Characteristics of women seeking emergency contraception in general practice

The aim of this study was to profile the users of emergency contraception (EC) attending general practices and a general practice out-of-hours co-operative service using a pre-piloted questionnaire. Questionnaires were offered to 171 women and completed by 144 (84.2%). Mean age was 24.4 years (Standard Deviation = 6.7, range 14 to 51). Most were single, 116 (80.6%). Those who had no regular partner at the time of seeking EC were more likely to have > or =6 lifetime sexual partners than those in stable relationships (OR: 3.5; CI: 1.14-10.86, p < 0.03). At the time of seeking EC 121 (84.0%) were using some method of contraception. Ninety-three (64.6%) presented within 24 hours of sexual intercourse. Concerns about condoms were the commonest reason for seeking EC. For 55 (38.2%) this was their first time to use EC. Thirty-three (22.9%) were drunk at the time of intercourse.

Meta-analysis of sentinel node imprint cytology in breast cancer

BACKGROUND

Intraoperative diagnosis of breast cancer metastases in axillary sentinel nodes is desirable to avoid a second operation for lymphadenectomy. Imprint or touch-preparation cytology is a popular technique that has high specificity and a wide range of sensitivity.

METHODS

A systematic search of electronic databases was performed. Included articles were assessed for methodological and reporting quality. Random-effects model pooled estimates of sensitivity and specificity were calculated. Single-variable and multivariable meta-regression analyses were performed for predictors of sensitivity.

RESULTS

Thirty-one studies were included; all were of good methodological quality but reporting quality varied. Pooled sensitivity of imprint cytology was 63 (95 per cent confidence interval (c.i.) 57 to 69) per cent and specificity was 99 (95 per cent c.i. 98 to 99) per cent. Pooled sensitivity for macrometastases was 81 per cent and that for micrometastases 22 per cent. Mean or median primary tumour size (P = 0.004), the prevalence of metastases (P = 0.103) and the proportion of micrometastases (P = 0.022) were significant risk factors in single-variable meta-regression analysis. Only the proportion of micrometastases remained significant in multivariable analysis. Frozen sectioning had better sensitivity than imprint cytology in three of four direct comparisons.

CONCLUSION

Imprint cytology is simple and rapid, and has good sensitivity for macrometastases. The significance of poor sensitivity for micrometastases will be determined by trials investigating their natural history.

Cortical activation associated with midtrial change of instruction in a saccade task

The appearance of a visual stimulus in the peripheral visual field can elicit different saccade responses depending on prior instruction. This flexibility is commonly attributed to differences in motor set. Little is known about how the brain switches between one saccade response and another. To investigate the neural processes associated with switches between saccade motor sets, we recorded event-related potentials (ERPs) in 13 subjects, in three tasks that required subjects to generate prosaccades to a visual stimulus on 75% of the trials. On 25% of the trials, the color of the fixation point (FP) changed 300 ms prior to stimulus presentation. In the "ANTI" task, the change of the FP was the instruction to generate an antisaccade; in the "NOGO" task, subjects were instructed to maintain fixation; and in the "PRO" task, subjects were instructed to generate a prosaccade. The switch in motor set from prosaccades to antisaccades in the ANTI task and the cancellation of the prosaccade motor set in the NOGO task modulated frontal and frontocentral channels. Futhermore, the ANTI task but not the NOGO task was associated with differences at central and parietal channels compared with the PRO task. We hypothesize that the frontal activation in the ANTI and NOGO task reflects inhibition and task-switching processes, whereas the parietal activation reflects the preparation of this area for the sensorimotor transformation process that is necessary for the generation of an antisaccade.

Effects of solution pH and electrical parameters on hydroxyapatite coatings deposited by a plasma-assisted electrophoresis technique

Hydroxyapatite (HA) coatings can be deposited using a hybrid process of plasma electrolysis and electrophoresis, called plasma-assisted electrophoretic deposition (PEPD). HA aqueous suspensions with various pH values were prepared using a modified ultrasonic cleaning bath as an agitator/stirrer. Both DC and unbalanced AC power supplies were used to bias the titanium alloy substrate materials employed in this work. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffractometry (XRD), and Fourier transform infrared spectroscopy (FTIR) were used to observe and analyze coating morphology and microstructure. It was shown that the morphology and composition of the calcium phosphate coatings were significantly influenced by solution pH values; the level of "pure" HA in the coatings' composition corresponded to both solution pH and the type of power supply employed. Loss of hydroxyl radials (i.e., dehydroxylation), which degrades the performance of the hydroxyapatite coating in terms of long-term chemical and mechanical stability, can be virtually eliminated by a combination of high pH and unbalanced AC plasma power. In addition, the underlying TiO2 coatings used to support the HA layer (preproduced by plasma electrolysis process) have a nanoscaled (10-20 nm) polycrystalline structure. TEM studies also revealed a dense, continuous amorphous titania layer (10 nm in thickness) at the interface between the Ti alloy substrate and the TiO2 layer, which may play a role in improving the corrosion resistance of the substrate. Such a nanophase TiO2 layer (if used as a coating alone) may also provide a further improvement in osteoinductive properties, compared to a conventional TiO2 coating on the Ti alloy substrate.

Effects of solution pH and electrical parameters on hydroxyapatite coatings deposited by a plasma-assisted electrophoresis technique

Hydroxyapatite (HA) coatings can be deposited using a hybrid process of plasma electrolysis and electrophoresis, called plasma-assisted electrophoretic deposition (PEPD). HA aqueous suspensions with various pH values were prepared using a modified ultrasonic cleaning bath as an agitator/stirrer. Both DC and unbalanced AC power supplies were used to bias the titanium alloy substrate materials employed in this work. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffractometry (XRD), and Fourier transform infrared spectroscopy (FTIR) were used to observe and analyze coating morphology and microstructure. It was shown that the morphology and composition of the calcium phosphate coatings were significantly influenced by solution pH values; the level of "pure" HA in the coatings' composition corresponded to both solution pH and the type of power supply employed. Loss of hydroxyl radials (i.e., dehydroxylation), which degrades the performance of the hydroxyapatite coating in terms of long-term chemical and mechanical stability, can be virtually eliminated by a combination of high pH and unbalanced AC plasma power. In addition, the underlying TiO2 coatings used to support the HA layer (preproduced by plasma electrolysis process) have a nanoscaled (10-20 nm) polycrystalline structure. TEM studies also revealed a dense, continuous amorphous titania layer (10 nm in thickness) at the interface between the Ti alloy substrate and the TiO2 layer, which may play a role in improving the corrosion resistance of the substrate. Such a nanophase TiO2 layer (if used as a coating alone) may also provide a further improvement in osteoinductive properties, compared to a conventional TiO2 coating on the Ti alloy substrate.

Training in obstetric sonography for radiology residents and fellows in the United States

OBJECTIVE

The purpose of our study was to assess the current experience of radiology residents and fellows in obstetric sonography.

SUBJECTS AND METHODS

Written surveys were sent to the directors of 206 accredited radiology residency programs and 85 fellowship programs in the United States. The surveys encompassed obstetric sonographic experience during routine working hours and after hours, the level of supervision, the types of scanning performed, and the extent of formal lectures available during training. Additional questions concerned the relative knowledge of laboratory accreditation processes and training of faculty covering obstetric sonography.

RESULTS

Sixty (29%) of 206 accredited radiology residency programs and 24 (28%) of 85 fellowship programs returned surveys. The experience among residency programs was similar, providing fewer than 4 weeks per year of obstetric sonography, usually within their own department of radiology. Residents were more likely to be sent to outside departments for second or third trimester sonography experience. A decrease in scanning assistance was reported for examinations performed after hours, more so for second or third trimester studies. Lecture topics revealed similar deficiencies for residency and fellowship programs.

CONCLUSION

Greater emphasis on the performance of prenatal sonographic examinations may be warranted during formal sonography rotations. Current levels of experience in obstetric sonography may not be providing sufficient experience to allow residents to appropriately manage call cases or for practicing radiologists to provide such services after their training is completed.

Family-based transmission disequilibrium test (TDT) and case-control association studies reveal surfactant protein A (SP-A) susceptibility alleles for respiratory distress syndrome (RDS) and possible race differences

A key cause of respiratory distress syndrome (RDS) in the prematurely born infant is deficiency of pulmonary surfactant, a lipoprotein complex. Both low levels of surfactant protein A (SP-A) and SP-A alleles have been associated with RDS. Using the candidate gene approach, we performed family-based linkage studies to discern linkage of SP-A to RDS and identify SP-A susceptibility or protective alleles. Moreover, we performed case-control studies of whites and blacks to detect association between RDS and SP-A alleles. Transmission disequilibrium test (TDT) analysis revealed that the frequency of transmission (from parent to the offspring with RDS) of alleles 6A(2) and 1A(0) and of 1A(0)/6A(2) haplotype in RDS was increased, whereas transmission of alleles 1A(5) and 6A(4) and of haplotype 1A(5)/6A(4) was decreased. Extended TDT analysis further strengthened the observations made. The case-control studies showed that in whites or blacks with RDS the frequencies of specific genotypes, 1A(0) and 6A(2) or 1A(0), were increased, respectively, but the frequency of specific 6A(3) genotypes was increased in certain white subgroups and decreased in blacks. Regression analysis revealed gestational age (GA) and 6A(3) genotypes are significant factors in blacks with RDS. In whites with RDS, GA and antenatal steroids are important factors. The data together indicate linkage between SP-A and RDS; certain SP-A alleles/haplotypes are susceptibility (1A(0), 6A(2), 1A(0)/6A(2)) or protective (1A(5), 6A(4), 1A(5)/6A(4)) factors for RDS. Some differences between blacks and whites with regard to SP-A alleles may exist.

Prestimulus cortical potentials predict the performance in a saccadic distractor paradigm

OBJECTIVE

In distractor paradigms, subjects sometimes respond to the wrong stimulus in a reflex-like manner. It is poorly understood why these errors occur.

METHODS

To investigate the cortical processes possibly responsible for these errors, we recorded event-related potentials (ERPs) in human subjects performing a distractor saccade task in which subjects had to select a saccade target based on the colour of the initial fixation point and ignore a distractor on the opposite side. The initial fixation point disappeared 200 ms before the presentation of the visual stimuli (gap period). We compared the ERPs between correct trials in which subjects looked to the correct stimulus with error trials in which they looked towards the wrong stimulus.

RESULTS

Correct response trials and error response trials showed a negative potential at the end of the gap period with the greatest amplitude over the fronto-central cortex. However, this potential had a lower amplitude in error response trials compared to correct response trials.

CONCLUSION

These findings suggest that task-specific preparatory cortical processes in the frontal lobe prior to stimulus presentation have a major influence on the performance in distractor paradigms.

Lack of cross-species transmission of porcine endogenous retrovirus infection to nonhuman primate recipients of porcine cells, tissues, or organs

BACKGROUND

Nonhuman primates (NHPs) have been widely used in different porcine xenograft procedures inevitably resulting in exposure to porcine endogenous retrovirus (PERV). Surveillance for PERV infection in these NHPs may provide information on the risks of cross-species transmission of PERV, particularly for recipients of vascularized organ xenografts for whom data from human clinical trials is unavailable.

METHODS

We tested 21 Old World and 2 New World primates exposed to a variety of porcine xenografts for evidence of PERV infection. These NHPs included six baboon recipients of pig hearts, six bonnet macaque recipients of transgenic pig skin grafts, and nine rhesus macaque and two capuchin recipients of encapsulated pig islet cells. Serologic screening for PERV antibody was done by a validated Western blot assay, and molecular detection of PERV sequences in peripheral blood mononuclear cells (PBMCs) and plasma was performed using sensitive polymerase chain reaction and reverse transcriptase-polymerase chain reaction assays, respectively. Spleen and lymph node tissues available from six bonnet macaques and three rhesus macaques were also tested for PERV sequences.

RESULTS

All plasma samples were negative for PERV RNA suggesting the absence of viremia in these xenografted animals. Similarly, PERV sequences were not detectable in any PBMC and tissue samples, arguing for the lack of latent infection of these compartments. In addition, all plasma samples were negative for PERV antibodies.

CONCLUSION

These data suggest the absence of PERV infection in all 23 NHPs despite exposure to vascularized porcine organs or tissue xenografts and the use of immunosuppressive therapies in some animals. These findings suggest that PERV is not easily transmitted to these NHP species through these types of xenografts.

Evidence of porcine endogenous retroviruses in porcine factor VIII and evaluation of transmission to recipients with hemophilia

Since 1984, unheated porcine clotting factor VIII (Hyate:C) has been used to treat severe bleeding episodes in persons with hemophilia who have antibodies to human clotting factor. We document the presence of porcine endogenous retrovirus (PERV) in plasma samples of pigs and in clinical lots of Hyate:C. Both gag and pol PERV RNA sequences were detected by reverse-transcriptase (RT) polymerase chain reaction in 13 of 13 lots of Hyate:C tested. Among 10 of these lots, RT activity also was detected, which confirms the presence of retroviral particles. To assess the transmission of PERV to Hyate:C recipients, we tested serum specimens from 88 recipients of Hyate:C and 23 noninfused control subjects for anti-PERV antibodies by using a Western blot assay. None of the samples was positive. Our data document that PERV particles are a common contaminant of Hyate:C products and suggest that the risk of PERV transmission from these percutaneous exposures is very low.

Long-term changes in the mammal fauna of logged, coastal forests near Bega, New South Wales, detected by analysis of dog and fox scats

In 1996, a study was undertaken to identify the mammals in Mumbulla State Forest near Bega on the south coast of New South Wales through the collection of dog and fox scats in the area. A total of 1121 scats was collected. The objective was to assess the changes in mammal fauna since 1981 when the first detailed analysis of predator scats was made after the forest was first logged for woodchips and sawlogs under the Eden woodchip agreement. The most notable change between the two surveys was a decrease in the canid diet of large mammals such as swamp wallaby and red-necked wallaby and the rabbit, and an increase of smaller mammals such as bush rat, long-nosed potoroo, common ringtail possum and dusky antechinus. The regrowth of the forest following logging, particularly of the understorey, increased available habitat for some species, such as the long-nosed potoroo. The shift to the smaller species was most pronounced in the diet of foxes. The decrease of rabbit in the canid diet was consistent with its relative abundance on adjacent farmland. The extensive 1996 scat collection also provided an opportunity to examine predator movements. Non-poisoned baits containing coloured markers were placed along the forest roads to determine how far dogs and foxes range between feeding and defecation. Of the marked scats collected in the forest, 67 % were found within 2 km and 94 % were found within 5 km of the bait station. These data will assist future researchers to find the locations of target species by narrowing the potential area to be searched. The primary finding of this study, namely that the mammal composition of the forest changed markedly between the two surveys, highlights the need to sample a forest through time to reveal the forest?s full ecological picture. It can be predicted that the mammal fauna composition will change again following the next logging cycle.

A survey of a low-density koala population in a major reserve system, near Sydney, New South Wales

cinereus) in Yengo National Park and Parr State Recreation Area, which together form a major reserve system where P. cinereus were known to be scarce. The first, a community survey which was distributed to 823 residences adjoining the reserves, yielded 139 responses. Of these, 31 responses provided information that allowed 26 P. cinereus locality records to be verified. A further eight P. cinereus locality records were obtained from interviews with neighbours. Most records were road-based. The second, a field survey based on scat searches, produced an additional 13 P. cinereus localities. P. cinereus scats were found under 11 tree species. Eucalyptus punctata was most frequently recorded with scats of those that were adequately sampled. A range of vegetation types and both ridges and gullies were used by P. cinereus. During field surveys, P. cinereus was found to be sparse and occurring throughout much of the survey area, concentrated in the eastern, southern and central parts of the reserve system. Both methods identified P. cinereus to be present before and after the extensive fires of January 1994, which burnt 60 % of the area. An appraisal of the methods revealed that they are complementary. The survey of residents provided recent and historical information and an indication of initial search areas for P. cinereus. The field survey yielded specific information about local P. cinereus habitat. The combination increased the number of P. cinereus records for the area more than four-fold. This study has provided the reserve managers with a clearer picture of the location of the local P. cinereus population.

Partner violence, social support, and distress among inner-city African American women

This study examined the role of social support in the partner violence-psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.

Effects of di-isononyl phthalate (DINP) on peroxisomal markers in the marmoset-DINP is not a peroxisome proliferator

In the present study the systemic toxic potential of di-isononyl phthalate (DINP) was assessed in a 13-week study in marmosets. Particular attention was given to its potential for hepatic peroxisome proliferation. Three groups of four male and four female marmosets received DINP, by oral gavage administration, at dosages of 100, 500 or 2500 mg/kg/day for 13 weeks. A fourth group served as a concurrent Control group and received the vehicle (1% methylcellulose and 0.5% Tween) only. A fifth group received clofibrate at a dosage of 500 mg/kg/day to provide a positive Control for liver peroxisome activity. At the end of the treatment period, the animals were killed and their livers were removed. 3000 x g supernatant and microsomal subcellular fractions were prepared from homogenised liver by differential centrifugation. The peroxisomal marker enzyme activity, cyanide-insensitive palmitoyl CoA oxidase, was assayed in the former, while cytochrome P450 concentration and lauric acid 11- and 12-hydroxylase activities (selective for CYP2E1 and 4A, respectively) were assayed in the microsomes. No statistically significant changes were seen in any of these parameters measured following DINP treatment, compared with the Control. Clofibrate treatment resulted in an approximately 100% increase (p < 0.01) in both male and female marmoset cyanide-insensitive palmitoyl CoA oxidase activity and a similar increase (p < 0.05) in male (only) lauric acid 11-hydroxylase activity. No other changes were statistically significant at the 5% level. These data provide no evidence that DINP was acting as a peroxisome proliferator when administered to marmosets under the conditions of the study.

Pre-hospital emergency medical services, phase I. Role of the Department of Community Health and Psychiatry

The Department of Community Health and Psychiatry was contracted by the Ministry of Health to assist with the implementation of a pilot programme in the Western Health Region to train fire fighters as basic level Emergency Medical Technicians (EMTs), and was responsible for its design, implementation and monitoring for the first 18 months. The course was covered in 440 hours over a 10 week period, and included training in emergency medical response, driving an emergency medical vehicle, emergency medical dispatching and inventory control. Of 76 fire fighters selected for training, 62 graduated, receiving Certificates of Merit from the Ministry of Health, Jamaica and were deployed into service on 17th April 1996. During the period 17 April to 31 December, 1996, the newly trained EMTs responded to 1,299 calls. Medical and surgical cases represented approximately 55% of all calls, followed by trauma (19%), motor vehicle accidents (9%) and obstetric emergencies (8%). Between 15% and 20% of calls in Montego Bay and Negril involved tourists. This first group of EMTs has performed well and was well received by the communities and the persons who used the service.

Accessibility of nucleosomal DNA to V(D)J cleavage is modulated by RSS positioning and HMG1

B and T cell receptor gene assembly by V(D)J recombination is tightly regulated during lymphoid development. The mechanisms involved in this regulation are poorly understood. Here we show that nucleosomal DNA is refractory to V(D)J cleavage. However, the presence of HMG1, a chromatin-associated nonhistone DNA-binding protein, stimulates V(D)J cleavage of nucleosomal templates. This HMG1 stimulation is differentially affected by the rotational or translational positioning of the recombination signal sequence on the histone octamer, with cleavage of the 12 bp spacer RSS showing sensitivity to rotational position and the 23 bp spacer RSS affected by its displacement from the dyad. These results suggest that V(D)J recombination can be modulated by controlling substrate accessibility and cleavage at the level of an individual nucleosome.

The cloning and expression of a new guanylyl cyclase orphan receptor

A novel membrane form of guanylyl cyclase (GC-G) has been identified through the isolation of a full-length cDNA clone; it is predicted to contain an extracellular ligand binding domain, a single transmembrane segment, and intracellular protein kinase-like and cyclase catalytic domains. That GC-G represents a guanylyl cyclase was confirmed by both transient expression in COS-7 cells and stable expression in H293 cells. Endogenous cyclic GMP concentrations of transfected or stable cells, however, were much higher than control cells, suggesting an inability of the cells to effectively regulate GC-G cyclase activity. Of six Cys residues found within the extracellular domain of guanylyl cyclase-A (GC-A), the receptor for atrial natriuretic peptide, five are conserved within GC-G. Ligands for the other cyclase receptors, nevertheless, failed to stimulate GC-G expressed in transient or stable cells, suggesting that the unknown ligands possess a structure different from the natriuretic peptides or heat-stable enterotoxins. 125I-ANP also failed to bind to H293 cells overexpressing GC-G. Based on Northern hybridization, mRNA for GC-G was predominantly expressed in lung, intestine, and skeletal muscle. Using the candidate gene approach to potentially define function, the gene for GC-G was mapped to the distal region of mouse chromosome 19 (syntenic with human chromosome 10q), but no human genetic defect has been ascribed to the GC-G locus. The finding of a new membrane form of guanylyl cyclase in peripheral tissues suggests the existence of another family or subfamily of ligands that signal through elevations of cGMP.

Determining the Distribution of The Platypus (Ornithorhyncus anatinus) in the Eden Region Of South Eastern New South Wales Through Community-Based Surveys

The distribution of Ornithorhynchus anatinus in the Eden region of south-east New South Wales is defined based on information from two community-based surveys. In 1986-87 a state-wide questionnaire survey was distributed to field staff from various government departments. A search for historical reports was also carried out. Fifty-five reports of platypuses were obtained from the Eden region, including 30 sightings on agricultural land. The second approach was through a joint National Parks and Wildlife Service and State Forests householder postal survey in 1991. The survey returns yielded 273 locations of O. anatinus of which 76% were on freehold rural land, 19% were in State Forests and 5% were in National Parks or Nature Reserves. Records from both surveys, spread from 1930 to the early 1990s, were from all parts of the region. The surveys showed that platypuses have been widespread in the region, but their now fragmented distribution indicates a reduction in the regional population of the species. Management of waterways and catchments are crucial to its long-term survival. The public awareness of the platypus shown by the number of questionnaire returns, is an encouraging sign that local plans to conserve or restore its habitat are likely to be well received if produced through the cooperative approach initiated by community-based surveys.

Development of preterm and full-term infant ability on AB, recall memory, transparent barrier detour, and means-end tasks

10 preterm and 10 full-term infants were tested longitudinally from 28 to 60 weeks of age on a modified version of the AB task, a nonreaching AB task, a Barrier Detour task, a Means-End task, and Perseveration in the Means-End task. Results show that age-corrected (age since conception) premature infants tolerated longer delays than full-term infants on the modified and nonreaching AB tasks. However, when compared by chronological age (age since birth), there were no group differences on either the reaching or nonreaching AB task. No group differences were found on Barrier Detour, Means-End, or Perseveration in either the age-corrected or chronological age comparisons. The results suggest that the function that mediates modified AB performance is one of memory and not of perseveration or means-end ability. Further, these findings suggest that current proposals about brain development based on single samples of infants may be tenuous. Finally, the results of this study suggest that development of the brain structure(s) that mediate modified AB performance is strongly influenced by experience in the postnatal environment.

Validation of probe EFD52 (D17S26) for forensic DNA analysis

Validation studies that meet TWGDAM (The Working Group on DNA Analysis Methods) and CAC (California Association of Criminalists) guidelines for RFLP (restriction fragment length polymorphism) analysis were performed with the DNA probe EFD52 (D17S26). These studies demonstrate that the probe EFD52 is suitable for forensic casework. No unexpected DNA banding patterns were obtained from controlled studies examining various tissues, sample consistency over many gels, mixtures of body fluids, various substrates, various contaminants and non-human DNA sources. Of all the animal DNAs tested, only one higher primate yielded a single band to EFD52 hybridization. The sensitivity of EFD52 was shown to be comparable to that of other forensic probes. Population frequency distribution tables were prepared from over 4000 alleles and two-locus studies were conducted on nine forensically useful probes. Black, White, Hispanic and Lumbee Indian populations were found to be in Hardy-Weinberg and linkage equilibrium. Comparisons between victim blood standards and epithelial fractions of mixed strains from sexual assault cases were used to demonstrate the robustness of the EFD52 probe in forensic casework.

African-American factor VII-deficient variants in Georgia (FVII variants)

We studied African-American Factor (FVII)-deficient variants and carriers in Georgia by measuring their levels of FVII antigen (FVIIAG) and FVII procoagulant (FVIIC). Factor VIIAG was determined using enzyme-linked immunoassay (ELISA), whereas FVIIC was measured in two ways: 1) by fibrin clotting methods that employed human recombinant (HRFVIIC), human placental (HPFVIIC), rabbit brain (RBFVIIC), and bovine brain (BBFVIIC) thromboplastins; and 2) by an amidolytic method (AMFVIIC). Prothrombin time tests (PT) were also performed by standard methods. These 4 FVII-deficient patients and 3 carriers demonstrated the following results: PT: 18.2 +/- 6.5 sec; FVIIAG: 73.0 +/- 14.9%; HRFVIIC: 30.6 +/- 20.3%; HPFVIIC: 30.5 +/- 21.4%; RBFVIIC: 25.3 +/- 21.4%; BBFVIIC: 30.6 +/- 17.5%; AMFVIIC: 44.1 +/- 18.3%. We conclude that a group of clinically mild African-American FVII-deficient variants exists in Georgia. This group is characterized by the presence of FVIIAG and decreased FVIIC, using a variety of thromboplastins; and excellent correlation was noted for both human thromboplastins.

Stimulation of oxyradical production of hepatic microsomes of flounder (Platichthys flesus) and perch (Perca fluviatilis) by model and pollutant xenobiotics

Stimulation of hepatic microsomal NAD(P)H-dependent hydroxyl radical (.OH) production by model compounds, viz. menadione (2-methyl-1,4-naphthoquinone) and nitrofurantoin (N-(5-nitro-2-furfurylidene)-1-aminohydantoin), and pollutant xenobiotics, viz. benzo[a]pyrene (BaP) diones (products of microsomal BaP metabolism), duroquinone (tetramethyl-1,4-benzoquinone--present in pulp mill effluent), and the pesticide lindane (gamma-hexachlorocyclohexane), was examined in flounder Platichthys flesus. Duroquinone was also studied in perch Perca fluviatilis, a freshwater species used in studies of pulp mill effluents in the aquatic environment. Microsomal .OH production was detected by the oxidation of the scavenging agent 2-keto-4-methiolbutyric acid (KMBA), using FeCl3/EDTA as a promotor of the Haber-Weiss reaction (O2- + H2O2 = .OH+OH- + O2). All xenobiotics tested, except lindane, showed synergistic interactions with ferric/EDTA indicative of redox cycling of the xenobiotic. Inhibition of menadione- and nitrofurantoin-stimulated .OH production by superoxide dismutase (50% inhibition) and catalase (80%) indicated respectively the involvement of O2- and H2O2 in .OH production. Maximal rates of KMBA oxidation (Vmax in nmol ethylene/min/mg protein) were similar for NADH and NADPH for menadione (4.58-4.61) and duroquinone (0.26-0.3 [flounder] and 0.93-0.99 [perch]), higher for NADPH than NADH for nitrofurantoin (1.21 and 0.77), and higher for NADH than NADPH for BaP diones, decreasing in the order 1,6-dione (1.12 and 0.14), 3,6-dione (0.75 and 0.25), and 6,12-dione (0.31 and 0.09). Rates for lindane, lacking a redox cycling structure, were low (0.01-0.05). Apparent Km (app. Km) values for xenobiotic were 1-2 orders of magnitude lower for BaP diones than the other compounds. App. Km was lower for NADH than NADPH for 3,6-dione (1.23 and 1.66 microM) and 6,12-dione (0.85 and 1.81 microM), but the reverse of this was found for the 1,6-dione (1.41 and 0.78 microM). App. Km values were almost identical for menadione and duroquinone and lower for NADPH (32-44 microM) than NADH (346-382 microM). The reverse was seen for nitrofurantoin, viz., 76 microM (NADH) and 269 microM (NADPH). Hepatic 1000 g supernatants of P. flesus metabolized BaP to oxyradical-generating products, moreso for beta-naphthoflavone-induced than control fish, and production was reduced by UDP-glucuronic acid for the latter but not the former. The studies indicate a widespread potential for contaminant-stimulated oxyradical generation via redox cycling and other free radical interactions of xenobiotics and their metabolites.

Transpulmonary angiotensin II formation and pulmonary haemodynamics in stable hypoxic lung disease: the effect of captopril

The effect of chronic hypoxic lung disease on the activity of the renin-angiotensin (RA) system and the role the RA system plays in the pulmonary vascular changes that accompany hypoxia remain controversial. We have measured transpulmonary generation of angiotensin II (A II) and pulmonary haemodynamics in nine patients with airflow obstruction (mean FEV1 = 0.741) and arterial hypoxaemia (mean PaO2 = 8.4 Pa) before and after captopril. In each patient pulmonary artery pressure, cardiac output, systemic arterial pressure, arterial and mixed venous blood gas tensions and arterial and mixed venous A II were measured at rest and at intervals for a total of 3 h after 25 mg captopril orally. The patients had moderate pulmonary hypertension (mean = 29 mmHg) and slightly raised A II levels (mean = 47.2 pg ml-1) but no step-up in A II levels across the lung. After captopril, both arterial and mixed venous A II levels fell by, on average 80% (SEM 2%), but the transpulmonary gradient for A II remained unchanged for each subject. The systemic arterial pressure fell by an average 18% (SEM 5%). In seven patients pulmonary vascular resistance fell (mean = 31%, SEM 6%) and in two patients it rose. There was no significant change in blood gas tensions. These findings suggest that patients with chronic hypoxic lung disease have decreased conversion of A I to A II in the lung but stimulation of the extra-pulmonary renin-angiotensin system. ACE inhibition appears to cause a fall in PVR in most patients with severe chronic airflow obstruction without deterioration in gas exchange.

Tumors of the pharyngomaxillary space

A bulging of the soft palate should alert one to the possibility of a mass in the pharyngomaxillary space. Work-up includes CT scan or MRI and possible needle aspiration. Open biopsy should be avoided. Benign, mixed tumors are most commonly encountered. Surgical excision by external approach is generally advocated.

Effects of naloxone on penile erection in cats

Male cats were anesthetized with pentobarbital. A Foley catheter was placed in the urinary bladder and physiologic saline, under a head of pressure, was allowed to flow at a constant rate through the bladder. Naloxone, 0.2 mg, caused penile erection in 5 of 11 experiments. The onset of action was 0.5 to 4 minutes, and the duration of the erection was 5 to 36 minutes. In two of three experiments a second injection of naloxone caused a second erection. The erection caused by naloxone was not changed by pre- or posttreatment with morphine or by posttreatment with propranolol. It was suggested that the erection could be due either to altered levels of hormones released from the central nervous system or to removal of reflex inhibitory tone in the spinal cord or sacral parasympathetic ganglia.

Survey of ophthalmic conditions in a Labrador community. I. Refractive errors

Of the 745 available members of the population of Nain in Labrador 650 (87%) were screened for refractive errors and ocular disease. Refraction by retinoscopy was done in 553 and axial length measured by an optical method in 514. The results showed that the incidence of low degrees of myopia was higher in Inuit (Eskimos) and those of Mixed Inuit-Caucasian blood in the age groups 10 to 40 than in those over 40. 75% of the myopes came from 20 families in which myopia was present in 2 or more generations. Although there was no significant correlation between the refraction of parents and offspring, there were significant correlations between them for axial length. The axial lenths of the myopic eyes of the Inuit and Mixed populations were significantly longer than emmetropic and hypermetropic eyes. The younger memebers of the population were taller than their parents, and except in female Caucasians axial length showed a significant positive correlation with height. More myopes than emmetropes and hypermetropes achieved grade 8 or more in school. It is suggested that the increased incidence of myopia in the younger age groups might be due to environmental factors interfering with the process of emmetropisation in eyes with a genetic predisposition to myopia by virtue of inheriting a slightlt longer eye. Better nutrition resulting in an increase in stature may also have had some influence.

Cerebrospinal fluid pseudocyst after urinary diversion

The development of an abdominal mass after urinary diversion in a patient with a ventriculoperitoneal shunt should alert the physician to the possibility of a cerebrospinal fluid pseudocyst. Two pediatric cases of cerebrospinal fluid pseudocysts are presented to illustrate this complication. The etiology, diagnosis and management of the pseudocyst are discussed and the literature is reviewed.

Menstrual blood-loss with intrauterine devices

The effect of three intrauterine contraceptive devices (I.U.D.)-Lippes D, Dalkon Shield, and Copper 7-on menstrual blood-loss has been studied serially by objective methods in 279 women. All the women had a minimum of two cycles following delivery, abortion, cessation of lactation, or previous pill or I.U.D. use. All pads and tampons used for two further menstrual cycles before and for 12 cycles after I.U.D. insertion were collected, and the blood-loss was measured by extracting the haemoglobin by conversion to alkaline haematin. Mean menstrual blood-loss increased with all three devices. The amount of loss, the percentage of women losing more than 80 ml, the decline in haemoglobin concentration, and the incidence of anaemia during the 12 cycles following insertion were all greater among users of the Lippes Loop than of the Copper 7 with generally intermediate values for Dalkon Shield users. The mean increases in blood-loss were: for parous women fitted with the Lippes Loop, 48 ml, with the Dalkon Shield, 34 ml, and with the Copper 7, 18 ml; for nulliparae fitted with the small size of Dalkon Shield, 27 ml, and, with the Copper 7, 19 ml.

Serial studies of immunocompetence of patients undergoing chemotherapy for acute leukemia

Immunocompetence was followed serially for 1 yr from the onset of treatment in 55 adult patients with acute leukemia. The tests used were delayed hypersensitivity responses to a battery of five recall antigens (dermatophytin, dermatophytin 0, candida, streptokinase-streptodornase, and mumps) and in vitro lymphocyte blastogenic responses to phytohemagglutinin and streptolysin 0. There was a strong correlation between immunocompetence at the start of treatment and a good prognosis; 32/39 patients who subsequently entered remission were initially immunocompetent compared to 4/15 who failed to enter remission. In the complete remission group there was a decline in competence starting from 2 to 5 mo after the onset of treatment. In those who remained in remission for 1 yr, competence recovered at 6 mo and remained vigorous thereafter. In those who relapsed before 1 yr, the decline in competence occurred 1 mo before relapse and competence continued to decline progressively during the 1 yr follow-up period. These studies suggest that therapeutic approaches which restore immunocompetence or prevent its decline will improve both the remission rate and the remission duration of patients with acute leukemia.