxantrone dose of 83.0 mg/m2. Three of these 10 patients had no predisposing risk factors, four had received thoracic radiotherapy that might have involved the heart, and three had received prior doxorubicin without clinical toxicity. The failure of dose intensification to augment the response rate when compared to the response rates reported for less myelotoxic doses of the drug, in addition to the extent of cardiotoxicity noted, calls into question the value of dose intensification of mitoxantrone in the treatment of metastatic breast cancer.

Censoring of patient-held records by doctors

Computer-held information is increasingly shared between general practice and hospitals and with the provisions of the Data Protection Act now in operation, the practical issues of disclosure to patients need to be reviewed. Patients attending diabetic clinics at University Hospital, Nottingham, are routinely issued with a copy of their computerheld record but a previous study showed a high level of censoring by the hospital doctors. This paper reports a review of a sample of 251 censored records, containing 426 problems, whereby the doctors concerned provided reasons for the censoring and restored information they thought suitable. After the review, only 8% of censored problems, that is 1% of all problems, remained censored. An additional 2% of all problems were deleted from the patient's copy at the request of the patient. It is essential that systems which allow censoring of patient records have continuous built-in audit to monitor the reasons for censoring.

Chlamydial infections

Chlamydia trachomatis infection is the most prevalent sexually transmitted disease in developed countries today. It produces a number of oculogenital syndromes in adults as well as conjunctivitis and pneumonitis in infants. However, the most important sequelae are infertility, ectopic pregnancy, and chronic pelvic pain in women. Available diagnostic tests including culture are less than 100% sensitive but may be of considerable value in detecting asymptomatically infected individuals. Antichlamydial therapy is usually effective and should be given empirically to individuals whose presentation places them at high risk for infection.

Efficiency and cost-effectiveness of field follow-up for patients with Chlamydia trachomatis infection in a sexually transmitted diseases clinic

Unlike contact-tracing procedures for syphilis and gonorrhea, field follow-up to locate and treat patients with Chlamydia trachomatis infections has not been extensively applied in the United States. We implemented two studies to assess the efficiency and cost-effectiveness of using field follow-up for contact of two groups: patients with chlamydial infection detected as part of a screening program and women who were sexual partners of men with nongonococcal urethritis (NGU). Of the 142 patients with chlamydial infection who had not been treated empirically, 112 (79%) returned for treatment when a reminder system was used, as compared with a return rate of 97% (259/266) achieved by field follow-up (P less than 0.0001). Among the 678 men with NGU enrolled in a randomized trial of field follow-up vs. two self-referral methods, field follow-up yielded over three times as many partners returning to the clinic for treatment as did either of the other two methods (P less than 0.001). Analyses using the estimated costs of the intervention strategies and the medical costs associated with an untreated chlamydial infection showed that field follow-up by trained investigators proved to be not only the most efficient method for locating patients with chlamydial infection and/or patients who were at risk for it, but also the most cost-effective in terms of total health-care dollars spent.

Correlates of smokeless tobacco use in a male adolescent population

This paper identifies the correlates of smokeless tobacco use in a sample of 1,030 males representative of 7th through 12th grade students of Dane County (Madison), Wisconsin. Variables independently associated with frequent use of smokeless tobacco were: being White; living in other than a two-parent home; performing poorly in school; smoking cigarettes; consuming beer, wine, or hard liquor; and deviant/delinquent behavior. Participation in team sports was associated with some "experimentation" with smokeless products.

Tonic immobility and heterophil/lymphocyte responses of the domestic fowl to corticosterone infusion

The tonic immobility (TI) fear reactions, plasma corticosterone concentrations and heterophil/lymphocyte (H/L) ratios of adults laying hens were measured before and at intervals of 4 and 11 days after the subcutaneous implantation of osmotic minipumps delivering either corticosterone solution (15 micrograms/hr) or only polyethylene glycol vehicle. The dummy pumps exerted no apparent behavioral or endocrine effects, whereas tonic immobility was significantly prolonged and circulating corticosterone concentrations significantly elevated at 4 and 11 days after implantation of the corticosterone minipumps. H/L ratios were significantly elevated from pre-treatment levels in both groups. However, H/L ratios were considerably higher at both post-treatment points among birds receiving corticosterone rather than vehicle. The present findings suggest that chronic elevations of plasma corticosterone not only alter the haematological profile but may also predispose birds to react more fearfully to alarming stimulation.

Fluorescent monoclonal antibody for confirmation of Neisseria gonorrhoeae cultures

We evaluated a monoclonal fluorescent-antibody (FA) reagent (Neisseria gonorrhoeae Culture Confirmation Test; Syva Co., Palo Alto, Calif.) for confirmation of N. gonorrhoeae isolates obtained from clinics for sexually transmitted diseases in four cities. The FA test was performed in parallel with established confirmation procedures on all organisms growing on 773 primary culture plates of modified Thayer-Martin agar. All N. gonorrhoeae isolates reacted with the FA reagent and produced a bright, easily interpretable fluorescence. The FA test correctly identified 533 N. gonorrhoeae isolates from 474 patients and did not react with 90 N. meningitidis or with 213 non-Neisseria isolates. In one city (Baltimore), Gonochek II (Du Pont Co., Wilmington, Del.) failed to identify four N. gonorrhoeae isolates reactive with the FA reagent and confirmed as N. gonorrhoeae by Phadebact (Pharmacia Inc., Piscataway, N.J.) and acid production from sugars. The FA test was rapid and specific and could be performed directly from primary isolation plates. The test requires 1 h to perform and is applicable to mixed-flora cultures.

Cognitive functioning in albino children

Twelve albino children with IQs in the normal range were psychometrically assessed and compared to a control group of equally visually handicapped children who were non-albino. A striking and consistent pattern of cognitive functioning emerged in the albino group (a large verbal/performance discrepancy in favour of verbal skills) which could not be attributed to their poor visual acuity. This unusual pattern of intellectual functioning may be related to the unique neuroanatomy and neurophysiology recently demonstrated in people with albinism.

Effect of prior sexually transmitted disease on the isolation of Chlamydia trachomatis

In developed nations, Chlamydia trachomatis is the most common sexually transmitted pathogen. To determine whether prior disease affects the probability of subsequent chlamydial infection, we took culture specimens from 2,546 men and 1,998 women attending a sexually transmitted diseases clinic. The men had nongonococcal urethritis and the women were contacts of men who had a positive chlamydial culture or nongonococcal urethritis. Significantly lower isolation rates for those with a history of sexually transmitted diseases were found for both men (29% vs. 38%; P less than 0.0001) and women (27% vs. 36%; P less than 0.0001). In addition, both men and women with previously documented chlamydial infections had a lower isolation rate at the index visit, if the previous infection occurred less than, as opposed to more than, six months earlier (men: 20% vs. 41%; P = 0.0006; women: 14% vs. 35%; P = 0.003). These relationships were found to be independent of age. However, the effect of partial immunity due to prior infection could not be distinguished from that of prior antibiotic therapy, and if such immunity does confer protection against reinfection, that protection appears to be both partial and of relatively short duration.

Assessment of fear in adult laying hens: correlational analysis of methods and measures

The fear responses of adult laying hens of two lines, flighty and docile, were assessed in each of three commonly employed and widely differing test situations. These were the pen with cone, novel rod and tonic immobility tests. Each hen was ranked for fearfulness on each behaviour pattern recorded and was then assigned an overall 'fear rank' in each of the three tests. Significant intra-individual correlations were found in both lines between the ranked responses within tests and between the overall fear ranks assigned in each of the three test situations. The findings support the use of these tests as methods of assessing fear in adult laying hens and are considered to reflect the estimation of general underlying states of fear rather than stimulus-specific responses.

Prevalence of smoking in a diabetic population: the need for action

Smoking habits in insulin-treated diabetics in Nottinghamshire (UK) and clinic-attending diabetics in Nottingham have been analysed. Compared with the general population, the prevalence of current cigarette smoking is significantly less (p less than 0.001) in both diabetic men and women older than 50 years. Fewer diabetic men over 60 years have ever smoked than in the general population (p less than 0.001) but this finding does not apply to diabetic women. While intervention probably plays some part in this lower prevalence, the most likely explanation is the multiplicative effect of both smoking and diabetes to produce high mortality risks. Actuarial analysis of insulin-treated clinic attenders diagnosed after 1970 showed that at most 14% (95% confidence interval [Cl] 9-18%) of the 183 who smoked at diagnosis had given up 5 years later while a minimum of 8% (95% Cl, 6-11%) of the 313 who were non-smokers had started smoking. Information about the patterns of smoking in patients with chronic disease is incomplete and it appears that too little is being done in clinical services which provide long-term management for these patients to either discourage smoking or determine why some patients give up smoking but others do not.

Diagnosis of chlamydial infection in women attending antenatal and gynecologic clinics

Two antigen detection systems (MicroTrak [MT], Syva Co., Palo Alto, Calif.; and Chlamydiazyme [CZ], Abbott Laboratories, North Chicago, Ill.) were compared with semiquantitative culture for diagnosis of chlamydial infection in 1,059 patients. Cultures were done on microtiter plates and blind passaged once. Culture-negative but CZ- or MT-positive specimens were recultured. True positives were positive by either initial or repeat cultures. Of 827 nonpregnant and 231 pregnant patients, 9.1 and 12.1%, respectively, had positive cultures. Overall sensitivity of the initial culture was 48.5% without passage and 86.4% with passage. The sensitivity of CZ was 67%. The sensitivity of MT in our laboratory was 50%; however, further review of these specimens by Syva employees gave a combined sensitivity of 71.6%. MT and CZ were more sensitive for pregnant patients (MT, 84.6%; CZ, 85.7%) than for nonpregnant patients (MT, 65.5%; CZ, 60.0%). All the tests had specificities above 95%. Of the specimens that were positive after initial culture without subculture, MT-negative specimens had a mean of 3.7 inclusions in culture, and MT-positive specimens had a mean of 24.8 (P = 0.002); CZ-negative specimens had a mean of 4.3 inclusions, and CZ-positive specimens had a mean of 20.0 (P = 0.026). In addition, cultures of specimens from pregnant patients had more inclusions than did those from gynecology patients, but this was not statistically significant (P = 0.096). No method is ideal; however, MT and CZ were less sensitive than was this culture system for detecting chlamydial infection in patients in gynecology clinics and were of comparable sensitivity for pregnant patients.

Chlamydial infections

Sexually transmitted infections caused by Chlamydia trachomatis are of epidemic proportions. Since chlamydial infections are often asymptomatic, identification of infected persons is the major public health challenge in the control of chlamydial disease. Unfortunately, asymptomatic infections in women can be complicated by salpingitis, ectopic pregnancy, and involuntary infertility. The best current diagnostic test is cell culture. Direct antigen tests are cheaper and more widely available than cell culture but are less sensitive. Improved diagnostic tests, screening of groups at risk, educating patients and health care providers, and reporting of chlamydial infections will be essential in controlling chlamydial disease.

A phase I-II study of intensive-dose adriamycin for advanced breast cancer

Twenty-six women with metastatic breast cancer were treated with intensive Adriamycin (Adria Laboratories, Columbus, OH) as a single agent administered for three successive days once a month. Dosing started at 25 or 30 mg/m2/d three times, and was escalated by 5 mg/m2/d monthly to maximal tolerance based on hematologic, mucosal, or cardiac toxicities. Four patients (15%) had complete remissions (CRs) pathologically proven, and six others (23%) sustained complete CRs, but were found to have microscopic residual tumor (three) or refused biopsy (three). Twelve patients (46%) attained partial remission (PR). The overall response (85%) and CR rates (38%) were approximately double those reported with conventional Adriamycin doses. Median unmaintained remission duration for the ten patients in CR was 11 months. Cardiotoxicity, determined by radionuclide physiologic studies, occurred in 16 patients at a mean dose of 459 mg/m2; three patients developed reversible congestive failure. There were no toxic deaths. The median overall survival was 18 months. These data suggest that there is steep dose responsiveness to Adriamycin in metastatic breast cancer, and that more effective techniques for using Adriamycin may exist than those conventionally used.

Effect of blind passage and multiple sampling on recovery of Chlamydia trachomatis from urogenital specimens

Detection of chlamydial infections depends on the sensitivity of the techniques used. Variables include the number of body sites sampled, the number of samples obtained, and the number of passages in tissue culture. To assess these factors, microdilution plate cultures with a single blind passage were performed on specimens from 10,291 men and women attending a sexually transmitted disease clinic. Overall, 21% of the men and 30% of the women were culture positive. However, 18% of endocervical, 28% of female urethral, and 29% of male urethral cultures that were positive became so only after a single passage. Of culture-positive women, 23% were positive at the urethra only. Pooled urethral and endocervical specimens were positive more often than an endocervical specimen alone but less often than separately cultured endocervical and urethral specimens. A total of 221 specimens from 92 men and 66 women were subjected to five serial blind passages. Of 83 positive specimens, 29 (35%) were positive only after two or more passages. A total of 37 (46%) women were culture-positive, but only 12 (33%) of those who were positive and had an endocervical culture would have been detected by a single endocervical culture that was not passaged. The sensitivity of chlamydial culture is substantially less than 100% but can be improved by culturing samples from both the urethra and endocervix in women and by serial passage in tissue culture.