Assessment of psychological distress in prospective bone marrow transplant patients

Patient psychological distress is associated with many aspects of the bone marrow transplantation (BMT) process and has been linked with poor treatment outcomes. We assessed psychological distress in potential BMT candidates, and compared patient and nurse coordinator ratings of emotional distress at the time of initial BMT consultation. Fifty patients self-reported psychological distress using both the NCCN Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Coordinators rated patient emotional distress using the DT and Coordinator Rating Scales that measure anxiety and depression. Fifty and 51% of patients self-reported clinically significant levels of emotional distress and anxiety, respectively, but only 20% self-reported clinically significant levels of depression. There was good correlation between ratings using the brief DT and the more comprehensive HADS. There was significant but only moderate agreement between patient and coordinator ratings of emotional distress and anxiety, with coordinators underestimating the number of patients with high levels of emotional distress. In addition, coordinator ratings of patient emotional distress primarily reflected anxiety, whereas anxiety and depression together only minimally accounted for patient self-reports of psychological distress. These findings suggest that: (1) the DT can be a useful screening device; (2) approximately half of patients at the time of initial consultation for BMT already experience significant levels of psychological distress; and (3) coordinators observe emotional distress primarily as anxiety, but patients experience psychological distress as something more than anxiety and depression.

A randomised controlled trial of a self-management plan for patients with newly diagnosed angina

BACKGROUND

There are approximately 1.8 million patients with angina in the United Kingdom, many of whom report a poor quality of life, including raised levels of anxiety and depression.

AIM

To evaluate the effect of a cognitive behavioural disease management programme, the Angina Plan, on psychological adjustment in patients newly diagnosed with angina pectoris.

DESIGN OF STUDY

Randomised controlled trial.

SETTING

Patients from GP practices in a Northern UK city (York) between April 1999 and May 2000.

METHOD

Recruited patients were randomised to receive the Angina Plan or to a routine, practice nurse-led secondary prevention educational session.

RESULTS

Twenty of the 25 practices invited to join the study supplied patients' names; 142 patients attended an assessment clinic and were randomised There were no significant differences in any baseline measures. At the six month post-treatment follow-up, 130 (91%) patients were reassessed. When compared with the educational session patients (using analysis of covariance adjusted for baseline scores in an intention-to-treat analysis) Angina Plan patients showed a greater reduction in anxiety (P = 0.05) and depression (P = 0.01), the frequency of angina (reduced by three episodes per week, versus a reduction of 0.4 per week, P = 0.016) the use of glyceryl trinitrate (reduced by 4.19 fewer doses per week versus a reduction of 0.59 per week, P = 0.018), and physical limitations (P<0.001: Seattle Angina Questionnaire). They were also more likely to report having changed their diet (41 versus 21, P<0.001) and increased their daily walking (30 versus 2, P<0.001). There was no significant difference between the groups on the other sub-scales of the Seattle Angina Questionnaire or in any of the medical variables measured.

CONCLUSION

The Angina Plan appears to improve the psychological, symptomatic, and functional status of patients newly diagnosed with angina.

A computerised quality control testing system for B-mode ultrasound

Current methods of ultrasound (US) imaging quality control involve an observer taking a series of measurements on test object images. This process is very labour-intensive, rapidly becoming more so as the complexity of US scanners increases. Also, many of the measurements are based on the subjective judgement of the operator and are, therefore, prone to an undesirable level of intraobserver and interobserver variation. We have developed a suite of programs to analyse captured US images to estimate a number of performance parameters, including resolution, high- and low-contrast penetration depths and high- and low-contrast sensitivity. In this system, images of the ATS Laboratories Multipurpose Phantom Model 539 are acquired on a PC with a video capture card, and analysed using the software developed. Automated tests have been developed for resolution, low- and high-contrast penetration and low- and high-contrast sensitivity. A preliminary validation of the system was carried out using images from two curvilinear probes and a linear-array probe operating at 5 MHz, 7.5 MHz and 10 MHz, respectively. The 95% confidence intervals ranged from +/- 17% to +/- 21% for resolution measurements and from 0% to +/- 1.5% for low-contrast penetration. The system provides an index of visibility for high- and low-contrast targets, as compared to the coarse visual assessment of a human observer, with 95% confidence intervals ranging from +/- 6% to +/- 13% for low-contrast sensitivity and from +/- 3% to +/- 25% for high-contrast sensitivity. Advantages of the system over the human observer include improved reproducibility and increased information regarding visibility of targets. A more detailed multicentre validation is currently being undertaken.

Novel (4-piperazin-1-ylquinolin-6-yl) arylsulfonamides with high affinity and selectivity for the 5-HT(6) receptor

The discovery of (4-piperazin-1-ylquinolin-6-yl) arylsulfonamides and their binding affinities for a selection of 5-HT and dopamine subreceptors is described. Many compounds show high affinity (pK(i)>8) for the 5-HT(6) receptor and >100-fold selectivity against a range of other receptors. Structure-activity relationships of these compounds are discussed.

Trends in the incidence of nonmelanoma skin cancers in southeastern Arizona, 1985-1996

This report describes trends in the incidence of various nonmelanoma skin cancers in a region of high ultraviolet exposure. The Southeastern Arizona Skin Cancer Registry routinely identified cases of skin cancer between 1985 and 1996 through pathology logs and reports from dermatology offices and laboratories in 3 Arizona counties. The incidence rates for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) for non-Hispanic whites were 3 to 6 times higher than the incidence rates from more northern regions. The rates for non-Hispanic whites were approximately 11 times greater than rates for Hispanics. Furthermore, there was no constant increase in the incidence of nonmelanoma skin cancers. The incidence of SCC, in particular, demonstrated a plateau or even a modest decline between 1985 and 1996. Thus the incidence rates of both SCC and BCC in Arizona, although among the highest in the world, do not appear to be increasing as rapidly as predicted elsewhere.

The use of a whole body index with bone scintigraphy to monitor the response to therapy in Paget's disease

Bone scintigraphy has long been used to assess Paget's disease and investigate the response to therapy. Objective visual assessment is, however, difficult. The aim of this study was to derive, from a bone scintigram, an index which objectively measured the extent and severity of Paget's disease in the entire skeleton. This whole body index would provide a single numerical value which could be used to monitor the response to therapy in both monostotic and polyostotic disease. Comparison with other methods of assessing the condition, such as biochemical markers and pain scores, would also be possible. The whole body index was developed and used to retrospectively analyse 80 bone scintigrams on 40 patients. The majority of patients (36) received treatment with a bisphosphonate between the two scintigrams. Whole body index was compared with serum alkaline phosphatase measured at the same time; a significant correlation was found (before treatment P=0.001, after treatment P<0.001). The change in whole body index and alkaline phosphatase following treatment with various bisphosphonates was also investigated and a significant correlation found (P<0.001). Whilst performing the analysis it was also noted that the increase in uptake of the radiopharmaceutical was significantly greater in the cortical long bones than in the trabecular axial skeleton. This study suggests that a whole body index may be a suitable tool for assessing the response to treatment in Paget's disease.

A review of two alternative ultrasound quality assurance programmes

OBJECTIVE

This study reviewed the results of B-mode Quality Assurance (QA) performance tests on 17 real-time ultrasound scanners, performed over a period of 3 years, in order to assess their value. Following this review we revised and simplified our testing schedules to include two tests for noise and sensitivity. The value of the new schedules was assessed.

METHODS

Initially, testing schedules were similar to those recommended by two professional bodies. Results were reviewed to determine whether the tests predicted or confirmed faults. We then introduced a simplified testing programme using alternative measurements, attempting to demonstrate or predict noise related faults that affect the image, but were not demonstrated by current tests. These new tests have been performed on 24 ultrasound machines for up to 18 months.

RESULTS

A review of results has shown that measurements occasionally fall outside tolerance due to chance, and that faults that significantly affect the image, e.g. probe faults and noise, are reported by the users without predictive or concomitant changes in test results using our original schedules. Faults occur that do not immediately affect image quality and are not reported by the users. Inappropriate settings, e.g. monitors, are frequently reset at QA, particularly where there are potentially untrained users. The additional tests showed consistent changes in noise (four) or sensitivity (one) on five machines.

CONCLUSION

Our earlier tests were inadequate in demonstrating deterioration in the clinical performance of ultrasound imaging equipment. Introduction of a revised testing schedule has resulted in changes in equipment performance being detected and rectified.

Phenyl benzenesulfonamides are novel and selective 5-HT6 antagonists: identification of N-(2,5-dibromo-3-fluorophenyl)-4-methoxy-3-piperazin-1-ylbenzenesulfonamide (SB-357134)

Substituted N-phenyl-4-methoxy-3-piperazin-1-ylbenzenesulfonamides and conformationally restricted analogues have been identified as high affinity and selective 5-HT6 antagonists. Compounds from this series had a range of pharmacokinetic profiles in rat and in general there was a correlation between clearance and CNS penetration. Based on its overall biological profile 2 (SB-357134) was selected for further pre-clinical evaluation.

A back-propagation neural network predicts absorption maxima of chimeric human red/green visual pigments

The absorption spectra of human red and green visual pigments have peak wavelengths, lambda max, that differ by 31 nm, yet the opsins differ in only 15 amino acids. Mutagenesis studies have demonstrated that seven of the 15 amino acids determine the spectral shift. We trained neural networks to predict the lambda max of any red/green chimeric protein. Seven mutants were excluded from the original training set. The trained networks were able to predict the lambda max for the excluded mutants. As an additional test, five new chimeric pigments were constructed and lambda max determined. The neural networks correctly predicted the lambda max of all five mutants. The use of neural networks is a novel approach to the problem of wavelength modulation in visual pigments.

Acute myocardial infarction: are there missed opportunities for reperfusion? UK Heart Attack Study Investigators

AIMS

To investigate the current use of thrombolytic therapy in the management of patients with acute myocardial infarction and to determine the potential for an increased use of thrombolysis or percutaneous transluminal coronary angioplasty (PTCA).

METHODS AND RESULTS

All hospitalised cases of acute myocardial infarction were identified in three health districts in the UK (population of 960,000) in patients under the age of 76 years during a 2-year period; 2439 patients had acute myocardial infarction, of whom 1264 (52%) received thrombolytic therapy. Failure to administer thrombolytic therapy was a result of the absence of diagnostic electrocardiograms in 712 (29.2%) patients, late presentation in 127 (5.2%), therapeutic error in 112 (4.6%), presence of a bleeding risk in 139 (5.7%) and other miscellaneous reasons in 80 (3.3%) patients. Thirty-eight of the 139 patients in whom bleeding risk was reported as a contra-indication could, in retrospect, have received thrombolytic therapy and a further 76 would have been suitable for primary PTCA.

CONCLUSIONS

The potential for increasing the use of thrombolytic therapy seems to be limited and is unlikely to make a major impact on the in-hospital mortality from acute myocardial infarction. However, primary PTCA should be considered in those who are ineligible for thrombolysis because of bleeding risk as a contra-indication.

The clinical course of patients with acute myocardial infarction who are unsuitable for thrombolytic therapy because of the presenting electrocardiogram. UK Heart Attack Study Investigators

OBJECTIVE

To examine the clinical characteristics and 30-day fatality rate among patients with electrocardiograms (ECGs) ineligible for fibrinolysis in a consecutive series in four general hospitals in the UK.

METHODS

We studied 2439 consecutive patients who were identified from regular ward visits, surveillance of results from hospital laboratories, and hospital discharge coding.

RESULTS

Thirty percent (732) of patients did not have ECGs eligible for fibrinolysis therapy, while indications were uncertain in 55 (2%). Within the ineligible group, patients presenting with ST depression (n = 294) had a higher 30-day fatality rate than those with ST elevation or left bundle branch block (26% versus 17%; P < 0.001); they represented 40% of the group ineligible for fibrinolysis therapy, or 12% of the total cohort. Thirty-day fatality rates in patients presenting with pathological Q waves and no diagnostic ST segment changes (n = 130), those with T wave changes but no other abnormality (n = 168) and those with a normal ECG (n = 128) were 10%, 5% and 3%, respectively. Despite their high fatality rate, fewer patients with ST depression were admitted to coronary care units than those with ECGs eligible for fibrinolysis therapy (61% versus 85%; P < 0.001) and 23% did not receive heparin. The coronary anatomy in a subset of patients with ST depression showed two- or three-vessel disease in 79% and left main stenosis in 9%. The rates of coronary revascularisation were low in all groups (< 10%).

CONCLUSION

Patients with ECGs ineligible for fibrinolysis therapy are a disparate group, with a high rate of fatality occurring in patients who present with ST depression. The high prevalence of multiple vessel coronary disease in patients with ST depression suggests that a more active management strategy is required.

Familial influences on gambling behavior: an analysis of 3359 twin pairs

BACKGROUND

Pathological gambling is becoming an increasing problem in the United States as the number of legalized gambling establishments grows. To examine vulnerability to pathological gambling, we estimated the familial contributions (i.e. inherited factors and/or experiences shared by twin siblings during childhood) to DSM-III-R pathological gambling symptoms and disorder.

METHODS

Data were obtained from a telephone interview performed in 1991-92 utilizing the Diagnostic Interview Schedule Version III-Revised. Interviews were administered to 6718 members of the nationally distributed Vietnam Era Twin Registry of male-male monozygotic and dizygotic twin pairs who served in the military during the Vietnam era.

RESULTS

Inherited factors explain between 35% (95% CI: 28%, 42%) and 54% (95% CI: 39%, 67%) of the liability for the five individual symptoms of pathological gambling behavior that could be estimated statistically. In addition, familial factors explain 56% (95% CI: 36%, 71%) of the report of three or more symptoms of pathological gambling and 62% (95% CI: 40%, 79%) of the diagnosis of pathological gambling disorder (four or more symptoms).

CONCLUSIONS

Familial factors have an important influence on risk for pathological gambling behavior. The increasing access to legalized gambling is likely to result in a higher prevalence of pathological gambling behavior among individuals who are more vulnerable because of familial factors.

The importance of rigorous testing of circumference measuring callipers

On-screen circumference measurements are frequently made in obstetric ultrasound and are also made in other ultrasound specialties. The accuracy of electronic callipers is traditionally checked by linear measurement in a test object; this does not adequately test callipers used for nonlinear measurement. This technical note describes a simple test object designed for both linear and nonlinear calliper checks. Results show one machine to generate consistently large overmeasurements (15%). The clinical consequences of such overmeasurement may be serious. Appropriate quality control is essential.

Utilization of ovarian cancer screening by women at increased risk

Our objective was to identify demographic, medical, and psychological correlates of ovarian cancer screening utilization in a sample of women at increased risk. We designed a cross-sectional study that evaluated demographic factors, risk factors, psychological factors, and utilization of ovarian cancer screening in first-degree relatives of ovarian cancer patients. In multivariable analysis, use of CA-125 was associated with number of affected relatives [odds ratio (OR), 2.9; 95% confidence interval (95% CI), 1.3-6.5] and ovarian cancer worries (OR, 2.9; 95% CI, 1.1-8.1). For ultrasound (transvaginal or abdominal), the model included employment status (OR, 2.7; 95% CI, 1.1-6.8) and ovarian cancer worries (OR, 3.3; 95% CI, 1.2-9.1). Significant interaction terms in the ultrasound models indicated that employment was a significant predictor of ultrasound utilization in women with 2 or more affected relatives. Among women with only one affected relative, ultrasound use was strongly associated with the presence of ovarian cancer worries. Utilization of ovarian cancer screening among women at increased risk is influenced by psychological and sociodemographic factors, in addition to level of risk.

The estimation of administered activity of krypton-81m for lung ventilation studies

Measurement or estimation of the activity of krypton-81m administered to a patient during lung ventilation imaging is difficult, due to the short half-life and continuous delivery via pipework, and no satisfactory method exists. Calculations based on generator activity have the disadvantages that this activity may not be accurately known and that not all activity eluted is inhaled by the patient. The aim of this study was to develop a simple method for estimating the administered activity from the number of counts in each patient image. A formula based on the ratio of counts in 81mKr and technetium-99m lung ventilation and perfusion images was developed and reduced so that administered activity could be directly calculated from the total 81mKr counts, the 99mTc count rate, the administered activity of 99mTc and a constant representing the ratio of counts expected from equal activities of each radioisotope. The formula allows a direct calculation from the image acquisition data following an initial set of experimental work to establish the constant for a particular gamma camera and collimator system.

Analysis of local electrogram characteristics correlated with successful radiofrequency catheter ablation of accessory atrioventricular pathways

Due to the limited myocardial lesions produced by radiofrequency current, the ablation of accessory pathways (AP) requires precise localization of such connections. The purpose of this study was to ascertain which characteristic(s) of the local bipolar electrogram, recorded from the ablation and adjacent electrode immediately prior to the application of radiofrequency current, correlated with precision in localization adequate to permit AP ablation. Signal analysis was performed for 326 sets of electrograms preceding the attempted ablation of 107 APs in 100 consecutive patients. For 80 antegrade APs, the following variables were evaluated: (1) the presence or absence of an AP potential; (2) the local atrial-AP interval; (3) the local atrioventricular (AV) interval; and (4) the relationship between the onset of local ventricular depolarization and onset of delta wave of the surface electrocardiogram. For the 27 concealed APs, the following characteristics were evaluated: (1) the presence or absence of an AP potential; and (2) the local VA interval during reciprocating tachycardia or ventricular pacing.

RESULTS

Antegrade APs: By statistical analysis, the best correlate of successful ablation of an antegrade AP was a local AV interval less than or equal to 40 msec (positive predictive value = 94%; 95% confidence intervals [CI] = 81%-100%). Local AV intervals less than or equal to 50 msec preceded 88% of successful AP ablations, compared to only 8% of failed radiofrequency current applications. The positive predictive value of the other variables were: presence of an AP potential: 35% (95% CI = 27%-40%); local atrial-AP intervals less than or equal to 40 msec: 54% (95% CI = 43%-66%); and local ventricular depolarization preceding onset of the delta wave 43% (95% CI = 34%-52%). For concealed APs, the positive predictive value of a VA interval less than 60 msec was 71% (95% CI = 48%-88%); the positive predictive value for the presence of an AP potential was 58% (95% CI = 32%-81%).

CONCLUSIONS

No single electrogram characteristic had a positive predictive value and a sensitivity greater than 90% for AP localization adequate for radiofrequency current ablation. For antegrade APs, the best correlate of adequate localization was a local AV interval less than or equal to 40 msec; as a corollary, radiofrequency current applications at sites where the local AV was greater than 60 msec, were unlikely to be effective. Objective criteria for the localization of concealed APs were less certain. Electrogram analysis, as a guide to AP localization and ablation, requires careful analysis of multiple variables, with analysis of the local AV interval a salient objective factor.

Caffeine and ventricular arrhythmias. An electrophysiological approach

Little information is known regarding caffeine's effect on the substrate supporting sustained ventricular arrhythmias. This prospective study evaluated the effect of coffee (275 mg of caffeine) on this substrate with programmed ventricular stimulation in 22 patients with a history of symptomatic nonsustained ventricular tachycardia, ventricular tachycardia, or ventricular fibrillation. Patients underwent electrophysiological testing before and 1 hour after coffee ingestion. Mean (+/- SEM) plasma caffeine level achieved after coffee consumption was 6.2 +/- 0.5 mg/L. Mean plasma catecholamine and potassium values were not altered significantly 1 hour following caffeine ingestion. The number of extrastimuli required to induce an arrhythmia was unchanged in 10 patients (46%), increased in six (27%), and decreased in six (27%). Rhythm severity was unchanged in 17 patients (77%), more severe in two (9%), and less severe in three (14%). In those patients with clinical ventricular arrhythmias, caffeine did not significantly alter inducibility or severity of arrhythmias, suggesting little effect on the substrate supporting ventricular arrhythmias.

Combined medical and psychological treatment of hospitalized children with encopresis

Sixteen children, all inpatients at a state psychiatric hospital, received combined medical and psychological treatment for encopresis. One-year follow-up showed significant improvement. The results suggest that encopresis can be treated in severely emotionally disturbed children with a multifaceted and multidisciplinary approach.

Effects of sexual and physical abuse: a comparison of adolescent inpatients

The present study was designed to collect descriptive data on a sample of hospitalized adolescents who were victims of sexual and/or physical abuse and to compare these groups to patients without a history of abuse. A questionnaire was administered to 51 inpatient teenagers at Fort Logan Mental Health Center, a state psychiatric hospital in Denver, Colorado. Information was obtained about family background, type, extent and duration of abuse, drug and alcohol abuse and self-reported mental health and general adjustment problems. In addition, clinical staff completed the Revised Behavior Problem Checklist (1) for the subjects. The results indicated statistically significant differences (p less than .05) between groups with adolescents who were both physically and sexually abused reporting the most problems. The implications for the findings for treatment are discussed.

Ventricular fibrillation survivors in whom tachyarrhythmia cannot be induced: outcome related to selected therapy

Eight-five patients were studied to determine the prognosis of the ventricular tachyarrhythmias at the time of electrophysiologic study. Twenty-five patients (29%) were not inducible when we used a stimulation protocol consisting of up to four extrastimuli delivered at two right ventricular sites. Patients with no inducible arrhythmias were younger (53 vs 59 yrs; p = .06) and had higher ejection fractions (.49 vs .34; p less than .04) than the inducible ventricular fibrillation survivors. Sex, cardiac diagnosis, time from event to electrophysiologic study, and antiarrhythmic therapy at the time of event did not discriminate between those with and those without inducible ventricular tachyarrhythmias. Survival free of recurrent sudden death or ventricular tachycardia was .86 +/- .05 and .95 +/- .05 for patients with and without inducible tachyarrhythmias, respectively (p = .22). Nine of 25 (36%) patients with no inducible arrhythmias developed inducible ventricular tachyarrhythmias when testing was repeated with an antiarrhythmic drug. Ventricular fibrillation survivors not inducible at the time of programmed ventricular stimulation (using a stimulation protocol consisting of four extrastimuli delivered at two right ventricular sites) seem to have a good prognosis. Many "noninducible" patients develop inducible tachyarrhythmias when placed on antiarrhythmic therapy. Because it is possible that these drugs are proarrhythmic, empiric antiarrhythmic therapy should be avoided in these patients.

Sudden death prediction by programmed electrical stimulation following myocardial infarction

To determine prospectively whether electrophysiologic testing is prognostically useful following a myocardial infarction, 38 patients were studied. Ventricular tachycardia was induced in 32 of 38 (84%) patients (sustained in 12) and was significantly increased with the use of three or four extrastimuli. In 17 months' mean follow-up, 4 patients died suddenly or survived an episode of sustained ventricular tachycardia. Programmed ventricular stimulation was a sensitive but not a specific predictor of these events with an overall 24% predictive accuracy. The use of one or two extrastimuli substantially improved specificity but was insensitive in predicting sudden death or ventricular tachycardia. Programmed ventricular stimulation soon after uncomplicated myocardial infarction was not a useful prognostic indicator for sudden death or subsequent ventricular tachycardia.

Prognostic value of programmed electrical stimulation in patients with a recent episode of unstable angina

Patients with a recent episode of unstable angina have a 10% 1-year risk of sudden cardiac death. To determine prospectively whether electrophysiologic testing might be useful in predicting sudden death, 20 patients admitted to our hospital underwent programmed electrical stimulation as part of their evaluation. None had persistent angina, severe congestive heart failure, or sustained arrhythmias at the time of testing. Because of their long-term benefits, beta-blocking agents were continued whenever possible (18 of 20 patients). Ten of 20 patients (50%) had inducible ventricular tachycardia. In 19.5 months' mean follow-up, three patients (15%) either died suddenly or survived an episode of ventricular fibrillation. Programmed electrical stimulation was an insensitive (33%) and nonspecific (47%) predictor of sudden death in these patients. Programmed ventricular stimulation soon after admission for unstable angina is not a useful prognostic indicator for sudden death. Such patients do have a frequent induction of ventricular arrhythmias which appears to be a nonspecific marker of underlying coronary disease.

A comparison of two behavioral treatments in decreasing the orofacial movement of tardive dyskinesia

In a study with an elderly female subject, two behavioral treatments were evaluated in terms of their effectiveness in decreasing orofacial movement associated with tardive dyskinesia. Video feedback and discreet-discrete prompting, a self-control procedure using a portable audio signal generator, were compared by means of an alternating treatments experimental design. Video and instructional controls were included in the study. Results indicated that both procedures were effective in decreasing orofacial movement. In addition, during the concluding phase of the study, a prompting card was carried by the subject at all times as a reminder to control mouth movements on an ongoing basis. This concluding phase resulted in generalization of treatment effects to the nontreatment environment. Follow-up sessions indicated maintenance of treatment effects.

Measurement of human skeletal muscle acetylcholine receptor antibodies using monkey receptors

Human skeletal muscle acetylcholine receptor (AChR) antibodies were assayed by a double immunoprecipitation technique using 125I-alpha-bungarotoxin as the label. Monkey AChRs were found to be superior to those from diabetic humans for analytical and practical reasons. The analytical sensitivity is 0.05 nmol alpha-bungarotoxin/L serum. The between-run and within-run precision (1 c.v.) of the assay are 13% and 3%, respectively. The normal range is 0-0.2 nmol alpha-bungarotoxin/L. There was no correlation between the antibody concentration and the clinical severity of myasthenia gravis. The clinical sensitivity and specificity of the assay for generalized myasthenia gravis are 79% and 96%, and for ocular myasthenia gravis 29% and 96%, respectively.

Immunocompetence and malignant lymphoma: immunologic status before therapy

One-hundred-eighty-six previously untreated patients with malignant lymphoma were evaluated for immunocompetence by means of several tests of immune function: total circulating lymphocytes, T cells (E-rosettes), B cells (EAC-rosettes), delayed hypersensitivity to six recall antigens, serum immunoglobulins, mixed lymphocyte culture, and lymphocyte mitogenic response to phytohemagglutinin and pokeweed mitogen. The results were correlated with histology, stage, and clinical features. Diffuse lymphomas, especially diffuse histiocytic (large cell) (DHL), were associated with decreased absolute lymphocytes and E-rosette forming cells. Skin test reactivity varied with both histology and stage. For example, only one of six tests was impaired in diffuse lymphocytic well differentiated (DLWD) lymphoma in contrast to two of six in localized DHL and five of six in advanced DHL. Patients with nodular lymphoma exhibited depressed mean levels of IgA and IgG, while only IgA was significantly decreased in diffuse lymphoma. Mitogen stimulation was depressed in all groups, although mixed lymphocyte cultures did not differ significantly from controls. In summary, there is a spectrum of immunodeficiency of both B and T cell type in patients with malignant lymphoma that correlated with histology and stage. Implications and possible mechanisms of these observations are discussed.

Circadian variation in urinary melatonin in clinically healthy women in Japan and the United States of America

Urinary melatonin excretion is lower in East-Asian (Japanese) than in North-American (whites of mixed ethnic origin) women. Moreover, a statistically significant circadian rhythm is demonstrated by population-mean cosinor in the data pool from both groups of women. Furthermore, statistical significance characterizes interactions of effects from geographic differences (between ethnic groups) with temporal factors. Such spatio-temporal interactions await further scrutiny with a view inter alia of carcinogenesis as it is influenced by a spectrum of intermodulating rhythms.

Limitations of a portable infusion pump in ambulatory patients receiving continuous infusions of anticancer drugs

The delivery of continuous iv bleomycin and 5-fluorouracil to nine ambulatory cancer patients was studied using a novel disposable portable infusion pump, the Ar/Med Infusor. Although the chemotherapy was satisfactorily delivered, there were significant mechanical problems, including variable flow rates and substantial drug cartridge failure. Most therapy courses were finished within 10% of the projected termination time. Serious venous complications did not occur. While further exploration of various devices for outpatient continuous iv therapy is recommended, we believe that technical improvements are needed for the Ar/Med Infusor.

Immunodeficiency in patients with non-Hodgkin lymphomas

Seventy-one previously untreated patients with non-Hodgkin lymphomas were studied with several readilyvailable tests of immune function: number of peripheral blood lymphocytes, serum immunoglobulins, and delayed hypersensitivity to six recall antigens. The results were correlated to histology (Rappaport classification), stage (Ann Arbor classification), the presence of symptoms, and survival. As a group, 38 patients with diffuse lymphomas exhibited marked impairment in reactivity to five of six antigens (p less than 0.03 to p less than 0.001). In addition, lymphopenia and reduced levels of serum IgA were found in association with diffuse histiocytic lymphoma. Among patients with diffuse lymphoma, lymphocyte number and skin test reactivity tended to be greater in those with localized disease or without constitutional symptoms, and survival was superior for patients free of symptoms (p less than 0.01). As a group, 33 patients with nodular lymphoma had normal numbers of lymphocytes, lower levels of serum IgG and IgA, and significant impairment of reactivity to two antigens (streptokinase-streptodornase and mumps; p less than 0.01); reactivity to three other antigens (Candida albicans, coccidiodin, and tuberculin) was normal. Survival for patients with nodular lymphoma was superior (p less than 0.01) compared to those with diffuse lymphomas. In summary, severe immunodeficiency was found in patients with diffuse lymphoma (particularly diffuse histiocytic lymphoma), and definite but much less severe immunodeficiency was characteristic of patients with nodular lymphoma.

Conversion of protein nitrogen into gaseous catabolites by the chick embryo

Chicken eggs incubated under hatchery conditions for 19 days show significant decreases in the total content of water and organic nitrogen, but not of sodium or potassium. The hypothesis is discussed that the formation of gaseous nitrogen is responsible for the nitrogen loss.