The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis

BACKGROUND

Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results.

METHODS

Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto.

RESULTS

Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81).

CONCLUSION

Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.

Nuclear cardiology in hospital-based practice

Managed care has drastically changed the environment in which we practice hospital-based nuclear cardiology. As of 1995, traditional fee for service comprises only 8% of all reimbursement in the United States. Nuclear cardiology is now a cost center, not a revenue center, for the hospital. In Minnesota, many physicians and hospitals work together toward common goals in various "integrated health service networks." There are several ways in which nuclear cardiology can help a health care network reduce costs. Results of myocardial perfusion, for example, can be used to help reduce unnecessary coronary angiography and revascularization procedures. On the other hand, nuclear cardiology is generally not cost-effective in patients with a low likelihood of benefitting from the test and should usually be avoided in such patients.

A protective domain of heat-shock protein 60 from Histoplasma capsulatum

Vaccination with recombinant (r) hsp60 protects mice against Histoplasma capsulatum. To map the domain of rhsp60 that confers protection, four gene segments were cloned into pET19b and expressed in Escherichia coli. rhsp60 fragments were tested for their capacity to induce proliferation by sensitized splenocytes and to protect BALB/c and C57BL/6 mice. All polypeptides stimulated cells from BALB/c mice immunized with yeasts or with rhsp60. Fragment 3 caused the most vigorous response by cells from mice immunized yeasts, and fragment 1 caused the most vigorous response by cells from mice immunized with rhsp60. Splenocytes from yeast-immunized C57BL/6 mice did not recognize any polypeptide. In contrast, cells from C57BL/6 mice inoculated with rhsp60 responded to all fragments but most intensely to fragment 2. In both strains, fragment 3 conferred protection against sublethal and lethal challenges. Thus, a common protective domain of hsp60 has been identified.

Human recombinant transforming growth factor-beta 1 in healing of calvarial bone defects

Bone healing plays an important role in orthognathic and craniofacial surgery. Bone tissue repair and regeneration are regulated by an array of growth and morphogenetic factors. Osteogenesis proceeds through a cascade of molecular and cellular events sequentially coordinated by members of both the bone morphogenetic protein and transforming growth factor-beta (TGF-beta) families. The efficacy of a single application of 2, 5, or 10 micrograms of recombinant human (rh) TGF-beta 1 to promote bone regeneration in 5-mm experimental calvarial defects of adult male rats was assessed histologically and histomorphometrically. The histomorphometric results of the experimental site were compared with those of the contralateral control side. Dosegroup comparisons were also performed. None of the control and experimental bone defects demonstrated complete bone closure. Limited bone regeneration was found close to the margins of the defects. A statistically significant difference in volume fraction composition (bone, osteoid, and soft tissue) was found between the 5- and 10-microgram rhTGF-beta 1-implanted and control defects. No difference was found in the 2-microgram rhTGF-beta 1-implanted group. The percentage of bone closure was statistically significantly higher in the 5-microgram rhTGF-beta 1-implanted group than in the control group. The present findings indicate that a single application of different doses of rhTGF-beta 1 does not promote clinically relevant osteogenesis in membranous calvarial bone defects in adult rats.

Age-related bone loss. A hypothesis and initial assessment in mice

The osteopenia associated with advanced age appears to be a universal phenomenon in humans and animals, but the mechanisms by which it occurs are understood incompletely. However, the explanation must lie in an absolute or relative diminution in the level of osteoblastic bone-forming activity when compared with osteoclastic bone-resorbing activity. The authors postulated that with old age there would be a reduction in the number or function or both of osteoblastic stem cells that could account for part of the diminution in bone formation. They further postulated that there would be either no change or an increase in osteoclastic potential and bone resorption. To test these concepts, bone marrow cells were isolated from 4- to 6-month-old or 24-month-old mice and cultured in vitro under a variety of circumstances that permitted an assessment of the stromal osteogenic cells and marrow hemopoietic progenitor cells belonging to the monocyte and osteoclast series. These data show a marked reduction in the number and in vitro activity of stromal osteogenic cells from old animals. There is an increase in old mice in the number of marrow cells capable of forming osteoclasts in coculture and responsive to the growth factors believed operational in the monocyte and osteoclast series. The authors now are exploring the hypothesis that an age-related diminution in transforming growth factor-beta levels is responsible for these changes in progenitor cell levels in marrow and their functional status as expressed in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical diagnosis of substance use disorders in private psychiatric populations

The clinical diagnoses of comorbid substance use and psychiatric disorders by psychiatrists in a private psychiatric inpatient setting were analyzed. Two hundred patients consecutively discharged from a private university-affiliated psychiatric service by clinical psychiatrists were examined for concomitant substance use and psychiatric disorders according to DSM-III-R criteria for Axis I and Axis II disorders. Fifty-nine patients (30%) were diagnosed with a comorbid substance use and psychiatric disorder on Axis I, supporting findings of previous studies. Comorbid diagnosis patients were more likely to be male (54%, 32) than were psychiatric only (noncomorbid diagnosis) patients (males 37%, 51). There were no differences between comorbid (dual diagnosis) and noncomorbid diagnoses in age, mean length of stay, or discharge type. Of the 59 patients with comorbid disorders, 83% had Axis I diagnoses, and 64% had Axis II diagnoses. Polysubstance use disorder was the most common dual diagnosis, cooccurring with an Axis I diagnosis in 47% of patients with an Axis II diagnosis in 45%. Psychiatrists in clinical psychiatric inpatient settings diagnose substance use disorders in rates similar to public settings despite absence of specific addiction treatment.

Interleukin-4 enhances murine bone marrow macrophage M-CSF receptor expression by a posttranscriptional mechanism

Activated T-lymphocytes secrete interleukin-4 (IL-4), which has been shown to modulate a variety of monocyte activities requiring monocyte/macrophage colony-stimulating factor (M-CSF). To account for this interaction, we postulated that IL-4 acts on target cells by altering the expression of the M-CSF receptor (M-CSFr). To test this hypothesis, murine bone marrow macrophages were cultured under conditions that down-regulate M-CSFr and the effect of IL-4 on the reexpression of the receptor measured by binding of 125I-labeled M-CSF to the cells. The data show that incubation with IL-4 results in a dose-dependent, 2-3 x increase in M-CSFr with no change in binding affinity and a maximal effect on binding at about 12 h. This increase in M-CSFr is dependent upon new, specific protein synthesis as shown by the inhibitory action of cycloheximide, and gel analysis of radiolabeled, specific protein, immunoprecipitated with anti-M-CSFr antibody. Treatment with IL-4 does not stimulate M-CSFr mRNA expression but, consistent with enhanced receptor levels, does result in a heightened proliferative response to M-CSF. Thus, IL-4 affects M-CSF treated monocytic cells, at least in part, by altering the expression of M-CSFr.

Time to reperfusion with direct coronary angioplasty and thrombolytic therapy in acute myocardial infarction

An analysis was performed of the Mayo Clinic randomized trial of direct percutaneous transluminal coronary angioplasty and tissue-type plasminogen activator (t-PA) to determine the time required to achieve reperfusion with direct coronary angioplasty. Because patients in the Mayo trial assigned to t-PA did not undergo protocol coronary angiography, reperfusion rates from the Thrombolysis in Myocardial Infarction (TIMI) I trial in which patients underwent coronary angiography 30, 60 and 90 minutes after thrombolytic therapy were used for comparison. TIMI perfusion grade 2 or 3 flow in the infarct artery was considered to represent reperfusion after thrombolysis. In the 56 patients assigned to t-PA, the mean time from randomization to initiation of the t-PA infusion was 20 minutes. Twenty minutes were therefore added to the previously reported 30-, 60- and 90-minute reperfusion rates to express these in terms of time from randomization (50, 80 and 110 minutes). In the 48 patients who had direct angioplasty, the mean time from randomization to arrival in the cardiac catheterization laboratory was 45 minutes; it took a mean of 6 additional minutes for patients to be prepared and draped and arterial access obtained, and a mean of 27 additional minutes to complete angiography and achieve reperfusion. At 50, 80 and 110 minutes after randomization, the reperfusion rates for direct coronary angioplasty were 12, 54 and 83%, similar to previously reported TIMI reperfusion rates with t-PA (24, 57 and 71%, respectively, p = NS) but significantly greater at 80 and 110 minutes than was reported for streptokinase (8, 23 and 31%, respectively, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related bone loss in mice is associated with an increased osteoclast progenitor pool

Age-associated osteopenia has been documented to occur in mice and, therefore, provides a model system whereby mechanisms of bone loss can be assessed in vivo and in vitro. One such mechanism, that could explain the increased resorptive activity seen in some forms of osteopenia, is an age-associated increase in the osteoclast precursor pool and osteoclastogenic formation. To test this hypothesis, we studied the bone marrow composition of aged (24 months) mice to determine if increased numbers of monocyte/macrophage/osteoclast precursor cells (MMOPC) were present when compared to young (4-6 months) animals. Our data show a moderate increase of 20-30% more hematopoietic cells obtained from the long bones of the aged animals. However, both liquid and semi-solid culture techniques demonstrate an approximately 2-3.5-fold increase in the numbers of plastic adherent macrophages or mononuclear colonies in bone marrow derived from the aged mice when stimulated by interleukin-3 (IL-3), granulocyte-macrophage colony stimulating factor (GM-CSF) or macrophage colony stimulating factor (GM-CSF), indicating a preferential increase in MMOPCs. In addition, cells derived from the aged mice show higher levels of cytokine stimulated incorporation of [3H]-thymidine and [3H]-leucine, with increased protein synthesis seen up to 7 days after cytokine stimulation, suggesting that these cells also have an enhanced sensitivity to cytokines.(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitivity and specificity of diastolic indexes for rejection surveillance: temporal correlation with endomyocardial biopsy

Although acute diastolic dysfunction is an early sequela of the rejecting heart, reported sensitivities and specificities have varied widely when Doppler echocardiography is used for rejection surveillance. This study examines the temporal relationship between changes in Doppler echocardiographic indexes of diastolic function and sequential endomyocardial biopsies to identify possible factors accounting for false-positive and false-negative results. A total of 114 Doppler echocardiographic studies and biopsies were performed weekly in 39 patients aged 14 to 59 years during the initial 3 months after heart transplantation. All Doppler examinations were within 24 hours of biopsy and were analyzed in a blinded fashion. Onset of restrictive physiology, defined as a 15% decrease in either isovolumic relaxation time or pressure half-time, was determined by analysis of the Doppler mitral flow velocity curve.

Time-related predictors of suicide in major affective disorder

The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.

Left ventricular diastolic function. Doppler echocardiographic changes soon after cardiac transplantation

In acute cardiac rejection, left ventricular diastolic function is altered, and a restrictive ventricular filling pattern occurs. Doppler echocardiographic indexes of mitral inflow have been proposed as sensitive markers of the rejection process. As rejection progresses, the restrictive ventricular filling pattern is reflected by a shortening of isovolumic relaxation time and mitral valve pressure half-time and by an increase in early transmitral filling velocity. Diastolic function is also compromised in the nonrejecting cardiac transplant recipient during the early postoperative period. This study examined the progression in Doppler-derived mitral filling indexes in 25 recent cardiac transplant recipients who demonstrated no histological evidence of transplant rejection. Isovolumic relaxation time, mitral valve pressure half-time, and early transmitral filling velocity were measured at postoperative weeks 1, 2, 4, and 6 on the day that surveillance right ventricular endomyocardial biopsies were performed. The initial indexes were comparable to previously described restrictive parameters and over the 6-week study period evolved into a nonrestrictive filling pattern. This evolution reflects a progressive improvement in postoperative diastolic function and a decrease in left heart filling pressures. None of the evaluated clinical characteristics, including preoperative pulmonary pressures, total ischemic time of the transplanted heart, cardiopulmonary bypass time, and age of the donor heart, correlated with this process. Given the increasing use of Doppler echocardiography as a means of screening for transplant rejection, it is important to have a thorough understanding of normal postoperative changes in left ventricular diastolic function.

Variability of Doppler echocardiographic indexes of left ventricular filling in transplant recipients and in normal subjects

This study examines the reproducibility and variability of pulsed wave Doppler versus continuous wave Doppler ultrasound indexes of left ventricular filling in cardiac allograft recipients and in normal subjects. The following indexes were studied: isovolumic relaxation time, pressure half-time, peak early mitral flow velocity, and peak mitral flow velocity after atrial systole. Intraobserver and interobserver variability were assessed by regression analysis. Individual components of variance (subject, reader, beat, day, and tracing) were estimated in a subset of five patients and five normal subjects, and estimated total variance defined for each group. Temporal (day-to-day) variability for 95% confidence was estimated for these patients and for normal subjects. Temporal variability in the group from which the subsets were drawn was measured from absolute and percent change in values on two occasions. Estimated and observed 95% confidence limits were compared. Intersubject variability was the largest component of variance in both transplant recipients and in normal subjects. For all indexes in transplant recipients (in the absence of rejection) and normal subjects, observed absolute mean differences (+/- 2 standard deviations) between values from recordings taken on two different days were larger than the 95% confidence limits estimated from the components of variance analysis. The observed 95% limits for transplant recipients versus normal subjects were as follows: isovolumic relaxation time, 20 msec versus 6 msec; pressure half-time, 16 msec versus 9 msec; peak early mitral flow velocity, 32 cm per second versus 17 cm per second; and peak mitral flow velocity after atrial systole, 28 cm per second versus 10 cm per second.(ABSTRACT TRUNCATED AT 250 WORDS)

Serial measurement of integrated ultrasonic backscatter in human cardiac allografts for the recognition of acute rejection

Cyclic variation of integrated ultrasonic backscatter (IB) was noninvasively measured in the septum and left ventricular posterior wall using a quantitative IB imaging system to assess the alterations in the acoustic properties of myocardium associated with acute cardiac allograft rejection. The study population consisted of 23 cardiac allograft recipients and 18 normal subjects. In each cardiac allograft recipient, one to eight (mean, four) IB studies were performed, each within 24 hours of right ventricular endomyocardial biopsy performed for rejection surveillance. The magnitude of the cyclic variation of IB in the posterior wall was 5.9 +/- 0.9 dB in normal subjects and 6.2 +/- 1.3 dB in the cardiac allograft recipients without previous or current histological evidence of acute rejection (n = 17, p = NS vs. normal subjects). The magnitude of cyclic variation of IB in the septum was 4.8 +/- 1.1 dB in normal subjects and 3.8 +/- 2.0 dB in the cardiac allograft recipients (n = 15, p = NS vs. normal subjects). A significant decrease in the septal IB measure was observed in cardiac allograft recipients with left ventricular hypertrophy (wall thickness of at least 13 mm) (2.6 +/- 1.7 dB, n = 8, p less than 0.05 vs. normal subjects). IB studies were done before and during moderate acute rejection in 11 recipients (14 episodes). During moderate acute cardiac rejection, the magnitude of the cyclic variation in IB decreased from 6.7 +/- 1.3 to 5.1 +/- 1.4 dB in the posterior wall (n = 14, p less than 0.05) and from 4.2 +/- 2.1 dB to 2.9 +/- 1.8 dB in the septum (n = 12, p less than 0.05). These data suggest 1) the magnitude of the cyclic variation in IB of the septum is different in cardiac allografts with cardiac hypertrophy and normal subjects, possibly reflecting regionally depressed myocardial contractile performance and 2) acute cardiac rejection in humans is accompanied by an alteration in the acoustic properties of the myocardium. This change is detectable by serial measurement of the magnitude of the cyclic variation in IB, both in the septum and in the posterior wall.

Echocardiographic contrast increases the yield for right ventricular pressure measurement by Doppler echocardiography

Doppler ultrasound has become accepted as a measurement of right ventricular systolic pressure in patients who have a quantifiable signal from tricuspid regurgitation. This study evaluated the use of intravenous injection of saline solution for echo contrast to increase the percentage of quantifiable tricuspid regurgitant signals in patients who have any detectable tricuspid regurgitation at baseline. Patients underwent a standard Doppler evaluation, followed by a contrast study with the injection of 4 to 6 ml of agitated saline solution into a brachial vein. Baseline and contrast tricuspid regurgitant signals were assessed for quality, quantifiability, and reproducibility of the derived pressures by three observers on two occasions. The average absolute pairwise deviation among the three observers was low: 1.6 mm Hg (standard deviation, 1.4 mm Hg). The intraobserver mean discrepancy was low: 0.03 mm Hg (standard deviation, 2.33 mm Hg). Patients who did not have tricuspid regurgitation (n = 10) failed to develop such regurgitation during contrast injection. Only eight of 40 patients (20%) who had trace or mild tricuspid regurgitation had quantifiable baseline signals, but 34 patients (85%) had quantifiable signals with contrast injection. All patients who had mild to moderate, moderate, or severe tricuspid regurgitation (n = 10) had quantifiable signals before contrast injection. Of all patients who had any tricuspid regurgitation, 88% had quantifiable signals with contrast injection. Echo contrast was shown to improve the yield of quantifiable signals in patients who had trace and mild tricuspid.

Increasing pericardial effusion in cardiac transplant recipients

Although pericardial effusion after cardiac surgery is frequent and usually benign, its etiology and prognosis after cardiac transplantation are unknown. During 1 year (1985-1986), 12 of our current transplant population (total, 189) developed moderate or large pericardial effusions confirmed by two-dimensional echocardiography. These effusions occurred within 1 month of transplantation in 10 patients and at 3 months and 4.5 years in the other two. Pericardiocentesis was performed because of clinical evidence of increasing effusions in eight patients, with demonstrable hemodynamic compromise secondary to tamponade in five. Pericardial fluid was sterile in all but one. Endomyocardial biopsy at the time of increasing effusion revealed moderate acute rejection in five patients, mild rejection in three, and no rejection in four. All three patients with mild rejection had moderate acute rejection on subsequent biopsy performed within 7 days. In two of the four with no rejection, repeat biopsy within 5 days showed moderate acute rejection; in a third, moderate rejection was present on biopsy performed 14 days later. Legionella dumoffii was isolated from the pericardial fluid of the fourth patient, whose subsequent biopsies never showed rejection. Three of the 12 patients developed progressive ventricular dysfunction sufficiently severe to require retransplantation. One patient died suddenly 12 months after transplantation, and autopsy examination revealed severe coronary artery disease. Two died of sepsis within 3 months of transplantation. Intense inflammatory infiltrates and thickening of the pericardium and epicardium were characteristically present in explanted and autopsy hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet monoamine oxidase in alcoholism

We studied platelet monamine oxidase (MAO) activity using 14C-tyramine as substrate in hospitalized alcoholic patients in the early phases of abstinence and in nonhospitalized normal control volunteers. Platelet MAO was determined in 75 patients (67 men, 8 women) with alcoholism and 123 normal control volunteers (52 men, 71 women). The platelet MAO activity in alcoholic patients was significantly lower than in normal control volunteers. We also observed that the mean platelet MAO activity in male alcoholics was significantly lower than in normal males. The analysis of platelet MAO in alcoholics revealed a mixture of two normal distributions. Alcoholic patients falling into the low MAO component were younger in age, with a lower age of onset of alcoholism, and had higher frequencies of family history of alcoholism. They thus resembled type II alcoholics described by other investigators. Platelet MAO may thus serve as a useful biological marker for subtyping alcoholism and identifying high-risk groups at an early stage. The findings of this study are consistent with previous reports of low platelet MAO activity in alcoholic patients.

Computed tomography of the rectum

CT is an important diagnostic procedure in patients with suspected or known disease of the rectum. Knowledge of proper technique for CT of the rectum, as well as an understanding of normal pelvic anatomy, is essential to its effective use. CT can demonstrate the extent of perirectal and pararectal abnormalities detected on barium enema. While routine preoperative staging of rectal cancer is not justified, CT can be used to solve specific problems. Perhaps the most important role of rectal CT is in evaluating postoperative rectosigmoid cancer patients in an attempt to detect early asymptomatic recurrences and, thereby, prolong patient survival.

Increased collagen synthesis and cross-link formation in the skin of rats exposed to vinyl chloride monomer

Rats treated orally with vinyl chloride (30 mg/kg) daily for 2 years developed a syndrome which included thickening of the skin. Analysis of the skin showed a 26% increase in collagen deposition per unit weight, and a corresponding 30% increase in the levels of glycosylated lysine and hydroxylysine. There was a significant increase in the amounts of the labile borohydride reducible cross-links, such as the intermolecular hydroxylysinonorleucine (+31%) and histidinomerodesmosine (+42%) as well as the intramolecular allysine aldol cross-links (+17%). These results provide evidence that fibrosis of the skin is one of the pathological consequences of exposure to vinyl chloride.

Catecholamine metabolism and disposition in healthy and depressed subjects

Depressed patients as a group have been found to excrete greater amounts of catecholamines (CAs) and metabolites than healthy control subjects, but these differences were not uniform for all metabolites. Patients may differ from controls in the metabolism and/or disposition of CAs. We analyzed the suggested metabolic-dispositional differences by determining 24-hour urine values for norepinephrine (NE), epinephrine (E), normetanephrine (NM), metanephrine (M), vanillylmandelic acid (VMA), and 3-methoxy-4-hydroxyphenylglycol (MHPG). For each subject, we calculated ratios of CAs or metabolites to an estimate of CA synthesis and determined ratios of CAs and metabolites to each other based on a precursor-product paradigm. The results indicate that as a group, patients have modestly but significantly greater CA synthesis rates than controls; patients excrete disproportionately more NE and E and disproportionately less MHPG relative to estimated CA synthesis, as well as other metabolites, than do controls; in contrast to NE, E, and MHPG, the increased NM, M, and VMA excretion rates by patients are proportional to each other as well as to the increase in CA synthesis; and the differences in NE, E, and metabolite excretion in the patients as a group are due principally to unipolar rather than bipolar depressives. The differences would be expected if patients, relative to controls, released more NE and E into the circulation. These data indicate the need to measure several CAs and metabolites when evaluating differences between groups since the significance of any given metabolite value needs to be examined in the context of total CA and metabolite production and excretion.

Self-efficacy and the control of anxious cognitions

This study was designed to explore the possibility that Bandura's notion of self-efficacy can be applied to control over cognitions as well as behavior. Subjects were asked to complete questionnaires designed to measure their dental anxiety, the number of their negative self-statements about a dental appointment and their perceived ability to control these thoughts. Subjects with low anxiety claimed to experience fewer negative thoughts than those with moderate or high anxiety, and also to have more control over these thoughts. Subjects believed that the extent of their control would decline as the appointment approached in time, but least for the low anxiety group and most for the high anxiety group. Finally, differences in self-efficacy scores between anxiety groups were maintained when the number of negative thoughts was controlled for, but differences in negative thinking between anxiety levels were not maintained when self-efficacy was controlled for. These results suggest that anxiety is more closely related to thinking processes than content.

Adult esophageal candidiasis: a radiographic spectrum

With the increasing use of cancer chemotherapy and organ transplantation requiring immunosuppressive therapy, and with the incidence of immunodeficiency states such as AIDS increasing, it is to be expected that candida esophagitis will occur with increasing frequency. Though fiberoptic endoscopy is a more specific and more sensitive approach to the diagnosis of candida esophagitis than barium esophagography, it is also more invasive, and many patients will continue to be examined radiologically, at least initially. The radiologist continues, therefore, to play a significant role in suggesting the diagnosis and it is incumbent on him to familiarize himself with the spectrum of common and unusual radiographic manifestations of this disease.

Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study

The authors report prospective uniform clinical data differentiating 25 patients who committed suicide from 929 patients who did not in a group of 954 patients with major affective disorder followed for an average of 4 years in the Collaborative Program on the Psychobiology of Depression. Eight (32%) of the suicides occurred within 6 months and 13 (52%) within 1 year of entry into the study. Hopelessness, loss of pleasure or interest, and mood cycling during the index episode differentiated the suicide group. Diagnostic subcategories, suicidal ideation at entry to the study, suicide attempts during current or past episodes, and medical severity of prior attempts did not differentiate the suicide group.

Preoperative and postoperative CT staging of rectosigmoid carcinoma

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.

Optimal cholangiographic technique for detecting bile duct stones

Twenty-eight patients with proven bile duct stones were evaluated during either operative or T-tube cholangiography. Two radiographs were obtained for each patient without changing patient position between films. The first was performed with low peak kilovoltage (75-80 kVp) and 15% iodinated contrast medium and the second with high kVp (110) and 38% iodinated contrast. Seven radiologists evaluated the radiographs individually and in matched pairs for ductal filling, ductal penetration, motion unsharpness, overall quality, and stone detectability. The high-kVp radiographs were rated significantly better overall than the low-kVp studies (p less than 0.001) for all five criteria. In the second evaluation, which compared the pairs from the same patients, the 28 high-kVp radiographs were considered superior to the 28 low-kVp studies by the radiologists in almost two-thirds of the comparisons (ductal filling, 68%; penetration, 59%; less motion unsharpness, 65%; overall quality, 77%; stone detection, 62%). On the basis of the results of this study, high-kVp technique with full-strength contrast medium for operative and T-tube cholangiography is recommended.

Intrathecal triiodothyronine administration causes greater heart rate stimulation in hypothyroid rats than intravenously delivered hormone. Evidence for a central nervous system site of thyroid hormone action

To determine whether intracerebrally localized iodothyronines produce thyroid hormone-related functional effects, heart rate responses were compared in conscious hypothyroid rats given triiodothyronine (T3) by either the intrathecal or the intravenous route. A significant increase in heart rate occurred within 18 h after 1.5 nmol T3/100 g body wt was delivered intrathecally through a cannula previously placed in the lateral cerebral ventricle. Injection of the same T3 dose intravenously through an indwelling jugular catheter or injection of vehicle only by either route produced no significant increase in heart rate during the 48-h postinjection period of observation. These differences were observed even though integrated serum T3 concentrations were significantly lower after intrathecal than after intravenous T3 injection. The results indicate that thyroid hormone effects on heart rate are exerted within the brain as well as within the heart.

Evaluation of host resistance and immune function in cadmium-exposed mice

Adult female B6C3F1 mice received distilled water only or water containing 10, 50, or 250 ppm of cadmium chloride (CdCl2) for 90 days. Body weights were measured weekly. On selected days during exposure and on Day 91, Cd tissue concentrations were measured along with changes in primary antibody responses. On Day 91 mice also received a primary challenge with various infectious agents. T- and B-cell mitogenesis, natural killer (NK) cell function, delayed type hypersensitivity (DTH) as well as macrophage bactericidal activity, and phagocytosis were measured. There was no change in body weight gain, organ weights, or in humoral immunity during treatment even though cadmium had accumulated in significant quantities in the tissues. Compared with controls, exposure to cadmium had no statistically significant effect on mortality and mean survival time following primary or secondary challenge with any of the infectious agents. However, there was a dose-related, increased susceptibility to Herpes simplex type 2 virus. T- and B-lymphocyte proliferation was significantly reduced, and macrophage phagocytosis was significantly increased following cadmium exposure. NK cell activity was augmented, but not significantly. Macrophage bactericidal activity and DTH were not significantly altered.

ECT: an assessment of mental health professionals' knowledge and attitudes

The attitudes of four groups of mental health professionals (psychiatrists, nurses, psychologists, and social workers) toward ECT were compared to their levels of clinical experience, knowledge about ECT, and professional background. In each of these four groups a more positive attitude about ECT correlated with increased levels of clinical experience and knowledge.

The effect of dimethylnitrosamine on host resistance and immunity

Adult female B6C3F1 mice were injected ip with 0.2 ml phosphate-buffered saline (PBS) only or PBS containing 1.5, 3, or 5 mg dimethylnitrosamine (DMN)/kg body wt daily for 14 days. On Day 16, mice were evaluated for changes in immune status as measured by the antibody response to sheep red blood cells (SRBCs), blastogenesis to T- and B-cell mitogens, natural killer (NK) cell function, delayed hypersensitivity, and alveolar macrophage (AM) bactericidal activity; and for changes in host resistance following challenge with various microorganisms or tumor cells. DMN-exposed animals exhibited reduced humoral antibody responses, T-cell mitogenesis, and AM bactericidal activity. B-cell mitogenesis, NK cell activity, and delayed hypersensitivity were increased. Resistance to challenge with Listeria monocytogenes, Trichinella spiralis, or Herpes simplex types 1 or 2 virus (HSV-1, HSV-2) was not significantly impaired, while that to Streptococcus zooepidemicus and influenza virus was significantly reduced. Resistance to B16-F10 tumor challenge was enhanced following DMN exposure. The data show that DMN treatment altered humoral immunity and antibody-mediated host defense mechanisms. Increased NK cell activity may account for the increased resistance to challenge with Herpes virus and B16-F10 tumor cells.

Biologic markers and antidepressant response

The use of biologic markers to predict antidepressant treatment response may lead to more rational selection of specific drugs for individual patients. Several biologic markers being developed as potential predictors of antidepressant treatment response are reviewed. Although research in this area is primarily concerned with predicting response to drug treatment, it may also prove useful in predicting which depressed patients may respond best to psychological treatments or combinations of biologic and psychologic treatments.

Determinants of regional distribution of a bolus inhaled from residual volume

The volume of lung at residual volume (RV) which fails to receive an inhaled tracer bolus (EXV) was quantitated in 13 normals by comparison of a scintigram of the distribution of a tracer bolus inhaled from RV (BORV) with a scintigram at RV of lung equilibrated with the tracer (EQRV). EXV was found in the dependent lung in the erect position in all subjects but also occurred to a lesser degree at the apex in 11 of 13 subjects. Basal EXV ranged from 1 to 7% of TLC, and unlike apical EXV increased with age (r= 0.91, P less than 0.01). EXV in the decubitus position shifted largely to the dependent lung with none remaining in the original erect apical and basal locations, demonstrating that gravity determined EXV location. Nitrous oxide, which is highly diffusible, failed in four subjects to carry the tracer to basal EXV even though perfusion was documented to persist to this area, implying basal EXV airways were closed, not narrowed. In one of the four subjects apical EXV was readily definable. Nitrous oxide carried tracer into this region, implying patent apical EXV airways.