[Intestinal malabsorption of glucose and galactose. Study of a family]

A girl with congenital glucose-galactose malabsorption and her two parents were studied. Hydrogen breath tests performed on the child during glucose and galactose tolerance tests (0.5 g/kg) were positive (increase in expired pH concentration of 21 p.p.m. and 32.5 p.p.m. from the basal level respectively). This was negative for fructose (2 g/kg). In vitro intestinal transport studies showed: 1) a selective decrease in active glucose accumulation (intracellular concentration 0.34 mM in 0.1 mM glucose bathing solution - controls: 1.58 +/- 0.56 (means +/- SD), and 12.1 mM in 10 mM bathing solution - controls: 38.4 +/- 12.4). 2) absence of net glucose absorption during in vitro Ussing chamber measurements with a marked decrease in mucosal membrane glucose permeability. For the parents, the hydrogen breath test was negative after glucose and galactose ingestion (2 g/kg) and intestinal transport was normal (father; intracellular concentration 1.32 mM and mother 2.04 for 0.1 mM bathing glucose concentration). The marked decrease in brush border permeability explains the absence of net glucose absorption in the child. The parents who are presumed to be heterozygotes did not exhibit any detectable transport defect.

Procedures and discrepancies of blood pressure measurements in two community health centers

Three studies of blood pressure measurement were conducted in two primary care clinics. In study I, procedures for taking blood pressure were observed for seven nurses, and their readings were compared with readings taken in a standard manner. The results show that the nurses' procedure needed improvement; the systolic/diastolic discrepancies with the standard averaged 10.2/7.5 mmHg. In study II, the nurses were trained to improve their procedure, and readings were again compared. The results show improvement for moderate, but not for large, discrepancies in diastolic readings. In study III, two physicians' procedure for taking blood pressure indicated that their procedures could also be improved. Overall, there was little correlation between potential biases in providers' procedures and discrepancies with the standard. The discrepancies between the nurse and physician readings led to different treatment indicators in 22-26 per cent of the observations.

In vitro human lymphocyte PHA response- the heterogeneous effect of methylazoxymethanol acetate

In earlier studies on the effect of methylazoxymethanol acetate (MAM AC), a mutagen, teratogen and carcinogen, upon sister chromatid exchange, the concentrations tested in short-term lymphocyte cultures from 9 individuals were not identical for each person. (The concentrations were derived from dose-effect curves for each individual, involving the quantity of MAM AC [5...50...80 µg/ml] versus blast transformation using PHA.) The differences obtained between the curves were investigated further by repeating the dose-effect curves in cell cultures derived from 10 normal male individuals, except that Ficoll-Hypaque-purified mononuclear cells were cultured at a concentration of 3 × 10⁵ viable cells/ml. Five identical microwell cultures (150 µl) were tested for each variable within an individual experiment. Controls with and without PHA (PHA+, PHA-) were included. The results show that not all individuals’ cultures exhibited the same PHA response for each concentration of MAM AC. In the 10 cases studied: (1) dose-effect curves were not uniform for all experiments; (2) the percentages of ³H-incorporation at 5 µg/ml of MAM AC compared to that of PHA+ controls were not the same across experiments; depending on the experiment, 5 µg/ml significantly increased, reduced or had no effect on PHA when ³H-uptake was compared to PHA+ control levels; (3) when mean log values of the above percentages were plotted with their confidence intervals, striking differences were exhibited between individuals or groups of individuals; (4) the TD₅₀ values, referred to as the concentration of MAM AC at which half as much label was incorporated as compared to PHA+ control cultures, were different, and (5) the lowest MAM AC concentrations effective in reducing ³H-uptake levels to those of PHA-controls were not the same. Familial and/or laboratory animal studies will demonstrate whether these differences are genetically determined.

Helping minority and low-income psychotherapy patients "Tell It Like It Is"

The development and field testing of an instructional slide/cassette program entitled "Tell It Like It Is" are described. The program is a major component of a three-year study to assess the effects of patient orientation, therapist orientation, and the interaction of the two upon the psychotherapy process and outcome for working class and low income Mexican American, Black American, and Anglo American patients.

Human sister chromatid exchange caused by methylazoxymethanol acetate

The incidence of sister chromatid exchange was determined in human leucocyte cultures treated with methylazoxymethanol acetate. In all individuals examined, treated cultures manifested a significantly higher frequency of sister chromatid exchanges than controls. Two concentrations of MAM AC were tested in blood cultures from nine individuals. The concentrations varied from individual to individual since they were determined by means of individual dose-response curves, which involved [3H]-thymidine incorporation in PHA-stimulated short-term lymphocyte cultures versus MAM AC contraction. The lower concentration was less than the TD50 dose. Compared to control cultures, the lower concentration caused a higher incidence of sister chromatid exchange in eight of nine individuals. The cumulative mean value for all control cultures was 5.32 exchanges per cell while that for cultures treated with the higher concentration was 10.73.

House staff training in cardiopulmonary resuscitation

An audiovisual instructional program has been developed to teach cardiopulmonary resuscitation (CPR) to new interns and house staff. The entire program conformed to standards established in this subject and was devised so that it could be used for either large or small group instruction. Special projection equipment and a computerized student response system made it possible to use the audiovisual material with large groups and yet maintain most advantages of individual instruction. Following the instructional sessions small group workshops gave students an opportunity to demonstrate CPR and to receive guidance from trained personnel. Small group instruction was also enhanced by use of the audiovisual materials. After participation in the program, all interns were judged competent in performing required CPR tasks; 98% rated the program "good" or "excellent".

Development of a self-instructional program on pressure-controlled ventilators

Discussed are the instructional development, materials, application, and evaluation of a program to train staff to apply pressure controlled ventilators correctly and to recognize and correct malfunctions in the apparatus. The self-instructional portion of the program requires slide sets, audiotapes, workbooks, and some of the sections require special apparatus. The rest of the program includes demonstrations, supervised practice, and experience in a recovery room. Compared to lecture technique, faculty teaching time has been reduced by half; teaching tends to be more satisfying, and the performance of students who complete the self-instructional part of the program is improved. For best results, the self-instructional materials must be supplemented with demonstrations and practice.

PHA response and methylazoxymethanol acetate

Several reports have indicated the mutagenicity of the cycasin aglycone, methyl azoxymethanol (MAM). Van Den Berg and Ball (1972) have demonstrated the inhibitory effects of MAM acetate (MAMac), a more stable form of the aglycone, on DNA synthesis and cell proliferation in HeLa cells. The purpose of this study was to observe the effects of MAMac on blastogenesis in the human short-term leucocyte culture system. A depression in blastogenesis by MAMac was observed cytologically derived from two individuals. The same effect was observed utilizing [3H] thymidine as an indicator of blastogenesis in a series of cultures from 11 male individuals exposed to varying doses of MAMac, ranging from 5 through 800 mug/ml.