Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status

Mortality and hospitalization rates for pneumonia have increased among older Americans during recent years (1979-86), despite a national commitment to the reduction of premature deaths from pneumonia. A prospective study of deaths and hospitalizations attributable to pneumonia was conducted among 5,474 subjects ages 55 and older who participated in the NHANES I Epidemiologic Followup Study. Prevalent chronic conditions, health behaviors, and nutritional status indicators, measured at baseline, were examined in relation to pneumonia hospitalization and death during 12 years of followup. Mortality and hospitalization rates for pneumonia were higher among men than women, and higher among those ages 65 and older than among those 55-64 of both sexes. Risk of pneumonia death was higher among subjects with a history of congestive heart failure, stroke, cancer, or diabetes. Risk of pneumonia hospitalization was higher among subjects with a history of chronic obstructive pulmonary disease and among men who were current smokers. Daily alcohol consumption did not increase risk of pneumonia in this study population. Four measures of nutritional status were examined taking age, prevalent chronic conditions, and cigarette smoking into account: body mass index, arm muscle area, and serum albumin and hemoglobin levels. Risk of pneumonia death was 2.6 times higher in men in the lowest quartile, compared with men in the highest quartile, of body mass index. Similarly, the risk was 4.5 times higher among men in the lowest quartile of arm muscle area. Risk of death from pneumonia was 3.6 times higher among women in the lowest quartile of serum albumin levels compared with women in the highest quartile. Relative risks for these nutritional status indicators remained elevated after adjusting for age and the medical history risk factors. These risk factors should be taken into account when designing and evaluating pneumonia vaccination trials and community prevention programs.

A cluster of chromosome 11p13 translocations found via distinct D-D and D-D-J rearrangements of the human T cell receptor delta chain gene

Human T cell tumours have few consistently occurring translocations which provide markers for this disease. The translocation t(11;14)(p13;q11), however, seems to be an exception, since it has been repeatedly observed in T-ALL. We have analysed a number of T-ALL samples carrying the t(11;14) with a view to assessing the nature of the translocated sequences on chromosomes 11 and 14. Three of the tumours studied have breakpoints, at 14q11, within the T cell receptor delta chain locus, while a fourth appears to break in the J alpha region. The TCR delta sequences involved in the translocation junctions are made from D delta-D delta-J delta joins or from D delta-D delta joins, allowing us to define distinct human D delta and J delta segments. These results allow us to make a comparison between the human and mouse TCR delta loci, both as regards sequence and rearrangement hierarchies. The disparate translocation breakpoints at chromosome 14q11 contrast with the marked clustering of breaks at chromosome 11p13; in all four cases, the breakpoint occurs within a region of less than 0.8 kb of chromosome 11. The analysis of junctional sequences at the 11p13 breakpoint cluster region only shows a consensus heptamer-like sequence in one out of four tumours analysed. Therefore, recombinase-mediated sequence specific recognition is not the only cause of chromosomal translocation.

Ineffective photodynamic therapy (PDT) in a poorly vascularized xenograft model

Haematoporphyrin derivative (HPD) photodynamic therapy (PDT) may have clinical application in the management of patients with retinoblastoma. Heterotransplantation of retinoblastoma cells into the anterior chamber of the nude mouse eye and the subsequent growth of small tumour masses has provided a model for evaluation of various therapeutic modalities. Ninety-four evaluable xenograft tumours in 54 nude mice were randomized to receive one of the following treatments: cyclophosphamide (CPM) alone, HPD-PDT alone, CPM followed by HPD-PDT, HPD-PDT followed by CPM, or saline control. Responses were demonstrated after CPM treatment in all three relevant groups. However, HPD-PDT was found to be ineffective either alone or as a contributor in the double modality treatment groups. The small tumour masses treated can be demonstrated histologically to be avascular. It is proposed that although the same retinoblastoma cells in different circumstances are responsive to HPD-PDT, no clinical response is demonstrable utilizing this model, due to the absence of tumor vascularity.

Confirmation of the assignment of MYCL to chromosome 1 in humans and its position relative to RH, UMPK, and PGM1

Data from family studies demonstrating RH:MYCL linkage (zeta = 4.07 at theta = 0.09) in paternal meioses are presented. Although positive, MYCL:PGM1 lods are not of the magnitude of those for RH:MYCL. Taken together, these results are consistent with the physical assignment of MYCL to 1p32. Furthermore, evidence to support the order RH-MYCL-UMPK-PGM1 is detailed.

Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma

Rat-bite fever results from an infection with the organism Streptobacillus moniliformis. Symptomatic patients often present with fever, malaise, cough, maculopapular rash, and occasional arthritis, and usually have a history of rodent exposure. This report describes a patient with rat-bite fever resulting in suppurative arthritis. The patient's diagnosis was made by culture of S moniliformis from his left wrist. The diagnosis was delayed, however, owing to the lack of an exposure history, atypical clinical presentation, and the unusual microbiologic characteristics shown by this organism.

Teleconferencing cme programs to rural physicians: the university of calgary teleconference program

Continuing medical education (CME) provides practising family physicians with the cornerstone of maintenance and improvement of skills. In rural areas the problems of isolation and distance are a barrier to continuing medical education. Provision of CME programs by audio-teleconferencing is an attempt to overcome these problems. This article describes the teleconference program of The University of Calgary, how it has developed over the five years of its existence, and its impact on rural physicians.

Aplastic anaemia in childhood: prognosis and approach to therapy

Thirty-four children with aplastic anaemia who presented between 1964 and 1984 are reviewed. Their ages ranged from one to 13 years (median, seven years). Twelve children had constitutional aplasia; nine of 11 children had responded to androgen and corticosteroid therapy. However, by actuarial analysis, only 48% would survive at five years and only 16% after 10 years. Twenty-two children had acquired aplasia; in 16 children this had no obvious cause. By means of the criteria of the International Aplastic Anemia Study Group, patients were categorized into severe and non-severe groups at diagnosis. Severe disease was present at diagnosis in nine of 22 children with acquired aplasia but in no child with constitutional disease. Two patients with severe acquired aplasia showed a transient response to androgen or corticosteroid therapy, whereas five of nine children with acquired aplasia which was not severe showed a sustained response to such therapy. A significant difference in survival times was seen between severe and non-severe groups at five years; two (17%) of nine children with severe aplasia survived, compared with eight (67%) of 12 children with non-severe aplasia. Three children with severe aplasia who were treated with antilymphocyte globulin showed no improvement. Of five children who underwent bone-marrow transplantation for severe or progressive disease, four survived. It is concluded that bone-marrow transplantation, as a matter of urgency, is the treatment of choice for severe acquired aplastic anaemia; it is also recommended for mild acquired or constitutional aplasia when progressive disease is present or where transfusion therapy will be required. Antilymphocyte globulin is an alternative form of treatment for acquired disease. Androgen therapy is effective in the treatment of non-severe acquired and constitutional aplastic anaemia.

Siblings of paediatric cancer patients: a population at risk

The psychosocial care of children with cancer has received increasing and welcome emphasis in the medical literature. However, the current and future status of siblings of such patients has been an underestimated area of concern. We examine the general importance of sibling relationships and present the literature regarding siblings of paediatric oncology patients. Donors and recipients of bone marrow transplants are considered specifically. Preliminary results of original research, supported by available published studies, suggest important disturbances in the mental health of siblings. Implications for paediatricians and other health professionals as well as prevention and intervention strategies are indicated.

Improved detection of metastatic Ewing's sarcoma with the use of bone marrow scintigraphy

Prognosis in Ewing's sarcoma is inversely related to the extent of the disease at the time of presentation. The most common sites of metastases are the lungs and skeleton. Bone marrow metastases may be present but clinically silent. We report the use of Technetium (Tc)-99m bone marrow scintigraphy to detect sites of marrow involvement by metastatic Ewing's sarcoma. This method of evaluation allowed identification of sites of involvement by Ewing's sarcoma that were not available by any other method of evaluation. In several instances, information provided by this method was pivotal in the management of these patients. Based on this small series of patients, bone marrow scintigraphy appears to be a sensitive modality in the detection of metastatic disease in patients with Ewing's sarcoma. Better understanding of the role of bone marrow scanning and its correlation with other diagnostic procedures in Ewing's sarcoma will require further study.

Distribution of immunoreactive peptide B in the rat brain

Peptide B represents one of the most highly conserved sequences in proenkephalin. To investigate the potential presence of this peptide in the mammalian nervous system, an antiserum raised to this peptide was used to measure the distribution and molecular weight forms of immunoreactive Peptide B in the rat brain. Peptide B-immunoreactivity (ir) was found to be most concentrated in the hypothalamus and the striatum, with lower concentrations in the midbrain and medulla-pons. Characterization of Peptide B-ir by gel filtration demonstrated that the major immunoreactive peak in the hypothalamus corresponded to a peptide with the approximate molecular weight of Peptide B. The major immunoreactive peptide exhibited a retention time on HPLC indicative of a peptide slightly more hydrophilic than bovine Peptide B. The results suggest that proenkephalin in rat brain can be processed to peptides related to bovine Peptide B.

Toxicity of benzyl alcohol in adult and neonatal mice

Benzyl alcohol, a bacteriostatic agent found in many parenteral preparations, has been implicated as the agent responsible for precipitating "the gasping syndrome" in premature neonates. To investigate this toxicity, benzyl alcohol was administered intraperitoneally to adult (23-28 g) and neonatal (2-7 g) CD-1 male mice. Gross behavioral changes were monitored. Low doses (less than 800 mg/kg) produced minimal toxic effects within an initial 4-h observation period. At the end of this time, the LD50 was determined to be 1000 mg/kg for both age groups. When mortality in the adult group was observed after 7 d following a single treatment with benzyl alcohol, the LD50 on day 7 was determined to be 650 mg/kg. Rapid absorption and conversion of benzyl alcohol to its primary metabolite, benzaldehyde, occurred within both experimental groups; the plasma levels of each were comparable in both neonatal and mature animals when determined by GC. In an attempt to alter the toxicity of benzyl alcohol, pyrazole and disulfiram were used to inhibit the activities of alcohol dehydrogenase and aldehyde dehydrogenase, respectively. Treatment with pyrazole, before benzyl alcohol exposure, resulted in an increase in benzyl alcohol levels to 203% of control values and a marked increase in toxicity. Although pretreatment with disulfiram led to benzaldehyde levels which were 368% of control values, toxicity was unchanged. These data imply that the acute toxicity of benzyl alcohol, which includes sedation, dyspnea, and loss of motor function, is due to the alcohol itself and not to its metabolite, benzaldehyde.

Bone-marrow transplantation for haematological malignancy in childhood

Twenty-three children with haematological malignancies and a poor prognosis underwent bone-marrow transplantation. Thirteen children had acute lymphoblastic leukaemia, eight had acute nonlymphoblastic leukaemia, one had chronic myeloid leukaemia and one had malignant histiocytosis. One child was in relapse at the time of transplant and 22 were in first or subsequent remission. Before transplantation all patients received cyclophosphamide (60 mg/kg) on two consecutive days followed by total body irradiation given as a single dose of 10 Gy at 0.18 Gy/min (one patient) or 0.07 Gy/min (three patients), or as a fractionated dose of 10-12 Gy at 0.07-0.1 Gy/min (19 patients). One child with malignant histiocytosis also received two doses of etoposide (5 mg/kg). Methotrexate was given after transplantation to prevent or modify graft-versus-host disease (GVHD). One patient who received a transplant in relapse died early from overwhelming bacterial sepsis. Twenty-two patients engrafted, and of these 11 developed acute GVHD; five developed chronic GVHD; seven developed interstitial pneumonitis, with four deaths; and five relapsed between three and 12 months after transplantation, with three deaths. Fifty-nine per cent (13/22) of patients who received a transplant during remission remain in continuous complete remission and 68% (15/22) have survived for a median of 18 months (range, four to 73 months). Bone-marrow transplantation that is undertaken during remission of disease offers a prolonged disease-free survival in selected childhood malignancies.

Reptilian enkephalins: implications for the evolution of proenkephalin

To shed light on the evolution of the opioid peptide precursor proenkephalin, we have investigated the profile of immunoreactive enkephalins in reptilian brain using six antisera directed toward different portions of the proenkephalin molecule. Three different orders of reptiles--turtles, alligators, and lizards--were studied; these orders represent lineages diverging more than 250 million years ago. Reptilian brain was found to contain large quantities of Met5-enkephalin (Met5-enk), Leu5-enkephalin (Leu5-enk), and Met5-enk-Arg6-Phe7 (MERF); gel filtration and reverse-phase chromatography of acid extracts prepared from turtle brain indicated that nearly all of the immunoreactivity corresponding to these peptides could be ascribed to the authentic penta- to heptapeptides. Immunoreactive metorphamide, but not amidorphin, was present in all three species. Unlike mammalian brain, reptilian brain does not contain immunoreactive Met5-enk-Arg6-Gly7-Leu8 (MERGL). These results indicate that reptilian proenkephalin, while similar to mammalian enkephalin in containing Met5-enk, Leu5-enk, MERF, and metorphamide, nevertheless differs from mammalian proenkephalin. Reptilian proenkephalin either may contain the MERGL sequence in a form not recognized by the MERGL antibody, or may lack the MERGL sequence entirely.